Skip to main content

Advertisement

SpringerLink
Log in

Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

Abstract

The role of workplace supervisors in the clinical education of medical students is currently under debate. However, few studies have addressed how supervisors conceptualize workplace learning and how conceptions relate to current sociocultural workplace learning theory. We explored physician conceptions of: (a) medical student learning in the clinical workplace and (b) how they contribute to student learning. The methodology included a combination of a qualitative, inductive (conventional) and deductive (directed) content analysis approach. The study triangulated two types of interview data from 4 focus group interviews and 34 individual interviews. A total of 55 physicians participated. Three overarching themes emerged from the data: learning as membership, learning as partnership and learning as ownership. The themes described how physician conceptions of learning and supervision were guided by the notions of learning-as-participation and learning-as-acquisition. The clinical workplace was either conceptualized as a context in which student learning is based on a learning curriculum, continuity of participation and partnerships with supervisors, or as a temporary source of knowledge within a teaching curriculum. The process of learning was shaped through the reciprocity between different factors in the workplace context and the agency of students and supervising physicians. A systems-thinking approach merged with the “co-participation” conceptual framework advocated by Billet proved to be useful for analyzing variations in conceptions. The findings suggest that mapping workplace supervisor conceptions of learning can be a valuable starting point for medical schools and educational developers working with changes in clinical educational and faculty development practices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Argyris, C., & Schön, D. A. (1995). Organizational learning II: Theory, method and practice. Reading, MA: Addison-Wesley.

    Google Scholar 

  • Billett, S. (1996). Towards a model of workplace learning: The learning curriculum. Studies in Continuing Education, 18(1), 43–58.

    Article  Google Scholar 

  • Billett, S. (2002). Workplace pedagogic practices: Co-participation and learning. British Journal of Educational Studies, 50(4), 457–481.

    Article  Google Scholar 

  • Billett, S. (2010). Learning through practice: models, traditions, orientations and approaches [Electronic verison]. In S. Billett (Ed.), Professional and practice-based learning (pp. 1–20). Dordrecht: Springer. Retrieved December 20, 2013 from http://library.lu.se/cgibin/ipchk/http://search.ebscohost.com/login.aspx?direct=true&db=cat01310a&AN=lovisa.002415746&site=eds-live.

  • Bleakley, A. (2002). Pre-registration house officers and ward-based learning: A ‘new apprenticeship’ model. Medical Education, 36(1), 9–15.

    Article  Google Scholar 

  • Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from teamworking. Medical Education, 40(2), 150–157.

    Article  Google Scholar 

  • Boor, K., Scheele, F., van der Vleuten, C. P., Teunissen, P. W., den Breejen, E. M., & Scherpbier, A. J. (2008). How undergraduate clinical learning climates differ: A multi-method case study. Medical Education, 42(10), 1029–1036.

    Article  Google Scholar 

  • Buchel, T. L., & Edwards, F. D. (2005). Characteristics of effective clinical teachers. Family Medicine, 37(1), 30–35.

    Google Scholar 

  • Calkins, S., Johnson, N., & Light, G. (2012). Changing conceptions of teaching in medical faculty. Medical Teacher, 34(11), 902–906.

    Article  Google Scholar 

  • Dahlgren, L, Abrandt Dahlgren, M., Hult, H., Hård af Segerstad, H., Szkudarek, T., & Kamlet, M. S. (2006). Conceptions of learning and teaching among teachers and students in higher education. A Swedish–Polish comparative study. Anthology of Social and Behavioural Sciences (pp. 89–115). Linköping: Linköpings universitet.

  • de Feijter, J. M., de Grave, W. S., Dornan, T., Koopmans, R. P., & Scherpbier, A. J. J. A. (2011). Students’ perceptions of patient safety during the transition from undergraduate to postgraduate training: An activity theory analysis. Advances in Health Sciences Education, 16(3), 347–358.

    Article  Google Scholar 

  • Dolmans, D. H., Wolfhagen, I. H., Essed, G. G., Scherpbier, A. J., & van der Vleuten, C. P. (2002). The impacts of supervision, patient mix, and numbers of students on the effectiveness of clinical rotations. Academic Medicine, 77(4), 332–335.

    Article  Google Scholar 

  • Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students’ workplace learning. Medical Education, 41(1), 84–91.

    Article  Google Scholar 

  • Dornan, T., Scherpbier, A., King, N., & Boshuizen, H. (2005). Clinical teachers and problem-based learning: A phenomenological study. Medical Education, 39(2), 163–170.

    Article  Google Scholar 

  • Duvivier, R. J., Van Dalen, J., Van Der Vleuten, C. P. M., & Scherpbier, A. J. J. A. (2009). Teacher perceptions of desired qualities, competencies and strategies for clinical skills teachers. Medical Teacher, 31(7), 634–641.

    Article  Google Scholar 

  • Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115.

    Article  Google Scholar 

  • Engeström, Y., & Sannino, A. (2009). Studies of expansive learning: Foundations, findings and future challenges. Educational Research Review, 5, 1–24.

    Article  Google Scholar 

  • Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247–273.

    Article  Google Scholar 

  • Fern, E. F. (2001). Advanced focus group research. London: Sage.

    Google Scholar 

  • Gibbs, G., & Coffey, M. (2004). The impact of training of university teachers on their teaching skills, their approach to teaching and the approach to learning of their students. Active Learning in Higher Education, 5(1), 87–100.

    Article  Google Scholar 

  • Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112.

    Article  Google Scholar 

  • Greenhill, J., & Poncelet, A. N. (2013). Transformative learning through longitudinal integrated clerkships. Medical Education, 47(4), 336–339.

    Article  Google Scholar 

  • Guile, D., & Griffiths, T. (2001). Learning through work experience. Journal of Education and Work, 14(1), 113–131.

    Article  Google Scholar 

  • Hager, P. (2004). Conceptions of learning and understanding learning at work. Studies in Continuing Education, 26(1), 3–17.

    Article  Google Scholar 

  • Hattie, J. A. C. (2009). Visible learning: A synthesis over 800 meta-analysis relating to achievement. London: Routledge.

    Google Scholar 

  • Hirsh, D., Gaufberg, E., Ogur, B., Cohen, P., Krupat, E., Cox, M., et al. (2012). Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: A way forward for medical education. Academic Medicine: Journal of The Association of American Medical Colleges, 87(5), 643–650.

    Article  Google Scholar 

  • Holmboe, E., Ginsburg, S., & Bernabeo, E. (2011). The rotational approach to medical education: Time to confront our assumptions? Medical Education, 45(1), 69–80.

    Article  Google Scholar 

  • Hsieh, H., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.

    Article  Google Scholar 

  • Illeris, K. (2003). Towards a contemporary and comprehensive theory of learning. International Journal of Lifelong Education, 4, 411–421.

    Google Scholar 

  • Kangasniemi, M., Ahonen, S., Liikanen, E., & Utriainen, K. (2011). Health science students’ conceptions of group supervision. Nurse Education Today, 31(2), 179–183.

    Article  Google Scholar 

  • Keating, S. (2006). Learning in the workplace: A literature review. Melbourne: Postcompulsory Education Centre, Victoria University.

    Google Scholar 

  • Kernan, W. N., Hershman, W., Alper, E. J., Lee, M. Y., Viscoli, C. M., Perry, J. R., et al. (2008). Disagreement between students and preceptors regarding the value of teaching behaviors for ambulatory care settings. Teaching and Learning in Medicine, 20(2), 143–150.

    Article  Google Scholar 

  • Kilminster, S., Cottrell, D., Grant, J., & Jolly, B. (2007). AMEE Guide No. 27: Effective educational and clinical supervision. Medical Teacher, 29(1), 2–19.

    Article  Google Scholar 

  • Knight, L. V., & Bligh, J. (2006). Physicians’ perceptions of clinical teaching: A qualitative analysis in the context of change. Advances in Health Sciences Education: Theory and Practice, 11(3), 221–234.

    Article  Google Scholar 

  • Lave, J., & Wenger, E. (2002). Legitimate peripheral participation in communities of practice. In R. Harrison, F. Reeve, A. Hanson, & J. Clarke (Eds.), Supporting lifelong learning Vol 1. Perspectives on learning (pp. 111–126). London: RoutledgeFalmer.

    Google Scholar 

  • Lave, J., & Wenger, E. (2005). Situated learning: Legitimate peripheral participation. Cambridge, New York: Cambridge University Press.

    Google Scholar 

  • Lindgren, S., Brännström, T., & Hanse, E. (2011). Medical Education in Sweden. Medical Teacher, 33(10), 798–803.

    Article  Google Scholar 

  • Lueddeke, G. R. (2003). Professionalising teaching practice in higher education: A study of disciplinary variation and ‘teaching-scholarship’. Studies in Higher Education, 28(2), 213–228.

    Article  Google Scholar 

  • MacDougall, J., & Drummond, M. J. (2005). The development of medical teachers: An enquiry into the learning histories of 10 experienced medical teachers. Medical Education, 39(12), 1213–1220.

    Article  Google Scholar 

  • Mann, K. V. (2011). Theoretical perspectives in medical education: Past experience and future possibilities. Medical Education, 45(1), 60–68.

    Article  Google Scholar 

  • McLeod, P., Steinert, Y., & Chalk, C. (2009). Which pedagogical principles should clinical teachers know? Teachers and education experts disagree Disagreement on important pedagogical principles. Medical Teacher, 31(4), 117–125.

    Article  Google Scholar 

  • Meyer, J. H. F., & Boulton-Lewis, G. M. (1999). On the operationalisation of conceptions of learning in higher education and their association with students’ knowledge and experiences of their learning. Higher Education Research & Development, 18(3), 289.

    Article  Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Ministry of Education and Health. (2003). The act concerning the ethical review of research involving humans. 2003:460. Retrieved 9 January 2014 from http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/Lag-2003460-om-etikprovning_sfs-2003-460/.

  • Morgan, D. L. (Ed.). (1993). Successful focus groups: Advancing the state of the art. Newbury Park, CA: Sage.

    Google Scholar 

  • Nilsson Skyvell, M., Pennbrant, S., Pilhammar, E., & Wenestam Claes, G. (2010). Pedagogical strategies used in clinical medical education: An observational study. BMC Medical education, 10(9).

  • O’Neill, P. A., Owen, A. C., McArdle, P. J., & Duffy, K. A. (2006). Views, behaviours and perceived staff development needs of doctors and surgeons regarding learners in outpatient clinics. Medical Education, 40(4), 348–354.

    Article  Google Scholar 

  • Peeraer, G., Donche, V., De Winter, B. Y., Muijtjens, A. M. M., Remmen, R., Van Petegem, P., et al. (2011). Teaching conceptions and approaches to teaching of medical school faculty: The difference between how medical school teachers think about teaching and how they say that they do teach. Medical Teacher, 33(7), e382–e387.

    Article  Google Scholar 

  • Postareff, L., Lindblom-Ylanne, S., & Nevgi, A. (2007). The effect of pedagogical training on teaching in higher education. Teaching and Teacher Education, 23(5), 557–571.

    Article  Google Scholar 

  • Postareff, L., Lindblom-Ylanne, S., & Nevgi, A. (2008). A follow-up study of the effect of pedagogical training on teaching in higher education. Higher Education, 56(1), 29–43.

    Article  Google Scholar 

  • Pratt, D. D. (1992). Conceptions of teaching. Adult Education Quarterly, 42(4), 203–220.

    Google Scholar 

  • Pratt, D. D., Harris, P., & Collins, J. B. (2009). The power of one: Looking beyond the teacher in clinical instruction. Medical Teacher, 31(2), 133–137.

    Article  Google Scholar 

  • Richardson, J. T. E. (2005). Students’ approaches to learning and teachers’ approaches to teaching in higher education. Educational Psychology: An International Journal of Experimental Educational Psychology, 25(6), 673–680.

    Article  Google Scholar 

  • Ringsted, C. (2011). Developmental aspects of medical competency and training: Issues of curriculum design. Medical Education, 45(1), 12–16.

    Article  Google Scholar 

  • Sahlén, K.G. (Producer). (2009). Open Code 3.6. [Software tool for coding qualitative data generated from text information such as interviews, observations or field notes]. Retrieved from http://www.phmed.umu.se/english/divisions/epidemiology/research/open-code/.

  • Seabrook, M. A. (2003). Medical teachers’ concerns about the clinical teaching context. Medical Education, 37(3), 213–222.

    Article  Google Scholar 

  • Senge, P. M. (2006). The fifth discipline: the art and practice of the learning organization (Rev. and updated edn). London: Currency Doubleday.

  • Sfard, A. (1998). On two metaphors for learning and the dangers of choosing just one. Educational Researcher, 27(2), 4–13.

    Article  Google Scholar 

  • Sheehan, D., Wilkinson, T. J., & Billett, S. (2005). Interns’ participation and learning in clinical environments in a New Zealand hospital. Academic Medicine, 80(3), 302–308.

    Article  Google Scholar 

  • Steinert, Y. (2010). Faculty development: From workshops to communities of practice. Medical Teacher, 32(5), 425–428.

    Article  Google Scholar 

  • Stenfors-Hayes, T. (2011). Being and becoming a teacher in medical education. Dissertation, Karolinska Institutet, Stockholm.

  • Stenfors-Hayes, T., Hult, H., & Dahlgren, L. O. (2011). What does it mean to be a good teacher and clinical supervisor in medical education? Advances in Health Sciences Education: Theory and Practice, 16(2), 197–210.

    Article  Google Scholar 

  • Stone, S., Ellers, B., Holmes, D., Orgren, R., Qualters, D., & Thompson, J. (2002). Identifying oneself as a teacher: The perceptions of preceptors. Medical Education, 36(2), 180–185.

    Article  Google Scholar 

  • Strand, P., Sjöborg, K., Stalmeijer, R., Wichmann-Hansen, G., Jakobsson, U., & Edgren, G. (2013). Development and psychometric evaluation of the undergraduate clinical education environment measure (UCEEM). Medical Teacher, 5(12), 1014–1026.

    Article  Google Scholar 

  • Sutkin, G., Wagner, E., Harris, I., & Schiffer, R. (2008). What makes a good clinical teacher in medicine? A review of the literature. Academic Medicine, 83(5), 452–466.

    Article  Google Scholar 

  • Swanwick, T., & Morris, C. (2010). Shifting conceptions of learning in the workplace. Medical Education, 44(6), 538–539.

    Article  Google Scholar 

  • Taylor, E. W., Tisdell, E. J., & Gusic, M. E. (2007). Teaching beliefs of medical educators: Perspectives on clinical teaching in pediatrics. Medical Teacher, 29(4), 371–376.

    Article  Google Scholar 

  • Teunissen, P. W., Boor, K., Scherpbier, A. J., van der Vleuten, C. P., van Diemen-Steenvoorde, J. A., van Luijk, S. J., et al. (2007a). Attending doctors’ perspectives on how residents learn. Medical Education, 41(11), 1050–1058.

    Article  Google Scholar 

  • Teunissen, P. W., & Dornan, T. (2008). Lifelong learning at work. BMJ, 336(7645), 667–669.

    Article  Google Scholar 

  • Teunissen, P. W., Scheele, F., Scherpbier, A. J., van der Vleuten, C. P., Boor, K., van Luijk, S. J., et al. (2007b). How residents learn: Qualitative evidence for the pivotal role of clinical activities. Medical Education, 41(8), 763–770.

    Article  Google Scholar 

  • Timperley, H., Wilson, A., Barrar, H., & Fung, I. Y. Y. (2007). Teacher professional learning and development; Best evidence synthesis iteration. Wellington: Ministry of Education.

    Google Scholar 

  • Trigwell, Keith, Michael, Prosser, & Fiona, Waterhouse. (1999). Relations between teachers’ approaches to teaching and students’ approaches to learning. Higher Education, 37(1), 57–70.

    Article  Google Scholar 

  • Trigwell, K., & Prosser, M. (1996a). Changing approaches to teaching: A relational perspective. Studies in Higher Education, 21(3), 275–284.

    Article  Google Scholar 

  • Trigwell, K., & Prosser, M. (1996b). Congruence between intention and strategy in university science teachers’ approaches to teaching. Higher Education, 32(1), 77–87.

    Article  Google Scholar 

  • Wenger, E. (2000). Communities of practice and social learning systems. Organization, 7(2), 225–246.

    Article  Google Scholar 

  • Williams, Reed G., & Klamen, Debra L. (2006). See one, do one, teach one-exploring the core teaching beliefs of medical school faculty. Medical Teacher, 28(5), 418–424.

    Article  Google Scholar 

  • Yardley, S., Teunissen, P. W., & Dornan, T. (2012). Experiential learning: AMEE guide No. 63. Medical Teacher, 34(2), E102–E115.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to express their gratitude to the physicians from Skåne University Hospitals in Lund and Malmoe and from Helsingborg General Hospital who participated in this study. Financial support was provided through the regional agreement on medical training and research (ALF) between The Skåne Regional Council and Lund University.

Conflict of interest

None of the authors have any conflicts of interest to declare for this article.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden

    Pia Strand & Gudrun Edgren

  2. Department of pediatrics, Skåne University Hospital, 205 02, Malmö, Sweden

    Petter Borna

  3. Centre for Teaching and Learning, School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Building 2621-B127, 8210, Århus, Denmark

    Gitte Wichmann-Hansen

  4. Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Renée E. Stalmeijer

  5. Department of Clinical Sciences, Faculty of Medicine, Lund University, Inga Marie Nilssons gata 32 plan 2, 205 02, Malmö, Sweden

    Stefan Lindgren

Authors
  1. Pia Strand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gudrun Edgren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petter Borna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Lindgren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gitte Wichmann-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Renée E. Stalmeijer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pia Strand.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strand, P., Edgren, G., Borna, P. et al. Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace. Adv in Health Sci Educ 20, 531–557 (2015). https://doi.org/10.1007/s10459-014-9546-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10459-014-9546-0

Keywords

Search

Navigation