By: Dr. Heather Buckley, MD, CCFP, FCFP, Clinical Educator Fellow (Biography & Disclosures), disclosures and Dr. Nawaaz Nathoo, MD, FRCSC, Clinical Educator Fellow (Biography & Disclosures), no disclosures
What I did before:
I wondered why new learners just transitioning to new clinical experiences sometimes seemed hesitant to participate and thus appeared less engaged in clinics and journal clubs. I found that some learners would jump in and take part in conversations, discussions, and even engage with patients. Others, however, seemed to take longer to feel comfortable – and on a short rotation/experience, sometimes it seemed like they never got to the point where they felt comfortable enough to participate or contribute meaningfully. I often wondered if there was something I could do to encourage them to participate more quickly and wholly.
What changed my teaching practice:
My teaching practice started to change when I learned about Communities of Practice theory and its accompanying notion of “legitimate peripheral participation” (LPP) (Lave &Wenger, 1991;Wenger, 1998)). Community of practice theory is a social learning theory that “emphasizes learning and identity formation through participation in practice” (Quinn, Cantillon, Redmond & Bennett, 2014). It can explain why learners who are new to a situation or environment may take some time to feel engaged and part of “the conversation”. According to LPP (Wenger, 1998 p.100-101)), newcomers become members of a community initially by participating in low-risk tasks. They can start to become familiar with their role in the new environment through peripheral participation before moving into more active roles. Gradually, their participation can take forms that are more and more central to the functioning of the community.
For example, they may not contribute to their full potential in group meetings (e.g. rounds, journal clubs, etc.) until they start to develop a comfort with the vocabulary, environment, organization, etc in the new practice community. As they gain more comfort through both formal and informal interactions, they may start to participate more actively and develop a sense of belonging (Wenger, 1998, p. 173-181).
What I do now:
Applying this theory to the context of learners entering the larger medical community of practice:
- I recognize that new learners may need some time to acclimatize and feel comfortable and I try to acknowledge their trajectory through the community of practice. Although some learners may acclimatize quickly, for others a slow start to contributing is okay and is not synonymous with being disengaged.
- I encourage and support activities that help foster a sense of legitimacy as opposed to one of marginality (Wenger, 1998, p. 165-169). For example, I encourage their participation in low-risk activities such as case discussions and conversations around specific topics or patient care activities. In addition, in some settings developing a learning plan that encourages movement towards higher-risk activities may help propel certain learners in the right direction.
- I recognize the importance of role modelling and having junior learners spend time with senior trainees and faculty (Passi et al., 2013). If newcomers can directly observe the practices of experts, they may better understand the broader context into which their own efforts fit and thereby start to feel more comfortable with increasing their engagement and participation.
How your experience is relevant to teachers in the Faculty of Medicine:
Learners often start out as peripheral participants in the broader medical community of practice – whether that’s in clinics, on the wards, or in other activities such as journal clubs. They are members of multiple communities in a “landscape of practice” (Wenger-Trayner, Fenton-OCreevy, Hutchinson, Wenger-Trayner & Kubiak, 2014, p. 15) and there is an expected transition to their various roles as a clinical learner. We can support these transitions by being aware that it takes time to acclimatize and feel comfortable as a participant. As Wenger-Trayner et al. (2014) have said: “Students need to learn to engage in this translation process and educators need to support that learning.” (p. 61).
Further Reading (Reference articles and add resources here):
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge university press.
Passi, V., Johnson, S., Peile, E., Wright, S., Hafferty, F., & Johnson, N. (2013). Doctor role modelling in medical education: BEME Guide No. 27. Medical teacher, 35(9), e1422-e1436.
Quinn, E. M., Cantillon, P., Redmond, H. P., & Bennett, D. (2014). Surgical journal club as a community of practice: a case study. Journal of surgical education, 71(4), 606-612.
Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. Cambridge university press.
Wenger-Trayner, E., Fenton-O’Creevy, M., Hutchinson, S., Kubiak, C., & Wenger-Trayner, B. (2014). Learning in Landscapes of Practice: Boundaries, identity, and knowledgeability in practice-based learning. Routledge.
Wenger-Trayner E., & Wenger-Trayner B. (2015). Introduction to Communities of Practice. Retrieved from http://wenger-trayner.com/introduction-to-communities-of-practice/.