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INTRODUCTION
Postgraduate medical education is predominantly
sited in the workplace. There are opportunities to
participate in structured tuition away from the
hospital or practice, but the bulk of learning is
expected to take place at, through or from work.
A number of bodies exist in order to facilitate,
enhance and quality-assure this process, including
Royal Colleges and Departments of Postgraduate
Medical Education. These organisations are also
responsible for ensuring that experienced doctors
participate meaningfully in a process of continuing professional development, a process which in
recent years has shifted from the clocking up of
time engaged in formal learning to a system
based on annual appraisal and the personal
development plan. Work-based learning has now
taken centre stage in the training and ongoing
development of the medical workforce and with
this has arisen the need to understand the
processes in operation, particularly those relating
to informal learning.
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informal learning
Overview
What is already known on this subject
Postgraduate medical education occurs predominantly in the workplace, largely through
an apprenticeship model. Informal learning
plays a central role in professional development.
What this study adds
Medical education has tended to emphasise
cognitive approaches to informal learning, but
learning can also be conceived as a cultural
phenomenon in which identity, knowing and
social membership entail one another.32
Recent changes in both service and education
require that, in the context of medical
apprenticeship, attention be paid to how the
socio-cultural progression of the individual
from newcomer to old-timer might be
enhanced.
Suggestions for further research
The impact of structured, competency-based
curricula should be carefully evaluated, particularly with respect to professional development.
INFORMAL LEARNING IN
POSTGRADUATE MEDICAL EDUCATION
Resnick2 defines formal learning as that which takes
place in an institution as a result of instruction, an
individual process, involving the purely mental activity of manipulating symbols resulting in the production of generalised concepts. Informal learning, by
contrast, is defined as characteristically collaborative,
usually involving the manipulation of tools and
leading to context-specific forms of knowledge and
skills. A distinction can also be made between formal
workplace learning and incidental learning.3 For
instance, Reber,4 adding empirical backing to
Polyanis concept of tacit knowledge,5 suggests the
term implicit learning as a descriptor for the
acquisition of knowledge independently of conscious
attempts to learn and in the absence of explicit
knowledge about what was learned.6
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SOCIO-CULTURAL APPROACHES TO
INFORMAL LEARNING
A number of authors have conceived learning as a
socio-cultural phenomenon. Bruners celebration of
culturism takes inspiration from the evolutionary fact
that the mind would not exist save for culture.1
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informal learning
Eraut8 presents 2 arguments as to why knowledge
may be conceived as a social, rather than an individual, attribute. The first of these hinges on the
concept of distributed cognition; that in certain situations individuals are unable to act effectively as they
depend on the knowledge of other people or other
things.37 The second argument is derived originally
from the developmental theories of Vygotsky38 and is
based on the concept that learning is embedded in a
particular set of social relations and that by inference
a given piece of knowledge may be socially rather
than individually constructed.
In their landmark study of Yucatec midwives, tailors,
quartermasters, butchers and non-drinking alcoholics, Lave and Wenger32 trace the progression of the
individual from newcomer to old-timer in which
legitimate peripheral participation in a community of
practice leads, in time, to full participation: Thus
identity, knowing, and social membership entail one
another.32 Lave and Wenger noted that very little
observable teaching took place in the 5 apprenticeships under study and that the foremost and more
fundamental educational process in action was
learning.
Lave and Wenger further noted that in an apprenticeship setting the curriculum unfolds with opportunities for engagement, and that engaging in
practice may well be a condition for learning.32
This theme of engagement as a fundamental prerequisite for informal learning is taken up by Billett,39
who places it as 1 of 2 foundational practices in a
workplace pedagogy. But it takes two to tango and
individual engagement is considered reciprocal to
what Billett defines as workplace affordances, that is
how the workplace invites and structures individuals
participation in work.39 This access to workplace
activities and guidance, he argues, shapes the quality
of learning and is socio-politically mediated, being
ultimately premised on the workplaces participatory
practices, so that the workplace confirms whether the
individual is to be considered as a learner and defines
the educational opportunities to be provided as a
result.
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informal learning
surgeon progresses from performing simple
appendectomies to complex bowel resections. The
practitioners sense of identity as a master is
enhanced as he or she offers graded contributions,
from low to high accountability, and through being
presented with work opportunities of increasing
challenge and value42 the individual develops a
heightened sense of professional identity. Central to
this escalatory process, however, must lie feedback
and support, and the building and maintenance of
learner confidence.49 High self-esteem is essential for
learning.31,42
Opportunities to transform social practice
Increasing participation in social practice results not
just in knowledge acquisition but also in knowledge
production and this too is an essential part of
developing a professional identity.22 All learners
should have the opportunity to mould social practice
and develop new ideas. In medicine this might
include devising a patient recall system or carrying
out a PDSA (plan-do-study-act) cycle to improve some
aspect of health care provision. Bleakley50 illustrates
this point well in his discussion of ward-based
transformative learning in pre-registration house
officers.
Acknowledgements: none.
Funding: none.
Conflicts of interest: none.
Ethical approval: not applicable.
REFERENCES
Transforming social practice, then, not only legitimises the learners participation, but also shapes the
very community of practice into which the learner is
being absorbed. The workplace in turn benefits from
becoming knowledge-producing, a noted feature of
successful organisations.51
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CONCLUSION
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