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Challenges and opportunities

Clinical teachers are readily able to identify the challenges to workplace-based learning. Typically they will list issues such as:

  • available time/resources
  • changing expectations (of students, patients, employers, medical schools, colleges)
  • competing demands and competing priorities (treating or teaching)
  • opportunistic nature of clinical work
  • knowing what to teach, when to teach and how to teach it
  • increased training paperwork and assessment load
  • issues around consent
  • concerns about risks involved in student/trainee practice.

Thinking points

  • Review the list above and note those you share and those you would add.
  • Which one(s) cause you greatest difficulty as a teacher-trainer?

 

Students and trainees also face similar challenges. Students in particular often report concerns about:

  • lacking a clear role or responsibilities
  • knowing what is expected of them
  • competing demands on time (studying for exams versus taking part in workplace activity or having to ‘do the job’ rather than learning ‘on the job’)
  • limited opportunities to be observed and receive feedback on performance
  • being unclear about the immediate relevance of workplace-based learning elements.

Thinking points

  • How could you address the above student/trainee concerns?
  • What strategies do you currently use to support workplace-based learning? 

If workplace-based learning creates so many challenges for both trainers and trainees, why do we persist in placing this type of activity so centrally in undergraduate and postgraduate curriculum? Some key reasons include:

  • familiarisation with healthcare contexts
  • development of  professional knowledge, e.g. case knowledge and clinical reasoning
  • development of professional skills, e.g. history taking, physical examination, procedural skills, etc.
  • development of professional socialisation, e.g. behaving and acting like a doctor/healthcare professional
  • continuing professional development.

Workplace-based learning is clearly highly valued, but is not without its challenges. For students there is the dual agenda described by Griffiths and Guile in 1999.

‘Learning in work-based contexts involves students having to come to terms with a dual agenda. They not only have to learn how to draw upon their formal learning and use it to interrogate workplace practices; they also have to learn how to participate within workplace activities and cultures’ ( Griffiths and Guile, 1999, p 170).

Our students and trainees are clearly very knowledgeable individuals, having demonstrated this knowledge in formal assessments and examinations, be it at medical school or via College exams. One of the difficulties for students and trainees, however, is learning how to draw on that knowledge purposefully in order to understand the patients and situations they meet in the clinical environment. This is one type of challenge. The other, which we will explore further later in this module, is the need to understand the ways in which teams operate in each particular context they encounter and find ways to fit in and work effectively.

For clinical teachers there is one further challenge: trying to fit teaching methods designed for the classroom to the workplace. In the next section we will explore some theoretical perspectives on workplace-based learning and consider the ways in which they can help us in developing approaches to the support and facilitation of workplace-based learning.

 

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