Alan Bleakley

Broadening conceptions of learning in medical education: the message from teamworking.

Background  There is a mismatch between the broad range of learning theories offered in the wider education literature and a relatively narrow range of theories privileged in the medical education literature. The latter are usually described under the heading of ‘adult learning theory’.

Stories as data, data as stories: making sense of narrative inquiry in clinical education.

Background  Narrative inquiry is a form of qualitative research that takes story as either its raw data or its product. Science and narrative can be seen as two kinds of knowing, reflected in the distinction between evidence‐based medicine derived from population studies and narrative‐based medicine focused upon the single case. A similar tension exists in the field of narrative inquiry between cognitive‐orientated analytical methods and affective‐orientated methods of synthesis.

From reflective practice to holistic reflexivity

ABSTRACT Schons formative and influential notion of ‘reflective practice˚s is in danger of being widely adopted in higher education without rigorous interrogation of the central notion of ‘reflection˚s itself. This article sets out to situate the notion of ‘reflectivity˚s historically, and to critically examine its possible forms, interpretations and underpinning values. Schons description of professional practice as an ‘artistry˚s (rather than a technique) is formally progressed, teaching being described as a critically reflexive, aesthetic practice. The article notes four underpinning epistemologies for reflective practice: technical rational; humanistic emancipatory; postmodern deconstructive; and radical phenomenological, and offers an articulation of different forms of reflectivity. A proposal is made for a complex, synthetic ‘holistic reflexivity˚s—distinguished from other kinds of reflection—as an aesthetic and ethical apprehension grounded in an ontological framework of radical phenomenology.

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors.

Medical Education 2010: 44: 449–458

Thinking the post-colonial in medical education

Context  Western medicine and medical techniques are being exported to all corners of the world at an increasing rate. In a parallel wave of globalisation, Western medical education is also making inroads into medical schools, hospitals and clinics across the world. Despite this rapidly expanding field of activity, there is no body of literature discussing the relationship between post‐colonial theory and medical education.

An open letter to The BMJ editors on qualitative research

Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

Improving teamwork climate in operating theatres:The shift from multiprofessionalismto interprofessionalism

A multi-faceted, longitudinal and prospective collaborative inquiry was initiated in December 2002 with one half of the cohort of operating theatre personnel in a large, acute UK hospital serving a mainly rural population. The same intervention was introduced in January 2004 to the other half of the cohort. The project aims to improve patient safety through a structured educational intervention focussed upon changing teamwork practices. This article reports one critical element of the larger project – changing teamwork climate as a necessary precursor to establishing an interprofessional teamwork culture. The aggregate of individual, unidirectional attitude changes across a large cohort constitutes a change in climate. This shift challenges the conventional culture of multiprofessionalism, where uniprofessional identification (the “silo” mentality) is traditionally strong.

Distributing menus to hungry learners: can learning by simulation become simulation of learning?

Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of ‘integration’. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education. Practice points•Learning by simulation can become self-referential to offer a simulation of learning.•Work-based learning requires effective structuring such as provision for hands-on practice, support, feedback and reflection.•Learning by simulation can be more effectively theorized to inform practice.•The interaction between effective simulation and work-based learning can increase the power of both.

Blunting Occam's razor: aligning medical education with studies of complexity.

Clinical effectiveness and efficiency in medicine for patient benefit should be grounded in the quality of medical education. In turn, the quality of medical education should be informed by contemporary learning theory that offers high explanatory, exploratory and predictive power. Multiple team-based health care interventions and associated policy are now routinely explored and explained through complexity theory. Yet medical education – how medical students learn to become doctors and how doctors learn to become clinical specialists or primary care generalists – continues to refuse contemporary, work-based social learning theories that have deep resonance with models of complexity. This can be explained ideologically, where medicine is grounded in a tradition of heroic individualism and knowledge is treated as private capital. In contrast, social learning theories resonating with complexity theory emphasize adaptation through collaboration, where knowledge is commonly owned. The new era of clinical teamwork demands, however, that we challenge the tradition of autonomy, bringing social learning theories in from the cold, to reveal their affinities with complexity science and demonstrate their powers of illumination. Social learning theories informed by complexity science can act as a democratizing force in medical education, helping practitioners to work more effectively in non-linear, complex, dynamic systems through inter-professionalism, shared tolerance of ambiguity and distributed cognition. Taking complexity science seriously and applying its insights demands a shift in cultural mindset in medical education. Inevitably, patterns of resistance will arise to frustrate such potential innovation.Clinical effectiveness and efficiency in medicine for patient benefit should be grounded in the quality of medical education. In turn, the quality of medical education should be informed by contemporary learning theory that offers high explanatory, exploratory and predictive power. Multiple team-based health care interventions and associated policy are now routinely explored and explained through complexity theory. Yet medical education--how medical students learn to become doctors and how doctors learn to become clinical specialists or primary care generalists--continues to refuse contemporary, work-based social learning theories that have deep resonance with models of complexity. This can be explained ideologically, where medicine is grounded in a tradition of heroic individualism and knowledge is treated as private capital. In contrast, social learning theories resonating with complexity theory emphasize adaptation through collaboration, where knowledge is commonly owned. The new era of clinical teamwork demands, however, that we challenge the tradition of autonomy, bringing social learning theories in from the cold, to reveal their affinities with complexity science and demonstrate their powers of illumination. Social learning theories informed by complexity science can act as a democratizing force in medical education, helping practitioners to work more effectively in non-linear, complex, dynamic systems through inter-professionalism, shared tolerance of ambiguity and distributed cognition. Taking complexity science seriously and applying its insights demands a shift in cultural mindset in medical education. Inevitably, patterns of resistance will arise to frustrate such potential innovation.

Making sense of clinical reasoning: judgement and the evidence of the senses

Background  Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education.