Clinical Teacher最新文献

The community of practice (CoP) theory, originally conceptualised by Lave and Wenger,¹ has significantly influenced health professions education (HPE),² contributing to our understanding of learning and professional development, with a focus on the social context of learning. CoPs offer a way of understanding student learning experiences within different contexts and focus beyond the actions of students but rather on the management of knowledge systems.³ This theoretical understanding of how learning occurs offers opportunities to explore the ways in which CoPs may serve to perpetuate colonialist tendencies and Eurocentric assumptions. This viewpoint aims to critically review learning through CoP, for the intention of decoloniality, and highlights the need for educators to develop critical consciousness.

Situated learning theory is a social constructivist approach that describes learning as occurring within the context of CoPs.¹ It emphasises human relationships and the environments in which these occur, with learning developing through the process of legitimate peripheral participation. The desired outcome of this process is co-construction of knowledge, as the learner develops knowledge based on what is modelled by the experts, and in relation to their own experiences and contexts.⁴ Lave and Wenger's theory of situated learning remains relevant to HPE as it has been instrumental in understanding the role of social contexts, and offers insights into many topical HPE issues, such as higher order learning skills and immersive experiences that address student roles, socialisation into the profession and professional role identity formation.³

Coloniality is recognised as a power structure that has outlived direct colonialism and has resulted in an asymmetrical world that categorises people and knowledge according to racial hierarchy, Eurocentric and patriarchal world views.⁵ In this regard, one view of knowledge and existence is seen as superior, with the silenced views of marginalised groups seen as underdeveloped and uncivilised.⁶ Decoloniality is an umbrella term used to describe any effort to resist and redress the process of coloniality by incorporating other, previously silenced views into the creation of knowledge in order to move away from colonial systems of power.⁵

As Lave and Wenger¹ highlight, learning within CoPs occurs through the legitimate peripheral participation of the entering learner, as well as the modelling of knowledge by experts to facilitate learning. Below, we apply a decolonial lens to critique the concepts of ‘modelling of knowledge by experts’ and ‘legitimate peripheral participation’.

The first question we ask: What happens if the experts modelling knowledge

The education of health professional students is informed by regulatory requirements, quality assurance standards and academic and clinical research. Biomedical research that contributes to the taught content of the curriculum is often well funded and supported by established career pathways. However, modes of curriculum delivery are not always informed by robust research. Where research in pedagogical practice is undertaken, it is often conducted within an informal aspect of an educator's role and may be underacknowledged, despite the benefits that such research brings.¹ Moreover, unlike the established career pathways that exist for biomedical science researchers and clinical training, career pathways in clinical education research are poorly defined.

Clinical Education research (ClinEdR) is important if we are to meet the challenges of training and retaining the number of health care professionals needed to meet the demands of an ageing population with multiple co-morbidities and complex conditions. Inspiring the next generation of clinical education researchers is vital to grow and sustain a community focussed on ensuring excellence in pedagogical practices in the education and training of our future clinical workforce. Early opportunity and exposure to research activity has been shown to be a significant motivator to pursuing a clinical academic career,^{2, 3} and it is proposed that by increasing interest and awareness in undergraduates, the number of people entering this discipline could be expanded such that even with losses at later stages, the pool of researchers grows.

Recognising our own (national) opportunities and limitations in ClinEdR engagement, career development and community-building, the National Institute for Health and Care Research (NIHR) Incubator for ClinEdR was established in 2020 to lead an expansion of career researchers in clinical education, while driving culture change to position educational research as an esteemed career.⁴ In the first year of this 3-year funded project, we explored and identified several key limitations and barriers to attracting people into the discipline of clinical education research; indeed, the most notable barrier was the recognition of ClinEdR as a discipline in itself. Armed with this knowledge, we then explored how career development and community-building may be done in the context of ClinEdR, specifically in growing an interest in the discipline from undergraduate level.

This ‘How to …’ paper has been informed by a series of series of semi-structured interviews with individuals identified as having success in involving undergraduates in ClinEdR. The individuals were identified through the NIHR Incubator network and through a snowballing recruitment strategy approved by our Research Ethics Committee. The interviews with seven individuals were transcribed and thematically coded using a reflexive th