How Professional Education Can Foster Praxis and Critical Praxis: An Example of Changing Practice in Healthcare

Learning is crucial to how professionals enact practices, and to how practices change. Professionals frequently encounter uncertainty regarding what to do, requiring praxis informed by practical wisdom, which takes into account the virtues of practice. Critical praxis takes this further, questioning current norms to reduce untoward effects. A simulation-based education program for healthcare professionals was selected for study due to strong evidence of sustained improvements in handling a rare and challenging birth emergency (shoulder dystocia). Videos of simulations and debrief discussions were analysed in terms of complexes of sayings, doings and relatings. Practitioners learned to respond in agile, collective ways to specific situations, through praxis. An extension to the theory of practice architectures is offered, based on two new concepts. ‘Connective enactments’ involved narration, questioning, and directing actions. These contributed to ‘collective accomplishments’ of fluid role-switching, responsive sequencing and pacing, and producing calm. These new concepts help to theorise how professional education can contribute to practice change by fostering praxis and critical praxis, addressing the architectures that shape practices.