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Background: Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID‐19 pandemic lockdowns and with physical isolation processes that decreased in‐person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences. Methods: Semi‐structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances. Findings: Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID‐19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices. Discussion: Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies. Conclusion: Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations. [ABSTRACT FROM AUTHOR]

The concept of employability extends beyond initial occupational preparation into the ability to remain employable as, inevitably, occupational capacities and workplace requirements change frequently across working lives. Hence, the need to continually learn to remain occupationally current and respond to changing workplace requirements becomes paramount. The evidence suggests that much of that learning arises through individual efforts and the support of co‐workers through work activities. So, there is a need to understand how that learning can be supported to sustain employability across lengthening working lives. Drawing on an Australian study, reported here are perspectives from managers and workers in diverse workplaces about current modes of continuing education and training and about how workers are assisted with their learning to meet personal needs and qthose of employers. Employers want an occupationally current workforce that can meet specific workplace needs; workers want the capacities to remain employable, which may extend to advancing their careers elsewhere. The data indicate differences in perceptions about what is being provided, how frequently the provisions are used, and the worth of its certification. Whilst the findings indicate shared concerns about the importance of learning, there were clear differences in views about the models and processes used to support that learning. Across both sets of informants can be seen distinctions between 'training solutions' and 'learning solutions'. A more nuanced analysis suggests that the training solution is appropriate and effective at some point in workers' worklife trajectories but in other circumstances, learning through practice is proposed as being more efficacious. [ABSTRACT FROM AUTHOR]

Competence in contemporary working life requirements is increasingly aligned with electronically mediated tasks and work roles: ie, the digitalisation of work. This alignment necessitates workers learning and utilising the conceptual knowledge and ways of working needed for this work. This knowledge is often distinct from and displaces workers' existing ways of knowing, which threatens their competence and sense of self. Yet, it can be difficult to access, learn and practice, requiring it to be mediated through interventions making it knowable. For working age adults, this often needs to occur through work activities for efficacy and practical reasons. These worklife learning issues are discussed here from a cultural psychological perspective, drawing on studies of contemporary work and human cognition, considerations for how these forms of knowledge can be made accessible and their processes of knowledge construction be supported. Four key propositions are advanced: (a) this knowledge needs to be made accessible to be engaged with and learnt; (b) that can often best occur in work settings; (c) workers' occupational subjectivities need accommodating; and (d) electronically mediated forms and artefacts offer means to make that knowledge accessible and support its learning. Hence, learning, work and digitalisation are reciprocally aligned in promoting both the initial and ongoing development of workers' capacities. Practitioner notesWhat is already known about this topic? The knowledge required for work constantly changes.Digitalised work has changed the requirements of much work and many occupations.Conceptual and symbolic knowledge are required for competence in digital kinds of work.Many studies have illustrated the impact of digital technologies across a range of occupations and industry sectors.What this paper adds? An elaboration of how the knowledge to be learnt and ways of knowing have changed in digital work.Considerations of the implications of the changes for worklife learning (lifelong learning).The importance of digitalised artefacts mediating access to this knowledge through symbolic representations.Implications for practice and/or policy Working age adults need to be able to access the kinds of knowledge required for digitalised work.Worksites and work practice are potentially the optimum circumstances for accessing and learning this knowledge across working life.The ability of this knowledge to be represented symbolically is a key basis for workers ongoing learning of digitalised work requirements.Digital technology offers means for the conceptual representations to be made accessible. [ABSTRACT FROM AUTHOR]

Objectives: Competency‐based medical education (CBME) requires that educators structure assessment of clinical competence using outcome frameworks. Although these frameworks may serve some outcomes well (e.g. represent eventual practice), translating these into workplace‐based assessment plans may undermine validity and, therefore, trustworthiness of assessment decisions due to a number of competing factors that may not always be visible or their impact knowable. Explored here is the translation process from outcome framework to formative and summative assessment plans in postgraduate medical education (PGME) in three Canadian universities. Methods: We conducted a qualitative study involving in‐depth semi‐structured interviews with leaders of PGME programmes involved in assessment and/or CBME implementation, with a focus on their assessment‐based translational activities and evaluation strategies. Interviews were informed by Callon's theory of translation. Our analytical strategy involved directed content analysis, allowing us to be guided by Kane's validity framework, whilst still participating in open coding and analytical memo taking. We then engaged in axial coding to systematically explore themes across the dataset, various situations and our conceptual framework. Results: Twenty‐four interviews were conducted involving 15 specialties across three universities. Our results suggest: (i) using outcomes frameworks for assessment is necessary for good assessment but are also viewed as incomplete constructs; (ii) there are a number of social and practical negotiations with competing factors that displace validity as a core influencer in assessment planning, including implementation, accreditation and technology; and (iii) validity exists as threatened, uncertain and assumed due to a number of unchecked assumptions and reliance on surrogates. Conclusions: Translational processes in CBME involve negotiating with numerous influencing actors and institutions that, from an assessment perspective, provide challenges for assessment scientists, institutions and educators to contend with. These processes are challenging validity as a core element of assessment designs. Educators must reconcile these influences when preparing for or structuring validity arguments. If A then B? Webster et al. explore if, when, how situational judgement tests can be used to evaluate personal attributes for medical trainee selection. [ABSTRACT FROM AUTHOR]

Context: A range of research methods have been used to understand effective workplace learning in the health professions. The impact of findings from this research usually requires knowledge translation activities in the form of faculty development initiatives, such as supervisor workshops. Far rarer, but with greater potential, are research approaches that concurrently seek to understand and change practice through empowering clinicians to refine aspects of their practice. Methods: In this methodological article, we describe video‐reflexive ethnography (VRE), a collaborative visual research approach that seeks to capture, illuminate and optimise in situ work and education practices. Video‐reflexive ethnography usually has three phases: (a) initial familiarisation with practice through field observations; (b) video‐recording of practice, and (c) reflexive sessions about the edited footage with participants and researchers. Drawing on our own experiences as researchers using VRE, we discuss four key principles of VRE: (a) exnovation; (b) collaboration; (c) reflexivity, and (d) care. Discussion: Although VRE has been used to illuminate and understand health professionals education, its potential for changing clinical education practices has yet to be realised. Video‐reflexive ethnography enables observation of the social and relational interactions in health care practice and allows individual (and group) perspectives to be articulated and analysed. The approach can prompt fresh perspectives and insights into health care education and practice for researchers and clinicians through shared deliberations about how practice might be reimagined and enacted. [ABSTRACT FROM AUTHOR]

Context Learning to prescribe is challenging for junior doctors. Significant efforts have been made to improve prescribing education, especially in view of the high rates of prescribing errors made by junior doctors. However, considerations of educational options often overlook the fact that learning to prescribe and prescribing practices rely on practice-based interactions with informed practitioners, such as pharmacists and consultants. Pharmacists have long made important contributions to developing prescribing capacities. Objectives The present study examines the potential of everyday co-working between junior doctors and pharmacists, in conjunction with consultants, as an accessible means of developing effective prescribing practices. Methods A qualitative interview study was conducted in an Australian tertiary hospital using thematic analysis to explore junior doctors', pharmacists' and consultants' perspectives on how co-working supports learning to prescribe in an acute tertiary hospital setting. Participants included 34 practitioners, comprising junior doctors ( n = 11), consultants ( n = 10) and pharmacists ( n = 13). The thematic analysis was informed by workplace learning theory. Results Learning to prescribe was found to be a highly interdependent process. In particular, junior doctors were dependent on co-working with consultants and pharmacists. Three interrelated themes related to co-working and learning to prescribe in the workplace were identified: (i) prescribing readiness of junior doctors; (ii) need for guidance, and (iii) the challenges of pharmacists co-working as outsiders. Conclusions Co-working with pharmacists and consultants contributes positively to junior doctors' prescribing practices. However, co-working is complex and is influenced by differing understandings of prescribing practices. These insights assist in informing how co-working can be enacted routinely in hospital settings to promote safe and effective prescribing practices. Consideration should be given to when and how co-working between junior doctors and pharmacists is initiated, including during medical school. In clinical settings, strategies such as having pharmacists attend ward rounds and adopt a role of learning facilitation rather than error identification may augment everyday opportunities for co-working and learning. [ABSTRACT FROM AUTHOR]

Context Learning through work has long been important for the development of health care workers' occupational competence. However, to effectively utilise this mode of learning, its particular qualities and contributions need to be understood and optimised and its limitations redressed. Concepts Optimising the experiences health care workplaces provide, augmenting their potential for learning and promoting workers' engagement with them can, together, improve workers' ability to respond to future occupational challenges. Importantly, such considerations can be used to understand and appraise workplaces as learning environments. Here, the concepts of practice curricula and pedagogies, and workers' personal epistemologies (i.e. what individuals know, can do and value) are described and advanced as practical bases for optimising learning in and for health care workplaces now and for the future. Conclusion Such bases seem salient given the growing emphasis on practice-based provisions for the initial preparation and on-going professional development of health care workers' capacities to be effective in their practice, and responsive to occupational innovations that need to be generated and enacted through practice. [ABSTRACT FROM AUTHOR]

Editors' note: In this Toolbox, Professor Stephen Billett applies his extensive experience in the areas of vocational and workplace learning, from a broad spectrum of professions and disciplines, to the fi eld of clinical education. In doing so, he opens a doorway into the wider education literature in this area, and a fresh and insightful perspective on learning for clinical practice and work-based learning. Consistent with much of the wider education literature, he uses the broad term 'knowledge' to encompass everything that individuals might know, be able to do and value - not just what they know. Although discussed separately, these three forms of knowledge are considered to be interdependent, and together determine the 'readiness' of individuals to engage with, and learn from, their experiences in any given situation. Billett stresses the importance of aligning experiences with what those practising the profession are expected to know, do and value (capacities we might express as intended learning outcomes, competencies or expected professional activities). He also highlights the importance of sequencing educational experiences so that learners move from concrete to abstract conceptualisation, from single to more complex and combined tasks, and from developing appropriate values and other dispositions to applying these in their subsequent learning and practice. This Toolbox offers a set of theoretical tools that are complementary to, but rather different from, those in the clinical education literature. We hope it will be useful to all clinical teachers and will promote further discussion and reflection. [ABSTRACT FROM AUTHOR]

The article discusses the possible extension of medical education research into research on clinical practice by graduates of medical schools. Topics include the importance of patient-focused medical practice, the possibilities for interdisciplinary research, and the impact of ageing on the practice of medicine.

The article presents a transcript of an electronic mail conversation between Olle Ten Cate of the University Medical Centre Utrecht, the Netherlands and Stephen Billett from Griffith University in Brisbane, Queensland, Australia. In the conversation the two discuss competency-based professional training in medicine and its roots, significance and limitations and reflect on the potential of competency-based medical education.

The perennial debate concerning the so-called ‘theory-practice gap’ pervades health professional education. It is uncertain whether this gap – the notion that knowledge gained in university does not translate well into the workplace – is unavoidable or if it is a manifestation of the learning approaches used and the cultures operative in the two locations. This paper examines how nursing students’ knowledge and skills gained within university clinical laboratories transfer into the reality of the clinical environment. A series of one-on-one interviews were conducted over a two year period with second and third year nursing students ( n = 28) participating in a preceptorship clinical placement model at one healthcare organisation. This paper focuses on data from the students' first interview. Data were transcribed and imported into NVivo 8 for thematic analysis. Four key themes emerged, including: ‘How I learn’ which focuses on students’ perceptions of their learning preferences; ‘Lack of engagement – it’s not real’ which concerns a perceived lack of authenticity of clinical laboratories; ‘Lack of affordances’ relating to the learning opportunities available in the clinical setting; and ‘Teacher Impact’ which focuses on the influence of individual teachers on student learning. The ‘parallel universes’ of academia and the workplace create dissonance for students as they juxtapose the authenticity of the clinical laboratories with the reality of professional healthcare practice. Transfer is inextricably linked with the individuals’ learning preferences, the affordances the workplace offers to students, and the willingness of staff to provide exciting, engaging learning opportunities. The challenge for health professional education is to provide a model of clinical education that meets not only the needs of university and clinical staff, but most importantly, the needs of students. [ABSTRACT FROM AUTHOR]

Aim and objectives. This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury. Background. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies. Design. A mixed method pretest–posttest group design was used. Methods. Nurses ( n = 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning. Results. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses’ capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented. Conclusions. The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting. Relevance to clinical practice. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care. [ABSTRACT FROM AUTHOR]

Identifies some bases for a workplace pedagogy using contributions from sociocultural, cognitive, and anthropological theories. Key goal for a workplace pedagogy; Shortcomings associated with learning in workplaces solely through everyday work activity; Prospects for the adoption and successful implementation of the workplace learning model.

Objective Setting Participants Design Results Conclusion To explore the impact of COVID‐19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team.Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic.Twenty‐three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students.Audio‐recorded semi‐structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees.Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated. [ABSTRACT FROM AUTHOR]