Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  51 between: (a) how CPD is currently organized around activities that promote decontextualized knowledge and skill acquisition, and (b) the evolving understanding that learning and participa- tion in authentic workplace activities are inextricably linked. We explore the limitations of formal CPD by addressing the primary factor that threatens patient safety: breakdowns in communica- tion among healthcare professionals. Since current CPD models foreground individual compe- tence, the competence of healthcare teams—and patient care—likely suffer. In the final section, we explore recent developments in healthcare education discourse relevant to clinical practice since collaboration and communication across professional and disciplinary boundaries are prerequi- sites for safe patient care. We then envision a world in which workplace learning plays a central role in certified CPD, and how foregrounding talk as a medium for collaboration and learning can enhance practice. Section I: Becoming a Doctor Medicine is one of many health professions. Undergraduate medical education consists of mostly uni-professional training programs, which are accredited by governmental and/or local medical regulatory bodies. These training curricula are not the focus of this chapter; see “Educating Physicians: A Call for Reform of Medical School and Residency” for an overview (Cooke, Irby, and O’Brien, 2010). After undergraduate medical studies, medical students emerge as doctors and enter the second phase of clinical training, or graduate medical education, termed ‘residency’. After residency, doctors become independent practitioners (Cooke et al., 2010). In primary care settings, as well as in hospitals, they work in teams usually composed of several fully-trained doctors and a complement of nurses and other providers. In teaching hospitals, teams might also include a number of doctors in training (i.e. residents) and perhaps undergraduate medical stu- dents if the institution is affiliated with a medical school. A newly qualified doctor might enter a 1- or 2-year period of foundational training in a broad area such as internal medicine or surgery with the aim of pursuing focused training in general practice, internal medicine, obstetrics and gynaecology, surgery, paediatrics, or emergency medicine. Not infrequently, physicians pursue further specialized training to master the nuances of a specific area within their specialty (Cooke et al., 2010). Examples include: zz Internal medicine: e.g. endocrinology, cardiology, gastroenterology zz Surgery: e.g. colorectal surgery, heart surgery, neurosurgery zz Paediatrics: e.g. cardiology, critical care, neonatology, emergency medicine Practising Medicine Requires More Than Acquiring Knowledge We can apply two metaphors of learning to doctors’ education: ‘learning as acquisition’ and ‘learn- ing as participation’ (Sfard, 1998). Medical education requires learners to command large amounts of codified propositional knowledge. A ‘knowledge as competence’ discourse emphasizes knowl- edge mastery as an indicator of competence (Hodges, 2006) and foregrounds formal classroom learning, embodied by the metaphor ‘learning as acquisition’ (Sfard, 1998). Although learning