Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  53 while engaged in supported participation in authentic environments, combine to promote com- petence and a sense of readiness for practice (Dornan et al., 2007). Importantly, feeling invited to participate and engage with a team is essential to initiate and maintain meaningful participation (Sheehan, Wilkinson, and Billett, 2005). Indeed, Teunissen (2015) claims that the key strength of learning from practice is that it enables people to learn how to perform, think, and interact in ways appropriate for their specific work setting. Further, health care settings are particularly challenging as workplace learning envi- ronments since not only are they highly contextual, they are also structured primarily for patient care rather than learning. In exploring this tension, he outlines an empirically-based framework for practice-based learning in healthcare workplaces (Teunissen, 2015). In conceptualizing those who participate in healthcare, including patients, as learners, he also views learning as a process of constructing meaning that is both situated in specific contexts at individual and social levels. Learning may be visible if it leads to changes in future behaviour, making it easier to describe and study. However, learning often represents reinforcing or slightly modifying existing knowledge or behaviours, making it difficult to recognize or observe. The utility of Teunissen’s experienc- es-trajectories-reifications (ETR) framework is to explore how individual and collective effects contribute to acting and learning in workplaces (Teunissen, 2015). First, learners engage in acts within specific situations embedded in social and cultural systems, select and make sense of infor- mation, and then adapt their behavior, which leads to personal experiences . They can be helped in this process when clinical teachers maximize the affordances of workplaces, support learn- ing, and help create meaning from participation in clinical work activities (Bleakley, Bligh, and Browne, 2011). Of course, different learners will experience situations—and draw meaning from them—differently, because of their unique personal histories. These collections and combinations of personal experiences lead to trajectories over time—for multiple individuals, whose trajecto- ries intertwine as their professional and social identities evolve. Indeed, Teunissen also asserts that because many aspects of individuals’ experiences and trajectories are shared with others, norms and conventions develop, hierarchies are established and exercised, and specific tools are invented, and a shared understanding of the situational requirements for performance emerges (Teunissen, 2015). Examples of these reifications are standard operating procedures, practice guidelines, tools, ways of talking, and structured communication strategies. Given the importance of talk and communication in healthcare workplaces for both learning and patient care, we will give these aspects special attention. Talk Is Central to Learning from Clinical Practice Learning from work can be seen as a by-product of engaging in work activities through social interactions with patients and other members of healthcare teams, highlighting the important role of talk in learning (Edmondson, 2012; Steven, Wenger, Boshuizen, Scherpbier, and Dornan, 2014). Both formal and informal opportunities to engage in conversation, including interactions over coffee with more experienced clinicians, contribute in important ways that promote learning and encourage professional thinking (Sheehan et al., 2005). Indeed, “learning to talk”, represents the