Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  59 (Campbell and Parboosingh, 2013; Hawkins, Lipner, Ham, Wagner, and Holmboe, 2013; Holmboe, 2013), and be ‘revalidated’ as practitioners who are fit for purpose (Archer and de Bere, 2013). The United Kingdom’s General Medical Council (GMC) defines CPD in this way: CPD is any learning outside of undergraduate education or postgraduate training that helps [physicians] maintain and improve [their] performance. It covers the development of…knowledge, skills, attitudes and behaviors across all areas of…professional practice. It includes both formal and informal learning activities. p. 7 (GMC, 2012). Traditionally, CPD focuses on the maintenance and development of medical knowledge and skills that are specific to an individual doctor’s specialty practice (Davis, Davis, and Bloch, 2008; O’Neil and Addrizzo-Harris, 2009; Peck et al., 2000) and takes various forms (Davis et al., 1999; Mazmanian, Davis, and Galbraith, 2009). Unfortunately, however, it targets relatively low order cognitive skills of remembering and understanding (Legare et al., 2015) rather than behaviour change, which is more likely to impact clinical practice. CPD is largely decontextualized from workplaces, thus divorcing learning from the social context of clinical practice and minimizing the complexity of the learning experience (Bleakley et al., 2011). ‘Knowing in practice’, which is an essential element of vocational expertise (Billett, 2001a), plays only a secondary role in CPD. Likewise, interprofessional and multidisciplinary working, which is ubiquitous in clinical workplaces, is largely ignored by contemporary CPD. Current frameworks privilege individual over collective accomplishment because they are profession-specific, constrained by regulatory bodies (Barr, 2009) and removed from the talks between different health workers, which is neces- sary for safe, effective patient care. While the metaphor of ‘learning as acquisition’ (Sfard, 1998) has at least some place, traditional CPD foregrounds ‘acquisition’ over ‘participation’ dispropor- tionately. The work of Lingard (2012), which contrasts individualist and collectivist discourses of medical competence, supports that interpretation. The individualist discourse views compe- tence as a construct which individuals acquire and possess, is context-free, and represents a state to be achieved. In the collectivist discourse, competence evolves from participation in authentic situations, is situated across networks of persons and artefacts, and manifests in interconnected behaviours occurring within time and space (Lingard, 2012). Lingard notes that “competent indi- viduals can come together to form an incompetent team” (p. 44). Therefore, individualistic CPD is not well aligned with patients’ needs (Kitto et al., 2013; Rowland and Kitto, 2014). It does little to combat tribal conflict between providers from different disciplines, whose values and cultural norms diverge (Weller et al., 2014). It seems reasonable to conclude that siloed initial and ongoing health professions education (Kohn, Corrigan, and Donaldson, 2000) contributes to collective incompetence. Collective incompetence is a serious problem because, according to the 2000 United States (U.S.)-based Institute of Medicine (IOM) Report To Err is Human (Kohn et al., 2000), over 70% of medical errors are caused by communication breakdowns within healthcare teams. Medical errors are a leading cause of death, estimated at 210,000–400,000 deaths/year in 2013 in the U.S. (James, 2013). Communication within and amongst healthcare teams is a critical medium for enacting knowledge and forms the basis for teamwork (Salas, Cooke, and Rosen, 2008),