Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  63 practice-based learning. These include collective competence (Lingard, 2012), intersubjectivity (Billett, 2014; Teunissen, 2014) and reciprocal interdependence (Edmondson, 2012). Talk links these themes because it intertwines learning and working within the social fabric of workplac- es. Collective competence involves making collective sense of workplace events, developing and using a collective knowledge base, and cultivating a sense of interdependency (Boreham, 2004). Thus, groups negotiate competence collectively through work and talk (Lingard, 2012). Viewing effective clinical practice through the lens of collective competence, it becomes clear that quality improvement work brings trainees and practicing clinicians together and nurtures meaningful collaboration and communication by focusing on patient outcomes achieved by the collective rather than on the competence of individuals. When teams have successfully implemented inter- disciplinary rounds, an important component of their intervention has been co-leadership by physicians and nurses (O’Leary et al., 2014; Stein et al., 2015), which mitigated the tradition of dominance by doctors and made space for truly interprofessional care (Bleakley, 2013a). They shifted “multi-professionalism to interprofessionalism” (p. 461) (Bleakley, Boyden, Hobbs, Walsh, and Allard, 2006) and co-promoted collaborative learning and patient-centeredness (Bleakley et al., 2011). Although entailing communication between physicians only, the effective practic- es orchestrated by Starmer and colleagues (2012, 2013; Starmer, O’Toole, et al. 2014; Starmer, Spector, et al. 2014) reframed handoffs as collective events that integrated socio-cultural and adaptive elements of healthcare environments. When checklists are implemented as part of a care bundle, they promote dialogue by opening channels of communication that make health workers collectively responsible for outcomes. The term intersubjectivity means that people working together share common understand- ing (Billett, 2014). This understanding involves sensing what others intend, think, and feel as well as imagining what impact their actions may have on those around them. Interactions are funda- mental for creating shared realities (Teunissen, 2014). Further, intersubjectivity helps explain how members of established healthcare teams understand and make sense of individual preferences and idiosyncrasies. This makes constant negotiation for routine tasks unnecessary while reserving it for grappling with non-routine or novel problems (Sheehan et al., 2005). One can envision high degrees of intersubjectivity on medical wards with nurse-physician co-leadership and processes that promote collaboration. Billett (2014) highlights that intersubjectivity itself can be viewed as a desirable learning outcome among interprofessional teams. Edmondson (2012) advocates reciprocal interdependence, which denotes a shared under- standing that professionals cannot work and learn without each other. This notion is at the very core of interprofessional practice. Specifically, she states that healthcare is at times so complex that processes must constantly adapt to the unique needs of patients, providers, and workplace contexts. As all of these are in constant flux, providers need to work together to promote collec- tive learning on a daily basis. Edmondson’s conceptual model uses the term ‘teaming’ to highlight the behaviours rather than the people (Edmondson, 2012). Notions of complexity (Lingard et al., 2012) and team working (Bleakley, 2006) as ‘liquid’ and ‘fluid’ (Bleakley, 2013c) support this approach. Individuals coming together to solve collective problems should engage in ‘teaming