Luminary Learning Gastrointestinal Disorder- Issue 1

64  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS behaviours’ to ‘organize-to-learn’ rather than ‘learning to execute’ (Edmondson, 2012). Those behaviours include: zz Explicitly framing activities as learning opportunities zz Making it safe to learn zz Learning from failure zz Spanning occupational and cultural boundaries These behaviours are enacted through the discourse of workplaces; specifically, by asking questions, sharing information, seeking help, talking about mistakes, and seeking feedback. Leaders in Edmondson’s ‘teaming’ model—lead nurses and doctors—frame their own roles in the process by espousing reciprocal interdependence and acknowledging their own fallibility in the service of psychological safety. Feeling safe to learn means feeling safe to disagree, to ques- tion, to be wrong (Edmondson, 2012), which is not typical of clinical practice. Indeed, even when we feel safe, we still engage in self-censorship and often remain silent, which inhibits knowledge sharing and group learning (Detert and Edmondson, 2011). Although we have focused on talk here, silence is discourse too (Lingard, 2013), especially when it comes to ‘speaking up’ and giving voice to ideas or concerns (Milliken and Morrison, 2003; Van Dyne et al., 2003; Eppich, 2015). The teaming behaviours outlined by Edmondson promote discourses of collective competence, intersubjectivity, and reciprocal interdependence. We now discuss ways forward by exploring how to enhance productive discourse in clinical practice to address communication breakdowns. Use of Simulation to Promote Productive Discourse The 2000 Institute of Medicine report recommended team training in simulated settings (Kohn et al., 2000), which promoted simulation-based education (Eppich et al., 2013). The team training literature, in general (Weaver et al., 2010) and simulation-based team training (SBTT) in par- ticular (Weaver et al., 2010) is beginning to show that simulation is effective in domains such as obstetrics (Draycott et al., 2008). This work has supported the expanded use of SBTT to promote teamwork and interprofessional collaboration (Tofil et al., 2014). More robust needs assessment is required to ensure that simulation-based experiences align with the demands of clinical prac- tices that depend upon interprofessional communication and collaboration (Eppich, Howard, Vozenilek, and Curran, 2011). Recent trends emphasize the importance of an interprofessional approach (Hammick, Olckers, and Campion-Smith, 2009; Thistlethwaite, 2012; WHO, 2010). We see potential for learners in team and interprofessional simulations to engage in types of talk that promote collaboration and team-working and the forms of communication that comprise sub- stantive elements of the work (Iedema and Scheeres, 2003; Scheeres, 2003). Exploring simulation experiences in post-event debriefings (Cheng et al., 2014; Eppich and Cheng, 2015; Fanning and Gaba, 2007) prepares health care providers to reflect on critical events in clinical settings (Kessler, Cheng, and Mullan, 2014), which has been beneficial in paediatric intensive care units (Wolfe et al., 2014). Voices are emerging that call for the greater integration of simulation-based strategies in the educational paradigm of clinical practice (O’Leary and Woods, Woods, 2014; Weller et al., 2014), while ensuring that sufficient theory guides practice and integrates simulation within