Luminary Learning Gastrointestinal Disorder- Issue 1

Learning to Work Together Through Talk: Continuing Professional Development in Medicine •  65 existing curriculum (Bleakley et al., 2011). So although healthcare simulation holds promise, it is not a panacea. How to best design and implement simulation-based activities during medical school and clinical training needs further study. Aligning Simulation andWorkplace Learning It has been suggested that “learning by simulation can become a simulation of learning” (p. 606) and that simulation may, in some instances, no longer accurately reflect actual clinical practice (Bligh and Bleakley, 2006). These authors call for greater dialogue between practitioners in work- based learning and simulation-based learning, noting that advocates of work-based learning may glean important lessons from strategies simulation educators use to structure learning environ- ments, integrate scaffolding, and facilitate feedback (Bligh and Bleakley, 2006). Team research could usefully address concerns about complexity including the need to study interprofessional teams in clinical settings during patient care (Salas et al., 2008). A pressing research agenda is to explore how healthcare providers learn collaborative practice and the personal and situational factors that influence this capability (Thistlethwaite, 2012). Mechanisms to incorporate sociological factors such as hierarchy, power relations, profes- sional identity, and interprofessional conflict (Kitto, Gruen, and Smith, 2009; Lingard, Reznick, DeVito, et al., 2002) in interprofessional team simulations are relatively underexplored. Some authors point out that current approaches to SBTT focus primarily on enhancing individuals’ team orientation, and propose increased emphasis on collaboration, negotiation, and communication skills (Sharma, Boet, Kitto, and Reeves, 2011). One strategy to align simulation with workplace learning is to rely less on resource-intensive simulations using computer controlled manikins and expand the use of simulated patient methodologies. The latter approach uses real people trained to mimic patient conditions to recreate clinical events (Cleland, Abe, and Rethans, 2009). Using such trained people to serve as unannounced or ‘incognito’ simulated patients in real primary care practice (Rethans, Gorter, Bokken, and Morrison, 2007) and for phone consultations (Derkx, Rethans, Maiburg, Winkens, and Knottnerus, 2009) demonstrates promise. Unobtrusive data col- lection in actual clinical practice can serve as a starting point for simulation scenario building and inform subsequent feedback/debriefing. More targeted work is needed in this area; and it seems particularly promising to align the needs of practitioners and their patients with an educational strategy to improve discursive practice. Summary In outlining learners’ paths towards becoming doctors, this chapter has highlighted the essen- tial role of discourse in learning, identity formation, and patient care. Shared understanding and co-construction of clinical experiences—and learning—are mediated through talk. We have argued that most forms of CPD, which focus on the ‘learning as acquisition’ rather than the ‘learn- ing as participation’ paradigm, are divorced from authentic clinical practice. We have provided examples of structures that strengthen collective learning processes--the space, the actors, the