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Column Editor: Helena Prior Filipe, MD, MMEd

This column aims to generate a conversation on how continuing education and practice development is currently viewed and developed around the world, especially through the lens of the educator. We will acknowledge a variety of experiences and systems of continuing professional development (CPD) to support healthcare professionals’ (HCP) lifelong learning.

AMEE Update: The Workplace as an Inspiring Social Continuing Professional Development Environment

By Helena Filipe MD, MMEd and Mila Kostic, CHCP (Speakers)

This is a summary report of a workshop presented by Mila Kostic, CHCP, FACEHP, Society for Academic CME, USA and Helena Prior Filipe, MD, MMEd, FSACME, FAMEE, University of Lisbon, Portugal at the international 2022 Association of Medical Education in Europe (AMEE) Annual Conference, Lyon, France, August 29, 2022.

Meaningful learning fits around work. Beyond considering corporate learning as a destination, professional development should incorporate opportunities that naturally and contextually meet the workforce learning needs within a practice setting. Bersin acknowledges the need to shift from “instructional design” to “experience design” supported by design thinking and technology which will enable seamless learning experiences in the workplace^1,2 . Learning in practice enables engagement, willingness to take further responsibilities, increases self-confidence, productivity, and success³.

Several strategies have been proposed to make learning occur during the natural flow of work. This workshop focused on the value of weaving professional networking, potentially enhanced by technology, and creating structured conversations at the workplace as pathways to develop professional development opportunities and creating value to the organization. For example, the classic, unstructured, interspersed time breaks in formal continuing education events that invite social interaction, can work as valuable and enjoyable enablers to share solutions for daily practice problems and build new meanings routed in personal practice⁴. These unplanned, informal learning moments should not be underestimated by continuing professional development (CPD) planning committees when designing continuing medical education activities.

While proposing that learning occurs by building knowledge upon experiences and reflecting on them, constructivism paved the way for social learning theories to explain learning as a social activity taking place in “communities of practice”⁵. Professions have been conceptually associated with communities of practice. United by a common area of passion or interest (domain), a social fabric is formed (community) to develop knowledge and skills that in healthcare generally consists of clinical care, educational practices, and research framed in a particular social work and learning environment (practice)⁶.

Practitioners create formal and informal networks that allow them to work as "groups of people who share a concern or a passion for something they do and collectively learn how to do it better as they interact regularly"⁵. This social learning landscape is available to all learners to develop their own professionalism and form a professional identity. Network building can be qualitatively and quantitatively escalated with the appropriate support of technology. Knowledge becomes distributed across a network of connections and learning occurs via the ability to construct and traverse these networks, connecting fields, ideas, concepts, and people⁷. Virtual communities of practice in healthcare and medical education have been shown to work effectively⁸.

Learning in the healthcare setting should explore social ways to develop facilitated, structured dialogue that allows knowledge to emerge and circulate, and to be translated into practice⁹. Peer-to-peer conversations deviate from giving/receiving advice to focus on assimilating the experiences of peers that inspire thinking about one’s own experience from a new perspective. Generative questions are the gold standard of learning from experience because they surprise us, engage both heart and spirit, build relationships, and reframe reality¹⁰.

Structured dialogue can be perceived as an “emerging pedagogy” to sustain robust continuing learning environments and improve learning outcomes¹¹. “Practice talk”¹² is a conceptual framework, a four-dimensional model and a stepwise process for leading and managing such strategic change that was first proposed by Hess et al and that we used in our workshop. As a story that reconstructs a practice event, a practice talk begins by a narrative-based dialogue including 1) opening phase with the question “How do we do this now?”, 2) a divergent phase, where asking “How could we do this better?” allows the group to share ideas for improvement, followed by 3) the convergent phase, that reflects the collective creation of a shared vision of improved practice and centers on the question “How should we do this better?”. By asking “How will we do this better?” the group closes the cycle with 4) the action phase that consists of piloting improved practice through traditional improvement methods. Practice talks stimulate professional engagement by creating fulfilling social learning spaces where individual perceptions and motivations require trusted and supportive relationships among colleagues. These narrative-based, structured dialogues have been proposed as a workplace learning strategy to translate daily practice conversations into a shared vision for better individual and team-based practice¹².

Consider that clinical workplaces are rich meaningful learning interactions that enable practitioners to ‘join the dots’ between structure and function, the need to harness the power of dialogue - while interacting to learn and learning to interact - runs across the continuum of medical education¹³. Learning from experience requires protected time to, both, learn and interact with peers. We need time and structure to enable reflection on shared experiences. Despite the value of creating knowledge and problem solving based on dialogue as a powerful tool for strategic change and performance improvement, many organizations and schools are yet to adopt the power of dialogue as a powerful and effective learning tool¹².

Frankford et al, define the ‘‘institutions of reflective practice’’ as those that encourage collegial, experiential, and reflective lifelong learning”¹⁴. “Institutions that embrace reflective practice” bring education into practice and practice into education, minding a significant continuous linkage within the local communities. However, these organizations need to balance a potential conflicting organizational structure hierarchy and the coordination of division of labor with risk-taking, creativity and a collegial reflection culture. Properly institutionalized, reflective practice will legitimize the importance of a professional social response with an intrinsic value of the medical work for the public good, enabling practitioners to develop both technical and normative dimensions of professionalism¹⁴.

Strategies that enhance practitioner engagement in practice improvement in innovative, team-oriented work environments:

The aforementioned vision requires an integrated and effectively engaged participation of every element of the complex intertwined network of CPD stakeholders.

Our workshop was well received among the very engaged international group of physicians and educators many of whom shared their thoughts about the need for implementing these strategies in local clinical and learning practice settings. As facilitators, we are now exploring creation of a virtual international community of practice that will enable learning and exchange of ideas and strategies in support of those needs.

References

¹Bersin J. Using Design Thinking to Embed Learning in Our Jobs HBR July 25, 2016. Available at https://hbr.org/2016/07/using-design-thinking-to-embed-learning-in-our-jobs

²Bersin J, Zao-Sanders. M Making Learning a Part of Everyday Work HBR. February 19, 2019 Available at https://hbr.org/amp/2019/02/making-learning-a-part-of-everyday-work

³Bersin J. New Research Shows “Heavy Learners” More Confident, Successful, and Happy at Work. Insights on Corporate talent, Learning, and HR technology

Available at https://joshbersin.com/2018/11/corporate-learning-does-drive-happiness-productivity-too/

⁴Tipping J, Donahue J, Hannah E. Value of unstructured time (breaks) during formal continuing medical education events. J Contin Educ Health Prof. 2001 Spring;21(2):90-6.

⁵Wenger E. 1999. Communities of Practice: Learning, Meaning and Identity

⁶Cruess, R. L., Cruess, S. R., & Steinert, Y. Medicine as a Community of Practice. Academic Medicine, 2018 93(2), 185–191.

⁷Siemens G. Connectivism: a learning theory for the digital age. 2005 Available at https://jotamac.typepad.com/jotamacs_weblog/files/Connectivism.pdf

⁸Struminger B, Arora S, Zalud-Cerrato S, Lowrance D, Ellerbrock T. Building virtual communities of practice for health. Lancet. 2017 Aug 12;390(10095):632-634. doi: 10.1016/S0140-6736(17)31666-5. PMID: 28816126; PMCID: PMC6402556.

⁹Parboosingh IJ, Reed VA, Caldwell Palmer J, Bernstein HH. Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education. J Contin Educ Health Prof. 2011 Spring;31(2):122-7. doi: 10.1002/chp.20116. PMID: 21671279.

¹⁰Bushe, Gervase R. “Appreciative Inquiry Is Not About the Positive.” 2007

¹¹Abbey, N. Developing 21st century teaching and learning. Quest, 2005 (3), 26–31. https://search.informit.org/doi/10.3316/aeipt.145818

¹²Hess DW, Reed VA, Turco MG, Parboosingh JT, Bernstein HH. Enhancing provider engagement in practice improvement: a conceptual framework. J Contin Educ Health Prof. 2015 Winter;35(1):71-9.

¹³King E, Turpin M, Green W, Schull D. Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts. Adv Health Sci Educ Theory Pract. 2019 Oct;24(4):691-706. doi: 10.1007/s10459-019-09891-8. Epub 2019 Apr 25. PMID: 31025212.

¹⁴Frankford DM, Patterson MA, and Konrad TR. Transforming Practice Organizations to Foster Lifelong Learning and Commitment to Medical Professionalism, Acad. Med. 2000;75:708–717

Acknowledgement

To John Parboosingh for his inexhaustible source of inspiration, and for his unique joy, expertise, and generosity to impart knowledge.

Helena Prior Filipe, MD, MMEd, is a consultant in the College of Ophthalmology of the Portuguese Medical Association International Council of Ophthalmology, University of Lisbon, Portugal, hpriorfilipe@gmail.com.

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