Editorial

Abstract

The learning professional always has competing agendas. In educational contexts, both teachers and learners have to navigate their way through what seems like an overwhelming amount of potentially relevant knowledge. So tensions inevitably arise between covering prescribed content, promoting conceptual understanding, developing skills of learning and critical thinking, and connecting areas of theory and practice. We reach the end of each course with great relief, but to what effect? Have we achieved a platform for further learning in the relevant areas? When is the newly acquired knowledge going to be next used, and will the need for it be recognized by learners embarking on new courses or entering practice settings? How much of that learning will survive changes of context or the passage of time without any use? In educational settings, there is at least some time for those who are inclined to think about these competing agendas. In practice settings, however, we are confronted by a glut of unanticipated claims on our attention, for example, a surfeit of patients or a tight appointment system that offers little scope for extending time to meet the needs of a particular client. Hence, there is a greater risk of decisions about time allocation and timing being made on-the-hoof in a crowded environment. Time for reflection or explicit learning is difficult to find, and the more frequent spells of implicit learning are liable to influence our practice in ways that bypass reflection and evade our conscious control. There is considerable evidence in both education and practice settings of a strong connection between working practices and learning practices, but neither educators nor practitioners give it the attention that it deserves. In practice settings there is an important distinction to be made between learning episodes in which learning is the main object, and those in which working is the main object and learning is an often unrecognized by-product. My own research has noted, for example, that explicit and implicit learning are likely to occur through participation in group activities, working alongside other people, tackling challenging tasks, problem solving and working with clients. The main factors affecting such learning through work can be separated into those deriving from the organization of work, those deriving from relationships at work and those deriving from the agency of individuals and those who help them (Eraut et al. 2004a,b). In educational settings, the connections between work and learning are not so very different. Learners constantly refer to academic work, and teachers strongly influence that work through teaching and assessment arrangements that are framed at both the organizational level and the level of the individual teacher or course team. However, much of the academic work in which students engage is also structured by their own agency and is not always visible to their teachers. Yet, we also know that classroom transactions rarely follow the distribution of time originally intended by the teacher, and students’ allocations of study time are often far from their original intentions. Indeed, the way in which students’ academic work is structured, and how and what they learn, is not only invisible to their teachers, but sometimes even to themselves. However, there is a body of relevant research on students’ work patterns, approaches to learning and capabilities for self-directed learning, to which I will return in a future editorial. Given the complexity of knowledge and learning, my preferred model of progression is a set of inter-related learning trajectories. This recognizes the principle of lifelong learning and does not assume that learning follows stages that correspond to artificial stopping points associated with competence or qualifications which, in spite of the rhetoric, rarely coincide. However, we also have to be careful not to assume that learning trajectories necessarily progress onwards and upwards. When knowledge is not used, it atrophies through lack of opportunity or failure to transfer it to a new context. When accustomed practices cease to be the best practices, because of new developments or changes in the client population or wider social environment, then the trajectory falls quite rapidly because it has effectively been recalibrated. Those who have to change their practices as a consequence have to unlearn the old practices before they can construct new practices, a disorienting and emotional experience, better expressed by the metaphor of a rollercoaster than that of a learning curve. Such discontinuities in what counts as good practice are an inevitable part of professional life, for which mid-career professionals are rarely prepared. As noted in a previous editorial (Eraut 2004), this is largely because the role of tacit knowledge in routinized professional practice is greatly underestimated, if not denied. However, discontinuities are more avoidable in areas where practice is more explicit, less routinized and more clearly linked to relatively simple theoretical concepts, especially if the relevant know-how can be communicated through words or simple demonstration, without requiring complex situational understanding. Transitions between education contexts and practice contexts are generally experienced as major causes of discontinuity. This often leads to considerable scepticism towards professional educators, partly because the discourse of professional education is rarely equipped to deal with knowledge transfer, and partly because education and practice use differently defined learning trajectories. In educational contexts, learning trajectories are aligned to aspects of academic, codified knowledge or to the skills of interacting, critical thinking and learning in a formal environment dominated by assessments. In practice settings, the trajectories are aligned to types of client and how they are treated, the performance of tasks and roles, the development and sustenance of relationships with clients and colleagues, and contributions to group or organizational activities. The bridging role of problem-based learning stems from the use of a case-based approach to knowledge in an educational context, rather than in a practice context. By linking theoretical knowledge to practice-based modes of thinking it provides an advanced organizer for case-base problem-solving, but does not address the skills involved in collecting evidence from patients. Nor does it provide continuity of learning in either academic knowledge or case knowledge. Thus, it provides excellent lateral continuity, but little vertical continuity. No course can do everything. The problems of providing continuity of content should be easier then those of providing continuity of skill development, so let us address them first. In educational settings, some aspects of content are followed-up in later courses (vertical continuity), while others are included because they are perceived as being of direct relevance to practice without further academic study (lateral continuity). Students are more likely to take seriously those aspects of a course for which continuity is recognized, than those without any signs of further use. Therefore, it is important to flag up future continuities, provided that those claims are credible. Credibility can be conferred either by senior students confirming those continuity claims, or by reciprocal arrangements, whereby the first course flags its usefulness for the second, and the second course documents its expectations of prior knowledge from the first. The educational research and pedagogic literature offer several types of ‘navigation aid’ to facilitate both coherence within a course and continuity across courses or contexts. Typically, they involve diagrams linking concepts together at either course level or topic level and are described as overviews, guides or concept maps. Sometimes their purpose is to provide a skeleton, which note-makers are then expected to flesh out. At a more advanced level, students might be given a hitch-hikers’ guide to the literature and asked to develop their own ‘navigation aids’, as individuals or in small groups. This would prepare them for the task of consulting literature when working in practice settings. All of these devices get students to think about how and what they learn and to see concepts as tools for understanding, rather than as gobbets for pasting into assignments or examination papers. Moreover, learning to navigate within courses will be good preparation for navigating the stormier seas between courses. Skill development in learning to learn and critical thinking requires co-ordination and continuity of a rather different kind. One has to develop a discourse that is easily grasped by students, together with a means of tracking student progress and providing feedback within that discourse. These important professional skills usually receive only limited attention in most modular systems. Coordination is probably much easier if a small number of key courses, spread out across the time-span of the programme, are given responsibility for skills development and planned with that in mind, using content that is suitable for this purpose. Later courses could also seek to extend these skills to problem areas arising from students’ placement experiences, as well as learning from books and other publications. This area of development is very challenging, for several reasons. First, it is difficult to pin down the practical meanings of terms so glibly used as ‘learning to learn’, ‘critical thinking’ and ‘self-directed learning’, more difficult to arrive at a shared understanding among a group of professional educators, and more difficult still to extend that understanding across a wide variety of clinical areas. Second, decisions will have to be made about the range of contexts to be covered by any learning strategy of this kind. It may be better to start small but long, as suggested above, and aim to gradually expand its scope. Finally, in order to sustain continuity of learning, the shared agreement will need to include how to map progression in these areas onto relevant learning trajectories, without which it would be difficult to provide consistent feedback to learners and thus developing their self-directed learning and sense of urgency. The opportunities for continuity across contexts are greater on programmes for experienced practitioners, because they have significantly more work experience to draw upon. Nevertheless, they still present a challenge of a rather different kind. I have already referred to discontinuities in what counts as best practice, but that was in the context of learners adjusting to changes in external expectations of their practice. In addition, it is important to consider that not only have these learners achieved some status in their own workplace, but they have also developed fluent practices that enable them to cope with their workloads. These practices serve them well when they are the best available and the environment is relatively stable, but make it more difficult for them to adopt a critical stance towards their practice, tackle cases for which their normal practices are less appropriate, or change over to a newer type of practice. Many professional development programmes are also concerned with internal changes driven by the goal of better meeting client needs. Only some aspects of practice can be separated and subjected to systematic research over a wide range of contexts. Others are embedded in the social practices of how we do things here, or constrained by conventions about who does what. This is where the potential agency of experienced professionals needs to come to the fore. To further develop practice, they need to acquire critical skills for evaluating their collective as well as their individual practices, and this involves working with other colleagues and across professions. Growing the critical capacity of a workplace community requires continuity, and often external support, over a considerable period of time, because it is unlikely that significant progress will be achieved by short bursts of professional development activity, whenever someone gets the urge to arrange it. This social perspective is equally important when we consider the discontinuity experienced by newcomers to a workplace. They will probably bring some skills with them that can be used with very little adjustment – personal as well as professional. Less visible, however, will be aspects of knowledge/skills that require further learning before they can be used in the new context. Recognizing the need for this further learning and then supporting it will enhance not only the capacity of the work group, but also the newcomer's confidence and self-esteem. This is easier to arrange when some locals have similar expertise, but could be even more important if it is new to the group. However, the greatest challenge for local leadership comes when the newly imported know-how threatens the status quo. Then, people may not want to know about it, or rely on a climate that discourages such matters from being raised. A complementary strategy is to recognize a newcomer's existing and potential strengths and support their further development, which also boosts their confidence and enhances their sense of identity within their new working group. Providing continuity starts from recognizing both what someone has to offer and in which directions they would prefer to further develop their practice. For students and newly qualified professionals, the greatest threat to continuity of learning is being swamped in the new workplace environment. Too many learning needs clamour for attention, and even implicit learning is constrained by the cognitive overload. The normal habit of doing nothing to ameliorate this ‘reality shock’ and asserting the value of baptism by fire negates the principle of continuity of learning, which demands some prioritization. There is also a danger of novices developing coping mechanisms that rely on a less effective mode of practice, which then get consolidated and routinized through regular use. There are two complementary ways to provide more directed approaches to learning: one is to restrict the range of allocated work or types of client; the other is to focus the attention of learners and those supporting them to specific short-term and medium-term goals. From both an economic and a psychological perspective, it is advantageous for newcomers to have short-term goals that involve them in achieving a level of competence in a set of specific activities that will enable them to work autonomously or under light supervision, and thus make a visible contribution to the overall workload of their group. Alongside these there should be medium-term goals, which will become more urgent as soon as the first set of activities begin to be mastered. Opportunities to participate in these medium-term activities will provide an orientation that gives them a platform for more focused learning when they become the top learning priority. In addition, there will always be ongoing experiences through which the wider work environment gradually becomes more familiar and awareness develops of yet other aspects of working practice. Work allocation decisions will affect which patients/clients the newcomer encounters and in which locations their work is situated. Within that context, newcomers and their significant helpers will need overt guidance on short-term and medium-term priorities, as well as on how appropriate learning opportunities and feedback on progress might be provided. Achieving this balance between short-term, medium-term and long-term learning poses a number of challenges for those responsible for planning and facilitating students’ learning. When students achieve learning that contributes to the work capacity of the local group, it enhances their motivation, confidence and sense of professional identity. However, if it becomes divorced from other work activities it seems like an external imposition and loses its authenticity. This has important implications for the length and timing of placements, and the type of learning opportunities that they present. Placements that are too short for achieving many practical goals, or lack suitable staff who can give students some time and attention, cannot make a sufficient contribution to learning. Nor is it good use of a placement to assign it to a student to whose career focus lies in another direction. If the aim is to introduce students to work settings that have links with those they already know and may receive or refer the same patients or clients, there are more effective and less intrusive ways of achieving this goal. One would be to set up reciprocal visits with a student working in that setting, so that each could explain their work group's contribution to care and its links with other care settings. They could also be asked to consult their mentors about any problems with communication through their common link and the implications for their clients. This would give a clear purpose to the visits, and both students could also be encouraged to challenge each other about the ‘taken-for-granted’ practices that they observed. This brings us back to the lateral discontinuities between education and practice settings. One critical issue is that of timing. Final-year students are further along their learning trajectories than first-year students, and this should be reflected in the work assigned to them. However, they can also play a useful role in the induction of first-year students, allowing mentors to concentrate on learning plans, finding appropriate learning opportunities and giving feedback. Final-year students will be more likely to receive naïve questions and be better positioned to respond to them. They will also be able to share their experiences of using theoretical knowledge in their practice, insofar as they have had any. The essence of the timing problem is that evidence suggests that the longer the gap between a topic being taught in an education setting and first being used in a practice setting, the less it will have been remembered (Eraut et al. 1995). If the gap is longer than a few months, the topic may have to be re-taught, an inefficiency that is frustrating for both students and their teachers. The difficulty is that the long tradition of frontloading theory in educational programmes, especially when the courses are provided by non-profession-orientated departments, has prevented any serious attention to continuity of learning. The main exception to the frontloading tradition has been the introduction of project-based learning, which avoids the lateral continuity problem of separating theory from practice, but at the expense of reducing vertical continuity in both education and practice settings. An even more difficult problem is the virtual absence of theory from workplace discourse in many practice contexts. One reason is that they can survive without it, another that theory is perceived as belonging to an educational context. Most practitioners feel distinctly rusty on the theory side as a result of long neglect, and are worried about being shown up by students. The most important reason, however, probably derives from the nature of practice itself. Fluent practice is effective, sustains the confidence of patients in healthcare settings, and lowers the cognitive load sufficiently for important informal communication with patients and general monitoring of the patients and their environment. It is often based on embedded theoretical knowledge, but the link is rarely mentioned and may even have been forgotten. The main occasions when theory may be spoken are when responding to students’ questions, when discussing problematic patients and when engaged in some form of practice review, but in many contexts this discourse is strongly discouraged. The danger of abstaining from theory altogether is that it is strongly associated with research, evidence-based practice and professional status. To abandon theory is to relinquish potential power and to reduce any work group's sense of agency. Many practitioners do not want this state of affairs, but find it difficult to maintain some respect for and interest in theoretical knowledge within their current working group. So what can be done to improve not just discontinuities of learning, but also major cultural discontinuity between professional practitioners and their former colleagues who now have responsibility for preparing new members for their profession? First, it is essential to be aware of the problems discussed above and the mutual concern about one group being imposed upon by the other. Second, it is important of be aware of the tacit nature of many aspects of practice and the advantages that this brings, as well as the disadvantages. Finally, it is wise to have limited goals and expectations. How might one best progress this project of reducing lateral discontinuities of discourse? First, as suggested above, it is helpful to map some of the territory by developing charts that map the connections between topics taught in educational contexts, types of client and associated practitioner activities (see, for example, Eraut et al. 1995). These provide tools for exploration and for focusing discussion on very specific areas of both theory and practice, while remaining mindful of what is not currently under the microscope. In some places, the discussion will seem like returning to an area where there appears to be order and agreement. Work with students should be focused on these areas, and negotiations about which should be on the students’ learning agenda, and when, will need to be decided upon, bearing in mind when the relevant theory is taught and possible changes in that time. In other places, the opening of this small Pandora's box will reveal considerable complexity, uncertainty and unevaluated tacit knowledge, which will alert people to a need for further monitoring and investigation. These might be important areas for professional development, or even for research. Compiling an agenda for students that addresses the issue of knowledge use would be a great step forward in reducing discontinuity, but appropriate and available learning opportunities would still have to be located, and agreement reached as to who might be able to best support that learning from among either the practitioners’ group or the relevant group of educators. After a time, it is probable that students will become more self-directed in this search and able to use the tools and the literature for guidance with only occasional consultations with staff (Parboteeah 2001). That would be an excellent training for future practice development activity.