Editorial

Abstract

Welcome to our new journal. We hope that you, our readers and potential contributors, will help us make it a journal that meets our aspirations and your needs. We are ambitious for the journal because so many new ideas have entered our field in the last few years, and the prospects for using a wide range of research approaches to focus on the rich variety of learning processes in health and social care have never been better. The stakes are also high. Huge changes in the practice of health and social care, and in the social relations between professionals and their clients, are affecting not only their interdependence but also the kinds of knowledge professionals need and the ways in which they acquire it. The rate of change makes the boundaries between ‘good practice’ and ‘good learning’ less distinct. Likewise, policies for professional and organizational learning are mushrooming; but there is little sign, as yet, that they are evidence-based. Worse still, their assumptions often betray profound ignorance of learning outside formal settings. Dislocation of policies from the context of practice can isolate learners and their mentors from much-needed support in their increasingly complex task of professional development. Hence, our journal will be seeking to publish innovative ways of involving policy-makers and managers in research projects and research issues. Their learning about learning is especially important. Higher education has a major role in the development of most professions. It is central to the process by which occupational groups seek to professionalize and enhance their status. It is central to the development of research into occupational practice and postgraduate education, as well as being a major provider of continuing professional development. It is central to the recruitment of new practitioners into the professions and into their pre-qualification education. A key reason for transferring pre-qualification education into universities was both to give fuller attention to learning than had often proved possible in practice settings and to broaden and deepen professional education. But this brought with it some significant disadvantages. Greater separation between learning in education and practice settings gave rise to the multifaceted problem of a theory–practice gap, which was then broadened by the cultural pressures within higher education to prioritize discipline-based ‘scientific knowledge’ at the expense of other forms of professional knowledge. It was also quite natural for hard-pressed researchers to focus attention on issues arising within their departments, to import research from education departments and to study the most convenient research subjects – their own students. When time and money are short, this was only to be expected, but it helps to explain why research into professional learning in settings other than higher education has developed only recently. This move into a wider range of contexts has coincided with an upheaval in theoretical thinking about learning that has highlighted contextual and situational influences. The sources of this upheaval are diverse and often older than many authors acknowledge, partly because the transfer across disciplinary and national boundaries was often very slow. Moreover, many of these evolving perspectives had complementary opposites. For example, a growing emphasis on mental models and individual constructions of ways of seeing the world directed attention towards individual variations in understanding of the ‘same’ ideas, while cultural psychology emphasized the social construction of common meanings and the evolution of those meanings across space and time. Both are worthy directions for research, one focusing on differentiation, the other on generalization. Another complementary pair of theoretical developments arose when the move towards more explicit descriptions of expertise in the form of computerized ‘expert systems’ was initiated by researchers into artificial intelligence, then challenged by the increasing attention given to the role of implicit knowledge in professional work – both the tacit knowledge of individual professionals and the implicit cultural knowledge of professional groups and professional-dominated organizations. This has given rise to an increasingly interesting, and as yet unresolved, debate about the nature and positioning of boundaries and transitions between the explicit and the implicit. Moreover, views about the relative significance of explicit and implicit knowledge underpin many new approaches to supporting professional learning. Those seeking to expand and transfer explicit knowledge have opted for newer, more flexible, modes of ‘delivery’: multimedia packages, e-learning, computer-supported access to and retrieval of research-based evidence. These have often been accompanied by an emphasis on individual responsibility for learning, using learning contracts, personal development plans, action plans, etc. Those who consider the major problem to be not knowledge acquisition and retrieval, but knowledge interpretation and use in complicated cases and situations, look for problem-based learning and more responsive modes of learning support within practice settings by individual mentors, coaches or lecturer–practitioners. When one begins to ask questions about what professionals know – both individually and collectively – and how they come to know it, many fruitful lines of inquiry emerge. Some inquiries are more accessible than others to research methods in common use, so there is a great need to develop new research methods to investigate new phenomena. Many professional workers provide very limited accounts of their knowledge, practice and learning. There are problems of representation, problems of explicitness and problems of self-awareness in aspects of professional practice and learning. Even modest incursions into this uncharted territory can yield significant results, but require innovative approaches, close collaboration between research participants and careful attention to validity. A particular problem in health and social care is the extent to which professional knowledge is embedded in highly complex individual cases. In so far as this knowledge is shared, it appears to comprise a mixture of case-based evidence, areas of scientific knowledge deemed relevant and narrative accounts of perceptions, theories and events. Acquiring such knowledge is commonly attributed to one’s own experience and working alongside experienced others. Over time, memories of sequences of broadly similar cases are aggregated through a largely unconscious process. The professional acquires the capability to recognize, check the evidence and respond to ‘familiar’ cases and deliberate more purposefully about ‘novel’ cases in a problem-solving mode. This is an essential feature of professional judgement in practice, a complex, often implicit and potentially individual approach to understanding the individual client in relation to categories of client. At the same time, abstracted accounts of such cases based on particular selections of data are fed into databases that enable searches for wider patterns using epidemiological or experimental methods. To what extent are these three different representations of a case – the individual story, similarity to other ‘typical’ cases and the statistical positioning of the case in a wider ‘research-based’ pattern – interchangeable? If professionals need to access and interpret all three modes of representation at the time of use, this has profound implications for how we research professional learning. There is also the question of whether the representations constructed by individual professionals differ significantly and, if so, how these affect their practices. Journals, databases and other scientific publications provide important foundations of cultural knowledge for professionals in health and social care, but most of this knowledge is published, accessed and read by members of a single profession. To introduce a cross-professional journal with a focus on learning in health and social care is to break new ground, because only a few professions have journals dedicated to learning, and researchers in this growing area have few natural outlets for publishing their work. However, the main reason for publishing our new journal is the amount of common ground across the health and social care professions when ‘learning’ is the focus of attention and exciting new research is in progress. We believe that generating a critical mass of high-quality research into professional learning, using a wide range of theoretical perspectives and research methods, can only be accomplished across professions. There is much to be gained and little to be lost by adopting a cross-professional approach, especially if one considers the need for policy-relevant research on professional learning that will have an impact on managers and policy-makers. One of the enduring problems in the social sciences is making connections between the micro-level of analysis in which most practice is constructed and the macro-level of organizational or even state policy. There is a long tradition of critical educational research, which looks at the influences on school systems or universities and links them to classroom events, but similar approaches to learning in the professional workplace have been rare. It is difficult to tell how far the micro-climate and micro-culture of the workplace are structured or framed by wider organizational requirements and expectations; until, that is, managers seek to introduce changes. Action research in such situations can contribute to theory as well as improve practice. Typically, the attention shifts away from learning and its potential benefits for patients and service users towards local micro-politics, power relations and the culture of the wider organization. Given the social nature of learning, we should not be surprised that theories and policies for learning have an ideological dimension, because they make assumptions about interpersonal relationships between people who are not accorded equal status. Theories of learning have preferred views about social relations in the workplace that are more acceptable in some contexts than others. For example, the recent popularity of the term ‘learning community’ owes little to an ecological perspective on access to the ‘food’ of knowledge and the high-level predators who ultimately consume the most. It is an ideologically constructed image of equitable social relations based on mutual respect and mutual learning. This might have seemed unrealistic 20 years ago, but today’s organizations for health and social care are increasingly committed to relations of mutual respect between professionals and clients. For how long can this principle coexist with lower levels of mutual respect between different professional groups or between professionals and other health workers, particularly when the main benefit may be learning more about their clients? We have already recognized that journals and scientific publications provide a knowledge base for professionals in health and social care; it might be expected that a new journal on learning in health and social care would focus only on professional learning of the scientific type. However, this would exclude not only other forms of knowledge that inform professional work, such as the off-the-job life experiences of professional workers, but also the everyday knowledge about health and social care that guides clients, users and carers. Both can have a very significant influence on outcomes. Such everyday culturally embedded knowledge affects how lay people, and indeed many professionals outside their domains of expertise, interpret and respond to the professional advice they receive. It determines how they understand their own fitness and wellness, and whether and from whom they seek advice. What and how non-professionals learn about health and social care is part of our new journal’s sphere of interest, and is now attracting increased attention from ethicists as well as health psychologists. Yet another relevant area of cultural knowledge is embedded in the organizational cultures of those public, private and not-for-profit organizations that provide services in health and social care. At every level within such organizations, both common cultural assumptions and differentiated sub-cultural assumptions can be found. Cultural differences between professions and specialisms often create hidden barriers to mutual learning. Conflicts between managers and professionals are common and constrain their mutual learning and that of others whose attention is distracted. Learning how to work in new contexts and localities repeatedly reveals how much local knowledge and practices are taken for granted. What constitutes ‘normal practice’? Whose job is it to do what? What is one’s duty towards colleagues, juniors and members of other professions? Whom should we consult for what purposes? Some of this knowledge refers to local etiquette, some to local micro-politics, some to getting things done, some to finding out what is acceptable and what is expected. Some newcomers may take a long time to learn these things, some may never do so. Whose responsibility is it to monitor and support such learning? One of the difficulties faced by researchers in this area is that most professionals do not use the term ‘learning’ to refer to the acquisition of important cultural knowledge of this kind. Indeed, use of the term is often restricted to learning in formal educational settings. Similar difficulties arise when researching informal learning through participation in novel clinical activities or solving challenging problems presented by clients. Recent research suggests that the majority of what is learned by experienced workers is learned through informal rather than formal modes, and also that the extent of this informal learning is highly dependent on the local learning climate. Given the rapid changes in many working groups, the development of a good learning climate and the creation of opportunities for newcomers to learn through participation in new activities has to be the responsibility of the local manager. Once more, we note the close interaction between learning, working, social relations and management. In this area, it would be helpful for researchers to seek management participation in their research at an early stage, and also to seek collaborative framing of questions about learning that enable a wide range of theoretical interpretations to remain potentially relevant. For example, it would be valuable to see the learning affordances of similar situations examined from different theoretical perspectives and linked to evidence of the conditions under which they were most, or least, likely to be activated. Another dimension of the recent theoretical upheaval has been the perspective of situated cognition – the view that the nature of the knowledge acquired in a particular situation is significantly affected by the characteristics of that situation. While it may still be meaningful to abstract ‘generalizable’ knowledge from a range of situations, that generalizable knowledge remains at an abstract level, perhaps fit for publication but not ready to use. Only situated knowledge is ready to use: both abstract knowledge and situated knowledge from other contexts have to be resituated in order to become usable. Such resituation is a learning process that involves both an understanding of the new situation and transformation of previous knowledge to fit it. Thus, the concept of situated cognition leads to a redefinition of the traditional concept of transfer of learning as ‘the learning process entailed in resituation’, whether or not the process is mediated by explicit abstraction. Situated cognition also raises questions about the sharing or transferability of knowledge between professionals. A constructivist would argue that the interpretation of situations involves personal as well as situational variables. It is also affected by the interpreter’s prior knowledge and conceptual frameworks developed through a unique history of personal and professional experiences. Therefore, there are cognitive as well as social constraints on mutual understanding. Attempts to overcome such constraints by knowledge elicitation methods based on typical or critical incidents, or by sharing stories about challenging cases and emotional encounters, or by discussing pictures, case records and other artefacts, all represent further new approaches towards promoting the elusive goal of mutual learning. Finally, the perspective of situated cognition challenges assumptions about generalizability that, some would argue, are too readily taken for granted. Perhaps some phenomena are more amenable to generalization than others, and some are more context-dependent than others? The reframing of certain common patterns of research question makes us more sensitive to these issues. For example, instead of asking whether a hypothesis is true or false, we could talk about the conditions under which it is most likely, or least likely, to be true or false. Many reviews of research into learning might benefit from this kind of treatment. As readers, we ask you to join with us in exploring the issues addressed above, and others besides. Your response to articles is welcomed; the most illuminating, thought-provoking and practice-linked responses will be published in our Forum section. Our next editorial will seek to open up discussion about the various ways in which the journal can tackle issues relating to interactions between research and practice and ways in which this journal in particular might best relate to practitioners. We can only publish contributions we receive from our readers, although our editors and board members have a brief to seek out and encourage prospective authors. A journal depends on both readers and writers: we hope many of you will do both. But writers also like to find an audience and to sense the preferences of that audience. For all these reasons, feedback from yourselves will help us to shape this new venture and to advise prospective authors about readers’ preferences as accurately as we can, and with full awareness of the wide diversity of your interests.