Learning Networks; their role in clinical learning

Problem

How are clinical learning episodes conceptualised and described?Large scale theories such as 'socio-cultural theory' and broad concepts such as 'participation' are often to describe clinical learning, but are difficult to operationalize methodologically or practically at the 'micro' level of individual learning encounters. That is to say it is difficult to apply socio-cultural 'theory' as an empirical tool to describe learning encounters and it is difficult to understand what 'participation' looks like in clinical learning encounters. Applying semiotics, a new analytic vocabulary has been designed to answer these questions.

Approach

A focussed ethnographic approach using quasi-participant observation of third year students over four years.Observations were triangulated using focussed interviews and focus groups.An analytic framework was devised iteratively using Actor-Network-Theory (ANT) to interpret observations.Vignettes characterising repeating patterns of learning interaction were then formally analysed using the new analytic framework that introduces a range of new analytic terms to describe clinical learning.

Findings

Analysis uncovers a range of hitherto unreported participants in clinical learning and presents a coherent system of explaining how participants are related to form learning networks producing clinical learning.

Consequences

A coherent analytic language has been developed capable of describing clinical learning as being mediated through networks.The language describes the relationships necessary between human (students, teachers and patients), material (pens, notes and computers) and immaterial (curriculum, culture and participation) factors necessary to create learning. The analytic terms used to describe these relationships begin to colour in what we mean when we use terms such as social, cultural or material in learning. This has a number of implications such as for planning teaching and beginning to examine what we mean when we use such broad terms as 'socio-cultural' and 'participation' (both dominant concepts) in learning. The findings begin to question whether all learning really is participatory and offers a more inclusive model of clinical learning.