Conceptualising undergraduate clinical general practice placements as clinical Communities of Practice: drawing on findings from a case study of an Undergraduate Longitudinal GP Placement

Problem

There has been a global shift towards longitudinal placements in undergraduate medicine, with UK programmes being predominantly primary care based. Such placements are believed to play an important role in supporting medical student learning and professional identity formation (PIF)(1), with many of the educational benefits rooted in the continuity elements. A better understanding of how PIF and learning occur on such placements is needed. Communities of Practice (CoP)(2), a social learning theory, has been proposed to form the pedagogical foundation of longitudinal placements; however, empirical research exploring this phenomenon and factors influencing student participation within CoPs on such placements is limited, and requires further exploration. 1. Brown M, Ard C, Adams J, O’Regan A, Finn G. Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study. Academic Medicine. 2022;26;97(9):1385-92 2. Wenger E. Communities of practice: Learning, meaning, and identity. Cambridge university press; 1998.

Approach

Case study methodology was used to explore how second year students undertaking an undergraduate longitudinal GP placement at a London medical school participate within CoPs and develop their professional identities. Data arising from routine student evaluation, written reflections, and in-depth interviews with tutors and students were triangulated.

Findings

Routine evaluation data was available for 57% of students (n239) and in-depth interviews were carried out with five students and three tutors. Inductive thematic analysis was undertaken, and findings illuminate how students participate and learn within CoPs on longitudinal GP placements. Making contributions to patient care; a welcoming clinical environment; access to the informal spaces and repertoires of the practice (such as clinical record systems); and effective brokerage of educational activities within the practice by the tutor greatly enabled student legitimate peripheral participation within the GP CoP.

Consequences

CoP is a theory that allows us to make tangible the somewhat abstract when deepening our understanding of how students learn and form their identities on longitudinal GP placements. Continuity relationships offer students the opportunity to become more central members within the GP CoP, as well as potentiating the powerful socialising effects of GP tutor mentorship and role modelling; further strengthening the educational rationale for longitudinal placements. The extent to which students become legitimate peripheral participants on longitudinal GP placements varies, and this theoretical framework allows us to consider the factors in a GP surgery setting that can enable such participation, with significant implications for how educators design curricula and support clinical tutors in developing placement infrastructure. This is more critical than ever as we face increased demand for high quality undergraduate GP placements that can support workforce planning goals (3).3. Wass V. By choice- not by chance, supporting medical students towards future careers in general practice. Medical Schools Council/ NHS Health Education England (HEE).; 2016