1. Developing professional competence through integrating experiences in practice and educational settings
Stephen Billett, Griffith University, Australia
Experiences in both educational and healthcare settings make distinct contributions to medical training, and professional education.
To optimise those contributions, the purposive integration of those experiences is likely warranted.
Conceptually, requires considerations of both experiences and experiencing
Draws upon two bodies of inquiry:
i)learning through practice and
ii)integration of workplace experiences within educational programs
Procedurally, considerations of curriculum and pedagogic practices and engaging and exercising students personal epistemological practices required
2. Progression
Premises: learning as experiences and experiencing
Goals for medical education
Integration of experiences
Integrating practice experiences into medical education
Considerations of:
curriculum and pedagogic practices
students’ personal epistemologies
So what? ………
3. Some premises ….
No separation between participation in practice and learning
… Also, remaking of cultural practice (e.g. medical practice)
Occupational knowledge (e.g. medical): a product of history, culture and situation
– this knowledge needs to be accessed and engaged (i.e. inter-psychologically)
Rich learning of medical knowledge likely dependent upon the:
i) kinds of interactions and activities available to students/junior medical staff (i.e. affordances) and
ii) quality of their engagement with them (engagement).
Educational provisions and practice-based experiences are nothing more or less than an invitation to change
How that invitation is taken up by learners is salient
4. Goals for medical education (building on Dewey, 1916)
1.Identifying and selecting an occupation/specialisation
2. Developing capacities to practice medicine
3. Sustaining medical competence across working life
Helpful to distinguish between - occupations and vocations
Occupations – arise from history, culture and circumstance – they are institutional facts (Searle)
Vocations – arise as personal experiences and to which individuals need to assent – they are personal facts (Dewey, Dawson)
5. Domain-specific conceptual knowledge – ‘knowing that’ (Ryle 1939) (i.e. concepts, facts, propositions – surface to deep) (e.g. Glaser 1989)
Domain-specific procedural knowledge – ‘knowing how’ (Ryle 1939) (i.e. specific - strategic procedures) (e.g. Anderson 1993, Sun et al 2001)
Dispositional knowledge - ‘knowing for’ (i.e. values, attitudes) related to canonical and instances of practice (e.g. Perkins et al 1993), includes criticality
Knowledge required for performance at work
Conceptual knowledge
Procedural knowledge
Dispositional knowledge
1. Different kinds of experiences generative of particular kinds of learning
6. Goals for medical education: Knowledge to be learnt
•Occupational specific capacities (i.e. domain- specific conceptual, procedural & dispositional knowledge)
•These capacities exist at the canonical (i.e. occupational) and situational (e.g. workplace) levels
•… yet need to be constructed by individuals as their personal domains of occupational knowledge
•Part of that process is integrating experiences across practice and educational settings
7. Considering the integration of experiences
Situational account of integration
Products or legacies from two social and physical settings – and their integration (i.e. theory and practice!!!!!!)
Phenomenological account of integration
Premised on individuals’ experience
- personal process of reconciliation
Downplays the suggestions of the social world
- Avoid Crusoe-like epistemological adventures
8. A socio-personal perspective of integration
A duality of the personal and situational contributions
- affordances and engagements
Reconciliations between suggestions of the world ‘beyond the skin’ (i.e. brute and institutional facts) and individuals’ knowledge and knowing
Need to account for individuals’ personal histories (ontogenies) and epistemologies, and intra-psychological contributions
That is, the ‘experience’ and ‘its experiencing’
9. Integrating practice experiences in higher education
Lessons drawn from the ALTC Fellowship - Promoting, aligning and integrating practice-based experiences within education experiences
Comprised 20 projects across a range of disciplines, each addressing specific issues of integration
A consideration of:
Curriculum practices
Pedagogic practices
Students’ personal epistemologies
Participants – ‘just plain folk’ Identifying practices sustainable by busy (time jealous) academics
10. Definitional matters
Intended curriculum - what is intended to occur and be learnt (i.e. educational outcomes) - promoted by sponsors or developers who are often remote
Enacted curriculum - what is implemented -shaped by available resources, teachers’ experiences and expertise, interpretations of what was intended, values and situational factors
Experienced curriculum - what students experience and learn - personal processes of construal and construction of what is enacted
Pedagogies – how learning experiences are augmented to assist students’ learning - includes teacherly engagements, particular experiences, interactions
Personal epistemologies – bases by which individuals construe and construct knowledge from what they experience - including interests, intentionalities and subjectivities
11. Focus on students’ personal epistemologies
Bases for Individuals’ engagements
•Subjectivities
•Interest
•Values
•Intentionalities (i.e. direction and exercise of perception, action & introspection)
•Capacities (e.g. existing knowledge and knowing)
•Brute facts (intra-psychological, energy, fatigue)
It is they who learn – that is decide how to take up the invitations they are afforded them
12. Intended curriculum - key considerations include:
being clear about what is to be learnt through practice experiences (educational outcomes)
aligning experiences provided for students with intended educational outcomes (e.g. orientation vs skill development)
aligning the duration of experiences with educational purpose
intentionally sequencing experiences and opportunities to secure, consolidate and reconcile learning from practice experiences
13. Enacted curriculum - key considerations include:
augmenting available opportunities (e.g. in regional settings)
considering range of options, not just supervised placements to secure experiences
accounting for students’ readiness (e.g. interest, capacities) when enacting experiences
specific experiences may be needed for particular student cohorts (e.g. overseas students)
14. Experienced curriculum - key considerations include:
students' capacities, interest and readiness central to their engagement and learning in practice settings, and reconciling it with their coursework
immediate concerns (e.g. performing in practicum) focus of students' interest
early and staged engagement in practice settings may enhance students' confidence to learn effectively
challenges to personal confidence and competence redressed by group processes (e.g. sharing of experiences).
16. Before practice experiences – likely to be helpful
orient students to requirements for engaging interdependently in work practices
clarify expectations about purposes of, support by and responsibilities of parties in practice settings
prepare students to engage as agentic learners (e.g. importance of observations, engagement, interactions)
develop procedural capacities required to assist participation in practice settings
prepare for contestations that might arise
17. During practice experiences
direct guidance by more experienced practitioners (i.e. close guidance)
active engagement in pedagogically rich work activities or interactions (e.g. handovers, grand rounds)
effective peer interactions (i.e. students’ collaborative learning)
active and purposeful engagement by students as learners in workplace settings
18. After practice experiences
facilitate the sharing of and drawing on students’ experiences
make explicit links to and reconcile what is taught (learnt) in the academy and is experienced and learnt in practice settings
emphasize the active and selective qualities of students’ learning through practice
19. So what?
Need to view this educational process as comprising both experiences and experiencing
But then, most of you seem to know this ……………..
Both settings make particular contributions, we need to utilise and augment them effectively through their integration
Appropriate curriculum and pedagogic practices, and personal epistemologies can effectively utilise and integrate experiences
Considerations of intended, enacted and experienced curriculum are evident here
More considerations how learners are prepared for and engaged experiences before, during and after practicum experiences.
Includes intentionally promoting their personal epistemologies
