Friday, 3 August 2012

Apprenticeship: a socio-cultural view


My starting point, when thinking about apprenticeship, is to turn to Lave and Wenger, who set out to ‘rescue the idea of apprenticeship’. Their social-anthropological study of diverse forms of apprenticeship opened up thinking about the nature of learning, challenging dominant (cognitive-behavioural conceptions of learning). It is their work that informs Sfard’s (1998) learning-as-participation metaphor, explored in an earlier blog. 

Lave and Wenger looked at learning as a social practice, analyzing apprenticeships out-with formal teaching and learning structures. As a result, they put forward an analytic viewpoint on learning, with two inter-related concepts, legitimate peripheral participation (LPP) in communities of practice.  The term CoP is widely (and loosely) evoked, but, for Lave and Wenger, it did not simply mean a team, rather a grouping of people, who shared a common purpose, working together (not in parallel) to sustain and develop practice, over time. Rather than use hierarchical distinctions (such as expert-novice, master-apprentice) they talked of newcomers (to a community) and old-timers, who preserve the work of the community. Newcomers are invited into the work of the established community through processes of legitimate peripheral participation, which socialize them into ways of thinking and practicing. The interesting point made, is that the engagement of a newcomer will always change established practice, and so the development of practice is a shared endeavor. Within a true community of practice, expertise is a distributed phenomenon; no single practitioner can undertake the work of the community alone. To over-simplify, apprenticeship might be seen as the learning arises from engagement in social practices, such as work, within a community of practice. Wenger later went on to explore the dimensions of any social theory of learning, arguing it encompasses elements of learning as meaning (sense-making), learning as practice (participation in a social practice (such as work), learning as belonging (to a community of practice) and learning as becoming (identity formation).

Lave and Wenger looked at informal apprenticeships, so their work is not directly applicable to medicine; their analytic standpoint is. The question for me therefore, is to what extent do (historical) forms of medical apprenticeship involve legitimate peripheral participation in a community of practice? (As an aside, I have written up research of medical student attachments as times spent in CoP in a forthcoming publication, which presents a range of interesting research on learning in clinical workplaces.) I would argue, from an analytic standpoint, that training to be a doctor has, historically, involved LPP in a CoP. The firms of old, with stable work teams were close to CoP, determining the nature, type and amount of work activity newcomers engaged in, as part of the shared care of patients.  Through processes of LPP (at different speeds, based on perceptions of readiness) newcomers therefore became integral to the work of the community.  Work is therefore the curriculum for training, with work activity being safety-netted by the CoP and other learning processes (sense-making, professional identity formation) being mediated by old-timers (firm leaders). 


CoP in the literature come across as being rather benign groupings, with issues of power differentials seldom explored. The critique of apprenticeship I tried to offer up in the earlier blog, suggested that these power differentials led to inequitable training practices. (Stephen Billet talks of workplace affordances, how these support learning and how they fail to be benignly distributed).

For a whole host of reasons, not explored here, I think this type of apprenticeship is unsustainable within current NHS/ medical working structures and practices. I think there has been a move away from a socio-cultural account of apprenticeship to something that is framed in cognitive-behavioural terms. Here, work-based learning is understood as having a work experience, that you subsequently reflect upon and, as a result, adapt your work practices to be more effective. Whilst I think socio-cultural accounts downplay the importance of cognition, ie how doctors put knowledge to work, they do provide a much richer, situated, collective account of learning arising through, from and for work reasons than the rather over-simplified metric of do-reflect-adapt which is put forward as being how medical learning happens. (I find Unwin and Fuller’s work on restrictive-expansive apprenticeships useful here, along with Evans, Guile and Harris’ work on ‘putting knowledge to work’ through processes of recontextualisation).

The current framing of medical training seems to isolate individuals and individual practice, disconnecting them from the work of the communities they are part of. This for me, is part of the diminishing of the cultural-heritage of apprenticeship.




7 comments:

  1. Hello again!

    Maximising continuity in training and medical care is clearly pivotal in this in order to maximise training standards and patient care standards.

    Also irrelevant to the apprenticeship argument is that massive importance of experience and exposure.

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    Replies
    1. Hi Ben
      Experience is key to this way of understanding apprenticeship i.e. over periods of time, newcomers to a community are inducted into the ways of that community, extending the range and complexity of their work activity until they become full participants - and indeed the new old timers!
      BW
      Clare

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  2. So if the old model of apprenticeship- that based in 'firms' - is unsustainable (or already gone) then what is the solution? How much have we lost? How important is what has been lost?

    Ben states that experience and exposure is what matters. But it only provides efficient opportunities for learning if it is within the context of some kind of apprenticeship, where you are learning from those with more experience than you have.

    Clare, you've stated before that EWTD is less important in the changes that have happened for specialist trainees. What are the big changes then? Why is there less experience and exposure? Is it because we are more risk averse and consultants feel uneasy entrusting activities to doctors who they know less well than in the past? If this is the case then the change in the apprenticehip model is central to why there is less oppritunities for experience and exposure for training doctors.

    I love you blog. Thank you!

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    Replies
    1. Hi Anne Marie, so many questions and the answers are so difficult to find!

      The issue with CoP, for me at least, is that it assumes fairly stable work practices and work conditions over long periods of time. One of the difficulties with L and W work is they fail to fully delineate what constitutes a CoP or how you identify a life cycle of a CoP. For that reason, it is very difficult to a) research CoP and b) sustain CoP when there is rapid change or reform. So, the relatively stable working conditions and practices that sustained (medical) apprenticeship have been unsettled by reform, and previously tight knit firms seem to be much looser 'knots' of individual workers. I think the solution is some re-thinking. For me, as a researcher, this is where activity theory is helpful, because it is an interventionist methodology which brings practitioners together, to analyse their working practices, the contexts in which they happen, the tools they use (etc etc) and to consider what can be taken forward in new conditions, and where new, expansive forms of activity need to be developed. In my research looking at how the faculty development was being taken forward in NHS trusts, the most interesting responses were where doctors were coming together, to think through local, workable solutions - often quite creative solutions at that. I suppose, in terms of what happens on the ground, outwith a research context, there needs to be some careful thinking through about where educational interventions are best placed. Given constraints upon time, fragmented training relationships (on basis of work patterns etc) is the best use of training time that which is focussed upon meeting regulatory requirements (WPBA, sign off of competences, 'doing' reflections) or that which makes the most of every working based learning opportunity. Much more careful mapping of experiences, much more explicit work to ensure breadth of experience, adopting principles of graded responsibility so always thinking on the basis of what can I delegate in full, what can I delegate in part (and support) what needs to be observed. This is particularly vital given the squeezes on time.

      I have, in the past, challenged the 'it is all down to EWTD' kind of knee jerk response - it is clearly much more complex. However, I do think it has had a profound effect in that we can no longer rely on the 'if you do enough hours, you will get enough experience' type of opportunisitic training of the past, it has to be more purposeful. I think the issue of trust is fundamentally important - but so is the increased emphasis on consultant led/delivered service - if the expectation is the most senior doctors do the treatment, I do wonder how we manage to train the next generation of most-senior doctors!

      Lots to think about - thank you, as always, for providing the stimulus to keep the thinking going!

      BW
      Clare

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