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.