Uncovering the ecology of clinical education: a dramaturgical study of informal learning in clinical teams
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Uncovering the ecology of clinical education: a dramaturgical study of informal learning in clinical teams Peter Cantillon1 · Willem De Grave2 · Tim Dornan3 Received: 30 January 2020 / Accepted: 8 September 2020 © The Author(s) 2020
Abstract Off-the-job faculty development for clinical teachers has been blighted by poor attendance, unsatisfactory sustainability, and weak impact. The faculty development literature has attributed these problems to the marginalisation of the clinical teacher role in host institutions. By focusing on macro-organisational factors, faculty development is ignoring the how clinical teachers are shaped by their everyday participation in micro-organisations such as clinical teams. We set out to explore how the roles of clinical teacher and graduate learner are co-constructed in the context of everyday work in clinical teams. Using an ethnographic study design we carried out marginal participant observation of four different hospital clinical teams. We assembled a dataset comprising field notes, participant interviews, images, and video, which captured day-to-day working and learning encounters between team members. We applied the dramaturgical sensitising concepts of impression management and face work to a thematic analysis of the dataset. We found that learning in clinical teams was largely informal. Clinical teachers modelled, but rarely articulated, an implicit curriculum of norms, standards and expectations. Trainees sought to establish legitimacy and credibility for themselves by creating impressions of being able to recognise and reproduce lead clinicians’ standards. Teachers and trainees colluded in using face work strategies to sustain favourable impressions but, in so doing, diminished learning opportunities and undermined educational dialogue. These finding suggest that there is a complex interrelationship between membership of clinical teams and clinical learning. The implication for faculty development is that it needs to move beyond its current emphasis on the structuring effects of institutional context to a deeper consideration of how teacher and learner roles are co-constructed in clinical teams. Keywords Asymmetries of power · Clinical education · Ethnography · Implicit curriculum · Impression management
* Peter Cantillon [email protected] 1
Discipline of General Practice, National University of Ireland, Galway, Republic of Ireland
2
School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
3
School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
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P. Cantillon et al.
Introduction There has been growing disquiet about the quality of graduate clinical education (Irby 1995; Parsell 2001; Spencer 2003; Kennedy et al. 2005; Swanwick 2008; Norman 2012; Steven et al. 2014; Wiese et al. 2018). At first, the concerns related to its perceived messy and unsystematic nature (Irby 1995; Spencer 2003; Parsell 2001). The advent of working time dir
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