Today’s healthcare can be characterised by the increasing importance of specialisation that requires cooperation across disciplines and specialities. In view of the number of educational programmes for interdisciplinary cooperation, surprisingly little is known on how learning arises from interdisciplinary work. In order to analyse the learning and teaching practices of interdisciplinary cooperation, a multiple case study research focused on how consults, i.e., doctor-to-doctor consultations between medical doctors from different disciplines were carried out: semi-structured interviews with doctors of all levels of seniority from two hospital sites in Switzerland were conducted. Starting with a priori constructs based on the ‘methods’ underpinning cognitive apprenticeship (CA), the transcribed interviews were analysed according to the principles of qualitative content analysis. The research contributes to three debates: (1) socio-cognitive and situated learning, (2) intra- and interdisciplinary learning in clinical settings, and (3), more generally, to cooperation and problem solving. Patient cases, which necessitate the cooperation of doctors in consults across boundaries of clinical specialisms, trigger intra- as well as interdisciplinary learning and offer numerous and varied opportunities for learning by requesting doctors as well as for on-call doctors, in particular those in residence. The relevance of consults for learning can also be verified from the perspective of CA which is commonly used by experts, albeit in varying forms, degrees of frequency and quality, and valued by learners. Through data analysis a model for collaborative problem-solving and help-seeking was developed which shows the interplay of pedagogical ‘methods’ of CA in informal clinical learning contexts.
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One author (NP) translated the interview data from German into English.
The number after each quotation links to the respective study participant. For example  refers to participant with the number 01 in the Table 1 "Description of sample characteristics".
Balmer, D. F., Serwint, J. R., Ruzek, S. B., & Giardino, A. P. (2008). Understanding paediatric residents-continuity preceptor relationships through the lens of apprenticeship learning. Medical Education, 42(9), 923–929.
Bardram, J. E., & Bossen, C. (2005). Mobility work: The spatial dimension of collaboration at a hospital. Computer Supported Cooperative Work (CSCW), 14(2), 131–160.
Barr, H., Koppel, I., Reeves, S., & Hammick, M. (2005). Effective interprofessional education: Argument, assumption, and evidence. Oxford: Blackwell.
Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13(4), 544–559.
Becker, J., Bergener, K., Mueller, O., & Mueller-Wienbergen, F. (2009). Documentation of flexible business processes-A healthcare case study. Paper presented at the Americas Conference on Information Systems, San Francisco.
Bennett, N. L., Casebeer, L. L., Zheng, S., & Kristofco, R. (2006). Information-seeking behaviors and reflective practice. Journal of Continuing Education in the Health Professions, 26(2), 120–127.
Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from team working. Medical Education, 40(2), 150–157.
Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32–42.
Carpenter, J. (1995). Interprofessional education for medical and nursing students: Evaluation of a programme. Medical Education, 29(4), 265–272.
Collins, A., Brown, J. S., & Holum, A. (1991). Cognitive apprenticeship: Making thinking visible. American Educator, 15(3), 6–11.
Collins, A., Brown, J. S., & Newman, S. E. (1987). Cognitive apprenticeship: Teaching the craft of reading, writing, and mathematics. Cambridge, MA: lllinois University (Urbana: Center for the Study of Reading. Bolt, Beranek and Newman, Inc).
Cortazzo, J. M., Guertler, A. T., & Rice, M. M. (1993). Consultation and referral patterns from a teaching hospital emergency department. The American Journal of Emergency Medicine, 11(5), 456–459.
Covell, D. G., Uman, G. C., & Manning, P. R. (1985). Information needs in office practice: Are they being met? Annals of Internal Medicine, 103, 596–599.
Derlet, R. W., Richards, J. R., & Kravitz, R. L. (2001). Frequent overcrowding in US emergency departments. Academic Emergency Medicine, 8(2), 151–155.
Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: A model linking the processes and outcomes of medical students’ workplace learning. Medical Education, 41(1), 84–91.
Durning, S. J., Artino, A. R., Jr, Pangaro, L. N., Van Der Vleuten, C., & Schuwirth, L. (2010). Perspective: Redefining context in the clinical encounter: Implications for research and training in medical education. Academic Medicine, 85(5), 894–901.
Eisenhardt, K. M. (1989). Building theories from case study research. The Academy of Management Review, 14(4), 532–550.
Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10), S70.
Ericsson, A. (2008). Deliberate practice and acquisition of expert performance: A general overview. Academic Emergency Medicine, 15(11), 988–994.
Fagin, C. M. (1992). Collaboration between nurses and physicians: No longer a choice. Academic Medicine, 67(5), 295.
Furmedge, D. S. (2008). Apprenticeship learning models in residents. Are they transferable to medical students? Medical Education, 42, 856–857.
Gemmel, P., Vandaele, D., & Tambeur, W. (2008). Hospital Process Orientation (HPO): The development of a measurement tool. Total Quality Management & Business Excellence, 19(12), 1207–1217.
Giacomini, M. K., & Cook, D. J. (2000). Users’ guides to the medical literature. Qualitative research in health care. Are the results of the study valid? JAMA: The Journal of the American Medical Association, 284(3), 357–362.
Go, S., Richards, D. M., & Watson, W. A. (1998). Enhancing medical student consultation request skills in an academic emergency department. Journal of Emergency Medicine, 16(4), 659–662.
Goldman, L., Lee, T., & Rudd, P. (1983). Ten commandments for effective consultations. Archives of Internal Medicine, 143(9), 1753.
Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35(9), 867–875.
Kirschner, P. A. (2006). (Interdependent) Learning. Learning is interaction. Inaugural address. Utrecht: Cip-gegevens Koninklijke Bibliotheek, Den Haag.
Lavin, M., Ruebling, I., Banks, R., Block, L., Counte, M., Furman, G., et al. (2001). Interdisciplinary health professional education: A historical review. Advances in Health Sciences Education, 6(1), 25–47.
Lee, R. S., Woods, R., Bullard, M., Holroyd, B. R., & Rowe, B. H. (2008). Consultations in the emergency department: A systematic review of the literature. Emergency Medicine Journal, 25(1), 4.
Mayring, P. (2004). Qualitative content anaiysis. In U. Flick, E. von Kardorff, & I. Steinke (Eds.), A companion to qualitative research (pp. 266–269). London, Thousand Oaks (New Delhi: SAGE Publications Ltd).
Merriam, S. (1998). Qualitative research and case study applications in education. Revised and expanded from “case study research in education”. San Francisco: Jossey-Bass Publishers.
Nardi, B. A. (1996). Studying context: A comparison of activity theory, situated action models, and distributed cognition. In B. A. Nardi (Ed.), Context and consciousness: Activity theory and human-computer interaction (pp. 69–102). Massachusetts Institute of Technology.
Parsell, G., & Bligh, J. (1998). Interprofessional learning. Postgraduate Medical Journal, 74(868), 89.
Patel, V., Yoskowitz, N., & Arocha, J. (2008). Towards effective evaluation and reform in medical education: A cognitive and learning sciences perspective. Advances in Health Sciences Education, 14(5), 791–812.
Patton, M. Q. (2002). Qualitative research and evaluation methods (Vol. 3). Thousand Oaks: Sage Publications, Inc.
Salerno, S. M., Hurst, F. P., Halvorson, S., & Mercado, D. L. (2007). Principles of effective consultation: An update for the 21st-century consultant. Archives of Internal Medicine, 167(3), 271.
Sargeant, J., Mann, K., Sinclair, D., Ferrier, S., Muirhead, P., van der Vleuten, C., et al. (2006). Learning in practice: Experiences and perceptions of high-scoring physicians. Academic Medicine, 81(7), 655–660.
Schön, D. A. (1983). The reflective practitioner—How professionals think in action. New York: Basic Books.
Schön, D. A. (1987). Educating the reflective practitioner. Toward a new design for teaching and learning in the professions. San Francisco: Jossey-Bass.
Slotnick, H. B. (1999). How doctors learn: Physicians’ self-directed learning episodes. Academic Medicine, 74(10), 1106.
Smith, C. S., Morris, M., Francovich, C., Hill, W., & Gieselman, J. (2004). A qualitative study of resident learning in ambulatory clinic. The importance of exposure to ‘breakdown’ in settings that support effective response. Advances in Health Sciences Education, 9, 93–105.
Stalmeijer, R., Dolmans, D., Wolfhagen, I., & Scherpbier, A. (2008). Cognitive apprenticeship in clinical practice: Can it stimulate learning in the opinion of students? Advances in Health Sciences Education, 14(4), 535–546.
Sternas, K. A., O’Hare, P., Lehman, K., & Milligan, R. (1999). Nursing and medical student teaming for service learning in partnership with the community: An emerging holistic model for interdisciplinary education and practice. Holistic Nursing Practice, 13(2), 66.
van de Wiel, M. W. J., Van den Bossche, P., Janssen, S., & Jossberger, H. (2010). Exploring deliberate practice in medicine: How do physicians learn in the workplace? Advances in Health Sciences Education, 16(1), 81–95.
Vogel, D. (1993). Patient-focused care. American Journal of Health-System Pharmacy, 50(11), 2321–2329.
Vosk, A. (1998). Response of consultants to the emergency department: A preliminary report. Annals of Emergency Medicine, 32(5), 574–577.
Wood, D., Bruner, J. S., & Ross, G. (1976). The role of tutoring in problem solving. Journal of Child Psychology and Psychiatry, 17(2), 89–100.
Woods, R. A., Lee, R., Ospina, M. B., Blitz, S., Lari, H., Bullard, M. J., et al. (2008). Consultation outcomes in the emergency department: Exploring rates and complexity. CJEM: Canadian Journal of Emergency Medical Care, 10(1), 25.
Woolley, N., & Jarvis, Y. (2007). Situated cognition and cognitive apprenticeship: A model for teaching and learning clinical skills in a technologically rich and authentic learning environment. Nurse Education Today, 27(1), 73–79.
We thank our project sponsors and partners, CTI—the Swiss Confederation’s Innovation Promotion Agency, AMTS, Agfa Healthcare, University Hospital Basel, Hightech Research Center of Cranio-Maxillofacial Surgery University of Basel and the University of Applied Sciences Northwestern Switzerland for their support of this study.
Appendix: Interview guide
Appendix: Interview guide
How do you experience consults? Please explain a typical consultation process as detailed as possible/step-by step
If not already addressed, the following sub-questions are discussed:
How and why/in which situations is a consult initiated? Please provide examples.
Who/what role/s is/are usually involved in consults?
What are responsibilities attached to the roles?
Are there different forms of consults? Is there variation in how a consult takes place?
How often are you involved in consults?
How do you interact with doctors in a consult? Please provide examples.
What tools/media are involved in consults?
Perceived learning and consults
What is you understanding of learning?
How do you learn in/through your clinical practice? Please provide examples.
Do you learn something in/through consults?
How do you learn in consults? Please provide concrete examples/situations.
Do you think other actors involved in consults can learn?
How do other actors involved in consults learn? Please provide concrete examples/situations.
What do you learn in/through consults? What sort of knowledge/skills/competences etc. do you gain in consults? Please provide examples.
With respect to learning: are consults more (or less) relevant compared to other clinical activities? Why? What are particularities of consults?
In which situations do you learn best in consults? Please provide examples.
With/from whom do you learn in consults?
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Pimmer, C., Pachler, N., Nierle, J. et al. Learning through inter- and intradisciplinary problem solving: using cognitive apprenticeship to analyse doctor-to-doctor consultation. Adv in Health Sci Educ 17, 759–778 (2012). https://doi.org/10.1007/s10459-012-9350-7
- Cognitive apprenticeship
- Consultation and referral
- Cooperative behavior
- Informal learning
- Interdisciplinary communication
- Problem-based learning
- Problem solving
- Workplace learning