Learning through inter- and intradisciplinary problem solving: using cognitive apprenticeship to analyse doctor-to-doctor consultation

Abstract

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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Fig. 1

Notes

  1. 1.

    One author (NP) translated the interview data from German into English.

  2. 2.

    The number after each quotation links to the respective study participant. For example [01] refers to participant with the number 01 in the Table 1 "Description of sample characteristics".

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Acknowledgments

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.

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Correspondence to Christoph Pimmer.

Appendix: Interview guide

Appendix: Interview guide

Consults: processes/characteristics/interactions

  • 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

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Keywords

  • Cognitive apprenticeship
  • Consultation and referral
  • Cooperative behavior
  • Informal learning
  • Interdisciplinary communication
  • Learning
  • Problem-based learning
  • Problem solving
  • Workplace learning