Skip to main content

Ad hoc supervision of general practice registrars as a ‘community of practice’: analysis, interpretation and re-presentation

Abstract

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger’s (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning (‘communities of practice’) guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger’s theory and highlights the researchers’ interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others’ experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Notes

  1. 1.

    We could have chosen a number of theoretical perspectives to re-analyse the data. As well as appearing to have a good fit with the data, we had a more personal motive for using Wenger’s (1998) theory, which was the challenge of developing a good understanding of Wenger’s concepts.

  2. 2.

    This quotation supports the point we are trying to make, but we are a little bit uncomfortable about the reference to culture. Culture and community of practice undoubtedly share a lot of concepts, but Wenger (1998) argues that the concepts are different. Some articles that are ostensibly about communities of practice move too freely between the terms (e.g. Fuller et al. 2005), when it makes sense to preserve Wenger’s distinction.

  3. 3.

    Language is a repertoire that people draw on. Sometimes it is worth pointing out the seemingly obvious; which in this case is that the encounter is peppered with medical terms that indicate a speaker’s medical identity.

  4. 4.

    Liddy is referencing another group that she is part of; her peers in the training program; a forum that is referenced again later in the encounter. As part their training, registrars have to attend a number of face-to-face workshops.

References

  1. Aagaard, E., Teherani, A., & Irby, D. M. (2004). Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: Proof of concept. Academic Medicine, 79(1), 42–49.

    Article  Google Scholar 

  2. Abma, T. A., & Stake, R. E. (2014). Science of the particular: An advocacy of naturalistic case study in health research. Qualitative Health Research, 24(8), 1150–1161.

    Article  Google Scholar 

  3. Ajjawi, R., & Bearman, M. (2012). Sociomateriality matters to family practitioners as supervisors. Medical Education, 46, 1145–1147.

    Article  Google Scholar 

  4. Alvesson, M., & Willmott, H. (2002). Identity regulation as organizational control: Producing the appropriate individual. Journal of Management Studies, 39(5), 619–644. doi:10.1111/1467-6486.00305.

    Article  Google Scholar 

  5. Atkinson, P. (1992). The ethnography of a medical setting: Reading, writing, and rhetoric. Qualitative Health Research, 2(4), 451–474.

    Article  Google Scholar 

  6. Atkinson, P. (1995). Medical talk and medical work. London: Sage.

    Google Scholar 

  7. Bernabeo, E. C., Reddy, S. G., Ginsburg, S., & Holmboe, E. S. (2014). Professionalism and maintenance of certification: Using vignettes describing interpersonal dilemmas to stimulate reflection and learning. Journal of Continuing Education in the Health Professions, 34(2), 112–122.

    Article  Google Scholar 

  8. Billett, S. (2002). Toward a workplace pedagogy: Guidance, participation, and engagement. Adult Education Quarterly, 53(1), 27–43.

    Article  Google Scholar 

  9. Blauner, B. (1987). Problem’s of editing “first-person” sociology. Qualitative Sociology, 10(1), 46–64.

    Article  Google Scholar 

  10. Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from teamworking. Medical Education, 40, 150–157.

    Article  Google Scholar 

  11. Bleakley, A., Bligh, J., & Browne, J. (2011). Medical education for the future: Identity, power and location. London: Springer.

    Book  Google Scholar 

  12. Boendermaker, P. M., Schuling, J., Jong, B. M.-D., Zwierstra, R. P., & Metz, J. C. (2000). What are the characteristics of the competent general practitioner trainer? Family Practice, 17(6), 547–553. doi:10.1093/fampra/17.6.547.

    Article  Google Scholar 

  13. Boud, D., & Middleton, H. (2003). Learning from others at work: Communities of practice and informal learning. Journal of Workplace Learning, 15(5), 194–202.

    Article  Google Scholar 

  14. Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32–42. doi:10.2307/1176008.

    Article  Google Scholar 

  15. Buchel, T. L., & Edwards, F. D. (2005). Characteristics of effective clinical teachers. Family Medicine, 37(1), 30–35.

    Google Scholar 

  16. Catchpole, M., Albert, E., Lake, F. R., & Brown, T. (2005). Teaching on the run: General practice training between consultations. Australian Family Physician, 34(12), 47–50.

    Google Scholar 

  17. Creswell, J. (2013). Qualitative inquiry & research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  18. Davis, J. M. (2000). Disability studies as ethnographic research and text: Research strategies and roles for promoting social change? Disability & Society, 15(2), 191–206.

    Article  Google Scholar 

  19. Diamond, M. R., Kamien, M., Sim, M. G. B., & Davis, J. (1995). A critical incident study of general practice trainees in their basic general practice term. The Medical Journal of Australia, 162(20 March), 321–324.

    Google Scholar 

  20. Eden, C., & Huxham, C. (1996). Action research for the study of organizations. In S. R. Clegg, C. Hardy, & W. R. Nord (Eds.), Handbook of organization studies (pp. 526–542). London: Sage.

    Google Scholar 

  21. Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247–273.

    Article  Google Scholar 

  22. Erickson, F. (1986). Qualitative methods in research on teaching. In M. C. Wittrock (Ed.), Handbook of research on teaching (pp. 119–161). New York: Macmillan.

    Google Scholar 

  23. Eteläpelto, A. (2008). Perspectives, prospects and progress in work-related learning. In S. Billett, C. Hariesis, & A. Eteläpelto (Eds.), Emerging perspectives of workplace learning (pp. 233–247). Rotterdam: Sense Publishers.

    Google Scholar 

  24. Farrell, E., Kypreos, H., Wong, E., & Vergara, E. (2013). In-practice teaching resource. Melbourne: General Practice Registrars Australia.

    Google Scholar 

  25. Fuller, A., Hodkinson, H., Hodkinson, P., & Unwin, L. (2005). Learning as peripheral participation in communities of practice: A reassessment of key concepts in workplace learning. British Educational Research Journal, 31(1), 49–68. doi:10.1080/0141192052000310029.

    Article  Google Scholar 

  26. General Practice Education and Training. (2010). PGPPP (Practice) guidelines for the supervision and training of doctors in the Prevocational General Practice Placements Program. Canberra: General Practice Education and Training Limited.

    Google Scholar 

  27. Handy, C. (1993). Understanding organizations (4th ed.). London: Penguin.

    Google Scholar 

  28. Hinds, P. S., Vogel, R. J., & Clarke-Steffen, L. (1997). The possibilities and pitfalls of doing a secondary analysis of a qualitative data set. Qualitative Health Research, 7(3), 408–424.

    Article  Google Scholar 

  29. Hodges, B. (2003). OSCE! Variations on a theme by Harden. Medical Education, 37(12), 1134–1140. doi:10.1111/j.1365-2923.2003.01717.x.

    Article  Google Scholar 

  30. Ingham, G. (2012). Avoiding ‘consultation interruptus’. Australian Family Physician, 41(8), 627–629.

    Google Scholar 

  31. Irby, D. M., & Wilkerson, L. (2008). Teaching when time is limited. British Medical Journal, 336, 384–387.

    Article  Google Scholar 

  32. Kaufman, D. M., & Mann, K. V. (2014). Teaching and learning in medical education: How theory can inform practice. In T. Swanwick (Ed.), Understanding medical education: Evidence, theory and practice (2nd ed., pp. 7–29). Chichester: Wiley.

    Google Scholar 

  33. Kennedy, T. J., Lingard, L., Baker, G. R., Kitchen, L., & Regehr, G. (2007). Clinical oversight: Conceptualising the relationship between supervision and safety. Journal of General Internal Medicine, 22, 1080–1085.

    Article  Google Scholar 

  34. Kennedy, T. J. T., Regehr, G., Baker, G. R., & Lingard, L. (2009). Preserving professional credibility: Grounded theory study of medical trainees’ requests for clinical support. British Medical Journal, 338(b128), 1–7.

    Google Scholar 

  35. King, N. (1998). Template analysis. In G. Symon & C. Cassell (Eds.), Qualitative methods and analysis in organizational research: A practical guide (pp. 118–134). London: Sage.

    Google Scholar 

  36. Lake, F. R., & Ryan, G. (2004). Teaching on the run tips 3: Planning a teaching episode. Medical Journal of Australia, 180(21 June), 643–644.

    Google Scholar 

  37. Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, NY: Cambridge University Press.

    Book  Google Scholar 

  38. Lingard, L., Schryer, C., Garwood, K., & Spafford, M. (2003). ‘Talking the talk’: School and workplace genre tension in clerkship case presentations. Medical Education, 37, 612–620.

    Article  Google Scholar 

  39. Martin, J. (2002). Organizational culture: Mapping the terrain. Thousand Oaks, CA: Sage.

    Book  Google Scholar 

  40. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  41. Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44(1), 40–49. doi:10.1111/j.1365-2923.2009.03440.x.

    Article  Google Scholar 

  42. Morrison, J., Clement, T., Brown, J., & Nestel, D. (2014). Ad hoc supervisory encounters between GP-supervisors and GP-registrars: Enhancing quality and effectiveness. Warrnambool: Southern GP Training.

    Google Scholar 

  43. Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2004). Realist synthesis: An introduction. ESRC Research Methods Programme working paper series. London: Economic and Social Research Council.

    Google Scholar 

  44. Pearce, C. (2003). Corridor teaching: ‘Have you got a minute…?’. Australian Family Physician, 32(9), 745–747.

    Google Scholar 

  45. Pearce, R., Laurence, C. O., Black, L. E., & Stocks, N. (2007). The challenges of teaching in a general practice setting. Medical Journal of Australia, 187(2), 129–132.

    Google Scholar 

  46. Pearson, D. J., & Lucas, B. J. (2011). Engagement and opportunity in clinical learning: Findings form a case study in primary care. Medical Teacher, 33(12), 670–677.

    Article  Google Scholar 

  47. Prentice, R. (2013). Bodies in formation: An ethnograpy of anatomy and surgery education. Durham, NC: Duke University Press.

    Google Scholar 

  48. QSR International. (1999–2012). NVIVO10. Doncaster: QSR International Pty Ltd.

  49. Rees, C. E., Ajjawi, R., & Monrouxe, L. V. (2013). The construction of power in family medicine bedside teaching: A video observation study. Medical Education, 47(2), 154–165. doi:10.1111/medu.12055.

    Article  Google Scholar 

  50. Rizan, C., Elsey, C., Lemon, T., Grant, A., & Monrouxe, L. V. (2014). Feedback in action within bedside teaching encounters: A video ethnographic study. Medical Education, 48(9), 902–920. doi:10.1111/medu.12498.

    Article  Google Scholar 

  51. Simons, H. (1996). The paradox of case study. Cambridge Journal of Education, 26(2), 225–240.

    Article  Google Scholar 

  52. Stacey, R. D. (2007). Strategic management and organisational dynamics: The challenge of complexity. London: FT/Prentice Hall.

    Google Scholar 

  53. Stake, R. E. (1978). The case study method in social inquiry. Educational Researcher, 7(5), 5–8.

    Article  Google Scholar 

  54. Sterkenburg, A., Barach, P., Kalkman, C., Gielen, M., & ten Cate, O. (2010). When do supervising physicians decide to entrust residents with unsupervised tasks? Academic Medicine, 85(9), 1408–1417.

    Article  Google Scholar 

  55. Steven, K., Wenger, E., Boshuizen, H., Scherpbier, A., & Dornan, T. (2014). How clerkship students learn from real patients in practice settings. Academic Medicine, 89(3), 1–8.

    Article  Google Scholar 

  56. Stewart, I., & Joines, V. (2012). TA today: A new introduction to transactional analysis (2nd ed.). Melton Mowbray: Lifespace Publishing.

    Google Scholar 

  57. Thorne, S. (1994). Secondary analysis in qualitative research: Issues and implications. In J. M. Morse (Ed.), Critical issues in qualitative research methods (pp. 263–279). Thousand Oaks, CA: Sage.

    Google Scholar 

  58. van der Zwet, J., de la Croix, A., de Jonge, L. P. J. W. M., Stalmeijer, R. E., Scherpbier, A. J. J. A., & Teunissen, P. W. (2014a). The power of questions: A discourse analysis about doctor–student interaction. Medical Education, 48(8), 806–819. doi:10.1111/medu.12493.

    Article  Google Scholar 

  59. van der Zwet, J., Dornan, T., Teunissen, P. W., de Jonge, L. P. J. W. M., & Scherpbier, A. J. J. A. (2014b). Making sense of how physician preceptors interact with medical students: Discourses of dialogue, good medical practice, and relationship trajectories. Advances in Health Sciences Education, 19, 85–98.

    Article  Google Scholar 

  60. van der Zwet, J., Zwietering, P. J., Teunissen, P. W., & van der Vleuten, C. P. M. (2011). Workplace learning from a socio-cultural per. Advances in Health Sciences Education, 16, 359–373.

    Article  Google Scholar 

  61. Verbakel, N. J., van Melle, M., Langelaan, M., Verheij, T. J. M., Wagner, C., & Zwart, D. L. M. (2014). Exploring patient safety culture in primary care. International Journal for Quality in Health Care, 26(6), 585–591.

  62. Ward, D. J., Furber, C., Tierney, S., & Swallow, V. (2013). Using framework analysis in nursing research: A worked example. Journal of Advanced Nursing, 69(11), 2423–2431.

    Google Scholar 

  63. Wearne, S., Dornan, T., Teunissen, P. W., & Skinner, T. (2012). General practitioners as supervisors in postgraduate clinical education: An integrative review. Medical Education, 46(12), 1161–1173. doi:10.1111/j.1365-2923.2012.04348.x.

    Article  Google Scholar 

  64. Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. New York: Cambridge University Press.

    Book  Google Scholar 

  65. Wolcott, H. F. (1994). Transforming qualitative data: Description, analysis, and interpretation. Thousand Oaks, CA: Sage.

    Google Scholar 

  66. Wolcott, H. F. (2001). Writing up qualitative research. London: Sage.

    Google Scholar 

Download references

Acknowledgments

We thank the supervisor and registrar participants, along with the staff of the respective practices. We gratefully acknowledge the research grant received from General Practice Education and Training Ltd (GPET).

Author information

Affiliations

Authors

Corresponding author

Correspondence to T. Clement.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Clement, T., Brown, J., Morrison, J. et al. Ad hoc supervision of general practice registrars as a ‘community of practice’: analysis, interpretation and re-presentation. Adv in Health Sci Educ 21, 415–437 (2016). https://doi.org/10.1007/s10459-015-9639-4

Download citation

Keywords

  • Ad hoc supervision
  • Clinical supervision
  • Communities of practice
  • General practice
  • Identity
  • Legitimate peripheral participation
  • Naturalistic generalisation
  • Power
  • Situated learning
  • Socio-cultural theory