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.
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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.
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.
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.
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.
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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).
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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
- Ad hoc supervision
- Clinical supervision
- Communities of practice
- General practice
- Legitimate peripheral participation
- Naturalistic generalisation
- Situated learning
- Socio-cultural theory