Harding, A; (2017) How do medical students learn technical proficiency on hospital placements? The role of learning networks. Doctoral thesis , UCL (University College London).

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Abstract

Medical students spend over 85% of their clinical learning time on hospital placements, but there has been comparatively little detailed analytical investigation. This work therefore seeks to further the understanding of clinical learning in hospitals. The study adopted a focussed ethnographic approach using quasi-participant observation of third-year medical students, on one hospital placement over a period of two years. Observations revealed repeating types of learning episodes, which are presented as vignettes. These vignettes are analysed using Actor-Network-Theory (ANT), a branch of material semiotics. ANT seeks to account for both the social and material aspects of learning relevant to complex socio-technical environments such as hospitals. Although theoretically attractive, socio-material approaches such as ANT have been difficult to operationalise for empirical use. I have developed a number of bespoke methodological and analytic approaches that are clearly articulated to enable critique and future use. Analysis suggests that clinical learning can usefully be conceptualised by learning networks that produce varying opportunities for learning. The networks comprise human and material participants (or actors), interacting in complex but definable ways. The material actors figure prominently, and often inhibit network formation. Within learning networks, differing actor combinations generate a range of learning processes that produce a corresponding variety of learning opportunities. The networks are time consuming to initiate, fragile and short-lived. When operational, networks can contribute to learning technical proficiency, but opportunities to learn clinical skills are rare. The analysis contributes towards the understanding of medical education by identifying new material and human actors. The analytic process also introduces a systematic way of describing how the actors interact to produce learning. Identification of new actors and relationships has led to opportunities to improve clinical learning at the observations site and generated several opportunities for further research.

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