Quilligan, Sally; (2013) Enabling fourth year student-doctors to learn through participation on ward rounds : an action research study. Doctoral thesis , Institute of Education, University of London.

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Abstract

This thesis develops the concept of apprenticeship to capture and explore how the learning of student doctors takes place in hospital ward rounds, with the aim of developing pedagogical approaches that enable and improve learning. The research pays particular attention to the shifting complexities of the hospital and ward-round environment and the ambiguous status of student-doctors as participants. Using action research the study sets up a collaborative inquiry with eleven student-doctors who use audio-diaries and reflective learning sessions to harness learning from ward-round experiences, explore the nature of their participation and facilitate critical reflection both on and through the workplace. Exploration enables the student-doctors to see that learning needs to be understood not simply as an intellectual activity but as participation in social practice and that this necessitates focusing upon development of their agency and professional identity. Changes were identified at three levels: in the student-doctors' practice, in their understandings of practice and in the conditions under which they practised. Nine of the students were enabled to learn through active participation on the ward round. Eight studentdoctors came to understand they were learning about becoming a doctor. By changing their own understandings of forms of knowledge, of their role and opportunities for learning they influenced the way other clinicians responded to them and were offered more opportunities to participate. The thesis as a whole represents an original and distinct contribution to the growing sociocultural literature in medical education and specifically points to the need for changes in the way learning in the workplace is conceptualised. It challenges medical educators and policy makers to think not just about the individual, but also the culture and power relationships which shape select and legitimise what learning affordances the student-doctors attend to; that is the relational interdependence between personal and social agency.

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