Using activity theory to transform medical work and learning

Abstract

This article introduces key concepts of activity theory and expansive learning. Expansive learning builds on the foundational ideas of the cultural–historical activity theory (CHAT). It is a research approach designed for studying the complexities and contradictions in authentic workplace environments. Change Laboratory is a formative intervention method developed for studying workplaces in transition and for stimulating collaborative efforts to design improved patterns of activity. We present concrete examples of formative interventions in healthcare, where good patient care was compromised by the fragmentation of care and disturbances in collaboration between the healthcare experts. This implies that physicians are challenged to develop collaborative and transformative expertise. We present three spearheads into a zone of proximal development, representing opportunities for change of medical expertise: (1) reconceptualizing expertise as object-oriented and contradiction-driven activity systems, (2) pursuing expertise as negotiated knotworking, and (3) building expertise as expansive learning. While medical expertise needs to expand, medical education must also look for ways to evolve and meet the challenges of the surrounding society. We call for adopting an interventionist approach for developing medical education and intensifying collaboration with the practitioners in healthcare units, their patients, and target communities.

Keywords:

• Activity theory
• expansive learning
• formative intervention
• change laboratory
• healthcare
• medical education

Disclosure statement

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Yrjö Engeström

Yrjö Engeström, PhD, is a Professor Emeritus of Adult Education at the University of Helsinki, Finland, and a Professor Emeritus of Communication at the University of California, San Diego, USA. He is a leading figure in CHAT and has developed expansive learning, a formative interventionalist approach to study organizations and expertise in transition. He is the author of several books on activity theory and expansive learning, including Expertise in Transition: Expansive Learning in Medical Work (Engeström 2018).

Eeva Pyörälä

Eeva Pyörälä, PhD, MME, is a Senior Lecturer in University Pedagogy at the University of Helsinki, Finland, and a Fellow of AMEE. Her scholarly work focuses on mobile learning and digitality in health professions education and communication in healthcare.