Expansive learning in medical education: Putting Change Laboratory to work

Abstract

This paper explores the purposeful use of conceptual and methodological tools provided by Cultural Historical Activity Theory (CHAT) to transform learning cultures and practices within and across diverse clinical learning environments. We describe how Change Laboratory methodology helped clinicians and others who support student, intern, and resident education to make changes collaboratively. A case study in undergraduate medical education shows how this created new forms of medical student placement and a postgraduate study shows how it addressed supervisors’ undermining behaviour towards Obstetrics and Gynaecology residents. This empirical work illustrates ways of modifying the classical Change Laboratory process to fit local contexts, resources, and needs. We conclude with lessons learned and future directions for practitioner-researchers who wish to broaden the range of methodological tools they use to transform clinical learning environments.

Keywords:

• Activity Theory
• Change Laboratory
• clinical placements

Acknowledgements

The work of CM was commissioned by Health Education England (working across London) and led by Dr. Indranil Chakravorty, Associate Postgraduate Dean. The authors thank Sue Kilminster and Richard Fuller, Leeds, UK for their contributions to the CL1 Team. The authors also thank Dr. Anjali Prinja (Darzi Leadership Fellow), Dr. Selina Sim (Education fellow and O & G Resident), and Dr. Maria Memsta (Education Fellow and O & G Resident), London UK, for their contributions to the CL2 Team.

Disclosure statement

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

Additional information

Notes on contributors

Clare Morris

Clare Morris, EdD MA(Ed) BSc (Hons) PFHEA is Course Director for the MST and Diploma in Medical Education Programmes, Institute of Continuing Education, University of Cambridge and Honorary Professor of Medical Education, Institute of Health Sciences Education, Barts & The London School of Medicine and Dentistry, Queen Mary University London, UK.

Anne-Marie Reid

Anne-Marie Reid, EdD BDS (Glasgow) PFHEA is an Associate Professor of Medical Education and Director of Student Education, School of Medicine, University of Leeds, Leeds, UK.

Alison Ledger

Alison Ledger, PhD MPhil BMUS (Mus Thy) (Hons) SFHEA is Associate Professor of Clinical Education Scholarship, Head of Intercalated Programmes and Programme Lead BSc Applied Health (Medical Education), Leeds Institute of Medical Education, School of Medicine, University of Leeds, Leeds, UK.

Andrew Teodorczuk

Andrew Teodorczuk, MD PFHEA FRCPsych MBChB (Edinb) is Professor of Medical Education, School of Medicine, Griffith University, Queensland, Australia and The Prince Charles Hospital, Metro North, Brisbane, Australia.