Learning and professional acculturation through work: Examining the clinical learning environment through the sociocultural lens

Abstract

Purpose: We examined studies of the clinical learning environment from the fields of sociology and organizational culture to (i) offer insight into how workplace culture has informed research on postgraduate trainee learning and professional development; (ii) highlight limitations of the literature; and (iii) suggest practical ways to apply sociocultural concepts to challenges in the learning environment.

Materials and methods: Concepts were explored by participants at a consensus conference in October 2018.

Results: We identified three enduring foci for research using a sociocultural lens: the hidden curriculum, exploration of medical errors, and the impact of time pressures on the relational nature of clinical education. Limitations included the lower value attributed to informal learning and a pejorative valuation of the hidden curriculum; and disconnect between practices in clinical settings and the priorities of the larger organization.

Conclusions: Research on the learning environment using a sociocultural lens suggest workplace goals, norms and practices determined which learners engage in learning-relevant activities, to what extent, and the degree of guidance provided, with these factors creating “tacit” curricula that may support or compete with formal learning goals. We close with guidance on how sociocultural constructs could inform research to improve the learning environment.

Acknowledgments

The authors would like to acknowledge the contributions of the attendees at the Clinical Learning Environment Preconference held in conjunction with the 2018 International Conference on Resident Education (ICRE), Halifax, Nova Scotia, October 17 and 18, 2018, as well as the enduring contribution of Frederic Hafferty, PhD, Professor of Medical Education, Program in Professionalism and Ethics, Mayo Clinic Medical Education and Training, Rochester, Minnesota, United States to the study of the sociocultural aspects of the clinical learning environment for several decades.

Disclosure statement

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

Glossary

Clinical microsystem: A small group of professionals who work together on a regular basis to provide care to a group of people and may serve as a site for clinical learning.

Workplace culture: The customs and social institutions of a group of individuals in a work context.

Hidden curriculum: The [often unintended] impact of social and structural factors on the learning process.

Informal learning: The types of activities learners participate in and the guidance they receive in the clinical learning environment.

Social science: The scientific study of human society and social relationships.

Socialization: The process of learning to adapt to the norms of society or a given social or professional group.

Additional information

Notes on contributors

Ingrid Philibert

Ingrid Philibert, PhD, MBA, Formerly Accreditation Council for Graduate Medical Education, Chicago, IL, USA.

Elizabeth Elsey

Elizabeth Elsey, MBChB, MRCS, PhD, University of Nottingham, UK.

Simon Fleming

Simon Fleming, MRCS, M.Sc., PhD Candidate, Barts and the London School of Medicine and Dentistry, London, UK.

Saleem Razack

Saleem Razack, MD, FRCPC, McGill University, Montreal, Canada.