Toward responsive attunement as health professionals

ABSTRACT

Despite considerable research into educating health professionals, debate continues about what is to be learned in becoming professionals. Some studies highlight what individuals are to acquire in preparation for health professional practice. Others attend to relations among people in healthcare and/or their social, material situations, including forming professional or interprofessional identity. Although these various studies have progressed the debate, they have not yet provided an integrated conceptual framework on preparing health professionals for the challenges of practice. Toward promoting such a framework, this article introduces a notion of responsive attunement for educating health professionals. A key concern in responsive attunement is developing an enhanced capacity to tune in to situations encountered, in order to respond on the basis of this attunement. This notion has three integrative features: (1) it has relevance for practice within and across health professions; (2) it couples what students know and can do (an epistemological dimension) with how they are learning to be (an ontological dimension); and (3) it is applicable at individual and collective levels. Promoting an enhanced capacity to respond with attunement – both individually and collectively – can contribute to preparing health professionals for the challenges of practice in our dynamic, complex world.

KEYWORDS:

• Attunement
• responsive
• responsive attunement
• tuning in

Introduction

Our dynamic and complex world presents challenges for educating health professionals capable of negotiating the changes they will inevitably encounter throughout their careers. Although many have experienced becoming professionals and there is considerable research into features of this process, debate continues about what it takes to be skilled health professionals (for example, Andersen et al. 2020; Davids, Kock and Waggie 2020; Gao 2020; M. Kelly et al. 2020; Nimmon and Regehr 2018). These debates – including differences in views and emphases – indicate there is further work to be done in discerning what is to be learned in becoming health professionals. This question arguably has important implications for health professional education.

Although various studies have progressed the debate on what is to be learned in becoming health professionals as I elaborate below, these studies have not yet provided an integrated conceptual framework on preparing health professionals for practice. This carries a risk of disparate programmes that leave to students the challenging task of integrating the parts in health professional practice. Moreover, notwithstanding important work on interprofessional education, much of the research in health professional education targets specific disciplines or professions within health. This is unsurprising, especially given it reflects the prevalent design of educational programmes in health. The necessity of educating health professionals within their own professions does not, however, preclude inquiring into the collective work across health professions, which constitutes healthcare (see, for example, Davin, Thistlethwaite, Bartle and Russell [2019]; M. Kelly et al. [2019]; Khalili, Hall and DeLuca [2014]). Inquiries within and across health professions are not mutually exclusive and much may be gained from exploring both avenues. Ultimately, all health professionals contribute to the collective enterprise that is healthcare.

In this article, I introduce a notion of responsive attunement toward promoting an integrated conceptual framework for educating health professionals. A key concern in responsive attunement is promoting an enhanced capacity to tune in – both individually and collectively – to situations encountered in healthcare, in order to respond on the basis of this attunement. This notion has three integrative features. First, it has relevance for practice within and across health professions, albeit in forms that vary depending upon the profession in question. Second, it couples what students know and can do (an epistemological dimension) with how they are learning to be (an ontological dimension). Third, it is applicable at both individual and collective levels, such as healthcare teams and particular health professions.

In proposing such a notion, the article is structured as follows. First, adopting a broad brush approach, I outline wide-ranging areas of current research on what is to be learned in becoming health professionals. These indicate the kinds of capacities presently considered important to develop, such as knowledge and skills that individuals are to acquire, adaptive expertise, and learning to negotiate complex relations in professional practice. The intention here is to take stock of current research over the past decade on what is to be learned in becoming health professionals, for progressing beyond the present. Second, drawing upon the broader research literature on educating for the professions, I elaborate some key learning principles to inform the notion of responsive attunement put forward in this article. Third, against the background of current research and learning principles, I explore the question of what is entailed in becoming health professionals, employing pertinent ideas from phenomenology as they relate to healthcare. Fourth, I then bring together major features of the process of becoming professionals for the purpose of exploring a composite notion of responsive attunement in health professional education. Finally, I point to some implications for health professional education and directions for further research.

Studies on what to learn in becoming health professionals

Given the extensive number and variety of present studies on what is to be learned in becoming health professionals, a complete or comprehensive account is beyond the scope of this article. Instead, I adopt a broad brush approach in outlining wide-ranging areas of research on this challenging question, as denoted by current studies.

Acquiring knowledge and skills in health professional education

Much of the research on what is to be learned in becoming health professionals has focused on specific knowledge and skills that individuals are to acquire, such as clinical reasoning (Cleary et al. 2019; Wang, Chen and Tsai 2020), communication with patients (Nimmon and Regehr 2018; Wolters et al. 2021), professionalism (Kaul et al. 2014; Page et al. 2020), thinking like a health professional (Mangold 2016; Tanner 2006), collaboration (Aspden, Wearn, and Petersen 2020; Davids, Kock and Waggie 2020), and so on. While competencies, attitudes, behaviours or attributes may be included, the main focus ultimately is expanding what individual students know and can do. Further, some of these studies explore how to promote this acquisition.

Adaptive expertise in health professional education

In recognition that acquisition of separate knowledge and skills does not capture the complexity of healthcare practice, there has been recent interest in the development of ‘adaptive expertise’ in the health professions (Kua, Lim, Teo and Edwards 2021; Mylopoulos et al. 2017). This draws on a distinction in cognitive psychology between ‘routine expertise’ and ‘adaptive expertise’ (Hatano and Inagaki 1986). Routine expertise ensures efficient and effective completion of previously encountered tasks, while adaptive expertise is demonstrated when performance is adapted on encountering unfamiliar or unexpected tasks. Similar to the initial work in psychology, studies of adaptive expertise in the health professions have emphasised an individual’s cognition and/or metacognition (Croskerry 2018; Cutrer et al. 2017) in adapting to what they encounter in their environment. Consequently, expertise – either routine or adaptive – is considered to be acquired by individuals. In one of these studies, a conceptual model was developed for skill acquisition in adaptive learning for the health professions (Cutrer et al. 2017). To date, much of the research ‘describes the nature and the development of an adaptive expert’ (Kua, Lim, Teo and Edwards 2021, 353). While there is some evidence from other fields that adaptive expertise can be developed (for example, see Carbonell and van Merrienboer [2019]; Kua, Lim, Teo and Edwards [2021]), there is currently limited empirical evidence that instructing in adaptive expertise improves adaptive or innovative performance in the health professions (Kua, Lim, Teo and Edwards 2021).

Relationality in health professional education

In contrast to research on what individuals are to acquire, other research in health professional education has directed attention to the relationality inherent in healthcare and in preparation for practice. Central to these studies are particular features of the relations among persons (such as students, experienced health professionals and patients) and/or the social, material situations in which they find themselves. The focus is on learning to negotiate some of the complexity of this relationality in healthcare settings, rather than primarily on what individuals are to acquire per se.

Some of these studies address dealing with uncertainty in practice (Weurlander 2020). Others consider the manner in which learning occurs through the body, such as the role of touch in health practice (Davin, Thistlethwaite, Bartle and Russell 2019; M. Kelly et al. 2020) or dealing with complex emotions in demanding healthcare settings (Helmich et al. 2018; Rydén Gramner 2022). Some studies explicitly adopt an extended time frame on relational processes, highlighting formation of professional (Cruess, Cruess and Steinert 2019; J. Kelly et al. 2017) or interprofessional identity (Thistlethwaite, Kumar and Roberts 2016), as well as how students are becoming, or learning to be, health professionals (Kilbertus, Ajjawi and Archibald 2018; Jarvis-Selinger, Pratt and Regehr 2012).

Varied theories and methods in health professional education

The areas of research outlined above show considerable variation on the question of what is to be learned in becoming health professionals. One of the reasons for this is that the theoretical perspective adopted and associated methods set parameters for the focus of research and its potential outcomes (Martimianakis, Mylopoulos and Woods 2020). In the various studies conducted, theoretical perspectives have ranged across conventional experimental studies (Wang, Chen and Tsai 2020), embodied cognition (van der Schaaf 2019), narrative studies (Kilbertus, Ajjawi and Archibald 2018), phenomenology (Burrows, Dall’Alba and LaCaze 2020), Actor Network Theory (Bearman and Ajjawi 2018) and decolonisation (Naidu 2021). In addition, a broad range of methods has been employed in promoting learning within health professional education, such as simulation (Isaranuwatchai et al. 2014) including in virtual environments (Wang, Chen and Tsai 2020), peer-assisted learning (Zaidi, Baig and Shamim 2021), entrustable professional activities (Shorey, Lau, Lau and Ang 2019), ‘students as partners’ (Barradell and Bell 2021), gamification (van Gaalen et al. 2021), visual thinking strategies (Aspden, Wearn and Petersen 2020) and exposure to historical accounts (J. Kelly et al. 2017). These varied theoretical perspectives and methods indicate a rich diversity within health education sciences (Ellaway, Tolsgaard and Martimianakis 2020). Analysis of theories and methods in themselves, however, is outside the scope and focus of the current article, which is concerned with what is to be learned in becoming health professionals.

Some key learning principles from research in professional education

As a background to promoting an integrated conceptual framework for health professional education, I briefly consider some key learning principles that can be gained from research on educating for the professions. In doing so, I make reference to some of the areas of research in health professional education outlined above. When considering research on what individuals are expected to acquire, for expediency I use the terms, knowledge and skills, to include the broad array taken up in the literature, including attributes, behaviours, competencies, competences, attitudes and so on.

Learning principle 1.

Given that practice changes over time (Porter 2003; Khalili, Hall and DeLuca 2014), it is important we educate for the future, beyond current knowledge and skills. For health professionals, often practice changes during a career span. Change in practice over time is readily apparent when we compare healthcare two decades ago with current technologies, procedures and medications. Although adaptive expertise also allows for change over time, currently ‘an instructional gap exists related to helping trainees prepare for future learning competencies’ (Kua, Lim, Teo and Edwards 2021, 348).

Learning principle 2.

Practice varies across contexts (Chang, Simon and Dong 2012; Ho et al. 2014; Hutten-Czapski, Pitblado and Slade 2004; Naidu 2021), from community health settings to hospitals, urban to rural settings, relatively well-resourced to poorly resourced settings, and across cultural contexts. So, what is learned must provide preparation for differences across contexts. While adaptive expertise potentially encourages adapting to diverse settings, to date the emphasis on acquiring individual expertise in health professional education has not extended to breadth of social or cultural environments (Kua, Lim, Teo and Edwards 2021, 353).

Learning principle 3.

As Donald Schön (1984) demonstrated in ground-breaking empirical research, professionals learn knowledge and skills in the act of applying them (see also Bowden and Marton 1998). This can explain why students often say they learn most from practising in clinical settings, although this is insufficient evidence for limiting learning to these settings. While periods spent in clinical settings are included in many health programmes, their intended purpose is typically application of acquired knowledge and skills, which may thwart other learning opportunities.

Learning principle 4.

While knowledge and skills are necessary, they are insufficient for skilfully performing practice. For instance, natural scientists recognised a focus on knowledge and skills in teaching science does not necessarily lead to good science, so they instead began paying attention to ‘thinking like scientists’ (Hake 2011; Watkins 1992), which spilled over into thinking like health professionals (Mangold 2016; Tanner 2006). Similarly, initial efforts to promote adaptive expertise in health recognised that separate knowledge and skills do not capture the complexity of healthcare practice (Kua, Lim, Teo and Edwards 2021; Mylopoulos et al. 2017). In addition, dissatisfaction with the practice of graduates in medicine led to including education for ‘professionalism’ (Coulehan 2005), although at times it has been reduced to another skill to be acquired (Kaul et al. 2014; Page et al. 2020).

Learning principle 5.

Importantly, research has shown that when knowledge and skills are gained, they are usually incorporated into existing ways of being professionals (Burrows 2019; Dall’Alba 2009). In other words, gaining knowledge and skills typically does not transform understanding as enacted in practice. For example, in taking a course on communication skills, those who treat the patient simply as a source of information use communication skills to obtain information. On the other hand, those who strive to work collaboratively with patients in addressing their health requirements tend to use communication skills to listen and respond to patients’ concerns. This means students learn different things from the same instruction or encounters, although this is not taken into account through a focus on acquiring knowledge and skills, or adaptive expertise. Moreover, students demonstrate differences in understanding professional practice and in being professionals, both on entering and completing programmes in health professional education (Burrows 2019; Dall’Alba 2004, 2009; Gilliland and Brown 2020).

Importantly, while expanding what students know and can do is necessary, it does not adequately prepare them for how they are to be in the complex healthcare situations they encounter (Burrows, Dall’Alba and La Caze 2020; Dall’Alba 2009; Kilbertus, Ajjawi and Archibald 2018). This is an enduring challenge in learning to be health professionals.

Re-conceptualising becoming health professionals

Given the principles outlined above, how can we conceptualise what becoming health professionals entails to inform their education as professionals? More specifically, in addition to gaining knowledge, skills and expertise, how can students be more fully prepared for both the relationality inherent in healthcare and being health professionals? In what follows, I draw upon selected ideas from phenomenology and healthcare in exploring this question.

Learning to be professionals in practice ‘worlds’

While developing as professionals includes learning knowledge, skills and expertise, our relation to the world also changes in the process, in line with traditions of practice:

Entry into the world of medicine is accomplished not only by learning the language and knowledge base of medicine, but by learning quite fundamental practices through which medical practitioners engage and formulate reality in a specifically ‘medical’ way. These include specialized ways of ‘seeing’, ‘speaking’ and ‘writing’. (Good 1993, 71)

Each field within health requires engaging in particular practices and formulating reality in a manner that aligns with the practice ‘world’ in question, in its complex relationality.

As well as each field comprising its own practice world, the German philosopher, Martin Heidegger, argued that areas of knowledge, such as audiology, nursing or pharmacy, depict ways of being in the world (Heidegger 1996, 327). For instance, being pharmacists entails identifying particular kinds of health issues or illnesses as relevant to pharmacy practice, acting in specific ways to provide appropriate medication or other treatments for patients, endorsing the importance given to pharmaceutical medicines as treatments, and so on. All these features are part of the world of pharmacy, with its particular ways of being pharmacy professionals. Students in health professional education are required, then, to gain knowledge, skills and expertise that contribute toward learning to be speech pathologists, occupational therapists or medical practitioners.

Moreover, each practice world is not entirely self-contained but contributes to, and thereby overlaps with, other practice worlds. For instance, the world of pharmacy overlaps with the worlds of medicine and nursing in the practice of healthcare. Across time and context, ways of being pharmacists, dieticians or optometrists develop within prolonged traditions of the practice world in question.

Performing professional practice through the body

As professional ways of being developed, what is learned is not simply acquired or applied, but is performed through the body, while professional practice is learned. The French philosopher, Maurice Merleau-Ponty, pointed out that the body provides access to the world:

The body is the vehicle of being in the world … . I am conscious of my body via the world … I am conscious of the world through the medium of my body. (1962, 82)

For Merleau-Ponty, the body is not merely an object among other objects and nor is it limited to interconnecting systems of organs. Rather, it is the dynamic ‘lived body’, continually engaging with others and things in varied situations. This is the performing body engaged in the complexities of health professional practice (for elaboration, see Bleakley [2020]; Dall’Alba [2009]; M. Kelly et al. [2019]). This bodily engagement is apparent in the clumsiness or frustration students can feel when learning something new, in contrast with the fluency and confidence of skilled performance (Dall’Alba 2009; Dall’Alba and Sandberg 2021).

Although ways of being are performed through the body, they are not only an individual matter. Students learn to act as others do, collectively engaging in social practice, while employing suitable tools, instruments and equipment. Through education, socialisation and work, they take up others’ ways of being (Dall’Alba 2009). This does not simply occur through imitating what others do. Instead, students selectively take up or distance themselves from ways of being they observe, depending upon whether or not these are consistent with the professionals they aspire to be. The lived body is, then, not only personal, but also social. What we learn is incorporated into the body and made our own, as we perform professional practice with others or go about in the world. A challenge in healthcare is promoting this bodily performance that being health professionals demands.

The lived body shifts focus from an individual’s cognition or metacognition, located in the ‘mind’, to bodily performance situated in practice worlds, such as the world of physiotherapy, audiology or occupational therapy. Moreover, it highlights the need to go beyond what students know and can do, toward developing their bodily experience of being professionals in these practice worlds. As Alan Bleakley noted: ‘Conventional research is biased towards epistemologies or theories of knowledge, rather than ontologies or descriptions of ways of being or experiencing’ (2012, 465). While some inroads have been made in correcting this bias, the observation remains largely accurate today.

Drawing upon Heidegger’s and Merleau-Ponty’s philosophies, phenomenology is strongly placed to highlight ways of being and experiencing, situated within the sociomaterial contexts in which professional practice occurs. It thereby can assist in further preparing students for the relationality inherent in being professionals in healthcare. Moreover, this theoretical perspective offers resources for researching and developing ways of being professionals as they change over time (see, for example, Burrows [2019]; Burrows, Dall’Alba and La Caze 2020; Dall’Alba 2009).

Tuning in to bodily experience of being patients

Against the background of the bodily performance of being health professionals, I now turn to some examples from healthcare for additional insights into re-thinking being and becoming professionals. These insights derive from tuning in to the bodily experience of being patients, including when health professionals themselves become patients. This tuning in, or attunement (see also Dall’Alba 2009; Hopwood 2016), is a key component of the notion of responsive attunement developed below.

Case 1. Emma Gee

Emma Gee was a 24-year-old occupational therapist, diagnosed with arteriovenous malformation (AVM), a cluster of blood vessels in her brain stem, that was in danger of bursting. During surgery to remove this malformation, Emma suffered a stroke that left her unable to move, speak or swallow. She was placed in an induced coma. On waking more than a week after surgery, Emma was shocked to find what had transpired:

There was no doubt. I’d had a bleed on my brain and acquired all these deficits … . All big medical terms that I understood in theory but was now experiencing first hand. Terms that I used daily as a health professional that seemed to stress the importance of my role and add to my credibility. Now I was beginning to see that, to a patient, they were just gobbledygook, adding unnecessary confusion and complexity to their situation. How differently I viewed the medical jargon now that it applied to my own body. (Gee 2016)

By her own account, Emma’s experience as a patient transformed her understanding of being a health professional, with greater attention to what being a patient entails.

Case 2. Kay Toombs

Kay Toombs, a US academic, was diagnosed with multiple sclerosis (MS). Like Emma Gee, the physical changes her body underwent were described in terms of complex terminology, which she considered did not capture the ‘actual experience of bodily disorder.’ Instead, the changes she experienced were better captured ‘in terms of the impossibility of taking a walk around the block or of carrying a cup of coffee from the kitchen’ (Toombs 1995, 10). It can be noted that changes in capacity and experience of bodily disorder can also occur during disruptions in mental health.

Case 3. Carl

In recent longitudinal research involving pharmacy graduates during a two-year period following graduation (Burrows 2019), one of the graduates, Carl (a pseudonym), experienced being a patient when in hospital for knee surgery. Prior to discharge from hospital, Carl felt no-one had talked through his medications with him. He began reflecting on his own practice as a pharmacist and considering pharmacy from the patients’ perspective. When Carl returned to work, an elderly man who had experienced heart failure came into the pharmacy, after discharging himself from hospital. The patient was confused about his medications. Carl tried unsuccessfully to explain each of the medications. Finally, he asked what the patient wanted to know and there was a breakthrough in the conversation.

In modifying how he interacted with patients after his own period of hospitalisation, Carl came to similar realisations as Gee and Toombs about the experience of being patients. This also led to substantial change in how he interacted with people with mental illness. He was not simply more pleasant, friendly or approachable when interacting with patients, but provided different healthcare than previously.

Consistent message from being patients

Already established in the literature is that health professionals can understand their work differently after being patients. If we look closely, there is a consistent message from each of the cases above, highlighting the importance for healthcare of not only identifying symptoms and treatment, but also tuning in to the bodily disorder and/or disruption that patients often experience. As Toombs points out:

the experience of illness … is typically characterized by a loss of wholeness and bodily integrity, a loss of certainty and concurrent apprehension or fear, a loss of control, a loss of freedom to act in a variety of ways, and a loss of the hitherto familiar world. (1992, 97)

The point I make here is not that it is first necessary to be patients before becoming health professionals. Rather, given the insights that can be generated from tuning in to the bodily experience of being patients, a question to be posed is how this tuning in can be promoted in healthcare practice. The late Oliver Sacks (2010), neurologist and author, noted in an interview for The Economist:

Although it’s up to me as a neurologist to diagnose the disease and to think in therapeutic terms, I always want to address the person as much as the disease, and I’m very glad my own doctor feels similarly. I’m not just a case to him, I'm a person responding to the situation.

Addressing the person as much as the disease or health condition is relevant for all areas of healthcare. It accords with the notion of patient- or person-centred healthcare (Little et al. 2001) that has gained traction internationally. While attending to the person who is the patient is central in healthcare, this does not diminish the need to negotiate the complex relations among patients, health professionals and other stakeholders in the interest of securing optimal outcomes for patient health.

Standardised knowledge and skills are insufficient, then, for responding to the particularities in each varied situation within healthcare, which research on adaptive expertise also indicates (Kua, Lim, Teo and Edwards 2021; Mylopoulos et al. 2017). As a student remarked about the challenge of responding to a particular patient in a specific situation: ‘You can’t read in a book what you should do or how you should be’ (Dall’Alba 2009, 66). This is because learning to be professionals incorporates what they know or can do (an epistemological dimension) as well as how they are learning to be (an ontological dimension) (Dall’Alba 2009). In other words, health professional education must enable students to acquire, evaluate and refine knowledge and skills toward learning to be health professionals. Preparing these aspiring professionals for the complexities of practice in healthcare requires that both epistemological and ontological dimensions are adequately addressed.

Developing responsive attunement in healthcare

In health professional education, how is it possible to develop not only necessary knowledge, skills and expertise, but also how these aspiring professionals are learning to be in negotiating the complexities of healthcare practice? Sacks’ reflection on his experience as neurologist and patient highlights the importance of fostering attunement to how the person experiences their social, material situation and responding accordingly. The experiences of Gee, Toombs, Carl and Sacks all support this claim. If we take seriously the experience of bodily disorder and/or disruption, this influences how we act (Watson and Rebair 2014), as these varied experiences attest.

Responsive attunement for health professionals

Tuning in to bodily experiences and responding accordingly can promote being health professionals who address the person as much as the disease or health condition, while paying attention to how this responding is received. Responsive attunement entails, then, ‘responding to the particularities and complexities of a situation on the basis of tuning in to others and things in the social and natural worlds, with reflexivity’ (Dall’Alba 2020). In striving to be reflexive, individuals, teams and professions can question the import of their own customary approaches and taken-for-granted assumptions, with a view to learning from practice.

Responsive attunement includes, but extends beyond, empathy (M. Kelly et al. 2020) or ‘noticing’ (Tanner 2006) relevant features of situations in healthcare, in the sense that these provide a basis for responding, both individually and collectively, as health professionals. In other words, responsive attunement places emphasis upon responding, on the basis of tuning in. This directs explicit attention not only to tuning in, but also to being thoughtful and informed about how and when to respond, while being reflexive about this responding.

Similarly, responsive attunement incorporates other relevant knowledge and skills, which are necessary – but not sufficient – for responding to each person and situation encountered in healthcare. Although responsive attunement shares with adaptive expertise the aspiration to respond to a particular situation at hand, it goes further in extending to individuals and collectives, as well as incorporating epistemological and ontological dimensions of learning to be professionals.

Responsive attunement also encompasses patient-centred care and working collaboratively, offering enhanced clarity on what these mean in practice. It does so by pointing to how they can be performed, namely, through carefully tuning in to patients’ experience and the perspectives of stakeholders, including expertise of other health professionals, as well as informed, thoughtful responding, with reflexivity. Hence, responsive attunement is embodied in being health professionals, as individuals and collectively, within and across health disciplines. It thereby includes attention to the relationality inherent in learning to be health professionals. Responsive attunement provides a composite concept, then, that draws together multiple aspects relevant to being and becoming health professionals.

Moreover, there are two senses in which the notion of the ‘person responding to the situation’ has relevance for healthcare. First, the patient or person in need of care responds to the situation in which they find themselves, including bodily disorder and/or disruption they experience, whether or not they have support from family and/or friends, as well as their living situation. Second, health professionals – individually and collectively – are challenged to respond to patients’ requirements, motivations and life situation. These health professionals, too, respond to the persons and situations they encounter. In addition to responding to patients, this includes the need to pay attention to self-care (Skovholt and Trotter-Mathison 2016), working constructively with other health professionals (Thistlethwaite, Kumar and Roberts 2016), taking account of the circumstances of the broader community – such as who is included or excluded from healthcare – and also awareness of the social and material impacts of their practice. Both these senses of the person responding to the situation – patient and health professional(s) – have relevance for learning to be health professionals.

Responsive attunement in health professional education

How can responsive attunement explicitly be addressed in health education programmes? While inclusion of a unit or course on communication with patients, empathy, adaptive expertise, professionalism, patient-centred care, working collaboratively or awareness of social issues affecting patients can make a contribution, responsive attunement goes beyond each of these efforts, extending across all of them. As a composite concept, responsive attunement unites these varied aspects of healthcare practice toward promoting an integrated conceptual framework. It thereby offers clearer direction for health professional education.

A central question concerns whether, and to what extent, responsive attunement is adequately addressed in educational programmes in health. Importantly, is responsive attunement rewarded in these programmes, including through formal assessment? These questions warrant both conceptual and empirical investigation. For example, how is/can be responsive attunement demonstrated, in practice, among those learning to be medical, pharmacy, nursing or physiotherapy professionals? In what particular ways are the development of responsive attunement explicitly promoted in these and other health programmes?

If developing an enhanced capacity for responsive attunement is a goal of programmes in health professional education, what are the design implications? This goal means that tuning in to the person’s experience of bodily disorder and/or disruption, within their social and material living situation, would be at the forefront of educational programmes. Relevant knowledge and skills remain necessary, but they would be learned in the context of responding to particular patients’ life situation, health requirements and concerns, within the applicable social and material contexts. This includes learning that, at times, different treatments may be appropriate for people with similar illnesses or health conditions, due to their differing experiences, requirements or motivations. It does not, however, excuse reinforcing poorer health outcomes, especially for disadvantaged populations.

Learning to tune in and respond accordingly also extends to attending to one’s own requirements and those of other health professionals, especially in demanding healthcare situations. It incorporates, too, learning to work collaboratively with other professionals, within and across the professions. Given the varied expertise that health professionals bring to any healthcare situation they encounter, it is in the interests of patient health that they use their collective expertise for tuning in and discerning how to respond to this person, in this situation. Placing emphasis on health professionals tuning in to patients’ experience and responding accordingly – both individually and collectively – can enhance health outcomes.

Moreover, responding based on tuning in relies upon patients and health professionals learning from each other, including when their experiences or perspectives differ (Chang, Simon and Dong 2012; Naidu 2021). Developing attentive listening becomes central, not simply explaining what one knows. Healthcare is not performed by one person upon another, then, but is negotiated cooperatively with patients and other health professionals (Little et al. 2001; Thistlethwaite, Kumar and Roberts 2016), with reflexivity.

Renewing professional education in health

Responsive attunement offers clearer direction for a systematic renewal of health professional education by providing a composite concept that addresses the question of what is to be learned in becoming health professionals. It has implications for the design, practice and evaluation of these programmes.

A central principle is highlighting the person as much as the disease or health condition. In other words, aspiring professionals would learn to take into account the person’s experience of bodily disorder and/or disruption in the context of their everyday living, expectations and requirements, for collaboratively devising a way forward. Research is required that continues to build upon constructive ways of attuning and responding to experience of bodily disruption, as well as working collaboratively in this endeavour across health and other relevant professions.

Developing an enhanced capacity for responsive attunement as a goal of health education programmes would be made explicit and integrated throughout each programme, affording direction for an integrated curriculum (Brauer & Ferguson, 2015). It entails promoting a capacity to respond, based on highlighting the person as much as their health condition within diverse communities, while building awareness of social and material impacts of the healthcare practice in question. In such an integrated programme, learning goals would signal this focus and learning activities be directed to its accomplishment, with assessment for learning underscoring this achievement. Empirical investigation would be required to determine the ways and extent to which learning goals, learning activities and assessment are directed to responsive attunement in an integrated manner throughout specific health programmes.

More particularly, assessment for learning would reward tuning in and responding to the person’s experience of bodily disorder and/or disruption, embedded within diverse community groups and sociomaterial settings. Assessment has a central role through its impact on learning (Brown, Bull and Pendlebury 1997), while also serving to signal what is important. Adopting an approachable, empathetic or professional manner is desirable, but insufficient for demonstrating responsive attunement. Research could shed light upon whether and how assessment for learning rewards this achievement within and across health programmes.

With responsive attunement in focus, there is recognition that learning occurs through the body and is performed in context. It requires developing attentiveness and sensitivity in responding, with reflexivity, to the care of diverse persons in particular circumstances and varied settings in which healthcare practice occurs. This extends beyond applying previously acquired knowledge and skills, toward learning to be attuned, responsive health professionals in the sense discussed above. Research can explore ways in which attending to learning through the body influences attentiveness and responsiveness in learning to be health professionals, individually and collectively.

Responsive attunement couples epistemological with ontological dimensions of learning to be professionals. One of these dimensions is not sufficient without the other. It is necessary that attention is paid to what aspiring health professionals are learning to do and know, in the process of how they are learning to be health professionals in diverse contemporary contexts. Further research is needed that explores the integration of these central dimensions of learning to be health professionals.

Responsive attunement in this broad sense is relevant not only for those learning to be health professionals, but also as a modus operandi for teaching staff in these programmes. As teachers, we, too, must respond through tuning in to learning by aspiring professionals; attending to what they find challenging, confusing or rewarding, and responding accordingly, with reflexivity. Research could continue to illuminate efforts by teaching teams, which tune in and respond productively to struggles and achievements among those learning to be health professionals.

In conclusion

Becoming professionals is necessarily uncertain: we cannot be confident we know what the future will bring, how the professions will change, nor how professionals will be required to develop over time. Moreover, the demands of professional practice shift as new technologies impact on practice, societies alter and our planet undergoes changes that can impact upon healthcare (Costello et al. 2009). Promoting an enhanced capacity to respond with attunement – both individually and collectively – provides a way of negotiating this complexity.

In proposing a composite notion of responsive attunement for health professional education, I have drawn together concepts previously identified in the research literature, such as person-centred healthcare, relationality, adaptive expertise, self-care, learning through the body, working collaboratively and learning to be professionals. My purpose in doing so is to promote the development of an integrated conceptual framework on preparing health professionals for the challenges of practice. Highlighting responsive attunement has relevance within and across health professions, couples epistemological with ontological dimensions, and is applicable at both individual and collective levels. Although there are important distinctions between health professions, providing high-quality healthcare also requires working together, so much can be gained in exploring and developing conceptual frameworks that extend across health professions.

Underscoring responsiveness to situations as they are occurring encourages attentiveness to changes over time and across contexts. By emphasising learning and responding in context, it is consistent with how professionals learn. Directing what aspiring professionals know and can do, toward how they are learning to be, promotes the bodily performance and reflexivity that being health professionals demands.

Providing support and challenge in developing an enhanced capacity for responsive attunement gives renewed direction for educational programmes attuned to learning. While it is never straightforward to substantially renew educational programmes, the research literature demonstrates that many health educators are committed to improvement. Moreover, the composite notion of responsive attunement proposed here includes and extends some existing features of health professional education, as noted above. Developing an enhanced capacity for responsive attunement, in the broad sense described here, can lead not only to knowledgeable, skilled, adaptive health professionals, but also offer aspiring professionals a clear sense of purpose, enabling them to thrive in a dynamic, complex world.

Acknowledgements

The author is grateful to Rola Ajjawi, Bryan Mukandi and anonymous reviewers for helpful comments on an earlier version of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).