by practice colleagues in the learning environment is likely to influence access to learning opportunities, and will be further discussed in this section.
The impact of previous experience on the student’s journey raises two very pertinent and interrelated themes: the first being the recognition of the student’s starting point and their potential for achievement. This is referred to by Vygotsky: an educationalist, in relation to a child’s educational development, as the zone of proximal development (ZPD) (Vygotsky, 1978; a text previously mentioned in chapter two). This theory has subsequently been applied to adult learning, in particular by Spouse (1998). Vygotsky (1978) suggests that the development of the child takes place on two planes: psychological and social. The child is required to internalise their learning in order for it to impact on personal development. ZPD is defined by Vygotsky (1978) as the distance between actual development determined by independent problem solving, and potential development; also determined through problem-solving yet under the guidance of or in collaboration with experienced peers. The achievement of the individual’s development potential is reliant upon learning together, and proximal development relates to the prospective, ongoing development of the individual (Veresov, 2004).
In communities of practice, the importance of socialisation and engagement is emphasised in enabling situated learning opportunities (Smith, 2003, 2009). The community of practice is a concept originally developed by Jean Lave – a social anthropologist and Etienne Wenger - a teacher (Lave & Wenger, 1991). Lave and Wenger’s work (1991) emphasised the importance of learning and knowledge in context, requiring mutual engagement in activities which the community share an interest in or a passion for (Wenger, 1998). Learning is ongoing and shared: shaped by the activities and enterprises of the group, which is in itself a form of community and is
therefore described as a community of practice (Wenger, 1998). This implies the importance of a socialisation process, and as identified in the literature review by Sharp et al (1995), the importance of the student being accepted into the culture of the workplace in facilitating development or the building of confidence.
The two concepts of ZPD and communities of practice are brought together via a paper by two academics at a Singapore University, David Hung and Der-Thanq Chen, in their discussion of situated or contextual learning in a web-based learning design programme (Hung & Chen, 2001). Hung and Chen suggest in this paper that the two concepts go hand in hand, in that the individual and the environment are required to interact with one another to ensure that situated learning takes place. They suggest that learning is embedded in practice, and although ZPD was originally developed in relation to learning in children they consider, in accord with Spouse (1998) that it can be applied to all learners as an aspect of situated cognition by recognising actual and potential development and engaging in the community of practice, in the pursuit of proximal development. These theories within the context of specialist practice rely on acceptance by the practice team of the SP student and on the student practicing as a team player; neither of which can be assumed will occur. Yet if the starting point of the student is not recognised by the team, and the socialisation of the SP student into the community of practice does not occur, achievement by the student of their full potential is unlikely. As suggested by one focus group member, when reflecting on her own experience as a SP student:
“…you feel like you’re intruding in the team because you’re only there two days a week. And you’re not sure whether – the people you’ve allied yourself with were more the students on the course rather than the team you were in practice with. And that’s quite difficult….so you did feel like you were an
from the other team members you were supposed to be managing”.
Focus group 2
Due to the project focus being on PT support, students were not included in the sample for the interviews or focus groups, however members of the sample at both stages of the research frequently referred back to their feelings and experiences gained as SP students (and in the case of academics, some as PTs also). This promoted understanding of the student’s situation and offered insight into the basis for PT expectations of them.
There is a clear dichotomy between the student’s identity; naturally being drawn towards the student group with shared aims, goals and experiences, and being aware of the need to ‘fit in’ with the practice team to achieve learning outcomes and optimise practice learning. There appear to be two communities of practice identified – one being the SP student group, the other the practice team. The importance of both should be emphasised and encouraged as aspects of social and collective learning (Smith, 2003, 2009). Supporting recognition by the PT of the student’s level of experience and emphasising the importance of an effective socialisation process, have the potential therefore to hasten the development of student knowledge and confidence and consequently ease the anxieties expressed by PTs in the interviews in relation to student development.
The development of learning and knowledge through active engagement in the community of practice as suggested by Lave and Wenger (1991) does however assume and rely on the community of practice being strong; unified by shared goals and unfettered by power relationships restricting participation and acceptance, as suggested by Smith (2003, 2009). A well-functioning, welcoming and balanced team would certainly provide optimum opportunities for the
SP student to develop knowledge and understanding, hence the focus on this from both PTs and focus group members.
During another interview, a PT emphasised the importance of a team focus by the student; indicating the PT’s protective stance towards both the student and the team:
“Generally…students are really good and fit into the team. All students I’ve had have been team players…We all work in teams; being precious over student status doesn’t help. Need to fit in.”
3rd interview
This links back to the focus group member quote above, and confirms the importance of the socialisation process in facilitating student development. This quote indicates a need for the student to take on a specific role as a team member in order to become part of the SP community of practice (supported by Sayer, 2011), and suggests a shared allegiance by the PT to the student and the team. This and the following quote suggest that the PTs clearly see the importance of developing the whole team, and see this as an area which the SP student should focus on within the specialist practitioner lead role:
“…it’s all progress; it is all development for the person but also for the team, for the practice to develop…must lead by example; by the way she’s been taught, and then she can be a role model for the team and to help them develop as well”.
3rd interview
In the first interview the PT had also discussed this team development process; warning of the dangers of an approach whereby the student took responsibility upon themselves for all aspects of practice. She also alluded to this team development as providing an opportunity for the PT to stand back and appraise the
“And often…people that think…because you’re the team leader you’ve got to direct everybody. They don’t let other people develop – so that gives you an idea of how to develop the leadership skills really – you know, it is a team effort.
You give yourself a lot of problems [as a SP] if you want to be the leader all the time, because then you develop a brood of children, rather than adults who can act for themselves. Often the team look to the SP student as someone who is very knowledgeable – and they’ll question – well what do you [SP student] think about something – and that is a very good time to pick up on what their [student] level of knowledge and skills are”.
1st interview
The Department of Health in their post-registration nursing careers consultation response report (DH, 2008d) recognise the importance of team leadership and team support as an aspect of higher level practice:
Similarly community nurses within district nursing could focus on leading skill-mixed teams, co-ordinate and manage a wide range of general long term care needs.
DH, 2008d, p14
This sentiment is echoed by the NMC in the Standards for Specialist Education and Practice (NMC, 2001):
…teaching and the support of professional colleagues and the provision of skilled professional leadership.
NMC, 2001, p4
And within the Standards of Proficiency for Specialist Community Public Health Nursing (NMC, 2004b):
…takes responsibility for the delegation of aspects of practice to others, and effectively supervises and facilitates the work of team members. It also involves the capacity to work effectively within wider multi-disciplinary and multi-agency teams, to accept leadership roles within such teams, and to demonstrate overall competence in community public health practice.
NMC, 2004b, p6
Learning is considered by the aforementioned authors as a social activity; a mutual learning experience benefiting all involved (Vygotsy, 1978, Lave and Wenger, 1991, Smith, 2003, 2009), as the above quote from the first interview suggests. Within medical education, the importance of early introduction to the clinical placement is stressed in a small scale qualitative study of ten university tutors and three focus groups involving medical students by Goldie et al (2007). The authors suggest that this approach facilitates the student’s socialisation process to enable them to become part of that community of practice, and Goldie et al (2007) consider guided reflection within this forum to be integral to medical students’ development from the early years of the curriculum. The research focussed on developing professionalism in medical students; an area of limited research and therefore further study would be required to establish if results were replicable, as recognised by the authors. Although the Goldie et al (2007) study relates to pre- registration medical students, some similarities and shared outcomes are evident between this and my own study. In particular, the research identified the medical students’ lack of recognition of the importance of the portfolio of practice until its completion – a finding of my own study, which I will return to in section 5.3.1. The guided approach to reflection employed in the Goldie et al (2007) study had also been emphasised as important in a discussion with a PT related to the student recognising and communicating thought processes to the mentor:
“…that they’re able to communicate that back to me; why they’re doing it and the rationale behind that…they’re looking forward to how the service should be delivered. That their working and their care delivery is in line with that; that it’s not just based on old, traditional values”.
4th interview
The student being able to communicate aspects of practice back and discuss the implications of different approaches is important to the PT; offering clear indications to the mentor of the student’s ability to function as a reflective practitioner; articulating knowing in practice, based on a combination of theoretical concepts and concrete experiences (Schön, 1983, Kennedy, 2002).
The above quotes illustrate the importance of the socialisation process for both the student and the team in facilitating learning and enabling the PT to observe the student’s development. This particular theme, possibly due to it specifically relating to the close relationship between the PT and student, did not feature significantly in the focus group discussions, although the participants could identify with the socialisation process and its impact on development.
The ability of students and practitioners to work and learn together is an aspect of the student journey which embraces the community of practice philosophy. PTs regularly referred during the interviews to reflecting with the students (as will be examined further in section 5.3); enabling them to challenge traditional practices and jointly explore new ways of working. As one PT explained:
“I like people to come and think this is an opportunity to look at things from a new point of view and learn in different ways…For students to challenge me and say maybe your practice does need to change, why do you do it like that? But not to be threatening or defensive”.
3rd interview
The approach of the student and the attitudes they exhibit are important here – it is clear that the PT has clear expectations of the role and behaviour of the SP student - to have the ability to challenge practice without appearing threatening. Conveying their level of experience appropriately to the PT would enable them to build confidence and enter enthusiastically into the community of practice. As Lave and Wenger (1991) describe this, the learner moves from peripheral participation where learning is restricted by limited involvement to full participation, as the student adopts the socio- cultural practices of the community of practitioners. This study indicates that the team play an important role in socialisation into the community of practice; supporting the PT by accepting and recognising the needs of the student. By entering this community, knowledge and learning are naturally accrued, which can lead to the development of innovative ideas and pioneering thinking in the SP student – my next category for examination.