Hegemonía cartaginesa y tejido urbano en Iberia.

From the literature search it became clear that work-based learning occupies a central role in ODA education and training. This observation was in line with Swanwick’s (2005:859-860) opinion that work-based learning

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plays an important role in healthcare education. Healthcare education and ODA education are predominantly sited within the workplace where the bulk of learning takes place by means of an apprenticeship model which is viewed as a suitable method for personal and on-the-job specific development.

Apprenticeship is seen as an internationally understood structure within which students can learn, develop their identity, and demonstrate their potential and abilities (Fuller & Unwin, 2003:41-42). The model focuses on ‘doing’ with the guidance of a ‘master’ as role model. In the operating department the master-apprentice relationship is typified by the qualified healthcare professional and student. Key factors to ensure success is the recognition of students as students and not as employees (Swanwick, 2005:863) and giving them access to and participation in a wide range of learning opportunities. Providing various and different learning opportunities is crucial to ensure students develop the attitutes, skills and knowledge to progress in and beyond their current workplace and develop lifelong learning skills (Fuller & Unwin, 2003:42).

Another key factor is modelling which links to the sociocultural theory of learning (cf. Ch. 2, sect. 2.3.4) and Bandura’s (1988) social cognitive theory in which self-efficacy and observational learning plays an important role (Swanwick, 2005:860). According to Bandura (1988), there are four processes involved in observational learning, namely attentional, retention, motor reproductive and motivational processes. Attentional processes are concerned with the usefulness of the observed behaviour (procedure), interpersonal report between the model and student, and the complexity and frequency of the modelled stimuli (Quinn & Hughes, 2007:99-100). The retention process is linked to the rehearsal and practising of the behaviour while the motor reproductive process involves the students performing the procedure and evaluating it for accuracy. The student is most likely to learn the modelled procedure if he or she understands the value of it and why it is done.

Apprenticeship is a potential powerful tool for ODA teaching and learning as it mainly occurs in the operating department where the students socialise with other healthcare professionals and patients (Meyer & Van Niekerk, 2008:116). For example, one of the early aspects of learning an ODA must acquire is the professional role. By being present in the operating department when other ODAs and nurses are performing their daily roles and functions, the student must be receptive to constantly observe the skills and teamwork being demonstrated; she or he must take note of and digest the staffs’ interaction with the patients. This is the way in which ODAs learn professional attitude as well as techniques (Quinn & Hughes, 2007:100).

The healthcare professionals in the operating department represent a group of people who share the common goal of safe perioperative patient care. Placing ODA students in the workplace to acquire knowledge and skills through collaboration, regular interaction and engagement in real-life activities is relevant to work- based learning in ODA education. Work-based learning further relates to the communities of practice (CoP) theory (Wenger, s.a.a:1 & 6; Wenger, s.a.b:7). Communities of practice, a term used by Jean Lave and Etienne Wenger (Lave & Wenger, 1991:25) for the first time in 1988, is defined by Wenger (s.a.a.:1) as “… groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly”. The shared interest of the group members and their shared learning keeps the CoP together (Wenger, 1998a:4).

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The CoP theory is perceived to be a social learning theory which could influence both theory and practice in health education (Wenger, s.a.a:6; Wenger, s.a.b:7). The theory centres on four assumptions, namely: (1) students are social beings and this forms the central aspect of learning; (2) competence demonstrates knowledge; (3) participation and active engagement with the world generates knowing and (4) engagement in social culture and the ability to experience it generates meaning (Graven & Lerman, 2003:187; Wenger, 1998b:4).

Yet, Wenger (1998b:4-5) theorised that learning is an everyday experience, and that learning and knowing by means of social participation are only achievable if the following four learning components are integrated namely community (learning as belonging), identity (learning as becoming), meaning (learning as experience) and practice (learning as doing). The community thus acts as a ‘living curriculum’ for the apprentice (Kauffman & Mann, 2014:22; Wenger, 1998b:5; Wenger, s.a.a:4). It is a locus for creation and acquisition of knowledge which involves an interaction between experience and competence (Wenger, 1998b:214). This interaction could provide ODA students, as upcoming healthcare professionals, with the opportunity to access socially defined competence by means of actions and interactions.

The acquisition of professional knowledge is linked to CoPs (Eraut, s.a.:9). According to Eraut professional knowledge has a large tacit knowledge component, which is enhanced through daily interaction with others. Students learn by performing (‘doing’) tasks/procedures through collaboration, social interaction and bonds with healthcare practititioners and other students (Kauffman & Mann, 2014:19-20). Much of the professional work and learning, in which area this study was situated, occurs in complex situations. Complex knowledge is required to master situational understanding, intuitive decision-making and routine actions which are seen as the three main components of professional learning (Eraut, s.a.:3-11). Applying it to ODA education means that when the student encounters complex situations they draw on social-cultural learning resources such as colleagues and peers for assistance. This implies learning happens everyday by joint collaboration (Morris & Blaney, 2014:103).

By applying communities of practice to ODA education, learning becomes situated and collective with students engaging in the activities of the team. The focus shifts from individual learning to collaborative learning and from the student and teacher to the team or community (Lave & Wenger, 1991:29; Morris & Blaney, 2014:103). The perioperative healthcare practitioners and ODA students, as newcomers, are brought together by mutual activities which allow the latter to participate in daily real-life activities - defined as situated learning - and to become participants in social cultural practices (Lave & Wenger, 1991:29; Morris & Blaney, 2014:103; Smith, 2003:1-2; Wenger, 1998b:4). Situated learning is based on the social cultural learning theory, and the authors posit that learning occurs through a process of engagement within the CoP (Kauffman & Mann, 2014:19-20; Smith, 2003:1). It provides students with the opportunity to develop roles, responsibilities and understanding, and to embed their knowledge in a clinical context (Kauffman & Mann, 2014:22).

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In summary, learning occurs by means of belonging to the perioperative community, by developing a professional identity, by grasping the meaning of procedures/tasks performed and by performing (‘doing’) the procedures/tasks (Kauffman & Mann, 2014:20).

Regardless of all the advantages, Allix (2000:197-198) critiqued the CoP theory by pointing out that Wenger’s CoP theory is not based on explicit epistemological and methodological theories. It is also a multidimensional and complex concept which is dependent on legitimised initial memberships, commitment and enthusiasm of members to the desired goals of the CoP and members’ perception of the CoPs relevance (Kauffman & Mann, 2014:23). The situated learning and CoP theory were further critisied for not focussing on the “emotional dimensions of work-based learning” (Morris & Blaney, 2014:104).