Box 2.
Theoretical frameworks informing this study
| Experiential learning |
| Adults (like children) are generally highly motivated to learn; they learn things that are immediately useful to them; and they learn best in a self-directed, task-oriented, and experience-based manner.27 The adult learner integrates new experiences into existing conceptual models, modifies these models in the light of experience, and tests the new models against external reality.27 This theory is helpful but not sufficient in guiding training, since (for example) feedback from others is an important component of the learning process37 and novice learners in particular may overestimate their competence and fail to recognise key learning needs.38 |
| Competence and capability |
| Competence is defined as ‘what individuals know or are able to do’; capability as the ‘extent to which individuals can adapt to change, generate new knowledge, and continue to improve their performance’.28 While competences are inherently conservative (for example, knowledge of an existing evidence-based guideline), general (apply to multiple situations), and assessed retrospectively (for example, by a trainee presenting a portfolio of evidence), capabilities relate to the creative production of new knowledge in particular situations — for example, generating multiple possible diagnoses and working through different management scenarios when assessing a complex case.29 Related to capability is entrustability, defined as occurring when clinicians can trust a trainee or colleague to perform a particular role unsupervised. Examples of entrustable professional activities include seeing undifferentiated patients in person, doing telephone consultations, and being duty doctor. |
| Social learning theory and relational aspects of learning |
| Learning to use technology is a highly social activity, as people learn by observation (from watching others), collectively problem solve, and share stories about troubleshooting.30 Indeed, multimedia storytelling in groups can be a powerful learning tool.39 In work-based learning, a positive relationship between the leader (trainer) and the follower (trainee) leads to higher expectations and better performance — the so-called Pygmalion effect.31 |
| Sociomateriality |
| The material properties and affordances of technologies shape and constrain what humans are able to do in a given context. Technology is designed for an idealised system (‘work as imagined’), but staff in any organisation must learn or develop workarounds (articulation practices) to deliver ‘work as done’.33 Contemporary learning is often more about making wise decisions in particular contexts, constrained by materiality, than about acquiring abstract knowledge.32 |
| Organisation-level theories of complex knowledge and routines |
| Tsoukas’ notion of ‘complex [organisational] knowledge’34 emphasises that knowledge in organisations is collective as well as individual, and embodied in business-as-usual patterns of acting and interacting. An organisational routine is defined as a repetitive pattern of interdependent action involving multiple actors.35,36 As experienced organisational actors, people ‘know the ropes’ — and usually know more than they can tell. People new to an organisation need to learn those ropes (for example, even if they know how to use a technology in general, they need to learn how it is used in the organisation). These distributed views of knowledge align with Gabbay and le May’s notion of mindlines: collectively generated and shared understandings that evolve through discussion and shared practices.40 |