Bridging patterns and practice: Cultivating shared understanding in health professions education

Short abstract

Bridging theory and practice in health professions education requires fostering shared understanding of concepts, recognising how context, experience, identity, and systems influence their enactment, and ensuring multi‐level support.

1. INTRODUCTION

The health professions education (HPE) community's diversity means contributors to HPE education and scholarship often use identical terms with varying intended meanings. As an example, in this issue Patocka et al. ¹ delve into heterogeneity in use of the term feedback, applying a pattern systems approach to more deeply analyse established models. A pattern system maps out the components (or pattern representations) that contribute to the shared understanding of a concept. ² Patocka et al. ¹ used this innovative approach to examine 11 feedback models allowing them to demonstrate that there is ‘disorder in the conceptualization of feedback in our field’. While there was some convergence (components that were common across the models), there was also substantial divergence in the conceptualisation of feedback, both across and within the categories of feedback models (coaching, audit and feedback, multi‐source feedback and augmented sensorimotor feedback). If we lack shared understandings of feedback concepts such as coaching, then there is the potential for miscommunication, frustration and ineffective educational practice. This incoherence in the conceptualisations of feedback is likely to be exacerbated in practice, where these feedback models are applied. In this commentary we examine how context, experience, identity and systems influence how these conceptualisations are enacted in practice, to help readers think about how incoherence may be limited.

This incoherence in the conceptualisations of feedback is likely to be exacerbated in practice, where these feedback models are applied.

Put yourself in the shoes of a clinician educator in a busy tertiary hospital. You have been fulfilling this role for 2 years, you value education, and you have a strong educator identity. However, there are staff shortages at your institution and you receive no protected time to engage in education focused work. You have been wanting to complete a postgraduate degree in HPE but have not yet found the time to do so. There is a new requirement that all trainees must be involved in coaching partnerships, and you have been assigned three trainees to coach. You had registered to attend the professional development offered by your hospital on coaching, but clinical emergencies have prevented you from attending. Your understanding of coaching is based on coaching you received at a previous workplace, and you take that experience into the coaching sessions. After several sessions it is apparent that your understanding of coaching differs from your trainees', resulting in unease, tension and misunderstanding around the process and goals of your coaching sessions. In other words, there is incoherence in the conceptualisation of coaching between you, as the clinician educator, and your trainees.

2. CONTEXT, EXPERIENCE AND IDENTITY

This example illustrates how context, experience and identity can all play a role in how conceptualisations are enacted in practice. The context (in this example, the workplace, including whether it has a supportive educational culture and the availability of staff and resources) can significantly influence how feedback is implemented. ³ , ⁴ A clinician's experience, whether they are a seasoned educator or new to the role, or whether they actively seek out or are mandated to contribute to educational activities, shapes their approach to engaging in feedback conversations. ⁵ Moreover, an individual's identity as an educator, reflected in their motivation to engage with education‐related continuing professional development (CPD), can profoundly affect their commitment to and execution of effective feedback practices. ⁶ , ⁷ So while you might infer that those with more experience and stronger identities as educators are more likely to utilise feedback models and have conversations with learners to ensure there is a shared understanding of the concepts being used, in reality the context in which they work and the support (or lack thereof that they receive) can substantially influence this. ⁸

Context, experience and identity can all play a role in how conceptualisations are enacted in practice.

3. SYSTEMS

Our example also offers some insight into how systems (whether they be local, institutional, regulatory or accreditation) can influence the enactment of conceptualisations in practice. While the introduction of a new requirement that all trainees must be involved in coaching partnerships may be educationally warranted, without adequate support from multiple levels of the system the utility may be impacted. CPD systems around the world provide a real‐life example of the impact of this issue. Globally, different systems have been implemented, with wide variations in requirements around participation in CPD. ⁹ One such variation lies in whether collecting and incorporating feedback is required and in the level of guidance provided for engaging in feedback. Perceptions of the utility of the various forms of feedback differ, such as patient feedback versus multi‐source feedback. ¹⁰ This may arise from a lack of shared understanding between clinicians and CPD systems on the added value of feedback from multiple perspectives. While there is generally a shared understanding of the benefit of CPD systems in theory, in practice, the lack of support, the disconnect from clinical practice and the bureaucratic burden result in varying degrees of engagement and oftentimes a lack of shared understanding of the underlying system's goals and best ways to achieve them. ¹⁰ This illustrates how one component of the system setting requirements without other parts of the system being responsive to such a change can influence enactment in practice.

One component of the system setting requirements without other parts of the system being responsive to such a change can influence enactment in practice.

Feedback is not the only conceptually contested term in medical education. In fact, there are many. Within the area of regulation and CPD for example it is argued that ‘there is not even any agreement about basic terminology. Even if such an agreement about terminology could be achieved, it will not be easy to achieve consensus about its contents’ ¹¹ (p. 639). Clearly, the pattern system approach used by Patocka et al. ¹ in this issue offers a way to begin to develop shared understandings of a range of concepts in HPE. While pattern systems are useful for creating shared understanding, as we have argued simply having the pattern system is not enough when it comes to implementing models in practice. Thought needs to be given to how experience, identity, context and systems can influence how concepts are enacted in practice, and how we can better equip those involved in education with accessible ways to build shared understandings, models and theories into their practice. In order to bridge patterns and practice local, institutional, regulatory and accreditation systems need to support them to do so.

In order to bridge patterns and practice local, institutional, regulatory and accreditation systems need to support them to do so.

Allen LM, Sehlbach C. Bridging patterns and practice: Cultivating shared understanding in health professions education. Med Educ. 2025;59(11):1148‐1150. doi: 10.1111/medu.70013