Table 1.

Participants’ Responses Relating to Wenger’s Summarised Conceptual Framework for a Social Theory of Learning “Communities of Practice”

Theme 1: Responses relating to Meaning: “Learning as experience”
	Sample of Student Comments
The beginning of the workplace learning experience. Overall participants were enthusiastic to be in the clinical work environment. Examining patients and doing the work of “the doctor” not only provided a valuable learning experience; such autonomy further extended their professional identity.	“I like being able to examine and take a history from people without six watching opposite me, I have been waiting for it for years.” “I felt that it is ‘proper medicine’ for the first time in years.”
Some participants saw third year as a new beginning: This “re-learning” is involved in the transition from pre-clinical learning to the workplace, and is a sharp contrast to the structured pre-clinical preparatory experience of the controlled simulated setting of the Clinical Skills Laboratory.	“It is like being in first year again” – “it is so different to being on the wards every day for a week and “a little unpleasant for me as it was just so different.” “Yeah me too, I felt like a fish out of water, felt useless just for my first week then it improved.”
Inter-disciplinary observation Participants observed and reported the value of observing other health professionals at work; they expressed surprise in witnessing, that our members of the team provide “extended care,” through discharge planning, and witnessing an exchange of knowledge shared through mutual collaboration.	“There is, “Extended care” ….not just being concerned about fixing the patient up and sending them home.” The other members of the team, the social workers, or the Occupational therapist (OT) …. so that when you send them home you know that they are in the best possible condition. They are extremely concerned about the patients’ home situation.
Theme 2: Responses relating to Practice: “Learning as doing”
	Sample of student comments
Participants felt they were of great value to the team by writing in the case notes it was not only a good learning experience, as students performed small tasks for their team they moved from the role of “novice observer” and “peripheral participant” to that of legitimate participant to their team as seen in Figure 1.	Writing in the notes was the best learning experience for me because you learn what the team needs to do every day - although it was a daunting experience at the time. “I have a lot to do with written notes,” “I wrote in the patients notes, having to listen at the same time.” “I found that I was running walking and writing, it was fine because the intern would always help me.”
The introduction of electronic medical record (EMR2) allowed students to type patient document prior to a senior clinician signing off.	“EMR2 is much more comfortable – they let me do the typing.”
	“One of the positive things is that you can see a patient when they come in and build a relationship until they leave.”
Theme 3: Responses relating to Community: “Learning as belonging”
Supporting student learning	Sample of student comments
Clear directives Clear established frameworks of direction, which included guidelines, expectations and responsibilities, were provided to students during induction to specialised units.	“With emergency we had an introduction session first.” “We were given guidelines and work responsibilities.”
Active support Participants learned skills were extended by workplace clinicians who facilitated workplace learning by offering their support.	“Once the second intern started, it really helped me out. They said, I will teach you how to take bloods and then supervise you.” “The more staff the higher level of support.” “Since the change- over, there are just oodles of people.”
Theme 4: Responses relating to Identity: “Learning as becoming”
Role models - identity formation	Sample of student comments
Respondents witnessed positive clinician- patient interactions, which exhibited examples of positive role modelling in clinical empathy. This observation indicates that clinical decisions were made in a humane manner and rather than their previous experience in a simulated setting, empathy was conveyed in a real life situation, therefore, providing the students with a deep learning experience as direct witnesses to positive role modelling. Dealing effectively with a combative patient in a professional calm manner- is example of unconditional professionalism and positive role modelling.	“I have had many situations whereby I have seen fantastic clinician skills” “A clinician spoke to a family about minimal intervention about end of life; The patient was suffering from aspiration pneumonia and the clinician was very clear with the family regarding what he thought was the most humane thing to do.” There was a combative patient who said, ‘I do not think much of doctors’ and the doctor just sat and diffused the situation by sitting and listening- he just let the person run out of steam. -It may have taken ten minutes.
Although new to the clinical area, participants exhibited astuteness in identifying unprofessional behaviours. This is surely and extension of their own professional development and an extension of their pre-clinical training, as in the clinical setting they are witnessing the reality of previously learned behavioural skills.	“I saw a doctors and a resident talking at the end of the bed about the patients” cancer- Eventually the patient interrupted – “I thought you said; Cancer!” Then the consult said, “we were going through the differentials and mentioned ‘cancer’.”