SAFILT Additional Concepts to Strenthen Facilitation: Situated Learning

Situated Learning

The ways in which debriefing can occur can be different, depending on the purpose of what is envisaged to be achieved. Whichever way you intend to do this, the group you are facilitating will benefit better from a more interactive approach to learning rather than a didactic teacher-driven debrief. A conceptual way of developing this is through a Situated Learning approach, which is probably better described as the development of a ’Community of Practice’. Arguably, the scenario candidates are a community of practice, albeit a small and brief one.

Engaging in a clinical simulation scenario and the following debrief are two components of one thing: Rather than constructing knowledge abstractly, as in learning from textbooks, the learners are doing knowledge, and as they do this knowledge they acquire it.

Whether engaging in a scenario or watching it, they form part of the community which in the following debrief can begin to construct that knowledge purposefully for their practice

Introduction

Jean Lave and Etienne Wenger developed the concept of situated learning as a way of describing how learning is essentially context-driven (i.e. situated). It is important to make a distinction between situated learning and situational awareness.

Situated learning suggests an alternative to the more traditional apprenticeship models of education and professional training and analyses the ways in which novices become integrated into a professional society or body. This is enabled by interaction and dialogue with others rather than through a ‘Master-Apprentice’ approach to learning.

Situated learning is a way of bridging the theory-practice gap. Rather then separate out education and training from practice, it suggests that they should be integrated.

Some Definitions

The concept of Situated Learning hinges around two key terms of jargon: Communities of Practice and Legitimate Peripheral Participation. As with all of these terms, their actual translation into use is far less of a challenge than might be imagined. To begin:

Communities of Practice

The basic premise of this is that these communities exist everywhere in ordinary life – work, school, family, neighbourhoods, and are made up of people with similar interests who want to learn more about something or improve it. The learning that takes place between them is inherently social.

Wenger (2007) suggests that communities of practice are distinguished by having three crucial elements:

1. The domain. The domain is an area of interest which is shared and which people are committed to. In this case the domain of improving medical practice.
2. The community. The community is where relationships are built and where information is shared between one another. It is where joint activities take place and where people learn from each other.
3. The practice. The members are practitioners. They share resources, stories, experiences and tools. They explore ways of managing recurring problems over time and with sustained interaction.

Legitimate Peripheral Participation

This construct suggests that learning is primarily a social activity rather than one through which learning is acquired via certain models or approaches. The new learner begins life on the edge of a profession, but over time and through the acquisition of key skill components and social participation they become increasingly absorbed into its centre. They learn to speak, act, and improvise in ways that reflect that particular community’s identity. The relationships built within this community are always renewable and able to change alongside the development of new knowledge.

A model that brings these two definitions together can look something like this.

In the outer layer are the kinds of factors that newcomers bring to their learning. The ways in which they experience, interpret and negotiate the world as they understand it. Their initiation into this new world involves living and acting in that new world in mutual relationships and there are certain structures which direct the learning focus: Instruments, documents and forms of learning. Participation and reification (making the learning feel real and useful for practice) combine so that they create a powerful community of practice and group identity.

Situated Learning in Practice

In the case of medical simulation and the debriefing of scenarios perhaps we are more concerned with developing a strong Community of Practice. The raw materials of the three domains opposite are all available for use and are brought to the scenarios and debrief by the participants.

For Foundation Year doctors, the vast majority hope to develop their clinical competence from the moment they enter FY1 until the moment they exit FY2 and onwards. For the facilitator, they hope to enable this process as best as they can, either by imparting knowledge where necessary or enabling others to do this. The domain of improving medical practice is already an area of shared interest and commitment.

The community is formed through engaging in scenarios while others watch as they are played out. Learning in action takes place both in the simulation lab and in the observation/console rooms through social interaction.

Learning on action is then transferred into the debrief room where a sharing of experiences both inside of and external to the scenario can take place.

What is crucial for the candidates in the community is that they may not know how to create the climate to share observations or experiences and knowledge. The facilitator is key to enabling this to happen productively and safely for the participants. Questions which open up discussion between the group members rather than create an answer reflected directly back are what you are hoping to achieve.

Communities of Practice thrive on sharing information and gaining new knowledge. The facilitator can provide the structure and focus for this to occur, with occasional corrections or advice. However, when a group is actively listening to the discussion you will see the evidence transferred into the subsequent scenarios and debriefs.

Key Questions to open up discussion

• Let’s start by asking what was good about what went on in there?
• Has anybody experienced or observed this (event) in practice?
• What do we think about other ways that that could have been done?
• Did anybody notice…?
• You did something really interesting in there. Would you like to share it with us?

Rather than be seen as a prescription, these questions need to be seen more as a ‘genre’. They move the debrief away from a potential ‘seminar’ by the lead facilitator (as a form of Master-Apprentice model) and place it firmly in the hands of the community of practice to share, explore, and debate. The role of the facilitator then shifts from being the ‘font of all knowledge’ to enabling the debate to remain focused, picking out learning points from the discussion and providing accurate clinical information as required.

ACCESS VIDEO FILE SITUATED_LEARNING_1 NOW USING THE BUTTON AT THE TOP RIGHT OF THIS WEBPAGE

This first in a sequence of clips beings with an opening question focused clearly on the affective domain.  This opens up some thinking around self-evaluation from the outset.

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The second clip carries on from the initial opening gambit, but becomes more clearly focused towards the events, unfurling in the scenario and the responses to them.

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It is not until some way into the debrief that the chronological events of the scenario are outlined.  In this debrief a particular platform has been built before the issues of practice can be explored.

Situated learning has emerged from an anthropological view of the world, focusing on the way in which things are communicated, what is communicated and its interpretation amongst purposeful groups. It is inherently a cultural as well as a psychological approach to the process of learning.

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References/Further reading

Photographs above kindly supplied by the Barts and the London NHS Trust Medical Simulation Centre

Wenger, Etienne (c 2007) 'Communities of practice. A brief introduction'. Communities of practice [http://www.ewenger.com/theory/.
Lave, J., & Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge, UK: Cambridge University Press.