237Workplace Learning
As medical students and residents become immersed in the clinical years, they tran-
sition from school-based learning environments into live, workplace learning envi-
ronments. Traditionally, the basic science years align closely with school-based
educational settings: classrooms, labs, self-directed/online learning time, and, for
some, problem-based learning in teams and small groups. The learning structure in
the basic science years is clearly defined (schedules, teacher directed), the knowl-
edge is broken down into smaller chunks (units, classes), professors and/or tutors
direct the learning process, and assessments are formal (tests, quizzes). The curricu-
lum is carefully crafted, objectives are clearly defined, and evaluations of perfor-
mance are standardized. When entering the clinical years, learning moves away
from the clearly defined structures of school-based learning and into a more
dynamic, less structured workplace learning environment. Some students and resi-
dents may have little prior experience learning “on the job.” Workplace learning
tends to be more process oriented, socially constructed, and ambiguous, and when
learners enter the particularly demanding surgical context, they may need guides to
help adjust to a more hands-on, relational approach to growth and development [ 3 ].
Researchers have explored the nature of workplace learning through a variety of
lenses (e.g., workplace learning, action learning, situated learning, and learning
organizations) [ 4 – 13 ]. While the lenses differ, the underlying arguments have simi-
larities: people within work environments are constantly learning in both formal and
informal ways [ 14 ]. The history of surgical education supports the idea that learning
through the practice of work is central to developing the necessary knowledge,
skills, and attitudes to become a surgeon. As a result, surgical education has heavily
relied on an apprenticeship model. The student/resident is proximally close to an
experienced surgeon who models, provides opportunities for practice, and, in time,
oversees the growth from novice to competent to proficient [ 15 ]. The apprenticeship
model might be questioned, and other models may have been offered, but what
continues within surgical education is a commitment to learning in the workplace.
This chapter scratches the surface of workplace learning; however, other chap-
ters may provide a more robust exploration. For this chapter, Billett [ 6 ] provides
four premises in connection with learning in the healthcare workplace:
- Learning occurs all the time.
- Workers engage in work activities they also remake and potentially transform.
- As clinical knowledge is a product of history, culture, and situational require-
ments, it has to be accessed and engaged with to be secured by workers. - Learning and development are two separate but interdependent processes.
Operating within the above premises, we argue, is the social and cultural nature
of working with others. In the surgical workplace, rounding, sharing experiences,
communicating with patients and families, making mistakes, and conducting team-
based procedures are done with high levels of social interaction. For brevity, we will
focus on Billet’s final premise that aligns with Vygotsky’s social development
14 The Surgical Workplace Learning Environment