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Connecting clinical practice and higher education

Ian Davies and Paul Orsmond outline a model for progressive degree apprenticeship education in biomedical sciences.

Focusing on the workforce changes and challenges COVID-19 has presented, in last June’s issue of the Biomedical Scientist, we highlighted a developing trend in biomedical science – addressing the new progressive NHS Long Term Plan demands a more agile workforce. To meet this transformational change, we have asserted that the false dichotomy between university and practice-based biomedical education needed to be reconfigured.

Our experiences delivering degree apprenticeship education has allowed us to conceptualise learning as occurring within a community of practice, where learning is understood as developing a professional identity. In this way an autonomous practitioner biomedical scientist can develop enduring learning practices to meet fresh challenges with agility, moral and ethical responsibility.

In this second article we present a model to encapsulate the changes to biomedical scientist education that degree apprenticeships bring. The model consists of domains of learning that are captured within a four-stage Community Personalised Learning Framework (CPLF) (Figure 1, below). 

Stage 1. Direct domain of learning participation:

Weekly engagement with blended modular learning material provides ample space for negotiation of meaning within four domains: (1) tutor interaction, (2) academic delivery, (3) peer-to-peer interaction and (4) workplace mentoring. These four domains of practice form the community of practice for apprenticeship students. Monitoring of weekly engagement and understanding is supported by signposted opportunities for discussion, differentiation and feedback, enabling theory to be applied in practice.

Stage 2. Learning domain through participation in targeted academic and pastoral support:

Targeted and self-referred intervention by other university communities of practice, such as support services, digital services and subject librarians provides an academic and pastoral scaffold to support wellbeing, engagement, and learning. This domain supports immediate one-to-one guidance with online and personalised support to develop learners’ academic practice and professional identity, providing a rich opportunity for developing interdependence as a learner.

Stage 3. Learning domain through academic community mentorship:

This contributes to continual cross-modular and longitudinal mentorship by an academic mentor, where students and mentors negotiate meaning. This will support the transition to higher education (explore), before building the professional and academic identities for university-level study (achieve). These will be enhanced to develop appropriate discipline-stretch (extend), and the professional identities needed for career progression (aspire).

Stage 4. Learning domain through monitored progress, review, and oversight:

Regular progress reviews triangulate learning domains such as workplace and academic experiences, developing the workplace learning environment and set targets for progression. Close, historical liaison between module tutors, academic mentors, work-based education officer and course leader identify students with community learning progression, or at-risk, marginalised community learners.

Learning principles underpinning the CPLF:

Learning is an experience of meaning. Meaning is achieved through negotiation with others in a community or network. In this way learning is a social process, and all learners are interdependent. Thus, learning is a negotiating process, and it is through developing students’ ability to negotiate that we develop enduring learners with the capacity to meet current learning and professional needs but who have the capability to master further learning challenges when required. In this way, learner identity changes as practitioners make sense of new experiences. Through negotiating new meanings in ongoing practice, students’ knowledge changes. This is referred to as knowledgeability.

The CPLF illustrates several community examples of where negotiated meaning can occur. For example, in Stage 1, learning occurs in the dynamic “jigsaw” at the centre of the framework, allowing negotiated meaning between peer-to-peer interactions, engagement with tutors or in workplace mentoring. Once such learning is occurring, students can move and use Stage 2 of the CPLF, where cross community learning occurs as students interact with members of the support service community to enhance their individual practice.

Stages 1 and 2 occur throughout the period of apprenticeship study, giving learning an historical context and developing the negotiating process as interdependence and independence evolves. As autonomous learners negotiating individual meaning, students interpret the course differently; finding their own knowledge of importance. That is “personalised” learning, and by integrating experiences from the workplace and university, the CPLF model shapes the identity change needed for career-long agile learning.

The CPLF also allows for a longitudinal approach to apprenticeship study to be investigated, and provides opportunities for specific practices to be participated in. Stage 3 considers a specific aspect of participation that occurs between students and academic mentors, and highlights key themes: explore, achieve, extend, and inspire. A longitudinal presentation of Stage 3 can be shown over four years of study, with suggested topics for consideration:

Year 1. Explore – Support for individual student transition into higher education (HE), with an emphasis on translating (not transferring) existing professional practices, including competences, into new learning through HE experiences. Here, identifying and signposting support mechanisms to enable learner autonomy is important. Encouraging reflections on changing student identities, for example the change in identities before apprenticeship study and on transition into HE, provides a good way to introduce personalised learning.

Year 2. Achieve – Reflection on the community learning practices built during Year 1 reminds students that knowledge changes because a person participates in ongoing practice. Students need to recognise those new negotiating practices that they are developing and with whom. Such practice can encompass workplace competences, but with the emphasis on negotiating meaning and the development of academic and professional identities necessary to progress through higher levels of academic study. Personalised learning can be achieved in several ways: guiding the learner to recognise what is important to them in terms of content and emphasising learning as a social process of becoming a member of a community of practice; expanding the dialogue of the social learning to integrate the values, beliefs, and practices of the community of biomedical scientists, and finally, developing responses to feedback and acknowledging that feedback can have both immediate and delayed value in developing new practices.

Year 3. Extend – Utilising personalised approaches to learning develops professionals who can critique and, where necessary, challenge long-held values and beliefs of a community. This is imperative in creating the new, agile workforce. Development of academic and professional identities further strengthens the critically evaluative skills needed to demonstrate the higher levels of understanding during the final years at university and consolidates feedback as a way of developing new knowledge. As well as having immediate value in enhancing grades, feedback then feeds forward into an evaluative approach to continuing autonomous practice.

Year 4. Inspire – Years 1–3 provide sound preparation for the transition from undergraduate study into professional practice as fully autonomous practitioners and career-long learners. This year allows consideration of onward career journey, including career structures, creating opportunities and mentoring. The development of new academic and professional identities allows students ownership to face and resolve community concerns that are not obvious to non-community members – using their newly developed skills and knowledge to identify and solve unmet needs. Negotiation provides opportunities for critical dialogue between community members and focuses on leadership, its development and implementation. This enables students to advance the boundaries of the community of practice of biomedical scientists in their onward careers.

Stage 3 of the CPLF provides a rich learning culture requiring review and oversight and that is provided at Stage 4. Stage 4 monitors learners progressing and identifies those at risk and not progressing (not learning). At-risk students may be understood as those not being able to negotiate meaning, hence no learning occurs. It is important to understand non-progression as community marginalisation, and not an individual event. Non-progression affects the whole community. Understanding non-progression in this way means that resolution of non-progression requires application of a community approach and not just, for example, further assessment opportunities within a decontextualised context. 

By reconsidering and reshaping the integration of work and university learning in the context of identity development in a community of practice, the ability to develop a highly agile, evaluative and autonomous biomedical science workforce is amplified.   

Ian Davies is a Biomedical Scientist and Healthcare Science Course Leader at Staffordshire University. Paul Orsmond is a member of the Staffordshire Centre of Learning and Pedagogic Practice.

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