THE APPLICATION OF LEARNING TO CLINICAL PRACTICES

The Application of Learning to Clinical Practices



The Application of Learning to Clinical Practices

Introduction

Reflective practice has been widely and consistently exhorted as a desirable and necessary attribute of a competent practitioner (Shepard & Jensen 1990, Graham 1995, Clouder 2000, Donaghy & Morss 2000). A criticism of reflective practice has been that it is seen as being introspective in nature, relating to individual knowledge thus denying a public arena for reflective practice (Clouder, 2000). This could be said not just of individual professions, but also between professions - of multidisciplinary working.

Discussion

McGrath (1991) identifies the main advantages of interdisciplinary working as:

* A more effective provision of service, by encouraging overall planning and goal orientation

* A more efficient use of resources, enabling specialist staff to concentrate on specialist skills

* Greater job/work satisfaction by promoting a more relevant and supportive service

Freeth & Nicol (1998) supported claims of multidisciplinary collaboration commencing at undergraduate level resulting in better interprofessional working, by addressing perceptions and stereotypes that can impede this process. Whilst recognising that ".... at a professional level, several organisations subscribe to the concept of shared learning better known as multidisciplinary education" ,Nyatanga, (1998) identifies three main barriers that may obstruct shared learning:

* Previous single-disciplinary training

* Professional territoriality

* Professional ethnocentrism derived from professional identity and socialisation.

The Department of Health (2000) has been explicit in the support of inter-professional learning, stating "The Government intends to build on successful initiatives to make inter-professional education a key feature of NHS education over the next few years." The same document describes how "learning together" was claimed to deliver added value for practitioners through developing understanding of roles of other professionals and team-working skills from "an early stage in the curriculum." Taking this perspective, it is argued that undergraduate reflective experience should not be limited to university-based teaching and learning and certainly not at a uniprofessional level. It would seem much more appropriate to use the reality of clinical practice to explore the experience of learning on a multiprofessional level. From data collection students have recognised the influence of context on learning:

* "Attitudes, skills, and behaviours acquired clinically are more profound and lasting than those acquired in university setting."

*"Placements were the most valuable tool in understanding the multidisciplinary team."

Observation in Clinical Settings

A clinician's approach to assessment is driven either explicitly or implicitly by their theoretical orientation. I declare my theoretical orientation to contextualize this entry. I understand normal and abnormal behaviour from a parallel distributed processing (PDP) connectionist neural network (CNN) approach to learning and memory that includes both cognition and affect. Tryon (1995) has given introductory details of this position, and reasons for holding it. McLeod, Plunkett, and Rolls (1998) provide coverage that is more complete. I refer to all PDP CNN models as neural network learning theory (NNLT) because they are brain-inspired memory systems that learn from experience. Memories are learned and learning implies memory; otherwise learning would not be cumulative. Consequently, one can speak of learning and memory as interdependent facets of a ...