Physicians’ Professional Learning In Working Context

This study focuses on the physician team’s professional learning in working context, aiming to describe and explain the phenomena and mechanisms of the physician team’s micro-professional learning in working context. It takes a Coronary Care Unit (CCU) of a northern China’s large comprehensive public hospital as a case, using a field work method to collect a large amount of first-hand data and make an analysis on the data by using single independent coding, group coding and multiple independent coding.On the basis of the description of the CCU physician team’s working context (Chapter4) and analysis of the process of professional genres (Chapter5), this paper makes the following explanation to the phenomena and mechanisms of the physician team’s professional learning in working context based on expansive learning theory.First, the physician team will identify professional learning phenomena in working context by way of "marking". Marking can be divided into "direct markers" and "indirect markers", and "teaching discourse markers" are the most typical indirect markers; teaching discourse markers, which can only identify the transfer of knowledge and skills of the physician team, failing to identify the process of expansive learning based on problem solving (Chapter6).Second, the expansive learning of the physician team occurs in the process of problem solving, CCU physicians often face four kinds of clinical problems (routine problems, intractable problems, social problems and complicated problems), each of which has its own specific problem-solving model. The physician team "learns from people" as well as "learns from model". When models for solving these problems failed, expansive learning would have got opportunities to start.(Chapter7)Third, solution of a problem, the process from an individual to a team can be called "evoking", it takes the vertical division of labor as the premise. Its implementation process can be divided into such three phases as speaking, undertaking and realization; the similar mechanism of working context and scientific innovation context promotes the expansive learning. But essential differences between the two contexts have led to the termination of expansive learning. This phenomena is known as "image".(Chapter7) Based on these discriminations and explanations, this paper concluded as follows:First, physicians or physician teams in working context have a professional competence called "professional genre competence", specifically including competencies of professional genre discriminating, professional genre using and professional genre development. Professional genre competence varies from person to person. The team professional genre competence is a joint capacity which is beyond the individual capacity of its members.Second, in working context of CCU physician team, the starting and terminating mechanisms of expansive learning can be explained respectively by "evoking" and "image", evoking is the refinement and correction to "questioning" stage of expansive learning model. Image then reflects the reasons why expansive learning fails to enter reflecting and the consolidating stages.Third, the main characteristics of the physician team’s professional learning in working context is "professional authority ranking", the main problem is that the teaching content of professional genre and professional genre function fail to achieve completely docking.This paper suggests that physician teams strive to cultivate the ability of professional genre, design the courses of professional genre and pay attention to the system implementation of professional genre; advising future researchers to continue to explore the physician team’s professional learning in working context by implementing formative intervention research (the change laboratory), multiple case study and quantitative research.