title: Contextual dynamics in clinical workplaces: learning from doctor-doctor consultations.
abstract: BACKGROUND
  Some studies have explored the role of learning context in clerkships and in clinical teams. Very little is known, however, about the relationship between context and competence development in more loosely framed, day-to-day practices such as doctor-doctor consultations, although such interactions are frequent and typical in clinical work.
  
  
  METHODS
  To address this gap in the literature, a study was conducted using semi-structured interviews in four different hospitals and participant observation at one site. Inductive content analysis was used to develop a framework. Special reference was made to the principles of situated cognition.
  
  
  RESULTS
  The framework illustrates how different situational, personal and organisational factors interact in every learning situation. The interplay manifests in three different roles that doctors assume in highly dynamic ways: doctors learn as 'actors' (being responsible), as 'participants' (being involved) and as 'students' (being taught); contextual influences also impact on the quality of learning within these roles.
  
  
  CONCLUSIONS
  The findings add to the current literature on clinical workplace learning and to the conceptualisation of context in the field of education. The practical contribution of the research lies in disentangling the complex dynamics of learning in clinical environments and in helping doctors and medical educators to increase their responsiveness to contextual factors.
authors.affiliation: Institute for Information Systems, HSW, University of Applied Sciences and Arts, Northwestern Switzerland, Basel, Switzerland. christoph.pimmer@fhnw.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Pimmer
authors.forename: Norbert
authors.initials: N
authors.lastname: Pachler
authors.forename: Urs
authors.initials: U
authors.lastname: Genewein
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D006276:Health Facility Size; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007400:Interprofessional Relations; D007858:Learning; D008297:Male; D009042:Motivation; D015279:Organizational Culture; D020377:Self Efficacy; D013663:Teaching / Q000379:methods; D013997:Time Factors; D016526:Workload; D017132:Workplace