Alignment and fit

I want now to move on to consider how the importance of a sense of identity appears to influence those seeking to gain membership to a profession-specific community of practice. I am returning again to Eliza and to a feedback interaction that was observed between her and her personal tutor, Rose. Rose is an experienced academic and comes from the same professional background as the course that Eliza is studying. Within her personal tutor meeting with Rose, Eliza was articulating her frustration regarding an interprofessional module for which Rose was the module leader. As module leader and given that this module was interprofessional in nature, members of staff from other disciplines contributed to its delivery. Eliza described the lectures by other members of staff as boring and claimed that they were focused on disciplines other than that of her own studies. She went on to state:

We are not seeing where [our discipline] fits into it because an [academic from our own discipline] hasn’t told us how [it] fits into it … (Eliza)

It appears that Eliza perceives this teaching as not supporting her own professional identity because these aspects of the module are being delivered by colleagues other than from within her own discipline. As an example (and including my own insertion of “nursing” to aid clarity), she is suggesting that only a nurse can deliver material that relates to nursing because only a nurse can make clear the relevance of the topic to the nursing profession. On a superficial level and in the spirit of effective interprofessional and cross-disciplinary working for the greater good of patient care (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013) Eliza’s view is naive but it illuminates the importance of having an overt confidence in a professional identity when novices are developing a professional role, and a professional presence to students within mixed or interprofessional learning

environments.

The importance of students recognising professional relevance and authenticity is

furthermore added to by Rose herself. Later in the same personal tutor meeting between Eliza and Rose, they discussed another module that was profession-specific. Within her

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discussion with Eliza, Rose emphasised that the module was “very (Rose’s emphasis) relevant to [Eliza’s professional] practice”. By Rose’s own emphasis and overt

acknowledgement of the profession-specific elements of the course, she is inadvertently drawing attention to the seemingly less favourable and less professionally-relevant aspects. By default, Rose is supporting Eliza’s perception that the interprofessional dimensions are of less value to her as a novice healthcare professional than the profession-specific elements of the course because they are less authentic to the profession-specific community of practice into which she is moving.

The integrated care agenda (Collins, 2016; National Collaboration for Integrated Care and Support, 2013) highlights the need for all healthcare professions to not only contribute their profession-specific skills to patient care but also to recognise the need to contribute more generically to holistic patient care. This is such that health and social care is more seamless, patient-focused within a changing health care climate, and cost-efficient. There is

international evidence exploring blurred boundary working within healthcare, including use of the Calderdale Framework (Nancarrow, Moran, Wiseman, Pighills, & Murphy, 2012; R. Smith & Duffy, 2010), to ensure that patients are receiving the best care by the right people with an appropriate skillset at a clinically-recognised right time. Based on such work it is paramount that student healthcare practitioners fully understand their role beyond their profession-specific boundary and into wider health and social care.

Rose’s unintentional highlighting that the interprofessional module is less relevant to Eliza’s professional development than the profession-specific module is of concern. Role-modelling is an important factor within development, both personally and professionally. In

considering a role-modelling approach to learning (Armstrong, 2008; Kilcullen, 2007) Rose’s apparent belief is troublesome because it may be self-perpetuating within a professional community of practice as new graduates, like Eliza, accept this belief and reinforce it within the community. As Eliza moves from a peripheral place to a more central place within a professional community of practice, she needs to have current and professionally-genuine values. Unintentional learning from unintended feedback is something that educators need to be consciously aware of. The impact of such “learning” from unintended feedback could augment underpinning values and beliefs within a given community of practice that do not develop that community in a positive manner nor meet the healthcare needs of the

population.

In order for a community of practice to be reflected as such, that community needs to have a shared understanding of fundamental and underpinning community values and beliefs

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(Fenton-O'Creevy et al., 2015; Wenger-Trayner & Wenger-Trayner, 2015; Wenger, 1998). The needs of healthcare consumers – i.e. patients – and the challenging financial climate in which healthcare services need to be delivered necessitate a different professional view to that experienced during economic buoyancy (Appleby, Ham, Imison, & Jennings, 2010). To meet the financial and consumer demands, healthcare professions need to be able to recognise the diversity of the role that they might play (R. Smith & Duffy, 2010), not only that which is professionally specific. Rose failed to highlight to Eliza the crucial role that the interprofessional module will play within the broad scope of her education toward becoming a healthcare practitioner. It is interesting to consider why this might be so and whether Rose herself did not see the value of the interprofessional aspects of the course or whether she was simply focussed on the profession-specific components.

Both university-based and practice-based educators at a pre-registration level have an important role to play in empowering the next generation of healthcare practitioners. It is essential though that this empowerment authentically reflects the role that the profession has across the spectrum of healthcare. It is crucial that it is not professionally narrow nor unrealistically reflective of the scope and breadth of that profession’s contribution to contemporary healthcare service delivery.