Department of Medical Ethics and Philosophy, Erasmus Medical Center, Erasmus University Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
Adv Health Sci Educ Theory Pract. 2013 Oct;18(4):597-615. doi: 10.1007/s10459-012-9398-4. Epub 2012 Aug 16.
In this article we discuss clinical workplace learning using a dual approach: a theoretical one and an empirical one. Drawing on the philosophical work of Aristotle, Polanyi and Schön we posit that the 'knowing and acting' underpinning day-to-day medical practice is personal and embraces by nature a tacit dimension. Consequently, imparting and acquiring this knowledge type necessitates personal interaction between trainer and trainee. The tacit dimension particularly influences modelling and feedback. In our empirical exploration we explore these educational routes in two disparate disciplines: surgery and paediatrics. We use a longitudinal design with in-depth interviewing. Our conclusion on modelling is: modelling is a dynamic and fragmented process reflecting discipline bound characteristics and working styles. On feedback it is: 'feedback' serves as vehicle for three distinctive forms of commenting on performance, each holding a specific power of expression for learning. We propose to view clinical workplace learning as: an interactive master-apprenticeship model encompassing modelling and feedback as natural educational routes. We conceptualise modelling and feedback as 'function' of interaction (developing grounded theory). Modelling function and feedback function may serve to study these routes as didactical components of ongoing interaction between trainer and trainee rather than an educator-driven series of unrelated events.
在本文中，我们采用双重方法讨论临床工作场所学习：理论方法和经验方法。借鉴亚里士多德、波兰尼和舍恩的哲学著作，我们假设构成日常医疗实践基础的“知与行”是个人的，并且本质上具有隐性维度。因此，传授和获取这种知识类型需要培训师和学员之间的个人互动。隐性维度特别影响建模和反馈。在我们的实证探索中，我们在两个截然不同的学科中探索这些教育途径：外科和儿科学。我们采用纵向设计和深入访谈。我们关于建模的结论是：建模是一个动态和碎片化的过程，反映了学科特有的特征和工作方式。关于反馈，它是：“反馈”是对绩效进行三种不同形式评论的载体，每种评论都对学习具有特定的表达力。我们建议将临床工作场所学习视为：一种互动的师徒模式，将建模和反馈作为自然的教育途径。我们将建模功能和反馈功能视为（发展扎根理论）互动的“功能”。建模功能和反馈功能可以作为培训师和学员之间正在进行的互动的教学组成部分来研究这些途径，而不是一系列不相关的教育者驱动的事件。
