Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, RGN Building, Rm 3231, Ottawa, ON, K1H 8M5, Canada.
Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
Adv Health Sci Educ Theory Pract. 2018 Mar;23(1):95-113. doi: 10.1007/s10459-017-9776-z. Epub 2017 Jun 9.
In 2007 the Cancer Care Ontario Hepatobiliary-Pancreatic (HPB) Community of Practice was formed during the wake of provincial regionalization of HPB services in Ontario, Canada. Despite being conceptualized within the literature as an educational intervention, communities of practice (CoP) are increasingly being adopted in healthcare as quality improvement initiatives. A qualitative case study approach using in-depth interviews and document analysis was employed to gain insight into the perceptions and attitudes of the HPB surgeons in the CoP. This study demonstrates how an engineered formal or idealized structure of a CoP was created in tension with the natural CoPs that HPB surgeons identified with during and after their training. This tension contributed to the inactive and/or marginal participation by some of the surgeons in the CoP. The findings of this study represent a cautionary tale for such future engineering attempts in two distinct ways: (1) a CoP in surgery cannot simply be created by regulatory agencies, rather they need to be supported in a way to evolve naturally, and (2) when the concept of CoPs is co-opted by governing bodies, it does not necessarily capture the power and potential of situated learning. To ensure CoP sustainability and effectiveness, we suggest that both core and peripheral members need to be more directly involved at the inception of the COP in terms of design, organization, implementation and ongoing management.
2007 年，在加拿大安大略省将肝胆胰服务进行省级区域化之后，成立了安大略肝胆胰（HPB）实践社区。尽管在文献中被概念化为一种教育干预措施，但实践社区（CoP）越来越多地被采用为医疗保健质量改进举措。本研究采用定性案例研究方法，通过深入访谈和文档分析，深入了解 CoP 中 HPB 外科医生的看法和态度。这项研究展示了如何在与 HPB 外科医生在培训期间和之后认同的自然 CoP 保持紧张关系的情况下，创建 CoP 的工程化正式或理想化结构。这种紧张关系导致一些外科医生在 CoP 中的不活跃和/或边缘参与。本研究的发现以两种截然不同的方式为今后的此类工程尝试提供了一个警示故事：（1）监管机构不能简单地创建外科手术中的 CoP，而需要以自然的方式支持其发展；（2）当 CoP 的概念被管理机构采用时，它不一定能捕捉到情境学习的力量和潜力。为了确保 CoP 的可持续性和有效性，我们建议核心和边缘成员都需要在 CoP 的初始阶段更直接地参与设计、组织、实施和持续管理。
