Letters to the Editor
We are pleased to reply to the letter from Dr. Morris concerning our article entitled “Medicine as a Community of Practice: Implications for Medical Education,”1 as it encourages a wider discourse on the fundamental nature of learning within the medical community that can only serve to enhance our understanding of this important subject. Her letter continues a debate between sociocultural and constructivist perspectives of learning that often overlap and complement each other.2 Dr. Morris favors a sociocultural approach, stating that “learning-as-participation” is preferable to “learning-as-acquisition,” referring to an article by Sfard3 proposing that both approaches represent different metaphors for learning that are not mutually exclusive.
We would like to make two points in reply. First, in our article, we synthesize much of the literature that views communities of practice as a social learning theory that results from a constructivist approach to education. We do not refer to any potential conflict between differing theoretical approaches and, in fact, believe that communities of practice entail both learning-as-participation and learning-as-acquisition.
Second, Dr. Morris seems to believe that the two approaches are incompatible, a point with which we disagree. We can turn to Sfard3 for support. She states, “The relative advantages of each of the two metaphors make it difficult to give up either of them: Each has something to offer that the other cannot provide.” In addition, we do not believe that the sociocultural approach focuses exclusively on learning-as-participation. Learning-as-acquisition is equally important. Our article acknowledges this and emphasizes the centrality of engagement and participation to learning within communities of practice. We continue to believe that the communities of practice theory is robust enough to encompass both approaches, either as metaphors or as foundational elements of the overall theory. As Packer and Goicoechea2 observe: “Whether one attaches the label ‘learning’ to the part or to the whole, acquiring knowledge and expertise always entails participation in relationship and community and transformation both of the person and of the social world.”
Richard L. Cruess, MD
Professor of surgery and core faculty member, Centre for Medical Education of McGill University, Montreal, Quebec, Canada; firstname.lastname@example.org.
Sylvia R. Cruess, MD
Professor of medicine and core faculty member, Centre for Medical Education of McGill University, Montreal, Quebec, Canada.
Yvonne Steinert, PhD
Professor of family medicine and director, Centre for Medical Education of McGill University, Montreal, Quebec, Canada.
1. Cruess RL, Cruess SR, Steinert Y. Medicine as a community of practice: Implications for medical education. Acad Med. 2018;93:185–191.
2. Packer MJ, Goicoechea J. Sociocultural and constructivist theories of learning: Ontology, not just epistemology. Educ Psychol. 2000;35:227–241.
3. Sfard A. On two metaphors for learning and the dangers of choosing just one. Educ Res. 1998;27:4–13.