To the Editor:
Sfard1 argues that the views of learning we hold will shape the way we approach our work as educators and researchers, illustrating this with two guiding metaphors distinguished by their intended goals for learning. The first, learning-as-acquisition, focuses on the purposeful accumulation of knowledge, skills, and attitudes. The second, learning-as-participation, focuses on full participation in a social practice, such as the practice of medicine. This metaphor explicitly draws upon the seminal work of Lave and Wenger,2 deriving from anthropological studies of learning outside the academy. Indeed, their work was designed to rescue the idea of apprenticeship, where learning arises from engagement in everyday practice.
It is interesting, therefore, that Cruess and colleagues3 argue that communities of practice should form the theoretical foundation of medical education, yet they rather puzzlingly position this within social constructivist thinking (learning-as-acquisition) rather than sociocultural thinking (learning-as-participation). Does this matter? I believe it does, as it again frames medical education in terms of the acquisition of knowledge, skills, and performed identities.
Reimagining medical education through the lens of learning-as-participation, however, would mean rather radically rethinking the curriculum. Authentic work becomes the curriculum for medical education, and learning arises through shared participative practices with those who share the care of patients as their primary endeavor—that is, all members of the health care team, not just doctors. The purpose of medical education therefore includes processes of becoming (a doctor) and belonging (to the health care team). Swanwick4 argues this point in terms of a move from cognitivism to culturism in medical education, Lingard5 from individual to collective competence. Although the intents of Cruess and colleagues’ article are admirable, they are perhaps another example of the ways in which the dominant views of learning in medicine continue to skew and distort different ways of thinking.
Clare S. Morris, EdD, MA(Ed)
Professor of medical education, Institute of Health Sciences Education, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; firstname.lastname@example.org.
1. Sfard A. On two metaphors for learning and the dangers of choosing just one. Educ Res. 1998;27:413.
2. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. 1991.Cambridge, UK: Cambridge University Press.
3. Cruess RL, Cruess SR, Steinert Y. Medicine as a community of practice: Implications for medical education. Acad Med. 2018;93:185191.
4. Swanwick T. Informal learning in postgraduate medical education: From cognitivism to “culturism.” Med Educ. 2005;39:859865.
5. Lingard L. What we see and don’t see when we look at “competence”: Notes on a god term. Adv Health Sci Educ Theory Pract. 2009;14:625628.