Focusing on future learning environments: Exploring

Journal of Interprofessional Care, 2011; 25(6): 391-393 Copyright © 2011 Informa UK, Ltd. ISSN 1356-1820 print/ISSN 1469-9567 online DOI: 10.3109/13561820.2011.624809

EDITORIAL

Focusing on future learning environments: Exploring the role of space and place for interprofessional education importance of the built environment in shaping patients and families’ experiences of their care (e.g. Gesler, Bell, Curtis, Hubbard, & Francis, 2004; Gesler, 1992; Poland et al., 2005). On the rare occasions when space is considered in health professions education research, this work usually explores the development and assessment of educational activities (e.g. Swanwick, 2005). In a health professions education context, learning is most broadly defined as the acquisition of skills, knowledge and patterns of behaviour. Theories in this domain overwhelmingly focus on the learning occurring at the individual level, such as cognitivism and behaviorism (Bleakley, 2006; Swanwick, 2005). Theories that focus on the individual are also important in the competency-based approaches to curriculum development and evaluation. However, recently, researchers have begun to explore and apply socio-cultural learning theories to research in this domain (Bleakley, 2006; Swanwick, 2005). These theories most often focus on the learning that takes place in the workplace, such as the hospital or the clinic, and examine the social and relational aspects of education. Examples include workplace learning, situated learning theory and communities of practice − many of which are beginning to gain popularity in the interprofessional education field (e.g. Barr, Koppel, Reeves, Hammick & Freeth, 2005; Howkins & Bray, 2008). However, although socio-cultural learning theories appreciate the context specificity of learning, research on this topic does not explicitly conceptualize nor empirically explore the nature and impact of space and place on learning. Bleakley, Bligh, & Browne (2011) suggest a number of ways in which education and place are closely intertwined. These include: changes in hospital architectural styles and their affect on care practices and styles of work; the location of education activities throughout undergraduate education and the spatial account of vertical hierarchies and horizontal geographies of interprofessional work that connects students with patients. Importantly, Bleakley et al (2011) link place with identity and power to critically examine explicit and implicit ways health professions education is affected by, and also affects place. We argue that this avenue of inquiry constitutes a critical nexus point for the development of interprofessional education.

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Introduction While space and place have been important units of analysis in studying learning across a number of social science domains (e.g. environmental studies), there has been little research exploring these elements in either the health professions education or the interprofessional education literature (Leander, Phillips & Taylor, 2010). This editorial highlights the importance of acknowledging and beginning to understand the role of space and place in interprofessional education. Specifically, our aim is to initiate a dialogue about how space, place and learning can affect the design and implementation of this type of education. We suggest that understanding the conceptual and practical relationship between space, place and learning is necessary to the construction and reconstruction of learning spaces that aspire to follow interprofessional education principles (e.g. student-centredness, flexibility, interactivity, collaboration and communication).

The absence of space and place in health professions education Space and place are units of analysis that are often used in geography and environmental studies (Gesler, 1992; Kearns & Joseph, 1993). In general, space is defined by geographic location and material form − referring to abstract geometrics (Gieryn, 2000); while place is defined not only by geographic location and material form, but by the meaning and value that people associate, attach and invest in a physical space (Poland, Lehoux, Holmes & Andrews, 2005). Kearns and Joseph (1993) differentiate these two factors in the following way, “… place [as] studied with an eye for its meaning for people; space [as] analyzed in terms of its quantifiable attributes and patterns” (p. 712). As a result, place can be seen as a negotiated reality whereby humans must interact with both the environment and other humans to create, maintain and (on occasions) contest place (Gesler, 1992). Both space and place are, however, under-conceptualized in the health professions education literature. In a health care context, space and place most often appear in health services and patient-centred research studies that examine the

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The nexus point: The interprofessional learning environment In education, learning occurs across three domains − the formal, informal and hidden curricula. The formal curriculum is the explicit and intended curriculum which is offered and endorsed by the educational institution (Hafferty & Franks, 1994). The informal curriculum is an unscripted and ad hoc curriculum which mostly unfolds in the interpersonal relationships between faculty and students outside of the ‘classroom’. The hidden curriculum is, importantly, the influence that functions at the level of organizational structure and culture (Hafferty & Castellani, 1998). The education that occurs across all three domains is directly involved in the professionalization, socialization and enculturation of students into their respective health and social care professions (Hafferty, 1988). What is of importance here is the connection between space, place and interprofessional learning within previously traditional profession-specific learning environments that create particular professional cultures and identities via the hidden curriculum. As Hafferty and Castellani (1998) argue, the function of the hidden curriculum is to ensure that learning environments promote the development of appropriate professional attitudes. Research on the socialization of health and social care professionals is most often associated with the hidden curriculum, and reveals it has an indirect and implicit effects on the professional development of learners over time (e.g. Becker, Geer, Hughes, & Strause, 1962; Hafferty & Castellani, 1998). However, a spatial understanding of the effects of the hidden curriculum on the socialization of health and social care professionals has not yet been explored (Kelly, 2010). Furthermore, there is a lack of a relational understanding of how the learning processes in one health care profession affects the processes in other professions; and how space and place may impact on, and shape, the development and delivery of new (and also existing) interprofessional education activities. Arguably, the learning environment is constituted by context-specific spaces and places of learning. Socio-cultural learning theories emphasize the importance of context and social factors that influence learning (Swanwick, 2005). Place as a unit of analysis requires an exploration of the negotiation of social and cultural relations in creating interprofessional learning spaces. Attention to the importance of place creates the need to examine the complexity of designing and implementing interprofessional learning in varying health and social care spaces. In effect, through using space and place as units of analysis, the examination of power and identity in interprofessional education (both in the classroom and in the workplace) could be more fully explored. Such an examination might yield new conceptualizations of how to construct or reconstruct interprofessional education spaces, places and curricula.

we have discussed above. This project focuses on designing and implementing new learning environments as well as reconfiguring existing local spaces. Given the increasing need for the use of collaboration in the delivery of safe patient care, colleagues at KI regard the future delivery of curricula as one in which learning needs to be student-centred, interactive and interprofessional in nature. Based on the long tradition of innovative pedagogical development at KI, this project takes a step towards the design of innovative learning environments for a range of professional and interprofessional education activities. The actual project is a co-operation between KI and Stockholm County Council, and involves formal and informal learning environments in clinical and non-clinical settings across basic, advanced and research levels within KI’s affiliated hospitals. Further information about this project is available at: www.ki.se/learningspaces

Concluding comments As argued above, an examination of the role of space and place in interprofessional education could usefully yield new conceptualizations of how to (re)construct educational spaces, places and curricula. Indeed, a firmer understanding of the conceptual and practical relationships between space, place and learning is likely to ensure the development of successful future interprofessional education activities across a range of learning environments. Many of the points we have raised in this editorial will be further discussed and debated in an upcoming conference, entitled, Future Learning Environments: How Space Impacts on Learning which will take place the Nobel Forum, KI in Stockholm, Sweden from June 3–5, 2012. This conference aims to gather an interprofessional and interdisciplinary group of academics, designers, architects, clinicians, managers and policymakers to explore key dimensions and issues related conceptualizing, evaluating and theorizing about the use of space, how it impacts on professional and interprofessional learning. Additional information about the conference can be found at the above website address. Jonas Nordquist Karolinska Institutet, Stockholm, Sweden Simon Kitto University of Toronto, Toronto, Ontario, Canada Jennifer Peller University of Toronto, Toronto, Ontario, Canada Jan Ygge Karolinska Institutet, Stockholm, Sweden Scott Reeves University of Toronto, Toronto, Ontario, Canada

Creating new learning spaces: An example

References

Colleagues at Karolinska Institutet (KI) have been working on a project that begins to explore a number of the issues

Barr, H., Koppel, I., Reeves, S., Hammick, M., & Freeth, D. (2005). Effective interprofessional education: assumption, argument and evidence. Oxford: Blackwell.

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Becker, H.F., Geer, B., Hughes, E.C., & Strause, A.L. (1962). Boys in white. Academic Medicine, 37, 406. Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from teamworking. Medical Education, 40, 150–157. Bleakley, A., Bligh, J., & Browne, J. (2011). Place matters: Location in medical education. New York: Springer. Gesler, W., Bell, M., Curtis, S., Hubbard, P., & Francis, S. (2004). Therapy by design: Evaluating the UK hospital building program. Health & Place, 10, 117–128. Gesler, W.M. (1992). Therapeutic landscapes: Medical issues in light of the new cultural geography. Social Science & Medicine (1982), 34, 735–746. Gieryn, T. F. (2000). A space for place in sociology. Annual Review of Sociology, 26, 463–496. Hafferty, F.W. (1988). Theories at the crossroads: A discussion of evolving views on medicine as a profession. The Milbank Quarterly, 66 Suppl 2, 202–225. Hafferty, F.W., & Castellani, B. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. In C. Brosnan & B.

Copyright © 2011 Informa UK Ltd.

Turner (Eds.), Handbook of the sociology of medical education. New York: Routledge. Hafferty, F.W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine: Journal of the Association of American Medical Colleges, 69, 861–871. Howkins, E. & Bray, J. (Eds.), (2008). Preparing for interprofessional teaching: Theory and practice: Oxford: Radcliffe Publishing. Kearns, R.A., & Joseph, A.E. (1993). Space in its place: Developing the link in medical geography. Social Science & Medicine (1982), 37, 711–717. Kelly, M. (2010). Handbook of the Sociology of Medical Education. Sociology of Health & Illness, 32, 507–508. Leander, K.M., Phillips, N.C., & Taylor, K.H. (2010). The changing social spaces of learning: Mapping new mobilities. Review of Research in Education, 34, 329. Poland, B., Lehoux, P., Holmes, D., & Andrews, G. (2005). How place matters: Unpacking technology and power in health and social care. Health & Social Care in the Community, 13, 170–180. Swanwick, T. (2005). Informal learning in postgraduate medical education: From cognitivism to ‘culturism’. Medical Education, 39, 859–865.