The apprenticeship

In the nineteenth century and earlier, doctors were trained as apprentices to practising doctors. The master accepted the pupil, who paid for the privilege and was taught and instructed in the methods and secrets (Calman 2006). In the late nineteenth and early part of the twentieth century the lack of attention to the scientific basis of medicine in undergraduate education and the varying quality of the apprenticeship experience offered led to a significant shift towards a university-based education. The emphasis was placed on more formal and theoretical education in the classroom and on the didactic lecture.

Over the years growing disquiet has been expressed about the removal of much of the education from the clinical setting and today greater emphasis is again being placed on learning on the job. The learning experience, however, is being more carefully arranged and monitored; on-the-job learning is now incorporated and plays a key role as part of a more formal planned curriculum.

Definition

Work-based learning (WBL) is a key strategy in postgraduate and continuing education but it is relevant too in undergraduate education. It can be seen as a continuum that stretches from formalised training at one end where a student or junior doctor learns under supervision through to an established practitioner sharing a clinical problem with colleagues.

A number of terms have been used to describe work-based learning (WBL). These include on-the-job learning (OJL), service-based learning, experience-based learning, learning from practice, situated learning and community-based learning. The key feature is that students or trainees participate in authentic activities that form the basis for their learning. They learn from their experience and at the same time are helped to generalise from the patient they have seen to other patients and situations. Students or trainees learn ‘on the job’ while ‘doing the job’. Learning in the work place enables students to learn about the context in which they will later practise.

Principles

WBL has powerful learning potential. A key underlying principle is that learning is inherent in everyday practice. The core condition for WBL is ‘supported participation’. This involves the learners:

Advantages

Learning on the job in the clinical environment offers a number of advantages: