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Augmenting the Clinical Apprenticeship Model

The School of Medicine at The University of Notre Dame Australia (UNDA) has adopted a clinical apprenticeship model for the final two years of its MBBS course. In the context of real clinical settings, students observe experienced clinicians as they consult with real patients. Students are provided with opportunities to practice clinical skills under the watchful eye of these clinicians who provide constructive feedback and gradually relax their level of intervention as the students become more proficient. For the first time since the course commenced, UNDA medical students began their clinical apprenticeships in 2007 and participated in six three week rotations at a variety of hospital sites. Whilst literature on clinical apprenticeship suggests that this approach has the potential to provide rich learning opportunities, data gathered over the semester intimates that there were deficits in the learning environment. Students largely found the experience to be a positive one but problems with implementation of the clinical apprenticeship model across most sites resulted in ineffective learning. This paper presents the findings from this evaluation program and describes the features of an implementation framework that will be used to facilitate the management of the clinical apprenticeship model in subsequent years. It is hoped that this framework will augment the clinical apprenticeship model and enable its affordances to be realised through the active participation of both the clinicians and the students. What is the apprenticeship model? The apprenticeship model is one of the oldest forms of learning by doing, where a novice learns how to perform a task (e.g., weaving) under the close tutelage of an expert (Honebein, Duffy & Fishman, 1993). The task provides a purpose for learning (e.g., weaving a net), however multiple skills and knowledge will be learned in the process of completing the task. Also, the authenticity of the task (e.g., weaving a net to catch fish) is intrinsically motivating and gives value and meaning to knowledge and skills learned in the process. Learned in the context within which the task is most functional and useful (e.g., on the banks of the river where the fish are to be caught), the novice also comes to understand the complexities, pitfalls, customs and rituals common to that environment (Honbein et al, 1993) all of which are important to his / her ability to perform the task effectively. The principles of learning underpinning this definition of the apprenticeship model are: a) Knowledge is individually constructed by learners b) Knowledge construction is mediated by others