From time-served apprenticeship to time-measured training: new challenges for postgraduate medical education

Reform of the NHS has systematically eroded medical apprenticeship. The shift from time-served apprenticeship to time-measured training has left doctors in a contradictory positioning: they must adopt approaches to medical training antithetical to their own learning histories and the literature on learning. New forms of work activity, framed as 'faculty developmenf are emerging in response. The policy and practice literatures urge the new faculty development workforce to 'professionalise medical education', signalling a particular type of response, where certain teaching, learning and assessment practices are advocated and accreditation for educational roles is instigated. The medical profession is faced with a choice: to conform or transform? This study draws upon the theoretical tools of Cultural Historical Activity Theory (CHAT) to analyse the medical profession's response (Engestrom, 2001, 2004, 2008 and Daniels 2009). It is argued that responses will be shaped by the biographical, theoretical and conceptual resources faculty developers bring to bear on their activity: in particular the conceptions of learning they hold. Drawing upon and extending Sfard's original work (Sfard 1998), three metaphors for learning (learning-as-acquisition, learning-as-participation and learning-as-expansion) become powerful analytical tools, used as an adjunct to CHAT, in order to trace a range of positions towards the professionalisation of medical education. An analysis of emerging practices across one postgraduate deanery reveals more differentiated responses than those reported in the literatures. Ideal-typical features of the identified conforming, reforming and transforming responses are elaborated and illustrated. This study concludes by arguing that if faculty development is to move beyond 'teaching-the-teachers-toteach', the faculty development community needs to radically re-think its practices and expand the range of resources it draws upon in its work. This means valuing the rich cultural heritage of medical apprenticeship, problematising medical education reform and seeking to establish new ways of developing practice through practice, alongside their medical colleaguesEThOS - Electronic Theses Online ServiceGBUnited Kingdo