Significance of relationships in the cognitive apprenticeship of medical specialty training

Background. The cognitive apprenticeship model is universally recommended for medical specialty training and has been introduced in some clinical disciplines by consultant specialists through the personal coaching of students and participation in the community of practice. In post-apartheid South Africa (SA), transformative initiatives gave rise to significant numbers of students from disadvantaged backgrounds in higher education that led to racial and sociocultural diversity among students and their consultants. Most notably, this occurred in medical specialties, where the number of students is much smaller than in undergraduate medicine. This stimulated interest in how this landscape may influence the cognitive apprenticeship model. Objectives. To explore how former students of a medical specialty discipline conceived the nature of racial and sociocultural diversity in their learning environment and if/how this influenced their relationships with peers and consultants. Methods. A qualitative enquiry was conducted with 9 formal postgraduate students (registrars) from 6 universities in SA. Data collection was through in-depth individual interviews with open, semi-structured questions. Data were analysed, recognising sub-themes and themes, and interpretation was done in a social constructionist approach of epistemology, where the participants and researcher co-construct the concepts. Results. Participants conceived the sociocultural diversity as personal differences and related their experience of not receiving one-on-one mediation or mentoring to a lack of relationship with the consultants, which was believed to be underpinned by sociocultural differences. Power-plays in departmental culture also inhibited the legitimate access and participation of postgraduate registrars in the community of practice, inhibiting their growth of professional expertise. Conclusions. Cognitive apprenticeship in medical specialty training has specific challenges in the context where postgraduate students and consultants are from societies previously divided by inequalities. Common acknowledgement was that learning in collaboration begins  with learning to know each other and by forming relationships. Students faced challenges seeking professional mentorship, which was conceived as a principal contributing factor in their failure to learn