Learning to practise, practising to learn: doctors’ transitions to new levels of responsibility

This chapter draws on a collective case study of doctors’ learning in transition to show that different ways of explaining learning in practice (for example situated learning and learning cultures) cannot fully account for what happens when doctors make these transitions. We develop Hodkinson, Biesta and James’ (2008) theories of learning cultures and cultural theories of learning in two ways to help us understand learning in transition. First, we draw on Thévenot’s (2001) notion of pragmatic regimes of practice to show how most approaches to doctors’ learning focus on the public regimes of justification and regular action; transitions, however, always involve regimes of familiarity which are usually ignored in theorising their learning. Second, we introduce our notion of doctors’ transitions as critically intensive learning periods, in order to explain the inter-relationships between learning, practice and regimes of familiarity. We ground our discussion in three scenarios to illustrate how practice always involves the socio-material world. We examine the theoretical and practical implications, particularly in respect of learning local practices or, as Thévenot would say, learning regimes of familiarity