Chris Hughes

This paper reports on an in-progress study of low-fidelity virtual patients (VPs) created by and for medical students at the University of New South Wales. Its goals were to advance the diagnostic reasoning and patient management skills of all participating students. Methods: Two groups of volunteers from among the University’s fifth-year medical students were trained in the use of software programs that enabled them to produce virtual patients. The cases they subsequently created were then reviewed for accuracy by clinical specialists, and are soon to be trialled with more junior student readers. Results: Student authors, who came to the project with varying levels of technical confidence and ability, were all able to create interesting and engaging cases. Thus far they have produced eleven VPs, and qualitative analysis indicates positive impacts for their confidence in diagnostic pathways, treatment options and consolidation of knowledge. Quantitative analysis of changes in their clinical reasoning abilities is ongoing. Conclusion: Given the success of the project, it is highly likely that student-created virtual patients will become an optional assessment task for senior medical students in the future, with the added benefit that this will develop a bank of VPs for future use in the program.

Supervisors are often urged by the workplace learning literature to take active roles as facilitators of the learning of their staff. The role that is envisaged is similar to the facilitative role developed in the humanistic traditions of adult education, in which facilitation is supportive but also proactive, challenging and interventionist. However, an exploration of the experiences and concerns of workplace learners raises issues of identity and trust that suggest that such a facilitative supervisory role may not be realistic. This is not to say that supervisors can have no impact on workplace learning; rather, their role is more indirect than direct, and that it is exercised through quite traditional supervisory activities. Issues of identity and trust development for workplace learners will be examined in this paper, and the implications for supervisory action in relation to learning explored. The paper draws on doctoral research with workers new to administrative positions in the public sector.

In 2000 the Diabetes Centre and the Medical Oncology Department of St Vincent's Hospital, Sydney established a joint clinic for the teaching of final-year medical students. The clinic was established amid concerns that hospitals are increasingly focused on acute care and have few resources available for teaching about chronic conditions. The clinic aimed to improve both patient care and learning opportunities by engaging students in useful activities with chronically ill patients. The students met with their patients regularly to monitor progress, adjust medication (under supervision) and arrange support services. The students and staff from both units met once a week in a coordination meeting where cases were reviewed and learning issues discussed. Students had informal interactions with medical and allied health staff at other times. Overall the clinic provided a rich learning environment for students with a focus on the development of the integrated skills required in the care of chronically ill people, rather than on the specific medical disciplines involved.

Most accounts of facilitation give the impression that their recommendations are applicable to all contexts and settings. Few envisage facilitation occurring under hostile conditions, or countenance the possibility of malevolent or perverted facilitation. In fact most accounts make assumptions about the context in which learning occurs which render them blind to these possibilities and impotent in the face of their reality. Yet an examination of one significant learning environment—the workplace—reveals that it can be far from ideal and poses unique challenges to the facilitator, especially when that role is assumed by a workplace supervisor. The issues raised are sufficiently significant to place a question mark over the effectiveness of some adult learning programs. The argument supports a closer examination of the dynamics of trust building, of the scope of learning that can be facilitated in any context, of the roles of participants, and the use of learning facilitators whose interests are independent of those dominant in the context.

The goals of practicum programs frequently require that the practicum experience is an authentic experience of work and workplace learning. The more authentic the experience, the more the situation of the student in the workplace conforms to that of the employee. Most accounts of adult learning assume that their recommendations are applicable to all environments. Few countenance the possibility of malevolent or perverted facilitation, or envisage facilitation occurring under hostile conditions. Yet an examination of the learning environment of the workplace reveals that it is far from ideal and poses unique challenges to the practicum facilitator, especially when that role is assumed by workplace supervisors. The specific interests of student and employee may not be aligned, but the interests of both diverge from those of organisations and owners sufficiently to raise issues for the applicability of adult learning approaches. The argument supports a closer examination of the dynamics of trust building, of the scope of learning that can be facilitated at work, and the use of learning facilitators whose interests are independent of workplace interests when designing practicum programs.