Communities of Practice in Health and Risk Messaging
Summary and Keywords
A community of practice (CoP) situated in a health and risk context is an approach to collaboration among members that promotes learning and development. In a CoP, individuals come together virtually or physically and coalesce around a common purpose. CoPs are defined by knowledge, rather than task, and encourage novices and experienced practitioners to work together to co-create and embed sustainable outputs that impact on theory and practice development. As a result, CoPs provide an innovative approach to incorporating evidence-based research associated with health and risk into systems and organizations aligned with public well-being.
CoPs provide a framework for constructing authentic and collaborative learning. Jeanne Lave and Etienne Wenger are credited with the original description of a CoP as an approach to learning that encompasses elements of identity, situation, and active participation. CoPs blend a constructivist view of learning, where meaningful experience is set in the context of “self” and the relationship of “self” with the wider professional community. The result is an integrated approach to learning and development achieved through a combination of social engagement and collaborative working in an authentic practice environment. CoPs therefore provide a strategic approach to acknowledging cultural differences related to translating health and risk theory into practice.
In health and risk settings, CoPs situate and blend theory and practice to create a portal for practitioners to generate, shape, test, and evaluate new ideas and innovations. Membership of a CoP supports the development of professional identity within a wider professional sphere and may support community members to attain long range goals.
Communities of Practice (CoPs)
A community of practice (CoP) is a model of situational learning and collaboration, where individuals work together linked by a common purpose. CoPs are defined by knowledge rather than task and are utilized as a tool for knowledge management and practice development. This is exemplified in health settings by Cassidy (2011), who describes the use of CoPs as a tool for constructing collaborative learning environments for mental health nurses caring for patients in rural environments. In a similar way, and used by Cassidy as an example, Tolson, McAloon, Hotchkiss, and Schofield (2005) evaluated the work of a CoP formed by a Scottish community of nurses to develop a knowledge framework for the care of older adults.
Etienne Wenger, an American academic and business consultant, is credited with the development and use of CoPs in business and industry. Wengers’ (1998) communities learn through the act of social participation. He strongly identifies with the concept of active group learning and co-creation in an authentic practice environment. Wengers’ work has roots in a social theory of learning (Figure 1).
Membership of a CoP engages the individual in the “process of being active participants in the practices of social communities and constructing identities in relation to these communities” (Wenger, 1998, p. 4). CoPs blend a constructivist view of learning as described by Resnick (1987) with the social anthropological view of Lave and Wenger (1991). Nemec and LaMaster (2014) strongly believe that active participation in health-focused CoPs relies on the degree of “buy in” by members.
The Concept of Participation Is Described by Boylan
The concept of participation can be used to inquire into both the moment-to-moment engagement in social practice and the way these moments connect over time to develop a learning history that changes a learners relationship to practice, to others engaged in practice, and as part of this changes their identity.
(Boylan, 2010, p. 61)
CoPs evolve from the things that individual’s value or that they rate as important. Even when subject to organizational restriction and boundaries, it is the community and not the organization that generates a knowledge base. Learning in a CoP encompasses elements of identity, situation, and active participation (Lave & Wenger, 1991). In health and risk, CoPs integrate these elements and provide a framework for practitioners to develop, shape, test, and evaluate new care practices. These CoPs are often multifaceted, and they directly reflect the identity and ideals of their members. Health CoPs can move practice from “what is known now” to “what will be known in the future,” allowing members to develop and transition new knowledge into practice (Andrew & Ferguson, 2008; Meyer & Land, 2005).
CoPs are defined by location as well as well as by situation and have proven value in bringing together geographically dispersed practitioners. In health fields, such communities are re-defining and changing the scope of practice in rural and urban settings. In rural settings particularly, the use of digital platforms increasingly allows practitioners to reach out into isolated populations and to collaborate with each other across a wide geographical divide (Cassidy, 2011; Tolson et al., 2005).
This article is focused on the use of CoPs as collaborative vehicles to promote practice and understanding in areas of health and risk. Specifically, the work explores the lifecycle of a community and, using health-related case studies, reflects on the role of CoPs in the formation of professional identity in the health professions. Finally the impact of specialized learning communities on the development and application of health knowledge is discussed in the context of higher education (HE).
Elements of a CoP
Nemec and LaMaster (2014) looked at the criteria for a successful CoP (one that survives in the longer term) in mental health and found that the critical success factors coalesce around a set of core principles, summarized as focus, leadership input, and crucially, commitment. The area of focus must be current, input has to be consistent, and members must be prepared to lead, share, and shape health knowledge and practice. A passionate core really helps sustain a CoP in the longer term, but equally, new members must join, have time, be motivated, and be encouraged to participate (Nemec & LaMaster, 2014; Saint-Onge & Wallace, 2003).
The ideal community is a long term rather than short term venture. A CoP differs from a short term network because it is “about something” and not just a set of informal relationships. The community exists because it produces a “shared practice as members engage in the collective process of learning” (Wenger, 1998, p. 4).
The stages shown in Figure 2 demonstrate the lifecycle of a CoP.
Communities form in the workplace, often in professional arenas. CoPs (wherever they occur) share three common elements or domains:
1. Knowledge, which creates common ground and common knowledge within the community.
2. Community, which creates the social fabric of learning.
3. Practice, which is a set of frameworks, ideas, tools, information, styles, language, stories, and documents shared by the community (Wenger, McDermott, & Snyder, 2002).
Deliberate knowledge cultivation and management is the key to productivity. In an ideal CoP, knowledge is not managed by chance but organized in such a way that its creation and deployment continuously drives the organization forward. Knowledge, if it is to be of value has to keep the organization at the cutting edge of innovation and should be managed “as companies manage other critical assets” (Wenger et al., 2002, p. 6). In terms of health and risk practice innovation is more likely to relate to developments around public, rural, and urban health and wellbeing. Generating health and social capital focused on the creation and management of knowledge (in a similar way to Wengers’ communities) keeps health practitioners at the cutting edge of their field (Anderson-Carpenter, Watson-Thompson, & Chaney, 2014).
The model is not without critics. Kupferberg (2004) argues that Lave and Wenger (1991) and Wenger (1998) have systematically “misread the modern landscape of learning” through their narrow interpretation of the underpinning theory (p. 4). Wenger (1998) strongly identifies with the concept of active collaboration in an authentic practice environment and believes that membership of a CoP engages the individual in active participation within both professional and social dimensions. Wengers’ original theory (unlike Kupferbergs’ belief of “how and who” forms a CoP) aligns with the contemporary concept of the use of CoPs in health and risk and supports the principle of CoPs as vehicles for self and peer support through dissemination of shared knowledge. Such communities are often formed and forged through the need or desire to protect and mitigate the health susceptibility of any community.
This less restricted view takes into account the broader needs of individuals and is less focused on professional outcomes and objectives. This is particularly relevant in rural or hard-to-reach and geographically spread communities. In isolated communities, individuals are less likely to be able to access professional health support and are, therefore, more reliant on “protection from harm” advice generated by a local population or a mix of lay and professional people (Tolson, Schofield, Booth, & James, 2006).
Wengers’ (1998) original interpretation of community, practice, and knowledge can be re-interpreted in health and risk as; belonging, participation, and mutual collaboration. This re-interpretation broadens the original definition to encompass the increased desire for patient and public involvement in the creation and application of health and risk related knowledge (Andrew & Ferguson, 2008; Andrew, Tolson, & Ferguson, 2008). Health focused communities are now increasingly placing the patient at the center of knowledge development, taking account of more than a professional standpoint which, although vital for practice development, does not always accurately reflect the views of the recipients of care (Anderson-Carpenter et al., 2014; Cassidy, 2011; Schofield, 2007; Tolson et al., 2006).
Health and Risk CoP Purpose, Power, and Participation
In terms of the purpose of CoPs in health, the ability to apply knowledge in a practice-focused environment is central to community working (Tolson et al., 2006). Health professionals need to collaborate with each other to gather a wide range of research, views, and opinions aimed at improving the lives and health of the populations they serve. Scholarship is often the main aim in areas such as education and is a key requirement; however, the need to test and evaluate practical interventions is fundamental to health practice (Hofmeyer, Newton, & Scott, 2007). Health CoPs are usually situated at the interface between theory and practice and have the potential to reshape professional practice and generate valuable discipline-based knowledge (Andrew et al., 2008; Young & Mitchell, 2003).
Increasingly, membership of health CoPs includes practicing clinicians and lay members, often service users. The place of service users and practicing professionals as valid collaborators in healthcare practice development and application has not always been evident. Researchers have traditionally viewed service users and practitioners more as participants than partners in the research processes (Andrew et al., 2008). In Scholarship Reconsidered, Boyer (1990) encourages academics to challenge and breech traditional research boundaries and to include a practice element to provide findings that are directly relevant to clinicians. Boyer’s paradigm challenges the traditional scholarship model and links education with practice to promote a collaborative approach to the acquisition of new knowledge. Wengers’ (1998) CoP applied to health and risk takes the concept of involvement further and deliberately includes practitioners as equal partners in the research process (Andrew et al., 2008).
Power issues exist in all organizations in relation to the use and perceived value of local and expert knowledge. While individuals may be active participants in their own community, the knowledge they generate and, in this case, the health and risk practices that emerge may not migrate beyond the boundaries of that community. Local knowledge is not always valued and often does not reach the strategic level of an organization or profession (Kelly, Schofield, Booth, & Tolson, 2006; Yanow, 2004). CoPs can help to address these issues. The growing requirement to hear, include, and respond to the service user voice and a contemporary emphasis on research and practitioner partnerships means that CoPs, as a democratic and equality driven approach, make an ideal platform for collaborative working between professional and lay communities (Kelly et al., 2006).
In reality, however, unless professional members are willing to accept the views of the laity as being of equal value to their own, there may be little actual fluidity of movement within a CoP. If lay members (such as service users) are intimidated by their professional partners, then the dominant meaning may continue only to reflect the professional view (Roberts, 2006). This restrictive attitude means that the lay members cannot participate as equals and a rich data seam may be lost (Tolson et al., 2006).
Exemplar 1 describes a health-focused CoP that illustrates the complexity of collaboration between professional and lay members.
There are challenges in the literature around the purpose of health CoPs and who should participate. The optimum composition of these communities (as illustrated by Peu et al., 2014) is not straight forward, and their effectiveness can be limited by the power dynamic between lay and professional members. There are also potential conflicts among and between professional groups. This may, as discussed in exemplar 2, limit the formation of a cohesive and coherent approach to healthcare planning.
This CoP highlights the fact that there can be conflict between professional groups as well as between professionals and lay members. In health sciences generally, there is now a drive to achieve a form of community-focused scholarship, an inclusive approach to knowledge generation, and one that takes the views of service users and practitioners into account (Hofmeyer et al., 2007). In terms of their ability to develop health practice it is now well established that CoPs are most useful when they are located at the intersection of local and national practice development, blending the skills of experts and care providers with the personal experiences of care recipients (Andrew & Ferguson, 2008; Tolson et al., 2006).
A CoP that focused on the development of interprofessional health practice and included service users as key partners illustrates the blending of skills described by Tolson et al. (2006).
This community appears to value the contributions of all members and the “them and us” experience described by Peu and colleagues (2014) is not evident here. Unlike the CoP described by Peu et al., where power struggles proved to be a major limitation, this community validated and valued the service user voice. This may be attributable to the fact that they were an established group with a distinct identity prior to joining the CoP and influential in their own right.
In this contemporary CoP, the interrelatedness of theory and practice is evident and in common with the findings of Tolson et al. (2006), the blending of the skills of care providers and personal experiences of the recipients resulted in a positive experience for all members.
Contemporary CoPs in Health and Risk
A review of the evolution of CoPs over the last two decades highlights four main functions (Ryan, 2015). CoPs as a means of re-invigorating congeniality and collegiality (Churchman, 2005; Nagy & Burch, 2009), as a framework for reflection on learning and teaching practice (Viskovic, 2006) as an institutional sponsored, embedded CoP model (McDonald & Star, 2006, 2008) and as a portal for learning and knowledge development (Farnsworth et al., 2016; Ryan, 2015). CoPs feature in higher education (HE) and organizational literature. In practice-based professions such as health and education they focus on infrastructure, co-creation, membership, and practice-based outcomes (Anderson & McCune, 2013; Andrew, Ferguson, Wilkie, & Simpson, 2009; Houghton, Ruutz, Green, & Hibbins, 2015; Laksov, Mann, & Lars, 2008; Ryan, 2015) and in organizational literature on knowing in action or knowing in practice (Amin & Roberts, 2008; Farnsworth, Kleanthous, & Wenger-Trayner, 2016; Lindkvist, 2005; Wenger et al., 2002).
Whether health and risk communities are designed to foster collegiality, develop and reflect on practice, or act as hubs for cutting edge knowledge cultivation and management, the contemporary use and function of a CoP remains true to Wengers’ central vision of peer supported collaboration, co-creation, and co-production (Figure 3).
Membership in a CoP engages an individual in the process of being an active participant, working with like-minded people to construct an identity within a professional community. CoPs vary in size. They can be long- or short-lived, co-located or distributed, inside or outside the organization, local or international, organized or spontaneous, hidden or institutional. CoPs have diverse or like members and can exist in virtual or real time. They thrive or die according to the commitment of their members. There are many professions but pursing them always involves the same kind of “embodied, delicate, active, social, negotiated, complex process of participation” (Wenger, 1998, p. 49).
A CoP is grounded in a shared culture that is “ripe for growth”; moving individuals towards a collective sense of “trust, potency, and commitment” (Bligh, Craig, Pearce, & Kohles, 2006, p. 300). This is illustrated in exemplar 4, focused on developing a shared discourse around mental health practice in rural areas.
CoPs can ameliorate physical and emotional isolation through their focus on active group participation and collective knowledge generation (Ryan, 2015). They promote a democratizing culture and bring together groups of individuals who are united by a common theme or purpose. In mental health, online service user communities can help to both shape practice and reduce the impact of social isolation and the attendant issues of depression and substance abuse (Cassidy, 2011).
Professionally, individuals are motivated to join a workplace community to develop a sense of identity and belonging (Andrew & Robb, 2011; Berry, 2011; Laksov et al., 2008). A CoP forms or is formed around groups of people who share a common concern or interest and who wish to deepen their knowledge and expertise in a particular subject or discipline. In health and risk, CoPs provide a fertile, creative, and collaborative space where the knowledge and skills of academics and practitioners blend productively to develop, apply, test, and evaluate new approaches to practice development (Booth, Tolson, Hotchkiss, & Schofield, 2007; Buggy, Andrew, Tolson, & McGhee, 2004).
Health communities are situated and rooted in the practice of their members and provide an energizing space for collaborative working and learning. They are not just managed knowledge networks (although there are similarities), and they are more than information exchanges although they do share information (Lai, Pratt, Anderson, & Stigter, 2006). CoPs reflect the passion of their members and encourage them to share personal histories and journeys, weaving a narrative to contextualize and integrate professional and practice development. Novices mix with experts, academics with practitioners, and practitioners with patients (Andrew et al., 2008; Andrew & Ferguson, 2008; Booth et al., 2007). The success of a CoP that encouraged members to contextualize and integrate practices that resulted in the production of good practice guidelines and an applied practice development model to support the care of older adults is illustrated in exemplar 5.
This CoP demonstrates care guidance drawn from a diverse evidence base and from capturing a range of complex and multi-faceted health views and beliefs. In health arenas, CoPs offer a space for members to form dynamic and engaged relationships. This type of engagement both complements and acts as a substitute for conventional learning by encouraging members to explore the pedagogical underpinning of practice. Generally, a health CoP acts as a vehicle for building shared professional understanding underpinned by knowledge that is tacit as well as explicit (Andrew et al., 2009; Booth et al., 2007).
Building Practice and Understanding in Health and Risk CoPs
The concept of practice, and linked to this the development of understanding, is both explicit and implicit. Practice is defined by overt terminology—“tools, documents, images, symbols, well defined roles, specified criteria, codified procedures, regulations, and contracts”—accepted as part of the job. Understanding is characterized by more covert language—“tacit conventions, subtle clues, untold rules of thumb, recognizable intuitions, specific perceptions, well-tuned sensitivities, embodied understandings, underlying assumptions, and shared world views”—less obvious and more complex in nature (Wenger, 1998, p. 47).
There are four key elements of practice, shown below in Figure 4.
All elements integrate and co-exist. A CoP is not primarily a group of people; it is a social process of “negotiating competence in a domain” that, over time, gives structure to social relationships among people who work in a common area of practice; often as a profession (Farnsworth et al., 2016, p. 4). In health disciplines, CoPs do not detach theory from practice. A CoP is a fluid, constantly changing, and emerging entity based on shared understanding, knowledge, and practice development. It is enacted in a flexible space that evolves from and around the community, who in turn drive the discipline forward.
This process is not necessarily led by those who hold managerial or strategic responsibility in an organization. The insurance workers observed by Wenger (1998) did not claim to be theorists nor did they hold strategic authority, but they did spend time theorizing and reflecting on the nature of their practice. In a similar way, health communities often flourish at a local rather than a strategic level (Tolson et al., 2006; Yanow, 2004).
An institution that is primarily focused on professional restriction and fails to take account of excellence in the organization arguably risks stagnation and eventual obsolescence (Wenger et al., 2002). A CoP usually forms in a vibrant and dynamic work environment and is often founded in order to move the profession and/or organization beyond restrictive beliefs and practices. In health arenas, CoPs can push through professional boundaries, induct new members, develop shared understanding, regenerate and reinvigorate collegiality, and add to the existing knowledge base (Schofield, 2007).
Shared understanding is the central tenant of and key to professional practice in the health professions. For health professionals to develop new and innovative practices, individuals need to share and benefit from the knowledge and guidance of experienced and expert practitioners. Medics are a good example. They have a professional responsibility to work with their peers to develop understanding and share knowledge. They commonly seek out intellectual challenges and practice opportunities even at considerable geographical distance. This is knowledge acquisition gained over a professional lifetime, evidenced by an ongoing commitment to the assimilation and sharing of practice expertise (Wenger et al., 2002).
Professional learning and development is about communities, their identities, and their practice. In health settings CoPs blend a constructivist view of learning with the authentic experience of practitioners and increasingly service users to form relationships with a “wider but identifiable group of people” (Fowler & Mayes, 1999, p. 7). The result is an integrated approach to learning achieved through a combination of social engagement and collaborative working in an authentic practice environment (Andrew & Ferguson, 2008; Andrew et al., 2008).
A CoP primarily functions to develop common understandings and to share practice. Individuals do not always have to deliberately construct or implement a CoP; they can develop organically through workshops, symposia, and structured and informal meetings. In health, education, and in organizations, CoPs often evolve naturally as a response to the needs of the workforce, emerging as a vehicle to share and showcase best practice within the institution (Moore, Elfving-Hwang, & Garnett, 2009).
Developing practice as a professional involves the acquisition of skills. The development of professional identity is a more complex process. In the health professions, much of this is centered on tacit knowledge or on developing a way of being. This facet of the occupational learning process, although less overt, is often the way that individuals come to understand and assimilate professional ways of knowing (Andrew & Ferguson, 2008; Booth et al., 2007; Eraut, 2000).
Constructing and Transitioning Identities in Health and Risk CoPs
The evolution of identity, and linked to this the emergence of a discipline-focused discourse, enables health professions to build capacity and generate knowledge in a collegiate environment. CoPs provide a space for these professionals to co-construct an identity and develop a shared understanding of their discipline. In health and risk, CoPs map a path to the resolution of complex professional issues and provide micro-level responses to work-related problems. They are open portals for informal professional learning and, when embedded in the workplace, support both personal and professional development (Andrew et al., 2008; Andrew & Ferguson, 2008; Andrew, Ferguson, Wilkie, & Simpson, 2009; Andrew & Wilkie, 2007; Kelly et al., 2006; Ryan, 2015).
The identity development of a group of student health professionals is explored in exemplar 6.
In the health professions, participating in a CoP supports learning for professional newcomers. Peer collaboration is crucial to the development of professional identity, work-based competence, and knowledge generation (Eberle, Karsten, & Fischer, 2014; Schofield, 2007; Tolson et al., 2006). CoPs utilize a gatekeeper of knowledge approach enabling organizations to “build, share, and apply deep levels of competence” (Wenger, 1998, p. 4). Competence (in these terms) implies not just a level of attainment linked to professional qualification, but an ongoing developmental process as well as a behavioral approach (Snyder, 1997). Allee (2000) observes that “knowledge cannot be separated from the communities that create it, use it, and transform it” (p. 4).
Constructing an identity in the health professions is becoming increasingly complex. The widespread adoption of joint academic/clinical positions and specialized professional roles highlight the need for clear and transparent organizing principles to underpin and articulate the dimensions of contemporary professional life. This includes the way the professions induct novices into the “complex, dynamic, and potentially contradictory contexts” that are pivotal to the forward movement of the individual and the discipline (Boyd & Smith, 2014, p. 694). The main issues identified by Gourlay (2011) (lack of role clarity, lack of organizational understanding, and finding out how the job is done) require the acquisition of tacit as well as explicit knowledge. A practice-based CoP can help achieve this by engaging novices as active participants in the ongoing process of professional acclimatization and socialization (Andrew & Robb, 2011).
An approach to the induction and support of health professionals transitioning into an academic role is conceptualized in a “close to practice model of working” developed by Andrew and Robb (2011, p. 431). This collaborative practice development model spans education and practice and is meaningful in both spheres. The concept is rooted in Wengers’ (1998) model and is underpinned by five practice dimensions: academic practice development; a sustainable learning environment; clinical/academic partnership; research capacity; and practice development (Figure 5).
A “close to practice” environment enables transitioning practitioners to work at the interface of theory and practice, building collegiate relationships with each other and maintaining productive relationships with their clinically based colleagues (Andrew & Robb, 2011).
Much of the research and opinion in the health and risk literature reflects the utilization of CoPs as a tool for professional practice and identity development. The broader underpinning of social learning theory, however, can also be applied to learning communities in health; a “flexible conceptualization of (student) participation” (Boylan, 2010, p. 61).
Learning Communities in Health and Risk
Part of the success of CoPs in health and risk is attributable to the emphasis on learning as a social process that results in members experiencing feelings of belonging (Andrew, McGuinness, Reid, & Corcoran, 2007; Andrew, McGuinness, Reid, & Corcoran, 2009). A learning community is similar to a CoP in that it “emphasises mutually supportive relationships and developing shared norms and values” (Stoll, Bolam, McMahon, Wallace, & Thomas, 2006, p. 225). When situated in an educational environment, it is less focused on the development of professionals and more orientated towards active and inclusive student participation in learning, teaching, scholarship, and curriculum design. In common with all CoPs “at the heart of the concept,” is the notion of community” (Stoll et al., 2006, p. 226). There are five key characteristics of learning communities: shared beliefs and understandings; interaction and participation; interdependence; concern for individual, and minority views (Westheimer, 1999, p. 75).
The HE sector in the United Kingdom is growing a student-centered ecosystem where active participation is central to engagement and is increasingly part of the mainstream academic sphere (Andrew, McAleavy, Whittaker, Main, & Gaughan, 2015; Hall, 2015; Thomas, 2012). Contemporary learning communities are spaces where students, staff, external scholars, and industry experts, (and in health and social care, service users, and care providers) collaborate to facilitate deep, ongoing, and lasting learning. In these democratic communities, all members actively strive to co-create and co-produce academic artifacts and shape learning practices (Andrew et al., 2007; Wayne, Ingram, MacFarlane, Andrew, McAleavy, & Whittaker, 2016). Learning communities reflect Wenger (1998) and Wenger et al. (2002) and are grounded in authenticity, honesty, inclusivity, reciprocity, empowerment, trust, courage, plurality, and responsibility.
The literature links learning communities with the development of positive behaviors such as “promoting openness to diversity, social tolerance, and personal and interpersonal development” (Zhao & Kuh, 2004, p. 118). These are core criteria for health professionals. To promote a sense of professional identity before becoming a fully-fledged professional, learning communities offer opportunities in and outside the academic sphere for collaborative learning and interaction with clinicians and service users. They encourage the use of high level skills such as critical thinking, reflecting, and knowing (in and for practice) that promote a deeper level of understanding and knowledge acquisition (Andrew et al., 2007; Bransford et al., 2000; Thomas, 2012; Wayne, Ingram, MacFarlane, Andrew, McAleavy, & Whittaker, 2016).
Active learning in health is exemplified by the concept of the flipped classroom. This is a student-centered approach underpinned by a pedagogy based on participation and problem solving. The flipped classroom brings together curriculum delivery by subject specialists and active learning tasks that go beyond formal content-based teaching. Lecture material is pre-recorded and placed (usually) in a VLE (virtual learning environment) to allow students to pre-engage with the theory at their own pace. The classroom sessions are usually conducted as small group seminars and use a wide range of activities to consolidate learning, develop understanding, and promote greater engagement with the lecture material, rather than the lecture material being at the center of the session (McLaughlin, Davidson, Griffin, & Mumper, 2014).
The use of the flipped classroom in health is illustrated by exemplar 7.
Immersion in pre-professional learning communities allows health students to experience an authentic work-based approach to their learning and development. In this sense, these communities probably reflect Kupferbergs’ (1999) more than Wengers’ (1998) theory, suggesting that professional identity starts to form before the individual enters the profession.
This work suggests that there is scope for approaches like the flipped classroom to be embedded in other curricula. In particular, utilization in disciplines such as the health professions, required to align theory with practice, could increase the sense of authenticity and professional relevance.
CoPs originate from the work of Lave and Wenger (1991), Wenger (1998), and Wenger et al. (2002). They are based on a model of situational and social learning underpinned by a democratic and participative approach to work and study.
In the health professions, CoPs evolve from the things that individuals value and that they rate as important. Usually the community, and not the organization, generates the ideas and undertakes the associated knowledge work. The development and membership of a CoP is fluid, and members are more or less active at different periods of time. In health as in other communities, CoPs last for as long as it is of importance to its members, and disbanded communities often leave legacies that influence the future development the work culture and associated professional identities.
CoPs are found in diverse areas, and their use is reviewed and explored in health and risk, education, and organization-focused literature. In health and education, they are characterized by a democratic approach to co-creation, and co-production. In organizational literature, the emphasis is on “knowing in action or knowing in practice.” The thread that runs through all communities, however, regardless of time and place, is their ability to foster collegiality, develop and reflect on practice, and, in health to act as a hub for practice development, testing, and evaluation. In the 21st century, health and risk-focused CoPs remain true to Wengers’ original vision of democratic and peer supported practice-based learning and knowledge generation.
In health and risk communities, although there is evidence of inequality of membership and lesser regard for the voices of practizing clinicians and lay members (such as service users), CoPs have been successfully used to forge strong researcher/clinician/service user relationships. This development adds to the work of Boyer (1990), whose influential publication Scholarship Reconsidered brought integrity and authenticity to the involvement and active participation of “others” in the research environment.
CoPs are of particular relevance to the construction of professional practice. In health, they can promote discourse, develop shared understanding of overt and covert practices, and support the emergence of professional identities. Participating in a workplace community can help to induct professional newcomers and support identity transition.
More recently CoP methodology has influenced the development of learning communities in the preparation of student health professionals. These pre-professional health communities take Wengers’ concept to a new level and to a new audience, as increasingly, they are utilized to nurture a student-centered ecosystem that places engagement, belonging, and collaboration front and center of the student experience.
The main types of primary resources utilized for this review were published works, mainly journal articles, case studies, and textbooks. Increasingly however authors are supplementing conventional publications with references to websites and online digital resources.
Table 1 links the main themes from this article with key references and locates complementary websites and online digital resources and collections.
Table 1. Primary Resources
Websites and Online Resources
Social and situated learning
Collaborative working and learning
Practice and understanding
Andrew, N., Tolson, D., & Ferguson, D. (2008). Building on Wenger: Communities of practice in nursing. Nurse Education Today, 28(2), 246–252.Find this resource:
Boyer, E. L. (1990). Scholarship reconsidered. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching.Find this resource:
Lave, J., & Wenger, E. (1991). Situated learning: legitimate peripheral participation. New York: Cambridge University PressFind this resource:
Tolson, D., Schofield, I., Booth, J., & James, L. (2006). Constructing a new approach to developing evidence based practice with nurses and older people. World Views on Evidence-Based Nursing, 3(2), 62–72.Find this resource:
Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. New York: Cambridge University Press.Find this resource:
Wenger, E., McDermott, R., & Snyder, W. (2002). Cultivating communities of practice: A guide to managing knowledge. Cambridge, MA: Harvard Business School Press.Find this resource:
Wenger-Trayner, E., Fenton-O’Creevy, M., Hutchinson, S., & Kubiak, C. (2014). Learning in landscapes of practice: Boundaries, identity, and knowledgeability in practice-based learning. London: Routledge.Find this resource:
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Anderson, C., & McCune, V. (2013). Fostering meaning: Fostering community. Higher Education, 66, 283–296.Find this resource:
Anderson-Carpenter, K. D., Watson-Thompson, J., Jones, M., & Chaney, L. (2014). Using communities of practice to support implementation of evidence-based prevention strategies. Journal of Community Practice, 22(1–2), 176–188.Find this resource:
Andrew, N., & Ferguson, D. (2008). Constructing communities for learning in nursing. International Journal of Nursing Education Scholarship, 5(1), 1–15.Find this resource:
Andrew, N., Ferguson, D., Wilkie, G., & Simpson, L. (2009). Developing professional identity in nursing academics: The role of communities of practice. Nurse Education Today, 29, 607–611.Find this resource:
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