On this page:

Introduction

What is informal learning?

Why is informal learning important?

Implementing informal learning in the practice

Creating opportunities for informal learning

Suggested further reading

There have been recent moves in medical education towards more competency-based training programs, with formal workplace education approaches and competency assessment. This move has involved the development of learning outcomes, formal curricula and more supervisor and teacher training. However, there are limitations in structured learning frameworks and topic-based curricula. These styles of teaching do not contribute greatly to informal learning processes or the sociocultural development of the medical students and registrar as newcomers to the profession.

There has also been a general decline in the opportunity for junior doctors to gain direct clinical experience, especially in hospital training. There is increasing evidence that gaining a level of expertise in the highly skilled profession of medicine requires at least five years (possibly up to 10 years) of direct practical experience. Supervised practice-based apprenticeship style informal learning is at the cornerstone of developing expert and competent doctors, including GPs.

Some of the literature suggests that for many professions informal learning is more important than structured teaching processes. Interaction with peers is central to professional learning, and supervisors need to provide work-based opportunities that support informal learning amongst individuals practising within the medical profession.

Swanwick9 identified that informal learning plays a central role in the learning and development of the entire medical workforce. However, the author argues that we need a better understanding of informal learning and ways in which it can be enhanced.

Informal learning has more often been considered as a cognitive process. However, the sociocultural aspects of this informal learning are also important. While competency frameworks and curricula are useful in driving formal, structured learning processes, they have little impact on the informal learning processes that are important in cultural assimilation into a profession.

Currently in Australia, general practice education involves oversight by professional Colleges and their curricula, with the delivery of structured tuition provided away from the workplace by training organisations. The cognitive aspect of practice-based learning is structured through defined feedback and reflection processes and development of learning plans. However, the important informal learning processes that are imbedded in the apprenticeship model and community of practice models are not so well defined.

The vertically integrated GP teaching practice, with multiple levels of learner offers a unique opportunity for these models to be applied, and allows for near-peer teaching, as well informal interaction with senior supervisors.

The informal interaction was useful and I learned a lot from it. - Medical student

Informal learning is a lifelong learning process whereby attitudes, values, skills and knowledge are acquired from daily experience. A useful definition in the general practice context is:

Informal learning is characteristically collaborative, usually involving the manipulation of tools and leading to context-specific forms of knowledge and skills.10

Many different forms of informal learning have been identified. Some forms of informal learning include:

• mentoring;

• ‘on-the-spot’ learning;

• incidental learning;

• museum learning; and

• community of practice or interest learning.

The last form of informal learning in the list, ‘community of practice’, includes acquiring the cultural competencies of a group.

Informal learning is often unpredictable and spontaneous, because it is driven by conversations and being with others. Informal learning can take place anywhere and anytime. The ‘moment’ is caught and the learner’s understanding of that particular situation is deepened. The task of the supervisor is to ensure that the learner has a deeper understanding of their experiences. On some occasions, it is the task of the supervisor to create an opportunity for such learning.

Informal learning may be implicit (that is, without a conscious attempt to learn). It can be serendipitous or planned. It is estimated that three-quarters of learning in organisations today (including in the general practice setting) is informal and occurs by chance. However, informal learning can be intentional in situations in which an individual sets up a specific learning opportunity outside a formal, curriculum-driven education program.

On-the-job experience is a term often used to describe informal learning. It is both the interaction with co-workers or near-peers, and the mentoring performed by more senior supervisors that is identified as the most important way to learn on the job.

There is limited literature on informal learning in the general practice context, even though it been identified as an important aspect of learning, especially with respect to learning clinical skills. It appears that all forms of learner in a VI practice (that is, medical students, junior doctors, registrars and GP supervisors) identify this type of informal learning as important.

Importance to the learner

Informal learning has become popular in many work environments, including general practice, because of the immediacy and relevance of this learning. Learners are able to immediately apply this learning and can also drive and direct their own learning to be meaningful.

Zhang et al.11 found that 75% of junior doctors, while often overwhelmed by what they are expected to learn in a formal curriculum, believe that informal learning helped them pass exams and two-thirds thought that informal learning helped them to become a good doctor. Interestingly, informal learning for them included past students’ notes and tutors’ notes as well as peer-led tutorials and peer small group study.

Acquiring key professional skills

Informal learning is important in skills acquisition with some of the key areas learned through informal processes in any profession being:

• Mastery of organisational processes (in general practice this is practice procedures like recall systems, software use, administrative tasks).

• Negotiation of relationships, for example, doctor–patient relationships, teamwork in the practice, referral processes.

• Dealing with the atypical, for example, the unusual or undifferentiated patient presentation.

Learners’ needs assessment

Part of informal learning is the needs assessment of the learner by the supervisor. This needs assessment also largely takes place through informal processes where the supervisor observes the direct patient care delivered by the learner (either directly observes it or through case review and patient review).

Apprenticeship learning

The apprenticeship model of learning in general practice essentially uses informal learning processes. This model occurs where the GP registrar ‘apprentice’ is learning by copying the GP supervisor as the ‘master’ role model. Role modelling is also probably occurring between medical students and GP registrars in the practice as well.

This model of learning involves observing behaviours, attitudes and emotions, which may then be adopted or rejected by the learner. The learner is being remodelled and their world-view developed. However, the learning that is taking place is not just from the ‘master’ but also from the whole practice group or ‘community of practice’. This form of learning is not just cognitive but is also sociocultural learning.

Grant has a very useful list describing the components of apprenticeship learning in medicine. These components form a good list for the supervisor to use in thinking about the informal learning opportunities in the general practice.

Communities of practice

Participating in ‘communities of practice’ has been described as being essential to the informal learning process. Relationships within a practice help create identity and meaning that are important for the ongoing development and self-identity of any professional. Such informal learning is often invisible.

Strategies to enhance practice-based informal learning include paying attention to the ‘community of social practice’ in which the apprentice is learning (that is, the general practice work environment). The community of social practice includes both the master–apprenticeship relationship and the whole practice team community. Vertically integrated GP training practices offer a broad range of these relational experiences.

Numerous strategies have been suggested to enhance informal learning of the medical apprentice. These strategies, described below, produce subtle processes of change in a learner.

Sharing goals

Both the practice and the learner need to have a shared commitment to learning. The learner needs to be engaged in the practice in such a way that it is clear the whole practice team has a commitment to the trainee’s learning needs, thus giving the learner confidence to seek out learning opportunities.

Improvised learning practices

The practice can provide planned situations within the workplace for the trainee to learn. This might include:

• Participation in group activities (for example, a practice audit).

• Working alongside others (for example, assisting with a procedure).

• Tackling challenging tasks (for example, performing nursing home visits).

• Problem solving for the practice (for example, developing a GP on-call roster).

• Working with a challenging patient (for example, managing a patient’s palliative care).

Individual engagement

Forming a social connection enables learning. The practice needs to engage with each learner on an individual basis. The way this is done is determined by the specific and diverse interests and values of each learner. Interactions that occur in the tea rooms and administrative offices and social get togethers are as important as formal education events in engaging individuals in learning. These important informal learning opportunities help the learner to feel part of a team.

Workforce affordance

The workplace environment can facilitate and invite learning in various ways to demonstrate that learning is a priority activity. For example, the practice can allow the learner exposure to various work groups inside and outside the practice. It is important to ensure the learning role is recognised in employment contracts.

Professional discourse and identity

In most professions, part of the informal learning is learning to ‘talk the talk’ and ‘walk the walk’. Language and communication processes are important and unique to each profession. Story-telling by experienced GPs is important in this process.

A trainee develops a professional identity and a sense of valued contribution to the team over time when they are given the opportunity and confidence to participate in the workplace more fully. Where possible, delegate responsibilities to learners in the practice.

Opportunity to transform social practice

Trainees are not just acquiring knowledge and skills as learners in a practice, but may also be able to produce knowledge if given the opportunity. For example, the trainee may undertake a project to improve the practice recall system.

Involvement in the community

A component of informal learning is understanding the role of the GP in the wider community and engaging the learner in that community. This is particularly important for rural GPs. Being involved in community-based activities (for example, sporting events) is all part of learning the professional role within the community at large.

It is possible to establish circumstances and environments that will promote and encourage informal learning to occur in the practice. The following table incorporates a few suggestions for promoting informal learning that are particularly relevant to the VI practice environment.

Swanwick T. Informal learning in postgraduate medical education: from ‘cognitivism’ to ‘culturism’. Med Educ 2005; 39:859–865.

This article describes the concept of communities of practice and the importance of cultural learning in the medical profession. It expands our understanding of the ‘hidden curriculum’ and aspects of learning that are not often considered.

Grant J. Learning needs assessment; assessing the need. BMJ 2002; 324:156–159.

This article focuses on learning needs assessment and provides a good summary of the apprentice-style learning model.

Zhang J, Peterson R & Ozolins l. Student approaches to learning in medicine: What does it tell us about informal learning? BMC Med Educ 2011; 11:87.

This is a good contemporary article exploring informal learning in medical education, particularly from the student perspective.

Back to top