Understanding paediatric resident-continuity preceptor relationships through the lens of apprenticeship learning

CONTEXT Apprenticeship learning is common in medical education, but is often situated in theoretical frameworks which highlight its cognitive but not its social dimension. METHODS We conducted an ethnographic case study of paediatric residents' learning relationships with their preceptors in a community-based paediatric continuity site. It included 5 months (100 hours) of direct observation, and semi-structured interviews with 10 residents (before and after observation) and 10 primary care paediatricians who served as their continuity preceptors (after observation). Interview transcripts and notes from observations were inductively coded and analysed for major themes. RESULTS Our observations and reports of resident learning trajectories fit well with the concept of legitimate peripheral participation. Residents learned the everyday practice of primary care as they worked alongside experienced paediatricians in the continuity clinic. Although the direction of learning was towards central participation in patient care, residents learned during transient shifts to the periphery of practice. As a function of residents' increased participation, preceptors moved into more supportive roles. Residents were not only learners; at times they were teachers who facilitated preceptors' learning. CONCLUSIONS Legitimate peripheral participation is a concept that helps to explain apprenticeship as a dynamic social relationship which shapes, and is shaped by, learning that takes place in clinical practice. Other concepts shed light on the bidirectional nature of apprenticeship learning.