What is WPBL?
Workplace-based learning (WPBL) transforms learning from the classroom to experiential learning in one’s workplace. It is an increasingly popular solution for talent development and acquisition. WPBL entails a category of academic learning models embedded in the real world of work, which includes, for example, internship or housemanship training, specifically in the field of clinical practice of medicine.
WPBL is known to deliver educational outcomes for learners which are superior to classroom learning as this approach not only facilitates practice and feedback, but also increases learners’ motivation, whilst supporting both mastery and “just-in-time” learning (Ambrose & Poklop, 2015).
Healthcare institutions play an important role in health service delivery whilst not compromising the educational environment for doctors in training. Hospitals and clinics are appropriate settings for WPBL for junior doctors who have newly joined the workforce. They will first tag along a senior doctor in the department, subsequently gaining the confidence to carry out assigned tasks independently following an assessment at the end of their tagging period.
Procedural skills in undergraduate medical training
The WPBL situation which I will be discussing here is procedural skills learning for undergraduate medical training. This is an area which demands competent and trained personnel as operators. Traditionally, junior doctors are provided with some exposure to basic procedural skills in undergraduate training, however, a review of curriculum and guidelines of housemanship training in select Medical Councils around the world have emphasised the importance of providing high-quality training in procedural skills in their undergraduate training level itself (Davis et al., 2014). As patient safety is given much utmost importance in the practise of medicine, it has driven the need for developing a more holistic framework of training specifically in the approach of procedural skills training (Davis et al., 2014).
WPBL Situation: Procedural Skills Learning
In this particular design of the WPBL situation, undergraduate learners are provided with pre-requisite knowledge through a stepwise guided pre-recorded slide tutorial. Each step of the basic procedures is demonstrated in a clear and structured manner. Learners first learn by observation. Observational learning is monitored through their watch time on their profiles. Additional notes are also shared through the same platform to assist with reasoning certain steps of the procedures shown.
The next phase is where learners assist in the procedures before being able to perform them on a mannikin and patients in the hospital. They are divided into small groups and rotated in venepuncture rooms as well as daycare wards. Here, they will assist junior doctors or nurses in basic procedures i.e venepuncture, blood culture procedure, urinary bladder catheterisation and wound dressing. Finally, they are allowed to perform these basic procedures under the supervision of clinical facilitators in small groups. Direct observation of the steps carried out and feedback is provided.
Social constructivism theory
The social constructivism theory is largely applied in this framework of learning. Constructivism transforms the student from a passive recipient of information to an active participant in the learning process through the guidance of a facilitator. Learners here construct their knowledge actively rather than just mechanically ingesting knowledge from notes or textbooks. The reflective theory is well applied in this learning process as shown in the flow diagram below:
Framework to provide feedback
First of all, observational learning can be assessed by utilising a short quiz in the end of each session to gauge the understanding and importance of specific steps in each procedure. Once the rationale of the step is learnt, learners will be able to reason out the process in their minds as they are performing the procedure.
Assessments on performing the procedure can be assessed through a practical session i.e Direct Observation of Practical Skills (DOPS). A wide range of practical procedures can be assessed with a calibrated rubric to look into not only the competency of the operator but also safety aspects as well. Assessments also should move from the use of numerical value to standards that are expected in procedural skills (Hassan, 2011).
Apart from that, a framework that entails reflective exercises have shown to be useful in the continuously learning and improving ongoing practice. This is possible by using the knowledge that learner’s are gaining from their experience in performing the procedure. A simple and short reflective exercise at the end of their sessions in the hospital is a useful activity for learners to develop a deeper connection with the activities performed in the learning process (Helyer, 2015).
Formalised teaching in procedural skills in the early stages of a medical degree can have long-term effectiveness in basic skills competence and may increase students' confidence to practise their skills. A framework that entails demonstrating pre-requisite skills and knowledge will provide a greater impact on the learning process in WPBL situations.
References:
Ambrose, S. A., & Poklop, L. (2015). Do Students Really Learn from Experience? Change: The
Magazine of Higher Learning, 47(1), 54–61. https://doi.org/10.1080/00091383.2015.996098
Davis, C. R., Toll, E. C., Bates, A. S., Cole, M. D., & Smith, F. C. (2014). Surgical and
procedural skills training at medical school – a national review. International Journal of
Surgery, 12(8), 877–882. https://doi.org/10.1016/j.ijsu.2014.05.069
Hassan, S. (2011). Faculty Development: DOPS as Workplace-Based Assessment. Education in Medicine Journal, 3(1). https://doi.org/10.5959/eimj.v3i1.94
Helyer, R. (2015). Learning through reflection: the critical role of reflection in work-based learning (WBL). Journal of Work-Applied Management, 7(1), 15–27. https://doi.org/10.1108/jwam-10-2015-003
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