LEARNING IN COMMUNITIES OF PRACTICE

Abstract

Problem-solving 'Can we discuss this patient and brainstorm some ideas? I'm stuck.' Requests for information 'Does anyone know a good website about treatment of Chagas disease?' Seeking experience 'Has anyone dealt with a patient in this situation?' Reusing assets 'I have a proposal for a new clinic that I wrote for our hospital last year. I can send it to you and you can easily tweak it for your situation.' Coordination and synergy 'Can we combine our purchases to achieve bulk discounts?' Discussing developments 'What do you think of the new patient information system? Does it really help?' Documentation projects 'We have faced this problem five times now. Let us write it down once and for all.' Visits 'Can we come and see your clinic? We need to establish one in our city.' Mapping knowledge and identifying gaps 'Who knows what are we missing? What other groups should we connect with?' The primary purpose of CoPs in this conception is knowledge translation. Knowledge translation has been defined as 'the exchange, synthesis and ethically sound application of knowledge-within a complex system of interactions among researchers and users-to accelerate the capture of the benefits of research … through improved health, more effective services and products, and a strengthened health care system'.(115) More recently, other terms have been proposed for essentially the same broad concept. These terms include knowledge mobilisation,(116) knowledge utilisation,(117) knowledge exchange,(118) knowledge management (119) and knowledge brokering,(120) all of which involve an active exchange of information among various stakeholders, such as researchers, healthcare providers, policy makers, administrators, private sector organisations, patient groups and the general public. Partnerships are at the heart of all knowledge translation activity,(115) and effective knowledge translation is dependent on meaningful exchanges among network members for the purpose of using the most timely and relevant evidence-based, or experience-based, information for practice or decision-making. In the field of continuing medical education, the limitations of traditional workshop/presentation models are becoming apparent.(121) It is now recognised that there is a need for continuous learning to occur in the context of the workplace, and for reflection-in-practice and reflection-on-practice to be supported.(5) Knowledge translation is essential to shortening the path from evidence to application of that evidence in practice, and CoPs provide an opportunity to embed learning within a clinical context. A highly effective way to learn about complex issues is through experience, application and discussion with mentors and peers in the same or similar contexts. Relevant learning occurs when the participants in the CoP raise questions or perceive a need for new knowledge. Using internet technology enables these discussions to occur in a timely manner, and records of these can be archived for later review or by those who missed the discussion. There are a number of key factors that influence the development, functioning and maintenance of CoPs.(122) The legitimacy of the initial membership is important. Commitment to the desired goals of the CoP, relevance to members and enthusiasm about the potential of the CoP to have an impact on practice are also key. On the practical side, a strong infrastructure and resources, such as good information technology, useful library resources, databases and human support, are essential attributes.