Social Learning models
By Paul Milne
In this section we outline the place of social learning models in GP training and education.
These models are important in educational theory and sit alongside the cognitive theories in
this chapter.
First, a little bit of philosophy. This will help give some epistemological background.
Philosophy
Philosophically, learning theory has a propensity towards a Cartesian model with an
‘individual –social’ separation. This model can be expressed as an assumption that knowledge
or knowing has a degree of certainty and that the knowledge is held within the individual and
that ideas emanate from within the individual. A counter argument to this position is
expressed through the Kantian view that learning is inter-subjective. Learning takes place
through an interaction between individuals or artefact. Social learning theories reflect this
philosophical view and within these, there is a range of perspectives.
But now something lighter
This is part of a conversation between two GPST registrars who are having a cup of coffee
during a break in the weekly VT scheme’s group teaching.
Yasmin: I’m going to the big group practice in town. I heard
that they really look after you and you are made to feel part of
the practice. Which practice are you going to?
Fiona: A two partner practice about two miles from the
hospital. Apparently it’s very busy. The last registrar said that
it was a bit lonely there and the administration staff don’t talk
to you very much.
Dr Paul Milne, 2011
Imagine you are a GP trainer, how would you describe the learning culture in your practice?
It’s important because if we are to succeed in training and learning so that our registrars
acquire the competencies, then we need to ensure a positive and supportive social learning
environment. Lifelong learning1, 2 is important and learning in the workplace is not only (and
obviously) important for GPST registrars but also for everyone in the practice team.
So, what are these social learning models?
There are several. The most pertinent and relevant to our training practices are
Activity theory
Communities of Practice
Social Capital
Although not strictly a social learning theory we would also include complex adaptive system
theory as a social metaphor but you will read more about that later in the chapter. Here is a bit
more about these theories and a suggestion as to how they fit together.
Activity theory
This theory is predicated on a dialectic between the internalisation and externalisation of
knowledge for the individual and that artefact, be it through physical object or through
regulation (e.g. practice computer, quality outcomes framework), mediates this exchange 3, 4 .
Artefacts reify events past and present to their users and within the social setting, artefacts
help the understanding of the process of social learning. They can be considered as mental
models which mediate activity. They can be internalised from the culture in which the person
is taking part and externalised by their use and development in the person’s environment.
Engeström has developed this concept through the activity theory model 3. An activity system
‘has as its minimum elements the object, the subject, mediating artefacts, rules, community
and division of labour’4. The subject in a primary care setting might be a health professional
who provides care for a patient (object). The resultant outcome is mediated by the practice’s
Dr Paul Milne, 2011
internalised rules and regulations, who the health professional works with and how tasks are
allocated in a practice. This is represented diagrammatically as
Mediating
artefact
Mediating
artefact
subject
subject
rules
Object 1
Divn of
labour
Community
Object 1
rules
community
Divn
Of
labour
Transformation leading to new sense and meaning
The
interplay between these two imaginary systems not only produces new knowledge as
individual systems but have the potential to generate new knowledge through the interaction
of the two systems. The communication between each facet of the system (e.g. rules –
subject-community) is at any point in time a mediational process which will have implicit
tensions and contradictions. In turn, these will be mediated by the other facets of power and
hierarchy within the system or organisation. The relationship between individual health
professional’s activity system and the practice or organisation’s overall activity system is
complex. The resultant developmental trajectory for the practice and its team is set by the
complex interplay between the different components of the system.
Dr Paul Milne, 2011
An example: From their initial conversation, Yasmin and Fiona, our
imaginary GPSTs, intuitively sense there may be a difference in the quality
of training between their practices (abbreviated to quality in the diagram).
That notion and its expression as a virtual artefact will interact with their
training practice’s own collective activity system
Quality
Health
Professional
Rules and
Regulations
Quality
Patient
care
Community
of Practice
GPST activity system
Division
of Labour
Health
Professional
Patient
Care
Learning
Rules and
Regulation
Transformation
Community
of Practice
Division
of Labour
Training Practice activity system
Yasmin or Fiona’s quality of training modifies and is modified by the
practices’ rules and regulations, its communities of practice, and how daily
life is timetabled for them as ‘employees’ in a practice. The resultant
learning and its transformation is an outcome whose nature is difficult to
predict (see complexity bit in this chapter). However it is more likely to be
positive if there is a balance between the components in the system.
Well, I bet you have noticed we have slipped in the phrase ‘communities of practice’. This
needs unpacking and leads nicely on to the next part of this section which considers Wenger’s
Communities of Practice.
Dr Paul Milne, 2011
Communities of Practice
Lave and Wenger 5, 6 developed various themes under the rubric of a ‘Community of Practice’
following their research which considered how apprentices (newcomers to an organisation)
learn in the workplace. They used the term communities of practice to describe learning
through practice and participation, which they named situated learning.
This is described as a ‘characterization of the concept of practice, to distinguish it from
less tractable terms such as culture, activity or structure’ and defines it as a ‘special type of
community.’ The word 'Practice' is given three dimensions in its relationship with
'Community'. These are ‘mutual engagement, a joint enterprise and a shared repertoire’.
Mutual Engagement
This term refers to how members of an organisation (e.g. a general practice) members
develop norms and build collaborative relationships. These relationships are the bonds that
hold the members of the community together as a social entity.
Joint Enterprise
Through their interactions, they create a shared understanding of what binds them together.
The joint enterprise is (re)negotiated by its members and is sometimes referred to as the
'domain' of the community.
Shared Repertoire
As part of its practice, the community produces a set of communal resources. This shared
repertoire is used in the pursuit of their joint enterprise and can have literal and symbolic
meanings.
Overall, Wenger views learning as social participation. A community of practice is then more
clearly seen as a group of individuals participating in communal activity. They experience and
continuously create their shared identity through engaging in and contributing to the practices
of their communities.
This theory has become popular in the business world as a tool for knowledge management in
order to value tacit knowledge.
Dr Paul Milne, 2011
An exercise (having read so far you may be feeling you need some time out)
Thinking about your practice, where are the ‘communities of
practice’? Who is in them? What is their history?
Activity theory and communities of practice seem interrelated and yet we think a third model
is needed to make the whole. This concerns itself with the notion of social capital and in
particular the concept of trust.
Social capital
As a model, social capital helps with an understanding of what holds the organisation together
in terms of its learning. Social capital has many definitions but the purpose of this section we
use Putnam’s definition of social capital 7.
‘Social capital has features of social life-networks, norms, and
trust-that enables participants to act together more effectively to pursue shared objectives’.
It is trust which seems important within the context of this model when we think about how
learning takes place for the GPSTs in the workplace. To use a metaphor then trust is the
equivalent of the ‘dark matter’ postulated by astrophysicists; present but difficult to quantify.
Trust is tricky territory and replete with an extensive sociological literature.
One of the more pragmatic and accessible models that relate to trust within social capital is
that proposed by Sztompka 8. There are four levels or sorts of trust in Sztompka’s model.
These are primary trust, secondary trust, trusting impulse, trust culture.
Primary trust is the ‘inner’ or individual sense of trust and could relate to professional
reputation, performance and appearance. The latter is described as dress, readiness to smile
and body language. Sztompka includes the appearance of buildings in primary trust.
Secondary trust relates to the sense of trustworthiness in institutions and the context in
which their actions take place. Accountability and awareness of bodies that monitor
performance is placed within secondary trust.
The trusting impulse is to be thought of as inculcating or fostering trust in the individual
Dr Paul Milne, 2011
through ‘fostering family life, encouraging trusting relationships and encouraging public
discourse about moral choice’ and this becomes elaborated through a trust culture.
A trust culture develops through the myriad of interactions between individuals and from this
develops norms and values that ‘regulate, grant, meet, return and reciprocate trust’.
An exercise: How would you relate Sztompka’s levels of trust to
your practice and the GPST registrar? You might want to discuss the
notion of trust with your colleagues
Another exercise: Sztompka says ‘Trust is a bet about the future
contingent actions of others’. Think about this in relation to the
components of the Activity Model.
Dr Paul Milne, 2011
Synthesising the models: Triangles and Pyramids
Based on an empirical study9 we suggest a synthesis of the social learning models which we
have discussed. There are other parts to the synthesis which relate to complex adaptive system
theory and the geography of the social spaces9. Tacit knowledge and its production are
important and are enabled or inhibited by the presence or absence of trust.
Le
ar
nin
g
sp
ac
e
Artefact
Health Professional
(being organised, responsibility,
caring, curiosity)
patients
LEARNING
m
m
un
Co
Informal
Learning
W
or
ki
ng
sp
a
ce
ity
TRUST
Rules and
Regulations
Division
of labour
Spatial
(The building)
The model is based largely on Activity theory. The model is enhanced by Wenger’s
Communities of Practice but would ‘fall apart’ in the absence of trust as part of social capital.
Social learning models intertwine with the cognitive theories discussed in this chapter and
provide a holistic theoretical perspective to the learning environment.
Dr Paul Milne, 2011
References
1. Department of Health, (2001). Working Together - Learning Together, Department of
Health. Her Majesty's Government.
2. Caley, L.R.S. (2002). Work related learning-key influencing factors. Cambridge, NHS
Leadership centre: 1-41.
3. Daniels, H. (2004). "Activity Theory, Discourse and Bernstein." Educational Review 56(2):
121-132.
4. Engeström Y., M. R., Punamaki R-L. (1999). Perspectives on Activity Theory,
Cambridge.
5. Wenger, E. (1998). Communities of Practice, Cambridge
6. Lave J. and Wenger E. (1991). Situated Learning Legitimate peripheral participation.
7. Putnam Robert D. Tuning In, Tuning Out: The Strange Disappearance of Social Capital in
America PS: Political Science and Politics, Vol. 28, No. 4 (Dec., 1995), pp. 664-683
8. Sztompka, P (1999), Trust. A sociological theory. Cambridge, Cambridge University Press
9 Milne P (2007) Contesting the freedom to learn: Culture and learning in a British General
Practice PhD thesis University of Newcastle. http://learninginprimarycare.com/.
Dr Paul Milne, 2011