Syndicom

Communities of Practice - A Shared Rhythm

“A culture of separation will collapse of its own incoherence. We need communities of memory that experience time as a continuous flow, a shared rhythm.” -Robert Bellah, Habits of the Heart

Time is precious. And because doctors provide services to one person after another, it can be a grind. You can lose your larger sense of purpose as Atul Gawande warned about in his afterward of

Better: A Surgeon’s Notes on Performance. Even more, time and medical education are talked about extensively. It is no secret that medical residents learn to function at high levels - often making life and death decisions - under extreme conditions of little sleep, poor nutrition, and low income levels. John Grohol recently talked about the flawed medical educational model where doctors become doctors during a period where they are literally worked until they can work no longer. Additionally, Pauline Chen agreed that exhaustion is not good for medical training, or for patients. But she has reservations for structuring the unpredictability of the illness experience and the individuality of human relationships into a scheduling grid. Would work hour restrictions improve your relationships with patients? Would work hour restrictions improve patient care and your own well-being? And would work hour restrictions allow you to know your communities and learn practices differently?

The notion of a “community of practice” has turned out to provide a useful perspective on knowing and learning to improve performance. As Etienne Wenger states, “communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavor.” Developing a shared practice takes time and sustained interaction as illustrated with SpineConnect. A community of practice could be a group of teenagers defining their identity in the 7th grade; a group of musicians seeking new forms of expression; a flock of birds learning to survive; or like you, a network of surgeons exploring novel techniques. In short, communities of practice are groups of people who are committed to a concern or carry a passion for something. Furthermore, members of the community engage in joint activities and discussions, create relationships, help each other, and share information.

Communities of practice are all around us. They have become familiar and we don’t always notice them. But when we acknowledge where they are, what they do and how they work - they become a lens. SpineConnect is that lens. It is always there, ebbing and flowing with your interactions, but also, ready for that challenging case at 1am with diverse perspectives when you and others need it. And this can help us all understand the experience of community as a continuous flow, a shared rhythm; rather than the experience of community as restricted and predictable. Great things emerge when we interact. Go ahead; let it unfold!

With thanks to Mark Abeland Caucas’for the images!

Carey Candrian

Tags: Atul Gawande, collaborative communities, collective learning, communities of learning, Communities of practice, doctor work hour restrictions, doctor-patient interaction, Etienne Wegner, John Grohol, medical continuing education, medical doctors, medical education, medical network, medical school training, networks, Pauline Chen, Robert Bellah, spineconnect, surgeon, surgeons, the collaboration, time, work week

This entry was posted on Thursday, January 8th, 2009 at 3:16 pm and is filed under Blog.

5 Responses to “Communities of Practice - A Shared Rhythm”

Karolyn Says:
January 9th, 2009 at 6:05 pm
Applying the community of practice concept to our broken healthcare system is a step in the right direction. There can be great power gained by strengthening community among healthcare providers. As mentioned, this could be especially beneficial to medical residents.
Susan Says:
January 11th, 2009 at 6:21 pm
I am not a doctor…plenty of them, inc. surgeons, in my family, though.
This post was alarming to me bec I have always thought that the “medical community” was just that: what you are calling “communities of practice”.
Hmmm, maybe “med. community” just means “a group of rich people at whom to market expensive stuff” (rich? not all doctors!)
Nowadays, I dread having an er dept event while out of town…lone, exhausted doc in the middle of the night at a stressed hospital. I am shockingly lucky to have insurance and a local doc I can call at 3 a.m., and a doctor cousin for “community of practice”.
We have third-world conditions out here for delivery of health care to the non-rich or uninsured, and for far too many facilities. We seem to be wasting great educations and great mentors. How long before even that fades into chaos?
Carey Says:
January 11th, 2009 at 10:43 pm
Karolyn, thank you for your comment and your enthusiasm for applying the concept of community of practice among healthcare providers in general and medical residents in particular. What do you think such training for medical residents would look like? What changes would need to take place in order to strengthen community? Would love to hear more of your thoughts!
Carey Says:
January 11th, 2009 at 11:06 pm
Susan, thanks for your insightful comments. I don’t think you are alone in thinking that the medical community is similar to the concept of a community of practice described. But of course, medicine, community, and practice all mean very different things to different people at various times. So my perception and understanding of a community of practice might be very similar to your perception and understanding of a medical community — we’re just using different language. Because of the challenges and barriers to effective care, as you mentioned, I think many have lost hope, comfort, peace and trust in our current system. But, I am fostering a more optimistic view by way of the notion of community of practice that has the ability to instill the very things people think are lacking. Albeit slowly, we are seeing productive changes happen like web-based solutions, Health 2.0 (patients as partners) and certain medical curriculums. I’m very interested in hearing more of your thoughts about communities of practice and medical communities…
Karolyn Says:
January 15th, 2009 at 8:36 am
I am a health writer and I frequently work with doctors. They seem stressed and overwhelmed and frustrated with our present system. Perhaps if they could build a stronger community that could then leverage their power to create a healthcare system that fulfills their needs and ultimately the patient’s needs, maybe they would be less frustrated and feel more empowered. I think Susan’s comments are totally valid and I share her fear. Unfortunately, I have no real concrete solutions as to how to strengthen the medical communities that already exist. I can only echo your concern and hope for change to come.