The need for rapid improvement in the quality and safety of healthcare delivery around the world is immediate,5
yet efforts to transform the preparation of health professionals are stymied by faculty's limited expertise in both a) quality and safety science, and b) new pedagogies that can capitalise on their emerging competence. This situation requires that the challenges of developing faculty-experts in quality and safety and attending to the formation of the next generation of providers occur simultaneously. Pedagogies that make co-learning a central aspect of the educational experience hold great promise for addressing these co-occurring challenges. Co-learning, defined here as teachers, students, clinicians, patients and families learning together how care can be improved, interrupts the traditional, linear model of health professions education that separates objectives, content, method and evaluation.6 7
In traditional teaching, teachers decide what is taught, when and how it is taught and how learning is to be demonstrated by students. The clinical situation is the mere medium in which student learning occurs. Although this model permeates the health professions, few teachers and students experience health professions education in such a ‘conceptually neat and procedurally unambiguous’ way (p. i21).8
More often than not, clinical learning is inherently context dependent, reflexive, evolving, and underdetermined and involves complex and multifaceted issues that both teachers and students must consider.
The complex and indeterminate nature of clinical learning not only belies the predetermination of what will be learnt in each encounter, but also raises questions about the utility of separating subject matter from teaching methods. Bingham1
suggests, for instance, that when a teacher poses a question, it does something to
the subject matter at the same time that it queries the student. If the question is a true question, it ‘breaks open’ the subject matter by showing what is still undetermined such that teachers and students together question their knowledge and understanding of the clinical situations they encounter and the possibilities for care. They attend to what they know and don't know, what they notice in a particular situation and what assumptions they are making as they devise a fitting response to a clinical situation. Because many faculty members teach as they were taught, relying on traditional education methods,9
it is commonly the case that faculty members raise ‘false questions’ (p. 557),1
by asking questions in ways that reinforce what is known (ie, a correct versus an incorrect answer—the correctness of which being determined by the teacher).
Yet, raising true questions is difficult because to raise a true question ‘one must want to know, and that means knowing that one does not know’ (p. 363).10
When a teacher asks a true question, she becomes a co-learner with the student. Importantly, asking true questions requires deference to the object of enquiry1
rather than to either predetermined lesson plans or identified learning needs. As co-learners, teachers and students together persistently pursue questions around the clinical situation they encounter and how the care being provided can be improved at micro, meso and macro levels.11
Embedded in such questioning is questioning even further10
or keeping the question in play. Thought of in this way, questioning is not merely an alternative method one can employ towards the same educational end (content transmission), but is a way of being in a practice situation wherein one consistently questions the possibilities for, and limitations of, practice.12
Such pedagogies not only facilitate the acquisition of the knowledge and skills for systems improvement but also support the learners becoming professionals who persistently engage the constitutive problems of quality and safety.
The Carnegie Foundation for the Advancement of Teaching's studies on Preparation for the Professions
, has highlighted the importance of examining how faculty's pedagogical practices influence the formation of those entering the field.13 14
Indeed, there is growing awareness among health professions faculty that how we teach is as important as what we teach. If the next generation of health professionals is to see improvement work as part of their professional identity, then the traditional, linear content transmission/application model of health professions education must be transformed. New pedagogies will build into health professions students a commitment to, and habit of, improvement.15