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Informal learning in postgraduate medical education: from cognitivism to ‘culturism’


Dr Tim Swanwick MA FRCGP, Director of Postgraduate General Practice Education, Department of Postgraduate General Practice Education, London Deanery, 20 Guilford Street, London WC1N 1DZ, UK. Tel: 00 44 20 7692 3040;


Education is not simply a technical business of well managed information processing, nor even simply a matter of applying ‘learning theories’… It is a complex pursuit of fitting a culture to the needs of its members and their ways of knowing to the needs of the culture.1

Background  Work-based learning occupies a central role in the training and ongoing development of the medical workforce. With this arises the need to understand the processes involved, particularly those relating to informal learning. Approaches to informal learning in postgraduate medical education have tended to consider the mind as an independent processor of information.

Method  In this paper, such cognitive approaches are critiqued and an alternative socio-cultural view on informal learning described. Recent and imminent changes in postgraduate medical education are identified, namely the reduction in patient experience, the fragmentation of teaching, and the development of competency frameworks and structured curricula. It is argued that although the latter may be useful in the construction of formal learning programmes, they will do little to enhance the progression of the individual from newcomer to old-timer or the cultural assimilation of the learner into a profession.

Discussion  Strategies for enhancing informal learning in the workplace are recommended in which increased attention is paid to the development of the medical apprentice within a community of social practice. These include the establishment of strong goals, the use of improvised learning practices, attention to levels of individual engagement and workplace affordances, immersion in professional discourse and behaviours, support in relation to the development of a professional identity and the provision of opportunities to transform social practice.