What’s so good about placement learning?
- Department of Philosophy, University of Warwick, Coventry CV4 7AL, UK
- Correspondence to: Professor Luntley; michael.luntley{at}warwick.ac.uk
Expertise and judgment
Placement learning seems a good thing. It’s where you pick up all the things they didn’t and couldn’t teach you in medical school. It’s where you finally learn what you need to learn to acquire expertise in your chosen field. Expertise requires not only the knowledge found in medical textbooks and disseminated in lecture halls, it requires experiential knowledge. This is the knowledge that is distinctive of professional expertise. It is difficult to articulate and relies as much on intuition as following explicit rules. And that’s why some of what you learn on placement is stuff they couldn’t teach you in medical school, for it cannot be abstracted from the contingencies of practice.
The concept of experiential knowledge gives a satisfying explanation of why placement learning is a good thing. But the idea is problematic. There are conflicting intuitions about it. First, it is knowledge that is embedded in practice, it is contextualised to situation. That is why you need to go into placement to acquire it. Second, the knowledge learnt on placement transfers from case to case. The expert medic is not a one-hit wonder. Expertise enables quality performance time after time. Therefore, whatever you pick up on placement cannot be contextualised. If it was, it would not transfer from case to case. And if it did not transfer, how could you legitimise performance?1 The first intuition supports the case for placement learning, the second takes it away. The puzzle is how to satisfy both intuitions at once. The solution is to make sense of the cognitive transfer from case to case.
What you learn from treating one patient makes your treatment of other patients better than it would otherwise have been. That’s the cognitive transfer. But if that is right, what becomes of the …
