Editorial

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 1, 1– 6

Blackwell Publishing, Ltd.

Editorial

Continuity of learning

The learning professional always has competing

agendas. In educational contexts, both teachers and

learners have to navigate their way through what

seems like an overwhelming amount of potentially

relevant knowledge. So tensions inevitably arise

between covering prescribed content, promoting

conceptual understanding, developing skills of

learning and critical thinking, and connecting areas

of theory and practice. We reach the end of each

course with great relief, but to what effect? Have

we achieved a platform for further learning in

the relevant areas? When is the newly acquired

knowledge going to be next used, and will the need

for it be recognized by learners embarking on new

courses or entering practice settings? How much of

that learning will survive changes of context or the

passage of time without any use?

In educational settings, there is at least some time

for those who are inclined to think about these

competing agendas. In practice settings, however,

we are confronted by a glut of unanticipated claims

on our attention, for example, a surfeit of patients or

a tight appointment system that offers little scope

for extending time to meet the needs of a particular

client. Hence, there is a greater risk of decisions about

time allocation and timing being made on-the-hoof

in a crowded environment. Time for reflection or

explicit learning is difficult to find, and the more

frequent spells of implicit learning are liable to

influence our practice in ways that bypass reflection

and evade our conscious control.

There is considerable evidence in both education

and practice settings of a strong connection between

working practices and learning practices, but nei-

ther educators nor practitioners give it the attention

that it deserves. In practice settings there is an

important distinction to be made between learning

episodes in which learning is the main object, and

those in which working is the main object and learn-

ing is an often unrecognized by-product. My own

research has noted, for example, that explicit and

implicit learning are likely to occur through parti-

cipation in group activities, working alongside other

people, tackling challenging tasks, problem solving

and working with clients. The main factors affecting

such learning through work can be separated into

those deriving from the organization of work, those

deriving from relationships at work and those deriv-

ing from the agency of individuals and those who

help them (Eraut et al. 2004a,b).

In educational settings, the connections between

work and learning are not so very different. Learners

constantly refer to academic work, and teachers

strongly influence that work through teaching and

assessment arrangements that are framed at both the

organizational level and the level of the individual

teacher or course team. However, much of the academic

work in which students engage is also structured by

their own agency and is not always visible to their

teachers. Yet, we also know that classroom transac-

tions rarely follow the distribution of time originally

intended by the teacher, and students’ allocations of

study time are often far from their original intentions.

Indeed, the way in which students’ academic work

is structured, and how and what they learn, is not

only invisible to their teachers, but sometimes even

to themselves. However, there is a body of relevant

research on students’ work patterns, approaches to

learning and capabilities for self-directed learning,

to which I will return in a future editorial.

2 Editorial: Continuity of learning


Given the complexity of knowledge and learning,

my preferred model of progression is a set of inter-

related learning trajectories. This recognizes the

principle of lifelong learning and does not assume

that learning follows stages that correspond to arti-

ficial stopping points associated with competence or

qualifications which, in spite of the rhetoric, rarely

coincide. However, we also have to be careful not

to assume that learning trajectories necessarily

progress onwards and upwards. When knowledge

is not used, it atrophies through lack of opportunity

or failure to transfer it to a new context. When

accustomed practices cease to be the best practices,

because of new developments or changes in the

client population or wider social environment, then

the trajectory falls quite rapidly because it has effect-

ively been recalibrated. Those who have to change

their practices as a consequence have to unlearn the

old practices before they can construct new practices,

a disorienting and emotional experience, better

expressed by the metaphor of a rollercoaster than

that of a learning curve. Such discontinuities in what

counts as good practice are an inevitable part of

professional life, for which mid-career professionals

are rarely prepared. As noted in a previous editorial

(Eraut 2004), this is largely because the role of tacit

knowledge in routinized professional practice is greatly

underestimated, if not denied. However, disconti-

nuities are more avoidable in areas where practice is

more explicit, less routinized and more clearly linked

to relatively simple theoretical concepts, especially

if the relevant know-how can be communicated

through words or simple demonstration, without

requiring complex situational understanding.

Transitions between education contexts and

practice contexts are generally experienced as

major causes of discontinuity. This often leads to

considerable scepticism towards professional edu-

cators, partly because the discourse of professional

education is rarely equipped to deal with knowledge

transfer, and partly because education and practice

use differently defined learning trajectories. In edu-

cational contexts, learning trajectories are aligned

to aspects of academic, codified knowledge or to the

skills of interacting, critical thinking and learning in

a formal environment dominated by assessments. In

practice settings, the trajectories are aligned to types

of client and how they are treated, the performance

of tasks and roles, the development and susten-

ance of relationships with clients and colleagues, and

contributions to group or organizational activities.

The bridging role of problem-based learning stems

from the use of a case-based approach to knowledge

in an educational context, rather than in a practice

context. By linking theoretical knowledge to practice-

based modes of thinking it provides an advanced

organizer for case-base problem-solving, but does

not address the skills involved in collecting evidence

from patients. Nor does it provide continuity of learn-

ing in either academic knowledge or case knowledge.

Thus, it provides excellent lateral continuity, but

little vertical continuity. No course can do everything.

The problems of providing continuity of content

should be easier then those of providing continuity

of skill development, so let us address them first. In

educational settings, some aspects of content are

followed-up in later courses (vertical continuity),

while others are included because they are perceived

as being of direct relevance to practice without

further academic study (lateral continuity). Stu-

dents are more likely to take seriously those aspects

of a course for which continuity is recognized, than

those without any signs of further use. Therefore, it

is important to flag up future continuities, provided

that those claims are credible. Credibility can be

conferred either by senior students confirming

those continuity claims, or by reciprocal arrange-

ments, whereby the first course flags its usefulness

for the second, and the second course documents its

expectations of prior knowledge from the first.

The educational research and pedagogic liter-

ature offer several types of ‘navigation aid’ to facilitate

both coherence within a course and continuity across

courses or contexts. Typically, they involve diagrams

linking concepts together at either course level or

topic level and are described as overviews, guides

or concept maps. Sometimes their purpose is to

provide a skeleton, which note-makers are then

expected to flesh out. At a more advanced level,

students might be given a hitch-hikers’ guide to the

literature and asked to develop their own ‘navigation

aids’, as individuals or in small groups. This would

prepare them for the task of consulting literature

when working in practice settings. All of these devices

Editorial: Continuity of learning 3


get students to think about how and what they learn

and to see concepts as tools for understanding,

rather than as gobbets for pasting into assignments

or examination papers. Moreover, learning to

navigate within courses will be good preparation for

navigating the stormier seas between courses.

Skill development in learning to learn and critical

thinking requires co-ordination and continuity of a

rather different kind. One has to develop a discourse

that is easily grasped by students, together with a

means of tracking student progress and providing

feedback within that discourse. These important

professional skills usually receive only limited

attention in most modular systems. Coordination

is probably much easier if a small number of key

courses, spread out across the time-span of the pro-

gramme, are given responsibility for skills develop-

ment and planned with that in mind, using content

that is suitable for this purpose. Later courses could

also seek to extend these skills to problem areas aris-

ing from students’ placement experiences, as well as

learning from books and other publications.

This area of development is very challenging, for

several reasons. First, it is difficult to pin down the

practical meanings of terms so glibly used as ‘learn-

ing to learn’, ‘critical thinking’ and ‘self-directed

learning’, more difficult to arrive at a shared under-

standing among a group of professional educators,

and more difficult still to extend that understanding

across a wide variety of clinical areas. Second, deci-

sions will have to be made about the range of con-

texts to be covered by any learning strategy of this

kind. It may be better to start small but long, as sug-

gested above, and aim to gradually expand its scope.

Finally, in order to sustain continuity of learning,

the shared agreement will need to include how to

map progression in these areas onto relevant learn-

ing trajectories, without which it would be difficult

to provide consistent feedback to learners and thus

developing their self-directed learning and sense of

urgency.

The opportunities for continuity across contexts

are greater on programmes for experienced practi-

tioners, because they have significantly more work

experience to draw upon. Nevertheless, they still

present a challenge of a rather different kind. I have

already referred to discontinuities in what counts as

best practice, but that was in the context of learners

adjusting to changes in external expectations of

their practice. In addition, it is important to con-

sider that not only have these learners achieved

some status in their own workplace, but they have

also developed fluent practices that enable them to

cope with their workloads. These practices serve

them well when they are the best available and the

environment is relatively stable, but make it more

difficult for them to adopt a critical stance towards

their practice, tackle cases for which their normal

practices are less appropriate, or change over to a

newer type of practice.

Many professional development programmes

are also concerned with internal changes driven by

the goal of better meeting client needs. Only some

aspects of practice can be separated and subjected to

systematic research over a wide range of contexts.

Others are embedded in the social practices of how

we do things here, or constrained by conventions

about who does what. This is where the potential

agency of experienced professionals needs to come

to the fore. To further develop practice, they need to

acquire critical skills for evaluating their collective as

well as their individual practices, and this involves

working with other colleagues and across profes-

sions. Growing the critical capacity of a workplace

community requires continuity, and often external

support, over a considerable period of time, because

it is unlikely that significant progress will be

achieved by short bursts of professional develop-

ment activity, whenever someone gets the urge to

arrange it.

This social perspective is equally important when

we consider the discontinuity experienced by new-

comers to a workplace. They will probably bring

some skills with them that can be used with very

little adjustment – personal as well as professional.

Less visible, however, will be aspects of knowledge/

skills that require further learning before they can be

used in the new context. Recognizing the need for

this further learning and then supporting it will

enhance not only the capacity of the work group,

but also the newcomer’s confidence and self-esteem.

This is easier to arrange when some locals have sim-

ilar expertise, but could be even more important

if it is new to the group. However, the greatest



challenge for local leadership comes when the newly

imported know-how threatens the status quo. Then,

people may not want to know about it, or rely on a

climate that discourages such matters from being

raised. A complementary strategy is to recognize

a newcomer’s existing and potential strengths

and support their further development, which also

boosts their confidence and enhances their sense of

identity within their new working group. Providing

continuity starts from recognizing both what some-

one has to offer and in which directions they would

prefer to further develop their practice.

For students and newly qualified professionals,

the greatest threat to continuity of learning is being

swamped in the new workplace environment. Too

many learning needs clamour for attention, and

even implicit learning is constrained by the cognit-

ive overload. The normal habit of doing nothing to

ameliorate this ‘reality shock’ and asserting the value

of baptism by fire negates the principle of continuity

of learning, which demands some prioritization.

There is also a danger of novices developing coping

mechanisms that rely on a less effective mode of

practice, which then get consolidated and routin-

ized through regular use. There are two comple-

mentary ways to provide more directed approaches

to learning: one is to restrict the range of allocated

work or types of client; the other is to focus the

attention of learners and those supporting them to

specific short-term and medium-term goals.

From both an economic and a psychological per-

spective, it is advantageous for newcomers to have

short-term goals that involve them in achieving a

level of competence in a set of specific activities that

will enable them to work autonomously or under

light supervision, and thus make a visible contribu-

tion to the overall workload of their group. Along-

side these there should be medium-term goals,

which will become more urgent as soon as the first

set of activities begin to be mastered. Opportunities

to participate in these medium-term activities will

provide an orientation that gives them a platform

for more focused learning when they become the

top learning priority. In addition, there will always

be ongoing experiences through which the wider

work environment gradually becomes more fam-

iliar and awareness develops of yet other aspects of

working practice. Work allocation decisions will

affect which patients/clients the newcomer encoun-

ters and in which locations their work is situated.

Within that context, newcomers and their signifi-

cant helpers will need overt guidance on short-term

and medium-term priorities, as well as on how

appropriate learning opportunities and feedback on

progress might be provided.

Achieving this balance between short-term,

medium-term and long-term learning poses a

number of challenges for those responsible for

planning and facilitating students’ learning. When

students achieve learning that contributes to the

work capacity of the local group, it enhances their

motivation, confidence and sense of professional

identity. However, if it becomes divorced from other

work activities it seems like an external imposition

and loses its authenticity. This has important impli-

cations for the length and timing of placements, and

the type of learning opportunities that they present.

Placements that are too short for achieving many

practical goals, or lack suitable staff who can give

students some time and attention, cannot make a

sufficient contribution to learning. Nor is it good

use of a placement to assign it to a student to whose

career focus lies in another direction. If the aim is to

introduce students to work settings that have links

with those they already know and may receive or

refer the same patients or clients, there are more

effective and less intrusive ways of achieving this

goal. One would be to set up reciprocal visits with a

student working in that setting, so that each could

explain their work group’s contribution to care and

its links with other care settings. They could also be

asked to consult their mentors about any problems

with communication through their common link and

the implications for their clients. This would give a

clear purpose to the visits, and both students could

also be encouraged to challenge each other about

the ‘taken-for-granted’ practices that they observed.

This brings us back to the lateral discontinuities

between education and practice settings. One crit-

ical issue is that of timing. Final-year students are

further along their learning trajectories than first-

year students, and this should be reflected in the

work assigned to them. However, they can also play

a useful role in the induction of first-year students,

Editorial: Continuity of learning 5


allowing mentors to concentrate on learning plans,

finding appropriate learning opportunities and giv-

ing feedback. Final-year students will be more likely

to receive naïve questions and be better positioned

to respond to them. They will also be able to share

their experiences of using theoretical knowledge in

their practice, insofar as they have had any. The

essence of the timing problem is that evidence sug-

gests that the longer the gap between a topic being

taught in an education setting and first being used in

a practice setting, the less it will have been remem-

bered (Eraut et al. 1995). If the gap is longer than a

few months, the topic may have to be re-taught, an

inefficiency that is frustrating for both students and

their teachers. The difficulty is that the long tradi-

tion of frontloading theory in educational pro-

grammes, especially when the courses are provided

by non-profession-orientated departments, has

prevented any serious attention to continuity of

learning. The main exception to the frontloading

tradition has been the introduction of project-based

learning, which avoids the lateral continuity prob-

lem of separating theory from practice, but at the

expense of reducing vertical continuity in both

education and practice settings.

An even more difficult problem is the virtual

absence of theory from workplace discourse in

many practice contexts. One reason is that they can

survive without it, another that theory is perceived

as belonging to an educational context. Most prac-

titioners feel distinctly rusty on the theory side as a

result of long neglect, and are worried about being

shown up by students. The most important reason,

however, probably derives from the nature of

practice itself. Fluent practice is effective, sustains

the confidence of patients in healthcare settings, and

lowers the cognitive load sufficiently for important

informal communication with patients and general

monitoring of the patients and their environment. It

is often based on embedded theoretical knowledge,

but the link is rarely mentioned and may even have

been forgotten. The main occasions when theory

may be spoken are when responding to students’

questions, when discussing problematic patients

and when engaged in some form of practice review,

but in many contexts this discourse is strongly

discouraged.

The danger of abstaining from theory altogether

is that it is strongly associated with research,

evidence-based practice and professional status. To

abandon theory is to relinquish potential power and

to reduce any work group’s sense of agency. Many

practitioners do not want this state of affairs, but

find it difficult to maintain some respect for and

interest in theoretical knowledge within their cur-

rent working group. So what can be done to improve

not just discontinuities of learning, but also major

cultural discontinuity between professional practi-

tioners and their former colleagues who now have

responsibility for preparing new members for their

profession? First, it is essential to be aware of the

problems discussed above and the mutual concern

about one group being imposed upon by the other.

Second, it is important of be aware of the tacit nature

of many aspects of practice and the advantages that

this brings, as well as the disadvantages. Finally, it is

wise to have limited goals and expectations.

How might one best progress this project of

reducing lateral discontinuities of discourse? First,

as suggested above, it is helpful to map some of the

territory by developing charts that map the connec-

tions between topics taught in educational contexts,

types of client and associated practitioner activities

(see, for example, Eraut et al. 1995). These provide

tools for exploration and for focusing discussion on

very specific areas of both theory and practice, while

remaining mindful of what is not currently under

the microscope. In some places, the discussion will

seem like returning to an area where there appears to

be order and agreement. Work with students should

be focused on these areas, and negotiations about

which should be on the students’ learning agenda,

and when, will need to be decided upon, bearing in

mind when the relevant theory is taught and possible

changes in that time. In other places, the opening of this

small Pandora’s box will reveal considerable com-

plexity, uncertainty and unevaluated tacit knowledge,

which will alert people to a need for further monitor-

ing and investigation. These might be important areas

for professional development, or even for research.

Compiling an agenda for students that addresses

the issue of knowledge use would be a great step for-

ward in reducing discontinuity, but appropriate and

available learning opportunities would still have to



be located, and agreement reached as to who might

be able to best support that learning from among

either the practitioners’ group or the relevant group

of educators. After a time, it is probable that stu-

dents will become more self-directed in this search

and able to use the tools and the literature for guid-

ance with only occasional consultations with staff

(Parboteeah 2001). That would be an excellent

training for future practice development activity.

Michael Eraut

Editor

References

Eraut M. (2004) Learning to change and/or changing to

learn. Learning in Health and Social Care 3, 111–117.

Eraut M., Alderton J., Boylan A., Wraight A. (1995)

Learning to Use Scientific Knowledge in Education

and Practice Settings. English National Board for

Nursing, Midwifery and Health Visiting,

London.

Eraut M., Maillardet F., Miller C., Steadman S., Ali A.,

Blackman C., Furner J. (2004a) Learning in the

Professional Workplace: Relationships between Learning

Factors and Contextual Factors. AERA Conference

Paper, San Diego.

Eraut M., Maillardet F., Miller C., Steadman S., Ali A.,

Blackman C., Furner J. (2004b) Early Career Learning

at Work – The LiNEA Project. ESRC-TLRP Conference

Paper, Cardiff.

Parboteeah S. (2001) The Effect of Using Knowledge

Maps as a Mediating Artefact in Pre-registration Nurse

Education. DPhil Thesis, University of Sussex, Sussex,

UK.

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Editorial