Professional Development: 2. Professional Knowledge and Situated Learning in the Workplace

Physiotherapy September 1999/vol 85/no 9

467Professional articles

Purtilo, R (1986). ‘Professional responsibility inphysiotherapy: Old dimensions and newdirections’, Congress Lecture, Physiotherapy, 72,12, 579-583.

Quinn, J B, Anderson, P and Finkelstein, S(1996). ‘Managing professional intellect: Makingthe most of the best’, Harvard Business Review, 74,2, 71-80.

Richardson, B (1992). ‘Professional educationand professional practice - Do they match?’Physiotherapy, 78, 1, 23-26.

Richardson, B (1997). ‘A longitudinal study ofstudent physiotherapists' understanding of theirprofession’, Nordisk Fysioterapi, 1, 34-39.

Rothstein, J M (1986). ‘Pathokinesiology: A nameof our times ?’ Physical Therapy, 66, 3, 364-5.

Ryle, G (1980). The Concept of Mind, PenguinBooks, Harmondsworth.

Schon, D A (1991). The Reflective Practitioner,Temple Smith, London.

Secretary of State for Health (1997). The NewNHS: Modern, dependable, HMSO.

Secretary of State for Health (1998). OurHealthier Nation, HMSO.

Sim, J (1985). ‘Physiotherapy: A professionalprofile’, Physiotherapy Practice, 1, 11-22.

Southon, G and Braithwaite, J (1998). ‘The endof professionalism?’ Social Science Medicine, 46, 1,23-28.

Stewart, M A (1985). ‘A question of education:Education for what?’, Physiotherapy, 71, 2, 34-39.

Tornebohm, H (1986). Caring, Knowing andParadigms, Report 10/12, Department of Theoryof Science, University of Goteborg.

Tryssenaar, J, Perkins, J and Brett, L (1996).‘Undergraduate interdisciplinary education: Arewe educating for future practice?’ CanadianJournal of Occupational Therapy, 63, 4, 245-251.

Vollmer, H M and Mills, D L (eds) (1966).Professionalisation, Prentice-Hall, Englewood Cliffs,New Jersey.

Williams, J I (1986). ‘Physiotherapy is handling’,Physiotherapy, 72, 2, 66-69.

Professional Development2. Professional Knowledge and Situated Learning inthe Workplace

Key Words

Workplace culture, symbolicinteraction, situated learning,experiential learning,professional development.

by Barbara Richardson

IntroductionContinual changes in the ethos and deliveryof health services point to an increasing needfor physiotherapy practitioners to be able toidentify and solve physiotherapy problems innew and unforeseen fields of health care.Undergraduate education programmes todayare challenged to ensure that physiotherapistsare prepared to respond to changes in healthcare demands over the extent of a careerwhich may span forty years. Theirprofessional development is dependent upontheir ability to be situationally responsive andcontinually to review and evaluate their workthrough critical thinking, clinical reasoningand processes of reflection. This paper

Summary This is the second of two papers which look at therelationship between the development of individualphysiotherapists and the development of physiotherapy as aprofession. It explores the nature of professional knowledge andthe process of professional learning which is seen to be crystallisedthrough an integration of theory with practice in the workplace.Important influences of situated cognition and situated learning onphysiotherapy practice are identified and discussed in the contextof theories of social action and symbolic interaction. These theorieschallenge the curricular assumptions on which manyundergraduate education programmes are based. It is concludedthat education programmes which aim to facilitate professionaldevelopment may more effectively link theory and practice topromote professional learning which is relevant to changes in theethos and delivery of health services and work in healthcare teams.


468

reconsiders the nature of physiotherapyprofessional knowledge and examines some influences on professional learningwhich may promote or limit professionaldevelopment in relation to current healthcare policies.

Physiotherapy and Changes in Health Care The major changes in the policy andpractice of the health service in recent yearshave led to a focus on client-centred careand on health promotion and managementof chronic disease as much as on treatmentand cure of acute disease (Secretary of Statefor Health, 1997, 1998; DoH, 1990, 1991).The aim now is to empower patients tomanage their own health needs and it isproposed that this will be best supportedthrough multidisciplinary andinterdisciplinary teamwork (Secretary ofState for Health, 1997, 1998). Maintaining aprofessional profile which is bothaccountable and effective in healthcareteams is central to concepts of quality innew approaches to patient care operatingwithin the health service.

For physiotherapists, collaboration in asocially-based, client-centred model ofhealth care is a radical change from thetreatment of patients in large acutehospitals dominated by a medical model ofhealth care. The diverse scenarios of care incommunity settings can challenge them inthe goals they set, the choices they make fortheir intervention and in the ways theyevaluate its outcome.

Amid competing claims from otherprofessionals for dwindling health resourcesit is vital that the education process preparesstudents to be ready to respond to varyingneeds for physiotherapy provision.Graduates need confidence in their skills todefine and solve physiotherapy problems inchanging contexts of care throughout theirprofessional careers. It is timely to review thelearning processes which are intended toprepare undergraduate students with skillsof self-directed life-long learning forprofessional development and to take afresh look at the nature of professionalknowledge and how it is acquired.

Professional Knowledge An epistemology of physiotherapy has yet tobe fully explored or defined. Much attentionand credence has been given to the theoriesand facts of the propositional knowledge ofthe profession, as witnessed by the range of

anatomy, biomechanics and pathology texts on any undergraduate booklist, and theprocedural knowledge for specificapplication of techniques and approaches tofields of practice as seen in texts fortreatment of neurology and musculoskeletalconditions. However, while it has becomeaccepted that practical experienceunderpinned by reflective practice isfundamental to professional learning (Binesand Watson, 1992, cited in Williams, 1998;Schon, 1991), little attention has been givento the nature of experiential knowledge orhow it is acquired. Experiential knowledge isthe knowledge gained through subjectiveexperience of how facts are interpreted andacted upon in the reality of work in clinicalsettings. There is a continuum of pro-fessional knowledge which extends fromknowing what the theories of treatment areto knowing how to apply them in ways whichwill achieve a successful physiotherapyoutcome. This knowledge of ‘knowing that’a particular approach taken in the choice oftreament or in an interaction with thepatient will achieve a treatment goal (Ryle,1980) forms a major difference betweenphysiotherapy being a mere application oftechniques, and a successful professionalservice which continually fulfills its purpose.

Experiential knowledge is personalknowledge (Eraut, 1994), and it lies at thecrux of individuals making wise professionaljudgements of action which befit thepurpose of an occasion. In each healthcareevent the physiotherapy practitioner has torecognise and integrate knowledge frommultiple sources to frame a physiotherapyproblem and to propose appropriatesolutions. In addition to documenting theclients’ symptoms and measuring andrecording the extent of their clinical signs, itis necessary to gain an understanding of theperspective of the patients, their relativesand carers and the expectations of others inthe multidisciplinary team. Decisions informulating goals and methods of care mustalso take into account the context of careand whether to treat, to educate or to advise.Experiential knowledge is drawn frommultiple contextual cues of the socialenvironment and integrated by thepractitioner into a problem-solving processwhich relates specifically to a patient and tothe others interested in their well-being.Professional knowledge is thus crystallisedthrough the personal experience ofsynthesising facts, theories and intuition topractice in the workplace. In this sense

Author and Addressfor Correspondence

Dr Barbara RichardsonPhD MSc MCSP is a seniorlecturer at the School ofOccupational Therapy andPhysiotherapy , Universityof East Anglia, NorwichNR4 7TJ.

This article was receivedon January 31, 1998, andaccepted on November 12,1998.

It is adapted from apresentation as guestspeaker at a conference at the University ofGothenberg, Sweden, on‘Physiotherapy theory,practice and education:What is the link?’ in 1997.

Richardson, B (1999).‘Professional development: 2. Professional knowledgeand situated learning inthe workplace’,Physiotherapy, 85, 9, 467-474.



experiential knowledge is professionalknowledge.

Professional knowledge is the integrationof person, process and propositionalknowledge into a dynamic whole (Williams,1998). Theories of education which areproposed to facilitate learning thepropositional knowledge of facts andpsychomotor skills in school settings are wellknown (see for example Barrows andTamblyn, 1980; James, 1993). There is lessconsideration of the nature of professionallearning which underpins the process ofinterpreting and amalgamating activitiessituated in the workplace to achieveprofessional goals.

Physiotherapy Practice Studies of newly qualified physiotherapypractitioners in their first year of work(Schwertner et al, 1987; Richardson, 1996),suggest that the working environment and senior physiotherapists' differingperceptions of the purpose and practice ofphysiotherapy can have a strong influenceon their actions. In a study carried out bythe author (Richardson, 1996) newly-qualified practitioners describedexperiences of a work culture whichappeared to be built around a model ofcompetence based on a notion of thenumbers of patients treated. The ‘patientmiles' acquired through years of experiencewere credited rather than an ability torespond effectively to individual patients inthe context of current health servicedemands.

The newly-qualified physiotherapists’ viewof themselves as professionals and theirautonomy in offering a professional servicewere dominated by an established hierarchyin which there was little recognition thatindividuals could aspire to achieve a level ofpractice competence in less time or byroutes differing from those of theirpredecessors. Their understanding ofprofessional knowledge seemed to imply aneed for them to gain the experience andknowledge of others. They gave theimpression that they were embarking on anapprenticeship rather than autonomouspractice and this was reinforced in theirworkplaces by concern for them to 'put onpatient miles' and acquire new skills in anadditive rather than integrative way. Thisimplicitly influenced their developingidentification with the purpose ofphysiotherapy and thus affected theirdecision-making. In particular they found it

hard to appraise their own practiceconfidently within a context of chronic carewhen the main practice culture appearedtacitly to follow a medical model of carewhich assumed a goal of cure. The studysuggested that a working culture caninadvertently conspire against individuals todevelop their own ideas purposefully. Takingan evaluative and analytical approach toone's own treatment outcomes is of littlevalue when it is not supported by afacilitating and permissive environment.These junior practitioners lacked anopportunity to explore and to defend theirwork with other colleagues in their ownprofession and this could undermine theirdeveloping confidence in interactions withother members of the multidisciplinaryhealthcare team.

Despite a lack of workplace experience,newly qualified practitioners may have agood understanding of the recent evidence-base for clinical effectiveness which canjustify their exploration of an approach topatient management. Graduating studentsneed a confidence in the legitimacy of theirown perspectives if they are to pursuetreatment approaches and treatment goalsin the multi-dimensional collaboration(Barr, 1998) expected of health care today,particularly if this may go against pre-vailing practice. Theories of social actionand situated learning help to explain the power ful influences of workplace culture helping or hindering professionaldevelopment. They provide a basis foreducators, clinicians and students criticallyto appraise factors which promote pro-fessional learning.

Social Action and Situated LearningThe important day-to-day and minute-to-minute social exchanges in the workplacemould physiotherapy practitioners towardsan acceptance of certain values andassumptions. Theories of social actionconsider people to be social creatures whonaturally and subconsciously shape, or 'gloss' (Giddens, 1976), their behaviour asthey see necessary for the currentconditions. People's behaviour in their socialinteractions is governed naturally by theculture in which it is situated. Culture can becharacterised as the acquired knowledgepeople use to interpret their experiencesand generate their behaviour (Spradley,1980). Members of a group acquire a sharedperspective, through the ways they tacitly orexplicitly negotiate and interact (Charon,


470

1995). Theories of symbolic interaction(Blumer, 1962; Charon, 1995) argue thatpeople create meaning about the peopleand phenomena they work with. At anymoment they view themselves as the objectof their activities by ‘taking the role of theother’ (Mead, 1932). They consider whatthey think other people understand to beoccurring in a group interaction and thenbehave in a way which they interpret to bestcontribute to a shared understanding of'what is going on' (Giddens, 1982). Peoplestrive to construct a view of the world whichwill justify their actions based on themeaning they see in the interactions withina social group. As Schultz (1967) points out,our seemingly objective reality actuallyresults from our own perspectives.

These theories suggest that physio-therapists, working in the social group of aphysiotherapy department, at each momentattach a symbolic significance to people,things and activities in their workplaces. Thisis a naturally occurring and continuousprocess. It will shape their decisions towardsbehaving in a way which seems to them to bethe best way of 'coping with the world' atthat moment (Charon, 1995). Others in thegroup will think similarly, and in the processof their interactions, some behaviours willbecome more positively reinforced by thegroup. Clearly the longer the groupinteracts, the more likely these collaborativelines of action will be defined andstrengthened to become recognisable asacceptable behaviour within that group.Consciously or sub-consciously, the patternsof interaction resulting from this collectiveway of thinking become established to formthe basis of the working culture (Charon,1995). The professional behaviour of agroup and the way it is perceived byindividuals within it will become inextricablylinked through these processes of social andsymbolic interaction. Cultural activitiesreinforce and shape individual behaviourand the behaviour of individuals merges todefine a professional culture.

Culture is the medium through whichpeople's understanding of work practices,attitudes and behaviour are learned andshaped (Wolcott, 1988). It will clearlyinfluence the experiential knowledge ofstudents and newly-qualified practitionerswith a potential to have an important effecton their professional learning. Theknowledge acquired through situatedlearning in the workplace cannot be ignoredin the context of professional development.

Situated LearningTheories of situated learning suggest that learning is closely linked to thecircumstances of its acquisition (Billett,1996). Actions are not stored in memory as adefined behaviour which is retrieved andperformed on cue in a specific context.Cognition occurs all the time. Cognitiveschema are built up on a continual basisfrom the experiences of life whichconstantly flow into each other and whichare appreciated through the mind and body,the activity and the culturally organisedsetting (Butterworth, 1992). The thinking,or cognition, which stimulates people totake action at any time occurs at thatmoment of interaction with others (Rogoff,1990). The inherent need for people tohave a positive reinforcement of theiractions by others results in their ideas beingin a continual process of development asthey continually interpret the dynamics of asituation. They will continue with theiractions only if they perceive some continualrecognition of them from within the group.The process of 'knowing' is not somethingthat is switched off in one context andswitched on in another. Their actions resultfrom their subconscious cognition ofsymbolism situated in group interactions atany one time. Clearly people learn all thetime (Lave, 1988). People learn through‘being’ there (Rogoff, 1990) in a continuumof learning as they continually respond tofeatures of their social environment. Anyone set of cognitive schemata will becomemore prominently embedded in memory ifit is recurrently recalled in situations whichare seen to be similar to others previouslyexperienced (Mercer, 1992).

Physiotherapy practice culture isdeveloped through the structure of socialinteractions which repeatedly take place in physiotherapy departments. Consciouslyor unconsciously physiotherapists gain astate of ‘knowledgeability’ about theirdepartmental practices and of 'knowing howto go on' (Giddens, 1982). Physiotherapistshave a view or paradigm of physiotherapypractice, built from educational activities inwhich they learn propositional facts andpractical skills, from which they formulatetheir goals and intentions of treatment.They will continually make assessments oftheir actions in a workplace context throughprocesses of symbolic interaction. Theirsituated cognition of factors they perceive tobe significant within a group at any one time will determine their judgements



and decisions for their behaviour. Theconsequence of their actions in thatsituation will become learned and will beadded to the backdrop of their experiencesagainst which further learning occurs.Development of professional knowledge canbe conceptualised as a wheel of learning(see figure above).

Over time, the processes of professionalinteraction and influence, which occurcontinually and unconsciously, have createda culture of physiotherapy. This hasprovided an unquestioned backdrop toeffective development of professionalknowledge within a stable system of healthcare delivery for many years. It comes underscrutiny now because the processes ofdecontextualising and recontextualisingskills which take place as students move fromschool to workplace settings have not beenfully explored in light of the major reformsin health care which are radically changingthe purpose and process of healthcare. AsEraut (1994) has said: ‘For every worksetting that teaches and inspires the nextgeneration of leaders of the profession,there are others that limit their developmentand perpetuate the weaknesses of theprevious generation’. Studies of newly-qualified practitioners highlight a potentialfor the strong views and practiceexpectations of their senior colleagues toinfluence their professional developmentadversely. However, individuals can moreactively influence the outcome of theirbehaviour if they have a conscious awarenessof the processes of symbolic interaction thatmay influence it. Social theories of human

action reject deterministic views ofbehaviour and assume people could havedone otherwise (Giddens, 1982). Culture is‘created, defined, altered and used’ bypeople (Charon, 1995). A notion of acomplex fluid world of social interactionwhich is continually changing and shapingpeople and events offers opportunity forprogress through purposeful behaviour.

The experiences of education in schooland practice settings need to be drawntogether in ways which decrease thevulnerability of the newly-qualifiedprofessionals to be uncritically moulded andshaped by the influences of an adverseworking culture. It is important thatprofessional learning will foster a confidencein practice which will increase the ability ofstudents to present and pursue their ideaswith their own colleagues and within aninterdisciplinary context. This will befacilitated through a professional knowledgeconstruction which is grounded closely in astrong identification with individualprofessional practice and self-direction inlife-long learning.

Knowledge ConstructionStudents learn through their totalexperience which includes the pervasivecommunication of innuendo, gestures,verbal behaviour and dress. At present thereis a sense that school and practice culturesare very different. For the students, thisresults in acquiring a great deal ofknowledge in the school setting which needsto be unlearned and re-learned in theclinical setting depending on rules which

Wheel of professional learning

experiential knowledge

PROFESSIONALKNOWLEDGE

knowing how

intuition

SITUATED LEARNING

successful/unsuccessfulinteraction

experience of action

propositionalknowledge and practice

knowledge

knowing what

intention

SYMBOLIC INTERACTION

PERSONAL PARADIGM


472

have been established in the workplace. Thiscan break the continuity of a coherentcurriculum of professional learning forthem and minimises the possibilities forthem to reflect on their practice and buildupon their practice knowledge (Keiny,1994). Confidence in their understanding oftheir professional knowledge base lies at thebasis of development of self-esteem and asense of self-efficacy which will influencethem to behave in particular ways (Fazey,1996) which are germane to multidis-ciplinary health care teams.

Situated cognition and situated learningunderpin all professional action. Mostlearning is specific to the situation in whichit is learned and occurs subconsciouslywhether or not there is any purposeful inputfrom educators or others. Knowledge maytransfer less readily from educationalsettings to the workplace (Billett, 1996) anda mismatch between school and ‘real world’experiences can reduce the quality ofprofessional development. It is important toconsider the kind of knowledge beingacquired and how tightly it is bound to thecontext (Anderson et al, 1996). While it isclearly an advantage to practise complexpsychomotor skills in isolation from theworkplace, the transfer of the knowledgelearned in one setting is dependent uponthe extent of the perceived commoncognitive elements with the next setting.This in turn depends upon where attentionis directed during learning or at the point oftransfer, whether from school to clinicalsetting or vice versa (Anderson et al, 1996).Changes in healthcare require learning tobe appplied to a ‘wide variety of frequentlyunpredictable future tasks’ (Anderson et al,1996) and this suggests the importance of promoting situationally-dependentunderstanding (Billett, 1996). Guidingattention to relevant cues provides a‘scaffolding of orientation to the task’(Rogoff, 1990) and a critical analysis of therelevant features of the social environmentof application will assist transfer to a varietyof contexts of care.

Theories of situated learning furthersuggest that the manner in whichprofessional knowledge building isencouraged is a central issue. This raisesquestions of the cultures in the schools andthe experiences of being studentprofessionals. Professional thinking andprofessional action is an acculturationprocess which can, by its nature, only takeplace in settings interpreted as 'professional'.

From the first day of entering professionaleducational programmes through toretirement from the profession, allexperiences whether in classroom orclinical settings will contribute to learningwhich will be interpreted as professionallearning. This presents a major challenge tomany educational curricula which explicitlysuggest that skills learned in the school arenot learned in professional settings butrather are decontextualised with theexpectation that they will transfer into thecontext of the professional workplacethrough a largely random process. Thequality of students' perceptions of beingprofessionals and their motivation toprofessional development will depend uponthe quality of their total experience in theschool and practice settings. There is aprevailing idea held by students andpractitioners in the workplace, that studentsacquire their knowledge from others'experience in a cumulative not integrativeway.

A fragmented view (Crowell, 1989) of pro-fessional knowledge leads to a piecemealcollection of knowledge without any overallunderstanding of where it all fits together ina total professional knowledge base. There isa crucial weakness in students believingknowledge to be a commodity to beacquired from others in packages. As Sim(1985) points out, a constructivist view ofknowledge is more closely related to self-direction and autonomy.

DiscussionProfessional knowledge is constructed byphysiotherapists through integration ofpublic procedural and propositionalknowledge with experiential knowledgewhich is mainly tacit (Polanyi, 1969) andindividual. The complexity of developmentof individual thinking patterns cannot bepredicted or controlled by educationalprocesses. Instead, educators can useprinciples of symbolic interaction andsituated learning to ensure that knowledge isacquired through repeated and recurrentexperiences which contain rich contextualclues for professional action. Guidedparticipation to appreciate the contextualdetail of healthcare events can provide thescaffolding cues (Rogoff, 1990) which arerelevant to foster good physiotherapypractice in changing contexts. A widespreadrecognition of knowledge as beingconstructed through individual subjectiveexperience will show a respect for students



to develop individual critical thinking skillsthrough learning processes which areintegrally linked to their practice and notimplicitly portrayed as separate andindependent from it. A strongly internalisedview of being a physiotherapist encouragesan autonomy in independent purposefulactions which are less influenced by externalfactors because autonomous people willadopt strategies to help them identify andemploy support for their activities (Sim,1985). Students who are motivated toinquire further into their practice willpursue professional goals regardless of theworkplace setting.

Physiotherapists' awareness of themselvesas active agents is essential to foster anability to pursue physiotherapy goals inmultidisciplinary contexts. Closer linksbetween school and clinical environmentsemphasise that the curriculum of learning isa continuum which extends from theclassroom to the clinic (see Gasner andCleave-Hogg, 1996). Practice videos andtape recordings or transcripts of practiceconversation can give detailed exemplars ofclient-professional and interprofessionalhealthcare practice. Use of these tostimulate debate and analysis in schoolsettings can enrich the meaning andunderstanding of physiotherapy andfacilitate thinking patterns which promoteindependence in critical thinking and

clinical reasoning. Ensuring a 'situatedcognition' of the important features ofhealth care events and the task ofphysiotherapy within them will help studentsto differentiate the sources of professionalknowledge and to realise that the processeswhich naturally underpin development oftheir own professional knowledge are thesame in all settings (Lave, 1988).

ConclusionThe development of a professional self-identity which is believable to both theindividual and others involves a complicatedchain of perceptions, skills, values andinteractions (Vollmer and Mills, 1966).Students need a strong and internalisedview of what it means to be a physiotherapist,if they are to pursue their own path tosolving the problems they identify withgreater resolve and more chance of successto resist any negative influences of aworkplace culture. They need confidence inthe authenticity of their own views ofpractice which will motivate them tonegotiate and collaborate confidently withothers. Educational processes can help toshape a physiotherapy culture in theworkplace which will foster professionalautonomy and professional development inindividuals and in doing so will ensure thesurvival of physiotherapy in health care forthe future.

References

Anderson, J R, Reder, L M. and Simon, H A(1996). ‘Situated learning and education’,Educational Researcher, 25, 4, 5-11.

Barr, H (1998). ‘Competent to collaborate:Towards a competency-based model forinterprofessional education’, Journal ofInterprofessional Care, 12, 2, 181-187.

Barrows, H S and Tamblyn, R M (1980).Problem-based Learning: An approach to medicaleducation, Springer, New York.

Billett, S (1996). ‘Situated learning: Bridgingsociocultural and cognitive theorising’, Learningand Instruction, 6, 3, 263-280.

Blumer, H (1962). ‘Society as symbolicinteraction’ in: Rose, A M (ed) Human Behaviour and Social Processes, Houghton Mifflin,Boston.

Butterworth, G (1992). ‘Context and cognition inmodels of cognitive growth’ in: Light, P andButterworth, G (eds) Context and Cognition; Waysof learning and knowing, Harvester Wheatsheaf,New York, pages 1-13.

Charon, J M (1995). Symbolic Interactionism;An introduction, an interpretation, an integration,Simon and Schuster, Englewood Cliffs, 5th edn.

Department of Health (1990). National HealthService and Community Care Act, HMSO.

Department of Health (1991). The Health of theNation, HMSO.

Eraut, M (1994). Developing Professional Knowledgeand Competence, Falmer Press, London.

Fazey, D (1996). ‘Individual differences in theautonomy-related psychological characteristics ofundergraduates’ in: Gibbs, G (ed) Using Researchto Improve Student Learning, Oxford Centre forStaff Development, pages 187-199.

Gasner, D and Cleave-Hogg, D (1996). ‘A modelfor integrative learning: Bringing the clinic into asubject-centred curriculum’, Physiotherapy Theoryand Practice, 12, 103-112.

Giddens, A (1976). New Rules of SociologicalMethod, Hutchinson, London.

Giddens, A (1982). Profiles and Critiques in SocialTheory, Macmillan Press, London.


474

James, R (1993). ‘Developing skilled behaviours’,Physiotherapy Theory and Practice, 9, 65-68.

Keiny, S (1994). ‘Constructivism and teachers’professional development’, Teaching and TeacherEducation, 10, 2, 157-167.

Lave, J (1988). Cognition in Practice: Mind,mathematics and culture in everyday life, CambridgeUniversity Press, New York.

Mead, G H (1932). The Philosophy of the Present,Open Court, Chicago.

Mercer, N (1992). ‘Culture, context and theconstruction of knowledge in the classroom’ in:Light, P and Butterworth, G (eds) Context andCognition: Ways of learning and knowing, HarvesterWheatsheaf, New York, pages 28-46.

Polanyi, M (1969). Knowing and being’ in:Grene, M (ed) Learning and Being - essays byMichael Polanyi, Routledge and Kegan Paul,London.

Richardson, B (1996). Paradigms of Practice inPhysiotherapy and the Implications for ProfessionalDevelopment, Microfiche DX191919, British Library,Boston Spa, UK.

Rogoff, B (1990). Apprenticeship in Thinking:Cognitive development in social context. OxfordUniversity Press, New York.

Ryle, G (1980). The Concept of Mind, PenguinBooks, Harmondsworth. Secretary of State forHealth (1997). The New NHS: Modern, dependable,HMSO.

Secretary of State for Health (1998). OurHealthier Nation: A contract for health, ConsultationDocument, DoH, London.

Schon, D A (1991). The Reflective Practitioner,Temple Smith, London.

Schutz, A (1967). The Phenomenology of the SocialWorld translated by Walsh, G and Lahnert, F,Northern University Press, Evanston, Illinois.

Schwertner, R M, Pinkston, D, O'Sullivan, P and Denton, B (1987). ‘Transition from studentto physical therapist’, Physical Therapy, 67, 5, 695-701.

Sim, J (1985). ‘Physiotherapy: A professionalprofile’, Physiotherapy Practice, 1, 11-22.

Spradley, J P (1980). Participant Observation, Holt,Rinehart and Winston, New York.

Volmer, H M and Mills, D L (eds) (1966).Professionalization, Prentice-Hall, Englewood Cliffs,New Jersey.

Williams, P L (1998). ‘Using theories ofprofessional knowledge and reflective practice toinfluence educational change’, Medical Teacher,20, 1, 28-34.

Wolcott, H F (1988). ‘Ethnographic research ineducation’, in: Jaeger, R M (ed) ComplementaryMethods for Research in Education, EducationalResearch Association, Washington, DC, pages187-209.

Key Messages

■ Professional knowledge is constructedthrough the integration of propositional andprocedural knowledge with personal experiencein practice.

■ Working culture may conspire against optimalprofessional development of newly-qualifiedphysiotherapists.

■ Attention must be paid to the continuity ofthe curriculum and the development of anintegrated professional knowledge base.

■ The ability to pursue physiotherapy goals inmultidisciplinary contexts is dependent upongraduates' awareness of their own independencein thought and action.

Documents

Professional Development: 2. Professional Knowledge and Situated Learning in the Workplace