Dissertation Abstract

A Beam's Eye View: Examining the Impact of Change on a Medical Practice

Most research in health professional learning focuses on traditional continuing medical education, rather than practice-based learning in the workplace, and examines solo practitioners, rather than large, organized, multiprofessional practices. Innovative technology has led to high precision radiation therapy that has dramatically altered the practice of Radiation Medicine. This qualitative study was conducted to explore the impact of this innovation on the knowledge, treatment, and organization of the practice from the perspective of the practitioners in a large academic radiation medicine program during a period of change, and to improve understanding of this process. Multiprofessional staff participated in a series of seven focus groups and nine in-depth interviews until theoretical saturation was achieved. The descriptive data from the transcripts was coded for concepts, and was analyzed using grounded theory methodology. Practitioners felt that there had been a major effect on many aspects of their practice, and these were analyzed in the light of historical events and other conditions that affected the working relationships. The team structure supported the adoption of change, but was also influenced by the technology, which was identified as a catalyst for change. Work themes that emerged centered on the impact on quality, workload and the generation of new knowledge. When the concepts were examined longitudinally, a four-step process of change and learning was identified. In step 1, there was anxiety as staff acquired the skills to use the technology and manipulate new images. Step 2 involved learning to interpret the new images, experiencing uncertainty until new perspectives developed. Step 3 involved questioning assumptions and critical reflection, which resulted in new understanding. The final step 4 identified a process of constructing new knowledge through research, development and dialogue within the profession. The study provides a unique insight into workplace learning and change, and describes a model that may apply to many medical practices. These findings expand our understanding of practice change and learning and contribute to health professional education in two main ways. First, this understanding helps prepare students to work in changing medical practices, and secondly, it demonstrates how workplace learning occurs in the context of change.

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