Community of practice and student interaction at an acute medical ward: An ethnographic study

A deeper understanding is needed of the acute medical care setting as a learning environment for students.

To explore workplace culture of an acute medical ward and students' interactions within this community.

An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.