Expansive learning in medical education: Putting Change Laboratory to work
Open accessAbstract
This paper explores the purposeful use of conceptual and methodological tools provided by Cultural Historical Activity Theory (CHAT) to transform learning cultures and practices within and across diverse clinical learning environments. We describe how Change Laboratory methodology helped clinicians and others who support student, intern, and resident education to make changes collaboratively. A case study in undergraduate medical education shows how this created new forms of medical student placement and a postgraduate study shows how it addressed supervisors' undermining behaviour towards Obstetrics and Gynaecology residents. This empirical work illustrates ways of modifying the classical Change Laboratory process to fit local contexts, resources, and needs. We conclude with lessons learned and future directions for practitioner-researchers who wish to broaden the range of methodological tools they use to transform clinical learning environments.
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Claims the paper makes
0 of 19 cited sources checked · 0 supported · 0 flagged
- Findingnone given
The second case study transformed learning cultures in postgraduate Obstetrics and Gynaecology training in London, UK.
“The second draws on work to transform learning cultures in postgraduate Obstetrics and Gynaecology (O&G) training, London, UK.”
Quote in the paperNot a substantial claim - Findingown data
Eight 3-hour Change Laboratory sessions enabled practitioners to identify, introduce, review and embed ways of working that could achieve the shared object of higher quality training and safer patient care.
“Eight 3-hour Change Laboratory sessions enabled practitioners to identify, introduce, review and embed ways of working that could achieve the shared object of higher quality training and safer patient care.”
Quote in the paperSubstantial claim - Findingnone given
In CL1, practitioners in two interacting activity systems came together to re-think clinical placements.
“In CL1, practitioners in two interacting activity systems came together to re-think clinical placements.”
Quote in the paperSubstantial claim - Findingcitation
The first case study co-created medical student assistant placements across a range of settings in Leeds, UK.
“The first case study illustrates how clinical, administrative and academic staff co-created medical student assistant placements across a range of settings in Leeds, UK (Reid et al 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Reid et al 2015
Not checked in the free run.
- Findingreasoning
Existing data such as placement evaluation responses and official surveys supplemented observations in helpful ways.
“Existing data such as placement evaluation responses and official surveys of trainees' experiences supplemented this in helpful ways.”
Quote in the paperNot a substantial claim
- Findingreasoning
Two education and leadership fellows played a pivotal role in the complex intervention because they could spend time observing and discussing workplace environments, cultures and practices.
“In addition, two education and leadership fellows played a pivotal in this complex intervention because they were able to spend time observing and discussing workplace environments, cultures and practices.”
Quote in the paperSubstantial claim - Findingcitation
Despite this, the degree to which workplaces were ready for students to take on more active roles in clinical work varied widely.
“Despite this, the degree to which workplaces were ready for students to take on more active roles in clinical work varied widely (see Reid et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Reid et al., 2015
Not checked in the free run.
- Findingcitation
CL2 created a 'safe space' where doctors, nurses and midwives used conceptual tools to re-think their currently 'siloed' working practices.
“CL2 created a 'safe space' where doctors, nurses and midwives used the conceptual tools to re-think their currently 'siloed' working practices (see Varpio andTeunissen 2020 andGrilo Diniz et al. 2020 in this issue analysing obstetric care).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Varpio and Teunissen 2020
Not checked in the free run.
- cites Grilo Diniz et al. 2020
Not checked in the free run.
- Findingown data
It proved difficult to get large groups of clinicians to attend together, which is needed to make Change Laboratory discussions multi-voiced and able to overcome historical tensions, hierarchies and power dynamics.
“It proved difficult to get large groups of clinicians to attend together, which is needed to make Change Laboratory discussions multi-voiced and able to overcome historical tensions, hierarchies and power dynamics.”
Quote in the paperSubstantial claim - Findingcitation
The studies confirm that readiness for and capability of expansive development varies between local instances of the same activity.
“Our studies confirm that 'readiness for and capability of expansive development varies between local instances of the same activity' (Virkkunen et al 2013:65).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Virkkunen et al 2013
Not checked in the free run.
- Findingreasoning
Workplaces varied in the degree to which managers and frontline staff 'bought in' to the Change Laboratory approach.
“Workplaces varied in the degree to which managers and frontline staff 'bought in' to the Change Laboratory approach.”
Quote in the paperNot a substantial claim - Interpretationnone given
Change Laboratory moves the gaze from reproducing individual practices to engaging purposefully with aspects of learning environments and cultures that too often stifle innovation.
“First, it moves our gaze from reproducing individual practices to engaging purposefully with aspects of learning environments and cultures that too often stifle innovation.”
Quote in the paperSubstantial claim - Interpretationcitation
Change Laboratory offers a new way of conducting shared redesign and reworking of complex care systems, which may otherwise be defeated by complexities of systems that prevent education translating into improved patient outcomes.
“Change Laboratory offers a new way of conducting the shared redesign and reworking of complex care systems, which may otherwise be defeated by complexities of systems that prevent education translating into improved patient outcomes (see Teodorczuk and MacLullich 2018).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Teodorczuk and MacLullich 2018
Not checked in the free run.
- Premisecitation
Double stimulation helps participants engage in reflective distancing from their own and coworkers' views, actions, and motivations.
“This double stimulation helps participants engage in a form of reflective distancing (Virkkunen et al 2013) from their own and their coworkers' views, actions, and motivations.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Virkkunen et al 2013
Not checked in the free run.
- Interpretationcitation
Rather than focusing on the preparedness of individual students, the team implemented system-level changes to achieve the shared object of students contributing to patient care.
“Rather than focussing on the preparedness of individual students (Kilminster et al 2011), we implemented system-level changes to achieve the shared object of students contributing to patient care.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kilminster et al 2011
Not checked in the free run.
- Interpretationreasoning
Team make-up was key to achieving systems-level change.
“Team make-up was key to achieving systems-level change.”
Quote in the paperSubstantial claim - Premisecitation
GMC requires student assistantships in the final year of UK undergraduate medicine studies.
“The General Medical Council (2009) requires student assistantships in the final year of UK undergraduate medicine studies.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites General Medical Council (2009)
Not checked in the free run.
- Interpretationreasoning
Envisioning students as 'assistants' able to make a more active contribution to patient care rather than 'students' in a more passive role bridged the ZPD.
“Envisioning students as 'assistants', able to make a more active contribution to patient care rather than 'students' in a more passive role, bridged the ZPD.”
Quote in the paperSubstantial claim - Interpretationnone given
Both projects posed problems that required local modifications to Change Laboratory procedures.
“Both projects posed problems that required local modifications to Change Laboratory procedures.”
Quote in the paperNot a substantial claim - Interpretationown data
Both case studies show that bringing together clinical practice and workplace learning focuses patient care as the shared object of activity.
“Second, both case studies show how bringing together clinical practice and workplace learning focuses patient care as the shared object of activity.”
Quote in the paperSubstantial claim - Interpretationreasoning
These alternative sources encouraged participants to reflect critically on historic practices and the 'ways things are done around here'.
“These alternative sources encouraged participants to reflect critically on historic practices and the 'ways things are done around here'.”
Quote in the paperNot a substantial claim
- May combine two claims. 20
- Classified as probably not a substantial claim. 19
May combine two claims.
Findingown dataThe education and leadership fellows mediated between practitioners and senior leaders and championed changes from Change Laboratory sessions in practical ways.
“They mediated between practitioners and senior leaders and, importantly, championed changes that arose from the Change Laboratory sessions in very practical ways.”
Quote in the paperSubstantial claimMay combine two claims.
FindingreasoningWork pressures in clinical systems made the composition of CL2 sessions different every time, although each had representation from nursing, midwifery and medicine, including trainees.
“Work pressures in clinical systems made the composition of CL2 sessions different every time, although each had representation from nursing, midwifery and medicine, including trainees.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe authors used Change Laboratory to expose historical and cultural roots of existing activity while engaging stakeholders in co-constructing new and shared objects of activity.
“We have used it to expose the historical and cultural roots of existing activity whilst engaging stakeholders in coconstructing new and shared objects of activity.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataParticipants were extremely reluctant at first to take part in multi-professional discussions, so the team started with profession-specific sessions, which analysed and made visible points of connectedness and established trust.
“Participants were extremely reluctant at first to take part in multi-professional discussions so we started with profession-specific sessions, which analysed and made visible points of connectedness, and established trust.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenIn CL1, providers recruited were interested in making improvements and their placements had been positively evaluated by students.
“In CL1, we recruited providers who were interested in making improvements and whose placements had been positively evaluated by students.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFactors showing when teams were ready for expansive development work included willingness to work collaboratively across professional roles and hierarchies, commitment to participating in sessions away from day-to-day work activity, and genuine support from healthcare managers.
“A number of different factors showed when teams were ready for expansive development work, including: willingness to work collaboratively across professional roles and hierarchies, commitment to participating in sessions away from day-to-day work activity and genuine support from healthcare managers.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenReleasing staff to attend CL2 was challenging, so many participants chose to come in on non-working days.
“Releasing staff to attend CL2 was challenging so many participants chose to come in on non-working days.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingnone givenThe authors were familiar with CHAT conceptual tools but these projects were their first experience of Change Laboratory.
“Whilst we were familiar with the conceptual tools of CHAT, these projects were our first experience of Change Laboratory.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenEven so, the project team had to negotiate hard to ensure the right mix of practitioners was released and supported to take part.
“Even so, the project team had to negotiate hard to ensure the right mix of practitioners was released and supported to take part.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCL2 identified strategies to foster closer working-learning relationships and more joined-up care, including multi-professional huddles on all wards, briefing and debriefing around antenatal clinics, and multi-professional in-situ simulations.
“This identified strategies to foster closer working-learning relationships and more joined-up care.These included multi-professional 'huddles' on all wards, briefing clinicians before and debriefing them after antenatal clinics and conducting multiprofessional in-situ simulations.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenA useful adaptation was to invite a senior manager to join the last half-hour of every Change Laboratory, to be briefed on proposed changes and asked to support them before clinicians on wards and in clinics were told.
“A useful adaptation was to invite a senior manager to join the last half-hour of every Change Laboratory, to be briefed on the changes being proposed and asked to support them before clinicians on wards and in clinics were told.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingreasoningIn CL1, placements made progress when a consultant, junior doctor, senior nurse, and placement co-ordinator attended, but were less successful when only a limited range of voices were heard.
“In CL1, placements made progress when a consultant, junior doctor, senior nurse, and placement co-ordinator attended, but were less successful when only a limited range of voices were heard.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenCommissioners of the CL2 project invested considerable effort in finding pilot sites with senior-level 'buy-in'.
“Commissioners of the CL2 project invested considerable effort in finding pilot sites with senior level 'buy-in'.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe success of interventions of this type is influenced by practitioners' and managers' motivation to find solutions for externally recognised issues, availability of expertise in CHAT, and prior knowledge or experience of Change Laboratory methods.
“The success of interventions of the type we describe here is influenced by practitioners' and managers' motivation to find solutions for (externally) recognised issues, the availability of expertise in CHAT and prior knowledge or experience of Change Laboratory methods (Virkkunen and Newham 2013).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Virkkunen and Newham 2013
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenUsing familiar ways of collecting data can help practitioner-researchers with qualitative experience distance themselves reflectively from practices with which they are over-familiar, and this can help formulate and solve problems collectively.
“If they are not available, practitioner-researchers with qualitative experience might use familiar ways of collecting data to distance themselves, reflectively, from practices with which they are (over-) familiar.This can help formulate and solve problems collectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataOne workplace had a very risk-averse culture because patient safety was high on the management agenda, making it much harder for students to be seen as valuable contributors to patient care.
“One workplace, for example, had a very risk-averse culture because patient safety was high on the management agenda.This made it much harder for students to be seen as valuable contributors to patient care.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone givenCHAT is highly relevant to problems in 21st century practice, whose complexity lends itself poorly to care processes rooted in historically-set divisions of labour.
“Despite being rooted in theories of Vygotsky and Leont'ev from the early 20 th Century, CHAT is highly relevant to problems in 21 st century practice, whose complexity lends itself poorly to care processes that are rooted in historically-set divisions of labour.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationnone givenThe emphasis on collective and multi-voiced practice invites engagement within and between medical education and healthcare systems.
“Third, the emphasis on collective and multi-voiced practice invites engagement within and between medical education and healthcare systems.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningChange Laboratory has the potential to open silos and foster respectful, creative working relationships.
“Change Laboratory has the potential to open silos and foster respectful, creative working relationships.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationExpansive learning occurs when established ways of doing things become unviable or undesirable because contradictions in work practices have accumulated.
“Expansive learning takes place when established ways of doing things are no longer viable or desirable because contradictions in work practices have accumulated.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Engeström 2011a
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationChange Laboratory brings work redesign closer to daily shop floor practice while keeping it analytical, creating a new dialectic of close embeddedness and reflective distancing.
“Change Laboratory 'bring(s) work redesign closer to the daily shop floor practice while still keeping it analytical -a new dialectic of close embeddedness and reflective distancing' (Virkkunen et al 2013 pp 24).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Virkkunen et al 2013
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningMaking members of different professions aware of their interdependency and making explicit the purposes, practices and divisions of labour in clinical work is key to making sense of complex clinical learning environments.
“We propose that making members of different professions aware of their interdependency and making explicit the purposes, practices and divisions of labour in their clinical work is key to making sense of complex clinical learning environments.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningThis work frames undermining as a systemic issue arising from processes and practices that lessen teams' abilities to work well together.
“This work frames undermining as a systemic issue arising from processes and practices that lessen teams' abilities to work well together.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductnone givenIt was not possible or necessarily appropriate to video-record authentic clinical care for use as 'mirror data'; instead, both teams observed practice and discussed observations with practitioners within and outwith sessions.
“It was not possible (nor necessarily appropriate) to video-record authentic clinical care for use as 'mirror data'; instead, both teams spent time observing practice and discussing their observations with practitioners both within and outwith sessions.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationUK residents' ratings of O&G learning environments are poor because undermining behaviour by supervisors is widespread.
“UK residents' ratings of O&G learning environments are poor because undermining behaviour by supervisors is widespread (RCOG 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites RCOG 2020
Not checked in the free run.
Classified as probably not a substantial claim.
InterpretationreasoningThe paper illustrates how the tools of CHAT can be put to use by practitioner-researchers seeking to transform the culture and practice of clinical learning environments.
“This paper illustrates how the tools of CHAT can be put to use by practitioner-researchers seeking to transform the culture and practice of clinical learning environments.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe terms under which a research project is commissioned are likely to limit what is possible, and one does what one can given available opportunities.
“Blackler (2009) noted that”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Blackler 2009
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone givenIt can be hard, at first, to understand the conceptual and methodological tools of CHAT, which require clinical educators to rethink radically the relationship between learning and system development.
“It can be hard, at first, to understand the conceptual and methodological tools of CHAT, which require clinical educators to rethink, radically, the relationship between learning and system development.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationExpansive learning is a product of social dynamics between humans within the material, cultural and historical contexts of work practices.
“Expansive learning, drawing on CHAT principles, is a product of the social dynamics between humans, played out within the material, cultural and historical contexts of work practices (Engeström and Sannino 2010;Engeström and Pyörälä 2020, this issue).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Engeström and Sannino 2010
Not checked in the free run.
- cites Engeström and Pyörälä 2020
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationChange Laboratory is a system-level interventionist research methodology that charts and analyses existing practices and co-creates new forms of work activity.
“Change Laboratory is a system level (beyond individuals and teams) interventionist research methodology, which charts and analyses existing practices in-depth and purposefully cocreates new forms of work activity (Virkkunen and Newnham 2013; Engeström and Pyörälä 2020, this issue).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Virkkunen and Newnham 2013
Not checked in the free run.
- cites Engeström and Pyörälä 2020
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationThe potential utility of Change Laboratory is obvious when considering resistance to change in clinical practices that must keep pace with changes in treatments and technologies.
“The potential utility of Change Laboratory is obvious when one considers the resistance to change that exists in clinical practices that have to keep pace with changes in treatments and technologies (Engeström 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Engeström 2018
Not checked in the free run.
The paper relies on this without support.
Previous interventions to change individual workplace behaviour have had limited success.
“Previous interventions have tried to change the workplace behaviour of individuals with limited success.”
The paper relies on this without support.
Most knowledge learned by participating is embedded in pre-existing work practices.
“Most of the knowledge learned by participating is embedded in pre-existing work practices.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
This research builds on previous CL research in healthcare education but brings novelty by using a CL-related approach to in situ simulation in general practice.
“This research builds on the previous CL research conducted in the field of healthcare education (Skipper, 2016, Vilela et al., 2020, Morris et al., 2021, Kerosuo et al., 2010), however it brings novelty by using a CL related approach to in situ simulation conducted in the context of general practice.”
From SimLab: an intervention to promote expansive learning and organisational change in team-based emergency care simulation (2025) · cites this paper as Morris et al., 2021
CHAT is attracting increasing interest in medical education for studying dynamic systems in change.
“Cultural historical activity theory (CHAT) is a social theory for studying social practice, and is attracting increasing interest in medical education for studying dynamic systems in change.3–5”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
The Change Laboratory has been shown to be of use in medical education contexts.
“The Change Laboratory has been shown to be of use in medical education contexts.”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
Morris et al highlighted two cases of effective Change Laboratory use within medical education in the UK.
“Morris et al5 also highlighted two cases of effective Change Laboratory use within medical education in the UK.”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
Researchers facilitated practitioner-led change laboratories which developed new ways of working to improve the training experience and lead to safer patient care.
“Researchers facilitated practitioner-led change laboratories which developed new ways of working to improve the training experience and lead to safer patient care.5,42,43”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
CHAT may be particularly helpful for practitioner-researchers, i.e. practitioners conducting research within their own field of practice.
“CHAT may be particularly helpful for practitioner-researchers5 ie, practitioners who are conducting research within their own field of practice.45”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
The RCOG project on improving learning cultures for obstetrics and gynaecology training was undertaken because of widespread and systemic undermining within UK Obstetrics and Gynaecology training.
“This had been due to widespread and systemic undermining within UK Obstetrics and Gynaecology training.”
From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [5]
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Using activity theory to transform medical work and learning
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“Expansive learning, drawing on CHAT principles, is a product of the social dynamics between humans, played out within the material, cultural and historical contexts of work practices (Engeström and Sannino 2010; Engeström and Pyörälä 2020, this issue).”
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Flagged first, then by citations
Research works printed but not linked: 1
- Virkkunen J, 2010, Activity Theory in practice. Promoting learning across boundaries and agencies
Cited by
Sorted by citations
Using activity theory to transform medical work and learning
Engeström, Y., & Pyörälä, E. (2021) · Medical Teacher · doi:10.1080/0142159x.2020.1795105 · Cited by 137 · see citing works
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“There have been several examples of CL interventions in medical education (Reid et al., 2015; Dornan et al., 2021; Engeström & Pyörälä, 2021) and healthcare (Skipper, 2016; Vilela et al., 2020; Morris et al., 2021; Kerosuo et al., 2010 ).”
- Authors
- Morris, C., Reid, A.-M., Ledger, A., & Teodorczuk, A.
- Affiliations
- University of Cambridge (GB)
- University of Leeds (GB)
- Griffith University (AU)
- Corresponding author
- Morris, Clare
- Venue
- Medical Teacher
- Publisher
- Informa UK Limited
- Published
- 2020-07-29
- Volume
- 43
- Issue
- 1
- Pages
- 38-43
- ISSN
- 0142-159X (ISSN-L)
- 1466-187X
- OpenAlex
- W3046141428
- Semantic Scholar
- e4a5c06557d28e6183f4f434c3dea8e2cd96e01f
- Cited by
- 31
- References
- 16
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 2
- FWCI
- 3.37
- Type
- journal article
- Language
- en
- Open access
- Locations
- Medical Teacher (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Griffith Research Online (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Human Factors and Ergonomics › Innovative Education and Learning Practices
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Keywords
- Change Laboratory, cultural-historical activity theory, medical education, clinical learning environment, undergraduate medical education, graduate medical education, medical student placements, collaborative change, practitioner-researchers
- MeSH terms
- Education, Medical, Health Personnel, Humans, Laboratories, Students, Medical
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