Making Room for Friction:  Boundary crossing in General Practitioners Residency

Abstract Patient care is compromised when residents cannot use and connect knowledge and skills developed in multiple learning environments. Although efforts are made in postgraduate medical education (PGME) to align learning environments, the nature of learning in the workplace through patient care is fundamentally different from learning in a classroom at an educational institute. Residents perceive these learning environments as separate, non-overlapping worlds. However, residents' efforts to cross boundaries and connect multiple learning environments can provide important learning experiences and contribute to innovation. In this study, we investigated which learning mechanisms general practice (GP) residents use when crossing boundaries between the workplace and the educational institute. Understanding how residents cross these boundaries can facilitate connecting multiple learning and working environments. This can help innovate postgraduate medical education, considering ongoing societal changes and medical advances. We conducted a case study based on 3 cohorts of residents from an innovative GP residency program. This program included classroom-based and work-based training. Data were collected through individual interviews, focus groups, and activity logs between 2017 and 2021, and analyzed thematically. We identified four learning mechanisms that residents developed and used cumulatively. The first learning mechanisms are associated with friction and frustration, which must be overcome before residents can develop the next learning mechanism. Addressing friction and frustration in GP residency programs, along with providing adequate time and opportunities for peer collaboration, seems to facilitate the development of strategies to connect different learning environments. Furthermore, our study provides a basis for further research on how initial frustrations in connecting multiple learning environments can be used to benefit residents' development as professionals and lifelong learners.