Learning through collegial conversations - a qualitative study of physicians’ professional development

Learning through collegial conversations - a qualitative study of physicians’ professional development | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning through collegial conversations - a qualitative study of physicians’ professional development Klara Bolander Laksov, Cormac McGrath, Erik Björck, Agnes Elmberger, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6155737/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Informal learning through interaction with colleagues is important in continuous professional development. Colleagues have the opportunity to function as resources for learning and they can facilitate or hinder change in practice. Empirical studies on learning between colleagues are however, scarce, and it remains unclear how and under what circumstances specialist physicians learn from peers. Methods : In this study we explore specialist physicians’ experiences of learning from colleagues. Semi-structured interviews were conducted with 22 specialists in general practice and psychiatry. Data was analysed thematically to identify different collegial interactions that led to what we conceptualise as learning conversations . A Landscapes of practice perspective was employed for examining the boundary objects – objects that facilitate transfer between communities of the landscape – that facilitate learning between colleagues. Results : Findings show a landscape of local, neighbouring, and distant collegial learning conversations, with boundary objects ranging from referrals to social media. Discussion : Collegial conversations within the Landscape of practice facilitates professional development among physicians. Learning conversations continued professional development colleagial learning Figures Figure 1 Introduction Continued professional development (CPD) is identified as a way for health care professionals to stay abreast of advances in practice and research. However, for more than two decades, CPD has been discussed in terms of challenges such as the unclear effect of CPD courses on professional and patient outcomes ( 1 ), the lack of impact in clinical practice from CPD courses ( 2 – 4 ), or the limited spread of knowledge and practices among collegues in the workplace ( 2 ). Other challenges pertain to the cost of participation in CPD programs ( 1 ), time and motivation for participation in CPD activities, and whether or not the activities target the needs of physicians ( 4 ). Studies show that formalized courses can lead to instrumental approaches to CPD, where ‘ticking boxes’ becomes more important than learning and developing practice ( 5 – 7 ). Moreover, findings highlight the importance of acknowledging activities that lead to learning, for example patient encounters and meetings with colleagues and argue that these too, could count as CPD ( 7 ) as they represent substantial gains in physicians’ learning. We identify that all physicians are members of communities of practice, with people who work in the same domain and share the same or a similar practice in terms of goals for everyday work, resources availability and ways of dealing with challenges and opportunities linked to work ( 8 ). Voices have been raised that the communities of practice physicians work in may be viewed as resources for learning, and constitute opportunities for various forms of CPD ( 7 ) and thus contribute to what we identify as ‘collegial learning’. In this paper we conceptualize collegial learning as the process of learning taking place between colleagues, near or distant, as they share experiences and knowledge. Physicans’ collegial learning has been targeted as crucial both during residency training ( 9 ) and for specialists ( 10 ). Yet, while collegial learning has been explored extensively in the broader higher education literature ( 11 ), few studies can be found on this topic in continuing medical education. Recent research on collegial learning in clinical practice however indicates several positive effects of collegial learning practices. One study identified that physicians sharing experiences of failures and success with each other helps medical doctors commit fewer medical errors ( 12 ). Another study showed how structured conversations about patient cases with colleagues significantly improved interns’ confidence in prescription practices ( 13 ). A third recent study identifies that physicians learn from collegial interaction both at the workplace and in other settings and contexts, the groups identified for learning were: general practitioners (GPs) at the workplace, colleagues/ peers in residency, GP colleagues in settings other than the workplace, and colleagues in other medical specialties and professions ( 14 ). The current study adds to previous research by focusing on the roles colleagues play for learning, and how knowledge sharing and learning between colleagues is stimulated and carried out. In addition, this study bridges a gap between physicians’ professional learning in clinical contexts and collegial learning in the context of higher education, to improve purposeful learning and sharing of knowledge for physicians. The aim of this is study is to explore the role colleagues play for physicians’ learning and how meaningful learning may be promoted between and across communities they are interacting with. Theoretical framework In this study, we employ a socio-cultural perspective on learning and use the theory of Landscapes of practice (LoP) to understand and interpret our data. Landscapes of Practice theory describes how multiple communities of practice (CoP) interact in a complex system. Each CoP has its own criteria and experiences that define membership and boundaries. In a CoP, members engage with and care about the same real-life problems, and interact regularly to learn together and from each other, i.e. they share a practice of some sort ( 8 ). In earlier work, Wenger focused on single communities, but people belong to multiple communities and face complex problems ( 15 , 16 ). LoP refers to the diverse and interconnected range of professional communities, disciplines, and knowledge domains that individuals engage with as part of their learning and work. It is a concept rooted in CoP and social learning theory, emphasizing how people navigate and participate across multiple CoPs throughout their professional journey ( 15 , 16 ). In his work, learning and identity is emphasized as a central component of LoP, where professionals or other groups of individuals engage in a shared so called ‘enterprise’ in their activities and create a shared repertoire of approaches and tools for their practice ( 8 ). A LoP perspective on continuing professional development acknowledges the professional relationships between individuals within and between practices, for example the medical professions collaborate and work together in complex settings like clinical settings, as important for the learning of individuals as well as for the community as a whole ( 15 , 17 ). In LoP, several CoPs can co-exist in the same clinical setting ( 16 ), and are viewed as linked and interconnected, creating opportunities for adopting new or different perspectives. From a LoP perspective, we focus on how different practices and interactions between physicians may influence their learning. For example, a psychiatrist also interacts with psychologists and social workers, and a general practitioner also interacts with nurses and physiotherapists. Further, in a LoP, the boundaries between CoPs are important for learning since membership in several practices enable reflection on similarities and dissimilarities, and where reflection can generate an ability to identify gaps in existing knowledge and use the multiplicity of landscapes to generate new knowledge, a concept known as ‘knowledgeability’, according to Wenger-Trayner and Wenger-Trayner ( 16 ). This means being a member of several CoPs enables comparison and transfer of knowledge of how things are carried out from one CoP into another. For example, a clinical supervisor in a medical undergraduate program who learns about how to provide feedback to students can use that knowledge also in other CoPs where one is in a supervisory role. This involves a process of brokering where knowledge is transferred from one CoP to another and is a central component of LoP. Brokers are individuals who are engaged in contacts across the boundaries of the CoP, building connections between different practices and introducing new practices, such as a routine for providing feedback, a new weekly meeting procedure or other practices. Sometimes, brokering is facilitated between CoPs by boundary objects. Boundary objects may be physical or abstract, and can function as a translational device and mediate between two or more CoP’s, and thus facilitate learning across a LoP ( 8 ). Boundary objects mediate the sharing of practice and collaboration across the landscape and provide a structure for aligning meaningful activity for all involved. In one study, patient symptoms, electronic medical records and status symbols were identified as boundary objects for enhancing interprofessional collaboration ( 18 ). Other studies have found boundary objects in feedback and teaching prizes as boundary object for new clinical teachers ( 19 ) and simulation environments for bridging the theory-practice gap ( 20 ). To explore the role colleagues play for physicians’ learning and how meaningful learning may be promoted between and across communities they are interacting with we posed the following research questions: What role do colleagues play in physicians’ learning at work? What boundary objects facilitate learning for physicians between and across communities? Methods We adopted a qualitative approach and interviewed physicians from two specialities on their experiences of collegial learning. The study was conducted in Sweden, where physicians become specialists after five years residency training. The study was carried out in accordance with the Declaration of Helsinki and approved by the Ethical Review Board in Stockholm (no: 2020–06669). Participation and data collection An interview guide (Appendix 1) was developed iteratively through discussion in the research team and based on previous literature on learning in the clinical work place. Pilot interviews were conducted with physicians from six different medical specialities: general practice, cardiology, internal medicine, psychiatry – child and adult, and ear-, nose- and throat. Following this, general practitioners (GPs) and psychiatrists were included in the study. These specialties were chosen for their similarity concerning largely working individually. A difference however, is the type of organisation the clinical practice is carried out within, where GPs work in primary health care centres geographically separated from hospitals, while psychiatrists often work in tertiary care hospitals. Invitations were emailed to eligible specialists in psychiatry and general practice. Snowballing technique ( 27 ) was used to further identify and recruit participants. In total, 11 general practitioners (GPs) and 11 psychiatrists were recruited. They received information about the study and written consent was obtained. As interviews were carried out in 2021–2022 during the Covid-19 pandemic, they were carried out via video conferencing software. Audio was recorded from the interviews using a separate recording device. Interviews had a duration of 60–80 minutes and were transcribed verbatim. Data analysis To analyse the data, the theoretical framework of LoP ( 16 ) and the concept of boundary objects ( 8 ) were used as lens for analysing the two groups first separately, and then together for comparison. As no major differences appeared, the data were then treated together. An abductive approach was used where theory was used to understand data ( 28 ). Analysis including the following steps: First, interviews were read through for familiarization, and initial ideas were noted (LSS + KBL). Second, the transcripts were read for initial codes looking for a) representations of learning through conversations or interactions with peers, and b) boundary objects that mediated those conversations (LSS + KBL). Third, the codes were sorted into themes, discussed in the light of the theoretical framework, and sometimes rearranged to establish a relationship between codes and themes (all authors). During the discussions about codes and themes, analysis moved between focusing on each data item, and zooming out to identify patterns across all data (all authors). For instance, when an interviewee told about an incident during lunch when a colleague discussing a case and an unexpected diagnosis, the quote was coded as ‘Learning at lunch breakes’. Later, when the lens of boundary objects was applied (objects that facilitate learning), we could see that there were several quotes that described how learning was generated during lunches or breakes. Results First, the role of collegial learning is presented, and thereafter follows a presentation on how boundary objects promote learning between and across communities. The role of colleagues for clinical learning We found that colleagues played different roles and contributed to learning differently, and that the interviewees engaged in dialogue with colleagues in different communities as well as formal and informal contexts to learn. We have conceptualised such dialogues as ‘learning conversations’. At the workplace, interviewees engaged in learning conversations with different groups of colleagues: specialist peers, other MDs and specialists, students and peers in residency, and other health care professionals. I ask some colleagues. I guess that's natural. At work I have two colleagues, and my boss, she isn't a physician, but you can ask her too. A lot, however, is specifically about the medical, so I ask one of my two-three colleagues, or one of the nurses depending on what it is. (Int11-GP) However, specialists at the workplace represented the members of the CoP they were most likely to engage with. In conversations with these co-members of the community, patient cases were discussed, information was processed, knowledge was tested, and questions and uncertainties were discussed. The urgency of a patient case usually determined the degree of spontaneity in these conversations. Another group for learning conversations was made up of medical students and physicians in residency. These colleagues were in the periphery of the CoP, staying for a limited time, but nevertheless could offer new perspectives and knowledge about how things are done elsewhere. Often, it was acknowledged that these particular people came with state-of-the-art knowledge about procedures and practices. This enabled learning through the conversations initiated as a result of the student and residency education. We actually let the residents in training, as part of their leadership training, educate all of us to make everybody up-to-date with the latest regulations about public health. Last it was about violence in close relationships, so that we keep to the same level to new things all the time. Indeed it is pretty difficult to keep updated. (Int1-GP) Several interviewees pointed out that engaging as supervisor contributed to openness and critical thinking regarding routines and taken-for-granted knowledge. Students, who recently had visited other clinical environments, could bring new perspectives on the clinical practice by reacting to procedures or routines, for example regarding the way of communicating with patients. Medical students, when they are here [...] pretty often we sit in when they have their patients, and they have a much nicer way of communicating with patients than I do. For instance, if they notice that it's a delicate subject, suddenly either the patient gets tense, or relaxes, and then the students, with their way of learning communication technique, well, there I learn a lot every time. (Int20-GP) Almost all interviewees described that they learned from other healthcare professions, who had different formal training and education, ways of working, and experiences. Some regularly asked colleagues from other professions, and said they were always open for discussion. Just as with exchange between physicians, this interprofessional exchange occurred mostly spontaneously, as they passed by staff at the workplace, but also with a specific purpose through e-mails, internal messages, medical rounds, or team conferences. [...] just because I have a certain title, I mean, you have responsibility for your area, but to learn [from] each other no matter your profession. Here at forensic psychiatry where there are occupational therapists and counselors and very early I just said that, please can you at some occasion tell me how you work? Because I never really understood, and they were so happy and put together a little lecture and had an hour where they told me. (Int17-P) Interviewees also engaged in learning conversations with physicians in other specialties. These were approached both at their physical workplace but also in other settings and contexts such as nearby clinics, or as a part of the specialist’s network as outlined in Fig. 1.1. Then I consult clinical pharmacology, at [university hospital], so you can contact other colleagues in that way and learn. (Int21-P) Among our interviewees, GPs more often used the possibility to consult colleagues in other specialties working at hospitals than psychiatrists. This contact was usually initiated due to a patient case, or a sense of insecurity. Other learning conversations beyond specialists’ immediate workplace involved colleagues at conferences and courses, and in social media forums. Finally, friends and family were identified as a reoccurring group to engage in learning conversations with. These were often friends from medical school or previous jobs, or physician spouses with whom they discussed patient cases. [I learn] in my spare time or through my wife, who is much wiser than I am. [...] we bounce cases, not particular patients you see, not personal details, but more if we have a problem with a certain type of treatment. (Int18-P) It happens that I phone my brother-in-arms or the group physicians, we were four who were rather tight when we worked at a primary care unit…(…) particularly I turn to [name], (…) she has extensive knowledge…”(Int11-GP) In summary, this theme has described that collegial learning of specialists is distributed both at the workplace, and in other contexts, and conversations happen both spontanesouly and purposefully. Learning from colleagues relates to both specific and general patient cases, learning of procedures and roles, and of course, learning of new medical knowledge and treatments. Thus, colleagues play a mediating role in terms of new knowledge, but also an important role of being reflective partners to enable problematization, processing and sharing of thinking. Boundary objects as enablers of collegial learning: who to turn to and how to interact We identify several boundary objects (see Table 1) that enable learning conversations and in this way promote meaning across the LoP: referrals, planned meetings, supervision, informal meetings, professional organisations, conferences and courses, and social media forums. Referrals were frequently mentioned as a way to facilitate dialogue with physicians, either for a second opinion at the workplace, or from physicians in other specialties. Referrals were used as a conversational framework to engage in text-based dialogue, and engaging with peers’ notes in the records contributed to knowledge of others’ ways of reasoning. Sometimes some colleagues write a question regarding something special where you hear, see, how others think. It is good to see how others think as you get other thoughts as well. (Int12-GP) Planned meetings , where physicians gathered regularly, was another boundary object. Here, the team shared knowledge and perspectives, not only regarding patient cases, but also on where to find relevant knowledge and expertise for advancing patient cases. Specialists with experience or knowledge from other settings had a brokering role when introducing other perspectives. It was common to ask a colleague who had attended a presentation elsewhere to summarize new advances in the field, or ask physicians in residency training to share state-of-the-art knowledge from courses they had recently taken. When I presented a case at our physician meeting a colleague reminded me… that we had a similar case previously… so I asked [name], who is professor and […] who I know from these closed web forums that exist… This, I have experienced, led to a lot of continuous learning, that you ask questions to each other and can get answers from the most experienced (physicians). (Int2-P) Supervision between specialists and residents, or medical students worked also as a boundary object for these kind of learning conversations. I have a new resident who is very energetic and asks a lot and it develops me in a way too, how to do... So that it becomes a kind of informal learning, since I am her supervisor. (Int10-P) Another boundary object that was more or less spontaneous was informal meetings . Here, collegial discussions about ones’ mistakes and patient cases took place in a confidential and informal environment, both during work but also during lunches and breaks. During lunch too, yes, there was a case last week which shocked my colleague and her eyes were almost popping out and she couldn’t hold back, so there was five minutes discussion on the quite unexpected diagnosis. (Int16-GP) When approaching peers at the same workplace to solve urgent patient case, interviewees reported selecting peers according to a number of factors including: perceptions about colleagues’ knowledge and skills, personality traits, trust, judgement, shared history, and similarity in working methods. Those peers to whom interviewees turned had gained legitimacy and trust over time, and were important brokers for learning at the workplace. Knowledge about colleagues’ special interests, other roles and assignments developed over time through discussions. This gave insights into other practices of the landscape – and increased the engagement in learning conversations with these specific colleagues. Apart from knowledge of colleagues’ reasoning and expertise, issues of trust were also important for whom to initiate conversations with. Trust, however, developed over time and required longitudinal relationships. Specialists described how these long-term colleagues enabled continuous learning since it was meaningful to seek out their perspectives as they were viewed as ‘wise’. Informal meetings functioning as boundary objects could moreover also take place outside the workplace and after working hours. As mentioned, specialists sometimes had physician spouses and physician friends which they discussed with during for example social gathering such as dinners. They sometimes also texted or phoned friends from medical school or previous workplaces to proceed in a patient case. Engagement in professional organisations were also a boundary object, as it enabled collaborative learning and sharing of research and practice with specialists beyond the workplace. Contact with medical specialists in other settings through professional organisations were based on knowledge of others’ knowledge, and knowledge about where to find knowledge. Over time, some had refined their way of gaining knowledge through others. One GP for example mentioned an informal list of consultants that could be contacted to get useful and meaningful answers, and a psyciatrist expressed: I’ve been active in the child psychiatry organisation. I was in the board for many years and met people from all over the country, so I have a number (of colleagues) who I like to talk to. (Int14-P) Conferences and courses was identified as a boundary object for collegial learning conversations as they enabled socializing with known or unknown physicians from other settings. In such learning conversations, specialists could call into question their own, as well as their workplace’s, knowledge and methods, which sometimes led to change in practice. We cooperate with a lot of teams outside of psychiatry as well. So, it is always food for thought; “oh, they do it like that, what we have been struggling with for so long, they have a solution for it” (Int20-P) We also found that interviewees engaged in learning conversations via social media forums , in asynchronous situations when physicians from different settings without close relationships communicated. Some interviewees were members in such forums consisting of thousands of physicians. The different forums could revolve around a specific subject such as dermatoscopy, the Covid-19 pandemic, or have a more general content. In these forums, information, questions, debate posts, and scientific articles were shared. Interviewees used the information directly or saved it for later. It was, however, more common among the GPs to refer to social media forums than for psychiatrists, even if they also existed. There is a guy in [city] who has been amazing in compiling research on the Covid pandemic, now for instance about vaccines…I am not active myself in writing back, but I read up on it. (Int1-GP) In summary, learning conversations took place with different colleagues and in different settings. Relationship to colleagues could vary from being close to distant, and not having any personal relationship or connection at all but being part of the same profession and social media group. Knowledge of others’ knowledge was an important aspect for engaging in collegial learning conversations, but also emotional/personal ties, physical proximity, and relevance to practice. Learning conversations were facilitated by the boundary objects, including: referrals, planned meetings, supervision, informal meetings taking place at for example lunches and breaks or after working hours when discussion with physician friends, professional organisations, conferences and courses, and social media forums. These boundary objects facilitated learning conversations and development of knowledge which the interviewees described led to changes in practice. We found links of various strength between specialists that led to learning conversations. Discussion This study aimed to explore the role colleagues play for each others’ learning, and how boundary objects promote meaningful learning between and across communities. Our analysis suggests that physicians in learn from colleagues across healthcare landscapes and develop knowledge of the landscape. Physicians’ learning is mediated by collegial conversations, which fulfill different purposes and are crucial for this process. Engagement in collegial conversations is based on knowledge, trust, and proximity. Our results thus highlight collegial conversations among physicians, and provides insights on how they are enabled through boundary objects. Based on our results, we suggest that physicians learn to navigate and develop knowledge of the Landscape of practice through these conversations. This is visualized in Fig. 1. The Landscape of practice facilitates continued learning and may consist of colleagues both at and outside the workplace, such as from medical school, specialist training, courses and conferences, previous work, and private life. The Landscape of practice influences the practice of physicians in it via boundary objects. These boundary objects are thus crucial for enabling collegial conversations, and we suggest that paying attention to existing or absent boundary objects could be a way to further promote physician learning. Collegial conversations are core for professional development Our findings align with previous research, but also adds new perspectives. Conversations showed to be a core activity for learning, and were experienced as crucial for development of thinking and practicing in the profession. Similar to Hale et al., ( 29 ) we found multiple types of interactions between colleagues leading to conversations. For instance, meaningful conversations that generated learning were not only held for consultation reasons in regard to a specific patient case, but also out of interest to better understand not only current but future cases, both with colleagues at the clinic, and with professionals from other health care professions. Additionally, we could see that collegial conversations via social media played an important role in some physicians’ learning. Our findings show a strong connection between the role as teacher or supervisor and learning. These findings are in line with work by Ding et al., (2019) who suggest physicians’ involvement in clinical teaching plays a crucial role in lifelong learning. Our findings thus add to the literature on the role of conversations for professional development in making explicit its role in clinical practice and we suggest collegial conversations to be important as mediator for how a community establish the shared direction or ‘enterprize’ of its practice ( 8 ). Backstage context is important for learning conversations to appear The Landscape of Practice consisted of communities of different proximity that were connected via boundary objects. We use the concepts of local, neighbouring, and distant, to explain how we see their connectedness. We found that the specialists repeatedly turned to a few trusted colleagues in the local CoP for conversations about urgent patient cases. Related to trust, these local communities were built over time, and physicians developed awareness of others’ knowledge and skills, judgement, and working methods. These findings are in line with research in higher education, where backstage conversations have been found crucial in microcultures of teaching ( 25 ). Due to matters of patient integrity and confidentiality, these collegial conversations had to be held backstage which is characterized by privacy, informality and trust. For example, spontaneous conversations were held with selected colleagues at work, but also at home with a spouse. In this local backstage context, the specialists tested their knowledge, thoughts, and ideas. These local conversations were also used for discussing other work-related issues, and could also deal with less urgent matters. Invitation of neighbouring and distant CoPs across the LoP are valued for learning The LoP also consisted of neighbouring communities, such as when invited colleagues at the workplace shared knowledge during planned meetings or through referrals. Learning conversations with neighbouring communities could also include colleagues whom the physicians socialized with during breaks at conferences and courses. Distant communities also impacted collegial learning, even if less frequently. For example, engagement with forums on social media enabled connection with distant communities and in these cases, specialists had no personal links to the other group members, only professional. Also, membership in professional organizations could fulfil such a role. A risk with overuse of local CoP is that a physicians’ knowledge, but also ideas and working methods, are not challenged and developed as it consist of physicians with similar approaches, views and practices, a risk that also have been found in other contexts ( 30 ). This risk was reduced when local practice was challenged, for instance when students give new perspectives on patient communication. It could however be counteracted by having a ‘forced’ neighbour CoP in the learning system. Therefore, we suggest that space, time, and place for structured conversations between colleagues across CoPs about for example patient case discussions are important at the local level, as well as conversations at distant level, by participating in conferences and courses of relevance for practice. Seeing the value of sharing knowledge with neighbouring CoPs, implies that formalised educational activities could be adressing sharing across CoPs. This also since previous research have shown that CPD activities usually focuses on individual levels, which is one reason for not contributing to knowledge reproduction and change in practice ( 2 ). Conclusion Overall, all physicians may be part of somebody else’s collegial learning in Landscapes of practice, and physicians seem to develop knowledge of where to find knowledge in their landscape. By paying attention to boundary objects, managers can facilitate collegial conversations at local, neighboring and distant levels. However, this requires consideration of the approach taken to working, where physicians are seen as individuals or in a sharing landscape, and thus it is important to establish multiple arenas and forums for engaging in discussions. This means that we conceptualise physicians’ learning as a result of negotiations and reflection on the different practices that physicians engage in. In conclusion, Landscapes of practice facilitates continued learning among physicians when enabling learning conversations on the different practices that physicians engage in. Declarations Disclaimer regarding conflict of interest None of the authors have conflict of interest. Ethics approval and consent to participate Ethical approval was applied for by The Swedish Ethical Review Authority confirmed that no ethical approval was required for this study, which was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was received. Dnr 2020–06669. Consent for publication Not applicable Availability of data and materials Data for this research cannot be shared openly, as participants were ensured interview data would not be distributed to any third party and only used as a basis for exploring the research questions of the current research study. However, anonymized data is available in the manuscript. Competing interests The authors declare that they have no competing interests that are relevant to the content of this article. Funding Financial support was received from Stockholm Region (dnr 2019–1097). Authors contributions All authors have contributed to the design of the study. LSS carried out all interviews. KBL and LSS carried out the initial analysis and interpretation of data which was then discussed in the full research team. KBL and LSS drafted the work which was then revised in several stages by all members of the team. All authors have approved the submitted version of the manuscript and have agreed to be accountable for the contribution. Acknowledgements We want to thank all interviewees who shared their time and experiences in a time stressful for many health care professionals. We also acknowledge the work of Jagjeet Singh in transcribing the interviews with psychiatrists as a part of his medical degree project. Authors information Klara Bolander Laksov is a professor at Stockholm University specializing in higher education and medical education. She leads research on academic leadership, clinical learning environments, and educational change. She also directs the Centre for University Teacher Education at Stockholm University. Cormac McGrath is a senior lecturer at Stockholm University, focusing on higher education, faculty development, and educational leadership. He has a background in secondary education and has worked at Karolinska Institutet. His research includes educational change and the ethics of AI in education. Erik Björck, MD, PhD, is an associate professor in clinical genetics at Karolinska Institutet. He is also a senior consultant at Karolinska University Hospital. His research focuses on rare diseases and genetic disorders, and he is an experienced medical educator and researches medical education. Agnes Elmberger, MD, PhD, is a researcher at Karolinska Institutet specializing in medical education and faculty development. She explores how clinical teachers transfer knowledge from faculty development to practice. Elmberger also teaches at Karolinska Institutet and contributes to educational change in clinical settings. Linda Sturesson Stabel, PhD, is a research specialist at Karolinska Institutet. Her work focuses on healthcare leadership, climate action in healthcare, and the integration of migrant physicians into the Swedish medical workforce. She has published extensively on professional development and digital transformation in outpatient care References Samuel A, Cervero RM, Durning SJ, Maggio LA. Effect of continuing professional development on health professionals’ performance and patient outcomes: a scoping review of knowledge syntheses. Acad Med. 2021;96(6):913–23. Cervero RM, Gaines JK. The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews. J Continuing Educ Health Professions. 2015;35(2):131–8. Khazanova D, Safdieh JE, editors. Continuing medical education in neurology. Seminars in Neurology. Thieme Medical; 2018. 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Med Educ. 2019;53(8):778–87. Weeks KW, Coben D, O'neill D, Jones A, Weeks A, Brown M, et al. Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: Pedagogies for reconceptualising the theory-practice gap. Nurse Educ Pract. 2019;37:29–38. McGrath C, Barman L, Stenfors-Hayes T, Roxå T, Silén C, Laksov KB. The ebb and flow of educational change: Change agents as negotiators of change. Teach Learn Inq. 2016;4(2):91–104. McGrath C, Bolander Laksov K. Laying bare educational crosstalk: a study of discursive repertoires in the wake of educational reform. Int J Acad Dev. 2014;19(2):139–49. Bolander Laksov K, Tomson T. Becoming an educational leader–exploring leadership in medical education. Int J Leadersh Educ. 2017;20(4):506–16. Paavola S, Lipponen L, Hakkarainen K. Models of innovative knowledge communities and three metaphors of learning. Rev Educ Res. 2004;74(4):557–76. Roxå T, Mårtensson K. Significant conversations and significant networks–exploring the backstage of the teaching arena. Stud High Educ. 2009;34(5):547–59. Earl LM, Timperley H. Understanding how evidence and learning conversations work. Professional learning conversations: Challenges in using evidence for improvement. Springer; 2009. pp. 1–12. Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. Sage; 2016. Timmermans S, Tavory I. Theory construction in qualitative research: From grounded theory to abductive analysis. Sociol theory. 2012;30(3):167–86. Hale AJ, Freed JA, Alston WK, Ricotta DN. What are we really talking about? An organizing framework for types of consultation and their implications for physician communication. Acad Med. 2019;94(6):809–12. Poole G, Iqbal I, Verwoord R. Small significant networks as birds of a feather. Int J Acad Dev. 2019;24(1):61–72. Bolander Laksov K, Elmberger A, Liljedahl M, Björck E. Shifting to Team-based Faculty Development: a Programme designed to facilitate change in Medical Education. High Educ Res Dev. 2022;41(2):269–83. Table 1 Table 1 is not available with this version. Additional Declarations No competing interests reported. Supplementary Files Interviewguide.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6155737","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454012395,"identity":"2159dca5-2291-473b-b52c-c0e46f490454","order_by":0,"name":"Klara Bolander Laksov","email":"data:image/png;base64,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","orcid":"","institution":"Stockholm University","correspondingAuthor":true,"prefix":"","firstName":"Klara","middleName":"Bolander","lastName":"Laksov","suffix":""},{"id":454012396,"identity":"bb38b03f-aaf0-4f18-8d04-9c3ede5f1aa7","order_by":1,"name":"Cormac McGrath","email":"","orcid":"","institution":"Stockholm University","correspondingAuthor":false,"prefix":"","firstName":"Cormac","middleName":"","lastName":"McGrath","suffix":""},{"id":454012397,"identity":"11e6c2d8-5c15-4f64-8535-7233dedce9f4","order_by":2,"name":"Erik Björck","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Erik","middleName":"","lastName":"Björck","suffix":""},{"id":454012398,"identity":"19cac4aa-72ea-4560-b0dd-3899cfb3aa76","order_by":3,"name":"Agnes Elmberger","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Agnes","middleName":"","lastName":"Elmberger","suffix":""},{"id":454012399,"identity":"9545bbad-c71c-495c-ac47-f8f99f237d1e","order_by":4,"name":"Linda Sturesson-Stabel","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"","lastName":"Sturesson-Stabel","suffix":""}],"badges":[],"createdAt":"2025-03-04 15:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6155737/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6155737/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82477937,"identity":"61cd70fc-699b-4600-bd57-5ca53c47ad9c","added_by":"auto","created_at":"2025-05-12 02:43:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40564,"visible":true,"origin":"","legend":"\u003cp\u003eCollegial conversations across the Landscape of practice.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6155737/v1/563c41f369ccdc30c2f33fc2.png"},{"id":84376511,"identity":"5142a038-c32e-4973-b0ab-d82df83769bd","added_by":"auto","created_at":"2025-06-11 08:24:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":628752,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6155737/v1/a8930d4c-8763-4f6a-b7d7-4974796e1073.pdf"},{"id":82477939,"identity":"5f40a901-d286-4491-92a2-fe85c6b0a5b7","added_by":"auto","created_at":"2025-05-12 02:43:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14704,"visible":true,"origin":"","legend":"","description":"","filename":"Interviewguide.docx","url":"https://assets-eu.researchsquare.com/files/rs-6155737/v1/9ced5b90721a1de1d3380314.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Learning through collegial conversations - a qualitative study of physicians’ professional development","fulltext":[{"header":"Introduction","content":"\u003cp\u003e Continued professional development (CPD) is identified as a way for health care professionals to stay abreast of advances in practice and research. However, for more than two decades, CPD has been discussed in terms of challenges such as the unclear effect of CPD courses on professional and patient outcomes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), the lack of impact in clinical practice from CPD courses (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), or the limited spread of knowledge and practices among collegues in the workplace (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Other challenges pertain to the cost of participation in CPD programs (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), time and motivation for participation in CPD activities, and whether or not the activities target the needs of physicians (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Studies show that formalized courses can lead to instrumental approaches to CPD, where \u0026lsquo;ticking boxes\u0026rsquo; becomes more important than learning and developing practice (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Moreover, findings highlight the importance of acknowledging activities that lead to learning, for example patient encounters and meetings with colleagues and argue that these too, could count as CPD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) as they represent substantial gains in physicians\u0026rsquo; learning.\u003c/p\u003e \u003cp\u003eWe identify that all physicians are members of communities of practice, with people who work in the same domain and share the same or a similar practice in terms of goals for everyday work, resources availability and ways of dealing with challenges and opportunities linked to work (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Voices have been raised that the communities of practice physicians work in may be viewed as resources for learning, and constitute opportunities for various forms of CPD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and thus contribute to what we identify as \u0026lsquo;collegial learning\u0026rsquo;.\u003c/p\u003e \u003cp\u003eIn this paper we conceptualize collegial learning as the process of learning taking place between colleagues, near or distant, as they share experiences and knowledge. Physicans\u0026rsquo; collegial learning has been targeted as crucial both during residency training (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and for specialists (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Yet, while collegial learning has been explored extensively in the broader higher education literature (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), few studies can be found on this topic in continuing medical education. Recent research on collegial learning in clinical practice however indicates several positive effects of collegial learning practices. One study identified that physicians sharing experiences of failures and success with each other helps medical doctors commit fewer medical errors (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Another study showed how structured conversations about patient cases with colleagues significantly improved interns\u0026rsquo; confidence in prescription practices (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A third recent study identifies that physicians learn from collegial interaction both at the workplace and in other settings and contexts, the groups identified for learning were: general practitioners (GPs) at the workplace, colleagues/ peers in residency, GP colleagues in settings other than the workplace, and colleagues in other medical specialties and professions (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study adds to previous research by focusing on the roles colleagues play for learning, and how knowledge sharing and learning between colleagues is stimulated and carried out. In addition, this study bridges a gap between physicians\u0026rsquo; professional learning in clinical contexts and collegial learning in the context of higher education, to improve purposeful learning and sharing of knowledge for physicians. The aim of this is study is to explore the role colleagues play for physicians\u0026rsquo; learning and how meaningful learning may be promoted between and across communities they are interacting with.\u003c/p\u003e\n\u003ch3\u003eTheoretical framework\u003c/h3\u003e\n\u003cp\u003eIn this study, we employ a socio-cultural perspective on learning and use the theory of Landscapes of practice (LoP) to understand and interpret our data. Landscapes of Practice theory describes how multiple communities of practice (CoP) interact in a complex system. Each CoP has its own criteria and experiences that define membership and boundaries.\u003c/p\u003e \u003cp\u003eIn a CoP, members engage with and care about the same real-life problems, and interact regularly to learn together and from each other, i.e. they share a practice of some sort (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In earlier work, Wenger focused on single communities, but people belong to multiple communities and face complex problems (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). LoP refers to the diverse and interconnected range of professional communities, disciplines, and knowledge domains that individuals engage with as part of their learning and work. It is a concept rooted in CoP and social learning theory, emphasizing how people navigate and participate across multiple CoPs throughout their professional journey (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In his work, learning and identity is emphasized as a central component of LoP, where professionals or other groups of individuals engage in a shared so called \u0026lsquo;enterprise\u0026rsquo; in their activities and create a shared repertoire of approaches and tools for their practice (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA LoP perspective on continuing professional development acknowledges the professional relationships between individuals within and between practices, for example the medical professions collaborate and work together in complex settings like clinical settings, as important for the learning of individuals as well as for the community as a whole (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In LoP, several CoPs can co-exist in the same clinical setting (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and are viewed as linked and interconnected, creating opportunities for adopting new or different perspectives. From a LoP perspective, we focus on how different practices and interactions between physicians may influence their learning. For example, a psychiatrist also interacts with psychologists and social workers, and a general practitioner also interacts with nurses and physiotherapists.\u003c/p\u003e \u003cp\u003eFurther, in a LoP, the boundaries between CoPs are important for learning since membership in several practices enable reflection on similarities and dissimilarities, and where reflection can generate an ability to identify gaps in existing knowledge and use the multiplicity of landscapes to generate new knowledge, a concept known as \u0026lsquo;knowledgeability\u0026rsquo;, according to Wenger-Trayner and Wenger-Trayner (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This means being a member of several CoPs enables comparison and transfer of knowledge of how things are carried out from one CoP into another. For example, a clinical supervisor in a medical undergraduate program who learns about how to provide feedback to students can use that knowledge also in other CoPs where one is in a supervisory role. This involves a process of brokering where knowledge is transferred from one CoP to another and is a central component of LoP. Brokers are individuals who are engaged in contacts across the boundaries of the CoP, building connections between different practices and introducing new practices, such as a routine for providing feedback, a new weekly meeting procedure or other practices. Sometimes, brokering is facilitated between CoPs by boundary objects. Boundary objects may be physical or abstract, and can function as a translational device and mediate between two or more CoP\u0026rsquo;s, and thus facilitate learning across a LoP (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Boundary objects mediate the sharing of practice and collaboration across the landscape and provide a structure for aligning meaningful activity for all involved. In one study, patient symptoms, electronic medical records and status symbols were identified as boundary objects for enhancing interprofessional collaboration (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Other studies have found boundary objects in feedback and teaching prizes as boundary object for new clinical teachers (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and simulation environments for bridging the theory-practice gap (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo explore the role colleagues play for physicians\u0026rsquo; learning and how meaningful learning may be promoted between and across communities they are interacting with we posed the following research questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat role do colleagues play in physicians\u0026rsquo; learning at work?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat boundary objects facilitate learning for physicians between and across communities?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eWe adopted a qualitative approach and interviewed physicians from two specialities on their experiences of collegial learning. The study was conducted in Sweden, where physicians become specialists after five years residency training. The study was carried out in accordance with the Declaration of Helsinki and approved by the Ethical Review Board in Stockholm (no: 2020\u0026ndash;06669).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipation and data collection\u003c/h2\u003e \u003cp\u003eAn interview guide (Appendix 1) was developed iteratively through discussion in the research team and based on previous literature on learning in the clinical work place. Pilot interviews were conducted with physicians from six different medical specialities: general practice, cardiology, internal medicine, psychiatry \u0026ndash; child and adult, and ear-, nose- and throat. Following this, general practitioners (GPs) and psychiatrists were included in the study. These specialties were chosen for their similarity concerning largely working individually. A difference however, is the type of organisation the clinical practice is carried out within, where GPs work in primary health care centres geographically separated from hospitals, while psychiatrists often work in tertiary care hospitals.\u003c/p\u003e \u003cp\u003eInvitations were emailed to eligible specialists in psychiatry and general practice. Snowballing technique (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) was used to further identify and recruit participants. In total, 11 general practitioners (GPs) and 11 psychiatrists were recruited. They received information about the study and written consent was obtained. As interviews were carried out in 2021\u0026ndash;2022 during the Covid-19 pandemic, they were carried out via video conferencing software. Audio was recorded from the interviews using a separate recording device. Interviews had a duration of 60\u0026ndash;80 minutes and were transcribed verbatim.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eTo analyse the data, the theoretical framework of LoP (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and the concept of boundary objects (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) were used as lens for analysing the two groups first separately, and then together for comparison. As no major differences appeared, the data were then treated together.\u003c/p\u003e \u003cp\u003eAn abductive approach was used where theory was used to understand data (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Analysis including the following steps:\u003c/p\u003e \u003cp\u003eFirst, interviews were read through for familiarization, and initial ideas were noted (LSS\u0026thinsp;+\u0026thinsp;KBL). Second, the transcripts were read for initial codes looking for a) representations of learning through conversations or interactions with peers, and b) boundary objects that mediated those conversations (LSS\u0026thinsp;+\u0026thinsp;KBL). Third, the codes were sorted into themes, discussed in the light of the theoretical framework, and sometimes rearranged to establish a relationship between codes and themes (all authors). During the discussions about codes and themes, analysis moved between focusing on each data item, and zooming out to identify patterns across all data (all authors). For instance, when an interviewee told about an incident during lunch when a colleague discussing a case and an unexpected diagnosis, the quote was coded as \u0026lsquo;Learning at lunch breakes\u0026rsquo;. Later, when the lens of boundary objects was applied (objects that facilitate learning), we could see that there were several quotes that described how learning was generated during lunches or breakes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFirst, the role of collegial learning is presented, and thereafter follows a presentation on how boundary objects promote learning between and across communities.\u003c/p\u003e\n\u003ch3\u003eThe role of colleagues for clinical learning\u003c/h3\u003e\n\u003cp\u003eWe found that colleagues played different roles and contributed to learning differently, and that the interviewees engaged in dialogue with colleagues in different communities as well as formal and informal contexts to learn. We have conceptualised such dialogues as \u0026lsquo;learning conversations\u0026rsquo;.\u003c/p\u003e \u003cp\u003e At the workplace, interviewees engaged in learning conversations with different groups of colleagues: specialist peers, other MDs and specialists, students and peers in residency, and other health care professionals.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI ask some colleagues. I guess that's natural. At work I have two colleagues, and my boss, she isn't a physician, but you can ask her too. A lot, however, is specifically about the medical, so I ask one of my two-three colleagues, or one of the nurses depending on what it is. (Int11-GP)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, specialists at the workplace represented the members of the CoP they were most likely to engage with. In conversations with these co-members of the community, patient cases were discussed, information was processed, knowledge was tested, and questions and uncertainties were discussed. The urgency of a patient case usually determined the degree of spontaneity in these conversations.\u003c/p\u003e \u003cp\u003eAnother group for learning conversations was made up of medical students and physicians in residency. These colleagues were in the periphery of the CoP, staying for a limited time, but nevertheless could offer new perspectives and knowledge about how things are done elsewhere. Often, it was acknowledged that these particular people came with state-of-the-art knowledge about procedures and practices. This enabled learning through the conversations initiated as a result of the student and residency education.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe actually let the residents in training, as part of their leadership training, educate all of us to make everybody up-to-date with the latest regulations about public health. Last it was about violence in close relationships, so that we keep to the same level to new things all the time. Indeed it is pretty difficult to keep updated. (Int1-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSeveral interviewees pointed out that engaging as supervisor contributed to openness and critical thinking regarding routines and taken-for-granted knowledge. Students, who recently had visited other clinical environments, could bring new perspectives on the clinical practice by reacting to procedures or routines, for example regarding the way of communicating with patients.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMedical students, when they are here [...] pretty often we sit in when they have their patients, and they have a much nicer way of communicating with patients than I do. For instance, if they notice that it's a delicate subject, suddenly either the patient gets tense, or relaxes, and then the students, with their way of learning communication technique, well, there I learn a lot every time. (Int20-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlmost all interviewees described that they learned from other healthcare professions, who had different formal training and education, ways of working, and experiences. Some regularly asked colleagues from other professions, and said they were always open for discussion. Just as with exchange between physicians, this interprofessional exchange occurred mostly spontaneously, as they passed by staff at the workplace, but also with a specific purpose through e-mails, internal messages, medical rounds, or team conferences.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e[...] just because I have a certain title, I mean, you have responsibility for your area, but to learn [from] each other no matter your profession. Here at forensic psychiatry where there are occupational therapists and counselors and very early I just said that, please can you at some occasion tell me how you work? Because I never really understood, and they were so happy and put together a little lecture and had an hour where they told me. (Int17-P)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eInterviewees also engaged in learning conversations with physicians in other specialties. These were approached both at their physical workplace but also in other settings and contexts such as nearby clinics, or as a part of the specialist\u0026rsquo;s network as outlined in Fig.\u0026nbsp;1.1.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThen I consult clinical pharmacology, at [university hospital], so you can contact other colleagues in that way and learn. (Int21-P)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAmong our interviewees, GPs more often used the possibility to consult colleagues in other specialties working at hospitals than psychiatrists. This contact was usually initiated due to a patient case, or a sense of insecurity. Other learning conversations beyond specialists\u0026rsquo; immediate workplace involved colleagues at conferences and courses, and in social media forums.\u003c/p\u003e \u003cp\u003eFinally, friends and family were identified as a reoccurring group to engage in learning conversations with. These were often friends from medical school or previous jobs, or physician spouses with whom they discussed patient cases.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e[I learn] in my spare time or through my wife, who is much wiser than I am. [...] we bounce cases, not particular patients you see, not personal details, but more if we have a problem with a certain type of treatment. (Int18-P)\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eIt happens that I phone my brother-in-arms or the group physicians, we were four who were rather tight when we worked at a primary care unit\u0026hellip;(\u0026hellip;) particularly I turn to [name], (\u0026hellip;) she has extensive knowledge\u0026hellip;\u0026rdquo;(Int11-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn summary, this theme has described that collegial learning of specialists is distributed both at the workplace, and in other contexts, and conversations happen both spontanesouly and purposefully. Learning from colleagues relates to both specific and general patient cases, learning of procedures and roles, and of course, learning of new medical knowledge and treatments. Thus, colleagues play a mediating role in terms of new knowledge, but also an important role of being reflective partners to enable problematization, processing and sharing of thinking.\u003c/p\u003e\n\u003ch3\u003eBoundary objects as enablers of collegial learning: who to turn to and how to interact\u003c/h3\u003e\n\u003cp\u003eWe identify several boundary objects (see Table\u0026nbsp;1) that enable learning conversations and in this way promote meaning across the LoP: referrals, planned meetings, supervision, informal meetings, professional organisations, conferences and courses, and social media forums.\u003c/p\u003e \u003cp\u003e \u003cem\u003eReferrals\u003c/em\u003e were frequently mentioned as a way to facilitate dialogue with physicians, either for a second opinion at the workplace, or from physicians in other specialties. Referrals were used as a conversational framework to engage in text-based dialogue, and engaging with peers\u0026rsquo; notes in the records contributed to knowledge of others\u0026rsquo; ways of reasoning.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSometimes some colleagues write a question regarding something special where you hear, see, how others think. It is good to see how others think as you get other thoughts as well. (Int12-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003ePlanned meetings\u003c/em\u003e, where physicians gathered regularly, was another boundary object. Here, the team shared knowledge and perspectives, not only regarding patient cases, but also on where to find relevant knowledge and expertise for advancing patient cases. Specialists with experience or knowledge from other settings had a brokering role when introducing other perspectives. It was common to ask a colleague who had attended a presentation elsewhere to summarize new advances in the field, or ask physicians in residency training to share state-of-the-art knowledge from courses they had recently taken.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWhen I presented a case at our physician meeting a colleague reminded me\u0026hellip; that we had a similar case previously\u0026hellip; so I asked [name], who is professor and [\u0026hellip;] who I know from these closed web forums that exist\u0026hellip; This, I have experienced, led to a lot of continuous learning, that you ask questions to each other and can get answers from the most experienced (physicians). (Int2-P)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eSupervision\u003c/em\u003e between specialists and residents, or medical students worked also as a boundary object for these kind of learning conversations.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI have a new resident who is very energetic and asks a lot and it develops me in a way too, how to do... So that it becomes a kind of informal learning, since I am her supervisor. (Int10-P)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAnother boundary object that was more or less spontaneous was \u003cem\u003einformal meetings\u003c/em\u003e. Here, collegial discussions about ones\u0026rsquo; mistakes and patient cases took place in a confidential and informal environment, both during work but also during lunches and breaks.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eDuring lunch too, yes, there was a case last week which shocked my colleague and her eyes were almost popping out and she couldn\u0026rsquo;t hold back, so there was five minutes discussion on the quite unexpected diagnosis. (Int16-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhen approaching peers at the same workplace to solve urgent patient case, interviewees reported selecting peers according to a number of factors including: perceptions about colleagues\u0026rsquo; knowledge and skills, personality traits, trust, judgement, shared history, and similarity in working methods. Those peers to whom interviewees turned had gained legitimacy and trust over time, and were important brokers for learning at the workplace.\u003c/p\u003e \u003cp\u003eKnowledge about colleagues\u0026rsquo; special interests, other roles and assignments developed over time through discussions. This gave insights into other practices of the landscape \u0026ndash; and increased the engagement in learning conversations with these specific colleagues. Apart from knowledge of colleagues\u0026rsquo; reasoning and expertise, issues of trust were also important for whom to initiate conversations with. Trust, however, developed over time and required longitudinal relationships. Specialists described how these long-term colleagues enabled continuous learning since it was meaningful to seek out their perspectives as they were viewed as \u0026lsquo;wise\u0026rsquo;.\u003c/p\u003e \u003cp\u003eInformal meetings functioning as boundary objects could moreover also take place outside the workplace and after working hours. As mentioned, specialists sometimes had physician spouses and physician friends which they discussed with during for example social gathering such as dinners. They sometimes also texted or phoned friends from medical school or previous workplaces to proceed in a patient case.\u003c/p\u003e \u003cp\u003eEngagement in \u003cem\u003eprofessional organisations\u003c/em\u003e were also a boundary object, as it enabled collaborative learning and sharing of research and practice with specialists beyond the workplace. Contact with medical specialists in other settings through professional organisations were based on knowledge of others\u0026rsquo; knowledge, and knowledge about where to find knowledge. Over time, some had refined their way of gaining knowledge through others. One GP for example mentioned an informal list of consultants that could be contacted to get useful and meaningful answers, and a psyciatrist expressed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI\u0026rsquo;ve been active in the child psychiatry organisation. I was in the board for many years and met people from all over the country, so I have a number (of colleagues) who I like to talk to. (Int14-P)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eConferences and courses\u003c/em\u003e was identified as a boundary object for collegial learning conversations as they enabled socializing with known or unknown physicians from other settings. In such learning conversations, specialists could call into question their own, as well as their workplace\u0026rsquo;s, knowledge and methods, which sometimes led to change in practice.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe cooperate with a lot of teams outside of psychiatry as well. So, it is always food for thought; \u0026ldquo;oh, they do it like that, what we have been struggling with for so long, they have a solution for it\u0026rdquo; (Int20-P)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWe also found that interviewees engaged in learning conversations via \u003cem\u003esocial media forums\u003c/em\u003e, in asynchronous situations when physicians from different settings without close relationships communicated. Some interviewees were members in such forums consisting of thousands of physicians. The different forums could revolve around a specific subject such as dermatoscopy, the Covid-19 pandemic, or have a more general content. In these forums, information, questions, debate posts, and scientific articles were shared. Interviewees used the information directly or saved it for later. It was, however, more common among the GPs to refer to social media forums than for psychiatrists, even if they also existed.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThere is a guy in [city] who has been amazing in compiling research on the Covid pandemic, now for instance about vaccines\u0026hellip;I am not active myself in writing back, but I read up on it. (Int1-GP)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn summary, learning conversations took place with different colleagues and in different settings. Relationship to colleagues could vary from being close to distant, and not having any personal relationship or connection at all but being part of the same profession and social media group. Knowledge of others\u0026rsquo; knowledge was an important aspect for engaging in collegial learning conversations, but also emotional/personal ties, physical proximity, and relevance to practice. Learning conversations were facilitated by the boundary objects, including: referrals, planned meetings, supervision, informal meetings taking place at for example lunches and breaks or after working hours when discussion with physician friends, professional organisations, conferences and courses, and social media forums. These boundary objects facilitated learning conversations and development of knowledge which the interviewees described led to changes in practice. We found links of various strength between specialists that led to learning conversations.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the role colleagues play for each others\u0026rsquo; learning, and how boundary objects promote meaningful learning between and across communities. Our analysis suggests that physicians in learn from colleagues across healthcare landscapes and develop knowledge of the landscape. Physicians\u0026rsquo; learning is mediated by collegial conversations, which fulfill different purposes and are crucial for this process. Engagement in collegial conversations is based on knowledge, trust, and proximity. Our results thus highlight collegial conversations among physicians, and provides insights on how they are enabled through boundary objects. Based on our results, we suggest that physicians learn to navigate and develop knowledge of the Landscape of practice through these conversations. This is visualized in Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Landscape of practice facilitates continued learning and may consist of colleagues both at and outside the workplace, such as from medical school, specialist training, courses and conferences, previous work, and private life. The Landscape of practice influences the practice of physicians in it via boundary objects. These boundary objects are thus crucial for enabling collegial conversations, and we suggest that paying attention to existing or absent boundary objects could be a way to further promote physician learning.\u003c/p\u003e\n\u003ch3\u003eCollegial conversations are core for professional development\u003c/h3\u003e\n\u003cp\u003eOur findings align with previous research, but also adds new perspectives. Conversations showed to be a core activity for learning, and were experienced as crucial for development of thinking and practicing in the profession. Similar to Hale et al., (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) we found multiple types of interactions between colleagues leading to conversations. For instance, meaningful conversations that generated learning were not only held for consultation reasons in regard to a specific patient case, but also out of interest to better understand not only current but future cases, both with colleagues at the clinic, and with professionals from other health care professions. Additionally, we could see that collegial conversations via social media played an important role in some physicians\u0026rsquo; learning. Our findings show a strong connection between the role as teacher or supervisor and learning. These findings are in line with work by Ding et al., (2019) who suggest physicians\u0026rsquo; involvement in clinical teaching plays a crucial role in lifelong learning. Our findings thus add to the literature on the role of conversations for professional development in making explicit its role in clinical practice and we suggest collegial conversations to be important as mediator for how a community establish the shared direction or \u0026lsquo;enterprize\u0026rsquo; of its practice (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eBackstage context is important for learning conversations to appear\u003c/h3\u003e\n\u003cp\u003eThe Landscape of Practice consisted of communities of different proximity that were connected via boundary objects. We use the concepts of local, neighbouring, and distant, to explain how we see their connectedness. We found that the specialists repeatedly turned to a few trusted colleagues in the local CoP for conversations about urgent patient cases. Related to trust, these local communities were built over time, and physicians developed awareness of others\u0026rsquo; knowledge and skills, judgement, and working methods. These findings are in line with research in higher education, where backstage conversations have been found crucial in microcultures of teaching (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Due to matters of patient integrity and confidentiality, these collegial conversations had to be held backstage which is characterized by privacy, informality and trust. For example, spontaneous conversations were held with selected colleagues at work, but also at home with a spouse. In this local backstage context, the specialists tested their knowledge, thoughts, and ideas. These local conversations were also used for discussing other work-related issues, and could also deal with less urgent matters.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInvitation of neighbouring and distant CoPs across the LoP are valued for learning\u003c/h2\u003e \u003cp\u003eThe LoP also consisted of neighbouring communities, such as when invited colleagues at the workplace shared knowledge during planned meetings or through referrals. Learning conversations with neighbouring communities could also include colleagues whom the physicians socialized with during breaks at conferences and courses.\u003c/p\u003e \u003cp\u003eDistant communities also impacted collegial learning, even if less frequently. For example, engagement with forums on social media enabled connection with distant communities and in these cases, specialists had no personal links to the other group members, only professional. Also, membership in professional organizations could fulfil such a role.\u003c/p\u003e \u003cp\u003eA risk with overuse of local CoP is that a physicians\u0026rsquo; knowledge, but also ideas and working methods, are not challenged and developed as it consist of physicians with similar approaches, views and practices, a risk that also have been found in other contexts (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This risk was reduced when local practice was challenged, for instance when students give new perspectives on patient communication. It could however be counteracted by having a \u0026lsquo;forced\u0026rsquo; neighbour CoP in the learning system. Therefore, we suggest that space, time, and place for structured conversations between colleagues across CoPs about for example patient case discussions are important at the local level, as well as conversations at distant level, by participating in conferences and courses of relevance for practice. Seeing the value of sharing knowledge with neighbouring CoPs, implies that formalised educational activities could be adressing sharing across CoPs. This also since previous research have shown that CPD activities usually focuses on individual levels, which is one reason for not contributing to knowledge reproduction and change in practice (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, all physicians may be part of somebody else\u0026rsquo;s collegial learning in Landscapes of practice, and physicians seem to develop knowledge of where to find knowledge in their landscape. By paying attention to boundary objects, managers can facilitate collegial conversations at local, neighboring and distant levels. However, this requires consideration of the approach taken to working, where physicians are seen as individuals or in a sharing landscape, and thus it is important to establish multiple arenas and forums for engaging in discussions. This means that we conceptualise physicians\u0026rsquo; learning as a result of negotiations and reflection on the different practices that physicians engage in. In conclusion, Landscapes of practice facilitates continued learning among physicians when enabling learning conversations on the different practices that physicians engage in.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eDisclaimer regarding conflict of interest\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have conflict of interest.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was applied for by The Swedish Ethical Review Authority confirmed that no ethical approval was required for this study, which was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was received. Dnr 2020\u0026ndash;06669.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData for this research cannot be shared openly, as participants were ensured interview data would not be distributed to any third party and only used as a basis for exploring the research questions of the current research study. However, anonymized data is available in the manuscript.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eFinancial support was received from Stockholm Region (dnr 2019\u0026ndash;1097).\u003c/p\u003e\n\u003cp\u003eAuthors contributions\u003c/p\u003e\n\u003cp\u003eAll authors have contributed to the design of the study. LSS carried out all interviews. KBL and LSS carried out the initial analysis and interpretation of data which was then discussed in the full research team. KBL and LSS drafted the work which was then revised in several stages by all members of the team. All authors have approved the submitted version of the manuscript and have agreed to be accountable for the contribution.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe want to thank all interviewees who shared their time and experiences in a time stressful for many health care professionals. We also acknowledge the work of Jagjeet Singh in transcribing the interviews with psychiatrists as a part of his medical degree project.\u003c/p\u003e\n\u003cp\u003eAuthors information\u003c/p\u003e\n\u003cp\u003eKlara Bolander Laksov is a professor at Stockholm University specializing in higher education and medical education. She leads research on academic leadership, clinical learning environments, and educational change. She also directs the Centre for University Teacher Education at Stockholm University.\u003c/p\u003e\n\u003cp\u003eCormac McGrath is a senior lecturer at Stockholm University, focusing on higher education, faculty development, and educational leadership. He has a background in secondary education and has worked at Karolinska Institutet. His research includes educational change and the ethics of AI in education.\u003c/p\u003e\n\u003cp\u003eErik Bj\u0026ouml;rck, MD, PhD, is an associate professor in clinical genetics at Karolinska Institutet. He is also a senior consultant at Karolinska University Hospital. His research focuses on rare diseases and genetic disorders, and he is an experienced medical educator and researches medical education.\u003c/p\u003e\n\u003cp\u003eAgnes Elmberger, MD, PhD, is a researcher at Karolinska Institutet specializing in medical education and faculty development. She explores how clinical teachers transfer knowledge from faculty development to practice. Elmberger also teaches at Karolinska Institutet and contributes to educational change in clinical settings.\u003c/p\u003e\n\u003cp\u003eLinda Sturesson Stabel, PhD, is a research specialist at Karolinska Institutet. Her work focuses on healthcare leadership, climate action in healthcare, and the integration of migrant physicians into the Swedish medical workforce. She has published extensively on professional development and digital transformation in outpatient care\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSamuel A, Cervero RM, Durning SJ, Maggio LA. Effect of continuing professional development on health professionals\u0026rsquo; performance and patient outcomes: a scoping review of knowledge syntheses. Acad Med. 2021;96(6):913\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCervero RM, Gaines JK. 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Routledge; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalmer DF, Rosenblatt S, Boyer D. Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education. Med Educ. 2021;55(10):1205\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeshet Y, Ben-Arye E, Schiff E. The use of boundary objects to enhance interprofessional collaboration: integrating complementary medicine in a hospital setting. Sociol Health Illn. 2013;35(5):666\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarber JRG, Park SE, Jensen K, Marshall H, McDonald P, McKinley RK, et al. Facilitators and barriers to teaching undergraduate medical students in general practice. Med Educ. 2019;53(8):778\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeeks KW, Coben D, O'neill D, Jones A, Weeks A, Brown M, et al. Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: Pedagogies for reconceptualising the theory-practice gap. Nurse Educ Pract. 2019;37:29\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath C, Barman L, Stenfors-Hayes T, Rox\u0026aring; T, Sil\u0026eacute;n C, Laksov KB. The ebb and flow of educational change: Change agents as negotiators of change. Teach Learn Inq. 2016;4(2):91\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGrath C, Bolander Laksov K. Laying bare educational crosstalk: a study of discursive repertoires in the wake of educational reform. Int J Acad Dev. 2014;19(2):139\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolander Laksov K, Tomson T. Becoming an educational leader\u0026ndash;exploring leadership in medical education. Int J Leadersh Educ. 2017;20(4):506\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaavola S, Lipponen L, Hakkarainen K. Models of innovative knowledge communities and three metaphors of learning. Rev Educ Res. 2004;74(4):557\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRox\u0026aring; T, M\u0026aring;rtensson K. Significant conversations and significant networks\u0026ndash;exploring the backstage of the teaching arena. Stud High Educ. 2009;34(5):547\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEarl LM, Timperley H. Understanding how evidence and learning conversations work. Professional learning conversations: Challenges in using evidence for improvement. Springer; 2009. pp. 1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. Sage; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimmermans S, Tavory I. Theory construction in qualitative research: From grounded theory to abductive analysis. Sociol theory. 2012;30(3):167\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHale AJ, Freed JA, Alston WK, Ricotta DN. What are we really talking about? An organizing framework for types of consultation and their implications for physician communication. Acad Med. 2019;94(6):809\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoole G, Iqbal I, Verwoord R. Small significant networks as birds of a feather. Int J Acad Dev. 2019;24(1):61\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolander Laksov K, Elmberger A, Liljedahl M, Bj\u0026ouml;rck E. Shifting to Team-based Faculty Development: a Programme designed to facilitate change in Medical Education. High Educ Res Dev. 2022;41(2):269\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Learning conversations, continued professional development, colleagial learning","lastPublishedDoi":"10.21203/rs.3.rs-6155737/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6155737/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Informal learning through interaction with colleagues is important in continuous professional development. Colleagues have the opportunity to function as resources for learning and they can facilitate or hinder change in practice. Empirical studies on learning between colleagues are however, scarce, and it remains unclear how and under what circumstances specialist physicians learn from peers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: In this study we explore specialist physicians’ experiences of learning from colleagues. Semi-structured interviews were conducted with 22 specialists in general practice and psychiatry. Data was analysed thematically to identify different collegial interactions that led to what we conceptualise as \u003cem\u003elearning conversations\u003c/em\u003e. A Landscapes of practice perspective was employed for examining the boundary objects – objects that facilitate transfer between communities of the landscape – that facilitate learning between colleagues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Findings show a landscape of local, neighbouring, and distant collegial learning conversations, with boundary objects ranging from referrals to social media.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e: Collegial conversations within the Landscape of practice facilitates professional development among physicians.\u003c/p\u003e","manuscriptTitle":"Learning through collegial conversations - a qualitative study of physicians’ professional development","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 02:43:31","doi":"10.21203/rs.3.rs-6155737/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa85ac20-9a0e-4975-b31b-9c1e19c70af0","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T08:24:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-12 02:43:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6155737","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6155737","identity":"rs-6155737","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}