Who do you belong to?

Communities of practice are an interesting concept which have helped people to understand professional groups and other collections of people.

They often have common goals, highly specialised terminology, a high level of general expertise, specific methods of information exchange, and participatory mechanisms – all of which help to define them.

These characteristics all go to help create a sense of belonging – and even loyalty to a particular community or identity.  We can see these communities at work within medicine all over the place – there are the orthopods, the anaesthetists, intensivists, surgeons, medics – and within each of these there are further groups.

As we move up the traditional hierarchy of medicine, it is possible to see that at some point consultants and GPs start to join the communities that exist within their workplaces.  They become ever more involved in the work of their trust or practice, and ultimately become a full member of that community.  Indeed, they would probably not be able to do their jobs effectively if they were not part of these groups.

As trainees, we move between organisations, and sites and specialties, even between regions.  This prevents us putting down roots and becoming accepted members of a community.

I think this can have negative effects – some trainees never truly feel like they belong in one place or another – and this is often a circular argument with organisations often seeming to treat juniors as peripatetic units of work rather than integrated members of their workforce, with meaningful contributions to make.

To reverse this, it is possible to take a few steps to start to reach out into the commuities we come into contact with.  Let’s look at two parts of the concept of communities of practice.

If we wish to join the community of practice that is our workplace, as well as the one which is our chosen specialty, then we could look to access some of their “participatory mechanisms” – that is, look at, analyse and probably get involved with the ways of working which exist within the organisation.  I would argue that one way to get involved is to identify areas where the quality of care being given is somehow sub-optimal and then in a non-threatening way, exlore this with the existing members of the community.

From the other direction, I think that there is a great deal more that organisations could do to improve their relationship with their juniors.  Information exchange is one way…

For example… at a hospital I worked for, I needed to contact the new registrars before they actually started work there.  The HR department were able to help me with a full list of personal email addresses, to which they would send information.  Two weeks later, once the registrars had arrived and started working, the HR department could only offer me internal mail addresses (which are almost never checked by junior doctors).  Quite how the hospital hoped to get important information about clinical issues to this group was beyond me, having discarded the most efficient way of getting in touch with them, and adopting one of the least efficient.

So – which communities do you identify with, and which would you like to join?  If you wish to be a doctors doctor, and always fight the system – beware – you may find that you have to let your guard down as you start to want to settle in one place, and establish yourself in that organisation, or face the consequences of always being a belligerent outsider.

On the other hand – if you are an employer of junior doctors – think about how you can engage your juniors in the work of the organisation, develop some loyalty and allegience by communicating effectively with them, and offering chances to participate.

As we move dangerously towards the fragmentation of the health service, it will become more and more important to be aware of how communities work – to keep them together where this is required, and nurture them when the quality of care depends on it.

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