Does a Conference Series Contribute to the Development of a Community of Practice in a Hospitalist Group?

Hospitalist physicians struggle with heavy clinical and teaching workloads and keeping up-to-date on current practices. There are limited data on the impact of a longitudinal CME case conference series on physicians’ workplace learning. Locally situated formal CME might be able to fulfil this void for hospitalist physicians. Wenger’s Community of Practice model (CoP) provides a conceptual framework for understanding the processes of workplace learning. This study explores the contributions of a patient care continuing education conference series to the development of a community of practice in an Internal Medicine hospitalist practice group. Study participants were recruited from a hospitalist group in a community hospital who had taken part in at least one case conference session. Individual semi-structured in-depth interviews were conducted with each participant. Wenger's Community of Practice model was used as the sensitizing concept. Participants were later invited to participate in a second shorter interview for member checking and verification. Data were analyzed qualitatively in an iterative and inductive process, and themes were identified using the constant comparative method associated with grounded theory. Four themes were formulated based on the analysis: Learning during and from the case conference series; Impact of the case conference series on patient care practices; Learning and Practicing as a Hospitalist; Belonging to this hospitalist group Three elements are required to develop to cultivate a CoP: the domain, the community and the practice. Our analysis resulted in formulating three intersecting domains: hospital medicine, discussing challenging cases, and improving patient care practices. With respect to community, study participants commented that learning occurred collaboratively, with and from peers. They also described feeling mutual trust and respect between members and team building that occurred as a result of the series. Lastly, although individual competence or practice skills were developed, the development of a shared group practice was not identified. Using the CoP framework as a lens, we were able to show that aspects of the CoP developed after a limited number of conference sessions focused on discussion of challenging clinical cases.