Author Identifier
Gemma Jenkins: https://orcid.org/0000-0003-0875-0810
Date of Award
2025
Document Type
Thesis
Publisher
Edith Cowan University
Degree Name
Doctor of Philosophy
School
School of Medical and Health Sciences
First Supervisor
Leesa Costello
Second Supervisor
Claire Palermo
Third Supervisor
Therese O'Sullivan
Fourth Supervisor
Alex Clark
Abstract
Background: Transformation is needed across health professions education, to address both historical challenges, such as adopting best practice assessment, and evolving challenges, such as those presented by generative artificial intelligence (GenAI), and ensure that future health professionals meet the needs of health systems and communities. Importantly, this transformation must extend beyond changes at the level of individuals, to create change across institutions and wider infrastructure that make up health professions education. Yet, little is known about how to achieve such transformation in the sector. Communities of practice offer an approach underpinned by theory, with existing evidence to suggest they can facilitate a range of meaningful outcomes. However, limited studies and methodologies employed to evaluate communities of practice in health professions education to date have prevented an in depth understanding of their potential to enable institutional and system-wide change in this sector. Evaluation of communities of practice in health professions education using theory-based methodology can address this gap by allowing researchers to unpack the complex, contextual ways that communities of practice work, to inform their future use to drive transformations in health professions education.
Aims: The aim of this research was to develop explanatory theory about communities of practice in health professions education that addressed the central research question ‘How might communities of practice facilitate change at the individual, interpersonal, institutional, and infrastructural level in higher education for health professionals, for whom, under what circumstances, and why?
Method: The research was conducted in two parts, using two specific forms of realist research. Study 1 was a realist synthesis of the existing literature on communities of practice that have brought together faculty members within health professions education, conducted according to the RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards) standards and steps described by Pawson and colleagues. Study 2 was a realist evaluation of an existing Community of Practice for Dietetic Educators in Australia and New Zealand. Study 2 was conducted longitudinally, using multiple methods, including analysis of both qualitative and quantitative data, over nine years of the Community of Practice. Data analysis in both studies focused on developing and refining theory about communities of practice in health professions education, expressed as context-mechanism-outcome configurations (CMOCs), and integrating relevant formal theory, to develop theory that is both practical and transferable.
Results: The realist synthesis (Study 1) resulted in theory about communities of practice in health professions education, comprised of ten CMOCs that describe how contexts and mechanisms interact to contribute to a range of individual, interpersonal, and institutional outcomes. The realist evaluation (Study 2) resulted in six CMOCs that describe how the Community of Practice for Dietetic Educators in Australia and New Zealand operated to create similar outcomes, as well as infrastructural level change, such as shifting institutional and discipline culture. Relevant substantive theories were integrated into a final theory illustrating how communities of practice in health professions education work best. In line with existing theory, communities of practice in health professions education can cultivate a shared repertoire of thinking and practice amongst members, through voluntary sustained mutual engagement, where they regularly meet to share and reflect around the joint enterprise of health professions education. Further, where the direction of a community of practice is shaped by members’ shared interests, and when feedback and debriefing is supported by a relaxed, supportive, and inclusive facilitator, members experience increased intrinsic motivation and commitment to apply learning to change practice, through a process of self-determination. Members may also experience a shift in identity, becoming future leaders that are empowered to make change. Diverse, cross institutional communities of practice, with a well-known and respected facilitator, can enable interactions across multiple, interacting landscapes of practice, including opportunities for members to interpret and contextualise evidence, and negotiate change within and beyond the community of practice. This can lead to broader outcomes across institutions and disciplines, including curricular change, cross-institutional collaboration, culture change, and advocacy.
Conclusion: The results of this research have shown how communities of practice have the potential to drive transformative change needed in health professions education, and informed a practical, yet transferable theory describing how, why, and in what circumstances they best do so. This theory can guide those in health professions education to design and evaluate communities of practice to optimise system-wide outcomes, and strengthen health professions education, and the future health workforce, to meet health care needs.
Access Note
Access to this thesis is embargoed until 18th December 2027
DOI
10.25958/r4t9-6z29
Recommended Citation
Jenkins, G. (2025). Communities of practice: Transforming education in the health professions. Edith Cowan University. https://doi.org/10.25958/r4t9-6z29