As we grow and age, we engage with or aspire to become a part of a multitude of cultures and communities. Do you have a current community or culture vital to your well-being and identity? Do you remember your initial awareness of culture or community?
Familial and ethnic cultural backgrounds are clearly important, but what I am considering here are the cultures and communities separate from our heritages that provide us with a place of learning, personal happiness, and individual character. For example, beyond medicine, I most often identify with the outdoors or athletic communities and the cultural habits within them. This manifests itself in the types of activities I learn, follow, or participate in and includes the style or brands of clothing and equipment I purchase. And I must say there is way too much equipment in my gear closet nowadays as a result. But that story is for another day . . .
The medical profession is both a culture and a community of practice, and within our profession, there are numerous subcultures and unique communities of practice. The recent pandemic has significantly shifted our culture, our profession, our industry, and our communities of practice. Similarly, the nonmedical society has shifted its view of healthcare and its expectations for receiving optimal care. How we now adapt and change is foundational for future directions of physician leadership.
According to Nicki Lisa Cole, PhD,(1) the term “culture” refers to “a large and diverse set of mostly intangible aspects of social life,” and it is “composed of both non-material and material things.” Sociologists define the nonmaterial aspects of culture as “the values and beliefs, language, communication, and practices that are shared in common by a group of people,” while “Material culture is composed of the things that humans make and use. This aspect of culture includes a wide variety of things, from buildings, technological gadgets, and clothing, to film, music, literature, and art, among others.”
Due to its crucial role in social life, Cole states that sociologists recognize culture as one of sociology’s most important concepts: “It is important for shaping social relationships, maintaining and challenging social order, determining how we make sense of the world and our place in it, and in shaping our everyday actions and experiences in society.” Cole further explains that culture is important to sociologists because it plays a significant role in the production of social order, which refers to “the stability of society based on the collective agreement to rules and norms that allow us to cooperate, function as a society, and live together (ideally) in peace and harmony.” Additionally, while culture is distinct from social structure and economics, “it is connected to them — both continuously informing them and being informed by them.”
Relatedly, a community is a social group whose members have something in common, such as a shared government, geographic location, culture, or heritage. More generally, according to dictionary.com, community can refer to a group that shares some trait or quality that separates it from the wider population. A “community of practice,” however, is described by social theorists Etienne and Beverly Wenger-Trayner(2) as a group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. These communities have been around for as long as human beings have learned together. They explain, “at home, at work, at school, and through hobbies, we all belong to communities of practice. In some, we are core members, but in many we are merely peripheral. And we participate with numerous communities over the course of our lives.”
Anthropologists Jean Lave and Etienne Wenger-Trayner coined the term “community of practice” while studying apprenticeship as a learning model. People usually think of apprenticeship as a relationship between a student and a master, but studies of apprenticeship reveal a more complex set of social relationships through which learning takes place, mostly with journeymen and more advanced apprentices. Think initially of how your own medical school and residency training programs were similar.
The concept of a community of practice has found several practical applications in business, organizational design, government, education, professional associations, development projects, and civic life. Communities of practice are everywhere. They are a familiar experience — so familiar, perhaps, that they often escape our attention. Yet when given a name and brought into focus, a community of practice becomes a perspective that can help us better understand our world. It allows us to see past more obvious formal structures, such as organizations, classrooms, or nations, and perceive the structures defined by engagement in practice and the informal learning that comes with it.
The Wenger-Trayners describe three crucial characteristics, and state it is their combination that constitutes a community of practice:
The domain: A community of practice is not merely a club of friends or a network of connections between people. It has an identity defined by a shared domain of interest. Membership implies a commitment to the domain and, therefore, a shared competence that distinguishes members from other people.
The community: In pursuing their interest in their domain, members engage in joint activities and discussions, help each other, and share information. They build relationships that enable them to learn from each other; they care about their standing with each other.
The practice: A community of practice is not merely a community of interest — people who like certain kinds of movies, for instance. Members of a community of practice are practitioners. They develop a shared repertoire of resources: experiences, stories, tools, ways of addressing recurring problems — in short, a shared practice.
Now consider how this concept influences your own approach to ongoing clinical skills acumen, as well as your unique approaches toward physician leadership development. Consider, also, the many evolving differences in the way our healthcare industry views its cultures, as well as the communities of practice in which we reside, including workforce migrations and shifting levels of commitment or loyalties toward patient care, for example. Patients themselves have varying expectations for their healthcare, and our payment system continues to create hurdles for all-inclusive care as we attempt to embrace the nuances for social determinants of health. And the list could go on and on . . .
Embracing change is always important, and physician leadership has the opportunity to reshape these evolving healthcare cultures. It is indeed an exciting time for creating potentially significant shifts in healthcare!
References
Cole NL. So what is culture, exactly? ThoughtCo. August 1, 2019. www.thoughtco.com/culture-definition-4135409 .
Wenger-Trayner E, Wenger-Trayner B. Introduction to Communities of Practice. www.wenger-trayner.com/introduction-to-communities-of-practice/ .
Excerpted from Inspiring Growth and Leadership in Medical Careers: Transform Healthcare as a Physician Leader (American Association for Physician Leadership, 2024).