BackgroundHealthcare students must learn to collaborate across professional boundaries so they can make use of each other’s knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students’ negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement.

MethodsThe study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice.

ResultsStudents relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student’s profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be ‘having time to negotiate or not’, as well as ‘feeling safe or not’.

ConclusionsFinal-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict. 

Background

Healthcare students must learn how to collaborate with colleagues from different professional backgrounds and organisational units. Research has showed what students themselves think they gain from interprofessional education. Less is known about what knowledge students share when doing interprofessional education.

Purpose

This paper aims to study students’ knowledge sharing when working together as an interprofessional team at an interprofessional training ward.

Method

The study was conducted using a focused ethnographic approach. Field observations were carried out at two different interprofessional training wards. Fieldnotes, drawings and informal interviews constitute data. Data was analysed iteratively with ‘practice architectures’ as theoretical lens.

Discussion/conclusion

We found that students share knowledge in different ways during ward rounds, at the student team room and during the reflection session. The ward rounds are more formal and structured; at the student team room, things are buzzing; and the reflection session is weary.

As health care increases its focus on collaborative practice, universities must provide students with opportunities to learn how to collaborate with different professions and translate this knowledge into practice, known as interprofessional education. Simultaneously, researchers struggle to understand the full complexity of interprofessional education and must therefore conduct multiple-site studies, employ observational work, and apply theory throughout the research process.This paper draws on focused ethnographic fieldwork at two different sites focusing on how students organize collaboration during interprofessional clinical placements. Findings indicate that the way students organize their collaboration is intertwined with how patients were introduced during handovers and involved mobilizing knowledge as “betwixt and between” familiar student practices and unfamiliar clinical practices. Findings also show how authentic situations, artifacts and spatial features supported students to mobilize collaboration.

Purpose Clinical placement is an important formalised student activity for linking healthcare education and healthcare practices. The purpose of this study is to investigate the organising of clinical placements by examining conditions for collaboration between higher education and healthcare organisations. Design/methodology/approach The study is based on interviews with central actors at a university and two healthcare organisations with official duties of organising clinical placements. Findings The findings indicate that collaboration in the organising of clinical placements is a complex matter of interconnected actors in different organisational positions, at both strategic and operative levels. The university and the healthcare organisations approached the clinical placement with a shared commitment. Practical implications The findings provide important guidance for improving collaboration in the organising of clinical placements. This may have an impact on how contextual conditions of the educational framing and daily healthcare practices are viewed and how the interdependency between the long-term strategic issues and the short-term needs of healthcare organisations is approached. Originality/value This research emphasises the need for careful consideration of the collaborative practices on an organisational level between higher education and healthcare organisations as different needs, motives and logics have to be considered.

There is a well-known gap between what we know and what we do within healthcare service processes. Models that facilitate quality improvement (QI) have seen used to eliminate these gaps. Knowledge and competence in QI work are necessary for every professional within the healthcare system and are ideally learned through interprofessional collaboration and introduced during undergraduate studies. To meet these competence needs, Linkoping University, Sweden, in collaboration with the main healthcare provider in the region, implemented a 2-week interprofessional QI learning module, which is mandatory for all undergraduate healthcare students. Ideas for practice-based QI projects were introduced to all the students who studied theory in the relevant domains of QI while working on these projects. A content analysis of students written reports was conducted to investigate the focus of the projects. The analysis showed that most projects (65%) concerned staff-related issues, while 35% had patient perspectives. This distribution changed over time, increasing the number of patient centered projects.

Background The use of simulated learning activities in occupational therapy education has emerged in the past decade. Studies describing experiences of using standardised patients in practical examination in occupational therapy is lacking. Objective To describe teachers and students experiences of a newly implemented practical examination in occupational therapy education using standardised patients. Material and methods A qualitative study using data from student questionnaires, a focus-group with five teachers, and teachers reflective diary notes. Data were analysed with problem-driven content analysis. Results Three categories were identified: The practical examination as a learning situation included a structured learning environment and scenarios with standardised patients with the right level of complexity. The teachers role was influenced by the educational approach applied to create equal conditions for all students, students thoughts about being assessed and the teachers emphasis of being well prepared. The examination was an opportunity for developing practical skills. The students valued being prepared for clinical practice and the teachers valued the examination as a bridge between theory and practice. Conclusion and significance A carefully planned practical examination can contribute to developing professional occupational therapy competences and is a tool for educators to replicate the authentic clinical settings students encounter in fieldwork.

Students’ learning in the workplace during their clinical placements is an important part of their education to become healthcare professionals. Despite the number of studies of student interprofessional learning in clinical placements, little is still known about the significance of interprofessional learning and how it is facilitated and arranged for to occur. This article aims to investigate interprofessional learning between students collaborating in a workplace-driven arrangement integrated into a clinical placement. A focused ethnographic research approach was applied, comprising observations of ten students participating in the arrangement organised by clinical supervisors on a medical emergency ward at a Swedish university hospital, followed by group interviews. Using a boundary-crossing lens, the article analyses the workplace arrangement, in which students’ learning across professional boundaries and their negotiations around a boundary object were prerequisites to coordinate their interprofessional knowledge and manage emerging challenges while being in charge of care on the ward.

 Denna rapport redovisar erfarenheter och lärdomar från ett forskningsprojekt som handlar om att finna nya former för verksamhetsförlagd utbildning som ett led i att möta förändringar inom hälso- och sjukvården och omsorgsverksamheter. Utmaningar kan gälla organisering av verksamhetsförlagd utbildning mellan universitet och olika vård- och omsorgsgivare, men även förändrade förutsättningar på arbetsplatser som formar verksamhetsförlagd utbildning till innehåll och de möjligheter studenter har till professionellt och interprofessionellt lärande i praktiken. Rapportens syfte är att undersöka och bidra med kunskap om organisering av verksamhetsförlagd utbildning mellan högskola och vård- och omsorgsgivare, och vad som händer på arbetsplatser när nya arrangemang genomförs för att möjliggöra professionellt och interprofessionellt lärande som ett moment under verksamhetsförlagda utbildning. Syftet preciseras i följande forskningsfrågor:Hur organiseras verksamhetsförlagd utbildning inom och mellan högskola och vård- och omsorgsgivare?Hur sker samverkan kring organisering av verksamhetsförlagd utbildning?Hur sker studenters professionella och interprofessionella lärande i praktiken under verksamhetsförlagd utbildning?Vilka förutsättningar och utmaningar kan identifieras på organisations- och arbetsplatsnära nivå gällande att finna nya former för verksamhetsförlagd utbildning? 

Forskningsprojektet omfattar två delstudier genomförda under tidsperioden 2017 till och med 2019. I delstudie 1 ligger fokus på hur verksamhetsförlagd utbildning inom hälso- och sjukvårdsutbildningar organiseras och hur aktörer samverkar vid planering och utförande av verksamhetsförlagd utbildning för att tillgodose studenters behov av utbildningsplatser. Det empiriska materialet utgörs av nio intervjuer med centrala aktörer som har till uppgift att organisera verksamhetsförlagd utbildning mellan universitet (medicinsk fakultet) och vård- och omsorgsgivare (en Region och en kommun). I delstudie 2 ligger fokus på studenters professionella och interprofessionella lärande på arbetsplatser. Ett särskilt fokus ligger på arbetsplatsdrivna arrangemang som stödjer studenters interprofessionella lärande, så kallade IPL-arrangemang, som en del av den verksamhetsförlagda utbildningen. Det empiriska materialet baseras på fallstudier genomförda på arbetsplatser inom ett universitetssjukhus och två kommunala omsorgsverksamheter. Datainsamling har skett genom observationer av tre IPL-arrangemang, sju fokusgruppintervjuer med totalt 23 studenter och 13 individuella intervjuer med vårdpersonal/handledare på arbetsplatserna.Resultatet aktualiserar en rad frågor om verksamhetsförlagd utbildning och särskilt arbetsplatsdrivna IPL-arrangemang inom vård- och omsorgsverksamheter. En sådan fråga gäller hur planeringspusslet kan hanteras på ett sätt som underlättar organisering av verksamhetsförlagd utbildning mellan de tre huvudmännen. Vid sidan av den nära samverkan som finns mellan medicinska fakulteten och Regionen respektive kommunen är det viktigt att fundera över om det finns behov av samverkan kring verksamhetsförlagd utbildning mellan de tre parterna kring den logistik som krävs för att organisera verksamhetsförlagd utbildning. Att ett sådant behov finns kan avspeglas i den problematik de centrala aktörerna befinner sig i. Trots fokus på långsiktighet genom samverkan mellan utbildning och vård- och omsorgsutövare i olika forum, får det arbetet ofta stryka på foten då arbetet med att lösa ständigt närvarande akuta lägen som finns inom dygnet-runt-verksamheter i praktiken upptar större delen av arbetsutrymmet.En annan central fråga, är frågan varför läkarprogrammet skiljs från övriga vårdprogram när det gäller rutiner för beställning av utbildningsplatser. Detta kan relatera till dels det ovan nämnda dilemmat med samordning av verksamhetsförlagd utbildning, dels till en uppdelning som inte direkt gynnar interprofessionellt lärande mellan studenter från olika utbildningar.

Interprofessionellt lärande och samarbete lyfts idag fram som både en nödvändighet och en möjlighet för framtidens hälso- och sjukvård i nationella såväl som internationella sammanhang. Med tanke på framtida behov och förändringar, kan man fundera på universitetets roll för att samorganisera professionerna. Interprofessionellt lärande omfattar mer än att träna samarbete utan det förutsätter att studenter – även läkarstudenter, ges möjlighet att över tid få sätta sitt eget yrkesperspektiv gentemot andra professioners perspektiv och på så sätt utveckla en yrkeskunskap om sin profession i förhållande till andra professioner.Slutligen, vill vi lyfta ytterligare en central fråga, som också är i behov av forsknings­mässig uppmärksamhet, gällande vilken status arbetsplatsdriva IPL-arrangemang har i förhållande till ’ordinarie’ verksamhetsförlagd utbildning. Vanligtvis utför studenterna professionsspecifikt arbete utifrån professionsspecifika lärande- och kompetensmål och följer sina handledares arbete med fokus på professionsutveckling till skillnad mot de IPL-arrangemang som redovisats i denna rapport som syftar till att stärka studenters interprofessionella lärande och stimulera samarbete över professionsgränser. Sådana arrangemang tycks följa en egen logik inom vilket samarbetet med andra studenter och professioner är något annat än studenter vanligtvis möter under verksamhetsförlagd utbildning. Sådana arrangemang blir också en angelägenhet för arbetsplatsers eldsjälar – ofta huvudhandledare med ambition att utforma ett nytt interprofessionellt moment utöver ordinarie verksamhetsförlagd utbildning. På central nivå välkomnas initiativ tagna på arbetsplatser för att stödja interprofessionellt lärande, men endast om utövarna är lojala mot de pedagogiska ramar och lärande mål som ställs av utbildningen. Vikten av dessa lokala IPL-arrangemang stannar vid den nytta de kan tillföra den specifika verksamheten, och på central nivå ses de som “goda exempel” vilka gärna får spridas mellan verksam­heter så att även andra kan ta del av dem, inspireras och göra liknande satsningar. Hur detta är tänkt att ske är mindre uppenbart.Det är mot denna bakgrund empiriskt viktigt att studera IPL-arrangemang som lokalt genomförs på arbetsplatser och de förutsättningar de ger studenter för både professionellt och interprofessionellt lärande under olika betingelser. Arbetsplatsen erbjuder en annan pedagogisk miljö som bygger på att tillämpa teoretiska kunskaper och träna profession­ella och interprofessionella färdigheter som utbildningen avsett att ge, men också på ett professionellt och interprofessionellt lärande som handlar om att socialiseras in i en tilltänkt profession genom att anpassa sig till regler, traditioner och professionella hierarkier som gäller inom hälso- och sjukvården och omsorgsverksamheter.

Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants knowledge can be shared in a team on a spinal cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural-discursive, material-economic, and social-political arrangements enabled possibilities through which nursing assistants knowledge informed other practices, and others knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team.

Abstract: Knowledge sharing is an essential part of interprofessional practice and will be even more important in the future in regard to the opportunities and chal-lenges in practices for delivering safe and effective healthcare. The aim of this ethnographic study was to explore how professional knowledge can be shared in an interprofessional team at a spinal cord injury rehabilitation unit. A sociomaterial per-spective on practice was used to analyse the data, and by theorizing upon this, we captured different aspects of interprofessional collaboration in health care. The find-ings illuminate how knowledge emerges and is shared between professionals, and how it passes along as chain of actions between professionals, in various ways. The findings offer a novel perspective on how interprofessional collaboration as a prac-tice, involving ongoing learning, unfolds. This reveals the mechanisms by which different forms of expertise are mobilized between professions as health care work.

Background: Interprofessional collaboration is of global interest for addressing to the complex health care needs and improving patient safety in health care. Professionals have to develop collaborative skills and the ability to share knowledge. Interprofessional education describes learning activities where students learn with, from and about each other to improve collaboration. The dimension of interprofessional collaboration is complex and includes different collaborative competencies to bring about the best for the patients. To  become a  professional, often understood as someone exerting expertise within a specific field of practice, involves a learning process that challenges the boundaries of the professions. Boundaries are not only barriers, but also places that increase learning. There is a complexity to studying the phenomenon of interprofessional collaboration and learning regarding how it occurs in education and health care practice. By using a sociomaterial perspective on practice, it is possible to more robustly explore the collaborative context.

Aim: The overarching aim of the thesis has been to explore interprofessional collaboration and learning in health care education and in interprofessional health care practice. More specifically, the research questions in the thesis were answered in two studies regarding how professional knowledge is developed and shared in interprofessional undergraduate health care education and in interprofessional health care practice.

Methods: A questionnaire was distributed to students from a medicine, nursing, physiotherapy and occupational therapy programme who participated in a two-week period of practice at an Interprofessional Training Ward in Linköping. The data was analysed quantitatively to explore how female and male students experienced their professional identity formation. The open-ended responses were analysed using a sociomaterial perspective on practice.

An ethnographic study was conducted in a hospital setting during a period of one year, during which two interprofessional teams were observed. A theory-driven analysis was made using a sociomaterial perspective on practice, and this provided a lens through which the nature of interprofessional collaboration and knowledge sharing could be observed.

Findings: The main findings from the questionnaire showed that the practice architectures of the Interprofessional Training Ward, prefigured practices where different professional responsibilities were enacted in ways that were reproducing expected and unexpected roles in a traditional health care practice. That disrupted the students´ practical and general understandings of professional responsibilities and the nature of professional work including their professional identity formation.

The findings from the ethnographic study showed different patterns of how knowledge was shared among professionals in their daily work practice as it unfolded, like chains of actions. The patterns arose through activities where collaboration between professionals was planned beforehand, and at other times it arose in more spontaneous or responsive ways. Due to the way the activities were arranged, the nursing assistants were totally or partially excluded from the collaborative practices.

Conclusions: The way that educational and health care practices were arranged had an influence on the patterns of interactions between the students as well as the professionals. The arrangement at the Interprofessional Training Ward enabled and constrained the possibilities for students to learn professional and interprofessional competencies. Professional practices in health care hung together through chains of actions that influenced interprofessional collaboration and learning. The relations between human actors, material objects and artifacts are of importance for understanding interprofessional practices.

Studies on graduates’ transitions from education into clinical work highlight inequalities concerning how women and men experience their professional learning and development. This study explores how female and male students from different programs within the health care education system, i.e. medicine, nursing, occupational therapy and physiotherapy programmes, experience an IPTW as a part of their professional identity formation.

Students from the medicine, nursing, physiotherapy, and occupational therapy programmes collaborate in teams during two weeks at one of three IPTWs at the medical school, Linköping University. They together take the responsibility for diagnosis, treatment and rehabilitation of the patients, albeit with professional supervisors as support. During 2010 to 2011 454 (93%) of the 488 students who practiced at the IPTWs answered a questionnaire on their experiences of the IPTW. The students stated that the IPTW had positively influenced their professional development. The female and male medical students were significantly less positive than other female and male students, respectively, concerning the value of IPTW. The male students from all programmes were slightly, but significantly, less positive than all the female students. These findings show that students “do gender” as an integral part of the educational practice. It is important to scrutinize the IPTW as an educational practice, influencing students’ preparation for future work. Gender should be discussed during the IPTW rotation but also in general during the curriculum for all healthcare programmes.

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linkoping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

Background: Employment is a priority in the European Union, and it is essential to address the needs of individuals disadvantaged at the labour market on grounds such as ethnicity, age, gender or disability, to increase the opportunities for these groups to gain employment. The Council of the European Union recognize the important role of national organisations in increasing gender equality and the need to integrate a gender perspective in all policies. Gender equality perspectives should also, according to the EU Plan of Action and Gender Equality be integrated in education. less thanbrgreater than less thanbrgreater thanObjectives: To equip students in higher education with knowledge, about gender, age, disability and ethnicity in relation to employability, a European group initiated a project; Euro-Education: Employability for all (EEE4all). less thanbrgreater than less thanbrgreater thanApproach: The project, funded by the European Lifelong Learning Programme, was aimed to develop and implement four course modules, each relating to employability with different focus: gender, age, disability or ethnicity. In this paper design, implementation, and evaluation of the course focused on gender, provided by the Occupational Therapy Programme at Linkoping University, is described. less thanbrgreater than less thanbrgreater thanConclusions: The students highlighted the importance of awareness and knowledge about gender theory and its application in relation to employability and client-centred approach.

In this paper, the context for discussing socio-material arrangements for professional practice andresponsibilities is a student-led interprofessional training ward in health care. These realistic hospitaltraining wards have been implemented in response to the ongoing debate about the need of collaborationin order to increase quality and safety for patients in the health care system. In Linköping, medicalstudents, nursing students, physiotherapy and occupational therapy students work together in the trainingwards during a two week period, taking a joint responsibility for the total care of the patient, as well as forcontributing their own professional perspective.A survey evaluation shows an overall positive attitude and perception among the students regarding thepossibility to collaborate and how they have developed the understanding of their own professional roleas well as other professional roles – but medical students rate a number of factors significantly lower thanother students. A qualitative analysis of the open answers, focusing on socio-material aspects give adifferentiated picture of how the arrangements of the training ward produce i) produce enactments ofdifferent kinds of professional responsibilities ii) deal with the ‘unexpected’ -conflicting understandings inthe enactment of caring work iii) proximity opens for negotiations and boundary work. In the paper, wediscuss how the material arrangements create a clash between the ‘expected’ professionalresponsibilities and the ‘unexpected’ responsibilities of caring work and we problematize the implicationsfor professional learning within the framework of health care education.

The implementation of interprofessional training wards (IPTW) aiming at enhancing interprofessional collaboration has proliferated in medical education over the last decade. The Faculty of Health Sciences, Linköping University has, in collaboration with the local health provider, arranged such wards since 1996. Students from medical, nursing, occupational therapy and physiotherapy programmes take a joint responsibility for the total care of the patients and thereby develop a greater understanding of their professional and interprofessional competences as well as of the competences of the other professions. A questionnaire survey was conducted during autumn term 2010 and spring term 2011 where 93% of the students participating at the IPTW answered. The quantitative analysis showed an overall positive attitude and perception among the students regarding the possibility to collaborate and how they have developed the understanding of their own professional role as well as others. The qualitative analysis of the open answers focusing on socio-material aspects gave a differentiated picture between the student groups of how the arrangements of the training ward produce i) enactments of “expected” professional responsibilities ii) situations dealing with the “unexpected” - conflicting understandings in the enactment of caring work and iii) proximity, which creates opportunities for negotiations and boundary work. Although students were positive the material arrangements of the training ward create a clash between the ‘expected’ and the ‘unexpected’ responsibilities. Practice theory can highlight the importance of the way in which socio-material arrangements are set up in different ways to allow the development of collaborative practice. It can also challenge us as educators to design creative learning environments for interprofessional education. To look upon professional education as a practice instead of an education preparing for practice, can help us view the importance of the arrangement of professional learning and how practice hangs together in terms of practical understanding, rules and professional traditions.

Bakgrund: Det är viktigt att utbildning också genomsyras av ett genusperspektiv. Kvinnor och män formas genom sin livscykel av kultur, samhälle och interaktioner mellan människor enligt genussystemet. Detta påverkar mäns och kvinnors livsstil och levnadsförhållanden och därmed också hälsa, livskvalitet och dagliga aktiviteter. De gränser som genus sätter för män och kvinnor förhandlas på tre nivåer; individuell, organisatorisk och samhällsnivå. Som en följd av detta förstås att möten inom hälso- och sjukvården också är situationer där genus konstrueras. Begreppet ”konstruera genus” baseras på en förståelse av genusbegreppet som en social konstruktion, inte enbart som biologiskt kön definierat av naturen och förutbestämd till specifika beteenden som en konsekvens av biologin.

Syfte:  Att implementera ett genusperspektiv på Arbetsterapeutprogrammet.

Metod: En utsedd person ansvarig för implementeringen har gått igenom bl a referenslitteratur, föreläsningar och examinationer. Förslag till föreläsningar, seminarier och examinationer har framkommit. Diskussionsseminarier bland personalen har också genomförts.

Resultat: Begreppet genus är tydliggjort i kursplaner med hjälp av specifika lärandemål och examinationer. Frågor om kön och genus är inkluderade i programutvärderingen.

Diskussion: Trots det klientcentrerade arbetssättet inom arbetsterapi leder inte detta automatiskt till ett genusmedvetet förhållningssätt vid möten med klienter. Ett medvetet förhållningssätt resulterar i att båda könen får behandling utifrån sina specifika behov och att arbetsterapeuten kan bortse från egna värderingar/traditionella könsroller. Forsknings- och utbildningsinsatser behövs för att öka kunskapen om genus inom arbetsterapi.

BACKGROUND: Care and education have much in common, and work in the healthcare sector is closely associated with learning and teaching. It is felt that many in the healthcare and medical services are not aware of their pedagogic skills and how they can be developed. FRAME OF REFERENCE: Belonging to a community of practice means that you share perspectives, methods and language. OBJECTIVE: The aim is to describe the pedagogical discourse by identifying pedagogical processes and studying the staffs awareness of such processes or situations in which a pedagogical approach would be useful in their work with patients and next of kin. METHOD: A qualitative study based on individual and group interviews. The analysis is directed by grounded theory. RESULTS: The pedagogical processes varied in length and quality. Most were unplanned and were usually embedded in treatment. The pedagogical process is linear (planning, goal setting, teaching and evaluating) in an educational setting but we found that the beginning and end can be unclear and the goals can be vague or non-existent. The pedagogical process is best described using the concepts Read, Guide and Provide learning support. DISCUSSION: The pedagogical discourse in healthcare is almost silent. Data indicate that at the collective level there is very little support for professional development of pedagogical ability. Tacit knowledge may therefore remain silent even though it may be possible to formulate and describe it. CONCLUSIONS: There is a strong need to focus on the pedagogical parts of the work and to encourage and support the development of professional pedagogical knowledge.