In this chapter we discuss a case of professional learning in higher education with a particular focus on health care. We focus in particular on what aspects of professional education become visible if we shift our viewpoint from a cognitive learning perspective on professional education, to a practice theory perspective, viewing this case of professional education as a practice, or a set of practices, in itself. Introducing a practice theory perspective on pedagogy on professional health care education might allow a new gaze on a field that for a long time been has been dominated by cognitive discourses about how to improve students’ learning. We focus on how the socio-materiality of professional practice is realised within the curriculum of the professional programs through three cycles, the courses Health, Ethics and Learning, part 1 and 2, and the Student Training Ward. We show how the relations between different sets of actors are connected, both as important mediating conditions through broader societal discourses, national legislation, local institution and organisation, as well as in terms of how every day educational practice is enacted. The chapter highlights the need for serious consideration of how to use the material arrangements in the educational setting to enable a collaborative practice to unfold.

If we aim to understand professional learning and practice in material, embodied and discursive terms,then one obvious place to turn methodologically is to ethnography and observation. Ethnographicmethods normally presuppose the physical presence of the researcher in the research setting. In thispaper we explore what it might mean to observe, document and represent practices throughethnographic work in contexts of (i) interdisciplinary collaboration; (ii) economic and time pressures,making extended periods of observation difficult; and (iii)multi-sited, including international, collaboration.As we conduct and plan projects that involve scholars from different national and disciplinarybackgrounds, and imagine the temporal and spatial opportunities and constraints within which ourresearch unfolds, we are forced to think through what it means to ‘be there’, observing, in the field, aspractices and learning unfold. The material contexts in which we now work challenge the notion of thesingle ethnographer whose embodied presence in the field underpins an embodied understanding of theworld. We have to rely on others’ experiences, read field notes we didn’t write ourselves, engage withsituations where we don’t share a common language with participants, and make sense of the differentways data, analysis and theory have meaning for us as collaborators from health, geography andeducation backgrounds, drawing on a range of theoretical frames in our research.In order to grapple more fully and tangibly with these issues, we undertook a piece of observational workin a health professional education setting in Linköping, Sweden. An experienced gynaecologist andeducator, ‘Birgit’, runs evening sessions for small groups of medical students. Central to these are the‘professional patients’ – women who make themselves, their bodies, available so that students can learnand practise pelvic examination. Two of us, Madeleine and Nick, were present at one evening’s session;Alison was not. In the paper we will present excerpts from Nick’s and then Madeleine’s account of thesame ‘moment’ during the session. These will be followed by reflections from Alison as a remote‘participant’, on the sorts of understandings and questions that arise for her in this different position. Wewill then develop a collective response to the ‘data’, foregrounding ways in which our personal,professional, and disciplinary backgrounds or ways of being shape our engagement with the world, thedifferent accounts, and our responses to each other. We complicate notions of ‘being there’ to exploremultiple ‘beings there’ and ‘beings apart’, highlighting important theoretical and methodological issuesaround observation, representation, and analysis, and reflecting on these in terms of theoreticalgroundings of our substantive analysis in practice theory.

This symposium presents studies of different professional groups – educators, nurses, police and social workers in Italy, Norway, Scotland and Sweden - to address two main themes in professional learning and knowledge construction. First, it outlines ways of understanding professional learning as material enactments of knowledge. Second, it troubles the category of ‘urban’ spaces of professional knowledge, exploring the ways that professionals enact different forms of knowledge work and objectual relationships at different sites. These sites of practice may be more urban or more rural, but together form the machinery of professionals’ knowledge production.

To the first theme, all four papers draw from theoretical perspectives that step aside from subject-centred, reflectivist orientations of professional learning to focus on the socio-material webs of practice. They explore the ways that professional knowledge is distributed and constructed or performed differently in different local sites. The paper authors, drawing from actor-network theory, science and technology studies, complexity science, Knorr-Cetina’s object-relations, and practice-based theory are all conceptualising professional learning as a matter of negotiating different knowledge resources to assemble and order strategies, objects, texts, technologies and values in moments of activity.

To the second theme, the papers each show how professional knowledge seems intended to flow outwardly from urban-based centres of research and practice, where resources are concentrated to develop ‘evidence-based’ universalised best practices that are then incorporated into regulatory codes and professional development for all practitioners, including those operating in very different settings such as remote ‘rural’ and community-based sites. For example, paper one examines police work and knowledge in Scotland, showing how models of best practice for police work are often derived from large urban environments, but then become reconfigured and recoded in non-urban environments where professionals must draw from other knowledge strategies such as community relationships and local resources. In paper two, hospital nurses in Norway engage in validating and explicating knowledge-based procedures in some working sites, while other sites are dominated by application of these in the interaction with patients/clients. If we are to understand the knowledge production and knowledge relations comprising professional learning, we need to take into account these different sites.

Furthermore, the papers show how professional practice and knowledge is difficult to conceive as bordered in particular static spaces designated as ‘urban’ or ‘rural’. The Scottish police case study shows that communities which some may describe as rural are in fact considered to be urban by many inhabitants, and also that certain ‘urban’ characteristics are enacted in more remote spaces. Professionals themselves can be highly mobile, transporting objects and texts embedding particular practices and knowledge across more rural or more urban sites of practice. The social workers case shows how professionals move across sites that encapsulate elements of both rurality and urbanity. All four cases show, in different ways, how professional knowledge is produced as professionals learn through combining very different, even conflicting, resources in everyday enactments of knowledge: local practices and values, organisational traditions and policies, disciplinary knowledge bases and commitments of their particular professions, regulatory standards for practice, transnational and web-based knowledge, improvised work-arounds, and so forth.

These two themes – the materiality of professionals’ learning and the diverse but connected enactments of professional knowledge at different sites – have important implications for continuing professional development. Each paper shows why and how to reconceptualise notions of ‘developing’ professionals to focus instead on professionals’ attunement to the different knowledge resources available, the knowledge strategies that can be most productive for them, and the ways that knowledge is enacted differently across different sites of practice.

Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents' view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.

For educators, scholars, practitioners and researchers this book offers an opportunity to explore and engage with practice-based education theories and concepts in real life teaching spaces. It is a place to see theory embodied and situated within PBE practices. It is also an opportunity to see how educators and scholars from other disciplines are applying theory to understand teaching and learning in their particular area. This volume provides an opportunity for readers to deepen their understanding of practice-based education and broaden and critically appraise their strategies for engaging

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.

STUDY DESIGN: Phenomenographic, cross-sectional. OBJECTIVES: To describe ways of experiencing participation in activities of individuals with a nonreconstructed anterior cruciate ligament injury and to describe the emotional aspects related to participation. Further, the objective was to explore factors affecting the activity level. BACKGROUND: The importance of assessing different factors (knee status, muscle performance, psychological factors, performance-based tests, and subjective rating of knee function) after an anterior cruciate ligament injury has been emphasized. However, the results of these assessments do not answer the question of how the individuals themselves experience their participation in activities. METHODS: Semi-structured interviews were conducted with 19 strategically selected informants (age range, 18-43 years) who had sustained an anterior cruciate ligament injury 18 to 67 months previously. A phenomenographic approach, which describes individuals' ways of experiencing a phenomenon, was used. RESULTS: Five qualitatively different categories were identified: (A) unconditioned participation, (B) participation as conditioned by risk appraisal, (C) participation as conditioned by experienced control of the knee, (D) participation as conditioned by experienced knee impairment, and (E) participation as conditioned by neglecting the knee injury. Within each category, 5 interrelated aspects were discerned: focus, level of performance, activities, strategies, and feelings. Categories A, C, and E reflected experiences of full participation, whereas categories B and D reflected experiences of modified participation. There were mostly positive feelings regarding participation. Negative feelings were expressed in category D. Factors affecting the activity level were grouped according to the framework of the International Classification of Functioning, Disability and Health and described as facilitating or hindering the activity level. Facilitating factors included regaining and maintaining physical function, regaining confidence in knee function, and learning/relearning movement patterns. Hindering factors included fear of injury/reinjury, uncontrollable giving way, and loss of motivation. CONCLUSION: With different strategies, most of the informants achieved a satisfactory activity level, despite impairments and decreased activity level. Both physical and psychological factors were described to affect the activity level, as well as time since injury.

Current assessment methods after an ACL injury do not consider how the individuals themselves experience their participation in activities or what factors they think have affected their current activity level.