Developing professional competence: lessons from the emergency room

This article begins by reassessing the nature and value of practice-based learning in the health professions. The role and status of work-based learning are then examined in the context of recent policy developments in the field of health care. The authors report the findings from a 1-year qualitative study of clinicians' perceptions of the workplace as an environment for learning, funded by the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE). Focusing in particular upon in-depth interviews with junior and senior clinicians in two hospital specialties, they explore the process through which novice clinicians become part of a ‘community of practice˚s, and their senior colleagues continue to learn in an environment which poses fewer professional challenges. Finally, the implications for the development of competent professionals are discussed.