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Adv Health Sci Educ Theory Pract. 2017 Jun 9. doi: 10.1007/s10459-017-9776-z. [Epub ahead of print]

What's in a name? Tensions between formal and informal communities of practice among regional subspecialty cancer surgeons.

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Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, RGN Building, Rm 3231, Ottawa, ON, K1H 8M5, Canada.
Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
The Wilson Centre, Toronto, ON, Canada.


In 2007 the Cancer Care Ontario Hepatobiliary-Pancreatic (HPB) Community of Practice was formed during the wake of provincial regionalization of HPB services in Ontario, Canada. Despite being conceptualized within the literature as an educational intervention, communities of practice (CoP) are increasingly being adopted in healthcare as quality improvement initiatives. A qualitative case study approach using in-depth interviews and document analysis was employed to gain insight into the perceptions and attitudes of the HPB surgeons in the CoP. This study demonstrates how an engineered formal or idealized structure of a CoP was created in tension with the natural CoPs that HPB surgeons identified with during and after their training. This tension contributed to the inactive and/or marginal participation by some of the surgeons in the CoP. The findings of this study represent a cautionary tale for such future engineering attempts in two distinct ways: (1) a CoP in surgery cannot simply be created by regulatory agencies, rather they need to be supported in a way to evolve naturally, and (2) when the concept of CoPs is co-opted by governing bodies, it does not necessarily capture the power and potential of situated learning. To ensure CoP sustainability and effectiveness, we suggest that both core and peripheral members need to be more directly involved at the inception of the COP in terms of design, organization, implementation and ongoing management.


Community of practice; Medical education; Quality improvement; Surgery

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