Title

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Interprofessional Participation and Reflection in a

Digital Network

Ragnhild Nilsen (corresponding author)

Professor
University of Tromsø, Faculty of Health Sciences
ragnhild.nilsen@uit.no

Line Lundvoll Nilsen, Ph.d.

Norwegian Centre for Integrated Care and Telemedicine,
University Hospital of North Norway
line.lundvoll.nilsen@telemed.no

Abstract

Interdisciplinary professional education (IPE) contributes to the formation of
effective collaboration in the field of practice. Education needs to be
organised so that health science students can learn with, from, and about
each other. This article explores how web-based collaboration contributes to
this, by describing how it promotes reflection and professional
understanding among health science students. Our data analysis is based on
focus group interviews and online student discussions. The findings show
that the flexibility of digital network, which represents both collaboration
triggered by videos and online communication, is important for the students:
they develop their argumentation together in reflective tranquillity. It is
important to practise reflection since a choice of actions is an integral part of
healthcare work, work which depends upon judgement exercised by the
individual healthcare worker. The digital network allows students from
different health science programmes to draw on each other’s knowledge and
expertise. The findings are relevant for the development of reflection and
professional understanding among health science students, as they show how
students discuss and seek solutions to complex challenges in the practice.

Keywords: Qualitative method, interprofessional education, web-based

learning, reflection

mailto:ragnhild.nilsen@uit.no
mailto:line.lundvoll.nilsen@telemed.no

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Introduction

Increased professionalization and increased attention to patients with complex
diseases have led to the requirement of different professions being able to
collaborate across disciplinary boundaries (Mulvale & Bourgeault, 2007;
Svensson, 1996). Collaboration is difficult because a profession, in principle,
has a monopoly: only people with a certain education are entitled to exercise
the profession in question, which, in practice, may be at the expense of general
knowledge and sharing with other professionals. Professional competence is
based upon science, is acquired through education, and has a practical and
clearly defined goal. This requires both theoretical and practical knowledge in
the subject.

Interprofessional education (IPE) is defined as occasions when two or more
professions learn with, from and about each other to improve collaboration
and the quality of care (Barr, Koppel, Reeves, Hammick, & Freeth, 2005). By
organising the training, IPE can provide effective cooperation with other
professions in the practice (Barr et al., 2005). Students who learn to
collaborate with other students can provide better service to patients, because
they develop the skill to reflect on collaborative processes with other
professions (Wilhelmsson, Pelling, Ludvigsson, Dahlgren, Hammar, & Faresjö,
2009). Experiential learning requires reflection on the process, both
individually and as a group. Schön (1987) divides the development of
knowledge in action into two themes: reflection-in-action and reflection-on-
action. Reflection-in-action means that practitioners think about their work
while carrying it out and can adjust and improve it while the action is in
progress. Reflection-on-action means that one can, in peace and quiet in the
aftermath of the situation, revise the events and one’s own actions. One reflects
on what has been done to whether the knowledge influenced the result. Schön
is concerned with the fact that knowledge cannot be separated from social
practice.

IPE involves learning, while learning, in turn, requires reflection. Students
should learn to reflect on their own profession as opposed to other profession,
and thereby discover the specific features of their own profession. Reflection is
often quoted as a key ingredient as being crucial to effective IPE and practice
(Barr et al, 2005; D'Eon, 2005). A common expression of reflection includes
“stepping or sitting back” from a situation to review it. The process is described
as consisting of the turning over of a subject in one`s mind and giving it
serious thought (Dewey, 1933). Rodgers (2002) suggests that reflection is the
process of the “reconstruction and reorganization of experience which adds to
the meaning of experience”. Just as situations must be interpreted in order to
be handled in an appropriate manner, so too a written text has to be read and
interpreted before the words can make sense.

The national curriculum for professional education in health and social care in
Norway describes a course whose goal is to develop a common frame of
reference as a basis for future interprofessional collaborations. The topics
comprise ethics, communication, state- and municipal-knowledge, health- and
social-politics, as well as scientific theory and research methods. This article
examines how health science students, participating in an interprofessional
web-based curriculum, collaborated. First-year students from northern
Norway who were enrolled in four educational programs (dental hygiene,
occupational therapy, physiotherapy, and radiography) took part in the study.
The study explores students’ online discussions relating to five filmed,
authentic healthcare cases. The purpose is to show how participation in a
digital network can promote professional understanding and reflection among
health science students when collaborating using online communication.

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Methods

The study presents findings from a qualitative study of a web-based curriculum
where students from four different health science programs participated
(Nilsen, 2012).

Study design

Two groups of six students from different health science programs were
selected to follow a web-based variant of the course. The supervisor for the two
groups was responsible for developing the programme. The students followed a
succession of presentation pages on a learning path, and a new page was
presented every day. The purpose of the programme was to challenge the
students to reflect and encourage discussions by adding new tasks every day.
The participants were given five authentic healthcare cases. These were filmed
with drama students as actors in order to show how traditional collaboration
between healthcare professionals could be. The students participated in five
online discussions, one per case. For each situation, there were one or two
lectures of 10–15 minutes in length. By following the lectures and reading the
literature for each topic, the students should have had sufficient grounds to
take part in the online discussions.

Data collection
Two methods of data collection were used: textual analysis of transcripts of the
online discussions (Nord, 1991) and focus group interviews (Vaughn, Schumm,
& Sinagub, 1996). The students were divided into two distinct groups, forming
two focus groups of six people. Group 1 consisted of a radiography student, an
occupational therapy student, two physiotherapy students, and two dental
hygiene students. Group 2 consisted of two radiography students and four
physiotherapy students. It was coincidental that no medical laboratory
medicine students were in the sample. Since interprofessional education was
explored, rather than the similarities/differences between the professions, this
was not deemed to be a weakness of the method.

Data analyses
The online discussions were transcribed, systematically reviewed, and analysed
(Nord, 1991). In the analysis, excerpts that included specific examples of
students from different programmes were selected in order to share their
knowledge and experiences with each other. For this article, three excerpts
from the online discussions relating to the two cases, The Good Encounter
(Figure 1) and The Role of the Healthcare Worker (Figure 2), were selected.
Excerpts from the online discussion from the case The Good Encounter are
presented in Excerpt 1, whereas those from the case The Healthcare Worker’s
Role are presented in Excerpts 2 and 3. These particular extracts were chosen
because they illustrate how web-based collaboration can be used for students
to share knowledge and reflect on practice together. The content of the online
discussions was analysed (Silverman, 2006) and spontaneous expressions and
their reflections on the material were noted and interpreted. The text was read
several times to create a holistic understanding (Geanellos, 2000). The
empirical analysis focused on student participation in the digital network and
opportunity for reflection when discussing online (Schön, 1987).

To complete the statement from the online discussions, the students were then
interviewed. Two focus group interviews, guided by the first author, were
conducted, one per group. A combination of open and closed questions was
used in the interviews; the answers were followed up and elaborated. The
interviews were audio-taped and transcribed (Vaughn et al., 1996). Four

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

statements from the focus group interviews form the basis of the textual
analysis (Excerpt 4). These are considered to be key statements highlighting
the students’ experience of participating in discussions in a digital community
of practice. The online discussions and focus group interviews are presented in
different formats. The online discussions show excerpts from situations with
students from different healthcare programmes. The results from the focus
group interviews are presented as statements. They are in response to the
question of the students’ experience of discussing online. Together, the use of
textual analysis of transcripts of the online discussions and focus group
interviews reflects how videos and written online communication fosters
collaboration and reflection among health science students.

Results

Interaction in online discussions

The Good Encounter (Figure 1) is a film depicting a “radiography student” and
a “radiologist”.

Figure 1. From the case The Good Encounter.

Excerpt 1 is the online discussion between a physiotherapy student, a
radiography student, and a dental hygiene student regarding a similar
situation.

Excerpt 1. Sharing professional knowledge

Physiotherapy student: (...) Because of the radiologist, the student became
increasingly insecure during the conversation; she finds an equal partner,
which allows for good teamwork in the communication. For example, the
radiologist moves to the same height as the student when he sits down; hence,
she avoids looking down at him, but makes sure they are equal, and the
conversation continues satisfactorily. Since it is the radiologist who has the
formal power in the form of her position, it is her task to make this an equal
relationship between her and the student, and I think she succeeds in this.
Radiography student: I think it is well pointed out that she sits down when the
student does, so as not to look down on him. I also think that her ability to
communicate well makes the student feel that he can safely turn to her later
on.

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Dental hygiene student: I think communication between the radiologist and
radiography student was pretty straightforward. They listen to each other, and
the student will, in the future, learn from his mistakes. There was also a great
conversation at the end where they sat down together and talked in a friendly
manner.

***

The physiotherapy student exemplifies an attempt to level the inequality in the
relationship between two healthcare workers by reducing the physical
asymmetry. The excerpt illustrates how health science students from different
programs draw upon each other’s knowledge and expertise. Both the
radiography student and the dental hygiene student agreed with the
physiotherapy student’s description that a beneficial situation for
communication between the healthcare professionals had been created.
The Healthcare Worker’s Role (Figure 2) is a film depicting a “doctor” and a
“nurse” discussing the organisation and division of duties in health- and social-
services.

Figure 2. From the case The Healthcare Worker’s Role.

Excerpt 2 is a discussion between an occupational therapy student and a
physiotherapy student, discussing various roles in healthcare.

Excerpt 2.Professions and the different roles in the health services

Occupational therapy student: I was lucky enough to experience teamwork
during my practice. It was a user who had CP, and an electric wheelchair had to
be adapted. Two physiotherapists, an occupational therapist, and a wheelchair
technician, as well as the guardians were present so I had the opportunity to
see how they worked together in a team, and role played by the occupational
therapist in relation to the physiotherapists. To be honest, I was surprised how
similarly these two occupational groups worked during the actual meeting. In
fact, the occupational therapist was more active than the physiotherapists on
the medical side in relation to correct posture. Here, anatomical knowledge
plays a part, and this comprises a major element in the profession of
occupational therapy. Of the cases I had access to, it was the occupational

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

therapist who was responsible for reporting and further treatment. In my
opinion, it was an exciting observation.

Physiotherapy student: Oh, how exciting! Yes, in that case it was perhaps the
occupational therapist that had the main task. The occupational therapist, for
example, adapts equipment, and is probably better at it than physiotherapists.
Physiotherapists places greater weight on identifying, and improve or sustain
the patient’s functioning.

***

The occupational therapy student examines a situation she has experienced
from her practice, in which she describes a team effort and the role of the
occupational therapist in that team. She describes being surprised to see the
similarity in the work of the occupational therapist and physiotherapists. She
points out the importance of the occupational therapist’s knowledge of
anatomy and claims that the occupational therapist was responsible for the
reports and further treatment. The physiotherapy student says enthusiastically
that it was an interesting observation, but believes that the occupational
therapy student’s experience is a special case. The physiotherapy student
outlines a general division of work between the occupational therapists and
physiotherapists in practice. The excerpt illustrates health science students’
reflections on knowledge and skills in an interprofessional team, based upon
the discussion of various tasks of the professions in the team.
Excerpt 3 illustrates the students’ discussion about their practical strengths
and weaknesses based on The Healthcare Worker’s Role.

Excerpt 3. Reflection on practice

Physiotherapy student: I have also noticed one thing. I simply feel a bit stupid
at times. (...) Yet, there is an advantage in not being expected to know
everything your mentor knows. Hence, you will be given more understanding,
and you get a lot of good advice that can help you further in your studies.
Dental hygiene student: I totally agree with what you say about feeling stupid
sometimes. As a reasonably young student, it is not always easy to “swallow the
big spoon of knowledge”. Fortunately, there are many good mentors out there
who understand how we feel, as they themselves were once in a similar
position.

Radiography student: I totally agree. It is easy to be overlooked as a student
(...). If we see one of the professional healthcare workers making an obvious
mistake, you are likely to be disregarded because you are “merely” a student.
The positive thing about being in practice is that you learn in different ways.
(...) At least that is how it is for me; I learn better by doing things rather than
sitting and listening to a lecture. Of course, there are things you cannot do, and
thus must be read!

***

The physiotherapy student says that she sometimes feels stupid in practice, but
usually the expectations for students in practice are lower. She also states that
good guidance leads students on in their studies. The dental hygiene student
and radiography student agree, and share ways of thinking, speaking, and
acting (Wenger, 1998). The radiography student says that it is easy to be
overlooked as a student and that it is better to learn in practice than to listen to
a lecture.

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Interviews about online discussions

In order to explore our analysis and interpretation of the excerpts, the students
were asked how they perceived the online discussions. Four statements were
selected for analysis, presented in Excerpt 4. The statements illustrate
experiences with written online dialogue, thereby allowing beneficial
opportunities for reflection. The focus is on the students’ experience in
participating in discussions online.

Excerpt 4. Statements about participation in online discussions

1: I thought it was alright, because I got to read through and sort out what

people had written and post a comment instead. It is a bit easier to read

and discuss online, because you can reflect on what to write. Yes, I don’t

know, I think it was much better to write online.

2: (...) Being online I thought it worked quite well, and in the discussion

forums we learned a lot. You can go back to look at what we discussed,

unravelling some of the topics of the discussions.

3: There were so many differences, people had emphasised different

things. (...) you could sort of compare, you learned a lot better and had a

broader view. At the same time, you had it in front of you, so you could

scroll back to see, “What did she mean? What was it he said?” In that

sense, it really is a good way to keep up with the discussion and perhaps

learn to join in.

4: Yes, once again, I agree. The fact was that you got a great overview of

what had been said before, and we could discuss by reviewing as well.

***

A student says (1) that the technology helps to promote reflection, because it is
easier to discuss in writing than verbally (Vetlesen, 2003). She justifies it by
saying that she has time to sort through and read what the others have written
and think about what to write. The excerpt highlights what reflection-on-action
means by re-evaluating the interactions in peace and quiet in the aftermath of
the situation (Schön, 1987). Different ideas were emphasised in the discussion,
and these gave a broader perspective and greater learning outcomes (3). The
student says that being able to go backtrack and see what the others had said
was very beneficial. Another student agrees, pointing out the opportunity to go
back to previous posted comments (4).

Discussion

This article explores how the digital network promotes professional
understanding and reflection among health science students triggered by
videos and written online communication. In the course of three excerpts from
online discussions, and additional excerpt of statements from the interviews
with the students, the analysis explores how students from different health
science professions reflect on practice and draw on each other’s knowledge and
expertise. Physiotherapy students, during their education, acquire tools for
describing, analysing, and interpreting the body and its movements in different
ways. Excerpt 1 illustrates how a physiotherapy student shares professional
knowledge with other students, thereby showing how students from different
backgrounds and perspectives draw upon each other’s knowledge and
expertise (Parsell, Spalding, & Bligh, 1998). Since our understanding of the
world is a continuous process in which our previous understanding is adjusted

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

or modified in light of new experiences (Säljö, 1998), new requirements are
established through our experiences, while being subject to reflection and
revision in the face of this new experience. This provides the students access to
new knowledge and new frameworks of understanding (Säljö, 1998). Thus,
Excerpt 2 illustrates a dialogue in which the students express different views
on the tasks of healthcare workers. In Excerpt 3, the students’ reflections on
practice are presented, illustrating that there are common ways in which
students think, act, and speak (Schön, 1987).

In the focus group interviews (Excerpt 4), the students say that discussion
online made it easier to acquire an overview because they could review the
discussion to see what had been written earlier. They were then able to reflect
on what had been written and post new comments (Holmes, & Gardner,
2006)). Writing is a good way to develop reflection (Eisner, 1991). The online
discussions lasted several hours, and the timescale ranged from virtually
synchronous to varying degrees of lag-time. Asynchronous tools promote
reflection to a greater extent than do synchronous tools (Benbunan-Fich &
Hiltz, 1999). The excerpts illustrate how written online dialogue provides
students with the opportunity to develop their argument in reflective
tranquillity. For the students, reflection means that they have to think through
the situation. Reflection is an important part of collaborative learning for
health science students; however, it requires a structure ensuring that students
have the space and time to be able to reflect (Clark, 2009). The goal is to
develop collaborative learning environments that encourage reflection and
professional understanding where students learn with, from, and about each
other (Barr et al., 2005).

The analysis illustrates how students from different health science
programmes share knowledge through different learning processes. It is
important that students are able to understand the value, functions, and roles
of other professions; furthermore they should possess interprofessional skills
(Wilhelmsson, 2009). The discussion regarding the authentic case studies gave
them the opportunity to focus on personal and interactive skills in relational
work, which is important for practice and also stimulates to remember their
own experiences. The discussions around the cases encouraged the students’
reflection-on-action (Schön, 1987). The different perspectives in the cases
challenged the students and resulted in creative and stimulating thinking and
increased insight. The students reflected on their own roles as health science
students and the particular nature of other professions too. Thus, they
discovered their strengths and skills thereby allowing them to complement
each other’s expertise. Therefore, they had a common point of departure for
practice. Although there are differences between professions, training in
reflection is important because healthcare often necessitates a choice of action
and is dependent upon the individual healthcare worker’s judgment in
practice.
Yet research on reflection in online discussions is divergent. Miers, Clarke,
Pollard, Rickaby, Thomas et al. (2007) found that although students shared
their knowledge online, their discussions were superficial and limited, showing
little reflection and analytical ability. Atack, Parker, Rocchi, Maher & Dryden,
(2009) describe how students from a range of programs such as nursing,
medicine, paramedicine, police, media, and health administration discussed a
simulated disaster situation in a web-based course, which increased the
students’ awareness and appreciation of other team members. Solomon,
Baptiste, Hall, Luke, Orchard et al. (2010) describe how students from
different institutions participated in an online discussion forum where the use
of problem-based learning (PBL) was intended to encourage interaction. The
results showed that students learned about each other’s roles, solved problems
together, and had a positive attitude towards web-based IPE.

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

This paper examines how participation in a digital network can promote
reflection and understanding among students. Unlike Miers et al. (2007) who
says that even if students share knowledge online the discussions is limited
and show little reflection and analytical ability, the results from this study
show that the web-based education helps the students feel that they are being
given an opportunity for professional reflection and knowledge development.
Although the limited number of participants in this study, our findings shows
that digital networks provide health science students with training in
collaborative reflection and increased understanding of each other’s
competence. This is relevant for the development of professional
understanding among health science students, because it shows how students
discuss and seek solutions to complex healthcare challenges. Our findings
differ somewhat Solomon et al. (2010) who found that students learned about
each other’s roles, solved problems together, and had a positive attitude
towards web-based IPE, since they were using problem based learning as
approach to learning. As compared to Atack et al. (2009) who describe that
participation in a web-based course increased the students’ appreciation of
other members in the team; however, in that study, the teams had
participation of students from police, media, and health administration
programs as well.

The primary focus of this study is reflection and professional understanding as
a basis for IPE. Virtual communities of practice (VCoPs) are a type of online
learning community that has been shown to improve knowledge sharing and
thus overcome professional and structural isolation (R´ıos, Aguilera &
Guerrero, 2009; Wenger, McDermott & Snyder, 2002). The value of VcoPs is
to communicate people who want to share or learn about a specific topic by
interacting on an ongoing basis (Wenger, 2009). The main driver has been to
create networks of people with common interests who are geographically
dispersed. The technology helps to expand physical space as an arena for
learning, while allowing the creation of a learning community, and providing
new opportunities for interaction. This study shows professional
understanding and reflection among health science students when they
collaborate using online communication. Many educational institutions use
different forms of web-based learning to motivate students to interact and
work towards common goals. According to Wenger (2009) the question is is no
longer whether this manner of teaching is “as good” as face-to-face learning.
The searchlight is now trained on the factors affecting group dynamics and
cooperative learning.

Concluding comments

It is important to find beneficial digital forms of cooperation, while
maintaining and developing the specific expertise of the healthcare student.
Discussing authentic cases stimulates students to remember their own
experiences and is a potentially useful tool for IPE. Web-based education is a
strategic tool for ensuring good and equitable health services and should be
included early in the educational curriculum. By taking advantage of having
resource to the network’s functionality, health science students are given the
opportunity to participate in online discussions with other students, regardless
of whether they are on the campus or not. This can help enhance the quality of
skills as well as the standardisation of health services, while allowing more
time for the treatment of the patient.

However, to develop good occupationally-oriented practice it is necessary to
conduct research focusing on the value of interprofessional collaborative
education. Web-based education is one way of achieving this.

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

References

Atack, L., Parker, K., Rocchi, M., Maher, J., & Dryden, T. (2009). The impact of an

online interprofessional course in disaster management competency and

attitude towards interprofessional learning. Journal of Interprofessional Care,

23 (6), 586–598.

Barr, H., Koppel, I., Reeves, S., Hammick, M., & Freeth, D. (2005). Effective

interprofessional education. Argument, assumption & evidence. London:

Blackwell.

Benbunan-Fich, R., & Hiltz, S. R. (1999). Educational applications of CMCS: Solving

case studies through asynchronous learning networks. Journal of Computer-

Mediated Communication, 4(3). Retrieved from

http://onlinelibrary.wiley.com/doi/10.1111/jcmc.1999.4.issue-3/issuetoc

Clark, P. G. (2009). Reflecting on reflection in interprofessional education: Implication

for theory and practice. Journal of Interprofessional Care, 23 (3), 577–589.

D`Eon, M. (2005). A blueprint for interprofessional learning. Journal of

Interprofessional Care; 19 (Suppl. 1) 49–59.

Dewey, J. (1933). How we think (Revised Edition). D. C. Heath, Boston.

Geanellos, R. (2000). Exploring Ricoeur’s hermeneutic theory of interpretation as a

method of analysing research texts. Nursing Inquiry, 7, 112–119.

Holmes, B., & Gardner, J. (2006). e-learning. Concept and practice. London: SAGE.

Eisner, E. W. (1991). The enlightened eye: Qualitative inquiry and the enhancement of

educational practice. New York: Macmillan.

Miers, M. E., Clarke, B. A., Pollard, K. C., Rickaby, C. E., Thomas, J., & Turtle, A.

(2007). Online interprofessional learning: The student experience. Journal of

Interprofessional Care, 21(5), 529–542.12.

Mulvale, G., & Bourgeault, I. (2007). Finding the right mix: How do contextual factors

affect collaborative healthcare in Ontario? Canadian Public Policy, 33(7), 49–

64.

Nilsen, R. (2012). Digital Network as a learning Tool for Health Sciences Students;

Seminar.net: Vol. 8 - Issue 2 2012 - ISSN 1504-4831.

Nord, C. (1991). Text analysis in translation: Theory, methodology, and didactic

application of a model for translation-oriented text analysis. Amsterdam,

Netherlands/Atlanta, GA: Rodopi.

Parsell, G., Spalding, R., & Bligh, J. (1998). Shared goals, shared learning: Evaluation of

a multiprofessional course for undergraduate students. Medical Education, 32,

304-311.

R´ıos, S., Aguilera, F., Guerrero, L. (2009). Virtual communities of practices purpose

evolution analysis using a Concept-Based mining approach. In: Knowledge-

Based and Intelligent Information and Engineering Systems, pp. 480–489.

Rodgers, C. (2002). Defining reflection: Another look at John Dewey and reflective

thinking. Teachers College Record; 104: 842–866

Silverman, D. (2006). Interpreting qualitative data. London: SAGE.

Schön, D. A. (1987). Educating the reflective practitioner – Toward a new design for

teaching and learning in the professions. London, England: Jossey-Bass.

http://onlinelibrary.wiley.com/doi/10.1111/jcmc.1999.4.issue-3/issuetoc

Seminar.net - International journal of media, technology and lifelong learning
Vol. 9 – Issue 1 – 2013

Solomon, S., Baptiste, S., Hall, P., Luke, R., Orchard, C., Rukholm, E. & Damiani-

Taraba, G. (2010). Students’ perceptions of interprofessional learning through

facilitated online learning modules. Medical Teacher, 32, 384–391.

Svensson, R. (1996). The interplay between doctors and nurses – A negotiated order

perspective. Sociology of Health and Illness, 18(3), 379–398.

Säljö, R. (1998). Thinking with and through artifacts: The role of psychological tools

and physical artifacts in human learning and cognition. In Faulkner, D.,

Littleton, K., &

Vaughn, S., Schumm, J. S., & Sinagub, J. (1996). Focus group interviews in education

and psychology. California: SAGE.

Vetlesen, A. J. (2003). Det forpliktende møtet. In Fritze, Y., Haugsbakk, G., &

Nordkvelle, Y. (Eds.), Dialog og nærhet. Kristiansand: Høyskoleforlaget.

Wenger, E. (1998). Communities of practice: Learning, meaning, and identity.

Cambridge: Cambridge University Press.

Wenger, E., McDermott, R.A., Snyder, W. (2002). Cultivating communities of practice.

Harvard Business Press, Boston.

Wilhelmsson, M., Pelling, S., Ludvigsson, J., Dahlgren, L.O., Hammar, M., & Faresjö, T.

(2009). Twenty years’ experience of interprofessional education in Linköping –

Ground breaking and sustainable. Journal of Interprofessional Care, 23 (2), 1–

13.