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It Takes a Village: Communities of Practice
in Chiropractic
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It Takes a Village: Communities of Practice
in ChiropracticWilliam E. Morgan, D.C.
In spite of all the advances in scientific knowledge, efforts
to promote evidence-based practices, and our labors to improve
our own practices, we have overlooked the key component that
affects how we all practice: our collegial community. We think
and practice like those with whom we commune. If our colleagues
use practice guidelines and outcome measures, then we are more
likely to use them. If our friends and mentors reject these
tools, we are more likely to reject them. This occurs regardless
of compelling knowledge or evidence. For the most part, we judge
our clinical decisions and practices based on what our closest
peers do.
What we know is dependent upon who we know.
This concept has been labeled as Community of Practice.*
Communities of Practice (CoP) can be formed with or without
overt intent. You may already have an informal CoP in the form
of colleagues with whom you converse or an ongoing e-mail stream
that discusses difficult cases. Unfortunately, a haphazard
CoP could actually impede intellectual growth and be deleterious
to your patients.
Human nature tends to make us seek relationships with those
who accept us, rather than with those who will challenge us.
That may explain why emotionally uplifting seminars lacking
substance attract more doctors than our challenging research
conferences offered by FCER or ACC/RAC. It would be easier to
sit around and pontificate with a group of like-minded and
comfortably relaxed practitioners than to engage in true
intellectual debate with people of varying opinions.
Chiropractors along with all health care providers should create
purposeful and challenging CoP relationships.
CoPs are already available in journal clubs, health care
committees, associations, group practices, hospitals and e-mail
discussion groups. These are great tools as long as they are not
steeped in intellectual inbreeding. In other words, form or join
a group that does not forbid any beliefs to be challenged—no
sacred cows. If you limit your interaction to those who have a
strong belief in a particular technique, you could inadvertently
place a ceiling on your level of growth. For example, if a group
of surgeons form a CoP and continually discuss the best way to
perform a certain surgery, they may miss input from other
physicians who would challenge the need for surgery altogether.
Seek diversity and integration to broaden your knowledge base.
Build Your Own COP
In the absence of a CoP that meets your needs, you may need
to form your own. Formal club charters, membership and physical
meetings may be valuable, but often an informal e-mail
community, electronic journal clubs, Web pages or lunchtime
meetings are sufficient to expose members to a culture of
learning.
If you are forming a CoP, strive for these goals:
- Allow for growth and change. Your organization should
not be so rigid that it can’t change to reflect those
involved in the community.
- Encourage diverse opinions. Seek opinions and
perspectives that are different from your own. Invite
medical doctors, chiropractors, psychologists, etc., to join
your group.
- Respect everyone’s time. Don’t waste participants’ time
with topics of little value.
- Protect everyone’s right to divergent opinions. Everyone
will not always agree in discussions, and that is normal and
healthy. Your community should expose everyone to different
opinions without risking awkwardness or humiliation. There
should be no wrong opinions, just divergent opinions.
For more information on forming a Community
of Practice, visit these Web-based resources:
http://www.ewenger.com/theory/index.htm
http://www.cpsquare.com/
http://openacademy.mindef.gov.sg/openacademy/central/html%20folder/km/bcp/
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