The document discusses the Rijnmond workplace learning project, a collaboration between vocational education institutions and healthcare organizations in the Netherlands aimed at optimizing workplace learning through learning departments. It details the methodological approach known as 'the Rotterdam approach' and highlights the importance of practical research and co-creation between education and healthcare to improve education quality and student outcomes. Key challenges identified include the gap between educational research and practice, along with the need for better knowledge application and cooperative frameworks in education settings.

1. EAPRIL Conference November 23rd to 25th, 2011
Roundtable 23rd of November 13.45-15.15 hours
Workplace Learning in co-makership or intermediate VET: a methodological introduction
Breakthrough method in education, innovation-driven research or research-oriented
innovation? "The Rotterdam approach", a case study
Niek van den Berg & Jan Streumer
n.vandenberg@zadkine.nl
j.n.streumer@hr.nl
Introduction
Since 2008, VET College Zadkine, Rotterdam University of Applied Sciences and three
healthcare institutions in the Rijnmond region in the Netherlands have participated in the
national Workplace Learning Breakthrough Project – an initiative of the national Platform for
Vocational Education (HPBO). The project is a research and development project in which
schools, healthcare institutions and researchers work together on various issues of
workplace learning. The main question is: how can the cooperation between education and
professional practice in learning in the workplace (in so called learning departments) be
optimized, using both scientific and practical knowledge and experience?
The Rijnmond project focuses on workplace learning in learning departments in hospitals,
nursing homes and other healthcare institutions in the region. About ten students ‘care’
(intermediate level vocational education) and ‘nursing’ (intermediate level vocational
education as well as higher level of vocational education), work and learn together in a
learning department under the responsibility of qualified health professionals (work
supervisors and trainers). The student posts are supplementary and provide all possible
activities in the field of ‘care’ and ‘nursing’. They work and learn in an authentic setting,
namely the actual job practice, in which the students – after obtaining their diploma – will
continue their professional carreer. During their workplace learning route, they will be
supervised by healthcare professionals and teachers from intermediate and higher
vocational education (also designated as trainers).
In the project a major role is allocated to (practical) research and experimentation. Thereby,
"co-maker ship in triplicate" – between education and healthcare institutions, between
research and education, and between rural and regional actors – will be addressed (Van den
Berg, 2009; Van den Berg, De Jongh, Klous & Streumer, 2010). These activities are dedicated
to the improvement of the practice of workplace learning. This means that research is
focused on specific changes in that part of the curriculum that is situated in the professional
practice. The emphasis is on increasing the professional behaviour of trainers, offering them
a wider range of intervention tools to increase learning effects for students. During an
interim audit, the Audit Committie described the approach used in the Rijnmond project, as
"the Rotterdam approach" and the commission called for this approach to be documented
further. This resulted in the seventh report on the project, which specifically, addresses the
'co-maker ship' between research and education (Van den Berg & Streumer, 2011).
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2. The Breakthrough Series and Breakthrough Method in Healthcare
The method underlying the Breakthrough Project Workplace Learning and other
Breakthrough projects in vocational education, has been developed in the last decade of the
twentieth century in the United States and was focused on healthcare. Some years later, this
breakthrough method was introduced in the Dutch healthcare sector.
Since 1999, the Institute for Healthcare Improvement CBO has put on pressure to implement
the BTS model in the Netherlands. In 2007 CBO published “Breaking Through with results in
healthcare” – a collection of a large number of project examples and a reflection on the
methodology – making the Breakthrough Method (also indicated as BTS model) available for
a wider audience (Schouten, Minkman, De Moel and Van Everdingen (ed.), 2007; Geurts,
2010a). The method involves "a fairly tight structure to introduce changes aimed at
improving an existing situation" (CBO, 2010, p.17). Organisations interested in the
breakthrough method are able to create a structure that enables parties to learn from each
other and from leading experts, both substantively and methodologically, in a field or
subject they want to improve – a combination of learning and changing. Collaborative
learning is a key element of the method. Therefore, the breakthrough method, is also
referred to as a ‘collaborative learning system’.
Research and practice: a problematic relationship
Geurts (2010a, 2010b, 2011) speaks of a disappointing situation with regard to the role
research plays in the innovation projects of HPBO. "(...) the returns on what works so far is
still disappointing; the same is true for available knowledge” (Geurts 2011, p.35). According
to Geurts this has to do with "a much more general phenomenon, namely the 'gap' between
educational practice and educational research. An analysis of the educational literature
shows that this view is widely shared (see e.g. Van den Akker, 1999, 2010, Barab & Squire,
2004; Ferrance, 2000, Martens, 2010; Dutch Education Council, 2003, 2006, Van den Berg &
Riemersma, 2006, Van den Berg, 2006; McKenny, Nieveen & Van den Akker, 2006, Plomp,
2010; Reeves, McKenny & Herrington, 2010; Verschuren, 2009; Van Tartwijk, 2011). It also
shows that the gap-issue has a long history. However, as noted by Broekkamp & Van Hout-
Wolters (2006), in recent years the debate becomes increasingly fierce and intense. Mono
causal analyses – the determination of a single cause, often associated with a plea for a
comprehensive and rigorous application of a solution – dominate frequently, resulting in a
polarized debate based on opinions and assumptions. It should be noted that this is not only
a 'battle' between concerned researchers and users of research data. Martens (2010) for
example, found himself within the so-called 'ivory tower' for a long time and therefore is
acquainted with the scientific culture from within. Now he seems to have shed his scientific
feathers, given his argument against the mores of the scientific enterprise. Even Reeves,
McKenny & Herrington (2010) hold an unequivocally clear opinion. They mention the
"hypocrisy of educational research as we know it." First, it is extremely difficult to assess the
impact of educational research on something that really matters; on the other hand more
and more countries and universities attempt to measure the 'impact' of their publications in
leading scientific journals based on citations analysis, which, according to the authors, are
"questionable" at the least.
In order to bring the different actors back to the discussion table – in a more constructive
way – the Dutch Education Council (2003) – in line with the demand of the Dutch Minister of
Education and Science – and Broekkamp & Van Hout-Wolters (2006), do not choose to
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3. represent a specific group and do not want to defend solutions that arise from a specific
group, but give a neutral description of the supposed gap between the educational practice
and educational research from a broad perspective. They discuss the problematic situation
between both phenomena, the causes as well as the possible solutions. The Education
Council (2003) points to the way research generally is funded, to how the research agenda is
established, to how defects in the translation of and information on knowledge is
transferred towards the world of practice, and to weaknesses in the cooperation between
researchers, intermediaries and practice.
The intermediaries encounter problems of fragmentation, and on the side of the schools –
according to the Education Council – insufficient skills to exploit knowledge is involved.
According to the Council, knowledge producers must pay much more attention to the
implementation of knowledge, energy and money should be invested in knowledge
communities, and finally incentives are needed to improve knowledge management in
schools. Broekkamp & Van Hout-Wolters (2006) come to a similar analysis. According to
them, negative labels of research deal with (a) the output of educational research and / or
(b) the use of the research output in daily educational practice. Practitioners – teachers –
find reports on educational research often inaccessible, irrelevant and unreliable and
therefore pay little attention to research output. Even politicians are generally negative
about educational research. In their eyes, educational research is making little progress and
research findings often look trivial and are sometimes contradictory. At the same time
politicians tend to "selective shopping": they often choose studies that fit their ideas best.
Researchers have their own frustrations. Research outputs, are frequently irresponsibly and
ineffectively used in policies, professionalisation programs and (commercial) educational
materials. The use and quality of use often leave much to be desired. In addition,
practitioners are not sufficiently stimulated, equipped and supported to make use of the
research output.
Growing attention to practice based research
In the social sciences, theory-oriented research has long been the most common type of
research. This involved the construction of a coherent, abstract and generally accepted body
of knowledge. In this context, Verschuren (2009) speaks of a focus on 'knowledge for
knowledge'; Den Boer a.o. (2011) specify this as knowledge of 'what is true'. Results of this
type of analysis were primarily conceptual of nature. The influence of science on the social
reality was thus a long-term effect, blurringly unpredictable, slowly and diffuse. Especially
communications media and education played an important role in the dissemination of
knowledge, while scientists focused exclusively on their colleagues. This did not mean that
the practical relevance of science never came up.
Since the nineteen eighties, scientists pay more attention to social reality, which is more or
less the birth of the phenomenon of applied research. Verschuren (2009) characterises this
development as a transition to an "instrumental use" of science. The idea is that "research
should provide a more direct basis for making decisions, to solve problems and more
generally, to consciously and actively intervene in reality” (p. 25).
Characteristics and results of the Rijnmond Project
The regional Rijnmond Breakthrough Project as mentioned above, evolved from an already
existing 'community of practice’ to learning departments in health care, with representatives
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4. from VET College Zadkine, Rotterdam University of Applied Sciences and a range of health
care institutions. With the introduction of learning departments the institutions hoped to
find a solution for (among others) the then impending shortages of traditional internships in
health care. Also the improvement of the flow of students (in health care programs) from
intermediate to higher vocational/professional education was an aim.
Learning departments have been on the rise elsewhere in the country for several years.
Since 2005 specific stimulants have been available and the number of learning departments
grew rapidly. The purpose of the community of practice in Rijnmond was to collect and share
(available) experiences and knowledge in setting up and running learning departments in
health care institutions as partners and to improve the actual practice. The community of
practice still exists and the number of participating institutions has increased drastically.
During this pilot phase of learning departments in Rijnmond, a small scale study on the
differences (and possible advantages) of learning departments in comparison with
traditional individual internships was done by Klingeman & De Lange (2008). According to
them, learning departments yield more benefits than traditional individual internships, but
as yet, their conclusion is not yet supported by other research (Streumer, 2010, p.26-33).
Because of this, the research question on the relation of design features to the effects and
efficiency of the learning departments compared with traditional individual internships,
remained open. For those involved in learning department, the Rijnmond Breakthrough
Project offers an opportunity for more research into the learning departments in the region
and also to benefit from the knowledge and experience in other regions and the national
research project (by Tilburg University). The regional project focuses on three learning
departments in hospital substitution health care (Hannie Dekhuyzen Humanitas, Rotterdam),
geriatric health care (the Plantation, Brielle) and psychiatric health care (Bavo Europoort,
Berkel and Rodenrijs).
Managers of these institutions, together with the project leader and the researchers, form a
steering group. In addition, a so-called 'consultation trainers' meeting’ is formed by the
project leader, the researchers, teachers form the participating schools and the
representatives of the participating health care institutions (in particular those who are
responsible for HRM and in service training). On December 9th, 2008, this 'consultation
trainers' meeting’ met for the first time. An important outcome of this meeting was that the
research done in the Rijnmond Project should, as much as possible, have the nature of
practice-based research and should be executed by researchers in close cooperation with
the trainers (teachers and mentors) of VET College Zadkine, Rotterdam University of Applied
Scjences and the participating health care institutions. This approach is aimed at helping
learning departments in action to become a learning community in which trainees and
trainers work and learn together. This approach appeals to all members of the learning
departments and is ratified by the steering group of the project.
As outlined in the national overarching project organisation in the steering group and the
'consultation trainers' meeting’ has been discussed and it was decided that in the first year
the trainers will go about their work as usual and that the emphasis of the research is on
describing what the actual situation is. In the second experimental year the trainers will
bridge the gap between the actual situation and the desired situation. Interventions will be
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5. implemented to improve the situation. At the same time the innovation process and
outcomes will be monitored. This implies that before the summer of 2009 decisions had to
be made on what aspects (innovations) the Rijnmond Project had to focus in the
experimental phase.
Furthermore, the research questions of the regional Rijnmond Project were discussed and
specified according to the wishes of the HRM professionals and trainers. The outcome is a
document with research questions that has to be dealt with. The questions were as follows:
1) Does recent research literature provide directions for the design, effects and ‘return on
investment’ on workplace learning, and learning departments in particular?
2) What is the current practice (actual situation) of the learning departments with respect to
the design characteristics?
3) What are the effects and the efficiency of the learning departments?
4) What are the design features, impact and cost of traditional individual internships?
5) What is the difference between the design features, effects and efficiency of learning
departments compared to design features etc. of traditional internships?
6) Which competencies should trainers (teachers and mentors) vocational/professional of
the school and in practice possess to be able to create a ‘powerful context-rich learning
environment’ in a learning department?
These questions were answered by a combination of literature review and qualitative field
research (with interviews and reflection-reports). At a regional conference on October 8th,
2009, the researchers presented the results of the first two studies (questions 1 and 2) to
the HRM professionals and trainers. During the same session trainers and HRM professionals
explored a number of additional themes. In response to the outcome of this exploration, the
researchers made a list of further research topics and possible interventions (improvement
suggestions) for workplace learning in the learning departments. On January 19th, 2010, the
result (approximately 30 described options) were discussed and prioritised by trainers and
HRM professionals. The priorities were categorised in three cross-cutting themes: 1)
‘counselling fatigue’, 2) learn-work route of the students in the learning department
(intermediate as well as higher VET students ), and 3) the skills of trainers (intermediate as
well as higher VET teachers and mentors) in relation to theme 2.
At a further session of the 'consultation trainers' meeting’ on February 18th, 2010, it was
decided to focus on themes 2 and 3 and more in particular on what distinguishes learning
departments from other forms of workplace learning, namely learning and working together
(experts and novices) to realise effective (successful) and efficient learning processes and
outcomes. One of the principles of teaching departments is that learning and working
together adds value compared to individual forms of workplace learning. Firstly, this applies
for learning and working together by a group of intermediate and higher VET students.
Secondly, this applies to the collaboration of trainers (teachers and mentors) and students.
Thirdly, the group-approach of the workplace learning implies that mentors as well as
mentors and teachers (should) work together. Furthermore, trainers and researchers found
that, before improvements in the workplace are implemented, sufficient knowledge should
be collected on which choices can be made which will prove to be promising.
Regarding the research questions, it was agreed that the researchers would further
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6. elaborate and accentuate the ideas set by the 'consultation trainers' meeting’ and develop a
proposal for a practical approach in which research, professionalisation and educational
improvement go hand in hand. The proposed approach does not only aim at substantive
answers, but also at giving substance to the professionalisation of trainers in relation to
improvements in students' learn-work route. On March 23rd, 2010, the 'consultation
trainers' meeting’ discussed the proposal developed by the researchers. This resulted in the
decision to start a small study concerning ‘counselling fatigue’ in one of the participating
health care institutions, where this problem was revealed. However, the main theme in the
proposed approach is "the learn-work route’of the student and the counselling skills of
trainers. The follow-up activities focus on aspects related to (successful and profitable)
collaboration and learning in learning departments of all involved. The relevant aspects for
successful collaboration and learning together are expected to lead to the intended learning
outcomes and the additional value of leaning departments compared to individual
traditional internships. In this context, three studies are planned:
1) literature review of counselling/coaching in learning departments,
2) field research on the design of the matching of students (student placement) and
interpersonal relationships on the work floor in learning departments between all working
and learning there and
3) field research (combined with an intervention aimed at the professionalisation of
mentors) focused on meaningful learning situations in the learning departments.
Based on the studies carried out, the researchers conclude that:
1. The variety of learning situations appointed, is an indication that the teaching
departments are basically rich learning environments. This richness could increase further, if
the learning departments would have more characteristics of a learning organisation, for
example by (explicitly) working on the implementation of health care innovations.
2. Meaningful learning is an issue in interactions between students and trainers, among
students, between trainers and between students and other persons (patients, relatives of
patients, other professionals in health care). In principle, due to the variety of relationships
in which the students are engaged, the learning potential of the learning department is
much higher than in an individual traditional internship. Mainly the group interaction
between students (peer review) and collaborative learning of students while working in the
learning department, are activities that do not exist in traditional individual internships.
According to students and trainers, these activities are very powerful for learning.
3. There is evidence that students learn more and/or learn faster, but hard evidence based
on comparative data is difficult to present. Data from tests, retention and graduation rates
and other data from study careers of students are available, but they are difficult to analyse
and interpret in relation to learning in learning departments compared to traditional
individual internships. Students take different internships, both individual and in learning
departments. As a result of the growth of the number of learning departments, almost all
students at any given time and even more than once in their educational career will be
assigned to a learning department, which makes a comparison difficult. Graus & Poortman
(2011) – researchers at the Utrecht Workplace Learning Project – also conclude that it is
difficult to attribute differences in learning (progress) exclusively to the two conditions:
learning in learning departments versus learning in individual internships. Learning
departments seem not inferior to an individual internship, but the question remains whether
students learn more in learning departments.
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7. 4. The quality of learning in the learning department can be enhanced by several factors.
Besides a careful matching of students and health care institutions/trainers, good
information and clear and laid down agreements, trainers should have excellent coaching
skills, hands-on and ‘hands on the back’ competencies, social competencies that will enable
them to collaborate successfully with students and each other, and above all have a positive
learning attitude. Various research themes mentioned are examples of “critical professional
situations" of trainers that belong on the agenda of information sessions, training programs,
peer support programs etc., provided that trainers are really professionally interested and
want to learn about these themes. How such a professionalisation process can take shape,
has been tried out in a pilot. The pilot shows that an this kind of investment effect on the
quality of supervision/coaching.
The third study concerning meaningful learning situations has immediately been used to
design and to implement a professionalisation program for trainers, more in particular the
mentors. The experience here is that reflection-reports that were used in the study, are a
good basis for professional development through peer review .
Reflection
The issue of design and performance output of the learning departments compared to
individual internships, culminated into three years applied research by researchers of the
Rotterdam University of Applied Sciences and VET College Zadkine, in consultation with
trainers (teachers and mentors) from both schools and the three participating health care
institutions. All parties have had their input into the project and research plan. In line, the
researchers elaborated the formulated research questions in close consultation with the
other members of the 'consultation trainers' meeting’ . Next, the researchers conducted the
study, and communicated the results for each sub-study with the 'consultation trainers'
meeting’. The 'consultation trainers' meeting’ determined the significance of these findings
for the future: either input for interventions in the learning and supervision/coaching
process, or for further research.
Generally speaking, the method is more an alternation of 1) joint meetings of researchers,
trainers and HRM professionals of the health care institutions to determine the approach
and next steps, 2) preparation and carrying out research by the researchers and 3)
communicating the results to the 'consultation trainers' meeting’ followed by discussion,
then there is 1) once more. The plan – in line with the nationally agreed approach – to
explicitly experiment (designing and implementation of interventions) in the second year of
the project was not achieved. Instead, after the first research round, a second, more in-
depth study followed, in addition to relatively small scale improvements by teams or
individual trainers, plus the temporary suspension of one, later a second learning
department. The in-depth study was followed by a professionalisation program for trainers,
based on results of the prior field study.
The fact that research questions derived from already existing learning departments are the
basis for the current project, basically means that the Plan phase of the Plan-Do-Study-Act
cycle already passed and the Do-phase was already under way, before the Rijnmond
Breakthrough Project started. Any accommodating research was already available, but that
did not adequately respond the research questions of the project. With the start of the
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8. current project they invested mainly in the Study-phase: to describe and evaluate the theory
and practice of workplace learning and workplace learning in learning departments in
particular, trying to grasp the effects of the learning departments, and the like. The
discussions and reports on these themes do give the professionals of the learning
departments an overview of the scientific insights in workplace learning (particularly through
the literature studies) and an a explicit and (more) objective view of their own work
practices (especially through field studies and the discussions).
The study did not produce concrete instruments – like manuals and so on – to improve the
practice, except for the form to describe meaningful learning that does occur in the learning
departments. Several participants in the project indicated that this form could also be used
by students and trainers in counselling/coaching situations; the pilot on the
professionalisation program provides clear evidence. However, the study first and foremost
has the function to encourage professionals to discuss the significance of research outcomes
for their own practice. This applies to both board and management of the health care
institutions involved as teachers, trainers and work supervisors. Increasingly they come to
the conclusion that the concept of learning departments should be reassessed to the
changed circumstances and opportunities. Full adjustment of the ‘learning department
concept’ is not (yet) an issue, although, as mentioned above, one, and later another learning
department temporarily stopped to rethink the format. The project helps them to
contemplate on the restart, as is shown in the words of one of the trainers in the concluding
dialogue between educators and researchers (June 2011): "To restart a learning department
that was punt on hold for two years, any material from the project is useful as discussion
material.” Trainers also make small improvements in their practice. One of the trainers said,
for example: "The discussion about ‘counselling fatigue’ of trainers was very informative and
has helped me to implement changes in practice.”
A strict distinction between the Study- and Act-stage where the revised innovation is re-
tested does not exist.
Regarding the co-maker ship between researchers and trainers the project leader and
researchers halfway during the project observed that professionals from research and
practice got to know each other and could easily find each other outside meetings (Van den
Berg, De Jongh, and Streumer Klous, 2010, p.9). In the final 'consultation trainers' meeting’
in June 2011 the attendees noted that the cooperation between trainers and mentors of
different institutions (schools as well as health care institutions), and cooperation amongst
these participants and researchers, are achievements of the project. Project participants are
positive about these achievements.
The 'practice based' nature of the research led to an intensive and positively valued
collaboration between educators and researchers. Inherent to this approach is that some
dangers are lurking: e.g. dangers related to the realisation of both good research (academic
quality) and impact in practice (improvements fuelled by the knowledge gained). The
impression may be that the Rijnmond project has produced more knowledge revenues than
change of practice.
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9. Are the reports accessible enough? And at the same time: Is the scientific quality of the field
studies at stake? The "shortcomings" in the study can be attributed mainly to the (too?)
large and possibly one-sided emphasis on the content of the research study, the research
theme (instead of a sound and scientific accepted methodology) . Several authors, including
Verschuren (2009) have warned for this problem, but apparently this is an inherent risk of
various forms of applied, practice-based research. The actual phase of the project explains
why there is so much focus on content. The learning department is a relatively new form of
workplace learning, thus still under construction. This explains why It is often unclear what
scientific paradigm suits best. Thinking of concepts such as evidence-based practice and
practice-based evidence, the approach used in literature study and descriptive/comparative
fieldwork is an adequate mix, especially in combination with oral presentations and
subsequent discussions.
Conclusions
The teaching department as a form of workplace learning is still under construction, for
which inside and outside the region no examples are available. This has clear implications for
the possibilities of research. For example, it is still too early to apply 'hard' research
methods. Therefore, the study is primarily targeted to content. In itself, this is not wrong,
provided the requirements for high quality applied research are not violated. At this point it
appears the shoe in some cases pinches. Are the researchers to blame? Given their
backgrounds – professors with a specific assignment and experience in this field – the
answer must be negative. A much more plausible explanation lies in the 'double' innovation
built in in the project: firstly, the Breakthrough Method, which was unknown to all involved
and secondly, of course, the learning department itself. This has resulted in the Rijnmond
Project to be mainly a research-oriented innovation, and consequently hardly an innovation-
oriented research study. Research in the Rijnmond Project almost became an end in itself,
partly because the need for knowledge from practice was big. Simultaneously, the
researchers experienced that practice can sometimes be very stubborn, and that things
sometimes not happen as expected. Thus, concrete solutions for practical problems were
not always energetically tackled, which also may have to do with the inexperience with the
phenomena of the learning department.
‘Co-maker ship' and 'practice-based' are indeed the core of the Rotterdam Approach, but in
their reflection on the sometimes disappointing response of trainers, researchers are
puzzled, because the research approach was an explicit choice of trainers, instruction
sessions have been organised and also during the study weeks there has always been
contact. That should have enabled a high level of participation. Are there basic principles of
the Rotterdam Approach at stake? It seems that frequent and intensive mutual contacts are
no guarantee for successful research. Perhaps luck is another indispensible criterion for good
research?
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