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Exploring Virtual Communities of Practice
in Healthcare Education
Robin Kay
Professor
University of Ontario Institute of Technology
Oshawa, Canada
robin.kay@uoit.ca
Jordan Holmes
The Michener Institute of Education at UHN
Toronto, Canada
JHolmes@Michener.ca
Abstract: The purpose of this study was to explore factors that influence participation in virtual
communities of practice (VCoPs) within the domain of healthcare education. A year-long, content analysis
of 11 simulation-based healthcare education VCoPs was used to examine the frequency of participation.
LinkedIn had poor user engagement compared to independently monitored discussion forums. Qualitative
feedback suggested that the unmoderated and commercial nature of the LinkedIn platform may have
limited the quality of interactions. Online surveys (n=100) revealed that ease of platform use, trust in the
community, direct and indirect personal benefits, self-efficacy and psychological safety were key factors
affecting participation in VCoPs.
Introduction
Community of Practices (CoPs) are defined as any group of professionals, formal or informal, who share common
interests, values, and norms, and who have the opportunity to work together towards supporting each other
personally and professionally (Barnett et al., 2012; Brown & Duguid, 1991; Edmonds-Cady & Sosulski, 2012;
Wenger, 1998). Virtual Communities of Practice (VCoPs) typically form when participants are unable to meet face-
to-face. VCoPs have recently emerged in a variety of contexts including healthcare (Barnett et al., 2012; Brooks &
Scott, 2006), social work (Edmonds-Cady & Sosulski, 2012), post-graduate studies (Cowan, 2011), and corporate
environments (Hung & Cheng, 2013; Lin, Hung, & Chen, 2009). VCoPs often evolve across multiple organizations
where users feel freer to seek advice, admit knowledge gaps, and voice divergent opinions than they would during
in-person CoPs (Ardichvili, 2008; Oliver & Carr, 2009). Additionally, VCoPs make it easier for professionals who
are geographically isolated to form peer support groups and share their stories or lived experiences (Hamel et al.,
2012).
There are at least seven factors that could influence user participation in VCoPs including
ease of using virtual community (Ardichvili, Page, & Wentling, 2003; Barab et al., 2004)
time available while at work (Ardichvili et al., 2003; Wenger et al., 2002)
direct or indirect personal benefits such as the ability to solve complex problems and share insider
knowledge (Ardichvili, 2008; Chen & Hew, 2015; Chen & Hung, 2010; Lin et al., 2009)
trust in the virtual community (e.g., shared values and expectations of knowledge-sharing)
(Ardichvili, 2008; Chen & Hew, 2015; Chen & Hung, 2010;).
the degree to which a user’s workplace encourages and facilitates participation (Chen & Hew,
2015; DeLong & Fahey, 2000; Hackett, 2000)
perception of self-efficacy (e.g., perception of have something of value to contribute (Ardichvili,
2008; Chen & Hung, 2010; Lin et al., 2009; Wenger et al., 2002).
psychological safety (e.g. posting content without fear of judgement or criticism) (Ardichvili et al.,
2003; Wenger et al., 2002; Zhang, Fang, Wei, & Chen, 2010).
To date, limited research has been conducted on the use of VCoPs in healthcare settings and specifically in
simulation-based education. The goal of this study was to conduct a formative analysis of VCoPs focusing on
frequency of involvement and factors that influence participation.
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Method
Context
In simulation-based healthcare education, real clinical experience is replicated to varying levels of fidelity in order
for learners to develop knowledge, skills and judgement in a safe, controlled environment, prior to real clinical
exposure (Ziv et al., 2003). The field is multi-professional, including technicians, clinicians, faculty, facility
managers, administrators, and simulated participants. Like many professionals who share common goals and
interests, simulation-based healthcare education practitioners have formed a variety of online interest groups that fit
under the VCoPs umbrella, including professional association forums, LinkedIn groups, listservs, and equipment
manufacturer forums.
Participants
The participants in the survey portion of this study consisted of 100 simulation-based education professionals of
varying roles and clinical foci. Most participants identified as having an educator role (n=58), followed by
operations (n=56), senior leadership (n=26) and researcher (n=24). The primary clinical foci were nursing (n=41)
and medicine (n=23) followed by paramedicine (n=6), respiratory therapy (n=2), medical radiation technology
(n=2), midwifery (n=1) and physiotherapy (n=1). Survey participants were predominantly female (67%, n=67; male
33%, n=33) from the United States (69%, n=69) or Canada (23%, n=23). Most respondents were either 35 to 44
(29%, n=29), 45 to 54 (36%, n=36), 55 to 64 (24.0%, n=24) years old. The range of years’ experience in working in
simulation-based healthcare education was: less than two (6%, n=6), between two and four (20%, n=20), between
four and six (26%, n=26), between six and eight (13%, n=13), and more than eight (35%, n=35).
Data Collection
Frequency Analysis
Posting frequencies were calculated examining all threads between September 1st, 2014 and August 31st, 2015.
Average posts per day for a specific VCoP was determined by dividing the total number of posts in all threads by
365. Percent of threads replied to was calculated by counting the number of threads in a VCoP that had at least one
reply and dividing that number by the total number of threads.
Independent Variable
Three groups were firmed and compared based on three levels of participation: never (n=22), rarely (n=38, once per
month), and often (n=40, once per week, 2-3 times per week, every day, multiple time per day).
Dependent Variables
Seven key factors identified in the literature as being important predictors of online community participation were
examined based on five-point Likert questions ranging from strongly disagree to strongly agree. The factors were
ease of use (1 item), time (1 item), personal benefits (5 items), trust in community (4 items), workplace support (2
items), self-efficacy (2 items), and psychological safety (2 items). The number of items used to constitute a factor
depended on the complexity of the underlying construct.
Qualitative Data
Survey respondents were asked to provide additional detail and clarification regarding what influences their
participation in online simulation communities with three open-ended questions focusing on enablers, barriers and
motivating factors for participation.
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Results & Discussion
Frequency of Participation in VCoPs
VCoPs with free or paid open forum platforms (n=3) averaged 2.1 posts per day, a 65% response rate to threads, and
2.9 replies per thread. On the other hand, LinkedIn groups (n=7) averaged 1.2 posts per day, a 21% response rate to
threads and 0.7 replies per thread. Qualitative data suggested that the reason for lower participation and response
rates for LinkedIn VCoPs may have been due to a lack of moderation (e.g., “I’d say that they completely lack
moderation) or mistrust of intentions (e.g., “It’s hard to tell whether they represent a particular business entity and
they’re pushing their view of things or their products”). Participants may be more trusting of open forum VCoPs
that have moderators and no obvious commercial agenda. Based on the low engagement rate, it is worth considering
whether LinkedIn groups in simulation-based healthcare education constitute authentic communities of practice.
Factors Influencing Participation in VCoPs
Ease of Use.
Usability was rated relatively high, on average (Table 1), for all VCoPs examined in this study, with a few minor
comments about having to register, paid VCoPs, and incompatible technology. An ANOVA revealed, participants
who found VCoPs easy to use, posted significantly more often in VCoPs than participants who found VCoPs harder
to use. These results are consistent with a number of studies of virtual communities in other domains (Ardichvili et
al., 2003; Gupta & Kim, 2008; Harrison & Daly, 2009; Lai et al., 2014).
Time at Work
Almost half the participants reported that they had enough time at work to participate in VCoPs, however, on third
noted that they did not (Table 1). Most participants who did not use VCoPs a work commented that they had higher
priorities and more pressing issues. Furthermore, an ANOVA revealed that participation in VCoPs was not
significantly related to time available at work. This result is inconsistent with previous research where time was a
significant influencer (Bock et al., 2006; Chen & Hew, 2015; Lai et al., 2014). One possible explanation for the
differing results is that previous studies looked at time and the intention to participate, whereas the current study
examined actual participation. It is also conceivable that this study may not have reliably measured the construct of
time, as only a single question was used on the Likert scale.
Potential Benefits
The potential benefits of participating in a VCoP included expanding one’s professional network, sharing insider
knowledge, answering complex questions, sharing knowledge and improving professional identity. The average
rating was relatively high (Table 1) for this factor, and an ANOVA indicated that participants who rate the potential
benefits of participating in VCoPs posted significantly more often than participants you did not. This finding is
consistent with several previous studies on CoPs in general (Ardichvili et al., 2006; Chiu et al., 2006; Lai et al.,
2014).
Trust in Community
Overall, most participants appeared to trust the VCoPs communities in which they participated (Table 1), noting that
these communities were an efficient way to share knowledge, that they aligned with their professional values and
that they trusted the community moderators. An ANOVA revealed that individuals who trusted the VCoP
community participated more often than those who had less trust. This result aligns with Chen & Hew’s (2015)
review of the existing empirical research on virtual participation.
Workplace Support
Most participants noted that their workplace was aware of VCoPs (70%), but only half (55%) claimed that their
workplace promoted knowledge sharing. Overall, workplace support was rated relatively high (Table 1). However,
based on an ANOVA, workplace support was unrelated to participation in VCoPs. This result is incongruent with
several previous studies (Chen & Hew, 2015; DeLong & Fahey, 2000). One possible explanation for the
discrepancy is that participants in simulation-based education VCoPs may derive sufficient motivation from other
participation factors to overcome deficiencies in workplace support.
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Self-Efficacy
Participants confidence in the value of their posts and ability to contribute in a significant way to VCoPs was
relatively high (Table 1). An ANOVA provided evidence suggesting that individuals who had higher self-efficacy
participated in VCoPs more than individuals with lower self-efficacy, a finding consistent with previous research in
other domains (Chen & Hung, 2010; Chen et al., 2009).
Psychological Safety
Just over half of respondents reported that they were not concerned about their level of competence being judged
when posting. However, nearly one-third stated that they were concerned. Results from the ANOVA suggested that
perception of psychological safety was related to participation rate in VCoPs. This result is supported by several
previous studies (Ardichvili, 2008; Ardichvili et al., 2006; Tseng & Kuo, 2014; Zhang et al., 2010). Fostering
positive perceptions of psychological safety in learners is a core philosophy of simulation-based healthcare
education (Cook et al., 2011; Raemer et al., 2011). The suggestion that negative perceptions of psychological safety
were present to some degree in simulation-based education VCoPs is somewhat surprising. It is possible that the
multidisciplinary nature of simulation VCoPs contributed to tension in psychological safety, as there is a historical
context of hierarchy and power gradients among the health professions (Price et al., 2014; Thistlethwaite & Jackson,
2014).
Table 1. Potential Factors Affecting Participation in VCoPs
Factor Mean (SD) 1% Disagree % Agree ANOVA Results
(Often vs. Rarely vs. Never Posted)
Easy to Use 4.2 (0.9) 7% 89% Often > Never
Time at Work 3.1 (1.2) 34% 46% No significant differences
Potential Benefits 3.7 (0.6) 10% 66% Often > Rarely, Never
Trust in Community 3.8 (0.5) 4% 70% Often > Never
Workplace Support 3.8 (1.1) 18% 55% No significant differences
Self-Efficacy in Posting 3.9 (0.7) 5% 75% Often > Rarely, Never
Psychological Safety 3.5 (0.9) 56% 21% Often > Never
1 Based on a 5-point Likert scale
Summary and Practical Implications
This study examined factors that affect participation in health care VCoPs. Overall participants trusted
open-ended, professional and non-commercial platforms. Based on the low engagement rate, it is
worth assessing whether LinkedIn groups in simulation-based healthcare education constitute authentic
communities of practice. Wenger (1998) stated that a community of practice is more than simply a
platform for knowledge sharing, and is further defined by professionals actively seeking to learn from
each other and growing their sense of embeddedness.
Seven factors were examined with respect to VCoP participation. Time available to post messages
at work and workplace support were not relevant predictors of VCoP participation. On the other hand,
ease of use, perceived benefits, trust in community, self-efficacy and psychological safety appeared to
influence participation in healthcare-based VCoPs.
Recommendations, based on the research in this study, for how organizations might effectively
build and maintain vibrant, authentic virtual communities of practice in healthcare education are:
1. Remove as many technical and administrative obstacles as possible to encourage participation in
VCoPs;
2. Consider hosting VCoPs on a dedicated platform and not on commercial platforms such as
LinkedIn to build confidence in the intent and moderation of discussions;
3. Implement a “code of conduct” where ground rules such as conflict of interest disclosure, civility,
and respect for users of all levels of expertise and points of view are made explicit to promote
psychological safety and trust in the community;
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4. After establishing safety and trust, explicitly articulate the benefits of VCoP participation within
organizations;
5. Encourage moderators and more experienced participants to support and mentor novice
participants to help develop self-efficacy in VCoP participation.
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