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            "note": "<p style=\"padding-left: 30px;\">Meeting nationally set performance measures is leading to senior managers becoming distanced from the everyday work of their service and, hence, losing sight of the important role which informal learning plays in the workplace. Whilst it might be possible to ‘measure’ the effectiveness of some of that informal learning, much occurs through collegial activity that cannot be defined in performance measurement terms. The shift to requiring nurses to take on more of the tasks traditionally assigned to doctors is leading to a form of specialisation which restricts the informal flow of skills and knowledge from nurse to doctor. The emphasis on formal education and training in the NHS discriminates against informal learning despite the fact that much of that learning is extremely valuable to the delivery of effective medicine. (7)</p>\n<p style=\"padding-left: 30px;\">In the UK, skills policy is still heavily influenced by the metaphor of ‘learning as acquisition’ (Sfard, 1998). We see this most starkly in the continued use of qualifications as a proxy measurement for skills, and in the number of surveys that depict learning related to the workplace solely in terms of formal episodes of ‘training’ that can be counted and costed. Once learning is viewed as a complex, contextualised process, we open the door to a much more meaningful exploration of how knowledge and skills are developed, adapted, transformed and shared within the dynamic setting of the workplace. This is, of course, highly problematic in policy terms because the shift away from the bean counting approach demands a much greater willingness to accept a much holistic approach to the development of skills strategies. (9)</p>",
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