Based on video data collected at a major ambulatory healthcare provider in Switzerland, our contribution adopts an ethnomethodological and conversation analytical approach (EMCA) to address the following question: How is health professionals’ active participation in non-formal trainings on digital technologies and tools interactively organized? Its aim is to reveal interactive patterns through which health professionals’ active participation is organized in the distinct trainings under study.

The advancing digital transformation is putting pressure on the healthcare system (cedefop, 2023; Ewers & Lehmann, 2023; Kuhn, 2019), while expectations of the supportive potential of digital technology are high, especially in view of the prevailing shortage of skilled workers in this sector (Angerer & Berger, 2023; OECD, 2020). At the same time, there is on the one hand widespread agreement that the development of digital health competence among health professionals (and patients) needs to be given more attention if the full potential of digital technologies is to be successfully realized in (Angerer & Berger, 2023; Bosch et al., 2022; Eriksen et al., 2023). On the other hand, given the rapid development of the digital transformation, researchers emphasize that non-formal and workplace learning is becoming increasingly important for acquiring the required competences (Dehnbostel, 2022; Harteis, 2022).

In Switzerland, studies on non-formal education do provide interesting insights on adults’ participation (BFS, 2018; SKBF, 2023). Whereas some classical factors, such as the level of formal education, are positively correlated with adults’ participation in professional non-formal participation, i.e., the higher the level of education, the higher is the level of participation (SKBF 2023: 342), others, such as increasing age (SKBF 2023: 337) are negatively correlated. Furthermore, it was found that in Switzerland the lion's share of non-formal education is funded by employers (BFS 2018) and that women participate less often in non-formal education that is covered by employers than men (SKBF 2023: 356). In the meantime, research has focused on adult participation in lifelong learning as a quantifiable phenomenon rather than as a social practice.

Initially, Ethnomethodological and conversation analytic research on the interactive organization of social practices has focused on formal education (Macbeth, 2003; Mehan, 1979, 1980). Studies have shown that the three-part structure, i.e., Initiation by the teacher, Response by the Student and finally Evaluation of Student’s response by the Teacher (I-R-E), constitutes a fundamental practice to achieve learning in a formal setting, as it makes knowledge and competences to do something publicly available to the whole class (MacBeth 2003). From a slightly distinct angle, a more recent study on formal education has focused on I-R-E sequences that are initiated by students (Duran & Sert, 2021). The study reveals that students were found to use a pre-sequence, through which they request permission from teacher to initiate an I-R-E sequence. The study thus sheds some new light on how students’ higher level of agency in formal education plays interactively out in the classroom. Finally, more recent studies have focused on non-formal medical training settings, to shed some new light on how specific videoconference systems, allow trainees not only to follow an ongoing surgery, but also to either address their emergent questions directly to the surgeons at work (Mondada, 2024) or to a supervisor that is co-present with them in the room (Lindwall & Lymer, 2014). Focusing on the ways trainees’ format and ask questions shows that trainees require knowledge and competences, notably to ask questions that relate in an accountable way to what is going in the surgery (Lindwall and Lymer 2014) and/or to choose the right moment for asking their question and, more importantly, for obtaining an answer to it by the addressed surgeon.

In our study, we examin distinct non-formal trainings on digital technology/tools that take place at the workplace of a major healthcare provider in Switzerland. Our investigation is based on video recordings and their transcriptions, carried out according to CA conventions (Jefferson, 2004). The contribution is part of on an exploratory study (DiTiG) that uses an ethnomethodological and conversation analytical approach (Heath et al., 2003; Luff et al., 2000; Pilnick et al., 2010) to investigate the acquisition of digital health competences at the workplace of an important provider of ambulatory healthcare in Switzerland. It was financed by a GRC-grant of the University of Zurich. From January until September 2024, we observed and filmed 11 non-formal trainings with several cameras/audio devices. Non-formal trainings involved 15 distinct intern and extern trainers and 126 health professionals (doctors, physiotherapists, medical practice assistants, practice coordinators, advanced practice nurses). Trainings concerned four different digital health tools, of which three are used in direct patient care and two involved a mobile health application that is destinated to the patient and a professional interface that serves the health professionals. Trainings were realized in three different formats, webinar sessions (N=3), bilateral or multi-party one-hour trainings on-site (N=2) and longer (2-4h) on-site workshops that involved hands on training regarding the concerned tools (N=6). A total of 64h14 audio and video recordings where thus collected, digitized, synchronized and anonymized. The study was approved by the ethical commission of the University of Zurich and all included participants agreed to be filmed and that collected data were used for research and/or teaching by signing a written consent form.

Our paper reveals how in different training formats, i.e., webinars, one-hour on-site trainings, longer on-site workshops, health professionals are given distinct opportunities to ask questions and/or they create opportunities to do so themselves. Our investigation thus shows that depending on the format, the interactions between health professionals and trainers generate different patterns of health professionals’ active participation. Given the limitation of the considered non-formal trainings, further research is though required to better understand how participation in non-formal education contributes to the acquisition of digital health competences, notably regarding distinct contents being addressed through trainees’ questions.

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