Social Capital and online learning – a brief intro

I decided to post a brief section of my literature review after reading the article Natalie tweeted this morning, which portrays similar ideas.

I’m happy to see my reasoning is supported by others but I realise I should probably make an effort to at least try and publish some! Anyway, here it is and I’ll post more…

Access to knowledge, information and ideas is mediated by the fabric of social relationships within individuals in a social network. These can be seen as benefits gained from social interactions and can be conceptualised as “Social Capital”.

This concept, which is also a theory, is rooted in the work of several scholars, starting from Bourdieu (1986) and Coleman (1988) who provided the first definition of social capital. The theory was then extended by the work of Burt (1992), Putnam (1995) and more recently by Lin (2001).

Social capital was defined by Bourdieu as “the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition”  (Bourdieu, 1986 p 51). Social capital allows individuals to access resources – e.g. information – through relationships with members belonging to the same network (Ellison, Steinfield & Lampe, 2007). This  process is not linear or transparent, in fact a person’s actions or practices are influenced by a complexity of social forces acting in the immediate locus where the action is exploited (“field”) and a set of dispositions of thoughts and behaviours assimilated over time by the individual (“habitus”).

The dynamics of reciprocal influence between a social structure and an individual’s ways of thinking and acting are explained by Bourdieu with a formula which highlights their interdependence:

[ (habitus) (capital) ] + field = practice (Bourdieu, 1984 p101)

These factors, if applied and understood within an online educational activity, could help theorise why different students embark in different trajectories and degrees of learning and engagement. If the success of an online educational intervention depends upon the relationships, the dynamics between participants, the medium itself and the social interactions, it is vital that we understand these processes. Steinfield, Ellison and Lampe (2008) argue that “the ability to form and maintain relationships is a necessary precondition for the accumulation of social capital” (p435) and this mechanism could determine the access to certain benefits – information, knowledge – by network members.

Putnam (2000) outlined the concepts of bonding and bridging capital, which reside in the fabric of relationships within a network. Bonding capital refers to the emotional benefits that individuals who have a very close personal relationship with each other can profit from, while bridging capital encompasses informational benefits derived from weak connections. These two processes can explain the acquisition of knowledge in a community of learning.

The importance of the strength of weak ties in bridging capital was highlighted by Granovetter (1973). The power of these connections resides in the fact that they allow individuals in the social network to access pieces of information that would otherwise be inaccessible. Another concept that emphasises the importance of weak ties in the information flow is that of “structural hole” introduced by Burt (1992). A missing connection – a “hole” – between two nodes, or two networks, can be bridged by an individual, a “broker” who can span the hole, bringing together otherwise disconnected contacts (Burt, 2000).

Applying these concepts to a social network of students engaged in an online educational activity, could help understanding on how knowledge flows within the network and subsequently how to moderate and facilitate this exchange between users. Lin (2001) has emphasised the importance of social networks and interpersonal relationships in the development of social capital, which he describes as “resources embedded in a social structure which are accessed and/or mobilized in purposive actions”  (p35). The access and subsequent use of resources embedded in the network facilitates the flow of information and gives some form of profit. So we have three ingredients in the notion of social capital: resources, accessibility and use. (Lin, 2001 p35). While these elements have been conceived within studies concerning the structures of society and the use of social resources in relation to socioeconomic statuses (Lin, 1982 in Lin, 2001), it is apparent that the mechanisms of accessibility and use of resources in an online social network can influence the creation and use of social capital. It is important to highlight the fact that it is not an intrinsic characteristic of technology that allows growth of social capital: it is the specific ways that individuals use technology which determine the amount of this benefit (Valenzuela, Park & Kee, 2009).

Further reading: The Habitus of Digital Scholars by Cristina Costa – and her Blog Post

References:

Bourdieu, P. (1986) The Forms of Capital. In: John G Richardson (eds) Handbook of theory and research for the sociology of education. New York: Greenwood Press.

Burt, R.S. (1992) Structural holes: the social structure of competition. Cambridge, MA: Harvard University Press.

Coleman, J.S. (1988) Social capital in the creation of human capital. The american journal of sociology. 94(Supplement): S95-S120.

Ellison, N.B., Steinfield, C. And Lampe, C. (2011) Connection strategies: social capital implications of Facebook-enabled communication practices. New Media & Society. XX(X):1-20.

Granovetter, M. (1973) The strength of weak ties. American journal of sociology. 78: 1360-1380.

Lin N (2001) Building a network theory of social capital. In: Lin N, Cook KS and Burt RS (eds) Social Capital: Theory and Research. New York: Aldine de Gruyter. 3–29.

Putnam, R. (1995) Bowling alone: America’s declining social capital. Journal of Democracy. 6:65-78.

Putnam, R. (2000) Bowling alone: The collapse and revival of american community. New York: Simon and Schuster.

Valenzuela, S., Park, N., Kee, K.F. (2009) Is there social capital in a social network site?: Facebook use and college students’ life satisfaction, trust and participation. Journal of Computer-Mediated Communication. 14:875-901.

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CoP in Education – thoughts from a workshop

I have recently attended the ASME Annual Scientific Meeting – #ASM13 – in Edinburgh and I had the luck of being involved, directly and indirectly, in few projects, including the #FOAMed workshop which I co-ran with @nlafferty and @rakeshpatel (have a look at the slides!). The other one I was directly involved with was aimed at introducing Communities of Practice (CoP) theory to medical educators and was ran by myself, @alismithies, @suzanneeve, @r_ajjawi (here are mine and Suzanne’s slides). I had had in mind to organise such a workshop for a while now,  the fact I am using CoP theory to ground my research in my doctoral studies gave me the inspiration to start writing an abstract. This does not mean that I feel necessarily confident enough to “teach” such a theory to clinicians and educators in general. My knowledge of this theory is in continuous transformation and, while the key points and assets of CoP are quite precise, I have my own views of how to apply it to my own practice and research and I wouldn’t want to influence listeners with these. However if it is true that we negotiate meaning and knowledge in any interaction with others, then I can be sure “novices” will elaborate what I said and integrate it with the information contained in books, articles and other sources.

This is why I love workshops in conferences and I tend to stick to these instead of submitting abstracts for talks or symposia. I like the informal character of these practice-based, interactive conversations, I like the idea of sharing my knowledge with others and discuss it, test it, reconfigure it. In a time where everything is going “massive” I find the comforting dimension of a small room the occasion to reflect on the dynamics of a small, newborn, maybe temporary learning network and of my ability to explain my thoughts to others while acknowledging different views and added information.

Lately I am hearing the term CoP more and more frequently. One of the aims of the workshop was to try and clarify what makes a CoP, differentiating it with a network of learners, and how/if this network can be “nurtured” to become a Community of Practice. How can we do so in educational contexts and what benefits would this bring? Would this even be possible?

My attention is currently focussed on one of the themes we touched at the workshop: the relationship between participation, learning and practice in an apprenticeship based educational environment, such as what we often have in medical education and is often not recognised as a “real” learning experience. Jean Lave and Etienne Wenger studied apprenticeship as a learning model, observing that learning takes place through a complex set of social interactions where everyone learns – both experienced and less-experienced participants. These are the origins of the CoP theory (6), however the term “legitimate peripheral participation” (LLP) was coined to describe the process by which individuals learn not by observing a master performing a task but directly participating in the process and learning from all participants through social interactions.

A slide from my presentation

A slide from my presentation

It is apparent that participation – and non-participation – influences practice, which influences learning and vice-versa. When I think about this relationship and the concept of CoP in its integration in educational practice, many thoughts and questions flow in my mind:

If

– Learning can happen through practice
– Engagement is vital in order to have meaningful learning

then

– How do we make sure that practice is valued by students? How is this learning embodied?
– As educators, do we value practice and the learning that comes from it?
– Do we need to measure this learning it in order to recognise it and do we do so?
– In what extent can we “cultivate” a CoP with students?

Learning through practice is not a new concept, I have already mentioned Socrate’s method, called maieutics, which involves helping learners discovering knowledge by guiding them in a reasoning process. John Dewey‘s concept of pragmatism explains quite well that the “practice” can not only be associated with the “end product”, the “artifact”, but the practice itself determines the situation, it comes into life within a social environment where actors interact to solve a problem. So we look at the process and the end at the same time.

Is this applicable to CoP dynamics? Definitely. But, can we tell students or team members “we are now a CoP”, and just expect people start behaving like one? I doubt this would work. I think it is possible to use CoP assets to benefit students in an educationally-led intervention and observe, looking through the lenses of this theory, how to facilitate knowledge creation and flow. When I asked Etienne Wenger if he thought it was interesting to analyse an online CoP of medical students to see how learning was happening, his answer was: “I think you should first determine IF a CoP is actually emerging”. This is important and true. Critically observing students in their environment, in their interrelated activities and multiple membership in different communities of learners is probably the key to facilitate engagement in a shared practice.

I wonder if the following reflections could help introducing a CoP approach in educational practice:

– Give recognition / value learning

This can even have a simple psychological value: recognition of people’s work, effort, role or learning – in any context – brings a positive flow to the practice. This is directly linked to the engagement process, because recognition itself reinforces good practices and participation, therefore learning and identification, both personal and professional.

If practice is both learning in action and its representation then, in order to make learning apparent, do we necessarily need proper assessment? We can make a learning process apparent by observing it through an interpretive paradigm where the comprehension process will be iterative, based an a continuous evaluation and re-evaluation of the learners in their environment, acknowledging psycho-social factors, interactions and social dynamic, while making causal connections between these.

Wenger says that while many argue that knowledge resources can’t be measured, because knowledge is socially distributed, dynamic and tacit, it is possible to measure and manage the “knowledge system”, the flow through which knowledge creates value (7, p166). Wenger identifies 2 knowledge processes: production and application – if we think about these processes it is possible to manage them, identify the key people involved, coordinate their activities.

In my opinion this is a great way to help students making sense of their learning through participation, using it as a scaffolding resource for reflection and ready to be  embodied in future practices.

– Magnify opportunities for learning

This is a matter of identifying affordances and constraints for learning. I think the #FOAMed workshop gave a good overview on this. While this workshop was aimed at identifying free open access online resources for learning, its roots were pedagogically led and applicable to other educational settings. The problem is to find the appropriate way or community-oriented technology – in a critical pedagogy sense: taking into account the particular time, environment, history, student group – to support students’ engagement in order to become legitimate participants of the community of learning and help them moving towards a full, mature participation – or “from less to more competence”, whatever fits better your vision. Student-led projects can be developed by using a CoP approach, nurturing students’ individual abilities and interests and creating interprofessional relationships. 

– “Walk the hall” and transform problems in to good practice (thanks Suzanne for the inspiration)

Walk the hall is a metaphor (from Wenger) of having direct contact with people/students, talking, asking about their activities, their leaning needs, negotiating a way to work together while giving them the freedom to create and develop practices and educational resources. It seems almost assumed that educators should have direct contact with students but what if we started creating a community of learning with them, developing an “enabling leadership” which promotes student flourishing, facilitates effective learning relationships and envisages a learning environment that is actually shaped by learners.

By taking into account the complexity and uncertainty of this process we can accept that meaningful moments of learning can come from moments of impasse, where problems, such as non-participation or non-engagement can be used to create a sense of community by finding a real connection with students. Hearing and valuing their voice, their identity, their creative skills and, in particular, their awareness of their own learning needs.

These are all situated practices, embedded in a socio-cultural environment but also, and more significantly, in a knowledge process that is embodied in context and involves:

– transdisciplinarity
– eterogeneity
– social accountability

These strategies need to value and make the most of social relationships by acknowledging their dynamic nature. They also need to allow autonomy by supporting learners while nurturing their accountability to other leaners, educators and the Institution.

This is such a vast subject for a simple blog post! I have more questions than answers… Surely there is no written recipe on how to embed a CoP approach in educational settings, however the following resources can help articulating a personal approach.

References and further reading:

  1. Communities of Practice Design Guide
  2. Distinctions between Communities of Practice and other structures
  3. Gibbons, M. et al.1994, The New Production of Knowledge:The Dynamics of Science and Research in Contemporary Societies, SAGE, London.
  4. Laurens, H. and van Lente, H. 2008. Re-thinking new knowledge production: a literature review and a research agenda. Research Policy. 
  5. Sfard, A. 1997. On two metaphors for learning and the dangers of choosing just one. Educational Researcher. 27 (2) – recommended by Rola
  6. Wenger, E., 2002. Brief Introduction to Communities of Practice.
  7. Wenger, E. et al. 2002. Cultivating communities of practice: a guide to managing knowledge. Boston, Mass., Harvard Business School Press.

Conexus fortuna iuvat: can learning happen by chance? – The serendipitous Twit-learning

“Fortuna iuvat eum qui conexus(est)” – fortune favours the connected – is an adaptation of the famous Latin proverb “audentes fortuna iuvat” – fortune favours the bold – which came from a short conversation I recently had on Twitter with @conquestfrca

It is apparent that being “connected”, being part of a network, helps finding information quickly and more effectively. I have experienced this many times on Twitter: I found information, suggestions, experiences just by sending a tweet, I got papers I couldn’t access because of the dreaded pay wall, I engaged in interesting discussions and connected with varied people. I lurked. I learnt.

However this purposeful learning mechanism often gives space to a less organised one, where learning happens by chance. The way in which Twitter is constructed makes it a malleable tool which utilisation can be shaped by users around their needs and preferences. This means that, depending on the quantity and quality of connections, the use of hashtags and lists, and even the platform used, it is possible to read tweets from the most disparate people and find unexpected, unconventional connections.

In an interesting paper by Rita Kop, a sentence from Latin philosopher Heraclitus sums all this quite well: “the unexpected connection is more powerful than one that is obvious”.

The twitter stream is a dynamic, ongoing conversation where information is collaboratively shaped by users. Learners need to “move” inside this stream, managing and filtering information, using it in original ways and – possibly – keeping this openness for others to enjoy and fit-in. Sometimes I think of tweets as small notes shared with an open community of learners. Sometimes they are relevant to our own learning, sometimes they are not directly connected to it but, just because they are so unexpected, they can bring insights and take us to new learning paths, original ideas and new perspectives. These tweets however need to attract our attention, personal interest, something we are engaged with, in order to stimulate learning.

This serendipitous character of twit-learning is important because it can stimulate creativity and critical thinking, urging us to use lifelong learning skills. I think Twitter is a great arena for students to practice and master their self-learning skills, especially because of the less controlled environment in which they have to find their way, select information, manage procrastination, too. However I believe we need to first introduce this tool to students as a specifically designed learning activity, in a way that they can gradually discover its value and then learn taking part in the conversation in a meaningful way.

Peeragogy – a recent example in Medical Education

While doing some rather solitary reading and scribbles for my DEd earlier, my attention was caught by this particular tweet:

I had a quick look at @twitfrg profile and the blog post explaining how this “Twitter-mediated revision” is going to work and I was positively surprised by the explanation of this initiative. As @nlafferty noted, this is not a first…

…but still, I was impressed by the pedagogical reasoning involved in the organisation of this activity. The inclusion of a revision document coupled with some MCQs to be answered before the discussion is excellent, in particular I liked the fact that students will be discussing the answers and “how they arrived at them”. I think this is an excellent way to reveal, break apart in a way, the clinical reasoning involved in the process of finding the answers to these MCQs.

I recently came across another, however different, peer-learning initiative: the “Peeragogy Handbook, a Resource for Self-organizing Self-learners”. This site contains resources and information on peer-learning  and provides a theoretical background which the authors call “paragogy”, a set of principles to understand the process of learning together.

“A healthy process for learning in paragogy consists in a direct evolution of the four principles of parliamentary democracy: (1) The right to speak; (2) The right to be heard; (3) The right to listen; (4) The right to cooperate in the proliferation of options, that is, the right to “co-lead” in the decision-making system.” – Fabrizio Terzi

                 From Peer Learning to “Peeragogy”

I wonder if students embarking in an activity like #twitfrg would be interested in reading about the theoretical background underpinning peer-learning, to plan it better and with a sound pedagogical setting; or they would rather learn-by-doing, organise in a way that answers their learning needs and just go with the flow. In this case I do not think the educational value of the activity would be lost. Of course careful planning, taking into consideration the learning needs and having clear in mind the aims of the activity would be the ingredients of a successful learning experience.

However, I immediately found this initiative quite interesting also for its connection with my doctorate subject, and, after a prompt re-tweet, I started observing the reactions. Not surprisingly the tweet called a lot of interest from many students and professionals, some offering help, others liking the initiative and starting to spread the world.

This could become a good example of multidisciplinary working other than a community of sharing, collaboration, co-construction of knowledge and I hope this initiative gets the participation and interest it deserves.

I am looking forward of seeing how this develops and I wish the best of luck to the organisers!

Some Thoughts on Participant Pedagogy

This week I am participating in a MOOC, a peculiar one, defined by the authors “a meta-MOOC“. This is in fact “a MOOC about MOOCs”, where participants are exploring collaboratively what these new “mystic entities” are, what we can expect from them and other issues they could bring involving online learning, pedagogy, teaching and assessment.

I am writing this post in an attempt to complete today’s task, which asks us to reflect upon participant pedagogy. Reading the short introductory piece to this activity I bumped into concepts like “hybrid” and “critical pedagogy”, which are put side by side with “participant pedagogy”, along with terms like “active”, “reflective”, “student-centred” and “power”.

These concepts are being increasingly discussed together, in relation to the rise of hybrid education, an education that encourages learning by offering a composition of different experiences and pedagogical strategies, often through the use of emerging technologies (my interpretation, please feedback!).

These are all important keywords in an online learning environment, BUT, as we noticed while working on the Google Doc for task1, these concepts are far from being new or innovative. They are just being highlighted by the increasing use of communication technology in teaching and learning. In our article we mentioned Socrates and again, while reading this sentence in the “Participant Pedagogy” piece…

“It is often a force of will for me to keep from explaining — to keep from providing details that carve out the space for learning too distinctly. What I expect from students, more than anything, is that they take their learning into their own hands — that they do the (often difficult) work of finding the right tools and the right recipes to meet the very loose demands of an open-ended task.” Jesse Stommel (@Jessifer)

…I could not help but thinking of the Greek term “techne maieutiké”. This literally means “the art of the midwife”, and was used by Socrates himself to refer to the dialectic art, which helps students “giving birth” to their personal thought.

Socratic teaching was based on dialogos (dialogue, conversation) and on 2 important points:

  • respect for the person one is talking to
  • the relativity of human knowledge, which is never conclusive or definitive.
Participation

Image source: opensourceway‘s Flickr stream

Now, I really think these are the basis for a participant pedagogy, both in a traditional educational setting and an hybrid one. Collaboration, dialogue, mutual interaction make learning happen in a dynamic process, where it is not a final product we are aiming at, but the process itself with all its characters of change, de-stabilisation, complexity, transformation. Participant pedagogy brings many challenges as it is never a linear process where knowledge is simply transferred from teacher to learner. Participation means active confrontation with others,  exchange, mutual enrichment; it can bring communication issues, misunderstanding, negotiation of rules, meaning and content.

These challenges and issues become heavier, more problematic in a way, with the rise of hybrid pedagogy, open education, and massive open online courses. These do change the relationships between teachers and students, who become empowered by the endless range of possibilities offered by the mediatic environment and increasingly feel the need to participate more actively in teaching activities, taking responsibility for their learning and even designing their own teaching and learning material.

Can we then extract the teacher entirely from the classroom? Should we?

Well, we could just enrol students to endless MOOCs (with no teachers!), leave them to be taught by YouTube University and Wikipedia. But here we are playing with the quality of the experience that a learner can do and finally with the shaping of their identity. Self-reflection, critical thinking, autonomous thought are skills that need to be nurtured through dialogue, online and face to face, and some kind of intervention from whom has gone through this growth before, has understood the quality and character of these experiences from a pedagogic point of view.

Collaboration between teacher and student here takes the role of Socratic maieutics. Educational technology and online material have a great power but teachers (and peers, I would add!) are the ones that can

“discern what is on a student’s mind (even though the thought may be novel and half-formed); sees how it relates to the material; and knows how to question, encourage, challenge, or otherwise prompt the student to find his or her own way out of confusion, to a clearer expression of thought or a more powerful argument or analysis.”  (Pamela Hieronymi)

Participation, especially when it happens online and within people who have never met before can be a challenge itself. An online learning environment is a place that needs to be explored exactly like a physical one. This is at least true for me. It brings uncertainty, or, as @VanessaVaile said

sounds like playing Build a Bear in the dark with total strangers #moocmooc

What and how am I going to learn? Will I be able to make interesting contributions? How am I going to manage all the amount of  information? Probably the first step to overcome this impasse is to fight the feeling and fear of uncertainty that the participatory attribute brings. There are learners that have no problem in sharing their thought with the world, they can make amazing contributions to a conversation and work actively from the beginning on collaborative tasks. There are other learners, defined as “introverts“, that may take more time, observing, analysing the environment and finally deciding if they feel confident enough to jump into the dances. Here is a situation where teachers/trainers/mediators have an important role. Not only in trying to make the educational environment as friendly as possible but also observing the group’s dynamics and communication, intervening when needed in motivating participation and critical self-reflection.

After all online participation can be a power, as dialogue is power in Democracy. Participation suppose a democratic attitude to dialogue, listening and respect, and the ability to critically reflect on owns and others behaviour. Learning happens here, too, situated in the social and historical environment where the communicative process itself is happening.

This is one of the reasons becuase participant pedagogy needs to be critical, too.

I will finish off here with this wishful thought by Pamela Hieronymi

“Technology can make education better. It will do so, in part, by forcing us to reflect on what education is, identify what only a person can do, and devote educators’ time to that.”

…and finally… This was really only an attempt to discuss today’s topic. I don’t quite feel my knowledge enough to write a blog post on pedagogy (plus, in English) but this is the challenge! I hope my thoughts will provoke some reactions, positive or negative,I would be really interested in having some feedback.

Musing on Critical Pedagogy, “care” and Medical Education – Part 1

I am in now in a stage where it seems that all I have been reading so far is not enough in order to write a decent literature review, so I am spending all the available time in full immersions of reading, jumping between several books and articles, following  a rather personal logic that often takes me to more reading and more information to digest. I wonder if I should just stick to a book at the time, being more organised and linear, or this approach is actually the normal result of an iterative reading, non-linear, where the connections with other resources are just part of the process.

Anyway, during the past few weeks I’ve been shifting between 3 books (see references) which made me think about the concept of care and how this is a bridge between education in general, the more specific area of medical education and more broad themes like co-belonging and formation/growth of the human being.

“Medical Education for the Future: Identity, Power and Location”. A particular passage has caught my attention:

“The traditional academic view of medical education as a translation of learning theory into clinical practice is no longer sufficient to help us face the culture of change and uncertainty in which doctors of the future will practice. To rise to the challenge facing medical education and practice for the future, medical educators need to develop a systematic and programmatic approach to research in the field and also to have a clear idea of what it is that they are researching, why they are researching it and what they hope to achieve. Medical educators— researchers, teachers and clinicians—need to look again at what they are doing, why they are doing it and how they can do it better. We argue in this book that all the answers to these questions can and should be found within the care of patients.” (Boldtype is mine)

I can see two big thematics here: one related to the concept of care, which is placed at at the centre of the whole medical education paradigm; and one related to the necessity of grounding medical education research, teaching and clinical practice within the social fabric, in a way that makes them intrinsically connected to the “here and now”. Both these concepts are at the heart of Critical Pedagogy.

Critical pedagogy gives full importance to the historical and social nature of educative process. This means that the educative process should start and be grounded on a critical theory of society, of science and of the subject. The meaning of the term “critic” here is to “explain and interpret the society in order to actively change it” (see Max Horkheimer).

In this sense I think critical pedagogy foundations should be applied to medical education, using a critical approach to research and teaching. This means really embedding these processes into the social environment to get full benefits, which will eventually improve patients care. This is not an innovative thought, in fact while reflecting on this I remembered about Virchow‘s social medicine, which I read about at the university. This 19th century’s German doctor stated that:

“Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution… The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

In fact, when he was invited to write a report on a typhus epidemic, he stated that that “the outbreak could not be solved by treating individual patients with drugs or with minor changes in food, housing, or clothing laws, but only through radical action to promote the advancement of an entire population, which could only be achieved by full and unlimited democracy, education, freedom and prosperity”. 5

He is not the only one to connect democracy, education and economy – just to mention some: philosopher and psychologist John Dewey, Economist Amartya Sen and sociologist Antony Giddens – but surely he connects these more explicitly with health. I will explore these connections further for my literature review.

Part 1 ends here, I need to translate some rather confusing itanglish sentences… Part 2 will be more about the concept of care and a wrap-up of both posts… Hopefully I’ll manage to do it tomorrow while travelling, or under the Sardinian sun perhaps!

 

References (3 and 4 are for Part 2):

1. Bernhard, A. (2006). Pedagogia critica : tendenze di sviluppo e progetti per l ’ avvenire. Collana di Studi Internazionali di Scienze Filosofiche e Pedagogiche Studi pedagogici, (1), 1-24.

2. Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, Power and Location. New York: Springer, 2011.

3. Carlgren, I. From Teaching to Learning: The End of Teaching or a Paradigmatic Shift in Teachers’ Work? in Hudson, H & Meyer, M. A. Beyond Fragmentation: Didactics, Learning and Teaching in Europe. BB, 2011.

4. Granese A. Istituzioni di Pedagogia Generale: Principia Educationis. Padova: CEDAM, 2003.

5. Wikipedia http://en.wikipedia.org/wiki/Rudolf_Virchow

Thoughts on Communication, Democracy, Complexity…

I recently attended a seminar organised by the Centre for Medical Education. Professor Alan Bleakley gave a thought-provoking presentation on “Communication matters: doctors must learn with, from and about patients.” I knew this seminar was going to be interesting but I am even more pleased I went because the talk was developed around 3 main points that I am developing in my literature review: Communication, Democracy and Complexity.

Complexity

This photo belongs to PhOtOnQuAnTiQuE’s photostream on Flickr.

I arrived a few minutes late and the fist slide I saw was describing this concept: “the purpose of medical education is to improve patients’ care”. In order to benefit patients, doctors need to communicate effectively with them, “listen to them closely and give them their rightful place—at the heart of medical practice.”(1)

This may look like something straight forward but in reality there are a lot of issues around it and this concept has stimulated a flow of thoughts which I am still in the process of connecting in a meaningful way. This is what I am trying to do with this post but, I must say, these thoughts will have a very personal, perhaps very tangled, thread.

Communication is one of the keys of good medical practice. Poor communication (doctor-patient, inter-team) can lead to medical errors and iatrogenic deaths, this is why it is so important that particular attention is given to it, starting from the early years of undergraduate medical education.

Prof Bleakley explained that students are often exposed to “bad examples” of doctor-patient communication. “The patient has to learn the doctor’s language, obey the doctor’s lead, follow the doctor’s advice and even work out how to negotiate his or her way around the doctor’s world.”(1) Medical students are spectators of this unbalanced dynamics and can luckily pick these habits. Why does this happens? Language for Pierre Bourdieu is not only used for communication but also as a mechanism of power. Every person uses a peculiar language which is strictly influenced by his/her position or status in the society. In this way everyone “makes clear” to others if and in what extent he/she is in the condition to “have the last word” for example or even to be interrupted or not in the discourse (sorry for the twisted thought!). This is exactly what happens sometimes in a doctor-patient and student-teacher dialogue – and in many other situations.

Bleakley said that first of all medical education needs to become more democratic, both in the communication process and in action. Moreover students need to learn how to face the culture of change, complexity and uncertainty in which they will practice as doctors in the future.

What can we do about this in undergraduate medical education? How could we facilitate, or even teach, if possible at all, good communication, complexity and understanding?

Two of my favourite thinkers, John Dewey and Edgar Morin, come to my mind when talking about these subjects.

Dewey has pointed the democratic society as the most suitable environment for the development of personal qualities and skills. An educative environment should be a place where dialogue and critical thinking are constantly practised and where communication and listening skills are developed alongside with personal constitutive skills and energies. These are fundamental because within democracy every single subject needs to collaborate for a common end, and at the same time everyone needs to be ready to face change, be accustomed and open to it, acknowledging the dynamic character of democracy.

And dynamism, change, transformation are definitely intrinsic aspects of today’s social environment. If Dewey has seen in democracy both a “place” where education is exploited and, at the same time, the “product” of a (democratic) education; Morin has put it within a list of seven facets of essential knowledge that should be covered in education for the future, along with principles of pertinent knowledge, mutual understanding, detecting error and dealing with uncertainty.

“We have to learn how to confront uncertainty because we live in a changing epoch where our values are ambivalent and everything is interconnected. This is why the education for/ in the future must review the uncertainties connected with knowledge. […] Learning is indeed an uncertain adventure which in itself permanently entails the risk of illusion and error.” (2) He then adds that “learning is navigation on a sea of uncertainties dotted with islets of certainties”. I particularly like this metaphor because it reminds of online learning. A journey that can take you to many little islands carrying information but also allow connections with people with whom you share knowledge and dialogue. This can sometimes bring communication and understanding issues, especially when dialogue happens in an online environment.

Now, if we consider learning as a “navigation on a sea of uncertainties”, it means that the learning process itself and the environment where it evolves is actually the place where students should be “trained” in coping with change, complexity and uncertainty.

Morin defines complexity in terms of an “extreme quantity of interactions and interferences between a very large number of units” (3). Social Media in this sense is definitely a paradigm of complexity. Now the question is: could SM be considered as a “playground” where students can experience interactions with different people, cultures and backgrounds, communicate with professionals in higher positions, patients, doctors, peers, etc… This also becomes a tool for reflection. In fact, according to Morin, the understanding of complexity of social interactions and of the human being itself  comes through introspection, which should also improve empathy.It also requires communication, discussion, exchange of opinions rather than ” damning and excommunicating” (3). In short, a democratic principle, which naturally entails a social interaction component, is needed to understand others, but it all starts from an introspective work of self-reflection. Obstacles to understanding come principally from egocentrism, inability to self-criticise, preconceived ideas, wrong assumptions, ethnocentrism.

Can we learn how to cope with complexity by experiencing it directly inside the complex SM environment? Can we practice (teach?) democracy and acceptance in an environment where (ideally) democratic principles of dialogue should be intrinsic, but are often neglected?  In Twitter for example, I saw many good examples of dialogue but also situations where the 140 characters were used as a substitute of pottery shards to ostracize someone, who only shared their opinion openly through a tweet.

There is no need to say how vital the role that medical humanities play in this; communication skills are taught in the curriculum and it is extremely important to facilitate students in recognising the sociological implications in every social interaction: with peers, teachers, patients… both face to face and online. During my Master’s I was introduced to basic counselling skills, the meaning and importance of being assertive and listen actively; I enjoyed reflecting on gender and power issues, group dynamics, inter-cultural communication issues, how assumptions can lead hour behaviour and thinking.  This kind of self-reflection is a good starting point for recognising unbalanced power situations and try to overcome them, both in language and in action.

References:

(1) Bleakley A, Bligh J, Browne J. Medical Education for the Future: Identity, Power and Location. New York: Springer, 2011

(2) Morin E. Seven Complex Lessons in Education for the Future.UNESCO, 1999.

(3) Morin, E. On complexity. New Jersey: Hampton Press, 2008