Sketching my approach in DBR

Design-based Research (DBR) is the approach chosen for my study. It provides a framework for the development of innovative improvements to pedagogical practices through the relationships linking theory, products and practice. The iterative cycles of evaluation and refinement are well suited to my teaching and research as we have five blocks of students through the year all going through the same teaching rotations in different time slots. DBR is a pragmatic approach that “focuses on understanding the messiness of real-world practice, with context being a core part of the story and not an extraneous variable to be trivialized” (Barab & Squire 2004:3).

Changes in Obstetrics learning need to be a collaborative effort from numerous stakeholders. Herrington, Reeves and Oliver (2010:189) point out that DBR offers opportunities for “supporting human interactions and nurturing learning communities”. The goal of DBR is improve practice while advancing theory that will be valuable to others.

The image above is a summary of my research project so far. It was created on the Notability App on my iPad while I was sitting on the aeroplane flying home to Cape Town. This was in preparation for our discussions with Prof Jan Herrington from Perth. Among other points related to DBR, she encouraged me to use tables. She also pointed out the importance of clearly identifying my design draft principles for this project. One of the most powerful aspects of using DBR is its emphasis on sharing and disseminating findings and principles (Wang & Hannafin 2005). The value of design principles lies in the contribution they make to the professional community.

Reeve’s model (2006)

Problem	Solutions / improvements	Implement, review & refine in cycles	Principles & artefacts
Silenced student voices Fear Curriculum as task driven Disrespect in Obstetrics	Draft design principles and guidelines enable collaboration elicit articulation provide facilitation offer feedback encourage reflection demonstrate diffraction engage with relationality illuminate affect Facilitator Explore the affordances of technology	Implementation with data collection Evaluation after each student block through self and student feedback Tools used Intro WhatsApp wordles Google drive - forms, sheets, docs, slides During rotation critical friends tips for colleagues articulation & reflection Interactive workshop expert’s input roleplays, poems etc drawings mindfulness exercise WhatsApp wordle Extra resources created video recordings iPad apps for blog images	Principles to be expanded Co-constitution of knowledge Exploring interrelationships Developing collaborative spaces Engaging with social injustices Principles related to new materialism that decentre the human E-learning resource to be published as an OER including expert images video recordings on YouTube from HOD website on probing professionalism more to be developed
How? Literature Survey senior students Interviews with educators Drawings	Using Barad’s sociomaterialism Deleuze & Guattari’s rhizome	Using affordances of emerging technologies group work Data collection & analysis through a diffractive methodology	Artefacts that are emerging Students’ shared reflections using the Six Step Spiral for Critical Reflexivity (SSS4CR) Student roleplays/videos/poems Storytelling Drawings Wordles Blog
To develop a socially just pedagogy	To use face2face and online engagement	Using different groups of students to iteratively develop intervention and theory - 40 in each block every 8 weeks (5 blocks annually)	Ethics approval received from UCT & UWC To share design principles rather than just the teaching improvement Consultative process with other actors and stakeholders

Barab, S., & Squire, K. 2004. Design-based research: Putting a stake in the ground. The Journal of the Learning Sciences, 13:1:1-14.

Reeves, T. C. 2006. Design research from a technology perspective. In J. van den Akker, K. Gravemeijer, S. McKenney & N. Nieveen (Eds.), Educational design research. London: Routledge.

Reeves, T., Herrington, J., & Oliver, R. 2005. Design research: A socially responsible approach to instructional technology research in higher education. Journal of computing in higher education, 16:2: 96-115.

Wang, F. & Hannafin, M. 2005. Design-Based Research and Technology-Enhanced Learning Environments. Educational Technology Research and Development. 53:4:5–23.  

Communication focus

Yesterday my research path led me to facilitating a focus group with seven amazing final year students. It felt like we were together-apart, creating a transformative space for the sharing of human dis/connectiveness (Barad 2007). It was an emotional meeting place for a conversation sparked by individual drawings. The images that each student created with pastels illustrated some of the dark moments that they recall from their fourth year learning in Obstetrics, as well as memories from remarkable role models who displayed admirable characteristics during difficult times.

As ideas and experiences became entangled in our conversations, it became evident that relationships matter a great deal in student learning, yet often neglected. The drawings and the discussions demonstrated some of the invisible tensions emerging through students’ learning, such as the hierarchical relations in the medical system, facility rules that undermine care, the closing down of communication following death and the associations with personal positions. Sometimes the best learning was grasped when a student observed the action from a distance.

The focus group was an example of material-discursive intra-activity (Barad 2007). The objects represented on the papers gave force and intensity to our discussions highlighting the entanglements of discourse and matter. For instance curtains drawn boldly across the page showed how a student was excluded from a bereavement experience. She observed the signs without any explanations. Wheels of movable equipment were visible rather than human suffering.

Looking at drawings that reflect the medical curriculum from a student’s perspective offers key insights into their being and becoming doctors. Their individual and collective learning experiences open up issues of social justice related to the curriculum. Furthermore, the critical gazes that students develop in their educational journey can contribute to meaningful changes particularly in terms of the integration of epistemological and ontological elements.  Drawing on hook’s Pedagogy of Hope, Carolisson et al (2011:158) assert that a crucial element for building critical citizens who can promote change in communities is to promote interpersonal relationships through “conversations that facilitate reflexivity, dialogue and criticality”.

The image above was drawn using the Penultimate app on my iPad.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

Carolisson, R., Bozalek, V., Nicholls, L., Liebowitz, B., Rohlender, P. & Swartz, L. 2011. bell hooks and the enactment of emotion in teaching and learning across boundaries: A pedagogy of hope? SAJHE 25:1:157–167.

Meeting Multiplicities

Tensions and contradictions inevitably exist in pedagogical processes. Medical education is no exception. The hierarchical power differentials in medicine as well as competing disciplinary needs compound these challenges.  Fenwick and Nerland (2014:78) assert that a “multiplicity of competing knowledge and abilities coexist in uneasy tension behind the authoritative normative accounts produced to support the myth of a coherent and bounded professional practice (and practitioner)”.

Medicine is a prestigious profession held together by tight authoritative controls. The need for change in established pedagogies is highlighted in the large collective study reported in the Lancet where it was stated that “medical education has not kept pace with [societal] challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped graduates” (Frenk et al 2010:1).The need for greater interdependence was one of the key findings from this study by 20 experts who recommended moving away from “isolated to harmonized education, from stand-alone institutions to networks, alliances, and consortia, and from inward-looking institutional preoccupations to harnessing global flows of educational content, teaching resources and innovations”(2010:3).  

Collaboration is a key tool to develop future health professionals who are equipped to promote quality healthcare for all. This is particularly pertinent in South Africa with its past history that plays out in present teaching and learning practices.  There is a great need to move beyond closed systems at both individual and group levels. At our Dean’s selection presentation last week, collaboration was presented as a pillar for progress; it is an underlying principle in the Open Education movement and a common thread that appears in most of my presentations related to my teaching, research and learning.

Respectful collaboration related to student learning involves surfacing multiplicity and embracing the complexity of practice. In the Health Sciences this fosters deeper and more meaningful insights that contribute to our understanding of the lived realities of our students and their engagement with the health system. These capacities to work both for and in collaboration foster the co-production of knowledge generation (Fenwick 2012).

Several theoretical approaches move away from understanding teaching within fixed boundaries and control. The dynamic and fluid nature of education is energized with intensities arising from tensions, contestations and perturbations. Hardman (2005) points out the value of Engeström’s system thinking for our South African context through activity theory, where the connection of tool-mediated activities are related to different and differing collective social relationships in the human activity of learning. Barad (2007) takes a more inclusive stance by including “spacetimemattering” in which intra-acting phenomena occur within dynamic assemblages. Fenwick (2012:156) puts forward complexity theory to “understand the dynamic multiplicities of practice”. She suggests that the emergence of relationships and connections between humans, non-humans and energies are seen as “nested within various systems of geographical arrangements, weather, political discourses, racialised identities and so forth”. In these nested relationships that are unstable and uncertain, there is possibility for fostering “trust-within-diversity” (Fenwick 2012:150).

Evidence is the driving force for change in medical education. However Fenwick (2012:157) points out a contradiction. She contends that the “problem for professionals is the more common expectation that they should solve problems, using ‘evidence’ obtained from past practice and distant contexts. Such evidence based knowledge is not about adapting with emerging complexity, but about prediction and control”.

The image above (drawn using Papers on my iPad) aims to show the richness in using a nested approach that draws on diversity rather than a linear, contained and closed educational system. By looking through and working with different lenses, I am able to appreciate the jagged edges rather than being compelled to take a single linear path that files out the perceived flaws.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

Fenwick, T. 2012. Complexity science and professional learning for collaboration: a critical reconsideration of possibilities and limitations, Journal of Education and Work, 25:1:141-162,

Fenwick, T. 2014. Rethinking professional responsibility. In Reconceptualizing professional learning: Sociomaterial knowledges, practices and responsibilities. (Eds) Fenwick & Nerland. Routledge. Abingdon.

Frenk, J., Chen, L. Bhutta, Z. et al.. 2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet. 376:9756:1923–1958.

Hardman, J. 2005. Activity Theory as a framework for understanding teachers' perceptions of computer usage at a primary school level in South Africa. South African Journal of Education. 25:4:258–265.

Consequences considered

“There is a world out there 

that shapes and constrains 

the consequences of the concepts 

we employ to understand it” 

(Hekman 2007:109).

The image above (drawn on my iPad using iPastels) illustrates an eye viewing the teaching process. The colander contains spaghetti that is squeezing through, and out of the container. Initially the pasta is neatly packaged in straight lines. In the cooking process, it transforms and then becomes slippery. It can be difficult and tricky to eat especially in the company of others.  There seems to be a link with education. Perhaps the colander is the idealized framework of the curriculum, also more broadly, of human rights education.  The straight, linear progression is changed to a complex mix of entanglements that become unpredictable.  Loris Malaguzzi (2006:6) uses this concept (at the Reggio Emilia School for Early Childhood Learning) to refer to a philosophy of knowledge that resembles a “tangle of spaghetti”.

Human rights and consequences go hand in hand. Yet the teaching of human rights frequently keeps a focus on the principle of universalism through the coded legal instruments rather than the broader relational aspects. How do our students relate this teaching to their future practice and to their responsibilities to promote social justice? This questioning was the catalyst that originally inspired my innovative teaching methods and this research.

All our undergraduate medical students are exposed to the same curricular content for certain core themes such as human rights. Like other topics, it is threaded through the curriculum In a spiral and segmented manner with different approaches. My earlier evaluation of human rights teaching in the Faculty in 2007 demonstrated how varied this teaching was - strongly influenced by the educator’s own conception of human rights. Similarly the uptake of the learning and knowledge by students seems to vary enormously. While assessments do indicate these differences to a certain extent, there are broader issues that become apparent when we engage more deeply with the students.  

There are criticisms relating to how human rights education is delivered especially when it is conceived in an uncritical way such as identifying rights violated and those realized in different case scenarios. A human rights approach is complex. Hoover (2013:953) claims that we need to “think agonistically about rights”. Rather than seeking commonality, we need “a generation of space for contesting existing identities and sites of political authority”. The need to engage with the plurality of human rights is taken further by Zembylas and Bozalek (2014) who assert that we can benefit from a broader perspective by drawing on theories of posthumanism and the affective turn. Through critical posthumanism and affect we can de-centre the human and recognize the relational ambiguities that lead to social, political and economic consequences - expressed as “a productive perspective to creatively re-imagine human rights” (2014:44).

How much do medical undergraduate students understand about their professional responsibilities and their powerful role that they can play in advancing rights? When I ask students in an introductory classroom session in the middle of their third year to write down in a sentence what they know about human rights in terms of women’s health, there is an astonishingly wide range of answers.  This variation highlights the different meanings associated with human rights. Like a bowl full of pasta, we all taste it in different ways. I wonder how we can better engage with these differences and use them in an affirmative and constructive way.

Thanks to Assoc Prof Karin Murris for introducing me to the Philosophy of Children

Hekman, S. 2006. Constructing the ballast: An ontology for feminism. In Emerging models of materiality in feminist theory.  Material Feminisms (Eds) Alaimo & Hekman. Indiana University Press. Bloomington & Indianapolis.

Rinaldi, C. 2006. In Dialogue with Reggio Emilia: Listening, Researching and Learning. Routledge. New York.

Zembylas, M. & Bozalek, V. G. 2014. A critical engagement with the social and political consequences of human rights: The contribution of the affective turn and posthumanism. Acta Academica. 46:4:29-47.