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it was stated that “medical education has not kept pace with [societal] challenges, largely because of fragmented, outdated and static curricula that produce ill-equipped graduates” (Frenk et al 2010:1).The need for greater interdependence was one of the key findings from this study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.