Analysing analysis

“What we do as researchers 

intervenes with the world 

and creates new possibilities 

but also evokes responsibilities” 

(Hultman & Lenz Taguchi  2010:540).

Over the past week, a sense of discomfort and a touch of anger permeated my thoughts as I reflected on recent interviews with clinician educators and students and considered ways of analysing my data. While we may take up a neutral stance in collecting data, with limited intervention as an interviewer and facilitator, the data impacts on our own being and becoming. We become immersed in the flows of relationships, in between the waves of encounters that interfere and intra-act with each other.

By recognizing affect in the data and in ourselves, our professional responsibility moves beyond contained, static and structured knowledge boundaries.  Fenwick (2014:158) suggests that it may be “more comforting to focus on human skill and [to] imagine that this can be resolved through training and discipline, rather than attempt to consider how responsibility may be distributed among the heterogenous entanglement of … material and technological assemblings”. In this sociomaterial approach “responsibility becomes reconfigured” through the “material enactments of conflict and compromise that appear in enactments of professional responsibility” (ibid). In my research, obstetric tensions are strongly related to societal inequities. There appears to be a crack or a disconnect between students who feel disheartened,  sometimes even traumatized, and others connected to educational practices who seek justification for unprofessional behaviours.

As I consider ways of analysing the growing data collected through these interviews, focus groups and drawings, the traditional method of coding to find common and recurrent themes and trends, becomes less attractive. Coding pulls together sameness through groupings and subgroupings, sometimes referred to as nodes. It offers a structured and layered genealogy that represents the information gained through the research process. If I choose a diffractive methodology that identifies differences, valuable truths can emerge that can be productive - “a different kind of knowing” (Hultman & Lenz Taguchi 2010:526).

Jackson (2013:742) argues for a posthuman ontology that engages with the entanglement of the human and non-human rather than coding that creates stabilized structures grounded on unchanging human-centred truths -- “an epistemological project flavored with humanism”. Deleuze and Guattari (cited in Hultman & Lenz Taguchi 2010:535) refer to ‘over-coded-machines” and Mazzei (2014) points out the predictability of the known in traditional coding with its consequent reductionism.

McClure (2013) draws on Deleuze’s rhizomatic thinking to note the hierarchical, arborescent nature of coding. She (2013:165) contends that coding is valuable as a “logic of representation [that] is culturally and politically significant”, however acknowledges the limitations especially associated with the dynamic relational ontology.

In terms of poststructural research, the following points suggest a need to explore alternative options for data analysis:

1. Coding happens in a safe, seemingly uncontested space as the distancing contributes to removing the researcher away from the complexity of the data, a “pull back from the data” (Mazzei 2014:743). There is distancing between the research analyst and the data.
2. The logic of representation has a contracting influence on the data. “Coding does not recognise changing speeds and intensity of relation, or multiple and mobile liaisons amongst entities” (McClure 2013:169).
3. The dynamic nature of the entanglement of data is lost in coding as it represents a fixed, limited and defined (by the researcher) reality.
4. Uncertainty is disregarded as “coding renders everything that falls within its embrace explicable” (McCLure 2013:169).
5. The act of slicing and cutting the data into groups or chunks tends to be human-centred. The interrogation of the dissected data by the researcher can lead to questions of ethical responsibility.
6. There is a sense of othering, a “colonial relation of researcher to subject” (McClure 2013:168). In addition objects tend to remain passive rather than mutually constituting meaningful data.
7. The naming of codes acts as a limiting mechanism. The dominance of language undermines the impact of affect.
8. There is privileging of a normative voice rather than a transgressive alternative according to Jackson and Mazzei (2012).

Jackson and Mazzei (2012) challenge us to think with data, to become enmeshed, immersed, and possibly unsettled as we plug in the theory with data and the data with theory. These forces and intensities attract me. I feel pulled towards postcoding in a post-qualitative framework that will allow me to ask myself, “how does the mangle move us into a different way of thinking” towards developing a socially just practice in medical education through a collaborative mutual inquiry that engages socio-material practices? (Jackson 2013:744).

Mazzei (2014), in drawing on Barad’s concept of diffraction, demonstrates the value of reading insights and meanings through each other. She recognizes that “knowing is never done in isolation but is always effected by different forces coming together” (2014:743). A diffractive, rhizomatic analysis “emphasizes difference by breaking open the data” that involves “moment[s] of plugging in, of reading-the-data-while-thinking the-theory, of entering the assemblage, of making new connectives” (ibid). There is an immersion and entanglement of ourselves and the data. There is a flow of encounters that takes place (Hultman & Lenz Taguchi 2010:537).

The image above was created with iPastels. My imported selfie image was painted over with the tools on the App on my iPad. I tried to give the impression of being caught in diffractive waves as my thoughts mingled with the audio playbacks of my recent interactions with research participants.

“[A] diffractive ‘seeing’ or ‘reading’ the data 

activates you as being part of and activated 

by the waves of relational intra-actions

between different bodies and concepts (meanings) 

in an event with the data” 

(Hultman & Lenz Taguchi 2010:537).

Fenwick, T. 2009. Rethinking professional responsibility. In Reconceptualizing professional learning: Sociomaterial knowledges, practices and responsibilities. (Eds) Fenwick & Nerland). Routledge. Abingdon.

Hultman, K. & Lenz Taguchi H. 2010. Challenging anthropocentric analysis of visual data: a relational materialist methodological approach to educational research. International Journal of Qualitative Studies in Education. 23:5:525-542.

Jackson, A. 2013. Posthumanist data analysis of mangling practices. International Journal of Qualitative Studies in Education. 26:6:741–748.

Mazzei, L. 2014. Beyond an easy sense: A diffractive analysis. Qualitative Inquiry. 20:6:742–746.

McClure, M. 2013. Classification or Wonder? Coding as an Analytic Practice in Qualitative Research. In R. Coleman & J. Ringrose (Eds). Deleuze and research methodologies. Edinburgh University Press. 164-184.

Significance of signatures

A signature has become the cornerstone of our society’s accountability mechanisms. For instance in professional practices audits require sign-offs, legal transactions are activated through signatures, medical procedures and instructions follow after permission is indicated through signatures. In many ways signatures act as the gateway to transact or take further action.

In higher education institutions students sign plagiarism forms when submitting their assignments, sign to indicate their presence in compulsory lectures and sign agreement for consent in research projects amongst other contexts. However we frequently hear about the undervaluing of these signatures when plagiarism is picked up in assignments, when students sign for their absent colleagues or when there may be coercion in research participation.

The significance of a signature is far more than a rubber stamp. There are many underlying meanings that have implications. In our Year 3 health and human rights workshops that focus on women’s reproductive health, students learn about coerced sterilization. Women find out years later that they were forced to sign consent for tubal ligation when they were in labour, about to have a caesarean section. Litigation is in progress in South Africa to seek retribution for some of these women.

The signature itself has undeniable agency. Medical Year 4 students in Obstetrics (as in many other disciplinary rotations) need signatures in their logbooks as sign-offs to indicate that they have achieved the required skills and number of procedures to complete the course objectives - a task-oriented move for accountability. There are relationship issues embedded in the event of signing that reflect power and authority. Students tell me how difficult it is at times to ask for the necessary signature. It drives their actions and denies them opportunities to challenge certain practices. Students learn to please those who are responsible for the signatures. They feel a dependency on others who hold the power for sign-offs. Sometimes students find themselves having to beg and plead. Any conflict can bring refusal to sign with unwelcome consequences.

Furthermore the need to get the required signatures shapes students’ attitudes and behaviours as they move through their 8 weeks in the learning block. A desire to achieve the necessary number of signatures appears to distract students’ sense of responsibility in caring for women in labour. For some, the signature matters most - at a cost.

In terms of new materialism, the signature-logbook-student becomes a dynamic apparatus that mediates the agenda of the task-driven process (Barad 2007). It can act as a barrier to care. While the signature plays an important role as a measure of accountability, it also has agency through its entanglement with other phenomena, resulting in certain exclusions - an ontological inseparability. The power dynamics in the material practice of acquiring signatures in a logbook create forces and intensities that conflict at times with compassionate caring. In the material-discursive practice of learning in Obstetrics in health facilities, the agency of matter is actually contributing to undermining the quality of health care.

What matters is the collection of signatures. It opens the academic gate to allow students to pass through into their next learning block. The image above reflects the intra-acting forces that surround the becoming-logbooks and that influence student learning. It was created on my iPad using the Brushes App.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

Just students

Springgay and Freedman (2009) write about touch and relationality in terms of (m)othering in their quirky paper referring to Canadian visual artist, Diane Borsato’s experimental narratives in which she touched 1000 people with different reactions to the entitlement of space emerging, and slept with ten cakes in her bed to sense the materiality of such closeness. The concept of space, both interpersonal and personal, when linked to the material, highlights the relationships between things and bodies.

These relationships of “inter-embodiment” where knowledge is gained through the intermingling of bodies and non-bodies, places educators and students in in-between spaces. When our medical students are immersed in their clinical rotations they traverse this “space of movement, of development, and of becoming” (Springgay & Freedman 2009:29). The suggestion of a “bodied curriculum” is helpful as it illuminates difference in the daily realities “where bodied encounters become the performance” (Springgay & Freedman 2009:32).

In a recent focus group with six year 4 students who had just completed their 8 week Obstetrics rotation, I heard about their many difficulties in building relationships with other health team members in their attempts to offer care and support to women in labour. One student claimed that she learnt more about people in this learning rotation than about medicine. There was agreement that students felt there was just nothing that could adequately prepare them for the situations they faced - a sense of feeling at the bottom of the food chain of the medical hierarchy. Even patients who had just been through the labours of labour, sometimes asked students why some midwives were so rude to them.

One of the objects that matter is the placenta. Its removal becomes a force and intensity that disturbs learning and relationship building. There are both active and passive options for cord traction with a multiplicity of viewpoints and ways-of-doing. It can get pulled and pushed with varying levels of tension. I’m told it’s about the feeling of tightness to the puller. Great caution is needed to avoid the cord snapping. Each practitioner appears to develop their own ways that work best for them and sometimes belittle different ways recommended by others. Judgemental comments about the touch and the pull are frequently experienced by students who then feel undermined rather than encouraged in their learning to become confident doctors. The placenta moves from a position of providing life to a foetus, to a point of tension between students and those with more experience. It then becomes a waste product leaving its mark. Students find themselves trying to be people-pleasers as their thoughts drift through their own agendas for passing through to the next learning rotation by fulfilling the curricular requirements.

Listening to the students’ voices brings a different perspective to curriculum matters. When they move from theoretical lessons in the classroom to practical encounters in the local health facilities, they find themselves in this in-between space where uncertainty prevails amidst many multiplicities. Apart from the memories of such challenging moments, the smell of the placenta also lingers with students long after they have left the learning space of Obstetrics facilities.

The image above was drawn on my iPad as I sat and reflected on the focus group. Using the Brushes App I tried to illustrate the powerlessness felt by students, and the force and intensity that the placenta can have on student learning. From their own drawings, 2 out of 6 students drew tearful faces indicating their struggles through this curricular imperative.

I wish I had more artistic skills to better portray the bodily encounters in my research intra-actions. Recently I was connected to the inspiring artworks by David Hockney. He uses the Brushes App on the iPad to create an innovative art collection. He shifts perspectives in unusual ways through the affordances of technology and his artistic expertise.

Springgay, S. and Freedman, D. 2009. M/othering a Bodied Curriculum Sleeping with Cake and Other Touchable Encounters. Journal of Curriculum Theorizing. 25:2:25-37.

Acts of articulation

The Merriam-Webster online dictionary defines articulation as

• a joint or juncture between bones or cartilages in the skeleton of a vertebrate
• the action or manner of jointing or interrelating
• the act of giving utterance or expression

Articulation in medicine generally refers to joints; bones articulate with each other in different ways. For instance a hinge joint provides a linear movement such as the ulna with humerus at the elbow, while a ball and socket joint such as the femur and pelvis at the hip provides constrained movement in many directions. Perhaps this can be useful when moving from binary approaches in pedagogy to postconstructionism where multiplicity matters.

The multiple roles and perspectives in real-life events contribute to authentic classroom learning according to Herrington, Reeves, and Oliver (2010). The learning environment embraces the complexity of real-world practices rather than working in a simplified version. Another one of the nine elements that are recognized in authentic tasks is articulation in terms of the expression of thoughts and feelings.

In pedagogical practices, articulation “enable[s] tacit knowledge to be made explicit” (Herrington & Kervin 2007:3). In my project articulation seems to be a strong thread that is pulled through the practice and pedagogy and in the research. Students going into their Obstetrics rotation converse with each other during the block and in preparing for their interactive workshop. Articulation occurs across several layers of interactions. In the introductory session, students glimpse into the real world of Obstetrics in Cape Town clinics where their taken-for-granted expectations are questioned. By engaging online and face-to-face at the different stages during the rotation, students can take a standpoint or question others’ perspectives.

My role is to create a safe and supportive space to foster honest articulation. The “responsibility for learning rests with the learner” rather than the teacher (Herrington, Reeves & Oliver’s 2010:190). Recently the introduction of drawings in the classroom and in the research focus group has created a multimodal approach that is enhancing the process and leading to new insights through sociomaterialism. While articulation assists students to express their feelings and to share their difficult experiences in maternal obstetrics facilities, it also acts as a channel to vent feelings of anger, disgust and helplessness.

Images have become a tool to engage with the needs of the diversity of our students. These drawings are connecting the discursive with the material providing an alternative avenue for expression. Barad (2007:267) asserts that “matter and meaning are mutually articulated”. Barad (2007:152) explains this intertwined and co-constitutive relationship: ‘Neither discursive practices nor material phenomena are ontologically or epistemologically prior. Neither can be explained in terms of the other. Neither is reducible to the other. Neither has privileged status in determining the other. Neither is articulated or articulable in the absence of the other; matter and meaning are mutually articulated’.

In a recent focus group a student explained that a classroom invitation to draw had left her powerless. However in the new space of our focus group, a large sheet of paper with markers enabled her to enthusiastically engage with a symbolic representation of her observations from a clinical encounter where a 15 year old girl in labour was treated with disrespect.

In the image above drawn using iSketchbook on my iPad I have tried to illustrate the jointing and interrelationships that occur in the different forms of articulation.

Barad, K. 2007. Meeting the universe halfway: Quantum physics and the entanglement of

matter and meaning. Durham, NC: Duke University Press.

Herrington, J & Kervin, L, Authentic learning supported by technology: 10 suggestions and cases of integration in classrooms. Educational Media International, 44(3), 219-236.

Herrington, J., Reeves, T. & Oliver, R. 2010. A guide to authentic e-learning. Routledge. London.