Racing tracks

To my surprise the image of a racing track was drawn by a couple of my research participants. They were asked to reflect on their involvement in the obstetrics curriculum. One drawing was created by a doctor educator and the other by a student who had recently completed the obstetrics’ eight week rotation in his fourth undergraduate year. These two drawings have produced an affect and effect on me as I continue thinking about them, their differences and the effect of these differences. I wonder about the tracks and about the pertinent connections made to the medical curriculum and student learning.

The clinician educator pointed out the curriculum as a clearly structured track designed through evidence-based practice, yet interrupted and mediated at measured and defined points by evaluations and assessments. Student resilience was central, marking its overriding importance in student performance and achievement.

This drawing reminds me of the competitive, individualistic nature of much of the medical curriculum. The obstetrics rotation is just a small chunk of the larger curriculum that aims at a speedy throughput to fill the national need for more doctor graduates. The starting point for the Health Sciences Faculty is at the first year orientation session and the endpoint at graduation from where students embark on their challenging career as interns, community service practitioners, medical officers, then possibly leading on to registrars and specialist consultants. It is a structured path set out for students and mediated by accreditation standards.

The other racing track drawn by a student participating in one of my focus group discussions showed a different perspective. He drew his car on the track with flags at different points indicating caution. The central area was filled with the distinct branding logo of the car he proudly drives. He explained how he considered his learning as a race to achieve the curricular requirements. During his obstetrics block, this was facilitated by his speedy driving (well over accepted limits) to reach an unexpected night time delivery that enabled him to attain the required number of deliveries. He did reflect on the irresponsibility of “driving like a lunatic”.

I wonder how differently the curriculum plays out for less privileged students who do not have their own transport or opportunity to make an extra trip at night. What about the positionality of students in terms of different forms and access of transport in relation to their curricular needs?

Through my engagement with the materiality of the data emerging from the drawings of these two research participants, new insights are emerging. My own connection with these images and resultant inquiry and curiosity is opened up through my personal limitations imposed by a visual impairment that prevents me from being a driver.  The image above (created using the 53 App on my iPad) foregrounds a car tyre and its tread. The shape and size of the tyre indicate the status of the car while the pattern of the tread gives the finer detail that can add insights into the relationship of the vehicle and the driver. The flag denotes the marked segments of the curriculum or the warning signs for danger.

MacLure (2013) points out the value of wonder in research methodologies. As I wonder with and through these two drawings, I feel the material forces, and sense how affect is constituted by the intra-active entanglements between the data and myself (Barad 2007).

MacLure (2010) refers to Massumi’s (2002:17) “exemplification”, a writing method where details in examples are important as they provide “microexamples” which can open up connections to inform theory.  MacLure (2010:277) states that “theory’s capacity to offend is also its power to unsettle – to open up static fields of habit and practice”. She asserts that “theory in educational research has not interfered enough” (MacLure 2010:281).

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

MacLure, M. 2010. The offence of theory, Journal of Education Policy, 25:2, 277-286.

MacLure, M. 2013. The wonder of data. Cultural Studies ↔ Critical Methodologies 13:4: 228–232.

Massumi, B. 2002. Parables for the virtual: Movement, affect, sensation. Durham, NC: Duke University Press.

Responsibility and accountability

“Questions of responsibility and accountability 

present themselves 

with every possibility; 

each moment is alive with different possibilities 

for the world's becoming 

and different reconfiguring of 

what may yet be possible” (Barad 2007:182).

The opening up of the possibilities of responsibilities presents many pedagogical challenges in medical education. In resource-constrained teaching environments, I wonder how far socially just pedagogies can extend?

This week I had the privilege of interviewing three midwives at a local Midwife Obstetrics Unit (MOU) -- part of the Public Health System’s Day Hospital group. These midwives teach our students during their busy duties. One key concern raised was that many women who arrive in labour to deliver their babies are hungry. The women come from impoverished conditions where food is scarce, and the birthing units do not supply anything to eat.

In terms of response/ability and accountability, is there scope for students in their Obstetrics learning block to engage with these basic needs that directly influence women’s health? The traditional approach to learning Obstetrics in Year 4 is to provide a service and to develop the skills and competence to become proficient doctors. However the comprehensive Primary Health Care approach taken up by the South African health system is more complex engaging with the broader societal issues such as the social determinants of health. When we acknowledge the entanglement of our relationships, different perspectives with potential possibilities may be helpful.

The lack of food is a material force that limits human flourishing. Barad (2014) claims that we need to acknowledge the material forces that play out in our intra-actions, moving away from a human-centred (anthropocentric) gaze. In support, Fenwick (2009) suggests that materiality is often dismissed when professional responsibility is analysed.  

With the increasing focus by medical schools on social responsibilty (SR) and social accountability (SA) these societal difficulties are now contributing to a more integrated approach towards healthcare in context. In the image above (drawn on my iPad using the Doodle Buddy App) I reflect on the entanglement of pedagogical practices in the context of multiple and divergent needs.

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

Barad, K. 2014. Diffracting Diffraction: Cutting Together-Apart, Parallax, 20:3, 168-187,

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