Alternative angles

From my school days I so clearly remember learning the basic law of reflection that states that a light wave’s angle of incidence equals the angle of reflection. Optical reflections have continually fascinated me whether in the outdoors, in my work as a rehabilitation specialist and more recently with cellphones and tablets on which we can take selfies that can be playfully distorted.

Reflective practice has become increasingly incorporated into medical education with the belief that self-awareness and critical thinking enhance professional development. Reflection is said to help us to make sense of an experience. To teach reflection is

to encourage the development of a habit of processing cognitive material that can lead the student to ideas that are beyond the curriculum, beyond learning defined by learning outcomes, and beyond those of the teacher who is managing the learning. 

Moon 2001:15

The many paths that reflection has taken since John Dewey first introduced the concept of the reflective practitioner in 1932, demonstrate the wide uptake of this dimension to pedagogical practices. There have been a growing number of educational theorists picking up different angles of reflective practice. To name just a few, Brookfield (1995) explains critical reflection in relation to influences of dominance and power. Kolb (1964) proposed a 4-step experiential learning cycle, Mezirow (1998) identified the transformative potential of reflection and Schon (1983) asserted that reflection is more valuable through a linear time frame that recognizes reflective action before, during and after an event.

When I worked with first year Health Science students in a module on developing their professionalism, the reflective dimension was a core component of the curriculum. Students had to write weekly reflective commentaries and hand these in, initially as hard copies then later by uploading the Word docs into a Learning Management System, like posting a letter. In my role as one of a group of facilitators, I conformed to instructions to allocate marks to these reflective commentaries according to set criteria. It irked me. I wondered how this practice could become more constructive and productive.

In my recent research findings a student openly shared that these reflections (and course evaluations) become a chore, something that just had to be done to get ticked off. This mindset appears to set a pattern of thinking for future years.  His insights are shared by others. How do we as educators bring a turnaround to these kinds of negativities?

In developing my own teaching initiative with fourth year students I have had opportunities to experiment with reflective practice without the pressure of assessment needs and conformity to a designed curriculum. My angles of teaching have changed. Moving away from a structured linear controlled approach I engage with rhizomatic thinking and practice. This opens up possibilities for connections and multiplicities where mapping differences can bring new insights.

Students upload their reflective commentaries on Google Drive to share with each other. This can initiate deeper thought across individual boundaries. Apart from normalizing their challenging experiences in obstetrics there is growing evidence of something else happening. It appears to be a circulation of affect that offers the potential to act in different ways. Perhaps the sharing of reflections in the online space (which can feel quite risky for some students) offers the potential for ‘asignifying ruptures’, one of the principles of Deleuze and Guattari’s concept of the rhizome.. There is a break in habits of thinking, a breaking off of development, or rupture in one direction to start a new and connected development in another direction (Deleuze & Guattari 1987). Possibly the process of sharing reflections facilitates a movement towards a ‘Body without Organs’ that O’Sullivan (2006:19) suggests “is a kind of strategy, or practice, that allows an opening onto the realm of affect”, a plane of becoming, a gap of potentialities.

The image above was drawn using the Visualator App on my iPad. I was illustrating the effect of looking through multiple and different lenses to create something new and exciting. It gives an idea of the effects of differences that overlap with each other.

Brookfield, S. 2010. Critical reflection as an adult learning process. In N. Lyons (Ed.), Handbook of reflection and reflective inquiry: Mapping a way of knowing for professional reflective inquiry (215-236). Dordrecht, The Netherlands: Springer.

Deleuze, G., & Guattari, F. 1987. A thousand plateaus: Capitalism and schizophrenia (B. Massumi, Trans.). Minneapolis: University of Minnesota Press.

Dewey, J. 1933. How we think: A restatement of the relation of reflective thinking to the educative process. Boston: D. C. Heath and Company.

Kolb, D. 1984. Experiential learning: Experience as the source of learning and development. Englewood Gliffs, NJ: Prentice Hall.

Mezirow, B. 1998. On critical reflection. Adult Education Quarterly. 48:3:185-198.

Moon, J., 2001. PDP Working Paper 4. Reflection in Higher Education Learning. http://www.york.ac.uk/admin/hr/researcher-development/students/resources/pgwt/reflectivepractice.pd

O’Sullivan, S. 2006. Art encounters Deleuze and Guattari: thought beyond representation. Palgrave MacMillan. New York.

Schön, D. 1983. The reflective practitioner. New York: Basic Books.

My affective turn

'Affect' is a relatively recent concept that has led to the so called ‘affective turn’ (Clough 2006). It offers a refreshingly new theoretical understanding of the interrelationships that occur in the body and mind. Theorizing with and through affect can be an enabler for change. The usefulness to education and pedagogy is becoming increasingly evident (Hickey-Moodey 2013, Hickey-Moodey & Page 2016, Zembylas 2006).

What is affect? There are several interpretations that map affect’s complexity. By choosing a Deleuzian understanding of affect, I focus on the intensities and capabilities that power the body to move or be moved. This is a stance away from representation.

It appears that Brian Massumi (2002) was first to put forward the notion of the ‘affective turn’ drawing on insights gained from Spinoza, Deleuze and Guattari. In Massumi’s (1987) Forward written in A Thousand Plateaus, he defines affect as “a prepersonal intensity corresponding to the passage from one experiential state of the body to another and implying an augmentation or diminution in that body's capacity to act”. Massumi (2002:36) asserts that affect is the “perception of one’s own vitality, one’s sense of aliveness, of changeability”.  There is an openness to affect that is determined by the body’s potential. Hickey-Moodey (2013:80) offers more detail explaining how affect varies as our “embodied capacities are increased or decreased by sounds, lights, smells, the atmospheres of places and people”.

There seems to be very little that has been published about affect in terms of curricular matters in Health Sciences education. This is not surprising as medicine is a scientific discourse that relies on evidence-based practices governed by clear accreditation standards. Therefore a turn to affect can be problematic, perhaps disrupting ‘business as usual’. In Ducey’s (2006) study with allied health care workers, she noted that “affect is not subject to the usual forms of measurement and analysis, so that the political responses its modulation calls forth are emergent and unpredictable”.

Massumi in conversation with Zournazi (2002) equates affect with freedom and hope, noting how uncertainty can be empowering. He refers to a “charge of affect”, asserting that affect offers “a way of talking about that margin of manoeuvrability, the ‘where we might be able to go and what we might be able to do’ in every present situation”  (Zournazi 2002:212). He explains it as the opening of thresholds of potential in which we can experiment. Through our bodies we have the experience of affect, the intensity as well as the experience of the movement.

I have recently chosen affect as a leading theme in my study because it offers a pragmatic approach that foregrounds experiences and movement. My interest is in the process of learning, a continuum of events that can transform individuals and practices. This movement that is affected and can be affected is a shift away from binary thinking such as what is right and wrong, object versus subject and culture/nature dualisms. I am exploring what emerges through the in/determinate teaching process.

In my study an example of an affective response could be the distancing that occurs when a student feels helpless in a difficult situation. Several students have described the intensity of disgust at witnessing disrespectful behaviours in their clinical encounters in Obstetrics and how this has led them to walk out of the room. The seeing and the hearing of abusive behaviour has energised these students to move away.  

The image above was drawn on my iPad using iPastels. It depicts a metal spring that has the potential and charge that affect theory conveys. Many new possibilities arise from the intra-actions that influence the affective dimension of learning.

Clough, P. (ed.). 2007. The Affective Turn: Theorizing the social. Durham and London:. Duke University Press.

Hickey-Moody, A. 2013. Affect as Method: Feelings, Aesthetics and Affective Pedagogy.  In (Eds.) Coleman, R & Ringrose J. Deleuze and Research Methodologies. Edinburgh University Press. Edinburgh. pp. 79-95.

Hickey-Moody, A. & Page, T. 2016. Introduction, Making, matter and pedagogy. In A. Hickey-Moody T. Page  (Eds)  Arts, pedagogy and cultural resistance: New materialisms. Rowman & Littlefield. London.

Massumi, B. 1987. ‘‘Notes on the Translation and Acknowledgments,’’ in Gilles Deleuze and Felix Guattari, A Thousand Plateaus: Capitalism and Schizophrenia (Minneapolis: University of Minnesota Press.

Zembylas, M. 2006. Witnessing in the Classroom: The ethics and politics of affect. Educational Theory. 56:3: 305-324.

Zournazi, M. 2002. Hope: New philosophies for change. New York. Routledge.

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.

Affective intensities

“affect is what moves us.

It’s a hunch. A visceral prompt”

(Hickey-Moodey 2013:79).

Affect is more than emotion. It is “our power to affect the world around us and our power to be affected by it, along with the relationship between these two powers” (Hardt in Clough, 2007: ix). Drawing on Deleuzian concepts, it is a dynamic opening up to possibilities that can bring change. This transition is explained by Massumi (2002:12) as a “passing of a threshold, seen from the point of view of the change in capacity” ...“[w]hen you affect something, you are at the same time opening yourself up to being affected in turn, and in a slightly different way than you might have been the moment before. You have made a transition, however slight”. HIckey-Moodey (2013:80) explains this movement as a change in capacity that alters the limits of a body, “the margin of modulation”, that can be human or non-human, or an assemblage.

Emotion on the other hand is considered “an expression of affect in gesture and language” (Massumi 2002:232). Emotions are frequently associated with feelings leading to a physical response that Ducey (i2007:192) suggests is “autonomous from conscious thought and attention”. Emotions like fear, joy, shame, guilt and anger form part of our affective capacities that are sensed and become visible through and in certain experiences.  

In the discipline of obstetrics, high levels of tension in the birthing performance release many emotions that vary for each of the role players. For instance there is fear of error for the healthcare providers and medical students, fear of the unknown for the mother-to-be, mixed with possible joy for the arrival of a new life. At times students express anger and shock at practices they witness when human rights violations are recognized in the birthing units. Often these students feel helpless to intervene leaving them with a sense of guilt and shame. This affective force, or lack thereof, impacts on their becoming-doctors. The intensity of the forces intersecting in obstetrics learning signifies the complex junction of political, social and cultural factors that influence the unfolding birthing events in public health facilities.

The practical obstetrics learning marks a vital moment, a defining and transformative threshold for medical students that is often viewed as the time of becoming real doctors. Despite my initial apprehension at engaging with affect in this research project, it seems an essential aspect of my study that seeks to develop a socially just pedagogy in obstetrics learning. “Affect ... shadows every event. It is the source of the unexpected, of the unmotivated, of surprise” (Ducey 2007:192). Sensitivity to the affective forces in the intra-actions of the material-discursive practices in student learning can provide important insights into the practical and political understanding of student learning. The image above was created on my iPad using the Pixelmater App. The brown ribbon-like symbols are similar to HIV/Aids activism and breast cancer, signifying collective affective agency.

 Ducey, A. 2007. More than a job: Meaning, affect, and training health care workers.  in Clough, P. (ed.) The Affective Turn: Theorising the Social. Durham and London: Duke University Press. pp. 187-208.

 Hardt, M. 2007. Introduction. in Clough, P. (ed.) The Affective Turn: Theorising the Social. Durham and London: Duke University Press.

 Hickey-Moody, A. 2013. Affect as Method: Feelings, Aesthetics and Affective Pedagogy.  In (Eds.) Coleman, R & Ringrose J. Deleuze and Research Methodologies. Edinburgh University Press. Edinburgh. pp. 79-95.

Massumi, B. 2002. Navigating Movements -- with Brian Massumi. In  Zournazi, M. (ed.) Hope: new philosophies for change. Pluto Press, Australia. pp. 210-243.

 

Photos versus drawings

When I began blogging about my PhD process I used photographs and photo collages. The first photo was taken in the sauna at a local gym. It represented the haziness of the research journey. SInce then my cellphone and iPad have exposed me to alternative pathways through drawings that open up the theory to the meanings emerging from readings and other resources.

Taking a photo involves some thought and planning. The implementation is quick, happening in a moment of time. The pressure of my finger on a point of the camera captures the image to produce the artefact. The photo is an instant product that can remain static or be reconstituted  through digital processes and other means. There appears to be a certain level of distancing with little bodily involvement.

When considering photos and drawings, both processes of image-making are opening up my rhizo-thinking to others. The images emerge from affective responses and variations representing “self-organized enfoldings” (Springgay & Zaliwska 2015:137). Both methods are creative approaches that make agential cuts thereby opening up possibilities and excluding others (Barad 2007).

There is a degree of exposure about myself and my position in terms of space, time and matter. However drawings have enabled me to place myself more on the edge, in the “open process that is emergent, vital, and abstract” (Springgay & Zaliwska  2015:137). They support my nomadic wonderings where I explore  a multiplicity of fields and flows that facilitate new lines of flight, creative offshoots (Deleuze & Guattari 1987). The gesture of drawing spontaneously through an affective response involves kinesthetic movement over a period of time. It moves away from an organized, structured response. Each artefact is a surprise that results from art-in-the-making. The drawings emerge in an iterative configuring  through the assemblage of the iPad-finger-myself As i look back over the collection of images created in the blogs over the past year, there is a distinct move away from photographs towards drawings.  

In considering what this experience means for my data collection I recognize that taking photos in the context of my research is a non-negotiable factor. Issues of confidentiality and privacy mitigate against the use photography in birthing facilities. However in the classroom I have been able to take a few photos such as the one above. This sign was created by a group of Year 4 medical students for our classroom workshops. It formed part of their roleplay relating to the lack of information given to women in labour. It resembles the many signs held up to us by beggars seeking assistance between the traffic at busy intersections -- a reflection of our inequality. The photo that is combined with lines and patterns was created using Skitch on my iPad. It illustrates how both photos and drawings can be open-ended.

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

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

Deleuze, G., & Guattari. F. 1987. A thousand plateaus: Capitalism and schizophrenia.

Trans. B. Massumi. Minneapolis, MN: University of Minnesota Press.

Springggay, S & Zaliwska, Z. 2015. Diagrams and Cuts: A Materialist Approach to Research-Creation. Cultural Studies ↔ Critical Methodologies. 15:2:136-154.

Drawing intensities

“Matter is agentive, not a fixed essence or property of things. 

Mattering is differentiating, and which differences come to matter, 

matter in the iterative production of different differences” 

(Barad 2007:137).

When we examine our research interviews and go beyond the usual interpretations associated with the linguistic interactions and observations, valuable revelations emerge. By asking interviewees to draw their thoughts about the conversation, a wide range of responses becomes apparent.

These interesting insights are revealed through exploring the material arrangement and relationships in the material-discursive practices. The apparatus of paper-drawing implement- interviewee-interviewer involves intra-activity which becomes mutually generative. The different agential possibilities offer potential for different meanings to be revealed. Barad (2007:140) claims that “it is through specific intra-actions that phenomena come to matter”.

The image above (created using the You Doodle App then Paper App on my iPad) reflects and represents my recent interview with an experienced midwife connected to our students. It was a challenging interaction in which my facilitation skills were tested. The interview highlighted the variation of flows and intensities of the intra-actions that can occur in such an apparatus. She agreed to create a drawing yet struggled at the start and at times through the process. She apologized for “being useless”. However once she began, there were noteworthy peaks of energy, force and intensity as she shared her valuable insights both verbally and through art-in-the-making.

This encounter was dynamic, moving in different ways over the time spent with and on the drawing. At the start there was hesitation with uncertainty. Her desire was to express her thoughts in an abstract way. Where to start and where to go caused her to seemingly freeze. She shared her weakness in artistic expertise, wishing that her daughter could be there to assist her. I encouraged her, explaining that artistic talent was not necessary and acknowledging the difficulties. I checked to understand if the blockage to action could be released by changing the paper orientation or size of the sheet, and whether coloured markers or pastels would be more comfortable for her. Eventually it was the colour grey that released the block, shifting inaction to an emerging and iterative revelation of her thoughts and ideas that became visible in/on/with paper-pastels.

I felt like a croupier at a roulette table, spinning a ball round a wheel, waiting to see where it landed. I emptied out the box of pastels onto the table. Perhaps the movement and array of colours could entice some action. It was the grey pastel that landed and gave me the next move. When my interviewee began speaking about the grey area that our students move into as they are becoming doctors, I passed her the grey pastel and the drawing began. She then moved into the next space on the paper, choosing blue as the colour of hope while explaining the bifurcation of ways in which students’ experiences influence their obstetrics learning.

This encounter was particularly meaningful to me. It illustrated the variation of intensity that was driving this healthcare provider/educator and influencing her power to engage with and through the paper. Deleuze and Guattari’s (1987) concept of body co-ordinates related to longitude and latitude helps explain the forces that shape and influence art-in-the making leading to the drawing on paper. On the one hand the longitude is described as “the set of relations of speed and slowness, of motion and rest, between particles that compose [the body] ... between unformed elements” (Deleuze 1988:127). On the other hand the latitude is “the set of intensive affects of a body, what the body can do and what it can undergo in joining assemblages” (Bonta & Protevi 2004:104). Both the longitude and latitude make up the co-ordinates that inform the body’s cartography (Deleuze & Guattari 1987).

McCormack (2012:136) points out that the “intersection of latitude and longitude is interstitial or inbetween existence”. It is part of our becoming through the in/determinancy of matter. There is no certainty in advance about what we can and cannot do. Haecceity, meaning the ‘thisness of things”, is a Deleuzian term that explains our “becomings in action” through the uniqueness of each individual (Sauvagnargues 2013:43).

After the interview both myself and the midwife were changed by this drawing experience. Through different roles and intra-actions we reached the point of recognizing the similar threats that both students and midwives endure in a threatening environment.

“the material and the discursive are mutually implicated 
in the dynamics of intra-activity”

(Barad 2007:184).

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

Bonta, M. & Protevi, J. 2004. Deleuze and Geophilosophy: A Guide and Glossary (Edinburgh: Edinburgh University Press.  

Deleuze, G. & Guattari. F. 1987. A thousand plateaus: Capitalism and schizophrenia. Trans. B. Massumi. Minneapolis, MN: University of Minnesota Press.

Deleuze, G. 1988. Spinoza: Practical Philosophy. City Lights Books. San Francisco.

MacCormack, P. 2012. Posthuman Ethics Embodiment and Cultural Theory. Ashgate Publishing Limited, Surrey.

Sauvagnargues, A. 2013. Deleuze and Art. Bloomsbury, London.