Medical education is a messy tangle of social and material elements. These material entities include tools, like curriculum guides, stethoscopes, cell phones, accreditation standards, and mannequins; natural elements, like weather systems, disease vectors, and human bodies; and, objects, like checklists, internet connections, classrooms, lights, chairs and an endless array of others. We propose that sociomaterial approaches to ethnography can help us explore taken for granted, or under-theorized, elements of a situation under study, thereby enabling us to think differently. In this article, we describe ideas informing Actor-Network Theory approaches, and how these ideas translate into how ethnographic research is designed and conducted. We investigate epistemological (what we can know, and how) positioning of the researcher in an actor-network theory informed ethnography, and describe how we tailor ethnographic methods—document and artefact analysis; observation; and interviews—to align with a sociomaterial worldview. Untangling sociomaterial scenarios can offer a novel perspective on myriad contemporary medical education issues. These issues include examining how novel tools (e.g. accreditation standards, assessment tools, mannequins, videoconferencing technologies) and spaces (e.g. simulation suites, videoconferenced lecture theatres) used in medical education impact how teaching and learning actually happen in these settings.
Purpose Videoconferencing—a network of buttons, screens, microphones, cameras, and speakers—is one way to ensure that undergraduate medical curricula are comparably delivered across distributed medical education (DME) sites, a common requirement for accreditation. However, few researchers have critically explored the role of videoconference technologies in day-to-day DME. The authors, therefore, conducted a three-year ethnographic study of a Canadian undergraduate DME program. Method Drawing on 108 hours of observations, 33 interviews, and analysis of 65 documents—all collected at two campuses between January 2013 and February 2015—the authors explored the question, “What is revealed when we consider videoconferencing for DME as a sociomaterial practice?” Results The authors describe three interconnected ways that videoconference systems operate as unintended “technologies of exposure”: visual, curricular, and auditory. Videoconferencing inadvertently exposes both mundane and extraordinary images and sounds, offering access to the informal, unintended, and even disavowed curriculum of everyday medical education. The authors conceptualize these exposures as sociomaterial practices, which add an additional layer of complexity for members of medical school communities. Conclusions This analysis challenges the assumption that videoconferencing merely extends the bricks-and-mortar classroom. The authors discuss practical implications and recommend more critical consideration of the ways videoconferencing shifts the terrain of medical education. These findings point to a need for more critically oriented research exploring the ways DME technologies transform medical education, in both intended and unintended ways.
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