Actor-network theory and ethnography: Sociomaterial approaches to researching medical education

Abstract

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.

The pause/play button actor-network: lecture capture recordings and (re)configuring multi-spatial learning practices

“…Ethnographic research is seen as a suitable methodology in the studying of sociomaterial phenomena (MacLeod, Cameron, Ajjawi, Kits, & Tummons, 2019;Nimmo, 2011). Ethnography seeks to provide detailed descriptions of "undisturbed" natural settings and assemble accounts by trying to obtain an "insider's view" into the studied phenomenon.…”

Materials matter: Understanding the importance of sociomaterial assemblages for OSCE candidate performance

“…10(p405) Sociomaterial approaches typically have a purposive focus on materials, viewing phenomena as sociomaterial collectives. 1,6,7,10,20,21 Indeed, a central ontological principle underpinning sociomateriality is symmetry, that is that materials and humans matter equally. 9,22 Sociomaterial approaches also see materials as things performed through connections and activity, bringing to the fore a second ontological principle, that is that materials have agency in that they can shape human activity and are therefore productive.…”

“…Although limited attention has traditionally been paid to material matters in healthcare education, 6 sociomaterial approaches are increasing. 1,[7][8][9][10][11] Studies in medical education have progressively drawn on sociomaterial approaches such as cultural-historical activity theory (CHAT), 12 actor-network theory (ANT) 13 and complexity theory. 14 Materials matter within the context of OSCEs because they serve to produce candidate performance, with potentially disastrous career impacts if materials influence performance unjustly.…”

Observational studies in health professional education research

“…• Social constructivist: Because knowledge and experience are understood as a coproduction between people, the researcher may adopt a more participatory approach and/or take a more interpretive approach to the researcher's findings. • Sociomaterial perspectives: Here, the phenomenon is studied by emphasising the interactions between systems, materials, places, humans and non-human actors that do not easily respond to methods such as surveys and interviews (Burm & MacLeod, 2020;MacLeod et al, 2019).…”

“…Sociologists, including those working in health professional education, have since adopted ethnographic observation methods. Articles and books have long reported on ethnographies within medicine and medical education (Atkinson & Pugsley, 2005;Becker et al, 1961;Bosk, 2003;MacLeod et al, 2019;Merton et al, 1957;Pope, 2005;. However, traditional ethnography is not always possible.…”