This presentation aims to highlight the complexity of medical education. It describes the necessity to engage in a non-linear approach that appreciates the students' experiences and their voices. Student-led workshops in their Year 4 & 5 Obstetrics blocks have led to collaborative initiatives promoting change in maternal healthcare services.
Promoting Critical Reflection in Obstetrics Education
1. Creating
a collaborative
space for criticality
Authentic Learning Colloquium
@the University of the Western Cape
March 22nd 2013
Veronica Mitchell
M Phil (HES) B Sc (Physio)
2. Medical Education
A case study in Obstetrics
CC:BY|:SA http://www.flickr.com/photos/29604926@N08/4033334428/sizes/z/in/photostream /
4. Overview
• Problem
• Initiative
• Authentic elements
Articulation & Reflection
• Impact
5. South Africa
Everyone has the right to
have access to health care
service
Section
27
Theory vs Reality
1996
6. Legal norms & standards
The South African A guide to the National Health Professions
Constitution Health Act (from the AIDS Council of South Africa,
Law Project) (CC BY-SA) General Ethical Guidelines
For The Health Care
Professions
7. the
gap
between
the teeth of legal
instruments
& the
implementation
challenges
CC-BY-ND-NC http://www.flickr.com/photos/hikingartist/5726750811/sizes/l/in/photostream/
8. Everyone has the right
to the enjoyment of
ICESCR
the highest attainable standard Article
12
of physical and mental health …
The Right to Health
“ The right to health cannot be realized
without the intervention and insight
of health workers”
Health care Underlying determinants
Backman G., Hunt P., Khosla R et al. The Lancet. 2008:2048
22. Reflection • Group, partners and individuals
Articulation • Tacit knowledge becoming explicit
• Expert guest
Scaffolding • Facilitator
Assessment • Not practiced here yet
Professional learning • Communities of Practice
Authentic elements
Herrington, Reeves & Oliver 2010
24. Peer scaffolding
“ To tell the stories
of a culture of practice is
fundamental to learning
Lave and Wenger (1991) in Herrington, Reeves & Oliver 2010
25. Initiative in Year 4
Department of Obstetrics
Shift from
a culture of silence
to dialogue
Articulation
of
real-world problems
26. Taking a closer look
CC:BY http://www.flickr.com/photos/aloha75/4024089915/sizes/o/in/photostream/
27.
28. Articulation
of
real-world problems
Personal ownership of learning
Students in social context
“
Inherent – as opposed to constructed – opportunities
Herrington, Reeves. & Oliver. 2010:32.
29. Articulation
Personal meaning-making
Hand-in reflection
Critical friend
Discussion, online posts
Small group interactions
Large group chat room
“
Inherent – as opposed to constructed – opportunities
Herrington, Reeves. & Oliver. 2010:32.
30. Vula & UCT Open Content
http://www.uct.ac.za
http://opencontent.uct.ac.za/Health-Sciences/Probing-Professionalism-Towards-Positive-Practice
31. Vula & UCT Open Content
Six Step Spiral for Critical Reflexivity (SSS4CR)
Thanks to Dr Kevin Williams, Prof Athol Kent, Nariman Laattoe, Dr Simone Honikman, Sarah Crawford-Browne
http://opencontent.uct.ac.za/Health-Sciences/Probing-
Professionalism-Towards-Positive-Practice
33. Cognitive conflict
is
recognized
valued
supported
Moving beyond conversations
Consensus for
the need to work collaboratively
towards change
34. Students’ feedback:
• good to normalize and debrief
experiences
• critical friend opens new insights
• good to reflect on own role as
students in upholding human rights
• gives a structured approach to
difficult problems
• helps to visualize how the different
concepts interact with each other
35. Collaboration with
Department of Health
Department meetings, Facility workshops
Government: New Codes of Practice
Accreditation towards:
Mother and Baby friendly Institutions
Value students’ voices
CC-BY-ND-NC http://www.flickr.com/photos/hikingartist/5726834773/sizes/s/in/photostream
38. Challenges
Resistance to reflection
why do we have to do this?
reflection is for mirrors
Hijacking online comments
Reflections are private
Group work dynamics & participation levels
Unintended consequences – nurses at MOUs
39. Making a difference to forge ahead
Students better prepared and equipped to
confront uncertainty, dissonance and
supercomplexity of practice
CC:BY|:SA http://www.flickr.com/photos/29604926@N08/4033334428/sizes/z/in/photostream /
Barnett 2000
40. Evidence of success
Promoting critical reflection
Student awareness & advocacy growing
Strengthening students’ resilience
Clinical curricular shift expanding to population concerns
beyond patient / doctor interactions
Partnerships towards improving maternal healthcare
New Code of Practice for mothers and babies
Open Educational Resources – sharing, openness
41. Kofi Annan
“health will finally be seen
not as a blessing to be wished for,
but as a human right
to be fought for
s
43. Thank You
.
References
Barnett, R. 2000. Supercomplexity and the curriculum. Studies in higher education. 25.3: 255-265.
Herrington, J., Reeves, T. & Oliver, R. 2010. A guide to authentic e-learning. Routledge. London.
Zembylos, M. 2012. Critical pedagogy and emotion: working through ‘troubled knowledge’ in posttraumatic contexts,
Critical Studies in Education.
Stacey Stent Illustrations CC:BY http://www.flickr.com/photos/44442807@N07/4084275497/sizes/z/in/photostream/