Becoming a professional: theorising transitions. CILPS and ANT

Transcription

1 Becoming a professional: theorising transitions CILPS and ANT

2 Ideas in progress. Transitions as CILPS Learning cultures and cultural theory of learning Learning as becoming An empirical example the Blue Form Actor-network theory Four moments

3 Transitions as Critically Intensive Learning Periods (CILPs) Critical limited time during which events may occur, resulting in transformation of some kind; Intensive immediacy invoked by immediate practice requirements (eg looking after patients) Learning becoming integral to generative social practice CILP trajectory: dependent on inter-relationships between doctor s dispositions and position, local regimes of familiarity (work-arounds, local conveniences), learning cultures, practices Allowances made early on in doctors careers (first transition); reduces significantly as responsibility increases.

4 But how to theorise CILP and responsibility? Just getting to grips with regimes of familiarity? (Learning how things are done around here?) OR Recontextualising knowledge? OR Learning cultures? OR Pedagogy of the material and everyday OR

5 Theory of learning cultures and cultural theory of learning Hodkinson, Biesta and James (2008) cultures exist in and through practices, interaction and communication ; Learning culture learning location; Learning culture= practices through which people learn. Learning cultures have histories and endurance through artefacts and institutions (name badges, bloods machine, forms) and systems of expectations which influence what s possible (laxatives) Field (Bourdieu) relationship between things, rather than the things themselves. (like force field) Learning culture functions and is constructed/reconstructed through forces of one or more fields. NB any learning culture will permit, promote, inhibit or rule out certain kinds of learning.

6 Cultural theory of learning Individual in the learning culture Individual is not just jetted in to the learning culture they are part of the field too influence and are part of learning cultures just as learning cultures influence and are part of individuals. Impact of individual depends on combination of position within culture, dispositions towards culture and various types of capital (social, economic, cultural) possessed by individual and valued in relation to field (habitus) Field operates at scale of individual interactions as well as at macro-scales. Learning as practical, embodied, social - what s learned entails practical activity and intelligent action; - learning exists in and through interaction, participation, communication

7 Learning as becoming Opportunities to learn depend on Nature of learning culture (theory of learning culture) Position, disposition and capitals of individual in interaction with each other in horizon for learning as part of a field of relationships (cultural theory of learning) Hodkinson et al argue that person learns through becoming, and becomes through learning; May be deliberative with explicit purpose, may be contingent; Learning as becoming transcends individual situations and learning cultures, but is always situational

8 Notes from an observation: the Blue Form (the Liverpool Care Pathway) When I come on the ward, the consultant is behind the desk with the matron and the specialist trainee. The consultant discusses the treatment of a dying patient and gives F13 an instruction to stop treatment F13 asks if she should fill in the blue form and the consultant goes through the form, showing which sections she needs to fill in. She asks about stopping all treatment and the consultant says yes, so she goes to find the patient s file, tells the nurse that they are stopping everything and brings them back to the desk. She returns to the blue form throughout the evening.

9 Follow-up I asked F13 about filling in the blue form in the follow-up interview three months later. In response, F13 said: I ve got better at recognising patients who are dying and maybe just benefit from palliative care and then just deciding when it might be appropriate to start that and then discussing that with a senior.

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11 What s the blue form doing? Most theoretical accounts of learning privilege the social/human/; Context is material notes, files, machines, bodily fluids, drugs, stethoscopes, badges, passes Context envelopes humans; context changes human adapts or learns; Material world ( things ) are important expensive simulations of skin, organs, microscopic cameras; But humans act on things things don t exert force. Learn from things.

12 Actor-network theory ANT humans and non-humans ( things ) are treated in the same way generalised symmetry Things include bodies and texts as well as materials things Such things are assumed to be capable of exerting force and joining together to form networks across time and space Lots of examples - Malcolm and Zukas, (2009) Making a mess of academic work workload allocation forms in universities

13 ANT - translation Forms, patients, junior doctors, consultants one entity connects with another to form a network that is, one entity works on another to translate it to become part of a network of things and action. Look at linkages and performances of human and non-human actors (entities) generalised symmetry of ANT.

14 Translation - theorising some aspects of transition Callon, 1986: four moments : Problematisation Interessement Enrolment Mobilisation

15 Problematisation Obligatory passage point through which ideas, problems, entities etc are framed Here - decisions on how best to treat dying patients within a variety of care settings (eg hospitals). The LCP affirms the vision of transferring the model of excellence for care of the dying from hospice care into other healthcare settings. We have demonstrated a process that inspires, motivates and truly empowers the generic workforce in caring for the patient and their family in the last hours or days of life."

16 Interessement Strategies to stabilise actors defined through problematisation Actors invited into this framing not only hospice workers but doctors, nurses, the MDT, patients families, patients, drugs, other treatments, organisations forms, protocols Some entities excluded in this process.

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18 Enrolment processes by which actors locked into roles proposed for them set of interrelated roles is defined and attributed to actors who accept them (Callon, 1986) the Blue Form (immutable mobile)

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20 Mobilisation Durable network where actors transformed into manageable entities that can be transported through space-time: I ve got better at recognising patients who are dying and maybe just benefit from palliative care and then just deciding when it might be appropriate to start that and then discussing that with a senior.

21 References Fenwick, T and Edwards, R (2010) Actor-network theory in education. Routledge. Hodkinson, P. Biesta, G. and James, D. (2008) Understanding learning culturally: overcoming the dualism between social and individual views of learning. Vocations and Learning, 1, Kilminster, S, Zukas, M, Roberts, T and Quinton, N (2010) Learning practice? Exploring the links between transitions and medical performance. Journal of Health Organization and Management, 24 (06), Malcolm, J and Zukas, M (2009) Making a mess of academic work: experience, purpose, identity. Teaching in Higher Education, 14 (05), Zukas, M and Kilminster, S (forthcoming) Learning to practise, practising to learn: doctors transitions to new levels of responsibility. In P. Hager, A. Lee & A. Reich (eds) Practice, Learning and Change: practice-theory perspectives on professional education. Springer.