1. Making sense of medical education Clare Morris Research Medical Learning and Practice conference

2. Introduction Aim of workshop To identify useful conceptual frameworks for ‘making sense’ of workplace based learning in medicine Aim of ongoing doctoral research To gain greater understanding of the cultures of education and training within medicine To tease out an appropriate pedagogy to underpin the work of doctors-as-teachers

3. Making sense of medical education “To understand learning as a socio-cultural phenomenon we must as some stage (…) turn to culture, history and institutionalised patterns of communication and action.” Saljo, R. (2007), p.12

4. Making sense of medical education “ in order to make sense of any action there is a need to examine the activity in relation to a wider cultural and material context, that is to say in relation to the activity system.” Arnseth, H. ( 2007)

5. An Activity System Tools Object Subject Community RulesDivisions of labour

6. Dimensions of Activity Theory Identified traditions, practices, cultures Historicity Contradictions and tensions Potential for change and transformation over time

7. Activity Theory A theoretical, methodological and analytical tool to 1.identify the unit of analysis 2.theorise the institution – to conceptualise and analyse the activity that relates to the education and training of future doctors 3.shine an illuminative lens through which to observe medical learning and practice (leading to formulation of research questions) 4.assist in the interpretation of data and frame concluding discussions

8. Identifying the unit of analysis The medical school as… A single activity system? A single object of activity? Rules & roles? Tensions & contradictions? Shaped by history? Changes over time? A single unit of analysis?

9. Theorising the Institution

10. School of Medicine Lectures, tutorials, cadavers Training future doctors Academic staff Research active Staff and students Nature & amount of teaching activity

11. NHS Clinical Attachments – AS2 Patients -real,simulated & symbolic Training future doctors Doctor as teacher Doctors as teachers Doctors, nurses, HCP, patients Hierarchical distributions

12. Tools of mediation? Historically recognised… Lectures Anatomy teaching Newly emerging… Teaching in simulation Problem Based Learning

13. Tensions Research Clinical work Education Training

14. A medical education sense maker? Yes! Theorising the institution Deconstructing complex network of interacting activity systems enables identification of primary unit of analysis Illuminates cultural practices and the ways in which history shapes activity

15. A medical education sense maker? but… Absence of debate about research methods places limitations on the use of AT as a methodological tool Illuminates interactions between activity systems yet fails to illuminate how ‘outsiders’ gain access into them Places great emphasis on mediating tools and acts yet fails to consider how they are used and the ways in which mediation is or is not successful Rarely used to conceptualise medical education in the UK, therefore lacks precedent and established theoretical foundation to build upon

16. Clare.Morris@beds.ac.uk Associate Dean Bedfordshire & Hertfordshire Postgraduate Medical School University of Bedfordshire