Re-visioning Academic Medicine Through a Constructionist Lens

Abstract

Constructionism in academic medicine matters. It encourages educators and researchers to question taken-for-granted assumptions, paying close attention to socially and historically contingent meanings. In this Invited Commentary, the authors explain what constructionism is; examine its ontological, epistemological, and axiological underpinnings; and outline its common methodologies and methods. Although constructivism favors the individual, constructionism privileges the social as the controlling force behind the construction of meaning. Where micro-constructionism attends to the minutiae of language, macro-constructionism focuses on broader discourses reproduced through material and social practices and structures. While social constructionists might situate themselves at any point on the relativist–realist continuum, many constructionists focus on constructionism as epistemology (the nature of knowledge) rather than ontology (the nature of reality). From an epistemological standpoint, constructionism asserts that how we come to know the world is constructed through social interaction. Constructionism thus values language, dialogue, and context, in addition to internal coherence between epistemology, methodology, and methods. Constructionism similarly values the concepts of dependability, authenticity, credibility, confirmability, reflexivity, and transferability. It also embraces the researcher–researched relationship. Given the privileging of language, qualitative methodologies and methods are key in constructionism, with constructionist-type questions focusing on how people speak. Here, the authors encourage the reader to develop an understanding of constructionism to re-vision academic medicine through a constructionist lens.

Exploring emergency physicians’ professional identities: a Q-method study

“…Therefore, while our study has provided a framework that illuminates the experiences of stress amongst emergency medicine physicians (Viewpoint 2, coping), we believe that future professional identities research, particularly amongst populations who deal with the physical and mental impact of stress on a regular basis, may benefit from engaging in a deeper analysis of their talk within a social constructionist framework (e.g. by attending more closely to the socially and historically-contingent meanings in identities talk) to understand the influences of the wider discourses on how professional identities are constructed (Rees et al 2019).…”

“…Drawing on social constructionism (Rees et al 2019), identities theorists contend that identities comprise a mutable process: they are informed by a variety of values and beliefs derived from one's environment, mediated through language and artefacts, and influenced by the many other identities that an individual holds (Jenkins 2008), which in turn are also imbued with values and beliefs. Identities are also interactional.…”

How medical school alters empathy: Student love and break up letters to empathy for patients

“…Within this study, we adopt a relativist ontology and social constructionist epistemology, which highlight the subjectivity and social nature of reality and knowledge 23‐26 . This is in contrast to the majority of clinical empathy research, which has been undertaken from a realist, or positivist, quantitative standpoint 11,27‐29 .…”

‘Too male, too pale, too stale’: a qualitative exploration of student experiences of gender bias within medical education

“…36 Within medical education, constructivism and constructionism are often used synonymously, yet the paradigms differ. 37 While both theories highlight the subjectivity of reality and knowledge, constructivism emphasises the role of the individual in knowledge formation, while constructionism maintains knowledge and reality, are influenced by, and exist only within social interactions. 36 38 While constructivist research gives primacy to the perspectives of individuals, constructionist research emphasises interaction, more frequently adopting observational methods of data collection and employing methods of analysis that focus on language.…”

“…36 38 While constructivist research gives primacy to the perspectives of individuals, constructionist research emphasises interaction, more frequently adopting observational methods of data collection and employing methods of analysis that focus on language. 37 Both constructivist and constructionist approaches add value within research, and the approach adopted depends largely on the focus of a work’s research question. This work adopts a constructivist orientation, conceptualising reality as a subjective, individual mental construct and emphasising knowledge construction as individual meaning-making in response to the social situations experienced by participants.…”