Technologies of Exposure: Videoconferenced Distributed Medical Education as a Sociomaterial Practice

Abstract

Purpose Videoconferencing—a network of buttons, screens, microphones, cameras, and speakers—is one way to ensure that undergraduate medical curricula are comparably delivered across distributed medical education (DME) sites, a common requirement for accreditation. However, few researchers have critically explored the role of videoconference technologies in day-to-day DME. The authors, therefore, conducted a three-year ethnographic study of a Canadian undergraduate DME program. Method Drawing on 108 hours of observations, 33 interviews, and analysis of 65 documents—all collected at two campuses between January 2013 and February 2015—the authors explored the question, “What is revealed when we consider videoconferencing for DME as a sociomaterial practice?” Results The authors describe three interconnected ways that videoconference systems operate as unintended “technologies of exposure”: visual, curricular, and auditory. Videoconferencing inadvertently exposes both mundane and extraordinary images and sounds, offering access to the informal, unintended, and even disavowed curriculum of everyday medical education. The authors conceptualize these exposures as sociomaterial practices, which add an additional layer of complexity for members of medical school communities. Conclusions This analysis challenges the assumption that videoconferencing merely extends the bricks-and-mortar classroom. The authors discuss practical implications and recommend more critical consideration of the ways videoconferencing shifts the terrain of medical education. These findings point to a need for more critically oriented research exploring the ways DME technologies transform medical education, in both intended and unintended ways.

12 Tips for Pivoting to Teaching in a Virtual Environment

“…It is important to orient yourself and your students with the technology and software encompassing the virtual teaching environment prior to the start of the course. We agree with MacLeod et al (2019) in that orientation materials should be prepared in a manner that facilitates a straightforward working knowledge of the chosen software in a just-in-time manner. These materials should be easily accessible, such as a one-page document, short video, or short podcast.…”

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

“…Whatever the entry point, the research process often grows from an observation that a material element accomplishes something important—whether intended or not—and that this accomplishment is worthy of investigation. This accomplishment can be anything, ranging from a policy document that encourages people to develop a set of workarounds [3], the physical layout of the beds, curtains, and other equipment in a critical care unit [44], bodily fluids that alter the ways in which healthcare professionals opt to deliver care [45], a videoconferencing screen that discourages people from participating in classroom conversations [2], a checklist that constrains an assessor’s judgments and ratings [1], or any number of others. Once the element of interest has been identified, our work involves figuring out how to best understand it.…”

“…In an exploration of the invisible work involved with producing distributed medical education, MacLeod et al. [2] explored accreditation standards, in order to understand the ways in which people work with, and around, these policies. They identified language from a standard and traced it across the network through interviews, observations, and document analysis, watching the language being put into practice.…”

“…Sociomaterial approaches offer new perspectives on the rich messiness of everyday medical education, prompting questions like: how do chosen assessment tools influence OSCE assessment practices [1]? ; how do videoconferencing technologies work to shape distributed medical education [2, 3]? ; how do clinical spaces influence role negotiation amongst interprofessional teams [4–8]?…”

Examining the clinical learning environment through the architectural avenue

“…Like action research, ANT narratives seek to disrupt the conventional view on situations or settings by focusing equally on the social roles of people and things. Recent work in medical education has used actor-network theory to explore boundary objects in oncology rounds (Heldal 2010), simulation (Gormley and Fenwick 2016), distributed medical education (Macleod et al 2015(Macleod et al , 2017(Macleod et al , 2018, and team collaboration (McDougall et al 2016;.…”