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.

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 /

3. Curriculum Complexity
Patients
Students
Clinicians
Other team members

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

9. Our curriculum

10. Graduates’ oath
@
UCT

11. The reality in
our Maternal Obstetric Units MOUs
Reflecting on good/not so good
Stacey Stent Illustrations

12. Discomfort
M. 2012 CC-BY. http://www.flickr.com/photos/aloha75/4024092009/sizes/o/in/photostream

13. Kaleidoscope of
experiences
Kaleido App on iPad

14. What are we doing ?
CC-BY. http://www.flickr.com/photos/aloha75/4024092009/sizes/o/in/photostream//

16. Response
Department of Obstetrics
Curricular spaces
for
engagement

17. Me & my Dilemmas
Promoting a
culture of
conversation in
exploring the
boundary lines
Year 5

18. Students – peer teaching
Year 5 roleplay in 2012
Video production

19. Me & my Dilemmas
Probing
professional
practices
Year 4

20. Theoretical frames
Freire
Popular education
Roleplays
Herrington
Authentic learning
Reflective
Mazur
Flipped classroom
Peer teaching
CC:BY:NC:ND :http://www.flickr.com/photos/hikingartist/3000884520/sizes/o/in/photostream/

21. Context • Obstetrics practical
Task • Critical reflection
Experts • Coaching
Perspectives • Diversity encouraged
Knowledge • Classroom chat & presentation
• Critical friends
construction
Authentic elements
Herrington, Reeves & Oliver 2010

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

23. http://www.elearnopen.info/images/AuthenticityAcademicSettings.png

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/

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

32. Vula UCT’s Learning Management System

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

36. Student Abuse handout
http://opencontent.uct.ac.za/Health-Sciences/Public-Health-and-Family-Medicine/Enhancing-
Professionalism-Human-Rights-Me-the-University-of-Cape-Town

37. Probing Professionalism
http://www.uct.ac.za
http://opencontent.uct.ac.za/Health-Sciences/Probing-Professionalism-Towards-Positive-Practice

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

42. Medical students’ awareness

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/