Thinking about context: consciously and critically.

Abstract

The Clinical TeacherVolume 16, Issue 5 p. 435-436 EditorialFree Access Thinking about context: consciously and critically First published: 13 September 2019 https://doi.org/10.1111/tct.13093 Acknowledgements: I would like to thank Elize Archer, Julia Blitz and Ian Couper, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa, for their insightful comments on an earlier version of this editorial. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In the June 2019 issue of The Clinical Teacher, Rachel Locke's editorial explored some of the characteristics of insider researchers, reminding us of the ways in which this role can significantly influence how we design our studies, engage with our participants and analyse our data. As she indicated, this is not an uncommon approach in educational studies where teachers investigate aspects of their own practice. Reflexivity is key to conducting insider research, requiring the systematic, critical and self-aware reflection on one's position within a particular study, and one's perspectives thereon. It is therefore good practice in such work to declare one's position and acknowledge its potential for influencing research outcomes. When reviewing the articles included in this issue of The Clinical Teacher, I reflected on another facet of the research that has been presented, namely the different contexts and countries where the work has been undertaken. We have authors from America, Australia, Austria, Finland, Malaysia, South Africa, Tasmania and the United Kingdom, writing about clinical teaching and classroom teaching, teaching in an emergency department, teaching linguistically diverse groups, and teaching with technology. Other topics include promoting clinical autonomy, issues of quality and supporting faculty member writing groups. A wide range of topics and contexts. In the same way that who we are as researchers inevitably influences our work, the contexts within which the work has been conducted also exert influence. In their review of the ‘dark matter of context’, Bates and Ellaway cite Dewey as having argued that ‘… we are not explicitly aware of the role of context just because our every utterance is so saturated with it that it forms the significance of what we say and hear’.1 Context, like the air that we breathe, is so often taken for granted that we seldom question it. As authors and researchers we are often blind to how country-centric and context-specific our work might be. Clearly, however, it has relevance for both our teaching and our research, requiring intentional and critical consideration, a form of ‘contextual intelligence’.2 This also explains why reviewers and editors will often request some description of the context within which a study has been conducted if such description is absent. In order for a reader to appraise the usefulness of what our work is offering, they need to understand how their context may or may not be aligned with the context within which the work was conducted. Context as a concern for teaching and learning in the health professions is increasingly attracting attention in the health professions education (HPE) literature. This focus is unsurprising given, for example, the current trend in a growing number of countries around the world towards moving the clinical training of our students to sites outside of the traditional academic hospital.3 One of the challenges when thinking about context, however, resides in the way in which it defies definitional clarity and is seen to have ‘many meanings’ that straddle issues of time and space.4 It is multi-dimensional and complex, comprising elements of the physical, the experiential, the relational and the sociocultural – elements that are interrelated, exerting influence on one another.1 There is much to consider when reflecting on context. There is, however, a further dimension to this discussion. Although it is true that much of the ‘knowledge’ being generated in HPE at the moment comes from insider research, we need to ask who those ‘insiders’ are. Who is generating the knowledge upon which we are basing our practice? And, from which contexts is this work emerging? At the 2018 Association for Medical Education in Europe (AMEE) annual conference, figures were presented during a symposium entitled ‘Equity in the Global Health Sciences Education Community: Levelling the Playing Fields?’, showing that for the period 2012–16, more than 90% of the articles published in two of the leading health professions education journals had first authors that were scholars from institutions from just five countries.5 Of course, there are many valid reasons for why this might be the case, reasons that can be debated at another time. Nevertheless, given the importance of context, we as the community of HPE researchers ought to be sensitive to the extent to which our ways of doing and being, including our clinical teaching practices, are informed by research conducted in a relatively small number of well-resourced and established environments. Is there sufficient interrogation of the usefulness of such knowledge for other environments, including those that are less well resourced? These issues are important and will become increasingly so as the field of HPE continues to grow. Knowledge has power and ‘the way we know has powerful implications for the way we live … every mode of knowing contains its own moral trajectory, its own ethical direction and outcomes’.6 De Sousa Santos has cautioned, however, that ‘since scientific knowledge is not distributed in a socially equitable way, its interventions in the real world tend to serve the social groups having more access to such knowledge’.7 How do we contribute to knowledge in the field in a scholarly way while at the same time ensuring that what we are contributing has the potential to serve the global HPE community? I would argue that acknowledging and understanding context, across all its dimensions, offers us opportunities for collaboration, developing cumulative case studies that explore key questions from a range of perspectives, and can contribute to building relevant theoretical understanding. It opens doors for transformative learning, as it challenges us to confront entrenched perspectives on meaning, and consider alternative positions and practices.8 This can greatly enrich our teaching and our students’ learning, and it can surely enhance the quality of our research. Associate Editor References 1Bates J, Ellaway RH. Mapping the dark matter of context: a conceptual scoping review. Med Educ 2016; 50(8): 807– 816. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2Blackmore P, Chambers J, Huxley L, Thackwray B. Tribalism and territoriality in the staff and educational development world. Journal of Further and Higher Education 2010; 34(1): 105– 117. CrossrefGoogle Scholar 3De Villiers M, van Schalkwyk S, Blitz J, Couper I, Moodley K, Talib Z, Young T. Decentralised training for medical students: a scoping review. BMC Med Educ 2017; 17(1): 196. CrossrefPubMedWeb of Science®Google Scholar 4Leibowitz B, Bozalek V, van Schalkwyk S, Winberg C. Institutional context matters: the professional development of academics as teachers in South African higher education. Higher Education 2015; 69(2): 315– 330. CrossrefWeb of Science®Google Scholar 5Costa MJ, van Schalkwyk SC, Jung-Ho M, Carvalho-Filho M, Schuwirth L. Equity in the global health sciences education community: levelling the playing fields? Symposium presented at the Association for Medical Education in Europe (AMEE), Basel, Switzerland, 26–29 August 2018. Google Scholar 6Palmer PJ. Community, conflict, and ways of knowing: ways to deepen our educational agenda. Change: The Magazine of Higher Learning 1987; 19(5): 20– 25. CrossrefGoogle Scholar 7De Sousa Santos B. Epistemologies of the South: justice against epistemicide. Boulder, CO: Paradigm, 2014. Google Scholar 8Mezirow J. Transformative dimensions of adult learning. San Francisco, CA: Jossey-Bass, 1991. Web of Science®Google Scholar Volume16, Issue5October 2019Pages 435-436 ReferencesRelatedInformation