key: cord-0999401-adv110ad
authors: Cleland, Jennifer; Tan, Emmanuel Chee Ping; Tham, Khum Ying; Low-Beer, Naomi
title: How Covid-19 opened up questions of sociomateriality in healthcare education
date: 2020-05-06
journal: Adv Health Sci Educ Theory Pract
DOI: 10.1007/s10459-020-09968-9
sha: 205947275e8a50839d768fa7178e408ab26fc3a0
doc_id: 999401
cord_uid: adv110ad

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In keeping with the theoretical focus of Advances in Health Sciences Education, to achieve this requires developing our understanding of Covid-19 and resulting education responses in a way which both helps us understand what is happening and produces transferable knowledge. To do so, we draw on a sociomaterial framework, one which specifically assumes that all things are what they are in relation to other things (Law 2009; Gad and Bruun 2010) , and the human and non-human are equal in terms of agency (e.g., Fenwick and Edwards 2010; Law 2009 ).

First, we believe that Covid-19 infection control measures can be framed as a sociomaterial practice. Drawing on the risk assessment literature, DORSCON Orange (and its equivalents in other countries) is founded on the assumption that "evaluating risk is a technical matter to be resolved through objective and rational means to minimize uncertainty" (Wherton et al. 2019, p. 329) . Covid-19 risk assessments and precautions were driven by governments, and so sit within wider political and social structures, but their implementation depended on human actions, interactions, and relationships as well as the material properties, affordances and symbolic meanings of precautions. For example, a face mask is a material object, but face masks also have potent sociocultural symbolism (e.g., Siu 2016). These symbolic implications influence how people perceive facemasks, how people perceive those who use them, and suggest that the precise nature of Covid-19 guidance may shift the symbolic significant of facemasks and hence influence people's adoption of facemasks as a precaution against infection. Similarly, focusing on documents as a material component of Covid-19 management, we might consider how official updates on Covid-19, circulated via different mediums, including Whatsapp, text messaging, and more complex documentation, are intermediaries between the macro-actor of government(s) and are all dependent on internet technology and reach. How do different sources of knowledge (e.g., government advice, popular media) impact on people, and act to construct or prevent certain behaviours? What is, and what is not, acceptable behaviour during these strange times is entangled with the material (e.g., communications) and the local (e.g., how people and groups respond to advice).

Moving our focus from societal to educational responses to Covid-19, we had to develop our practices to fit within the boundaries of what was, and was not, allowed or possible (e.g., with limited clinician availability). The medical school leadership had to mobilise individuals (e.g., academic, administrative and IT staff, and students) and existing technologies (e.g., the digital learning platform [LMS]), as well as integrate more technologies into teaching processes (e.g., Whatsapp, Zoom), and these people then collaboratively problem-solved how to address Covid-19 challenges within the constraints of time and the boundaries of available technology. Different systems came together more explicitly than was the case during "business as usual". For example, IT and digital learning colleagues became core rather than invisible (MacLeod et al. 2017) , and the systems of teaching and teaching delivery were more obviously tied together, with people and systems relating to one another in new and particular ways (Landri 2012) . There was also a very obvious interdependency of users and tools in the network (Cecez-Kecmanovic et al. 2014): for example, we could not deliver teaching or communicate with students without the use of laptops, cameras, Zoom, Whatsapp, etc. IT had a dual materiality, enabling mobilization of teaching across space but it also had design-driven constraints that required the IT and digital learning team to engage in real-time "articulation work" (Kling and Lamb 1999) to make the IT work in the way we needed.

Similarly, our initial observations were that using a combination of Zoom and Whatsapp to deliver teaching offered affordances, opening up new channels of communication and permitting new kinds of interactions. Yet at the same time, it changed some aspects of the encounter; for example, students were more likely to pose questions via the chat functionality than verbally. This suggests that the technology was shaping what teachers and students did and hence mediating patterns of teaching and learning. This generates questions relating to, for example: the "choreography" between the human (clinicians, facilitators, content experts, students) and the material (the LMS, Zoom, Whatsapp); how the role and significance of technology in our institution may have shaped our response; and the hardware and videoconferencing may have shaped the interaction between teachers and students, and potentially influenced the process and impact of observation and feedback (Fenwick 2014) .

Our examples are just that, but they are apt in the sense that they focus on some of the central sociomaterial notions: affordances; of associations, or entanglements, between elements; how practices might act to construct a particular reality; "knot-working" (collaborative problem-solving; Engestrom et al. 1999 ) and articulation. We have not provided a comprehensive overview of the many different sociomaterial approaches, key concepts and terms (see Micheal 2017 for a general introduction). Nor have we given a full or even satisfactory description of the situated, complex and messy situation facing many medical educators around the world. These were not our aims in this short commentary. Rather, we make the suggestion that sociomaterial approaches may provide the language and methods to unveil and understand the nature of educational responses to Covid-19.

Rather than merely describing was done during Covid-19, considering how practices, people and things came together to enable educational practices to emerge is a way to "forth particular realities in practice and learning, while highlighting opportunities and entry points for change" (Fenwick 2014, p. 51) .

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When the center does not hold: The importance of knotworking

Sociomateriality in medical practice and learning: Attuning to what matters

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On the consequences of post-ANT. Science, Technology and Human Values

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The invisible work of distributed medical education: Exploring the contributions of audiovisual professionals, administrative professionals and faculty teachers

Actor-network theory: Trials, trails and translations

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Implementation of team-based learning on a large scale: Three factors to keep in mind

Qualitative study on the shifting sociocultural meanings of the facemask in Hong Kong since the severe acute respiratory syndrome (SARS) outbreak: Implications for infection control in the post-SARS era

Wandering as a sociomaterial practice: Extending the theorization of GPS tracking in cognitive impairment