CHAPTER 5: SYNTHESIS, CONCLUSIONS & RECOMMENDATIONS
5.3 The epistemological glance
Four leaning theories are used to underpin this manuscript and these include the co-creation of knowledge, community of practice, teaching and learning in context and learning informally.
5.3.1 Co-creation of knowledge
The concept of the co-creation of knowledge is borrowed from the educational theory of social constructivism which proposes that “human development is socially situated and knowledge is constructed through interaction with others” (McKinley, 2015; p. 184).
In this thesis, the theory of social constructivism was used in the following manuscripts: Bits, bytes and bones: An autoethnographic account of challenges in anatomy education: Perceptions emanating from
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a selected South African university; and Reflective journals: unmasking student perceptions of anatomical education (Figure 6). In the next section I use the autoethnographic lens to view how the broad generalisations based on the insights and findings from this manuscript inform theoretical analysis.
In this autoethnography, I address the self (auto), research and praxis of human anatomy (ethnos), and the writing and research process (graphy), (Reed-Danahay, 1997), recognising that I am “both the researcher and the researched” (Muncey, 2010). I have taken a social constructivist approach where the practice of autoethnography presumes that reality is socially created (Ellingson and Ellis, 2008) and where I, as the autoethnographer, can contribute to the social production of what is known in the
research and praxis of human anatomy.
The findings of this study were established by reporting the researcher experience as opposed to being the subject with regard to the epistemological processes of generating knowledge. I was able to use Chang’s (2008) writing exercises to increase my engagement with the reflexive processes. The methodology of autoethnography assisted me in unravelling my story of how I developed into an anatomy educator and to evaluate the foundation of my knowledge creation.
Therefore, my autoethnographic narrative is not just about me but is a contextual account of my practices in relation to the historical, technological and cultural experiences of the time, all of which have shaped my identity, and will continue to do so.
In this study. the gross anatomy laboratory provided an ideal setting for small group interactions between students themselves and faculty and students, concurring with Drake (1998), Miller et al., (2002) and McLachlan and Patten (2006) who suggested that these interactions provide invaluable opportunities for active learning and reflection on anatomical knowledge. This study highlights the fact that by facilitating collaboration among peers, aspects of the discipline, such as an appreciation of anatomical variations and the experience of differential observations can be supported and enriched by allowing students to share and benefit from each other. Such interactions with students and faculty promote a mutual learning style that assists to develop a healthy and profound understanding of the
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subject. This study also reports that the gross anatomy laboratory is also a setting where students experience emotional responses to difficult or disturbing clinical situations, corroborating the sentiments expressed by Chan (2015). The laboratory also provided a site where students could deal appropriately with these emotions caused by such exposure concurring with authors such as Rizzolo (2002) and Stewart and Charon, 2002).As illustrated in this study, small group engagement in the laboratory promotes a co-creation of knowledge by encouraging co-operative learning and stimulating reciprocal teaching among peers.
The gross anatomy laboratory allows students to assimilate, accommodate and interpret information.
Students are faced with scenarios that provoke reflection, dialogue and conceptual reasoning which leads to the creation and recreation of student anatomical knowledge. By reflecting on their experiences, students demonstrate conceptual understanding. Additionally, exposure to the cadaver and the emotions that this experience evokes provides a context that some students can perceive as being personally meaningful to them.
5.3.2 Collaborative research in human anatomy
Sullivan (1998) reports that collaboration is a dynamic process between partners to address needs and problems to reach desired outcomes or a common purpose successfully through well-functioning communication (Winge et al., 2005). Crist and Escandon-Dominguez (2003) stated that collaboration creates a sense of shared autonomy between partnerships to achieve mutually identified goals that would otherwise not be possible.
"Communities of practice" consist of members who interact with each other for their pursuit of a common practice (Wenger, 1998; p.7). It is therefore this collective social practice that links individuals together across boundaries and departments and makes up the community.
In the manuscript entitled Communities of practice: a new methodology in anatomical research and teaching, autoethnography via narrative story-telling functions as a wisdom repository and is instrumental in the creation of new knowledge (Sole and Wilson, 2002). Vygotsky’s (1978: p.131)
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model of the zone of proximaldevelopment which proposes that “the distance between the [learner’s] actual developmental level as determined by independent problem solving and the level of potential development as determined through problem solving under (adult guidance) or in collaboration with more capable peers” can be applied to the above manuscript where the learner is the “self” and the knowledgeable experts refer to the nodal informers identified in this thesis. Communities of
practice need not be limited to one department or school if there is sufficient commonality between disciplines (Scott et al., 2014). Collaboration between myself and clinical colleagues resulted in engagement of joint activities and discussions so that we could assist each other and share information.
Relationships were formed that assisted us to learn from each other. Prawat and Floden (1994) proposed that knowledge creation is not an individual experience, but a shared one and knowledge is generated through working within collaborative discourse communities. This latter proposal can be applied to the manuscript on Views of South African Academic Instructors to the Scholarship of Teaching and Learning in Anatomy Education where the communities of practice can exist independent of the prevalent research and teaching mechanisms of the institution. Thus, communities of practice can be extrapolated to incorporate national faculty adding richness to the community as a whole.
Students readily form small communities of practice in learning on their own as seen in the gross anatomy laboratory and echoed in the manuscript entitled Reflective Journals: Unmasking student perceptions of anatomical education. Collaboration is essential to allow students to exceed their current levels of understanding and to encourage metacognition. Small learning groups participating in cadaveric dissection exemplifies a communal learning experience.
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5.3.3 Teaching and learning in context (praxis)It is proposed that teaching and learning in context is underpinned by the educational theory of situated learning in this study. Situated learning theory hypothesises that ‘everyday’ unconscious learning occurs by reference to activity, context and the culture in which it takes place or is situated (Lave and Wenger, 1991; McHarg and Kay, 2008), and can be used to provide insights into the three manuscripts
described in Figure8.
The situated culture highlighted in the manuscript on “Bits, bytes and bones: An Autoethnographic Account of Challenges in Anatomy Education: Perceptions Emanating from a selected South African University” demonstrates the challenges experienced as an anatomy educator within a selected discipline at a higher education institution in South Africa. In this study, autoethnography promoted a state of mindful awareness of the self as both inquirer and respondent, as teacher and learner in the research and praxis of human anatomy. It is through this lens that I sought to examine the complex processes of situated learning of practice through episodic reflection captured in narrative writing.
The situated culture referred to in the manuscript entitled Views of South African Academic Instructors to the Scholarship of Teaching and Learning in Anatomy Education refers to the teaching and learning of human anatomy at various medical schools in South Africa. The perceptions gleaned from this component of the thesis highlight anatomists’ cultural journeys with regard to knowledge, skills and attitudes within their discipline. Socialisation into the anatomy profession occurs via the co-creation of knowledge with several different experts. Hence, this study explored the views of the anatomists with more than twenty years of experience.
This study concurs with Wessels et al. (2015) who stated that learning in a gross anatomy laboratory can be a function of the various learning activities within a specific community that related to the subject matter. In this study, students found that they were able to develop an understanding of the three dimensional nature of structures by performing dissection. These sentiments are highlighted in the manuscript entitled Reflective Journals: Unmasking student perceptions of anatomical education.
Participation with fellow students extended the teaching and learning process in the laboratory and for
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myself as the educator. By applying teaching and learning in context laboratory, learning experiences that facilitated knowledge transfer by authentic tasks, learning experiences that created personal meaning and learning experiences that encouraged social interaction among learners, teachers, and the environment was promoted.
5.3.4 Learning informally
Learning informally in this thesis is underpinned by the educational theory of informal learning. Informal learning is typically defined as a broad term that describes learning which takes place outside the classroom (Berth, 2006). Bullock and Webb (2015) cite the impact of technology on Eraut’s (2004) theory of informal learning in the work-place as being either implicit, reactive or deliberative. In this study, the so- called work-place refers to the University environment. In this study, learning from social media was regarded as being implicit learning; reactive learning was opportunistic which often occurred in the middle of an action such as accessing the tablet in the gross anatomy laboratory “to view content and determine anatomical positions realistically”
(Participant 3; female). Deliberate learning occurred when the learner clearly thought about his/her actions such as accessing lecture notes for study purposes. Students reported that the immediate access to information enhanced in-class understanding of content, concurring with that reported by Nguyen et al., (2014).
5.3.5 Conceptual framework for research and praxis of human anatomy
I consider a conceptual framework as an overall worldview. It is an individual perspective defined not only by values and perceptions (Northcutt and McCoy, 2004), but also by the sum of one’s experiences, beliefs, and knowledge from every facet of life, including, for example, gender, religion, family, politics, society, and the academic, and environmental milieu. Brink (2006) states that a framework of a research study assists the researcher to organise the study and it provides a context in which he or she examines a problem and gathers and analyses data, through identifying and outlining concepts and
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proposing relationships between these concepts. The researcher is then able to illustrate that the study under investigation is a logical extension of current knowledge by developing the framework within which ideas are structured (Scrooby, 2012).
Learning is an active process of creating meaning and transforming understandings in interaction with the environment (Gravett, 2005). Gravett (2005) further emphasises that meaning is arrived at through creating relationships between information and facts and one’s existing knowledge, results in coherent knowledge structures. The building of an integrated conceptual framework (connected knowledge) results in learning that is meaningful. When learning (the creation of meaning) occurs, students and faculty actively connect new information or ideas to their existing knowledge.
Garrison and Archer (2000) state that students can best create meaningful personal knowledge when they are able to confront new information from the perspective and awareness of their existing knowledge base. When students link new material to their existing conceptual framework, they can create new, meaningful interconnections so that their existing conceptions are enriched in one way or another (Gravett, 2005).
The approach to generating a conceptual framework was positioned in the scientific context of the existence of knowledge and the identification of the epistemological lenses were derived from empirical data in Chapters 3 and 4 of this thesis. This is an iterative process between myself and each of the manuscripts (Figure 10).
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5.3.6 Anatomical symbolism of conceptual frameworkMy human anatomy knowledge impels me to use an anatomical structure to depict my conceptualisation of the study. I have opted to use the heart to represent the self with the different chambers and vessels depicting the concepts outlined in Figures 5-10. The overall aim of this study was to explore the research and praxis of human anatomy through autoethnography.
All of the manuscripts are symbolically seated in the right ventricle as they were investigations and had to follow a particular path in a similar fashion that deoxygenated blood flows into this ventricle and is pumped to the lungs for oxygenation. The results of these investigations are referred to as outputs (which are seated again symbolically in the left atrium and left ventricle for dissemination to the rest of the body via the aorta).
Likewise outputs of these investigations have been (a) distributed for publication, (b) recommendations have been made via these manuscripts for change in the way human anatomy is taught and researched, (c) all of this has been captured in the format of this thesis with further recommendations for future studies.