Sociomateriality in medical practice and learning: Attuning to what matters

Abstract

CONTEXT In current debates about professional practice, learning and education, increasing emphasis is being placed on understanding learning as ongoing participation rather than as acquiring knowledge and skills. Close attention is paid to the sociocultural context as well as to cognition. While this general sociocultural view is important and useful, issues have emerged in studies of practice-based learning that point to certain oversights. METHOD Three issues are described here: (1) the general lack of attention to the importance of materiality – objects, technologies, nature etc – in questions of learning; (2) the human-centric view of challenges and complexities in practice that fail to note the transformational entanglements among social and material forces; and (3) the conflicts between ideals of evidence-based standardized models and the sociomaterial contingencies of clinical practice.    DISCUSSION It is argued here that a sociomaterial approach to learning and practice offers important insights for medical education. This view joins a growing field of research in the materiality of practice and everyday life, which embraces wide-ranging theoretical families that can only be briefly mentioned in this short introduction. The main premise they share is that social and material forces, culture, nature and technology, are enmeshed in everyday practice. Objects and humans act upon one another in ways that mutually transform their characteristics and activity. Examples from research in medical practice show how materials actively influence clinical practice, how learning itself is a material matter, how protocols are in fact temporary sociomaterial achievements, and how practices form unique and sometimes conflicting sociomaterial worlds, with diverse diagnostic and treatment approaches for the same thing.   CONCLUSIONS The article concludes with implications for learning in practice. The shift is from sole emphasis on acquiring knowledge representations to learning how to participate more wisely in particular situations. Focus is on learning how to attune to minor material fluctuations and surprises, how to track one’s own and other’s effects on the ‘intra-actions’ and emerging effects, and how to improvise solutions.