In the UK, health education takes place in a social world in which health and care services are rarely out of the news, sometimes as a cause for celebration, more often as a cause for concern and even vilification. Yet education seeks to develop caring, principled, un-self-serving public servants, who are motivated, thoughtful, curious, and simultaneously savvy to the realities, and critical of the imperfections, of healthcare practice. As highly regulated, professional education, healthcare’s learning environments, processes and relationships need to incorporate and negotiate, yet not be subjugated by, the many rules and constraints not only of Higher Education itself, but of professional and commissioning organisations. It is our contention in this workshop that Dewey’s concept of democratic education is nowhere more needed than in health education, presenting as it does an essential and fundamental challenge to reactive, hierarchical or authoritarian approaches and cultures.
This workshop introduces a new approach to ‘doing’ health care research in one professional health programme, occupational therapy. A focus on ‘evidence based practice’ (EBP) (Sackett et al, 2000) has influenced all aspects of health education in recent years, coming to dominate courses in research and research methods. This is despite EBP having a different purpose to the wide range of activities recognised as ‘research’. EBP seeks to improve health outcomes by a systematic process of searching, analysing and comparatively evaluating research findings, in order to decide on the most suitable treatment intervention or approach in a given context (Sackett et al, 2000). Social science research, in contrast, is generally exploratory and speculative, and is more relevant to occupational therapists’ work. It relies on minds open to all possible outcomes and is often described as a journey of discovery during which working hypotheses are refuted or refined, beliefs challenged and findings have the capacity to surprise; its purpose is to ‘answer questions posed by the problems we face’ (Benton and Craib, 2001:3) rather than to find the ‘right’ answer.
The common sense nature of the EBP project, and its more recent incarnation as ‘real EBP’ (Greenhalgh et al, 2014) is not disputed here; decision making is enhanced when experience and intuitive knowledge are informed and challenged by systematically-derived forms of empirical data and objective measurement. Rather, it is its insidious influence on the broader, riskier, more iterative and essentially creative nature of more socially-oriented research that interests us as we seek to foster, nurture and cultivate learning about things, while developing a reflexive interest in the processes and technicalities of research and inquiry (Dewey, 1916).
Our purpose, in a single research module, is to create a learning environment and develop relationships that bring Dewey’s notion of unity to the contradictory requirements of, on the one hand, prescribed learning outcomes and assessment processes, and on the other, deep and multifaceted learning about self, others and the practical world of healthcare (Newble and Entwhistle, 1986). We are doing this by supporting students to undertake their own research projects, ‘real world’ inquiries into questions of their choice and design, with the support and expertise of peers, educators, researchers and practitioners. Research carried out by students and academics as part of the HEA’s ‘Students as Partners’ theme will be discussed as a catalyst for change, and as a starting point for our more radical rethink of research as democratic education.
In this workshop we want to reclaim research – with its practical, methodological and ethical concerns - as a central component of vocationally-orientated health education. We draw on funded research in which students are co-researchers and authors (Wintrup et al, 2015), we introduce and experiment with a new project we are calling ‘the international classroom’, and discuss Dewey’s concept of democratic education as the source of our intellectual nourishment.
The workshop aims to do three things:
Research with and by students and educators into international exchanges (Wintrup et al, 2015), will be presented, critiqued and debated using Deweyan concepts of democracy.
Led by students, the “circles of partnership” exercise (Wintrup et al 2015: 39) will be carried out in small groups, to experiment with approaches to preparing students, organisations, visitors, groups and individuals for international exchanges, and to consider the ethical concepts of care, hospitality and reciprocity.
Partners and collaborators – students, academics and community health providers - in Sweden and Zambia will participate in discussion by Skype and explain how ‘the international classroom’ offers scope to explore values and beliefs in healthcare, and to develop relationships that foster new kinds of learning.
Participants will be given copies of the HEA report “Purposeful partnerships and practices: an international collaboration in global health” (Wintrup et al, 2015) and invited to join our growing international network of health students and educators working collaboratively towards more democratic health care systems.
Benton, T. and Craib, I. (2001) Philosophy of Social Science. Basingstoke: Palgrave.
Dewey, J. (1916) Democracy and Education. New York: MacMillan.
Greenhalgh, T., Howick, J. and Maskrey, N. (2014) Evidence based medicine: a movement in crisis? British Medical Journal Accessed online 14/1/16: http://www.bmj.com/content/348/bmj.g3725
Newble, D.I. and Entwhistle, N.J. (1986) Learning styles and approaches: implications for medical education. Medical Education. 20: 3, 162 – 175.
Sackett, D.L., Straus, S.E., Scott Richardson, W., Rosenberg, W. and Haynes, R.B. (2000), Evidence-Based Medicine: How to Practice and Teach EBM. 2. Edinburgh and London: Churchill Livingstone.
Wintrup, J., Nascimento, J., D’Aeth, A., Phillips, L., Wheeler, L., Laosebikan, P., Adams, J. and Truman, J. (2015) Purposeful partnerships and practices: an international education collaboration in global health. York: Higher Education Academy.