3-Os/Reflexivity

=Reflections on a Critical Learning Incident where I suffered a setback=

''Submitted to Medical Education Journal on 23 Dec 2011. Rejected on 29 Dec 2011.''

Editor claimed in an email that: ''I enjoyed reading your letter and would publish it in the journal if not for having recently accepted another letter from this authorship group. As space is limited in the journal I feel compelled to spread out the opportunities to have correspondence published. In the near future we will be releasing discussion boards that will remove this constraint. In the meantime, if you would prefer this letter to be published rather than the other recently selected letter please let me know as soon as possible.''

Analysis of incident
I had a back and forth with my supervisor and the journal editor on this issue. 2 separate issues came up: ''I vehemently deny the accusation that I had any duty to inform Gurmit since first, there was no conflict of interest in the topic and second, I was not aware of any possibility that submission of two letters from the same institution at approximately the same time would jeopardise the chance of publication of either being published. If I did, then I would have discussed a tactical approach to ensure that both letters were accepted. I think both letters raise important issues and are worthy of a wider audience.''
 * 1) Does the journal have a hidden quota in publications?
 * 2) Did my supervisor commit a serious breach of trust as a result of not informing me he would be in competition with me at the same time for the same journal? He has in a separate e-mail said that:

Solution
No satisfactory solution found as I do not trust I will get a fair hearing or support from my institution or the journal. This critical incident convinced me that marginalisation, denial of access and unhealthy competition persists. I reflected on what had happened to me in relation to my own innovation of e-mentoring to widen access and build capacity in research and scientific writing through my prior work at IAS, with WikiEducator LearnShare HIV/AIDS Africa project, and also with building the HIVe. I am convinced that the society, the institution and the journal could do better but are caught up in the illusion of the reproductive game.

Action Points
I have emailed the journal editor on 8 January 2012 to suggest that that the society and the journal:


 * 1) Develop a transparency and accountability policy in Medical Education as we have fought hard for in HIV/AIDS research and capacity building
 * 2) Consider developing an open-access web-based research and writing capacity building approach so that we can all learn from what was done to me and ensure further researchers from marginalized backgrounds do not get discriminated against as a result of being made to compete with their supervisors unfairly


 * I have sent him a copy my paper on online mentoring to raise his awareness of what is lacking in their approach.
 * I await the journal's response to these practical steps that I have suggested.
 * I will disseminate this incident through my peers to raise their awareness so we can all transform this experience from failure to a positive outcome.

Insights

 * Level 100 - I believe in open access and learning from experience to improve our world, hence my decision to air this incident publicly on my wiki to productively disrupt denial of access and as part of transparent digital literacy practices when immersed in praxis.
 * Level 200 - It takes a higher mind to give way so that the superior ego can reign and the arbitrary social hierarchy is established in favour of the ruling elite.
 * Level 300 - Smarter Learning as a Reflexive Networker to change the field of educational practices requires a strategic discursive practice integrated into strategic reflexive research practice.
 * Level 400 - Thoughts, Actions, Emotions, Courage, Risk, Peace of Mind.
 * Level 500 - It is what it is. Swaha.

Title
The importance of a reflexive edge to realist medical education research

Dear Editor,

While the recent warm reception given to realism in medical education research is welcome [1,2], its contribution would be greatly enhanced by paying critical attention to reflexivity. [3]

When a medical education researcher designs realist research on an intervention to identify what works for whom, how and why, it is essential to consider not only the the reflexivity of the researcher to develop an understanding of the situation, but also the reflexivity of the learners and the educator since they too have an active engagement with the intervention. Although Wong et al. acknowledge the need to think reflexively about findings from realistic evaluation [1], we are concerned that the need to do research on ‘effectiveness’ for influencing policy and practice could fail to fully recognise and acknowledge the variety of reflexivities at work in producing explanations. A single interpretation bias could be potentially dangerous. It would obscure issues of perception, cognition, judgement, subjectivities, discourses, culture, power, and interests at work in developing normative evidence base medicine, and reproduce rather than change medical educational policy and practice to the detriment of learners and patients [4-6]. In our current research to improve the impact of online continuing professional development interventions on changing the practice of healthcare professionals, we are taking the benefits of realist evaluation a step further with reflexive methodologies. In addition to specifying the C, M, O relationship, we want to know what works for whom, how and why in relation to the social contexts where educational and healthcare practices are reflexively produced by the learners and educators to get a better understanding on the mechanisms as well as the principles of change. We argue that it is not only what works, for whom, how and why, but what can be transformed through investigating educational interventions as post-learning social practices that a reflexive edge adds to the realist conceptual model – a new ‘C-M-O-R’ relationship.

We recommend that realist researchers interested in critical explanations of what, how and why educational interventions are effective consider how to strategically integrate the added value of the reflexivity of researchers, learners and educators.

References


 * 1) Wong G, Greenhalgh T, Westhorp G, & Pawson R. Realist methods in medical education research: what are they and what can they contribute? Medical Education 2012; 46: 89-96.
 * 2) Roberts TE.  To every complex problem there is a simple solution...Medical Education 46: 9–10.
 * 3) Grenfell M, James D. Bourdieu and Education. London: Falmer Press 1998.
 * 4) Bourdieu P, Passeron JC. Reproduction in society, education and culture. London: Sage 1997.
 * 5) Tilburt JC. Evidence based medicine beyond the bedside: keeping an eye on context. Journal of Evaluation in Clinical Practice 2007;14:721-725.
 * 6) Reeve J, Irving G, Dowrick Chris. Can generalism help revive the primary care vision? Journal of Royal Society of Medicine forthcoming.