Medical students’ response-ability to unjust practices in obstetrics: A relational perspective
Mitchell, Veronica Ann
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This study is located in the fourth-year obstetrics curriculum that undergraduate medical students at the University of Cape Town, South Africa, traverse, and in which they are initiated into the knowledge and skills of practical obstetrics practices in local birthing facilities. I investigate student learning and what contributes to students being rendered in/capable when they find themselves immersed in the high levels of prevailing injustices to women in labour. Disrespect during the intrapartum period is a local as well as global problem which has actually reached epidemic levels. Drawing on the theoretical frameworks of posthumanism and feminist new materialism, and using post-qualitative inquiry and non-representational methods, I put forward a novel perspective for interrogating responsibilities in terms of students’ ability to respond to unjust practices they observe, I discern what matters for student learning, exploring the troubled practices that emanate through/with/from the curriculum-student relationships in the past/present, and what it means for the future. Assemblage thinking provides a relational tool to understand the impact of the curriculum, assessment processes and other materialising forces that have agency as students are becoming-with human and more-than-human bodies. An initial survey was followed up with interviews and focus groups with students, midwives, educators and administrators. My study revealed hidden aspects of student engagement with their curriculum in obstetrics. What emerged was that students are entangled in a mesh of forces influencing their ability and capacity to respond to the injustices they witness. These forces arise from the discursive and material practices and the in-between relationships that are generated in the learning processes. The study also brought to the fore the intensive forces of affect that appeared to be obfuscated in terms of students’ response-abilities. My findings foreground how reciprocal relationships matter and that a relational ontology can provide helpful insights to engage with responsibility, response-ability and social justice. Students’ capacity to respond to the injustices they witness is limited by multiple forces that include the curriculum itself and other materialising forces generated, for instance by floors, beds, curtains and the student logbook. Time is also a crucial issue amidst the tensions emerging in the complex and risky process of birthing. What matters to students, such as their assessment needs, appears to undermine their efforts to offer care and to promote social justice. Affect plays a powerful part in shaping students’ actions, yet there are few opportunities for acknowledgement of affect. I used drawings as data-in-the making. The process of drawing contributed an extra material force to the study illuminating the power of an affective pedagogical approach for fostering students’ capability to respond to injustice. This socially just pedagogy as well as classroom performances and online collaborative engagement contributed to a collective effort to engage with obstetric disrespect in an innovative and empowering manner that gave voice to students’ experiences and the emerging forces. My study contributes to the field of medical education by opening up a relational perspective to issues of social justice and responsibility that moves beyond individualist and human-centred conceptions of student learning. Through a relational ontology, students’ clinical encounters can be conceived as enactments of the multiple prevailing forces. Each moment matters.