FRAMEWORK
Apart from the field of rural health education, there is a growing body of literature concerning health professional socialisation, but studies specifically concerning the development of identity are less common. This study aimed to describe how academics, practitioners and students understand rural health education in different contexts, and interpret how they produce and make sense of different social meanings51. It also considered how students’ identities were shaped by these relations. In order to do this, it was necessary to consider how these construction processes might be conceptualised for analysis.
The aim of this section is to develop a new conceptual framework that hinges on the dialectical relation between material practices and symbolic meanings that individuals attach to their spatial environment. Drawing on Paul Worley’s (2002a; 2002b) writings about relationships, four conceptual themes were used to theorise rural health education as a process of professional socialisation and identity formation. The conceptual themes included, space, boundaries, relationships, and change, which are reflected in Figure 3. This figure illustrates the complex system of flexible, elastic, embracing, including and
51 The study aims are presented on page 533 of the introductory chapter.
182 excluding boundaries for meaning and identity construction that exist in rural health education.
Figure 3333. Individuals and groups shaping the boundaries of the pedagogical space for rural health education
A key finding to emerge from the professional socialisation literature is that people acquire their meaning and significance only within a context of social relations between people52. The rural health education literature appears to suggest that four main groups make contributions to rural health education knowledge through practices in three interrelated social contexts. Undergraduate nursing, medical and pharmacy students are socialised by rural health
practitioners, rural people and health science academics. Rural health education, as a process of socialisation, predominately takes places in the institutional settings of the university and rural health care agencies, as well as the social setting of the rural community. The boundaries of these separate, yet
52 See pages 193 and 363 for arguments about the importance of context in rural health
education and the links between place, meaning and identity. Rural health
practitioners
Students’
Pedagogical space for
rural health education
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intertwined, fields of knowledge and practice converge. The Venn diagram, Figure 3, is useful for representing the overlapping boundaries that are created by the relationships between the social, institutional and psychosocial
dimensions of rural health education. As a result of these intersecting boundaries a metaphoric space is created—a pedagogical space53, which has flexible
boundaries for knowledge, meaning and identity formation.
When considering the practice of rural health education, it is also important to recognise that its purpose and nature changes according to the group defining its boundaries. Education is a defining feature of social life just as social relations are a defining feature of the pedagogical space for rural health education. Relations between people always occur somewhere: in a place, a location and at a particular time. No description of the social circumstances of rural health education can be complete without some consideration of their spatial component.
The pedagogical space for rural health education is being continually reconfigured as its boundaries are negotiated, defined and produced through social interaction and local contestations between academics, practitioners and students. Each of these groups will bring their own ideological beliefs and values to the situation of teaching and learning. Rural health education therefore derives from the socially constructed networks of knowledge and action by academics, practitioners and students that cross the boundaries of space. Creating the
53 The concept of the pedagogical space was introduced on page 153, 223, 533 and 543 of
the introductory chapter.
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184 pedagogical space for rural health education therefore requires a reconfiguration of knowledge in and across spatial, symbolic and geographic dimensions.
The pedagogical space for rural health education is an integral
component of structure and agency. The social organisation of this space and the organisation of individuals have become two sides of single preoccupation. Spatial configuration in rural health education lies at the intersection of
knowledge, power and practice. Authority is assembled by establishing control over spheres of sociocultural activity, such as teaching and learning, in part through the production of the pedagogical space. In other words, the socially constructed pedagogical space has flexible boundaries that define the possibilities for meaning‐ and identity making. For these reasons, a full understanding of the actions of academics, practitioners and students in rural health education required some recognition of the spatial nature of structure and human agency54. The seminal work of Foucault was used to account for the reflexive relationship between space and social action through his concepts of space, power and discourse.
The pedagogical space is a dynamic space that is shaped by professional, cultural and psychosocial knowledge from different communities. It is a socially
54 The need for this study to account for structure and human agency in the study of rural
health education has been identified elsewhere (see pages 313, 1233, 1283, 1343 and 1373). Theories of professional socialisation and identity formation underscored the need to develop a theoretically informed conceptual framework for this study to account for these dual
considerations (see page 1433 in this chapter). The remainder of this section outlines how the pedagogical space for rural health education was conceptualised in a way that clarifies the influences of intersecting relations of power, discourse and identity. Section four will outline the analytic framework used to analyse these abstract and often hidden dimensions of rural health education. Deleted: 25 Deleted: 101 Deleted: 104 Deleted: 110 Deleted: 112 Deleted: 118
constructed metaphoric space in which social knowledge and practices are defined, interpreted, and negotiated by various groups and individuals. This is known as boundary work. Boundary work can be understood as the ‘composite set of claims, activities and institutional structures that define and protect particular knowledge practices’, (Klein, 1996). At the core of this agenda, is a sense of active agency as a complex spatial dynamic. By focusing on this
dialectical interplay, the pedagogical space for rural health education becomes an object of political struggle. It is a political struggle that is enacted in the real life spaces of university classrooms, rural health care agencies and the rural community itself. Foucault theorises space in two ways that were particularly relevant for examining these abstract dimensions of rural health education.
First, rural health education involves students in both intra and extra mural teaching and learning spaces where power relations manifest to influence social action. Foucault uses the term ‘heterotopias’ to describe the way spaces, such as hospital wards, classrooms, and pharmacies, etc. work to define human existence through relations of power within institutions (Rabinow 1991). These are real spaces in which several incompatible sites are juxtaposed. They remove individuals from everyday social spaces and involve them in spaces that are governed by their own internal social order.
Foucault (1988a) generalises two types of heterotopia: crisis and deviance. Boarding schools and military school are examples of heterotopias of crisis, and prisons and clinics are heterotopias of deviance. In this study, the
186 classroom, the doctor’s surgery, the pharmacy, the district hospital and the rural community are the spaces of key interest. In rural health education these spaces come together as a site of juxtaposition in which there is contest and struggle where different spaces come into contact with other spaces that seem to bear no relation to them (Danaher & Schirato 2000). Each of the groups located within these spaces will define the boundaries of the pedagogical space for rural health education in ways that are contextually meaningful for them.
Second, rural health education generally involves students in a set of power relations that define what is accepted as the way things are done in a particular space. These accepted ways of thinking, talking and acting are not designed as such by those in positions of authority, but are instead inscribed in a multitude of minor, seemingly unimportant activities. Foucault (1977a, pp. 195 ff.) uses the panopticon as a metaphor for the ways in which architectural space is designed to allow surveillance and the exertion of disciplinary power over individuals. The panopticon was a design for Jeremy Bentham’s prison in which each cell was visible from a central guard tower. The unique design feature of the tower was that while the prisoners were always observable they could not tell whether or not they were being watched. As a result of this surveillance individuals often effectively disciplined themselves (Foucault 1977).
The technologies of the Panopticon are applied in a less articulated for in higher education. In rural health education, students’ are under the constant surveillance of health science academics and/or rural health
practitioners. Not only do the classrooms and rural health care agencies become key learning spaces, they become centres for observing and organising students. In higher education, students are regarded as individuals who need to be supervised, trained and disciplined. Here, the technology of discipline links the production of useful individuals with the production of ‘controlled and efficient populations’ (Dreyfus & Rabinow, 1983). Rural health education is a process of professional socialisation that imposes its own standards for thought and action. Foucault (1975) calls any process that organises constructs of normality and abnormality, ‘normalisation’. An essential component of technologies of normalisation is that they are an integral part of the systematic creation, classification and control of anomalies (Dreyfus & Rabinow, 1983).
In rural health education, the concept of normalisation effectively transforms from a theoretical construct to a technical problem. Political technologies tend to take political problems and recast them using neutral language (Dreyfus & Rabinow, 1983). For example, in Australian society disciplinary power55 is shaping researchers and social commentators’ thoughts and actions through the notion of improving rural health. Here, the ideals of being healthy and living in an urban location are normalised. Rural populations, when compared to their urban counterparts, fall into the category of abnormal because of their failure to achieve the same level of health status as ‘normal’ urban populations. Language of health is benign. Thus, when interventions that
55 Disciplinary power was introduced on p 683.
188 are designed to improve rural health fail, this only justifies the need for further political intervention. Similar patterns of normalisation are in existence in higher education, however, because they are so taken‐for‐granted it is difficult to easily recognise their influence and effects.
Undergraduate students are under the ongoing surveillance of academics and practitioners as they traverse their journey in becoming qualified health professionals. Surveillance is a particularly strong form of power because it can proceed in a way that can influence actions without the need for coercion or force. Instead, it involves just a gaze. An inspecting gaze, which each individual under its weight will end by internalising to the point that s/he is his or her own overseer (Foucault 1980, p 155). According to Foucault (1977, p 104), disciplinary power is exercised when individuals monitor themselves and regulate their actions in order to conform to conventional social practices.
These themes of space and human behaviour are germane to the analysis of rural health education as a socialisation process because they move beyond spaces of enclosure and confinement to a new openness characterised by learning in health care agencies and in the rural community setting itself. While this openness makes the boundary of the pedagogical space for rural health
education elastic and highly permeable it does not mean the heterotropic spaces disappear or that social control through disciplinary power diminishes. On the contrary, the pedagogical space becomes even more contested because the opportunities for knowledge multiply, divide and overlap with one
another. Rural health education therefore reconfigures spatial interrelationships by collapsing the dichotomy between the public and the private spaces between ‘school’, ‘home’ and ‘work’. As a process of professional socialisation, rural health education can therefore be seen as a “laboratory of power” (Foucault 1977, 204) that ‘links knowledge, power and space’ (Herbert 1996, p 49). From this perspective, what can be known in the pedagogical space of rural health education is not only bound to the institutional and cultural spaces of rural health education but is relational to way students have already come to understand their social world.
The pedagogical space for rural health education is metaphoric space in which discourse clearly plays a central role. The term discourse56 is highly contentious. As a noun it refers to a “… way of signifying experience from a particular perspective” (Fairclough, 1993, p.138). For Foucault (1970, p 138), a discourse is a body of thought, writing or speech that is united by having a set of common terms, ideas or rules. Discourse facilitates social order because it is a way of “… constituting knowledge, together with the social practices, forms of
subjectivity and power relations, which inhere in such knowledges and relations between
them” (Weedon, 1987, p 108) . The findings chapters (5 and 6) will show that while rural health education is understood as a rural workforce supply strategy within the field of rural health, there were other ways it was known by health
56 The notion of discourse and its relevance to the study of rural health education is
discussed on pages 143, 483, and 553.
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190 science academics and rural health practitioners in this study. These chapters powerfully illustrate the way that discourse manifests in language use.
Language use and social interaction is a core feature of rural health education. Patterns of language use are historically specific, socially situated, signifying communication practices set within social institutions and action contexts (Weedon 1987). Language, then, is a structure and a social practice that changes the nature of rural health education. This change occurs each time academics, health professionals and students engage in social interaction every time they participate in it. Different discourses are different ways of
representation, which tend to be associated with different positions (Fairclough, 2000, p 170).There are many possibilities and limits of language for shaping the boundaries of the pedagogical space for rural health education. As such, many meaning making opportunities are available through the teaching and learning practices of rural health education. Focussing on language use was therefore useful for examining the way different groups produced meanings through the professional socialisation process of rural health education, in this study. Language was therefore a useful unit of analysis that provided a critical lens for assessing the way different spatial and discursive contexts shaped rural health education as a socialising and identity forming process.
This study was concerned with more than how various groups construct meanings about rural communities. It was also interested in examining how various discourses influence the way students construct their personal
and professional identities. Discourses are more than ways of thinking and producing meaning. They constitute the ʹnatureʹ of the body, unconscious and conscious mind and emotional life of the subjects they seek to govern (Weedon, 1987, p 108). In other words, they condition the ways identity can be formed in rural health education. The pedagogical space was a useful conceptual tool for developing the analytical framework in a way that would be conducive to analysing students’ identity formation.
The pedagogical space for rural health education is conceived as a contested site in which undergraduate nursing, pharmacy and medical students shape themselves to become whatever different institutional or cultural spaces hold as desirable. The findings chapters show that within the pedagogical space of rural health education particular systems of meaning (discourses) provided students with information about whom and what they should desire to become. There were two forms this process took.
Firstly, the students were susceptible to the attention of academics and rural health practitioners who often demanded they enact particular attributes that are considered to be characteristic of emerging health professionals. This was often explicit, but most an implicit and unspoken expectation. Foucault understood this form of surveillance as the ‘gaze’ of the expert upon the body to be subjected (Foucault, 1975).
Secondly, the students came to identify with a particular version of who they wanted to be as emerging health professionals. Foucault
192 understood this form of desire as ‘self governance’ (Foucault, 1988b). For any individual the expectation to conform to particular ways of being and the desire to behave in a particular way co‐exists in a complex mix, in any space and at any time. These theories are premised on the idea that the internalisation of social and cultural rules is a significant medium of identification (McHoul & Grace, 1993).
The framework developed for this study enabled rural health education to be theorised as a pedagogical space in which students may or may not internalise beliefs and values that have been conditioned by discourses to shape their identity. In order to explicate this argument further it is necessary to give some more consideration to how processes of identification operate. A key finding to emerge from the identity literature is the dual process of identification and classification. Some commentators (Jenkins 1996) claim people, through social interaction, place others within social categories that relate to their interpretations of ways of life, values and attitudes. Internalisation is therefore not the only significant medium of identification.
The shared understandings of contextual codes and social practices that various individuals bring to the pedagogical space for rural health education can be understood as ‘normative mechanisms’ (Foucault, 1972; Foucault, 1975; Foucault, 1980; Jenkins, 1996). These normative mechanisms work to highlight the boundaries between ‘us’ and ‘them’ (Jenkins, 1996; Lamont & Molnar, 2002), which are symbolic boundaries that signify the point where group
similarities and differences begin and end. Students’ talk about similarities and differences in their experience of rural health education was therefore an important source for analysing their boundaries of personal and professional identity formation.57 The analysis of these boundaries was at once an analysis of student’s identity formation.
The next section draws on the theoretical framework to develop an analytical model for examining the relations between power, discourse and identity formation involved in the socialisation process of rural health education.