Thoughts on “can we introduce the rhizome into medical undergraduate education?”

 

Before we can examine what rhizomatic learning can mean for undergraduate medical education,
we have to describe some important terms which when interpreted differently can lead to much confusion.
We will start with a definition of rhizomatic learning by Dave Cormier.

Definition of rhizomatic learning

While “trying to write Rhizomatic Learning in 300 words”, Cormier (2012b) writes the following:
The idea is to think of a classroom/community/network as an ecosystem in which each person is spreading their own understanding with the pieces  available in that ecosystem. The public negotiation of that ‘acquisition’ (through content creation, sharing) provides a contextual curriculum to remix back into the existing research/thoughts/ideas in a given field. Their own rhizomatic learning experience becomes more curriculum for others.

Rhizomatic learning, then, is non goal-based learning that is not focused on students tracing the teacher’s lesson plans, but on students performing: ripping, remixing, and feeding content back into the course for others to manipulate. Teacher and student roles are radically restructured. Course content and value come mostly from students, not the teacher, who, at best, is a curator providing a starting point and guidance.

Cormier, D. (2012a, March 04). Seeing rhizomatic learning and MOOCs through the lens of the Cynefin framework. [web log post] Retrieved from: http://davecormier.com/edblog/2012/03/04/seeing-rhizomatic-learning-and-moocs-through-the-lens-of-the-cynefin-framework/

Cormier, D. (2012b, December 13). Trying to write rhizomatic learning in 300 words. [web log post] Retrieved from: http://davecormier.com/edblog/2012/12/13/trying-to-write-rhizomatic-learning-in-300-words/

 

Learning versus Education

Learning is a inborn capability of all animals. A human can not not-learn. In humans this capability to learn has taken a big leap forward as compared to other primates. Learning goes on continuously, chaotically, often non-intensional. You could say that natural learning grows like a rhizome; works rhizomatically.

Learning is distinct from education. Education is intensional. Education always has got a certain goal, whether it be described precisely in the form of learning objectives or whether it is declared in more vague learning goals.

 

Education with or without a contract

In education there is an important difference between education with and without a “contract”.

In education without a contract there is no explicit agreement between the learning party and the teaching party on what should be learned, when, how. There are no learning goals, no deadlines.
The learners are free to learn whatever they want. The role of the teaching party (teacher, institution) is merely to provide learning sources and facilities, maybe even to stimulate and facilitate the learners.

Most formal education though is education with a contract. In this contract there are at least two parties involved: the learner and the teacher/teaching institution. Very often there is a third party involved: the financiering party.
These three party have to agree to some extent on what will be learned and how much money and time it may cost. There is much less freedom in choosing what/how/when/how-fast to learn for the students and ditto less freedom to teach for the institution.

If students in the latter situation deviate from the set learning goals or follow a personal more lengthy learning path, it can lead to financial punishments by the financiering party for either the students and/or the institution.

 

CYNEFIN framework

Another important difference is the difference between novices to a certain knowledge domain and experts. In this context the Cynefin framework can be of use (( reference: http://www.goalsys.com/books/documents/Systems-Thinking-and-the-Cynefin-Framework-Final.3.pdf )

It’s not the intention to go into the details of the Cynefin framework here too much, but basically the framework describes 4 kind of domains:

• Obvious/simple domains
  Here we “know what we know” and we “know what we don’t know”. There is little variability and there are rather clear relations between causes and solutions. A problem here is sensed, categorized and acted upon.
• Complicated domains
  Complicated domains don’t have single right answers to problems. There may be several effective answers, but while not as straightforward as in the obvious domain, in the complicated domain the relationship between cause and effect still pertains, though such relationships may not be obvious. Here problems are sensed, analyzed and responded to.
• Complex domains
  Complex systems have large numbers of components that interact and adapt. The key to dealing with complex systems is a high degree of adaptive capacity. Problems and solutions often emerge from circumstances unexpectedly. Dealing with problems calls for probing, sensing and responding.
• Chaotic domains
  The chaotic domain is turbulent and highly uncertain. In the chaotic domain, cause-and-effect analysis is likely to be nearly useless. Causes and effects may not be perceivable, and if they were, the environment may be changing so fast that there isn’t time to conduct an orderly cause-effect analysis. Waiting for patterns to emerge may be a waste of time, or a recipe for disaster. This is the realm of “unknown unknowns”.

Cause-and-effect relationships are both operative and discernible in the obvious and complicated domains. It is also potentially useful in the complex domain, if the necessary content knowledge is available and it is clearly recognized that its results can have a fairly short “shelf life” (i.e., a periodic re-do may be necessary).

 

Novice versus Expert

The problems which medical experts deal with in practice are from all four domains mentioned above. Their long medical training has taught them how to deal with that. Novices though miss the knowledge and experience to deal with complex or chaotic problems.
Becoming an expert takes time, a lot of time in the medical profession. E.g. in the Netherlands it takes a student at least 9 years to become a GP or 12 years to become a doctor in internal medicine. The program would hold a university study consisting of 3 years Bachelors and another 3 years Masters. After that the fresh medical doctors (MD) can apply for a place where they can specialize in e.g. internal medicine or any other medical speciality.
More on this in the following paragraph.

For experts the situation is very much different. They operate daily within complex situations, often on the verge of what is known within the medical field and what is not known. Rhizomatic learning, will be at its place here. There are no learning goals, there are lots of opportunities to meet experts from other specialities, there is no financier that demands a certain set of skills within a certain time or financial budget.

 

Rhizomatic Learning and medical undergraduates

The medical schools in the Netherlands are not totally free as to what they deliver to the society as their “end product”. E.g what doctors should be able to do is defined in Dutch law ( reference: The 2009 framework for undergraduate medical education in the Netherlands, 2009, Van Herwaarden, Laan, Leunissen ). The medical schools hold a responsibility to deliver a certain number of medical doctors, with the proper skills, within a certain amount of time and a certain budget.

Introducing goal free education, rhizomatic medical education, could jeopardize this because students, especially novices would have to spend a lot of time to research what they need as knowledge/skills for many different kinds of problems. Even establishing whether they are dealing with an “obvious problem” or a “complex problem” takes a lot of expertise, which the novices understandably lack.

Structured instruction for novices has proven to be more efficient than minimal guidance instruction as rhizomatic learning would be. Scaffolding is a proven way of helping the novices to get a grip on the medical domain. But as the novice progresses to an intermediate expert the amount of scaffolding should become less so that the students still have enough challenge in their study.
( reference: Why Minimal Guidance During Instruction Does Not Work: An Analysis of the Failure of Constructivist, Discovery, Problem-Based, Experiential, and Inquiry-Based Teaching; Paul A. Kirschner, John Sweller & Richard E. Clark )

 

Elective courses and projects within formal education

In the Dutch medical curricula there is a certain amount of time reserved for students to do topics of their own choice. This can be within the medical school but also on any other academic faculty. Students also have to do a certain number of scientific projects. This too is an opportunity for medical students to choose for topics that have their personal interest.

It is at this point that some rhizomatic learning gets a chance within formal education. Even when the programs that the students follow are an obligatory part of another faculty, the unique combination that arises by students participating in other faculties, gives unpredictable learning goals an opportunity.

 

Conclusion

Rhizomatic learning is the most common form of learning for medical experts. For medical novices though, undergraduate students, this kind of learning is less efficient and less effective. For them guided instruction with scaffolding is more applicable.

Rhizomatic learning can get a chance in formal education in those places where learning goals are less strict. This could be e.g. where students can choose their own electives or projects.

Many medical schools have time reserved within their curriculum for free choice courses for their students. Medical schools that do not have this, could introduce this in order to let students have experience with a certain amount of rhizomatic learning which will prepare them better for their roles as becoming medical experts.