Medical Education in a Digital Age: Sociomaterial Considerations


  • Anna Macleod
  • Olga Kits
  • Cathy Fournier




Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada

Medical Education in a Digital Age: Sociomaterial Conditions at Dalhousie University

Context is important!
So, where in the world is Dalhousie University?
We're located on the Atlantic Ocean, on Canada's East Coast.


The Maritime Region of Canada
The region consists of three small Provinces - Nova Scotia, Prince Edward Island & New Brunswick.
The total population is about 1.8 million.
Our region is largely rural - and this is reflected in our patient population.


A Word About Dalhousie University
Dalhousie University is located in Halifax, Nova Scotia, the largest city in the region.
It's one of Canada’s oldest universities – founded in 1818.
There are approximately 20,000 students in 190 degree programs.
We are consistently rated one of Canada’s top universities.


Distributed Medical Education at Dalhousie Medical School
Beginning in September 2010, our undergraduate program became fully distributed.
We now have two campuses – Halifax NS & Saint John NB.
Halifax and Saint John are in two different Canadian Provinces and are two very different cities!

The Medical School of the Maritimes

Halifax, Nova Scotia

Saint John, New Brunswick



Summary of Work

What has becoming fully distributed meant to us at Dalhousie? 

Lots of changes!

A significant consideration is the adoption and integration of new technologies, including: 

1. a state-of-the-art telepresence (videoconferencing) system; 

2. the increasingly paperless delivery of our curriculum; and

3. the use of electronic teaching cases, assessment tools, and curriculum management systems.


We are a "living lab!"

Our goal is to address the research question: How is technology-focused curriculum renewal experienced by students, faculty & staff?

How are we exploring this question?

We are using a sophisticated qualitative methodology.

We are conducting a three-year institutional ethnography (Smith, 2005) informed by insights from sociomaterial theory (Ajjawai & Bearman, 2012) including actor-network theory (Latour, 2005). 

Our study benefits from a large and diverse research team with a variety of skill sets and areas of expertise.

Our methods include:

A comprehensive textual analyses of documents and policies related to undergraduate medical education and learning technologies.

In-depth observations of technologically-mediated events (lectures, small-group learning, committee meetings, etc.).

In-depth interviews with faculty, staff and students.


What do we mean by "sociomateriality?"

Sociomaterial approaches to education research take into account both social and material considerations.


Social Considerations:

Social issues have received significant attention in medical education.

This includes things like relationships and affective learning.


Material Considerations:

These have not been explored in detail in medical education.

The material becomes very important when considering technology and distributed learning.


“The material world includes tools, technologies, bodies, actions, texts, discourse and objects, treated as continuous with and embedded in human relations”

Ajjawi & Bearman (2012)


Summary of Results

Education is Digital!


Education is Social


Education is Material



What are we learning?

  • We are learning that matter matters (available technologies, classroom spaces, placement of videoconferencing cameras etc.).
  • Relatedly, material conditions also are highly important (the geography of our institution, availability of technicians to monitor videoconferencing, access to mobile devices, access to internet connections, barriers imposed by firewalls, etc.).
  • Matter does not exist in isloation of the social!

Take-home Messages

The sociomaterial matters!

  • An individual learner is enmeshed in a network of influential factors, both human and non-human. (Bleakley, 2012)
  • Optimizing digital medical education requires an understanding of this network of social and technological influences.
  • While we’ve long recognized the importance of social learning in medical education, material conditions have been largely ignored.
  • We are learning that both social (relationships) and material (technological) contexts have a significant influence on learning.


Social Science and Humanities Research Council of Canada


Ajjawi, R. & Bearman, M. (2012).   Sociomateriality matters to family practitioners as supervisor. Medical   Education, 46 (12), 1145-1147. 

Bleakley, A. (2012). The proof is in the pudding: Putting Actor Network Theory to Work in Medical Education. Medical Teacher, 34(6), 462-467.

Latour, B. (2005). Reassembling the Social: An Introduction to Actor-Network Theory. NY: Oxford University Press.

Smith, D. (2005). Institutional ethnography: A sociology for people. Toronto, ON: AltaMira Press.



Summary of Work
Summary of Results
Take-home Messages
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