Narrative Based Healthcare

Searching around Amazon to find out what’s been published on Medical Rhetoric, I came across this 2003, London-based study/workbook that aims to provide healthcare professionals with a model for investigating the needs of the patients in order to improve their services: Narrative Based Healthcare:Sharing Stories–A Multiprofessional Workbook.

The book shows how collecting ethnographic-like qualitative  data about Diabetes patients with a particular condition can be translated into meeting the needs of patients who, ordinarily, in a clinical setting, are not able to communicate those needs to health professionals.

I haven’t read the book, but I’m going to find a copy; it provides specific assignments, templates, and further reading, so I’m considering looking at it as an example of qualitative research in Medical Rhetoric/Communications.

The publisher, BMJ Books, produces medical text books in primary care and evidence based medicine (EBM). The first author, Trisha Greenhalgh, has written many books on these two topics as well as technical writing types of text books such as How to Read a Paper, a bestselling EBM textbook worldwide.

Educational Controversy–What is “Learning” Anyway?

I’d like to start by thanking my classmates Dan, Susan and Karen for setting an example for me as I adapt to this new genre of blogging. It’s proving fun, but challenging, and their bloggs are giving me an idea of where I might go with my own public space.

Most of our ethnographies we read this week revolve around educational controversies–sororities, censorship, and the effectiveness of the public college education. I say controversies because in each case, a moral accusation lurks behind the exigence of the study. In Storm in the Mountains: A Case of Censorship, Conflict, and Consciousness James Moffett recounts the truly mind-blowing circumstances which led to the Virginia Text Book Riots of 1974-75. Parents in rural Appalachia, in particular, Kanawaha county VA raised an objection to the state’s adopted language arts curriculum, which transformed into a protest, which transformed into outrage and mob chaos. As the facts quickly disappeared behind sensationalism, and political process gave way to anarchy, an often powerless and voiceless population gained a hearing in the courts of educational history, even if it was by means of radicalism, misunderstanding, and injustice. A promising scholar and curriculum designer lost a lifetime’s worth of credibility, a generation of educators was impressed with a deep fear and defensiveness toward parents, and text-book companies took on the motto “never again.”

I was left with a deep sense of tragedy: for the “common man” who, when desiring change, does the only thing he knows how: “go home and sit down”; for a state whose inability to communicate over vast caverns of cultural difference led to indelible mark of strife; and for the utter havoc that was wreaked on individuals and communities through the insidious power of false information, inflamed by the sparks of zealous belief. I cannot help but believe that such an event constitutes a kind of collective trauma, an EmerAgency which has left a lasting scar on the educational system of the nation. It would be interesting to see what types of Memorials might arise out of such memories.

Pledged by Alexandra Robins and Academically Adrift: Limited Learning on College Campuses by  Arum and Roksa, both deal with University life and culture–although the first is written by a journalist, and the second is based on a quantitative study. Sustaining the (vast) methodological differences and implications, both set out to question the value of current cultural practices in higher education–be it Greek life, or the study habits of  students in general. While I would have to perform a full reading of Pledged to comment on its conclusions, Academically Adrift finds that students who remain more focused on individual study and less on university social life improved their critical thinking and writing at a substantially higher rate than those living out the traditional college experience. The assumption seems to be one in line with a WAC mentality–that writing is the best way to both develop and test intellectual growth. I would like to buy/read the books methods section, if only to learn more about how they interpreted their data. According to The Community College Spotlight, the study employed the Collegiate Learning Assessment essay test “that asks students to solve real-world problems, ‘such as determining the cause of an airplane crash, that require reading and analyzing documents from newspaper articles to government reports.’” The circumstances in which such standardized tests are administered often fly in the face of much Composition research which indicates that writing effectively requires in-depth knowledge of particular topics, research, time, multiple drafts, and collaboration.

The New York Times did an interview with Arum which also reveals the very simplistic view of “learning” which the general public has, and which the study seems to capitalize on in its ability to gain attention. In the interview, Arum says that “areas like critical thinking, complex reasoning and written communication. . . . are the general skills that most people believe should be at the core of undergraduate learning.” I think many here at USF would agree. However, from a compositionist’s standpoint, such standards often seem to dismiss factors such as the time required to ingest new knowledge, much less learn to perform it within a new discourse community and professional culture, which Composition has tried so hard to bring to scholar’s attention through qualitative studies. The assumption is that “learning” is a monological thing that can be appropriately demonstrated by a standardized critical thinking test after two years of nothing but GED classes. To be clear, I agree that the current University system might undergo some reform in it’s proclaimed priorities and concerns regarding student education–however I am in agreement with critics of the Adrift study who object to its lack of attention to disciplinary specialty.

(As a tie-in to the first reading by Moffett: it is interesting to note that Josipa Roksa is from the University of Virginia, and the ABC article cites The University of Charleston, in West Virginia as one of the institutions dedicated to “beefing up” their writing assignments within majors as a response to the study.)

I think this project segues well into the Spencer Foundation CFR which Dr. Moxley passed to us last class (before he had to release us early because of tornadoes, and long drives home), requesting research about how individuals and institutions within the educational infrastructure use data to improve and shape pedagogy and policy. The national response TO this study would be a fantastic case to answer just such questions. The Foundation specifically calls for inquire into “how individual teachers, faculty members, as well as principals and department heads, learn how to use data and how they can work together to understand, interpret and apply data in their specific professional contexts.”

So, I haven’t gotten to Stake’s Qualitative Research yet, but for the sake of time, and to end on an entertaining note, I’ll just say that I was struck by his conception of research as collecting more information than any one person could experience, because it reminded me of this (my apologies for the painful English dubbing): http://www.youtube.com/watch?v=chhtNIKafvU&feature=relatedv=chhtNIKafvU&feature=related.