When I teach Lave and Wenger’s (1991) altogether brief introduction to “legitimate peripheral participation,” I do not teach it as a theory of learning but as a model for social structuring in Lévi-Strauss’s sense (1962 ). But Lévi-Strauss was seeking to model a moment in the organization of a people while Lave, in a major development, seeks to model movement through social structurings when everyone and everything involved in the movement constitute this structuring as it will be available for the future. By an implication that remains to be developed, Lave also opened the way for a modeling of culture change.
In brief, for those who do not know the background to this approach, Lave asks us to move from imagining participation in any position as dependent on earlier learning to imagining this participation itself as producing some personal learning. Thereby she argues that a personal movement into a position is dependent on mechanisms other than learning (or socialization/enculturation). These are the mechanisms that make the initial positioning “legitimate” and authorize the acknowledgment of movement. Wondering about legitimacy and authorization leads to searches for the interactional, political forces that establish legitimate participation, authorize certain forms of leaning, and thus of course, refuse participation, does not acknowledge learning, etc.
Much of this formulation sprung from an interest in apprenticeships and it has been found to be a very useful way of approaching traditional problems generally phrased as matters of socialization into positions—for example the movement that transforms a medical student into a physician. But there is still a need for more exact accounts of movements that might help us develop further properties of the model.
Given all this, I am thankful to Dr. Yan-Di Chang and her dissertation about a moment in the education of physicians in Taiwan. At some point in their career, people who are moving towards being acknowledged as Mds enter what is known there as a “clerkship” where they will be, for the first time, authorized to care for a patient, under the gaze of doctors and nurses with various experiences and authority. So what happens during various stages within this clerkship?
Dr. Chang has a good sense of what makes ethnography worthwhile and also infuriating: there is a long chapter in the dissertation about orientation day when the new clerks are told, among many, many, many things … where the bathrooms are! Do we really need this level of detail? Yes, if we are not going to gloss over the difficulties involved in movement across the virtual spaces of social structure. Yes, if we are going to highlight how much work it is not only to be a “peripheral” participant but also to be the fuller participants who have the responsibility to teach what they can never be quite sure the students do not know. The people who plan the orientation, and those who actually perform it, are faced with the “instruction manual” problem discussed by Garfinkel (2002: Chapter 6): we, the instructors, know that they, the inductees, will need instruction, we can imagine what they will need, but we cannot be sure. So the actual moment of interaction is difficult for all, and open for much deliberation, including self-reflective deliberation by the instructors about how to do it the next time.
Dr. Chang then proceeds through several other moments when all these matters become salient. There is the encounter with one’s first patient and how to balance his care with one’s personal life while knowing that one might make mistakes, while knowing that one should ask for advice but not necessarily from whom, while being told that one has made a mistake one had not noticed, and all the while knowing that a person well-being, if not life, is at stake. Moving into the position of “physician” re-arranges a small crowd!
Dr. Chang then takes us into a more detailed, almost conversational analytic, look at another salient moment in the life of the whole polity: the senior doctor’s rounds when a few students (including both beginners and some more advanced) have to present a case to the doctor, in the presence of fellow students, as well as other more seasoned personnel. Everyone is participating legitimately. The hierarchies are multiply indexed discursively and practically, particularly by the balance between questioning, proposing answers, redirecting and sometimes actual instructing. But the detail of the conversation reveal again and again that noone is following a script. Everyone has to handle multiple uncertainties that cannot be resolved simply by following rules or applying knowledge.
Everyone is indeed in movement, re-constituting hierarchies which, as Dr. Chang illustrates in a later chapter are themselves subject to meta-pragmatic deliberation among the most legitimate and fullest of participants. There the questions keep arising: how do we best prepare future doctors? Could we produce “happy doctors”? These are the conversations that must have guided medical education as it shifted though various models in the history of Taiwan. And they are the conversations that will participate in transforming it.
The detail in Dr. Chang’s dissertation made me think in a somewhat inchoate fashion about the interactional consequences of the instruction manual problem. At any moment in an asymmetrical interaction (and perhaps all interactions are) one must wonder what it is that the other person does (not) know. But, of course, this wonder cannot be settled in any definite fashion. In any event there would be no time. Conversational analysis has clearly demonstrated the extent of “repairs” in face to face interaction. It is as if all conversation occurred in what, to play on Vigotsky, one might call a zone of “proximal ignorance” where all participants have to play with first, what they can make each other pass as knowing (that is they authorize each other’s participation), and, second, what some must instruct others who have exhibited allowable ignorance at this moment and about this (that is, at other moments, a display of ignorance about this might lead to status degradation).
What Dr. Chang, building on other work, illustrates again is that this is not simply a moment to moment matter that must proceed under meta-pragmatic discursive awareness (as classical theories of cultural learning have assumed). It is also a process taking place in longer sequences where meta-pragmatic discursive awareness is very much involved. In the day to day matter of moving students into the position of physicians experiential difficulties abound: a future doctor must find out where the bathroom are, must face her first patient along with experienced nurses, must explain her actions to other doctors. At every moment further deliberations must occur to develop, repair, redirect what has happened before. And these deliberations may, or may not, make moving medical students into physicians a smoother process for all involved.Print This Post