10.6092/issn.2038-3460/17573
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2038-3460
17573
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Roberto Lusardi
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Tecnoscienza – Italian Journal of Science & Technology Studies
Bethan Mitchell, Engaging with Actor-Network Theory as a Methodology in Medical Education Research, Routledge, 2021
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Book Reviews
2022-07-07
2023-06-30
2022-07-07
2023-10-26
165-168
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Roberto Lusardi
2022/07/07
10.6092/issn.2038-3460/17573
165
University of Bergamo
2038-3460
1
en
168
Bethan Mitchell, Engaging with Actor-Network Theory as a Methodology in Medical Education Research, Routledge, 2021
https://tecnoscienza.unibo.it/article/download/17573/16423
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Book Review                                                                165

    Bethan Mitchell
Engaging with Actor-Network Theory as a Methodology in Medical Edu-
cation Research, London and New York, Routledge, 2021, pp. 150

Roberto Lusardi University of Bergamo

    Actor-Network Theory (ANT) has proven to be particularly useful for
analyzing and understanding technoscientific practices in health-care set-
tings. From the study of laboratory practices by Bruno Latour and Steve
Woolgar (1979) to the multiple ontologies identified by Anne Marie Mol
(2002), researchers inspired by this approach highlighted how the hetero-
geneity of the phenomena involved in various ways in the practical of sci-
entific products and care practices can be understood only considering
their relational and dynamic dimensions. Technoscientific objects and
practices, according to ANT, are not universally given entities, endowed
with unique and immutable properties. On the contrary, they need of be-
ing analyzed in the environment of use and in their socio-material networks
to identify their salient characteristics. How can this perspective also be
useful for studying the production of knowledge in a medical educational
program? This is the question Bethan Mitchell intends to answer with the
book Engaging with Actor-Network Theory as a Methodology in Medical
Education Research.
    Analyzing two empirical case studies situated in UK, the author takes
the socio-materiality position of ANT by considering knowledge and learn-
ing in its development through space and time, bringing together objects,
people, knowledge, institutions, and relationships. Starting from this as-
sumption, the author aims at bringing those who are not familiar (especially
in the educational field) with ANT into this approach, and at producing
new scientific arguments regarding the production of knowledge in medi-
cine. The book tries to reconcile both communities in an argumentative
path structured in successive steps that gradually provide the intellectual
tools to understand when applying ANT to medical education research.
    The volume consists of eight chapters, with a brief introduction acting
as a prelude to the book. The first two chapters are mainly aimed at those
who are not familiar with ANT to illustrate its main theoretical and meth-
odological characteristics, by briefly retracing the salient stages of its his-
torical development. Although these chapters do not provide those famil-
iar with ANT with new content, they are relevant for them too for under-
standing the book’s purpose and structure. The third chapter provides the
historical and theoretical coordinates to frame the UK institutional system
in medical education and pharmacy studies; it deals with the specific set-
ting in which the research was carried out: a peculiar regulatory device that
166                                                           Tecnoscienza – 13 (1)


falls within what is called “improvement science”. This label defines a sys-
tematic approach that identifies desirable improvements in the medical
field (in terms of quality, efficiency, equity, and value), and validates their
reliability and credibility so that such improvements can also be dissemi-
nated in contexts other than the medical one.
    The author defines the two case studies as Student-Led Improvement
Science Projects (SLISPs). These consist of two training courses, which
represent an elective part of the formal curriculum in medicine and phar-
macy, whose participants act as “change agents” to improve existing prac-
tices: the first case refers to medical students working on an improvement
to the process of antimicrobial prescribing practice in two different wards;
the second case regards an inter-disciplinary students group investigating
insulin prescribing practices and how these could be improved. It is not
always easy to understand the articulation of different levels the study re-
fers to: educational, professional, organizational, and cognitive. All are fil-
tered by the ANT reflective and socio-material perspective. Although the
author makes considerable efforts to clarify the above-mentioned levels, at
times the text is not so easy to follow, which may be problematic for readers
not already accustomed to the multilevel complexity of ANT reporting.
    The fourth chapter describes the methodology of the study and is sig-
nificantly called “the research assemblage”, to show how the ANT ap-
proach permeates the entire research path and is not just a heuristic means
to address the empirical field. The chapter consists of two parts: in the first,
the methodology is outlined by describing socio-materiality and ANT as
derived from the practice and professional education (network, symmetry,
and multiple worlds are the key concepts); in the second part, the research
design, the data gathering, and the analysis procedures are described by
using the two SLISPs cases. The next chapter focuses on exploring SLISPs
in the hospital setting. In the first case (about antimicrobial prescribing as
part of a wider project in quality improvement), “the antibiotic story”
comes out as a network of interconnecting materials (gentamycin form,
roles, ward, etc.) which requires the alignment of humans and non-hu-
mans; the second case (about improving medical reconciliation for insulin-
dependent patients) shows the effects of non-human actants on the learn-
ing process intended as socio-material assemblage. In the sixth chapter, the
different enactments of SLISPs become explicit, with a focus on the peda-
gogies of improvement science and with professional and practice learning
orientation. The chapter oscillates between the discussion of ethnographic
data concerning the research paths pursued by students and the inclusion
of these researches within improvement science. Here, the ANT perspec-
tive helps to grasp how improvements are enacted between two main ele-
ments: the clinical staff of the ward, who need to be convinced that the
SLISPs will improve practices, and the students, who require the time and
the commitment to developing the improvement. This analysis also shows
Book Review                                                                167

that there is no single, predictable, a priori outcome of improvement sci-
ence interventions. Mitchell uses the expression “multiple worlds of
SLISPs” (p. 111) to emphasize how different realities coexist at different
stages of students’ research until an alignment is found and produces a
stabilization in practice. The overlaps between different ontologies gener-
ate ambiguities and controversies that students are led to resolve by moving
through material assemblage (lockers and electronic equipment) and or-
ganizational spaces (rooms and areas for group work). Exposure to the in-
definite, and to the areas of possibility that this uncertainty produces, is
seen as a primary source of learning for students. Learning itself, as im-
provement science, is not predefined, unique, and immutable in practice:
Mitchell’s work shows how it is “distributed through space and through
assemblage of objects” (p. 115).
    The last two chapters address the key points of Mitchell’s investigation.
The network perspective applied to educational practices shows that learn-
ing is not just a heroic, benevolent individual act, as it is usually conceived
in medical education (Bleakley 2012), and makes it possible to grasp the
disruptive force that accompanies the intrusiveness of improvement pro-
cesses in daily practice. The assumption that learning and improvement are
positive in themselves is only an ideal: in their development they can bring
disruption and uncertainty to organizational routines and professional pro-
cedures, forcing their stability and legitimacy. Objects also move changes
in preexisting practice. They “invite” practice through colors, shapes, dis-
positions, accessibility, and degree of visibility. These characteristics are
partly inherent to the objects themselves and, at the same time, are the re-
sult of interactions within the network in which they are situated. The ANT
perspective applied to medical education opens the “black box” of learn-
ing and reveals the ambivalences that inhabit it: expectations and impossi-
bilities, commitments and resistances, convergences and divergences. The
main merit of Bethan Mitchell’s book lies in this disenchanted look at
learning processes within the boundaries of improvement science. From
the analysis of the practices, one understands the transformative scope in-
herent in these processes but, at the same time, the complex articulation
they require and the challenges they can bring.
    In conclusion, the answer to the question that opened this review (How
can this perspective also be useful for studying the production of
knowledge in a medical educational program?) is definitely positive, even
though the book does somewhat suffer the same fate typical of publications
that intend to reach different targets and audiences. It is difficult to main-
tain the right balance in the dual register of argumentation throughout the
text. However, Bethan Mitchell succeeds quite well in this task, ensuring
an appreciable readability and an adequate degree of scientific depth of the
content, thus managing to satisfy ANT scholars looking for new stimuli
168                                                            Tecnoscienza – 13 (1)


and a new scientific contribution, and those who are interested in the pro-
duction of knowledge in medicine for professional or educational pur-
poses.

References
Bleakley, A. (2012) The Proof Is in the Pudding: Putting Actor-Network-Theory to
       Work in Medical Education, in “Medical Teacher”, 34 (6), pp. 462-467.
Latour, B. and Woolgar, S. (1979) Laboratory Life: The Construction of Scientific
       Facts, Princeton, Princeton University Press.
Mol, A. (2002) The Body Multiple: Ontology in Medical Practice, Durham, Duke
       University Press.

                                    ***

   Ilenia Picardi
Labirinti di Cristallo. Strutture di Genere nell’Accademia e nella Ricerca
[Crystal Labyrinths. Gender Structures in Academia and Research],
Milano, FrancoAngeli, 2020, pp. 124

Letizia Zampino Sapienza University of Rome

    The book Labirinti di cristallo. Strutture di genere nell’accademia e nella
ricerca [Crystal Labyrinths. Gender structures in academia and research] by
Ilenia Picardi outlines a framework aiming at unravelling gendered prac-
tices in academic and scientific institutions.
    The author adopts the theoretical perspective provided by feminist
studies in the field of Science and Technology Studies (STS) as a toolkit
capable of discussing the complexity of the metaphorical and iconographic
representations of “crystal ceiling” and the “leaky pipeline” and of observ-
ing how gendered practices construct academic paths similar to “crystal
labyrinths”. With the labyrinth’s metaphor, Picardi shows how women do
science by oscillating between innovative disciplinary mobility and hybrid-
isation dynamics practices (Sciannamblo and Viteritti 2021) and the repro-
duction of male-dominated career models. Crystal labyrinths expose the
rhetoric of merit as a system designed to justify the low presence of women
in high positions because they are supposedly less competent than men in
fields such as science, politics, and business. Indeed, Picardi’s book high-
lights that the current systems of evaluation of competence and conse-
quently of career progression in academic and research work are under-
pinned by gendered processes.
