Sociomateriality in medical practice and learning: attuning to what matters.

CONTEXT: In current debates about professional practice and education, increasing emphasis is placed on understanding learning as a process of ongoing participation rather than one of acquiring knowledge and skills. However, although this socio-cultural view is important and useful, issues have emerged in studies of practice-based learning that point to certain oversights.
METHODS: Three issues are described here: (i) the limited attention paid to the importance of materiality - objects, technologies, nature, etc.-- in questions of learning; (ii) the human-centric view of practice that fails to note the relations among social and material forces, and (iii) the conflicts between ideals of evidence-based standardised models and the sociomaterial contingencies of clinical practice. DISCUSSION: It is argued here that a socio-material approach to practice and learning offers important insights for medical education. This view is in line with a growing field of research in the materiality of everyday life, which embraces wide-ranging families of theory that can be only briefly mentioned in this short paper. The main premise they share is that social and material forces, culture, nature and technology, are enmeshed in everyday practice. Objects and humans act upon one another in ways that mutually transform their characteristics and activity. Examples from research in medical practice show how materials actively influence clinical practice, how learning itself is a material matter, how protocols are in fact temporary sociomaterial achievements, and how practices form unique and sometimes conflicting sociomaterial worlds, with diverse diagnostic and treatment approaches for the same thing.
CONCLUSIONS: This discussion concludes with implications for learning in practice. What is required is a shift from an emphasis on acquiring knowledge to participating more wisely in particular situations. This focus is on learning how to attune to minor material fluctuations and surprises, how to track one's own and others' effects on 'intra-actions' and emerging effects, and how to improvise solutions.