Fanny Pettersson

Implementing distance teaching at a large scale in medical education: A struggle between dominant and non-dominant teaching activities

This paper examines possibilities and challenges when implementing distance teaching of theoretical content in a regionalized medical program (RMP). It will be argued that Cultural-Historical Activity Theory (CHAT) and the concepts of dominant and non-dominant activities, including conflicts and transitional actions, can lead to an understanding of the distance teaching implementation process. The concepts further provide a theoretical lens through which one can understand the complex relationship between the established and historically rooted, face-to-face teaching activity and the new non-dominant distance teaching activity introduced in the educational setting. Data in the study was collected through an online survey, log data, observations, and in-depth interviews. During the analysis, conflicts between the dominant face-to-face teaching and non-dominant distance teaching activity were identified, and they partly inhibited medical teachers at the program from adopting and developing distance teaching. By illustrating transitional actions as small, innovative bottom-up solutions, further analysis revealed how medical teachers tried to overcome those conflicts to facilitate the adoption and development of distance teaching. The non-dominant distance teaching activity, even if not fully adopted, actually influenced and facilitated change in educational practice. The discussion argues that understanding the implementation of a non-dominant teaching activity in medical education in terms of mere success or failure is not fruitful. Instead, we should strive for sensitivity by closely analyzing the implementation process as interplay between dominant and non-dominant teaching activities. Such sensitivity will make it possible to cultivate future educational development and change.