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professional development
Radiography (2004) 10, 109e117
Discourse analysis and personal/professional development C. Boyes) Professional Health Studies, York St. John College, Lord Mayor’s Walk, York YO31 7EX, UK Received 23 September 2002; revised 19 January 2004; accepted 2 February 2004
KEYWORDS CPD; Qualitative case study; Text; Identity; Narrative
Abstract The article discusses discourse analysis and its relevance to personal and professional development, drawing on elements of social theory. Related terms such as text, discourse and genre are defined and social theoretical implications explored. Practical application of discourse analysis to CPD is illustrated. A case is developed for understanding contemporary practice and the construction of personal and professional identity through discourse. Understanding discourse is presented as an enabling structure for personal and professional development. ª 2004 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction This article arises from the author’s concern for realistic personal and professional development. It presents a discussion of discourse and discourse analysis, an understanding of which can be helpful to professionals planning their own personal and professional development. Discourse is likely to be an unfamiliar topic to many readers and a glossary of terms is therefore provided. A table outlining how discourse analysis may be put to use is also provided to orient the reader. The author’s understanding of discourse arose from research published as a PhD thesis.a This ) Tel.: D44-1904-716403. E-mail address: [email protected]. a Role change, identity and personal/professional development in radiography: dialogues, discourses, directions. University of East Anglia, 1998.
paper does not present the results of that research since issues that were important at the time (e.g. revision of the PSM Act) are now dated. However, the author remains convinced that a basic understanding of discourse can enable professionals to adopt a more critical analytical approach to understanding and developing their own roles and can therefore be helpful in continuing professional development (CPD). Social theorists such as Foucault and Bourdieu inform this field of study and reference to their work will be included in the discussion that follows. Discourse analysis may be put to use in formal research but may also be utilised in a less formal way to aid critical analysis of texts (e.g. diaries, interview transcripts) to identify opportunities for development. Both processes will be referred to as research in this paper. Such research can be developed from interviewing colleagues and therefore tends to be
1078-8174/$ - see front matter ª 2004 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2004.02.003
110 qualitative, grounded in the interview accounts. A semi-structured approach in which colleagues are asked to talk about their own role, their development and perceived obstacles to development can generate complex but enlightening data. This approach specifically attempts to portray the ‘messiness’ of contemporary personal/professionalb lives by using narrative as the predominant form of expression. The strength of narrative is its tendency to resist reductionist readings i.e. it provides a fuller, more accurate account of the complexity of practice (rather than over-simplifying issues). Accounts of the researcher’s own development during the research can be included to help the reader judge the researcher’s bias. The result will be a case study bounded by local circumstances but relating through the application of social theory to more global issues; analysis of the discourses thus permits a certain kind of generalisation. Engagement of the reader in the narrative accounts enables them to explore their own situations reflectively and such research therefore has both ‘particular’ and ‘general’ implications. Less formally, a professional may keep a personal/professional journal, reflecting on critical incidents not only in relation to clinical episodes but also developmental concerns (e.g. feeling that traditions of power imbalance between radiologist and radiographer, rather than ability, may be preventing the development of radiographer reporting, or that managerial control may be limiting an individual’s potential). Subsequent analysis of themes repeatedly emerging in the journal may enable the radiographer to more accurately identify the problem and develop a strategy to tackle it.
Text, discourse and genre Understanding discourse implies a ‘textual’ approach to research and aspects of text, discourse, genre and other concepts are now briefly described. Data from interview transcripts can be considered as texts open to a form of discourse analysis. Exploration of the discourses in contention in a text provides a way of relating the local to the global. Outside pressures on radiographers exert influence in the form of texts (documents, reports, and journal articles, for instance) and radiographers tell the story of their response in text. The social, cultural and professional world is laden with text b
The term personal/professional is used to indicate the difficulty in separating out one from the other in terms of a professional’s lived experience.
C. Boyes and professional and social practices in which radiography is embedded operate through discourse which is also constitutive of those practices. Approaches to language and textual analysis take many forms and are closely related to issues of representation. Debates about representation centre on how meaning is made through language. A discursive constructionist view is most helpful since it is realistic in representing the role of both subject and structure (individual and institution) without giving pre-eminence to one over the other. The simplest way to understand this is to recognise that in bringing about change neither individual nor institution (e.g. radiographer nor hospital) is all-powerful; neither can completely dictate what happens to the otherdthey are in ‘conversation’ with each other. Fairclough follows Halliday in his definition of text in relation to both spoken and written texts (Fairclough, 1989, p. 24)1 ‘‘a text may be either written or spoken discourse, so that, for example, the words used in a conversation (or their written transcription) constitute a text.’’ (Fairclough, 1995, p. 4)2 Kress provides some useful working definitions from a socio-cultural perspective of language ‘‘Discourses are systematically-organised sets of statements which give expression to the meanings and values of an institution. (.) Discourses do not exist in isolation but within a larger system of sometimes opposing, contradictory, contending, or merely different discourses. Given that each discourse tends towards colonisation of larger areas, there are dynamic relations between these which ensure continuous shifts and movement, progression or withdrawal in certain areas.’’ (Kress, 1985, p. 7)3 Fairclough points out that institutions are not monistic (uniform), but pluralistic, i.e. they provide ‘‘alternative sets of discoursal and ideological norms’’ (Fairclough, 1995, p. 40).2 Discourses may thus represent particular ideological positions and institutions and texts can both be seen as sites for struggle between opposing ideologies (representing a particular class or theory), represented in and through contending discourses. Fairclough relates such struggle to class struggle: ‘‘These institutional struggles are connected to class struggle, though the relationship is not necessarily a direct or transparent one; and ideological and discoursal control of institutions is itself a stake in the struggle between classes.’’ (Ibid. p. 40).
Discourse analysis Texts arise in particular circumstances which have an effect on what kinds of texts are allowed to arise, and which are not. Social situations (including interviews) in which texts arise are conventionalised and structured and result in ‘‘conventionalised forms of texts.specific genres (which have) specific forms and meanings, deriving from and encoding the functions, purposes and meanings of the social occasions.’’ (Kress, 1985, p. 19)3 Texts should be understood in the contexts in which they arise and are read. Clark and Ivanic use Halliday’s definition (and point to the summary of it in Halliday and Hasan, 1985, Chapter 1)4 of context as a starting point towards their own definition which makes writing more explicitly political: ‘‘we distinguish between the physical context and the wider socio-cultural context and argue that writing is an activity embedded in and dependent on not only the immediate social circumstances and people participating in it but also on the social and cultural values, beliefs and patterns of privileging surrounding it. This is what makes writing a political act.’’ (Clark and Ivanic, 1997, p. 58)5 As well as context, texts are read, and should therefore be understood in terms of, co-texts. No text is understood in isolation; for example, contemporary texts about CPD should be understood in relation to the wider picture (e.g. the emerging role of the Health Professions Council, Government publications about strategies for introducing skill mix, cutting costs etc.). Power is always at play in text (either directly in spoken discourse or indirectly in written discourse) since discourse is about difference and power is about ‘‘relations of difference’’ (Kress, 1985, p. 52).3 However, it is important not to confuse ‘cause and effect’ or to see power in purely negative, oppressive terms. Power can also lead to emancipation: ‘‘Power does not derive from language, but language may be used to challenge power, to subvert it, and to alter distributions of power in the short or in the longer term.’’ (Ibid. p. 52) It is important to remain realistic about the degree to which creating texts (written or verbal) can bring about change, but it is also important not to underestimate the contribution writing makes within the wider socio-political arena:
111 ‘‘writing plays a central role in the circulation and consumption of ideas and, for that reason, in the development of democracy.’’ (Ibid., p. 241) All texts contain discourses in contention. Texts arise out of difference and are the ‘‘sites of attempts to resolve particular problems’’ (Kress, 1985, p. 12).3 But discourses (aided and abetted by authors) tend to ‘colonise’ texts, to impose one particular view or perspective. Indeed ‘‘it is a demand made by most genres that discursive difference should be resolved’’ ‘‘the task of the author/writer is precisely. to construct a text in which discrepancies, contradictions, and disjunctions are bridged, covered over, eliminated.’’ (Ibid. p. 35 and p. 15, respectively) So within any text there are discourses in contention, but at the level of text there is also conflict between different accounts, arising from different perspectives (e.g. differences in the accounts given by two different practitioners, or between an account written for publication in a journal and a spoken account, etc.). Research accounts should attempt to illuminate both of these levels of discordance.
Discourse analysis Interpretive discourse analysis (developed from the perspective of an insider) can be used to explore issues (e.g. relating to role extension) implicit in texts arising from interviews, diary notes, questionnaires, institutional documents and the wider literature. Data are subject to analysis at various stages in the research process. The interview process itself relies on interpretation in order to take place, both on the part of the interviewer, in understanding the participant’s account, and on the participant’s part, in bringing forth their interpretations of practice. The process of transcribing is a further act of interpretation, as is participant checking. More formal analysis involves deliberately engaging in the act of interpretation, making sense purposefully through the exploration of themes and discourses in various categories (Table 1). Approaches to discourse analysis which emphasise ‘structural’ elements of text construction are only really helpful in understanding the
112 Table 1
C. Boyes Process of discourse analysis
Stage
Examples
Collect data
Interview a colleague (e.g. peer, manager, subordinate or consultant)dyou may want to focus the interview around a particular subject such as radiographer reporting or you may wish to ask more ‘open’ questions such as eliciting what issues are important to that individuala
Transcribe the data into a format ready for analysis
Text representing the content of the interview which should be checked for accuracy by the interviewee
Begin analysis of the text to identify important elements
Content (themes, issues) Interpersonal (process of creationdturn-taking etc.)
Further analyse the content to identify discourses in contention
Different world-views Alternative conceptualisations of issues Power imbalances Professional autonomy/institutional control
Consider how these relate to more global discourses
Professional power and knowledge State intervention and control Social justice Democracy
Reflect on what could be done to change the status quo
Stakeholder analysis (who influences the current situation) Identify alternatives
Devise an action plan for change
What elements make up the total process? Who will be affected? How could change be achieved?
Initiate exploratory dialogue
Discuss the proposed change with stakeholders (e.g. managers, peers, consultants etc.)
Agree how to proceed and how to review
CPD record Appraisal
a The process of recording and transcribing interview data should not be underestimated but is outside the scope of this paper.
method used to obtain the interview transcripts, i.e. the face to face interview. They explore turn-taking, the asymmetric initiation of questions etc., in order to understand how researcher and researched negotiate their way through the interview. Interpretive discourse analysis is a more useful approach since it emphasises the content of language (its themes and discourses) rather than its structure. Each text (e.g. interview transcript, questionnaire, document) can be reviewed to identify constituent themes. Each text can be considered in terms of its discourses, asking what discourses were in contention, what debates were implicit in the text? This form of analysis emphasises content and context over linguistic structure, and is based on a view of language described by, for example, Bourdieu (1977), Foucault (1980), and Kress (1985).10,6,3 This approach is the kind used by Phillips in his research into nurse education (Phillips, 1995)7. It understands discourses to mean,
‘‘the value-laden, socially constructed beliefsystems which contribute to the shaping of social and interactive practices.’’ (Ibid. p. 88) Understanding the discourses embedded in the data (texts) provides the link between the local and the global, since texts and social practices are mutually constructive and serve to relate local contexts to the wider culture. This approach can illuminate the parts played both by individuals and the institution in the creation of local ‘reality’. Neither should be completely dominated by the other. Each is jointly responsible for the way things are. Subjects may not feel it an easy task to change their world, but neither should they feel completely under the control of institutions. So in analysing participant responses, what was it hoped to make of their answers? Antaki argues that explanations can ‘‘lock together as a means of constituting the social world (.) and constituting the people
Discourse analysis who navigate through it.’’ (Antaki, 1994, p. 116)8 and that ‘‘an account, by selecting its vocabulary from available cultural themes and concepts, and by its choice of their arrangement, makes positive claim to a certain vision of the world.’’ (Ibid., p. 7) Both of these quotes imply a reciprocal relationship between how people talk about their world, how they experience it, and how it is constituted. This relationship between local context and wider culture is taken further in Antaki’s discussion of ‘talk in action’, in which he refrains from fully endorsing the Foucauldian account: ‘‘‘action’ shades into abstract relations between cultural meanings and practices, not necessarily locatable in any one person’s talk and behaviour at any one place or time, but infusing the general understanding of some institution like government, madness or sexuality.’’ (Ibid., p. 119) The less radical version of ‘talk in action’, which he appears to favour, refers to ‘‘what is achieved in the very local organisation of talk.’’ (Ibid., p. 119) Implicit in Foucault’s references to discourse is that they remain in contention, and there remains therefore the potential for re-construction, for change: ‘‘Discourses are tactical elements or blocks operating in the field of force relations; there can exist different and even contradictory discourses within the same strategy.’’ (Foucault, 1981, pp. 101e102, author’s emphasis)9 Although radical sounding, this leads to an understanding of discourse which is political in linking local practices with the wider social practices and political contexts in which they occur. Texts are brought into being in relation to social norms and institutional habitus (Bourdieu’s term meaning roughly systems of dispositions or inclinationsdsee for example Bourdieu, 1977)10. Discourses seek to ‘dominate’ texts in order to make them understandable, but other discourses are always present, and while these discourses are in ‘play’ with each other there exists the potential, albeit a struggle, for re-construction, for change. The political, as well as personal,
113 dimension to discourse analysis makes it an appropriate method for analysing interview transcripts. Interviewee’s responses can be legitimately treated as narrative accounts or stories because of the centrality of story telling in communication. Narrative may also represent a route towards understanding practitioners’ actions, what Schon (1987)11 calls knowing-in-action: ‘‘it is sometimes possible, by observing and reflecting on our actions, to make a description of the tacit knowing implicit in them. Our descriptions are of different kinds, depending on our purposes and the languages of description available to us. We may refer, for example, to the (.) values, strategies, and assumptions that make up our ‘‘theories’’ of action.’’ ‘‘Whatever language we may employ, however, our descriptions of knowing-in-action are always constructions.’’ (Ibid., p. 25, author’s emphasis) Narrative is a form rich enough to encapsulate more than one mode of thinking and this approach is described as an alternative strategy towards research interview data analysis by Mishler: ‘‘telling stories is one of the significant ways individuals construct and express meaning. This assumption informs work by many investigators from a variety of disciplines having different theoretical perspectives.’’ Mishler (1986, p. 67, author’s emphasis)12 Mishler provides evidence from an anthropologist, a linguist, a psychologist, a literary critic, and a moral philosopher to support his thesis. This cross-discipline ‘transferability’ of the idea suggests good reason for supporting it. This is a quotation from just one of the proponents: ‘‘It is because we all live out narratives in our lives and because we understand our own lives in terms of the narratives we live out that the form of narratives is appropriate for understanding the actions of others.’’ (MacIntyre, 1981, p. 197)13 Narrative thus occupies a central position in how we understand things, how we attempt explanations, in general, how we account for things in terms of stories. In the process of interviewing steps should be taken to avoid the problem of what Mishler describes as ‘standard’ interview practice,
114 ‘‘where respondents’ stories are suppressed in that their responses are limited to ‘‘relevant’’ answers to narrowly specified questions.’’ (Mishler, 1986, p. 68)12 Delay to closure should be sought so that the interview dialogue resembles what Phillips describes as ‘exploratory talk’ (Phillips, 1994).14 This can be achieved by trying to create space in the interview for the interviewee to respond thoughtfully. According to Mishler, ‘‘Telling stories is far from unusual in everyday conversation and it is apparently no more unusual for interviewees to respond to questions with narratives if they are given some room to speak.’’ (Mishler, 1986, p. 69, author’s emphasis)12 Analysing interview data may lead to a better understanding of language and in this respect the work of Halliday (see, for example, Halliday, 1973)15 is important. He described three interdependent functions in language which it is useful to distinguish. The ‘textual’ function (concerned with syntactic devicesdgrammatical rules) is important to linguists but less helpful for CPD. ‘Interpersonal’ (the relationships between speakers constructed in talk) and ‘ideational’ (the subject of what is being referred to) functions are more important for radiographers interested in this area to understand. All three functions in language are dependent on each other, but emphasising content and interpersonal contexts (i.e. what was said, and how the interview situation contributed to its saying) emphasises the educational, rather than linguistic, issues for CPD.
Discussion The author’s view of professional practice was altered as a result of studying discourse and social theory; rather than seeing practice as a sphere in which external events tended to dictate what happened to individuals, the author began to conceptualise the continually changing climate in which radiographers work as a ‘lived curriculum’, i.e., a set of circumstances and contexts, problems and dilemmas that also represent opportunities for development. The notion of habitus presented itself as useful. Even in contexts of ‘conventional’ role radiographers are affected by the institutional habitus and ‘learn’ to accept relationships of control,
C. Boyes leaving much of their practice unchallenged. However, some radiographers see ‘outside pressure’ as ‘opportunity’ and reframe their curriculum into an active and pro-active stance, leaving them better positioned to extend their roles and develop their practice. Such a response provides the best opportunity for reconstructing the relationship between individual and institution, working towards a dialogic, learning workplace. Understanding this process as a complex and ‘untidy’ narrative (as opposed to ‘tidying up’ and de-personalising the account in more traditional approaches) can be an enabling structure (i.e. can capacitate the processdsee Giddens, 1984)16 for helping radiographers to better understand their own position. Positions are socially constructed within discourses of power, knowledge, identity, education, competence, professionalism, caring and technology. These discourses are in tension with one another and they should remain so if a critical understanding is sought, resisting the natural tendency towards closure and control. Understanding this should place radiographers in a better position for transforming their practice in personal, professional and political terms. Contending discourses are thus dialogic: they are in ‘conversation’ with one another and ‘agreement’ or ‘resolution’ is not what is sought. That said, formal accounts of such research can be constructed with a conscious meta-narrative (single overarching story) to give overall coherence to the stories and accounts of practice given. The meta-narrative will be concerned with the ‘major’ discourses of power, knowledge, and identity which are constitutive of the ‘minor’ discourses immanent in the stories and accounts presented by research participants. Self-development through an understanding of discourse and social theory represents a particular kind of educational process in the context of others to which it should be seen as complementary, not competitive. It does not reduce the need for political strategy towards increasing access to, and funding towards, formal courses. Neither does it reduce the need for greater clinical and medical education for those radiographers wishing to extend their role. However, it does represent a way in which radiographers may become more autonomous in setting their own CPD agenda. Discourses are a continuous part of everyday practice but usually remain hidden from view, implicit rather than explicit. Discourse analysis enables the deliberative consideration of the values implicit and enacted in professional practice. Such an approach may enable practitioners to resist, for example, market economic readings
Discourse analysis of their practice in favour of caring, moral and ethical readings. The political nature of their practice may thus be brought more clearly into view, generating the possibility of greater awareness for intentional personal and political agency (action). It is thus valuable to understand something of the way in which discourses operate in texts since it permits alternative readings of historical as well as contemporary practice. For example, radiological control of the radiographic profession could be read as a westernised, masculine-oriented history of control and dominance, the ‘scientific’ process of research could be read as a strategy for hegemony (continued, dominating leadership) by privileged male actors. Illuminating such readings may offer some hope for the generation of alternative stories. An understanding of discourse and social theory can help radiographers develop their own CPD curriculum in relation to their own needs and particular circumstances. The curriculum would be an attempt to bridge the gap between unreflective practice and formal courses which may more fully support the development of reflective practitioners in radiography. It should encourage the move towards greater, more critical dialogue in the workplace as a foundation for individual and institutional development separate from (or complementary to) formal courses. Critical dialogue is at the heart of this process, expressed in challenging, exploratory talk. Reflection is an integral part of the process and can be enabled through a narrative approach to practice (e.g. diary-keeping) if supported by opportunities for unrestricted dialogue in the context of a spirit of institutional enquiry. The approach can make individuals more critically aware of the constructedness of their own subject positions and therefore has an emancipating dimension. The aim is to empower individuals to engage in a process of individual and institutional transformation which incorporates greater awareness of the local enactment of more global issues of social justice and democracy. This requires an understanding of professional and social practices as socially constructed with discourses of power influencing what becomes accepted as ‘common sense’. Discourse analysis can expose this constructedness by examining multiple interpretations and understandings and can thus reveal something of the values enacted in everyday professional and social practice. Outside factors shape the development of local practice (e.g. the demands of the Health Professions Council, changes to the health service brought about by Government reforms and changing professional boundaries expressed in texts as
115 skill mix and role extension). What radiographers experience are circumstances similar to those facing many other professions and are rooted in basic tensions between professions and the state. Discourses of education, training, flexibility, quality, and such like work (or are made to work) in texts to conceal the economic imperative to reduce unit labour costs through a process of skill mix. Such a process constructs professionals as ‘sets of competencies’ rather than people and therefore has implications for individual senses of identity. The approach gives validity to the use of narrative (e.g. in diary accounts) and therefore invokes issues of identity since the two are interdependent, having a reciprocal shaping effect on each other. Such deliberative self-reflection is a useful activity for the purposes of self-renewal, personal and professional development and the development of self and self-identity. Contemporary practice is advancing so quickly that practitioners may have to practice in relative ignorance and need enabling structures to support their subsequent understanding of what it is they have done. Theory is thus constructed as separate from practice. Such a separation can be beneficial: it is educationally valid to reconsider theory in relation to actual practice and also to imagine new practice which is therefore theoretical precisely because it has not yet happened. However, consideration of theory and practice as integral parts of the same activity is also helpful since it reintroduces a moral character to practice when we ask ‘what values underpin a certain practice to which this is the theory?’ Re-visioning theory and practice together can lead to practitioners asking different questions about their practice: ‘what do I do now and why do I do it?’ for example, rather than ‘what theory/ knowledge do I need to read about to understand what I (already) do?’ Practitioners may thus come to see their own theory/practicec as the starting point in education rather than looking at what formal courses can ‘provide’ or ‘deliver’. It is hard to imagine this kind of research being carried out without exploring the tension between discourses of external, imposed constructions of quality assurance as surveillance and self-regulatory professional accounts which emphasise autonomy and individual responsibility. The surveillance discourse contradicts the professional self-regulation discourse but, in the light of cases of apparently poor NHS practice attracting media
c The term theory/practice is used to indicate the notion of theory and practice unified; praxis may be an alternative term.
116 attention, it is hard for professionals to justify no form of external quality assurance or audit. If professionals are to regain public confidence in this respect there is a need for the development of a moral discourse in professional practice in which practitioners regularly ask questions of their own practice and their experience of local practice specifically in terms of advocacy for patients being exposed to poor practice. Such moral enquiry could be rooted in discourse analysis of narrative accounts of practice since this engages readers in the value-ladenness of practice in a way that traditional research accounts conceal. The approach envisages a kind of education concerned with the construction of autonomous, ‘curriculum-creating’ professionals who seek to critically appraise and transform their own practice. It is therefore related to wider issues of democracy and social justice. The ‘lived’ curriculum with which practitioners should engage is about democratic decision-making rather than ‘learning’ to follow edict, setting one’s own CPD agenda rather than simply following what is imposed. Discourse analysis can expose knowledge as socially constructed and open to critique, though subject to the influence of power exerted by socially privileged groups known as professionals. Such critical consideration of knowledge can be further facilitated by choosing ways of talking and writing about such knowledge that maintain complexity. This results in accounts which are denser but ultimately more valid. Exposing discourses about values and uncertainty in personal and professional knowledge may ultimately affect the institutional habitus, transforming practitioners’ dispositions towards knowledge from something given and unchanging towards something which is challengeable, along with the subject positions which both create it and are created by it. Understanding professional issues in terms of wider discourses may ultimately lead to better political understanding and therefore represent a precursor to professional political action. Talk which is exploratory, challenging, and interrogative in nature should be encouraged. The genre in which the resulting text is shaped is thus altered to one in which knowledge is treated as provisional and challengeable, the context changed from hierarchical to egalitarian (more equal), and the ‘lived’ curriculum is transformed from transmissive to dialogic (more open for debate than based on received wisdom). Narrative accounts (e.g. diaries) and oral stories of local practice may be the basis for generating individual heuristic, reflexive curricula (i.e. discovering by trial and error and implying awareness of the subject’s action on self) if supported by structures
C. Boyes for discourse analysis and critical dialogue. Appraisal may represent such a structure if it is democratic and includes the means to be critical of the system within which individuals work as well as the performance of appraisee and appraiser. Such an appraisal should be part of a general process towards establishing a dialogic, learning workplace founded on principles of enquiry and trust. Other structures for support may include the development of mentoring roles (to help radiographers find a direction for development or simply to cope with their changing roles) by those already successful in developing their roles and coping with change. The construction of personal and professional identity is a political matter. The way in which individuals are organised to work with each other, to develop (or not) together is, therefore, also political, and the degree to which convention can be challenged has democratic and social justice implications. Re-framing the problems of practice (or problematising practice through deliberative reflection) within an educational discourse requires dialogue which is critical and challenging and therefore can only proceed with effect in a culture of trust and legitimate enquiry. Structures for regular dialogue are therefore a pre-requisite and require reflexive, self-critical, risk-taking managers to enable them to happen. This can be very challenging for managers and structures for support are also therefore required for all practitioners engaged in this process. These are part and parcel of the spirit of enquiry necessary to engage in this process at all. Increasing awareness and debate about local political issues can enable individuals to become more politically competent in relation to the global political issues which are taken up on their behalf by professional bodies. Professionals have, by definition, a duty to consider these issues and engage in democratic means to improve the quality of their service through involvement in political processes, necessitating critical dialogue between local practices and national organisations.
Conclusion A case has been made for understanding contemporary practice and the construction of personal/ professional identity through discourse and social theory. This emphasises the complexity of real-life practice in contrast to some traditional approaches which aim to reduce practice to discreet elements. It also encourages radiographers to look outside of their own practice and see the ‘wider picture’. Examples have been provided illustrating how discourse analysis can play a part in CPD and/
Discourse analysis or in formal research. Such an approach empowers practitioners to be more autonomous in setting their own CPD agenda. Discourse and social theory may be unfamiliar subjects to many radiographers but the author contends that they have great potential in helping radiographers critically understand and transform their practice.
References 1. Fairclough N. Language and power. London: Longman; 1989 [1993 sixth impression]. 2. Fairclough N. Critical discourse analysis. London: Longman; 1995 [1997 second impression]. 3. Kress G. Linguistic processes in sociocultural practice. Oxford, UK: Oxford University Press; 1985. 4. Halliday MAK, Hasan R. Language, context and text: aspects of language in a social-semiotic perspective. Australia: Deakin University Press; 1985 [1997 corrected reprint]. 5. Clark R, Ivanic R. The politics of writing. London: Routledge; 1997. 6. See, for example, Foucault M. Power/knowledge. UK: Harvester; 1980. 7. Phillips T. Changing nurse education: dialogue and discourse in the education of student-professionals. PhD thesis. Norwich: University of East Anglia; 1995. 8. Antaki C. Explaining and arguing: the social organisation of accounts. London: Sage; 1994. 9. Foucault M. History of sexuality, vol. 1. UK: Penguin books; 1981 [1990 paperback reprint]. 10. Bourdieu P. Outline of a theory of practice. Cambridge, UK: Cambridge University Press; 1977. 11. Schon D. Educating the reflective practitioner. UK: JosseyBass; 1987. 12. Mishler EG. Research interviewing. Context and narrative. London: Harvard University Press; 1986. 13. MacIntyre A. After virtue. UK: Duckworth; 1981. 14. Phillips T. Exploratory talk: a critical learning discourse. Unpublished paper. Norwich: School of Education and Professional Development, University of East Anglia; 1993.
117 15. Halliday M. Explorations in the functions of language. London: Edward Arnold (Publishers) Ltd.; 1973. 16. Giddens A. The constitution of society: outline of the theory of structuration. UK: Polity press in association with Basil Blackwell; 1984.
Glossary Curriculum: Curriculum is used here in a broad sense to describe all those things which contribute to the act of learning with the intention of developing personally and professionally. ‘Curriculum-creating’ professionals are thus those who want to and are able to critically appraise and transform their own practice. Dialogic: Relating to dialogue, i.e. conversation in the everyday sense, but again the meaning is extended here to indicate questioning, ‘argument’, debate and critique. Suggests an intentional ‘openness’. Discourse: In an everyday sense discourse equates with talking or writing, but here discourse takes on another meaning related to what is talked about and how those subjects are constructed in texts; e.g. discourses of power and knowledge pervade most professional texts. Discourse indicates sites of struggle, of resolving difference; e.g. market economic discourses of health care practice are in tension with caring, moral and ethical discourses. Discourse influences the construction of identity; e.g. a caring discourse may compete with a technological discourse in the notion of what defines a radiographer. Genre: Types of text which arise from social conventions and influence what can and cannot be said within what is considered ‘normal’; e.g. the genre of a job interview permits very different texts to come into being compared with the genre of a party. Habitus: Systems of ‘predisposition’ in institutions which contribute to ‘normal’ ways of thinking and acting within that institutionddefines what is ‘common sense’ or ‘normal practice’ within an area and tends to perpetuate the status quo. Social construction/constructionist: The notion that ‘reality’ is not ‘given’ or seen in the same way by everyone, but is ‘constructed’ through social acts such as speaking. The way we perceive things is thus partly governed by how we talk about them.
Discourse analysis and personal/professional development C. Boyes) Professional Health Studies, York St. John College, Lord Mayor’s Walk, York YO31 7EX, UK Received 23 September 2002; revised 19 January 2004; accepted 2 February 2004
KEYWORDS CPD; Qualitative case study; Text; Identity; Narrative
Abstract The article discusses discourse analysis and its relevance to personal and professional development, drawing on elements of social theory. Related terms such as text, discourse and genre are defined and social theoretical implications explored. Practical application of discourse analysis to CPD is illustrated. A case is developed for understanding contemporary practice and the construction of personal and professional identity through discourse. Understanding discourse is presented as an enabling structure for personal and professional development. ª 2004 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Introduction This article arises from the author’s concern for realistic personal and professional development. It presents a discussion of discourse and discourse analysis, an understanding of which can be helpful to professionals planning their own personal and professional development. Discourse is likely to be an unfamiliar topic to many readers and a glossary of terms is therefore provided. A table outlining how discourse analysis may be put to use is also provided to orient the reader. The author’s understanding of discourse arose from research published as a PhD thesis.a This ) Tel.: D44-1904-716403. E-mail address: [email protected]. a Role change, identity and personal/professional development in radiography: dialogues, discourses, directions. University of East Anglia, 1998.
paper does not present the results of that research since issues that were important at the time (e.g. revision of the PSM Act) are now dated. However, the author remains convinced that a basic understanding of discourse can enable professionals to adopt a more critical analytical approach to understanding and developing their own roles and can therefore be helpful in continuing professional development (CPD). Social theorists such as Foucault and Bourdieu inform this field of study and reference to their work will be included in the discussion that follows. Discourse analysis may be put to use in formal research but may also be utilised in a less formal way to aid critical analysis of texts (e.g. diaries, interview transcripts) to identify opportunities for development. Both processes will be referred to as research in this paper. Such research can be developed from interviewing colleagues and therefore tends to be
1078-8174/$ - see front matter ª 2004 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2004.02.003
110 qualitative, grounded in the interview accounts. A semi-structured approach in which colleagues are asked to talk about their own role, their development and perceived obstacles to development can generate complex but enlightening data. This approach specifically attempts to portray the ‘messiness’ of contemporary personal/professionalb lives by using narrative as the predominant form of expression. The strength of narrative is its tendency to resist reductionist readings i.e. it provides a fuller, more accurate account of the complexity of practice (rather than over-simplifying issues). Accounts of the researcher’s own development during the research can be included to help the reader judge the researcher’s bias. The result will be a case study bounded by local circumstances but relating through the application of social theory to more global issues; analysis of the discourses thus permits a certain kind of generalisation. Engagement of the reader in the narrative accounts enables them to explore their own situations reflectively and such research therefore has both ‘particular’ and ‘general’ implications. Less formally, a professional may keep a personal/professional journal, reflecting on critical incidents not only in relation to clinical episodes but also developmental concerns (e.g. feeling that traditions of power imbalance between radiologist and radiographer, rather than ability, may be preventing the development of radiographer reporting, or that managerial control may be limiting an individual’s potential). Subsequent analysis of themes repeatedly emerging in the journal may enable the radiographer to more accurately identify the problem and develop a strategy to tackle it.
Text, discourse and genre Understanding discourse implies a ‘textual’ approach to research and aspects of text, discourse, genre and other concepts are now briefly described. Data from interview transcripts can be considered as texts open to a form of discourse analysis. Exploration of the discourses in contention in a text provides a way of relating the local to the global. Outside pressures on radiographers exert influence in the form of texts (documents, reports, and journal articles, for instance) and radiographers tell the story of their response in text. The social, cultural and professional world is laden with text b
The term personal/professional is used to indicate the difficulty in separating out one from the other in terms of a professional’s lived experience.
C. Boyes and professional and social practices in which radiography is embedded operate through discourse which is also constitutive of those practices. Approaches to language and textual analysis take many forms and are closely related to issues of representation. Debates about representation centre on how meaning is made through language. A discursive constructionist view is most helpful since it is realistic in representing the role of both subject and structure (individual and institution) without giving pre-eminence to one over the other. The simplest way to understand this is to recognise that in bringing about change neither individual nor institution (e.g. radiographer nor hospital) is all-powerful; neither can completely dictate what happens to the otherdthey are in ‘conversation’ with each other. Fairclough follows Halliday in his definition of text in relation to both spoken and written texts (Fairclough, 1989, p. 24)1 ‘‘a text may be either written or spoken discourse, so that, for example, the words used in a conversation (or their written transcription) constitute a text.’’ (Fairclough, 1995, p. 4)2 Kress provides some useful working definitions from a socio-cultural perspective of language ‘‘Discourses are systematically-organised sets of statements which give expression to the meanings and values of an institution. (.) Discourses do not exist in isolation but within a larger system of sometimes opposing, contradictory, contending, or merely different discourses. Given that each discourse tends towards colonisation of larger areas, there are dynamic relations between these which ensure continuous shifts and movement, progression or withdrawal in certain areas.’’ (Kress, 1985, p. 7)3 Fairclough points out that institutions are not monistic (uniform), but pluralistic, i.e. they provide ‘‘alternative sets of discoursal and ideological norms’’ (Fairclough, 1995, p. 40).2 Discourses may thus represent particular ideological positions and institutions and texts can both be seen as sites for struggle between opposing ideologies (representing a particular class or theory), represented in and through contending discourses. Fairclough relates such struggle to class struggle: ‘‘These institutional struggles are connected to class struggle, though the relationship is not necessarily a direct or transparent one; and ideological and discoursal control of institutions is itself a stake in the struggle between classes.’’ (Ibid. p. 40).
Discourse analysis Texts arise in particular circumstances which have an effect on what kinds of texts are allowed to arise, and which are not. Social situations (including interviews) in which texts arise are conventionalised and structured and result in ‘‘conventionalised forms of texts.specific genres (which have) specific forms and meanings, deriving from and encoding the functions, purposes and meanings of the social occasions.’’ (Kress, 1985, p. 19)3 Texts should be understood in the contexts in which they arise and are read. Clark and Ivanic use Halliday’s definition (and point to the summary of it in Halliday and Hasan, 1985, Chapter 1)4 of context as a starting point towards their own definition which makes writing more explicitly political: ‘‘we distinguish between the physical context and the wider socio-cultural context and argue that writing is an activity embedded in and dependent on not only the immediate social circumstances and people participating in it but also on the social and cultural values, beliefs and patterns of privileging surrounding it. This is what makes writing a political act.’’ (Clark and Ivanic, 1997, p. 58)5 As well as context, texts are read, and should therefore be understood in terms of, co-texts. No text is understood in isolation; for example, contemporary texts about CPD should be understood in relation to the wider picture (e.g. the emerging role of the Health Professions Council, Government publications about strategies for introducing skill mix, cutting costs etc.). Power is always at play in text (either directly in spoken discourse or indirectly in written discourse) since discourse is about difference and power is about ‘‘relations of difference’’ (Kress, 1985, p. 52).3 However, it is important not to confuse ‘cause and effect’ or to see power in purely negative, oppressive terms. Power can also lead to emancipation: ‘‘Power does not derive from language, but language may be used to challenge power, to subvert it, and to alter distributions of power in the short or in the longer term.’’ (Ibid. p. 52) It is important to remain realistic about the degree to which creating texts (written or verbal) can bring about change, but it is also important not to underestimate the contribution writing makes within the wider socio-political arena:
111 ‘‘writing plays a central role in the circulation and consumption of ideas and, for that reason, in the development of democracy.’’ (Ibid., p. 241) All texts contain discourses in contention. Texts arise out of difference and are the ‘‘sites of attempts to resolve particular problems’’ (Kress, 1985, p. 12).3 But discourses (aided and abetted by authors) tend to ‘colonise’ texts, to impose one particular view or perspective. Indeed ‘‘it is a demand made by most genres that discursive difference should be resolved’’ ‘‘the task of the author/writer is precisely. to construct a text in which discrepancies, contradictions, and disjunctions are bridged, covered over, eliminated.’’ (Ibid. p. 35 and p. 15, respectively) So within any text there are discourses in contention, but at the level of text there is also conflict between different accounts, arising from different perspectives (e.g. differences in the accounts given by two different practitioners, or between an account written for publication in a journal and a spoken account, etc.). Research accounts should attempt to illuminate both of these levels of discordance.
Discourse analysis Interpretive discourse analysis (developed from the perspective of an insider) can be used to explore issues (e.g. relating to role extension) implicit in texts arising from interviews, diary notes, questionnaires, institutional documents and the wider literature. Data are subject to analysis at various stages in the research process. The interview process itself relies on interpretation in order to take place, both on the part of the interviewer, in understanding the participant’s account, and on the participant’s part, in bringing forth their interpretations of practice. The process of transcribing is a further act of interpretation, as is participant checking. More formal analysis involves deliberately engaging in the act of interpretation, making sense purposefully through the exploration of themes and discourses in various categories (Table 1). Approaches to discourse analysis which emphasise ‘structural’ elements of text construction are only really helpful in understanding the
112 Table 1
C. Boyes Process of discourse analysis
Stage
Examples
Collect data
Interview a colleague (e.g. peer, manager, subordinate or consultant)dyou may want to focus the interview around a particular subject such as radiographer reporting or you may wish to ask more ‘open’ questions such as eliciting what issues are important to that individuala
Transcribe the data into a format ready for analysis
Text representing the content of the interview which should be checked for accuracy by the interviewee
Begin analysis of the text to identify important elements
Content (themes, issues) Interpersonal (process of creationdturn-taking etc.)
Further analyse the content to identify discourses in contention
Different world-views Alternative conceptualisations of issues Power imbalances Professional autonomy/institutional control
Consider how these relate to more global discourses
Professional power and knowledge State intervention and control Social justice Democracy
Reflect on what could be done to change the status quo
Stakeholder analysis (who influences the current situation) Identify alternatives
Devise an action plan for change
What elements make up the total process? Who will be affected? How could change be achieved?
Initiate exploratory dialogue
Discuss the proposed change with stakeholders (e.g. managers, peers, consultants etc.)
Agree how to proceed and how to review
CPD record Appraisal
a The process of recording and transcribing interview data should not be underestimated but is outside the scope of this paper.
method used to obtain the interview transcripts, i.e. the face to face interview. They explore turn-taking, the asymmetric initiation of questions etc., in order to understand how researcher and researched negotiate their way through the interview. Interpretive discourse analysis is a more useful approach since it emphasises the content of language (its themes and discourses) rather than its structure. Each text (e.g. interview transcript, questionnaire, document) can be reviewed to identify constituent themes. Each text can be considered in terms of its discourses, asking what discourses were in contention, what debates were implicit in the text? This form of analysis emphasises content and context over linguistic structure, and is based on a view of language described by, for example, Bourdieu (1977), Foucault (1980), and Kress (1985).10,6,3 This approach is the kind used by Phillips in his research into nurse education (Phillips, 1995)7. It understands discourses to mean,
‘‘the value-laden, socially constructed beliefsystems which contribute to the shaping of social and interactive practices.’’ (Ibid. p. 88) Understanding the discourses embedded in the data (texts) provides the link between the local and the global, since texts and social practices are mutually constructive and serve to relate local contexts to the wider culture. This approach can illuminate the parts played both by individuals and the institution in the creation of local ‘reality’. Neither should be completely dominated by the other. Each is jointly responsible for the way things are. Subjects may not feel it an easy task to change their world, but neither should they feel completely under the control of institutions. So in analysing participant responses, what was it hoped to make of their answers? Antaki argues that explanations can ‘‘lock together as a means of constituting the social world (.) and constituting the people
Discourse analysis who navigate through it.’’ (Antaki, 1994, p. 116)8 and that ‘‘an account, by selecting its vocabulary from available cultural themes and concepts, and by its choice of their arrangement, makes positive claim to a certain vision of the world.’’ (Ibid., p. 7) Both of these quotes imply a reciprocal relationship between how people talk about their world, how they experience it, and how it is constituted. This relationship between local context and wider culture is taken further in Antaki’s discussion of ‘talk in action’, in which he refrains from fully endorsing the Foucauldian account: ‘‘‘action’ shades into abstract relations between cultural meanings and practices, not necessarily locatable in any one person’s talk and behaviour at any one place or time, but infusing the general understanding of some institution like government, madness or sexuality.’’ (Ibid., p. 119) The less radical version of ‘talk in action’, which he appears to favour, refers to ‘‘what is achieved in the very local organisation of talk.’’ (Ibid., p. 119) Implicit in Foucault’s references to discourse is that they remain in contention, and there remains therefore the potential for re-construction, for change: ‘‘Discourses are tactical elements or blocks operating in the field of force relations; there can exist different and even contradictory discourses within the same strategy.’’ (Foucault, 1981, pp. 101e102, author’s emphasis)9 Although radical sounding, this leads to an understanding of discourse which is political in linking local practices with the wider social practices and political contexts in which they occur. Texts are brought into being in relation to social norms and institutional habitus (Bourdieu’s term meaning roughly systems of dispositions or inclinationsdsee for example Bourdieu, 1977)10. Discourses seek to ‘dominate’ texts in order to make them understandable, but other discourses are always present, and while these discourses are in ‘play’ with each other there exists the potential, albeit a struggle, for re-construction, for change. The political, as well as personal,
113 dimension to discourse analysis makes it an appropriate method for analysing interview transcripts. Interviewee’s responses can be legitimately treated as narrative accounts or stories because of the centrality of story telling in communication. Narrative may also represent a route towards understanding practitioners’ actions, what Schon (1987)11 calls knowing-in-action: ‘‘it is sometimes possible, by observing and reflecting on our actions, to make a description of the tacit knowing implicit in them. Our descriptions are of different kinds, depending on our purposes and the languages of description available to us. We may refer, for example, to the (.) values, strategies, and assumptions that make up our ‘‘theories’’ of action.’’ ‘‘Whatever language we may employ, however, our descriptions of knowing-in-action are always constructions.’’ (Ibid., p. 25, author’s emphasis) Narrative is a form rich enough to encapsulate more than one mode of thinking and this approach is described as an alternative strategy towards research interview data analysis by Mishler: ‘‘telling stories is one of the significant ways individuals construct and express meaning. This assumption informs work by many investigators from a variety of disciplines having different theoretical perspectives.’’ Mishler (1986, p. 67, author’s emphasis)12 Mishler provides evidence from an anthropologist, a linguist, a psychologist, a literary critic, and a moral philosopher to support his thesis. This cross-discipline ‘transferability’ of the idea suggests good reason for supporting it. This is a quotation from just one of the proponents: ‘‘It is because we all live out narratives in our lives and because we understand our own lives in terms of the narratives we live out that the form of narratives is appropriate for understanding the actions of others.’’ (MacIntyre, 1981, p. 197)13 Narrative thus occupies a central position in how we understand things, how we attempt explanations, in general, how we account for things in terms of stories. In the process of interviewing steps should be taken to avoid the problem of what Mishler describes as ‘standard’ interview practice,
114 ‘‘where respondents’ stories are suppressed in that their responses are limited to ‘‘relevant’’ answers to narrowly specified questions.’’ (Mishler, 1986, p. 68)12 Delay to closure should be sought so that the interview dialogue resembles what Phillips describes as ‘exploratory talk’ (Phillips, 1994).14 This can be achieved by trying to create space in the interview for the interviewee to respond thoughtfully. According to Mishler, ‘‘Telling stories is far from unusual in everyday conversation and it is apparently no more unusual for interviewees to respond to questions with narratives if they are given some room to speak.’’ (Mishler, 1986, p. 69, author’s emphasis)12 Analysing interview data may lead to a better understanding of language and in this respect the work of Halliday (see, for example, Halliday, 1973)15 is important. He described three interdependent functions in language which it is useful to distinguish. The ‘textual’ function (concerned with syntactic devicesdgrammatical rules) is important to linguists but less helpful for CPD. ‘Interpersonal’ (the relationships between speakers constructed in talk) and ‘ideational’ (the subject of what is being referred to) functions are more important for radiographers interested in this area to understand. All three functions in language are dependent on each other, but emphasising content and interpersonal contexts (i.e. what was said, and how the interview situation contributed to its saying) emphasises the educational, rather than linguistic, issues for CPD.
Discussion The author’s view of professional practice was altered as a result of studying discourse and social theory; rather than seeing practice as a sphere in which external events tended to dictate what happened to individuals, the author began to conceptualise the continually changing climate in which radiographers work as a ‘lived curriculum’, i.e., a set of circumstances and contexts, problems and dilemmas that also represent opportunities for development. The notion of habitus presented itself as useful. Even in contexts of ‘conventional’ role radiographers are affected by the institutional habitus and ‘learn’ to accept relationships of control,
C. Boyes leaving much of their practice unchallenged. However, some radiographers see ‘outside pressure’ as ‘opportunity’ and reframe their curriculum into an active and pro-active stance, leaving them better positioned to extend their roles and develop their practice. Such a response provides the best opportunity for reconstructing the relationship between individual and institution, working towards a dialogic, learning workplace. Understanding this process as a complex and ‘untidy’ narrative (as opposed to ‘tidying up’ and de-personalising the account in more traditional approaches) can be an enabling structure (i.e. can capacitate the processdsee Giddens, 1984)16 for helping radiographers to better understand their own position. Positions are socially constructed within discourses of power, knowledge, identity, education, competence, professionalism, caring and technology. These discourses are in tension with one another and they should remain so if a critical understanding is sought, resisting the natural tendency towards closure and control. Understanding this should place radiographers in a better position for transforming their practice in personal, professional and political terms. Contending discourses are thus dialogic: they are in ‘conversation’ with one another and ‘agreement’ or ‘resolution’ is not what is sought. That said, formal accounts of such research can be constructed with a conscious meta-narrative (single overarching story) to give overall coherence to the stories and accounts of practice given. The meta-narrative will be concerned with the ‘major’ discourses of power, knowledge, and identity which are constitutive of the ‘minor’ discourses immanent in the stories and accounts presented by research participants. Self-development through an understanding of discourse and social theory represents a particular kind of educational process in the context of others to which it should be seen as complementary, not competitive. It does not reduce the need for political strategy towards increasing access to, and funding towards, formal courses. Neither does it reduce the need for greater clinical and medical education for those radiographers wishing to extend their role. However, it does represent a way in which radiographers may become more autonomous in setting their own CPD agenda. Discourses are a continuous part of everyday practice but usually remain hidden from view, implicit rather than explicit. Discourse analysis enables the deliberative consideration of the values implicit and enacted in professional practice. Such an approach may enable practitioners to resist, for example, market economic readings
Discourse analysis of their practice in favour of caring, moral and ethical readings. The political nature of their practice may thus be brought more clearly into view, generating the possibility of greater awareness for intentional personal and political agency (action). It is thus valuable to understand something of the way in which discourses operate in texts since it permits alternative readings of historical as well as contemporary practice. For example, radiological control of the radiographic profession could be read as a westernised, masculine-oriented history of control and dominance, the ‘scientific’ process of research could be read as a strategy for hegemony (continued, dominating leadership) by privileged male actors. Illuminating such readings may offer some hope for the generation of alternative stories. An understanding of discourse and social theory can help radiographers develop their own CPD curriculum in relation to their own needs and particular circumstances. The curriculum would be an attempt to bridge the gap between unreflective practice and formal courses which may more fully support the development of reflective practitioners in radiography. It should encourage the move towards greater, more critical dialogue in the workplace as a foundation for individual and institutional development separate from (or complementary to) formal courses. Critical dialogue is at the heart of this process, expressed in challenging, exploratory talk. Reflection is an integral part of the process and can be enabled through a narrative approach to practice (e.g. diary-keeping) if supported by opportunities for unrestricted dialogue in the context of a spirit of institutional enquiry. The approach can make individuals more critically aware of the constructedness of their own subject positions and therefore has an emancipating dimension. The aim is to empower individuals to engage in a process of individual and institutional transformation which incorporates greater awareness of the local enactment of more global issues of social justice and democracy. This requires an understanding of professional and social practices as socially constructed with discourses of power influencing what becomes accepted as ‘common sense’. Discourse analysis can expose this constructedness by examining multiple interpretations and understandings and can thus reveal something of the values enacted in everyday professional and social practice. Outside factors shape the development of local practice (e.g. the demands of the Health Professions Council, changes to the health service brought about by Government reforms and changing professional boundaries expressed in texts as
115 skill mix and role extension). What radiographers experience are circumstances similar to those facing many other professions and are rooted in basic tensions between professions and the state. Discourses of education, training, flexibility, quality, and such like work (or are made to work) in texts to conceal the economic imperative to reduce unit labour costs through a process of skill mix. Such a process constructs professionals as ‘sets of competencies’ rather than people and therefore has implications for individual senses of identity. The approach gives validity to the use of narrative (e.g. in diary accounts) and therefore invokes issues of identity since the two are interdependent, having a reciprocal shaping effect on each other. Such deliberative self-reflection is a useful activity for the purposes of self-renewal, personal and professional development and the development of self and self-identity. Contemporary practice is advancing so quickly that practitioners may have to practice in relative ignorance and need enabling structures to support their subsequent understanding of what it is they have done. Theory is thus constructed as separate from practice. Such a separation can be beneficial: it is educationally valid to reconsider theory in relation to actual practice and also to imagine new practice which is therefore theoretical precisely because it has not yet happened. However, consideration of theory and practice as integral parts of the same activity is also helpful since it reintroduces a moral character to practice when we ask ‘what values underpin a certain practice to which this is the theory?’ Re-visioning theory and practice together can lead to practitioners asking different questions about their practice: ‘what do I do now and why do I do it?’ for example, rather than ‘what theory/ knowledge do I need to read about to understand what I (already) do?’ Practitioners may thus come to see their own theory/practicec as the starting point in education rather than looking at what formal courses can ‘provide’ or ‘deliver’. It is hard to imagine this kind of research being carried out without exploring the tension between discourses of external, imposed constructions of quality assurance as surveillance and self-regulatory professional accounts which emphasise autonomy and individual responsibility. The surveillance discourse contradicts the professional self-regulation discourse but, in the light of cases of apparently poor NHS practice attracting media
c The term theory/practice is used to indicate the notion of theory and practice unified; praxis may be an alternative term.
116 attention, it is hard for professionals to justify no form of external quality assurance or audit. If professionals are to regain public confidence in this respect there is a need for the development of a moral discourse in professional practice in which practitioners regularly ask questions of their own practice and their experience of local practice specifically in terms of advocacy for patients being exposed to poor practice. Such moral enquiry could be rooted in discourse analysis of narrative accounts of practice since this engages readers in the value-ladenness of practice in a way that traditional research accounts conceal. The approach envisages a kind of education concerned with the construction of autonomous, ‘curriculum-creating’ professionals who seek to critically appraise and transform their own practice. It is therefore related to wider issues of democracy and social justice. The ‘lived’ curriculum with which practitioners should engage is about democratic decision-making rather than ‘learning’ to follow edict, setting one’s own CPD agenda rather than simply following what is imposed. Discourse analysis can expose knowledge as socially constructed and open to critique, though subject to the influence of power exerted by socially privileged groups known as professionals. Such critical consideration of knowledge can be further facilitated by choosing ways of talking and writing about such knowledge that maintain complexity. This results in accounts which are denser but ultimately more valid. Exposing discourses about values and uncertainty in personal and professional knowledge may ultimately affect the institutional habitus, transforming practitioners’ dispositions towards knowledge from something given and unchanging towards something which is challengeable, along with the subject positions which both create it and are created by it. Understanding professional issues in terms of wider discourses may ultimately lead to better political understanding and therefore represent a precursor to professional political action. Talk which is exploratory, challenging, and interrogative in nature should be encouraged. The genre in which the resulting text is shaped is thus altered to one in which knowledge is treated as provisional and challengeable, the context changed from hierarchical to egalitarian (more equal), and the ‘lived’ curriculum is transformed from transmissive to dialogic (more open for debate than based on received wisdom). Narrative accounts (e.g. diaries) and oral stories of local practice may be the basis for generating individual heuristic, reflexive curricula (i.e. discovering by trial and error and implying awareness of the subject’s action on self) if supported by structures
C. Boyes for discourse analysis and critical dialogue. Appraisal may represent such a structure if it is democratic and includes the means to be critical of the system within which individuals work as well as the performance of appraisee and appraiser. Such an appraisal should be part of a general process towards establishing a dialogic, learning workplace founded on principles of enquiry and trust. Other structures for support may include the development of mentoring roles (to help radiographers find a direction for development or simply to cope with their changing roles) by those already successful in developing their roles and coping with change. The construction of personal and professional identity is a political matter. The way in which individuals are organised to work with each other, to develop (or not) together is, therefore, also political, and the degree to which convention can be challenged has democratic and social justice implications. Re-framing the problems of practice (or problematising practice through deliberative reflection) within an educational discourse requires dialogue which is critical and challenging and therefore can only proceed with effect in a culture of trust and legitimate enquiry. Structures for regular dialogue are therefore a pre-requisite and require reflexive, self-critical, risk-taking managers to enable them to happen. This can be very challenging for managers and structures for support are also therefore required for all practitioners engaged in this process. These are part and parcel of the spirit of enquiry necessary to engage in this process at all. Increasing awareness and debate about local political issues can enable individuals to become more politically competent in relation to the global political issues which are taken up on their behalf by professional bodies. Professionals have, by definition, a duty to consider these issues and engage in democratic means to improve the quality of their service through involvement in political processes, necessitating critical dialogue between local practices and national organisations.
Conclusion A case has been made for understanding contemporary practice and the construction of personal/ professional identity through discourse and social theory. This emphasises the complexity of real-life practice in contrast to some traditional approaches which aim to reduce practice to discreet elements. It also encourages radiographers to look outside of their own practice and see the ‘wider picture’. Examples have been provided illustrating how discourse analysis can play a part in CPD and/
Discourse analysis or in formal research. Such an approach empowers practitioners to be more autonomous in setting their own CPD agenda. Discourse and social theory may be unfamiliar subjects to many radiographers but the author contends that they have great potential in helping radiographers critically understand and transform their practice.
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Glossary Curriculum: Curriculum is used here in a broad sense to describe all those things which contribute to the act of learning with the intention of developing personally and professionally. ‘Curriculum-creating’ professionals are thus those who want to and are able to critically appraise and transform their own practice. Dialogic: Relating to dialogue, i.e. conversation in the everyday sense, but again the meaning is extended here to indicate questioning, ‘argument’, debate and critique. Suggests an intentional ‘openness’. Discourse: In an everyday sense discourse equates with talking or writing, but here discourse takes on another meaning related to what is talked about and how those subjects are constructed in texts; e.g. discourses of power and knowledge pervade most professional texts. Discourse indicates sites of struggle, of resolving difference; e.g. market economic discourses of health care practice are in tension with caring, moral and ethical discourses. Discourse influences the construction of identity; e.g. a caring discourse may compete with a technological discourse in the notion of what defines a radiographer. Genre: Types of text which arise from social conventions and influence what can and cannot be said within what is considered ‘normal’; e.g. the genre of a job interview permits very different texts to come into being compared with the genre of a party. Habitus: Systems of ‘predisposition’ in institutions which contribute to ‘normal’ ways of thinking and acting within that institutionddefines what is ‘common sense’ or ‘normal practice’ within an area and tends to perpetuate the status quo. Social construction/constructionist: The notion that ‘reality’ is not ‘given’ or seen in the same way by everyone, but is ‘constructed’ through social acts such as speaking. The way we perceive things is thus partly governed by how we talk about them.