From the factory model to the classroom-workshop: Learning from practice in the fields of health and education

ABSTRACT

In this article, we engage in a dialogue about structural competencies based on the proposal of the classroom-workshop, aimed at educational and work environments in the fields of health and education. Our starting point is the notion that practical experiences do not merely represent a collection of specialised technical knowledge, as they are part of the complexity of the social game. Drawing from the theoretical frameworks of Pierce, Gadamer, Freire, and others, the proposal of the classroom-workshop recovers the power of collective praxis. Learning from and with others becomes central in the social game in order to collectively appropriate knowledge by making the autonomy of learning as horizontal as possible. By centering the relational world of learning and working, the classroom-workshop recovers the circular structure of understanding that enables a reflective appropriation of the territory – understood as the social space where life takes place – while de-instrumentalizing the reading of theoretical traditions and resignifiying the practice of writing. It establishes connections, links, and anchors that enable a dialogue between theory and practice, so often dissociated and fragmented.

KEYWORDS:

• Collective praxis
• classroom-workshop
• structural competencies
• medical education

Introduction

Science is a method of fixing beliefs.

Charles Peirce

The incorporation of structural competencies (Harvey et al., 2020; Metzl & Hansen, 2014; Neff et al., 2020) represents a challenge for university agendas and healthcare and education institutions, as it calls for the construction of capacities related to the sociocultural, political, and economic contexts of territories, understood as the social space where life takes place (Santos 1996, 2001; Spinelli, 2016, 2022a). The contribution of the concept of structural competencies focuses on recognising the need to incorporate social and cultural dimensions – which shape the health-disease-care process – into the training and work of healthcare teams. In this sense, structural competencies are inscribed within the important tradition of European and Latin American social medicine, with figures such as Johann Peter Frank (1745–1821), Rudolf Virchow (1821–1902), Cecilia Grierson (1859–1934), Henry E. Sigerist (1891–1957), Josué de Castro (1908–1973), Ramón Carrillo (1906–1956), Salvador Allende (1908–1973), Hugo Behm Rosas (1913–2011), Giovanni Berlinguer (1924–2015), Juan César García (1932–1984), and Maria Cecília Donnangelo (1940–1983), among many others, who highlighted at different historical moments the relevance of sociocultural dimensions and social inequalities in the ways people become ill and die.

In line with the structural competencies proposed by Shela Sridhar et al. (2023), Carlos Piñones-Rivera et al. (2023), Francisco Ortega et al. (2023) and Mary Alice Scott et al. (2023), we understand that both in the educational and work environments related to health and education, practices should not be solely reduced to the accumulation of specialised technical knowledge but should instead focus on understanding the complexity of the social game. According to Metzl and Hansen (2014), ‘structure connotes assumptions embedded in language and attitude that serve as rhetorical social conduits for some groups of persons, and as barriers to others’. Enabling the development of competencies that allow for the interpretation of how diversities, inequities, or violence are expressed in bodies and language requires breaking away from the instrumental notion of teaching these competencies as mere ‘content’ located in the realm of understanding, as even if opportunities for discussion are provided, these contents often remain dissociated from any transformative action.

From this perspective, making explicit the epistemologies from which the interpretation of the social environment is proposed should be a fundamental aspect of structural competencies. Recovering an interrogative dialectic regarding the epistemic frameworks operating in our practices and in our ways of understanding the social game restores the reflective capacity that promotes autonomous, collective, and situated learning, as opposed to dependent, individualistic teaching immersed in universal premises.

In the realm of academic training, disciplinary fragmentation – combined with the segmentation of knowledge, hyper-specialization, and technical supremacy – tends to instrumentalize both the educational processes and their outcomes. It is this fragmentation that, in the terms of Edgar Morin, ‘has made us blind”:

Complexity presents itself with the unsettling features of entanglement, inextricability, disorder, ambiguity, and uncertainty … Hence the need for knowledge to bring order to phenomena by rejecting disorder, to discard the uncertain, that is, to select the elements of order and certainty, to remove ambiguity, clarify, distinguish, and put into hierarchies. However, these operations, necessary for intelligibility, run the risk of causing blindness if they eliminate the other characteristics of complexity; and, indeed, as I have already indicated, they have made us blind. (Morin, 2011, p. 32)

Enthrallment with technological and scientific advancements – signalled in the first half of the nineteenth century by Wilhelm von Humboldt, one of the founders of the University of Berlin – has led to a dehumanisation of both educational spaces and academic production across all university disciplines. Indeed, academic disciplines largely have their backs turned to social issues, and when they do address them, tend to focus on a structured narrative of what ‘ought to’ and ‘should’ be done, lacking an understanding of the actions that can change or transform these realities (Matus, 2007a).

This discussion is not limited to the realm of university education but extends to the practices of all healthcare and education workers who, in general, tend to hold representations of industrial models for actions that, in addition to scientific, are also relational, semiotic, and linguistic. It is not only the workers at the operational level of these institutions who are affected by this lack of understanding of the game they are playing; the situation is the same for those who lead the institutions. Consequently, work is conceived of as industrial, in blatant contradiction with the ontology of work in health and education, which is essentially relational, ludic, and artisanal, and thereby counterposed to industrial work (Spinelli, 2015, 2022a). In summary, the majority of actors in the fields of health and education, regardless of their position within the organisation, are unaware of the game they are actually playing, while they imagine a game that they rarely play.

Curriculum reforms

The issue of the dehumanisation of scientific practices has been addressed by universities through curriculum reforms. Such actions can be found, for example, in the thinking of Henry Sigerist, who in the first half of the twentieth century proposed an educational reform at the Johns Hopkins School of Medicine to train social physicians conscious of the developments and the social function of medicine (Nunes, 1992; Sigerist, 2007). Sigerist emphasised the need for medical students to be interested in health, not just disease, and for every clinical case to be analyzed both medically and socially, allowing students to directly understand the living conditions of social groups and how they influence the ways people become ill and die. He proposed significant space in medical school curricula for social sciences and humanities (Fee & Brown, 1997; Nunes, 1992). These ideas were shared by Abraham Flexner, who supported Sigerist's entry into Johns Hopkins University and who also held these concerns (Spinelli, 2022b). However, Sigerist's proposal for curriculum reforms in medical programmes had little impact, especially if we take into account that it was the students themselves who brought about his expulsion as part of the McCarthyist policies in the United States in the 1940s (Nunes, 1992).

Between 1960 and 1970, Juan Cesar García conducted research on education in Latin American medical schools, in which he highlighted the significant limitations of curriculum reforms, arguing that it was ultimately the market that defined the orientations of professionals (Galeano et al., 2011; García, 1972). This affirmation remains relevant today, as there is abundant empirical evidence of how market influence stymies the proposals of humanistic curriculum reform.

It should be recognised that limiting the problem of the dehumanisation and mechanisation of medical education – or the professional behaviours of university graduates – to market influence is not the whole of the issue.

In 2010, we visited the Latin American School of Medicine (ELAM) in Cuba, invited by the Pan American Health Organization through the Cuban government, accompanied by Francisco Rojas Ochoa, a referential figure of social medicine in Cuba (Silva Ayçaguer, 2020). We were guided by the academic secretary, who kindly and amicably provided us with the organisation and contents of the curriculum provided to Latin American youth seeking a different and more socially committed medical education. On the way back at the end of the visit, Francisco Rojas Ochoa, facing forward as he drove his old Lada car, summarised the visit in an ironic tone as ‘Marx, Engels, and Flexner’, alluding to an education that mixed Marxist concepts with structural-functionalist and positivist ones. The irony was relevant as, generally speaking, it was a typical medical school built upon the Pasteurian revolution, similar to other faculties or schools of medicine around the world.

If the ELAM, supported by the efforts of the Cuban people and the government, promotes social commitment among its students, it should be asked: Why does critical theory occupy such a small space in the educational process? Why do some of the doctors who graduate and return to their home countries adapt so quickly to market logic? This reality highlights the need to go beyond the market as an explanatory cause and incorporate other concepts related to the field of health: the type of work performed; the importance of relational, linguistic, and symbolic aspects; the unique organisational and institutional forms in which work is conducted; the game being played by its workers, a game no one explicitly taught them; and the complexity of managing these institutions. All of these elements necessitate an epistemological reflection.

It is easy to verify empirically that the work of graduates in the fields of health and education is relational but that they conceive of their work in a rational manner. As Bourdieu suggests, when one does not comprehend one’s own actions, suffering is produced (Bourdieu & Wacquant, 2008). This is reflected in the high number of leaves of absence for health reasons among these workers. This has been the reality for decades in the fields of health and education, for the workers in these fields and the related institutions, and it has worsened over time, reaching its peak during the COVID-19 pandemic.

Who reforms the reformers?

In the absence of putting into play the epistemological dimension, an easy way out – such as reforms – is often sought as a magical solution to chronic problems. In different countries and historical periods, various types of reforms have been implemented: state reforms, education reforms, pension system reforms, healthcare system reforms, curriculum reforms, to name just a few. These processes often confuse epistemological problems with sectoral or disciplinary problems, which is why they fail.

Those who propose reforms seek to change reality without questioning the underlying epistemes (Castro, 2004), which highlights the relevance of Carlos Matus's question: ‘Who reforms the reformers?’ (Matus, 2007b). For Matus, ‘there can be no effective organisational reforms if the reformers themselves are not first reformed’, because ‘the leadership of an organisation imposes an upper limit to the quality of the reform’ (Matus, 1997, 2007c). He expresses this idea in a way that is not devoid of irony regarding the act of governing:

The person who governs is an experienced cyclist on flat terrain who must now face a race up a steep hill, subject to time constraints and riding a stationary exercise bike. They lack governing capacity, do not know how to design and choose their government project, and because they do not know how to modernize their bicycle, they adapt to the inefficiency of the public apparatus they command. They paint the bike the color of their party and put a sign on it that says ‘reformed bicycle’. And, since they don't know that they don't know, they also don't know how to choose their government team and advisors. When the situation becomes more critical, they pedal harder, losing weight without moving forward. (Matus, 2007b)

Epistemologies at play

When Matus says that the governor ‘doesn’t know they do not know’, we understand this to be an indirect allusion to the philosophical discussion regarding the ontic (entities, things) and the ontological (being) (Ferrater Mora, 2002; Heidegger, 2012). For Heidegger, the ontological question is more important than the ontic question, the latter pertaining to the positive sciences that Heidegger critiques for not considering the meaning of being that precedes the entity. However, in the fields of health and education, this critique is overlooked, and an ontic conception of the social persists.

By denying the differences between the ontic and ontological in the fields of health and education, the true structure and dynamics of these fields are negated. These fields present the following characteristics:

• Work is predominantly relational, making it more akin to artisanal work than industrial work (Sennett, 2017; Spinelli, 2015, 2022a).

• Scientific, semiotic, and linguistic practices construct unique identities within each institution. However, these linguistic and semiotic practices are not taken into consideration, particularly by professionals who presume that their work is solely based on scientific practices (Bourdieu, 2008).

• These artisanal models make up a form of organisation antagonistic to mechanical bureaucracies based on the concept of the factory, constituting professional bureaucracies where individuals have levels of freedom to perform their work that are inconceivable in a factory organisation (Mintzberg, 2003).

• The institutional structure imitated is that of the factory, resulting in large hospitals and universities, disregarding the fact that the larger such institutions are, the more ungovernable they become (Elias, 2011). The absence of a reflection on work in health and education made it possible for these professions to be associated with the industrial model, and so the organisational and institutional design of the factory was copied.

• In health and educational institutions, play (Homo ludens) is central to carrying out the work process. In this sense, it is useful to apply the metaphors that these institutions are venues for Olympic games played daily, as well as grand theatrical productions, where each actor has numerous masks and costumes. Despite the realities experienced every day, Homo ludens is ignored and negated through the industrial illusion that the organisation functions through the relationship between Homo sapiens and Homo faber, following the dynamic of orders and compliance. Doing so brings about high personal, group, social, and institutional costs (Huizinga, 1968; Spinelli, 2022a).

• The organisations in the field of health and education are the most complex to direct and manage, as workers have high levels of freedom and autonomy. This freedom and autonomy are of such importance that these organisations cannot be understood through the logic of industrial work (Matus, 2007c; Spinelli, 2012, 2017, 2022a).

• All of the above characteristics are upheld by a complete lack of reflection, which is supplanted by complaints and discontent that ultimately destroy work teams and the workers themselves, leading to the solution of privatising public services (Spinelli, 2022a).

In this way, the dominant thinking about health and educational institutions demonstrates a subordination to industrial logic, initiated in the second half of the eighteenth century as a mode of production structured on the ontic perspective by idealist and rationalist schools of thought and consolidated in organisational and institutional terms between the late 19th and early 20th centuries in the general theory of administration (Taylor & Fayol, 2003). This subordination, in both education and health, facilitated the hegemony of the ontic in the interpretation of the worker, the work itself, the forms of organisation, the institutional dimensions, and the forms of management. In this process, ways of understanding these fields were imposed that ignored the relational, ludic, symbolic, and linguistic nature that constitutes them ontologically, and differs from the ontic nature of the industrial logic and its hegemonic organisational and institutional forms (Spinelli, 2022a).

Some of the main problems in the fields of health and education stem from the failure to recognise this ontological structuring that shapes them, based on intersubjective relational processes mediated by verbal and non-verbal language. These processes are radically opposed to the ontic conception of industrial models and the organisational and institutional forms expressed in the factory model and constituted by objectified relationships between subjects and objects, which have over time evolved into relationships between objects (Spinelli, 2022a), a reality is reflected today in both robotics and in artificial intelligence (Žižek, 2023).

Understanding the game in order to play it better

Work in health and education institutions should not be subordinated to an organisational design centred around the figure of Homo sapiens, as it disenables Homo ludens (Huizinga, 1968) and makes it difficult to understand the work performed each day in these institutions. As a result, the work is not thought about or discussed epistemologically. This situation, persisting over time, demands an epistemological repositioning that moves away from the predominance of scholasticism, which considers truth to reside solely in books – an inheritance that reproduces and reinforces illuminism (Horkheimer & Adorno, 1988).

Abandoning the founding principles of European science, based in scholasticism and self-proclaimed universal science, should lead us to engage in dialogue with, for example, the critical theory of the Frankfurt School, especially regarding the processes of industrialisation, instrumentalization and technification of social actions (Habermas, Horkheimer, 2007, 2008) and the Chicago School, based in interpretive paradigms of the social (Glaser & Strauss, 2010). These positions question the epistemologies that fuel practices and accompany numerous philosophical developments that highlight the limitations of modern reason and idealist philosophy (Gadamer, 1999; Habermas, 2003; Heidegger, 2012; Santos, 2013).

This process of abandoning dominant epistemology requires adopting relational approaches that overcome the idea that the central units of the social sphere are isolated objects and beings, placed above the relationships established among people. In this ways, objects, concepts, and analyses in general are assumed to be independent or prior to the relationships that produce them, thereby negating not only the importance of seeking meaning in actions but also the relational and transactional configurations inherent in the social game (Bourdieu & Wacquant, 2008; Ferrater Mora, 2002; Menéndez, 2009).

It is necessary to recognise that practices are defined by knowledge, values, power relations, and work structure, among other factors. Within this understanding of reality, learning should produce meaning for subjects, be significant, and problematise the common sense that has colonised it. Subjects are part of socialisation processes that demand analysis and reflection regarding the relational aspects, the institutional context, the work situation, the rationalities at play, and people’s actions within the institution, which should lead to a greater self-understanding and greater understanding of others, enabling the possibility of making agreements (Gadamer, 1999).

Moving beyond a self-referential and cathartic narrative prevents the field of action from becoming a ‘landscape’ (Matus, 1992, 2007a, 2007c), which requires sharing perceptions of the situation or problem with other social actors. Doing so should enable critical reflection that facilitates the construction and consolidation of actors capable of acting on issues up to then considered impossible. The only possibility of transforming this historical construction is through progressive change resulting from action in the continuous present, staying true to one’s conscious decisions and understanding that the event – that which emerged from what was originally sought – is recognised retrospectively (Badiou, 2015; Zourabichvili, 2004).

From teaching to learning

In the history of pedagogy, we find a constant tension between the ideas of teaching and learning, which are structured by the historical and philosophical discussions we have been analyzing (Abbagnano & Visalberghi, 1987). If we understand and accept that, in both the fields of health and education, the ontological is relational, the limitations of teaching and the need to prioritise learning become evident. The industrial revolution required teaching in order for society to unlearn its own knowledge; in this process, Victorian morality played a fundamental role (Foucault, 2014) by banishing the idea of learning, so fundamental to artisanal practices.

The works of Dewey, influenced by Peirce, postulate the importance of learning over teaching, starting a line of thought in the field of education that counts among its influences Flexner, Vygotsky, and Paulo Freire, among many other educators who challenged the factory vision of education (Dewey, 1995; Flexner, 1908, 2017; Freire, 2009, 2012; Freire et al., 2013; Vygotsky, 2010). Understanding learning as a constant process throughout one’s working life, both in the field of education and in the field of health, is consistent with the ideas of constructivism, which promotes learning by doing. As Paulo Freire emphasises, ‘questions initiate and enable interactive processes of learning and engaging with problems’ where ‘teaching is not the transfer of knowledge but the creation of the possibility of producing knowledge’ (Freire et al., 2013).

In this sense, social movements play a significant role in knowledge production. However, the medical cultural authority, by denying knowledge produced outside the realm of the sciences, does not see social movements as active participants bearing knowledge but rather as passively part of the social structure, thereby hindering the possibility of collectively problematising the health-disease-care process (Menéndez, 2009, 2015, 2020).

When the importance is placed on learning rather than on teaching, the inadequacy of large health and educational institutions that end up imitating the factory model can more easily highlighted. At the same time, an emphasis on learning favours a smaller institutionality that recovers the artisan workshop. At the beginning of the twentieth century, Dewey pointed to the need to create forms of education that were not industrial in nature and that could accompany the trajectory of the students, an idea also found in Abraham Flexner and Bertrand Russell. Richard Sennett suggests liberating the artisan within us and working together in artisan workshops (Sennett, 2012, 2017).

The linguistic turn: The classroom-workshop and forgetting how to learn with others

Alongside the advancement of processes of industrialisation and technification, which instrumentalized both work relationships and educational spaces, the linguistic turn proposed by philosophical hermeneutics placed language as the primary means of access to the world. In doing so, it questioned the objective and unmediated access to the social world postulated by the rationality that characterised modernity. In the words of Gadamer, ‘the intermediate world of language appears in the face of illusions of self-awareness and of the naivete of a positivist concept of facts as the true dimension of reality’ (Gadamer, 1998, p. 327).

For Habermas (1999), rationality speaks to us about the ways in which subjects capable of language and action make use of knowledge that is expressed through symbolic expressions and actions, among other manifestations. From a phenomenological perspective, these ‘symbolic expressions refer to a background knowledge intersubjectively shared by the communication community’ (Habermas, 1999, p. 31). To the extent that technical rationality penetrates this ‘background knowledge intersubjectively shared by the communication community’ that Habermas mentions, it transforms the institutional arenas of society and ruptures the conditions by which consensus is reached, technifying the relational space of communicative action.

The critiques of technical rationality, carried out in critical theory by Herbert Marcuse and Jürgen Habermas, took on new meaning in Hans-Georg Gadamer's philosophical hermeneutics, as they brought to the fore the mechanisms through which technical rationality – belonging to the factory model and uncritically adopted by the social institutions of health and education, among others – obliterates the historical and relational character of practices. In Gadamer's terms, ‘in the age of science with its ideal of certainty […] the concept of technology displaced that of praxis; in other words, the competence of experts has marginalised political reason’ (Gadamer, 1999, p. 647). By annulling political reason in both practice itself and the educational contexts for these practices, technical rationality becomes the very rationality of social action. This advancement of technical rationality becomes so blinding that it at once mechanises the worker and dehumanises society.

To undo this path in the educational spaces and workplaces within the fields of health and education, we must take the opposite course: exit the factory model in which we find ourselves and enter into the classroom-workshop. This journey is not technical nor methodological, but rather epistemological in nature, and one of the initial steps is to identify the extent to which technical rationality is present in our practices, in the ways we interpret the social environment and appropriate preexisting knowledge, which also translates into instrumentalized ways of conceiving the production of new knowledge. As Ayres highlights, ‘health actions rely on a powerful techno-scientific arsenal aimed at instrumental success. In contrast, they have a fragile conceptual basis for understanding and transforming the practical sense of health-disease-care processes’ (Ayres, 2008, p. 159).

Recognising this fragility, in the graduate programmes of the Institute of Collective Health, we work with the proposal of the classroom-workshop (Jaramillo, 2003), following the founding guidelines of the National University of Lanús (Argentina). This proposal seeks to reclaim the autonomy of the learning process regarding health actions based on collective agreements, which implies moving away from the unidirectional monologue of teaching and explaining, and embracing the complex polyphony of collective learning. In this regard, the central role given to interpretation inverts the classic perspective of social determination (Almeida-Filho, 2021; Breilh, 2021; Minayo, 2021a, 2021b), avoiding attributing uses and practices to predefined social groups.

To build a conceptual foundation for a new praxis, we start from Gadamer's notion of ‘hermeneutical conversation’, which goes beyond a dialogue between individuals and extends to any interpretive action in which the dialogical action of question and answer leads to understanding. This allows us to dismantle technical rationality and recover the historical, relational, and collective nature of understanding. This praxis of understanding has implications for thinking about health practices, as ‘we need to consider the very way in which we can identify and understand the identities and relationships with which we deal every day in health actions. Actively reappropriating the foundations of understanding means expanding our capacity to interfere with the rationality of our health practices, especially their practical rationality’ (Ayres, 2008, p. 169).

The interpretive action, stripped of the explanatory nature of technical reason and focused on interrogative dialectics, privileges the notion of hermeneutical conversation based on ‘agreements’. In Gadamer's terms, ‘understanding in a dialogue is not merely a matter of putting oneself forward and successfully asserting one’s own point of view, but being transformed into a communion’ (1999, p. 458). A hermeneutical conversation ‘requires that one does not try to argue the other person down but that one really considers the weight of the other’s opinion’ (Gadamer, 1999, p. 445). And this idea of ‘not arguing down the other’ implies open listening, that is, not imposing preconceived interpretations on the understanding of human relationships, the social environment, or a text.

When put into action in the classroom-workshop, these notions reclaim the power of collective praxis. Learning from and with others becomes central to collectively managing and appropriating knowledge and making as horizontal as possible the autonomy of learning. The notion of agreement, which in Gadamer's terms implies not ‘arguing the other person down’ but rather promoting ‘being transformed into a communion’, puts into play a non-hierarchical dialectic of understanding. By horizontalizing the action of understanding, it allows us to recover those forms of knowledge discredited as invalid, which are central to the practices of all health and education workers.

The workshop classroom, by reclaiming the relational world of learning and work experience, recovers the circular structure of understanding that enables a reflective appropriation of the territory – as an operational as well as analytical concept (Santos, 1996) – while de-instrumentalizing the reading of theoretical traditions and re-signifying the practice of writing. It establishes connections, links, and anchors that enable a dialogue between theory and practice, which are often dissociated and fragmented. From this perspective, writing regains its significance as part of a dialogue that takes into account the interpreter. As Gadamer suggests, doing so demands ‘opening up in the text itself, in some way, a horizon for interpretation and understanding’ (1998, p. 332).

This reflective appropriation of territory, practices, knowledge, texts, and one's own actions is grounded in the historical nature of understanding. Gadamer builds upon Heidegger's hermeneutical circle of understanding to recover the situated dimension of understanding, which requires the ‘temporality of being there’ (Gadamer, 1999, p. 332). In other words, it is not the isolated individual who interprets, but rather their understanding is rooted in a specific time, space, and social environment, as well as in a shared rationality that gives meaning to a possible interpretation of the world.

By way of conclusion

In this text, we have introduced the transition from teaching based on factory models to the relational learning of the classroom-workshop and work based on the social. We understand that this transition is not limited to adding new specialised technical knowledge, but rather should focus on understanding the complexity of the game and the epistemologies from which the game is interpreted, that frame what one does, what one expects to do, and how one thinks about what one does.

These epistemologies are materialised in the ways of understanding the world, practices, and relationships, and they reveal the tension between more technical rationalities (which reduce language and therefore action to mere instruments) and more humanistic rationalities (which place language and interpretive action at the centre of understanding). This tension highlights the complex range of educational projects, ranging from dependent, individualistic teaching framed by universal premises to proposals for autonomous, collective, and situated learning. In this sense, programmatic changes that rely on ‘teaching’ social differences based on predefined social groups lead to stigmatising readings immersed in preconceptions, in contrast to proposals based on open and interpretive listening, grounded in dialogue aimed at mutual understanding.

From this perspective, we ask ourselves: How dialogical are curriculum reforms and the conceptions of work involving the social? Do they capture the complexity of the social game? To the extent that we do not recognise the ontological nature of work in health and education and continue to address it ontically, focusing on ordering and partitioning the complex fabric of the social sphere, discarding the uncertain and selecting only elements of certainty, we will encounter blindness rather than effective change.

Author contribution

All authors participated in the conception of the study, contributed to the drafting of the manuscript and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).