This year many conferences have gone virtual. While we are excited about the possibilities this affords in terms of rethinking the conference, we are also aware of the limitations of online meet-ups, especially if they attempt to be digital replicas of the in-person conference rather than creatively different events. We are working in various ways with experiments at our conferences and at the same time recognise we need to find different audiences for our work and to engage in conversations about it. As part of this we will share our accepted conference abstracts in this logbook and invite people to get in touch however they wish if they want to explore these ideas further with us. To begin with we are posting our accepted abstracts for the EASST/STS (formerly Prague) 2020 annual conference (one of the bigger STS conferences in our field). Here is Andrea's: From peers to patients: On the effective entanglements of touch in medical education Andrea Wojcik
Within medical discourse, touch is often presented dualistically as either serving a diagnostic or an affective end. Much of the traditional social science research on medical education, which theorized it as a process of learned detachment, would support such a dualistic understanding of touch. More recently, however, STS researchers have disrupted notions of detachment by showing that sensory knowledge is entangled with affect (Latour, 2004; Prentice, 2013; Myers, 2015), which suggests that learning to touch, even for diagnostic purposes, is also a case of learning to connect. In this paper, I focus on practices of learning to touch in medical education, drawing on ethnographic research at a medical school in northern Ghana, where I participated in physical examination classes and observed bedside teaching in hospital wards. Learning to touch at this school was an act of coordinating different materials and contexts—a grid drawn on a whiteboard, a gynecology manikin in a classroom, a simulated physical examination amongst peers, a physical examination of patients on the ward or during assessment. In and amongst these various practices of learning to touch, students were confronted with various experiences of concern, excitement, pain, and pleasure, indicating that practices of learning diagnostic touch were also touching practices, in the sense that they moved students to differently relate to patients (real or imagined). This entanglement of learning to touch with learning to relate to the patient raises questions about developments in medical education programs to move away from tangible learning experiences, especially those in which students are themselves the active recipients of touch.
Sensory ethnographers deploy methods such as drawing, video and photography in order to examine the more ineffable and non-representational aspects of practices. Usually, these studies are conducted by individual researchers who deal only with their own material. What happens when a team of ethnographers explores questions of a sensory or non-representational nature? How do they share their findings not only with their audiences, but also with each other? Team ethnography is becoming increasingly common across the social sciences and humanities, yet to date there has been little attention paid to the important work of communicating findings within a group. To explore this further, we conducted a methodological ‘proof of concept’ study, observing and documenting people learning to make omelettes. We found that sensory methods have a role not only in studying practices but crucially, in also facilitating a form of immersion into the ethnographic practices and imaginations of others within the team. In the end, we suggest that experiments with sensory methods, such as through proof of concept methodological studies, are useful for thinking about how teams of social scientists work together, whether their research deals with sensory topics or not.
This paper was greatly inspired by the probing questions and observations of Kristen Haring, who spent time with our research group during the running of the omelette experiments. We are also indebted to our colleagues (many of whom are part of the Maastricht University ethnography group), family and friends who participated in the experiments and for their wonderful comments on the methodologies throughout. We were able to conduct two days of experiments in a dedicated kitchen laboratory thanks to the generosity of the Faculty of Psychology and Neuroscience, Maastricht University. Thomas Fuller and Ido Holkamp kindly helped out with cooking lessons and catering. We were able to repeat the experiment at Marres House for Contemporary Culture, Maastricht, several times and thank Ilse van Lieshout, Valentijn Byvanck and the medical students who participated for thinking along with us. Rachel also re-enacted the experiment as part of a #collexx conference in Lisbon. The Maastricht University STS research group offered insightful feedback on an earlier version of the paper during our Summer Harvest (especially Simone Schleper, as discussant), and we received comments from other members of the Making Clinical Sense project team, especially Sally Wyatt, Harro van Lente and Carla Greubel. So in sum, this article would not have been possible if not for real teamwork, and the generosity of our fellow ethnographers and collaborators. Finally, we wish to thank the reviewers for their excellent comments and suggestions for revision, the new editorial team of this journal.
The title of the exhibition roughly translates to ‘death of movement’ and speaks to movement’s ephemeral nature, but the exhibition’s creator, choreographer Katja Heitmann, aimed to preserve and display unique but simultaneously mundane bodily motions of individuals by creating a corporeal archive in dancers’ bodies.
Museum Motus Mori shares some commonalities with the Making Clinical Sense project. Like the dancers performing in the exhibition, we have also had to find ways to jog the bodily memories of our research participants. It’s not as simple as it may sound. Try for yourself to recall the feel of a childhood couch, the smell of your favourite meal, or – in line with exhibition – a parent’s typical gestures. In truth, the process of donating my movement to the exhibition via interview felt quite familiar, aside from my role reversal as interviewee, but there was one thing that was strikingly different from the majority of interviews I have conducted – the use of space.
The interview took place across two rooms open to one another via large, square archways. The effect was more or less one large space, which was mostly empty apart from some benches along the walls, which were for spectators as much as for us to use during the interview, and a few blocks that could be easily moved around for sitting or climbing. There were no tables and no typical chairs. But this kind of sterilized and empty space in conjunction with the dancer’s questions and enthusiasm did invite movement. There was room to walk or even run (briefly), sit with legs splayed, or stretch out on the ground. Had I been a child, I may have resorted to rolling wildly across the floor, unimpeded by furniture.
As the Making Clinical Sense project progresses, Rachel Allison and John Nott have a growing interest in the relation between space and sensory education. People, objects, buildings, smells, sounds, textures, colours, and movements work together to create atmospheres, in the figurative and affectual sense of the word (see e.g., Sumartojo and Pink 2018), and delimit the kinds of activities and interactions possible in a given space. Donating my movement to Museum Motus Mori was a reminder that atmospheres also envelop interviews, and that two chairs facing one another might not create an atmosphere most conducive to exploring questions about the body.
Sumartojo, Shanti, and Sarah Pink. Atmospheres and the Experiential World: Theory and Methods. Routledge, 2018.
Le Guin’s Steering the Craft: A 21st Century Guide to Sailing the Sea of Story is “a handbook for storytellers” (p. iv). As we wrote our way through exercises, we did our best to give ourselves over to Le Guin’s sage advice on writing “narrative prose” (ibid.), but our discussions afterwards always begged the question: What can we take with us in our ethnographic writing? In many ways, we regard ethnography as storytelling, albeit storytelling bounded by academic conventions, and while we puzzled over the relevance of some exercises (point of view and voice being particularly difficult), we delighted in others. Below I share some of my own reflections on a topic I found particularly intriguing – repetition.
Repetition in Narrative and Argumentative Writing
“…to make a rule never to use the same word twice in one paragraph, or to state flatly that repetition is to be avoided, is to go right against the nature of narrative prose. Repetition of words, of phrases, of images; repetition of things said; near-repetition of events; echoes, reflections, variations: from the grandmother telling a folktale to the most sophisticated novelist, all narrators use these devices, and the skillful use of them is a great part of the power of prose” (Le Guin, p. 37).
Formative language arts teachers taught me to avoid repetition. They were tasked with training us students in the art of the argumentative essay. Thesis statements should stand prominently in the introduction and repeat themselves in the conclusion, but otherwise every paragraph – every word – was precious, and they should work to advance an argument. Read: Don’t waste time repeating yourself; new paragraph = new idea. This was the world of five paragraph essays and timed writing assignments.
My essays have gotten longer, with more time allotted for their completion. Five paragraphs turned into five pages turned into five sections of five pages turned into five chapters (my current endeavour). With each multiple of five, the chances of losing the reader – and myself – in the text has increased. It has been a slow realization that the straight jacket of no repetition imposed on me in high school was only a pedagogical tool for weeding out redundancy, but deliberate repetition can, in fact, be a helpful stylistic and structural tool.
Le Guin, of course, pushes readers beyond literal repetition of thesis statements. She draws attention to ways in which narrative writers use repetition of words, phrases, and events to create rhythm, invite laughter, build suspense, and elaborate themes.
Repetition in Ethnographic Writing
How might ethnographers use repetition to enhance their writing? In order to allude to the possibilities I will engage in a brief show and tell of a writing exercise I completed using ethnographic material.
Here are Le Guin’s instructions for one of the exercises on repetition: “Write a paragraph of narrative (150 words) that includes at least three repetitions of a noun, verb, or adjective (a noticeable word, not an invisible one like was, said, did)” (p. 41).
And here is my attempt using ethnographic material:
The truncated gynaecology mannequin lay with its leather buttocks towards the edge of the examination table, imaginary legs splayed so as to permit the medical student access to the vagina. “Ow, ow, ow!” the tutor exclaimed on behalf the mannequin. The student had been caught in the act of withdrawing the speculum with the blades open, an act that would have been painful for any real woman who did not have an oversized slit for a vagina. The tutor instructed the student to begin the speculum examination again, this time with the tutor offering commentary from over her shoulder. The student moved to part the labia majora with the thumb and forefinger of her left hand to make room for inserting the speculum. Wrong position. On a real woman, the entrance to the vagina would be much lower. Begin again. She parted the labia majora correctly, and she began to insert the speculum. Wrong angle. The speculum was to be parallel to the angle of the woman’s legs (if her feet or knees are propped up) so that the blades, once fully inserted, will be in position somewhere below the cervix. Begin again. Once again, she parted the labia majora, and this time she was able to actually insert the speculum. Wrong technique. The blades should not be opened until the speculum is fully inserted to avoid causing the woman pain. Begin again.
Learning bodily skills requires at times painstaking repetition. I can emphasize this aspect of learning by using repetition in my prose, but by juxtaposing the repetition of the word “wrong” followed by an explanation of the mistake with the command “begin again”, I also show that repetition in learning is not about doing the exact same thing twice. Instead, it is about making adjustments, what students and tutors would likely recognize as advancements in skill.
Taking my cue from Le Guin, I suspect repetition in writing should work similarly to repetition in learning. Whether words sprinkled in a paragraph or events spread across a book, to repeat is not to do the same thing twice, contrary to the word’s denotation. Perhaps “advancement” is not the right word, but with each repetition, something should shift, whether that be the way in which the piece affects its audience or the argument the author makes.
Thank you to Janelle Taylor for recommending Le Guin’s Steering the Craft.
Le Guin, U. K. (1998). Steering the craft: A 21st-century guide to sailing the sea of story. Boston, MA: Mariner Books.
11th JANUARY 2019, MAASTRICHT – In December I attended a workshop organized by the Netherlands Graduate Research School of Science, Technology and Modern Culture (WTMC) on “smart” technologies. It was a stimulating three days that allowed for surprising connections and interesting questions related the ‘Making Clinical Sense’ research project. In particular, the lecture given by Merel Noorman, from the Tillburg Institue for Law, resonated with something I came across at the University for Development Studies in Tamale regarding learning physical examination skills—the potential bias of medical education material found online.
Noorman spoke about the role of science and technology studies (STS) amidst the current fascination and application of smart technologies. She drew on a number of examples to build her talk, but one that struck a chord with me was a Google image search of a three letter acronym—CEO. This isn’t the case anymore, but back in 2015, the first woman to appear in that image search was Barbie. Gender bias clearly made its way into Google’s image search algorithms.
Jumping over to medical education, Google is often a good friend to medical students. Need a quick physiological explanation? Google it on your smartphone. Don’t know how a condition may present clinically? Google it on your smartphone. Surely, having information at their fingertips has benefited medical students all over the world, but the story above does raise some questions about the limitations of immediate information.
For example, students were learning about cyanosis in class. According to a quick Google search: ‘Cyanosis refers to a bluish cast to the skin and mucous membranes…It’s usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood to your body’. So it is recognisable via a bluish tint. The class tutors explained that the tint is usually visible on the hands and feet and/or the lips, tongue and gums. The following image is of a Google image search for ‘cyanosis’ zoomed out at 50%. Anything striking?
In class, tutors informed students that a bluish tint would be more difficult to recognize in people with dark skin, which to be fair is the majority of the patient population in Northern Ghana where I did my fieldwork. They also pointed out that a Google image search would not be helpful in generating images of how cyanosis presents in dark skinned people. Indeed, the image search above, zoomed out to 50%, came up with only a few presentations of cyanosis in a dark skinned person’s hands and feet and one image of a dark skinned person’s lips, tongue or gums. (What might appear to be an extreme case on the bottom right is actually artwork.)
One of the biggest takeaways from the WTMC workshop was that “smart” technologies are sometimes quite dumb. Perhaps it comes as no surprise, but Google clearly doesn’t have all information one click away. For the medical students in Tamale, this isn’t per se a problem. They will come across presentations of cyanosis in dark skinned patients when they enter the clinic.
But as Noorman pointed out in her lecture, the role of STS is to ask the big picture questions. Beyond raising questions about who benefits from smart technology in medicine, then, we have to question the smart technology itself. Noorman made it clear that questioning how to eliminate bias in smart technology isn’t the only question we can ask. Besides, many STS scholars would argue that such a question is futile given that we, human beings, make the tech and feed the algorithms. Instead, we have to decide how to use smart technology. We need to learn what it can and can’t do. In medical education, this might mean emphasizing that Google can’t stand in for other important sources of learning, such as clinical experience, either of the students themselves or their teachers.
The workshop was an intimate affair with participants coming from a variety of backgrounds. We were a mix of medical specialists, young doctors, a few biochemists, tutors, administrative staff, and quantitative and qualitative researchers. While a few participants used the workshop as an opportunity to explore qualitative methods for the first time, most participants had conducted interviews in some fashion, whether to take a patient’s medical history or to generate research, and as such were able to draw on a variety of experiences to inform discussions.
John and I divided the workshop into roughly two parts. We began with a discussion of the potential value of qualitative methods for medical research. We provided some examples of research which has inspired us (e.g., that of Margaret Lock, Vinh-Kim Nguyen, and Caroline Bledsoe and Jennifer Johnson-Hanks), and John was able to draw on his experience of researching the history of nutrition in Ghana during his PhD to briefly highlight the shortcomings of national surveys and the possibilities of using mixed methods.
After this, we bowed out of the limelight and asked participants to conduct their own interviews in a role playing activity. They were divided in groups of three or four, and each group had an interviewer, an interviewee, and at least one observer. We instructed them to choose their own interview topics, invent characters, and play with format (e.g., structured or semi-structured); the goal was not per se to conduct “the best” interview, but to experiment with the setup.
Upon reconvening, the groups drew on their experiences of doing the activity to inform the closing discussion. Together we touched on a variety of topics ranging from some of the difficulties and ethical dilemmas associated with conducting interviews to general tips for good practice, which John recorded for distribution later via email.
We thank those who attended the workshop and shared their experiences of interviewing with us as well as SMHS for allowing us to facilitate the workshop. We must as well extend our gratitude to the European Research Council for funding the ‘Making Clinical Sense’ research project, of which this workshop is a part.
Charles the plastic skeleton was a constant companion of the students in their skills lessons the last five weeks. Even when it seemed he managed to escape to the sidelines, he was pulled front and center to make a point for the class’ benefit. One instructor would temporarily neglect the living, breathing student volunteer who sat on an examination bed in front of the class and instead rely on Charles for demonstrating the limitations of human limbs. The instructor would, for instance, extend Charles’s leg at the hip in the direction of his spine to the point that the leg was perpendicular to his upright back, a move that would have been nothing short of grotesque in someone of flesh and blood. The purely skeletal nature of Charles’s dangling limbs, held together by wire pins, allowed for something the healthy student volunteer did not, a kind of hyperbolic modelling which ironically highlighted the normal degrees of human movement and invited an imagination of the muscles and ligaments needed to adequately limit Charles’s movement.
At times, however, even the models were too limited in their movement, and instructors would default back to the body, but not necessarily to the part of the body under scrutiny. For example, before going through the protocol for examining the knee, an instructor used a model of the knee to zoom in on two ligaments nestled in the hollow between the femur and the tibia. These ligaments prevent the tibia from dislocating. Then the instructor tried to demonstrate what would happen if the ligaments were torn, holding the floating femur with one hand and pulling at the tibia with the other (see my reenactment below). After a few attempts, the instructor put the model down, made fists, and placed them against each other with one forearm running towards the floor and the other towards the ceiling, creating a model of the knee using hands and forearms. This model was easily able to demonstrate the abnormal movement of a dislocated tibia resulting from torn ligaments in the knee.
During the musculoskeletal physical examination block, instructors creatively utilized models and modelling to teach students about bodily movement. This often took the form of using a model to exaggerate an abnormal degree of human movement to ironically invoke the normal. At other times, the models were too securely and representatively constructed to deviate from normalcy for the purposes of education. When this was the case, instructors created models on the spot, using their own body as the resource.
Sensory ethnography is becoming an increasingly popular method for exploring taken-for-granted practices that are otherwise difficult to articulate. Sensory ethnographers are often asked to attune to their own learning, to learn with, not about, others. Much of the discussion, however, is focused on the solo researcher, and there is limited attention given to collaborative studies of the sensory. In a quasi- “proof of concept study”, our team – Rachel Allison, Anna Harris, and Andrea Wojcik – sets out to experiment with different digital methods of elicitation and notation which imaginatively attend to sensory learning – namely drawing, photography, and video – while taking another example of a sensory skill that demands finely tuned technique – making omelettes.
Because our interest in the medical world is the role of pedagogical technologies, we will document others learning through the use of different technological arrangements: video (Julia Child’s The French Chef); written recipe (M.F.K Fisher’s How to Cook a Wolf); and apprenticeship (under the guidance of a chef). In doing so, we mimic the arrangements we expect to encounter in our individual fieldsites. Working from these arrangements also enables us to cross disciplinary boundaries and collaborate with media and art historians to understand more about what it means to experimentally re-enact and reconstruct recipes.
To recap, our starting point is the awareness that our methods don’t describe practices but rather help create them. Through ethnographic experimentation, we look for insights from other disciplines – such as media and art history – to be able to understand how we can create practices which inform us about difficult to articulate sensory experiences of learning to cook an omelette. This experiment should help us direct our use of audio-visual methods as a collaborative team studying doctors’ learning of sensory skills across three fieldsites.
We look forward to conducting this experiment in the summer 2017, and will report back on our experiences later in the year.