Holiday reading

The program started with a conversation between an embroider and a surgeon, facilitated by Roger Kneebone. This alone was worth the trip to London for me. Having embroidered medical and botanical objects into old linens for years as gifts, I was enthralled by how Fleur Oakes, who holds the marvellous (and totally enviable) title of “embroider in residence” at a vascular surgery department in London, translated her ethnographic observations of surgical theatres into a fabric body (see above and below, complete with tattoo).

This anthropological approach to surgery recalled for me the work of Barbara Hepworth, Bill Viola and Ian McEwan that I have previously explored in my article “The artist as surgical ethnographer: participant observers outside the social sciences“. I was intrigued by how Fleur Oakes may have taken fieldnotes in the theatre, in order to make her creations. What kind of sketches did she do while observing? How did she make traces of textures and colours? This topic was not explicitly explored in the workshop but returned again in other conversations, such as with the restorer at the V&A who made notes about her broken objects and the tailor that found other ways of recording movement beyond measurements. How do these craftspeople document their observations and what can we learn from that when doing sensory ethnography?

The fabric body was also inspiring for another reason, for it was a material manifestation of Fleur’s fieldwork that was not verbal, not directly representational. It was completely tactile and analogous. As semiotician Gunther Kress, the leading scholar on multimodality, pointed out in some closing remarks and reflections at the end of the day, this fabric body was a wonderful realisation of the multimodal ways in which we need to work, of an alternate sensory lexicon, required for dealing with embodied knowing, and communication in a contemporary world.

There were many other fascinating conversations facilitated by Roger Kneebone, between anaesthetist and tailor, chef and microbiologist, as well as several smaller group conversations where participants talked with their favourite instruments and other objects they brought along.

You can read more about Professor Kneebone’s approach to collaborations of these kinds in a recent article in Nature.

The event was filmed by the filmmaker Paul Craddock of SmartDocs, so look out for that, and in the meantime, enjoy some of his other films on craft, embodied knowledge and collaboration on his website too.

The event was an elective for medical students at Maastricht University. The elective, initiated by the Art and Heritage Committee at Maastricht University, ran for some weeks across a number of art institutions in Maastricht. We were involved for the week which was organised in collaboration with Marres House for Contemporary Culture and the Skills Lab, at Maastricht University. A particularly exciting aspect of this event was that the students were encouraged to extend beyond the more traditional task of looking at paintings. The exhibition at Marres, which the medical students engaged with during the week, was called The Painted Bird, and involved murals exploring the themes of Europe. Led by arts educator Ilse van Lieshout and director Valentijn Byvanck, students were not only encouraged to look, but also use their other senses in the space, such as movement, through a number of moving exercises, or touch, through examination of various objects. Students also drew maps of the spaces based on their experiences.

We contributed with an exercise designed to train the students’ skills of observation, through following a recipe of how to make an omelette, exploring not only how to read and interpret a recipe, and observe, with their senses, the cooking process, but also what it meant to observe others’ cooking. While one half of the class cooked, the other half were taking fieldnotes, writing or drawing about that they were seeing, hearing, smelling in front of them. Later in the week the students went to the Skills Lab, and during some sessions led by Femke Jongen, Laura Navarro, Valentijn Byvanck and Ilse van Lieshout, conducted experiments in sensing each other’s bodies, based on their insights from their time at Marres.

During these exercises, the students were invited to attend to differences (in sounds, sight, taste, smell, texture, movement etc.), to guide them to noticing aspects of their body, materials, their environment, they might otherwise not notice, to find ways to articulate these experiences and to reflect on the skills of observation and attentiveness to those observations that are required for their work as doctors. It was wonderful to be involved in this pilot program in Maastricht, a program which, as Eleanor and I argued for in our paper, reinforced the importance of attending to attentiveness when teaching medical students physical examination skills, a quality which is important, and indeed crucial, to their abilities as diagnosticians.

Many medical students feel like a “real doctor” when they receive their first stethoscope. For others it is when they spend time with a patient for the first time by themselves. For me, it was perhaps when I was loaned my first pager. Suddenly the medical work I had been learning moved beyond the realms of a scheduled curriculum, into the after-hours of “real” clinical work, a time when textbooks and libraries were left behind, and we were allowed, as students, into the lives of the doctors who were teaching us on the wards. Sometimes we were given a pager as a group, and once we received a message from the resident or registrar on our unit that there was “something interesting happening”, we would spread the word and gather in the hospital. It was especially exciting if this happened in the middle of the night! In other rotations we had our own pager. When we became residents the novelty soon wore off; the pager was the way in which all hospital staff communicated with us. Its beep, a sound I will never forget, could mean anything from a new drug chart rewrite to, nerve-wrackingly, a medical emergency.

The pager was more than a symbolic manifestation of the profession we were entering. It was a material that was important to how we learned our clinical skills, linking us to the everyday practices of hospital medicine. I was a medical student in the 1990s, when pagers were much more widely used than they are today. Nowadays, the medical students I follow in my ethnographic work all carry smartphones, as do the doctors who teach them.

Are the days of the pager over? This is debatable. Recently the two main manufacturers of pagers in the UK consolidated into one provider, meaning 1,000 users needed to change company. Who are these users? According to an article in The Guardian:

“Put simply, they are anyone who needs the one remaining technical advantage that pagers have: slightly more reliability. Where mobile phone networks can be patchy, or slow, or overloaded, the separate paging network offers a modest improvement in reception and reach, especially in rural areas. Compared with modern smartphones, pager batteries also last much longer.”

There are bean-counters however who have pointed out the financial burden of using pagers in the NHS, advocating for other digital solutions: “Pagers represent 20th-century technology and are a blunt instrument for communication.” Others argue: “They do only one task, but they do it well. They provide a last line of defence”.

I remember when residents  started carrying PDAs (personal digital assistants), accessing all kinds of information I couldn’t imagine having at your fingertips on the ward, away from a computer. Now the smartphone is ubiquitous in hospitals. What might these technological transformations mean for medical education, and the ways students learn on the wards? How does this influence students’ engagements with patients? These, amongst others, will be questions we will consider in our fieldwork, as well as other ways in which smartphones are used in learning and teaching. We are not only interested in what is new however, but also how “older” technologies, such as the pager, may endure in the education of doctors.

For previous work we have done on materiality, please see:

Harris, Anna. (2017) “Sounds like infrastructure: Examining the materiality of pneumatic tube systems through their sonic traces” in Historicizing Infrastructure, edited by Andreas Marklund and Mogens Ruediger, Aalborg University Press.

Image used under the Creative Commons lisence, from Hades2k’s Flickr page.

Thanks to Annika Richterich for sending us the latest news on pagers.

Drawing inspiration from these other fields of sensory expertise, and the recent surge in art appreciation and creative writing classes in medical schools, we are as a team in the midst of an exciting collaboration with the Art and Heritage Commission at Maastricht University, the SkillsLab in the medical faculty of the same university, Marres and other arts and university departments, to organise a multisensory training workshop for medical students.

This workshop, which will take place as part of an elective on the role of art in medicine, stems from existing collaborations across these sites, and previous experiments, such as the workshop that Anna organised for medical educators attending the annual European conference AMEE, Barcelona (28th August – 31st August 2016).

This AMEE workshop was part of the now annual AMEE Fringe event, which proved very popular, with hundreds of participants. Anna set up 12 tables in total for the workshop, each focusing on a difference “sense” (although of course distinguishing them apart is a false exercise, but helped delineate out some exercises for the 15 minutes Anna had for the workshop!). There were tables with: wine odour smell kits; different Rooibos teas to taste; a learning to listen exercise; paintings to find differences between; and clays and plasticines to make pinch pots.

The aim of the workshop was to help participants attend to differences that they might otherwise not notice; to find ways to articulate these experiences; to consider how such exercises might be introduced in medical schools; and to reflect on the skills of observation that are required for medical practice. After a short introduction by Anna introducing the exercises and aims of the workshop, participants gathered around a chosen table or the one they were sitting at. There was a roving mike capturing thoughts and reflections. The participants seemed to be enjoying themselves and many said afterwards that they liked creatively engaging with what it means to observe and articulate sensory differences. Some participants told Anna it was an inspiring sensory training exercise which would use with their own medical students.

We are looking forward to the workshop with Maastricht medical students in June and will report back on our experiences later in the year.

For some further reading behind sensory training for medical students in workshops, see:

Harris, Anna and Flynn, Eleanor (2017) Medical education of attention: A qualitative study of learning to listen to sound. Medical Teacher 39 (1): 79 – 84.