Negotiating humanity: an ethnography of cadaver-based simulation.

Human body donation (HBD) serves an essential function in many medical schools, particularly in institutions where people engage in cadaver-based simulation (CBS) as a pedagogical approach. The people who facilitate HBD and CBS have a highly specialized skill set, yet their expertise remains largely unacknowledged, and takes place out of sight from the broader medical school community. This manuscript, based on a two-year practice-based ethnography (Structured Observations n = 68 h, Unstructured Observations n = 150 + hours; Interviews n = 24; and Document/Policy Analysis n = 14) illuminates the complex work of HBD. We identify three primary functions of HBD and CBS (1. Cadaver Intake & Administration, 2. Cadaver Preparation, and 3. Cadaver-Based Pedagogy). We describe how medical educators involved in CBS have developed a skillset specific to their role: negotiating humanity.

The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography.

PhenomenonCadavers have long played an important and complex role in medical education. While research on cadaver-based simulation has largely focused on exploring student attitudes and reactions or measuring improvements in procedural performance, the ethical, philosophical, and experiential aspects of teaching and learning with cadavers are rarely discussed. In this paper, we shed new light on the fascinating philosophical moves in which people engage each and every time they find themselves face to face with a cadaver. ApproachOver a two-year period (2018/19-2019/20), we applied ethnographic methods (137 hours of observation, 24 interviews, and the analysis of 22 documents) to shadow the educational cadaver through the practical stages involved in cadaver-based simulation: 1. cadaver preparation, 2. cadaver-based skill practice with physicians and residents, and 3. interment and memorial services. We used Deleuze and Guattari's concepts of becoming and acts of creation to trace the ontological "lifecycle" of an educational cadaver as embedded within everyday work practices. FindingsWe delineated six sub-phases of the lifecycle, through which the cadaver transformed ontologically from person to donor, body, cadaver, educational cadaver, teacher, and loved one/legacy. These shifts involved a network of bureaucratic, technical, educational, and humanistic practices that shaped the way the cadaver was perceived and acted upon at different moments in the lifecycle. By highlighting, at each phase, 1) the ontological transitions of the cadaver, itself, and 2) the practices, events, settings, and people involved in each of these transitions, we explored questions of "being" as it related to the ontological ambiguity of the cadaver: its conceptualization as both person and tool, simultaneously representing life and death. InsightsEngaging deeply with the philosophical questions of cadaver-based simulation (CBS) helped us conceptualize the lifecycle as a series of meaningful and purposeful acts of becoming. Following the cadaver from program entry to interment allowed us to contemplate how its ontological ambiguity shapes every aspect of cadaver-based simulation. We found that in discussions of fidelity in medical simulation, beyond both the physical and functional, it is possible to conceive of a third type: ontological. The humanness of the cadaver makes CBS a unique, irreplaceable, and inherently philosophical, practice.

Actor-network theory and ethnography: Sociomaterial approaches to researching medical education.

Medical education is a messy tangle of social and material elements. These material entities include tools, like curriculum guides, stethoscopes, cell phones, accreditation standards, and mannequins; natural elements, like weather systems, disease vectors, and human bodies; and, objects, like checklists, internet connections, classrooms, lights, chairs and an endless array of others.We propose that sociomaterial approaches to ethnography can help us explore taken for granted, or under-theorized, elements of a situation under study, thereby enabling us to think differently. In this article, we describe ideas informing Actor-Network Theory approaches, and how these ideas translate into how ethnographic research is designed and conducted. We investigate epistemological (what we can know, and how) positioning of the researcher in an actor-network theory informed ethnography, and describe how we tailor ethnographic methods-document and artefact analysis; observation; and interviews-to align with a sociomaterial worldview.Untangling sociomaterial scenarios can offer a novel perspective on myriad contemporary medical education issues. These issues include examining how novel tools (e.g. accreditation standards, assessment tools, mannequins, videoconferencing technologies) and spaces (e.g. simulation suites, videoconferenced lecture theatres) used in medical education impact how teaching and learning actually happen in these settings.

Progressive research collaborations and the limits of soft power.

Collaboration in diverse teams is a central topic area in medical education, health research, and healthcare. As medical education researchers we implemented an internal grant policy to develop a progressive research partnership based on widely accepted guidelines for responsible conduct of research. Our intention was to proactively manage and guide group expectations around issues such as access to data and authorship. Our policy was based on 'soft power' principles, using the persuasiveness of ideas, relationships and inducements to encourage people to 'want what you want.' This article shares how we developed and implemented the policy, experienced first-hand the limits of soft power, and it explicates some of the lessons learned.

Technologies of Exposure: Videoconferenced Distributed Medical Education as a Sociomaterial Practice.

PURPOSE: Videoconferencing-a network of buttons, screens, microphones, cameras, and speakers-is one way to ensure that undergraduate medical curricula are comparably delivered across distributed medical education (DME) sites, a common requirement for accreditation. However, few researchers have critically explored the role of videoconference technologies in day-to-day DME. The authors, therefore, conducted a three-year ethnographic study of a Canadian undergraduate DME program. METHOD: Drawing on 108 hours of observations, 33 interviews, and analysis of 65 documents-all collected at two campuses between January 2013 and February 2015-the authors explored the question, "What is revealed when we consider videoconferencing for DME as a sociomaterial practice?" RESULTS: The authors describe three interconnected ways that videoconference systems operate as unintended "technologies of exposure": visual, curricular, and auditory. Videoconferencing inadvertently exposes both mundane and extraordinary images and sounds, offering access to the informal, unintended, and even disavowed curriculum of everyday medical education. The authors conceptualize these exposures as sociomaterial practices, which add an additional layer of complexity for members of medical school communities. CONCLUSIONS: This analysis challenges the assumption that videoconferencing merely extends the bricks-and-mortar classroom. The authors discuss practical implications and recommend more critical consideration of the ways videoconferencing shifts the terrain of medical education. These findings point to a need for more critically oriented research exploring the ways DME technologies transform medical education, in both intended and unintended ways.

The invisible work of distributed medical education: exploring the contributions of audiovisual professionals, administrative professionals and faculty teachers.

Distributed medical education (DME) is becoming increasingly prevalent. Much of the published literature on DME has focused on the experiences of learners in distributed programs; however, our empirical work leads us to believe that DME changes the context significantly, not only for learners, but also for other important members of the educational community including audiovisual professionals, administrative professionals and faculty teachers. Based on a three-year ethnographic study, we provide a detailed account of how alliances between various workers involved in DME develop to produce and deliver an undergraduate medical curriculum across geographically separate campuses. We explore the question 'What is the work involved in the delivery of a DME program?' and cast a critical gaze on the essential but invisible, and therefore potentially unrecognized and underappreciated, contributions of AV professionals, administrative professionals, and faculty teachers. Our goal is to make visible the complexity of DME, including the essential contributions of these workers. The study was theoretically framed in sociomateriality and conceptually framed in Star and Strauss' notion of articulation work.

Sociomateriality: a theoretical framework for studying distributed medical education.

Distributed medical education (DME) is a type of distance learning in which students participate in medical education from diverse geographic locations using Web conferencing, videoconferencing, e-learning, and similar tools. DME is becoming increasingly widespread in North America and around the world.Although relatively new to medical education, distance learning has a long history in the broader field of education and a related body of literature that speaks to the importance of engaging in rigorous and theoretically informed studies of distance learning. The existing DME literature is helpful, but it has been largely descriptive and lacks a critical "lens"-that is, a theoretical perspective from which to rigorously conceptualize and interrogate DME's social (relationships, people) and material (technologies, tools) aspects.The authors describe DME and theories about distance learning and show that such theories focus on social, pedagogical, and cognitive considerations without adequately taking into account material factors. They address this gap by proposing sociomateriality as a theoretical framework allowing researchers and educators to study DME and (1) understand and consider previously obscured actors, infrastructure, and other factors that, on the surface, seem unrelated and even unimportant; (2) see clearly how the social and material components of learning are intertwined in fluid, messy, and often uncertain ways; and (3) perhaps think differently, even in ways that disrupt traditional approaches, as they explore DME. The authors conclude that DME brings with it substantial investments of social and material resources, and therefore needs careful study, using approaches that embrace its complexity.