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Terhi’s Reflections on the Cadaver Simulation

The thought of going to the Royal College of Surgeons was quite intriguing, let alone what was going to happen on the day of 19th July. Sharon and I dropped off some equipment there the day before, and I was admiring the building and curiously peeking into the labs and rooms as we made our way to meet Richard and Amit, two registrars organising the day of cadaver simulation. I can’t quite put it in words what it is about surgery that enthrals and puzzles me at the same time. The more I get to understand surgery as a craft, and the more I get to know surgeons, nurses, anaesthetists, and ODP’s and how they work through our project, the more intrigued I get (about almost everything, like the settings and props at the Royal College of Surgeons; even what I found in this cupboard is somehow poetic…)

I wasn’t quite sure what to expect from the simulation day using a defrosted cadaver, and I wasn’t the only one, for sure. However, it wasn’t so much about death, as I have seen a dead body before. I guess it was more about the thought of taking a person “apart” and then “fixing” them while they weren’t alive in the first place.

The first scenario on the 19th however involved a live actor, using the inflatable operating theatre borrowed from Imperial College. Sharon and I set up our cameras to film the scenario, and then watched the team going through an assessment of a leg injury through a window in the next room.


 

I have seen several scenarios where a live actor acts as a conscious patient and made a note about prosodic changes when talk is either addressed to other team members or to the patient. For example, when consultants and nurses talk amongst themselves about the patient around the patient, they often talk more quietly than when addressing the patient directly. That is, when the conscious patient becomes the recipient (e.g., a consultant asks whether they are in pain) the professional routinely speaks louder as if to make it explicit that the patient is being addressed and that their participation (response) is now required. Simultaneously, there might be an element of speaking up so as to alert other team members about patient’s upcoming response and thereby projecting a subsequent course of action that might be required from the team (a paper by Hindmarsh and Pilnick [2002] comes to mind, namely how anaesthetists move from “front stage” talk to “backstage” talk as the patient falls asleep).

                                                                                           [talking to the patient]

The two other scenarios involved the use of cadaver; Richard and Amit’s idea was to explore how body could be used in surgical simulation training, and as they’ve put it, to see what a real body can do in this respect. The scenarios involved first a team conducting a laparotomy, and then an orthopaedic surgery on the leg. These were clearly very different to the kind of simulation in the picture above (that involved a trauma assessment of a conscious patient), namely that these were real operations conducted on the body of a person who had donated their body to medical education and research.

                                                           [Kathy Nicholson on the left]

It was interesting to note how the training involved the more experienced professional teaching “professional vision” for a trainee. Much of such work can be conducted through the use of body movement and gaze, for example, as the consultant creates a centre for drilling a bone. In particular, surgical teaching involves not only demonstrating how things are done but also embodying how things should feel like. This can be partly accomplished through enacting and gesturing what is being felt (e.g., tightness) while sustaining gaze at the trainee who is to develop such understanding without having direct access to the feeling itself. The use of gaze is interesting insofar as the surgical masks cover half of the face thereby limiting the use of facial expressions as a potentially important resource.

The day was intense, two different teams operating, several people observing, us trying to capture the scenarios as well as we could, and Sharon taking no less than 700 photographs. The events only sank in later that evening as I reflected on how it must have felt like for the participants to the simulation. I remember hearing one of the anaesthetists saying how strange it was when the patient’s chest didn’t move at all; indeed anaesthetists continuously monitor heart rate and breathing during operations. It might be that while increasing the realism in surgical training, the use of cadaver might also compromise realism in other, less obvious, ways.

I’m waiting to hear what Richard and Amit made of this day and how the participants talked about their experiences.                                                          [Richard and Amit sorting out fake blood] 

Reference

Hindmarsh, J. & Pilnick, A. (2002). The tacit order of teamwork: Collaboration and embodied conduct in anesthesia. The Sociological Quarterly, 43, 139–164.

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