learning and communication in the operating theatre: a multimodal perspective (j. bezemer, g. kress)

Learning and communica.on in the opera.ng theatre: A mul.modal perspec.ve

Jeff Bezemer and Gunther Kress Talk given at the Learning and Communica.on in the Clinical Workplace Roundtable, Ins.tute of

Educa.on, 28 May 2012.

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some issues for our talk

•  what counts as knowledge? – ‘tacit’ / ‘implicit’ vs ‘explicit’ knowledge

•  how is knowledge enacted / made evident / what are means for ‘recogniJon’ of knowledge?

•  what is the relaJon of communicaJon – meaning and knowing – learning?

•  what are the contemporary characterisJcs of environments of communicaJon /knowing / learning?

•  how can and do we assess / evaluate / rate / value knowledge? 2

What counts as learning?

•  (1) Cons: What’s this? •  MedStud: No idea. •  Cons: I’ll give you a clue, this is the liver •  MedStud: The ovary •  Cons: Yes. •  •  (2) Cons: holds 'ssue up •  SpR: operates diathermy on 'ssue

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Gunther Kress 5

•  A different model of communicaJon

•  The Opera'ng Theatre

Gunther Kress 6

A rudimentary theory of communica.on

•  Communica'on happens as my response to a prompt

•  Communica'on happens when there is interpreta'on

•  Communica'on is mul'modal

Gunther Kress 7

•  communica'on and learning

•  communica'on as learning

•  recogniJon

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Learning and teaching

•  the communicaJonal framing of learning •  communicaJon as learning / learning as an effect of communicaJon

•  The social environment of learning •  ‘communiJes of pracJce’ in a period of instability and provisionality

•  The ‘recogniJon of learning’ – explicit and ‘implicit’ knowing

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‘learning’

• learning is the (work and the) outcome of the transforma've engagement by an individual with an aspect of the world which is the focus of her or his

a?en'on, with principles brought by her or him to that engagement;

• this leads to a transforma'on of the individual’s semio'c/conceptual/social resources

• and, • in the ceaseless transforma'on of these ‘inner’ resources in inner and outward social ac'on, there is a constant transforma'on of iden'ty

Gunther Kress 12

Methodological stance

•  Analyzing video recordings of actual operaJons instead of (only) using interviews and observaJon sheets completed on-‐the-‐spot.

•  Analyzing meanings made in all modes of communicaJon, not just speech.

DistribuJon of roles and instruments in Clip 1

•  Registrar is ‘operaJng surgeon’; he holds a grasper in each hand; the one in his right hand can be used to cauterize.

•  Consultant is ‘first assistant’: he holds the camera and at Jmes also a grasping instrument

•  Second assistant: holds a grasper in fixed posiJon retracJng

They rinse camera…

•  Cons: Okay. Now this bit is best done with your le_ hand closed.

•  … •  Reg: Le_ hand closed into the space and then •  Cons: Exactly. So that le_ hand kind of closed into the space just and then slow/ sweeping movements le_wards.

Registrar is dissecJng…

•  Cons: And you can see that you’re just thinning out onto the soas there. So you wanna stay in that superficial plane. Up there. To not skin soas. Yeah. That’s it. That’s perfect.


•  Consultant is ‘operaJng surgeon’; he holds a grasper in each hand; the one in his right hand can be used to cauterize.

•  Registrar is ‘first assistant’: he holds the camera and at Jmes also a grasping instrument


Consultant is dissecJng… •  So once we get into that posiJon this is the movement that I was saying.

•  You can see that that liale flat bit of Jssue now becomes a cul-‐de-‐sac. And that cul-‐de-‐sac is kind of what I’m always aiming to do. Because then I can put that le_ hand instrument in closed. And with the right hand just kind of thin it out.

•  Okay kind of point to there where you’ve got decent Jssue and you know you’ve got nothing too serious.

•  Cuts.


•  Registrar is ‘operaJng surgeon’; he holds a grasper in each hand; the one in his right hand can be used to cauterize.

•  Consultant is ‘first assistant’: he holds the camera and at Jmes also a grasping instrument


Registrar is dissecJng •  Holds leG instrument closed in space and makes ‘sweeping’

movements with right instrument. •  Withdraws right instrument, opens its jaws, approaches

poten'al cuJng point, then moves instrument back into space, jaws closed.

•  Reposi'ons leG instrument. Makes more sweeping movements with right instrument.

•  Reposi'ons right instrument, opening its jaws and grasping onto cuJng point.

•  Withdraws leG instrument, opens its jaws, approaches poten'al grasping point, then moves instrument back into space, jaws closed.

•  Cauterizes.

Areas of applicaJon

•  Safe training: showing how trainer and trainee can manage risks

•  Assessment: showing what counts as “ackward instrument handling”

•  Decision making: showing who is involved and implicated in intra-‐operaJve decisions

•  Transient team work: showing how clinicians communicate in changing teams

learning and communication in the operating theatre: a multimodal perspective (j. bezemer, g. kress)

Education