; ; 31 Jan 2017

Restarting Hearts

Learning the Heart with the Hands by Katharine Vann

In my first year at the RCA/V&A, I set out to explore the ways that medical students learn the anatomy of cardiovascular structures to understand how they mobilize knowledge in operating theatres. In doing so, I asked whether new and allegedly innovative simulation technologies, are radically changing the ways that medical students are learning the basic structures of the heart. I chose to look at hearts because of their cultural and biological significance; hearts beat, bleed, and circulate fluid to vital organs. They are both the literal and figurative cores of bodies, connecting networks, chains and assemblages of body-bound biological organisms that collide and interact at biochemical levels. [1]

What I found in my research is that rather than letting ourselves get seduced by the alleged revolutionary facets of new digital technologies, we need to see simulation technologies that teach cardiovascular structures as building upon predisposed modes of learning, and as such, as working in harmony with embodied, acted and thoroughly material knowledges.

Illustration one depicts CVSim, an open-source software simulation package developed by MIT in 1984 and used to teach medical students about cardiac conditions under different stresses [see Illustration 1]. Historians, social scientists and medical professionals have framed such digital technologies as revolutionizing medicine and radically altering the ways that students learn knowledge. [2] Such technologically determined accounts would view this software as an example of the ‘biodirectional’ evolution of digital technologies in medicine, where the material has been superseded by the virtual. [3]

 

Illustration 1: CVSim: A Cardiovascular Simulator’,PhysioNet, https://physionet.org/physiotools/cvsim/ [accessed 07 April 2016] (para. 1 of 3)

The Visible Human Project (VHP) is another example of an allegedly revolutionary digital initiative that was realised by the U.S. National Library of Medicine in 1994, digitizing two dissected human cadavers [see Illustration 2]. The project produced cross-sections of vital organ systems in the human body and the cardiovascular system. These images were then put online for both medical practitioners and the public to view. In 2001, sociologist Catherine Waldby argued that the VHP marked ‘a decisive move away from book-based anatomical texts towards computer-based cyber anatomies’. [4]Waldby thus saw these digital cadavers as symbolizing the dawn of new modes of computerized learning.

 

Illustration 2: ‘The Visible Human Project: Color Crysosections’, U.S. National Library of Medicine, https://www.nlm.nih.gov/research/visible/photos.html [accessed 07 April 2016] (para. 2 of 6)

Since the 1990s anthropologists and sociologists have become increasingly concerned with bodies and phenomenological perceptions. In 2006, Dirk vom Lehn suggested that ‘a small but growing corpus of research’ was drawing attention to ‘the existential import of the body’s acting-and being-in the world’. [5] These phenomenological studies looked at how ‘participants experience their body in and through their actions’ as well as ‘through the ways in which they are seen and acted upon by others’. [6]

Let us now turn to an example of a 3D printed heart, shown in illustration three [see illustration three]. Over the past decade, 3D printing has been heralded as the latest technology that will revolutionize medicine, and yet looking closely at the contexts in which 3D printing has been used, reveals that it may not be as revolutionary as we think. [7]

Illustration 3: Halterman, T. E., ‘A Little Girl in Miami Saved Thanks to 3D Printed Heart’, 3DPrint.com: The Voice of 3D Printing Technologies, (January 15 2015) https://3dprint.com/37449/3d-printed-heart-saves-4-yo/ [accessed 08 April 2016] (para. 6 of 10)
The Heart Program at Miami Children’s Hospital built the 3D printed heart it so that surgeons could identify problem sections of before taking on a complex surgical procedure. [8]  Surgeon Dr. Burke commented,

‘I think about heart repairs in three dimensions, imagining what I will do with my hands during each step of the operation […] I thought that holding and manipulating a flexible 3D replica of this child’s heart might allow me to plan an operation that hadn’t been done before – configuring the necessary patches to create the exact shapes and dimensions to match her deformed pulmonary veins’. [9]

By peeling back the layers of innovation, here it is evident that 3D printing changed nothing about how medical practitioners learned or deployed knowledge. New simulation technologies may enable more ‘accurate’ renderings of heart defects, but in this case, did not change how the surgeon actually fixed the defect in practice. Although reliant upon digital imaging and printing technologies, the 3D heart was held in the surgeon’s hands and merely acted as a visualization tool. This example highlights how supposedly revolutionary technologies are always tempered by ‘traditional’ methods of embodied learning, often involving haptic touch. Anatomical knowledge thus appears to involve more than just deploying rote learned cardiovascular structures from textbooks; instead it involves planning ahead and thinking with the body. New technologies must be seen as merely aiding this process.

Sociological and anthropological accounts of surgeries were published throughout the 2000s in attempts to redirect discussions of new medical simulation technologies by seeing medical learning as taking place through embodied interactional processes. In her 2005 paper, The Anatomy of a Surgical Simulation, anthropologist Rachel Prentice built upon Latour’s assemblages and networks to look at the medical knowledges that simulators teach. [10] Prentice proposed that while using simulators, surgeons deployed embodied knowledges acquired through habitual practice. Simulators accompanied traditional methods of learning, such as verbal cues from surgeons in the operating theatre, the deployment of pre-learnt names and the layouts of anatomical structures, as well as habitual knowledge accumulated through practicing dissections with the hands and body. As such, Prentice argued that there is no such thing as abstract anatomical knowledge that can be supplanted into the minds of medical students. [11] Rather, she would see cardiovascular knowledge as generated through interaction with bodies in surgery and most importantly, through embodied practice and familiarity with a nexus of medical codes, symbols and cues. Prentice thus makes us question the very premise that abstract anatomical knowledge about the heart even exists.

The main problem with viewing digital simulators and exciting new technologies as revolutionizing medical learning, is that such accounts focus upon moments of innovation rather than looking at how technologies become established through use. [12] By focusing upon practices of embodiment, it becomes evident that complex nexuses of traditional learning methods, including 2D images in textbooks, verbal cues in the operating theatre, as well as practice dissecting real cadavers, continue to be used alongside new digital technologies. Rather than replacing and changing the ways that students learn, such technologies rely on thoroughly embodied, learned knowledge practices.

1. Latour, Bruno, Reassembling the Social: An Introduction to Actor Network Theory, New edn (Oxford: Oxford University Press, 2007)
2. Rosen, Kathleen ‘The History of Simulation’, The Comprehensive Textbook of Healthcare Simulation, ed. by Adam I. Levine, Samual de Maria, Andrew D. Schwarz, and Alan J. Sim, 1st edn (New York: Springer, 2013)
3. Nance, Richard and Sargent, Robert, ‘Perspectives on the Evolution of Simulation’, Operations Research, Vol. 50, No. 1, 2002, p. 161
4. Waldby, Catherine, ‘The Visible Human Project as a Technology of Anatomical Inscription’, in Digital Anatomy, ed. by Lammer, Christina, 1st edn (Wein: Turin and Kant, 2001), p.53
5. vom Lehn, Dirk ‘The Body as Interactive Display: Examining Bodies in a Public Exhibition’, Sociology of Health and Illness, Vol. 28, No. 2 (2006), p. 227
6. vom Lehn, ‘The Body as Interactive Display’, Sociology of Health and Illness, (2006), p. 227
7. Ungureanu, ‘3D-Printed Heart Plays Huge Role’, Tech Times, 2016 (para. 6 of 10)
8. Halterman, T. E., ‘A Little Girl in Miami Saved Thanks to 3D Printed Heart’, 3DPrint.com: The Voice of 3D Printing Technologies, (January 15 2015) https://3dprint.com/37449/3d-printed-heart-saves-4-yo/ [accessed 08 April 2016] (para. 6 of 10)
9. Halterman, ‘A Little Girl in Miami Saved’, 3DPrint.com, (2015), (para. 6 of 10)
10. Prentice, Rachel The Anatomy of a Surgical Simulation: The Mutual Articulation of Bodies in and Through the Machine’, Studies of Social Science, Vol. 35, No. 6, 2006, pp. 837-866
11. Prentice, ‘The Anatomy of a Surgical Simulation’, Studies of Science, 2006, pp. 837-866
12. Edgerton, David, The Shock of the Old, 2nd edn (London: Profile Books Ltd, 2008)

 

Related Articles