Digital learning could imply hands-on learning, a physical engagement of bodies and fingers (digits) finding out how to do something. But mostly it implies, particularly during a pandemic, education online, a learning practice which seems to almost excise the body from the encounter.
Of course, it doesn’t really. Video calls, for example, offer ethnographic windows into corporeal realities at home—dirty washing on beds, children hugging us, remnants of lunch on the table. And we are inundated with images of bodies in the news—bodies in the ICU, bodies exercising on balconies, bodies in PPE. But in many cases, especially for those who work so closely with bodies but aren’t in healthcare, for those for whom touch and being touched is what they do and learn to do, bodies seem to have to some extent disappeared.
Our interest in particular is those who must learn about bodies, in their fleshy, variable, variegated, healthy, ill, and other forms, who now cannot touch the bodies of others—only the keys on their keyboards, the flesh on their own bones, or those of their roommates, family members, or pets—as they try to learn more about others’ corporealities. It could be physiotherapy students, nursing students, massage students, or hairdressing apprentices, but here we talk about medical students, often described as exemplars of “body workers.”
Medical students are receiving a lot of attention in the media these days, as healthcare workers quickly graduated to help in the crisis. But what about students deemed still too inexperienced to help? We have been doing fieldwork in medical schools, along with our colleagues on a research project called Making Clinical Sense, and with collaborators around the world in different disciplines, to try and understand how medical students learn about bodies. Many medical programs that have physically closed their doors are encouraging students not yet providing healthcare to continue their education online. The Association of American Medical Colleges (AAMC), for example, has put an extraordinary list of resources for medical students online that involve “no physical contact with patients.” What does this digital learning mean for how medical students will come to know the bodies of their future patients?
Of course, the dream of digitally aided learning in medical education is not new (Prentice 2013). In past years, Anna has attended medical education trade fairs where virtual technologies for learning how to examine and be with patients abound—virtual reality headsets, augmented reality applications, digital dissection tables, the list goes on. These technologies largely imagined futures and were targeted at medical schools capable of investing in high-cost solutions to the difficulties they increasingly experience teaching on wards and with patients (Taylor 2014).
In our fieldwork, we encountered another side of digital learning. Students already learned about physical examination skills online, mostly finding their own way around the Internet. They searched for, found, and used applications and YouTube videos that demonstrated techniques. They shared resources using private links and databases of downloaded material. They accessed their library books virtually. The students were extremely resourceful. But there was also confusion with this material. There was too much of it to begin with, and it needed sorting out. Videos required a mirrored kind of learning where students needed to reverse their techniques, switching the demonstrator’s left for their right and so forth. And the techniques were sometimes different from those the teachers wanted them to develop in their local settings, counterintuitively highlighting the locality of biomedical practice. Moreover, these digital practices supplemented what the students learned with each other, with experienced teachers, with physical models, and with simulated patients. These other kinds of physical interactions are fundamental to how students imagined, perceived, and oriented themselves as they learn more of their clinical skills off the ward.
Students’ digital learning practices did not seamlessly replace or complement other practices of learning physical examination skills. Instead, they often stood in juxtaposition to them, requiring students’ and teachers’ work to make them fit. Helen Verran (2007) locates learning in these moments of successfully coordinating disparate practices. What can these insights offer for teachers and medical students struggling to continue education away from their normal material settings? Is it possible to find, as the AAMC urges, “meaningful alternatives” to learning through clinical and other forms of contact? We suggest it is, and want to end this piece with three practical suggestions for educational approaches that are based on embracing a more sensory-digital learning. This may not only apply to medical schools but also other sites where teachers of bodywork practices are having to grapple with new conditions. These suggestions draw from our fieldwork as well as the classic phenomenological observation that tools of learning are enmeshed with embodied ways of knowing.
- Move the focus in learning about bodies and with bodies from fidelity of simulations to embrace the power of analogy, metaphor, and imagination.
- Experiment with creating more expansive sensory vocabularies, using multi-modalities to develop students’ storytelling and narratives about anatomy, disease, examination findings, and so forth, both in learning and assessment situations.
- Explore and encourage a range of possibilities of learning with the student’s own body, as well as those of roommates, family members, and pets, with reflection on diversity and how these observations may relate to others.
Importantly, these suggestions work with how medical students, and no doubt many other students, have already been studying and learning, individually and in the classroom. They do not focus on trying to introduce expensive, new technological innovations at home during and after the pandemic, through virtual simulations for example (technologies which are unequally distributed and out of the reach of most body worker learners). However, they also do not aim for straightforward replication of the classroom at home, that is, not for a reproduction of in-class learning. Instead, it is about finding opportunities to continue juxtaposing as a form of learning, to expand creatively on the sensory-digital possibilities in students’ own messy bedrooms and at their lunch-strewn dining tables.
Anna and Andrea's research is part of the Making Clinical Sense project at Maastricht University in the Netherlands, and is supported by the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 678390).
Prentice, Rachel. 2013. Bodies in Formation: An Ethnography of Anatomy and Surgery Education. Durham, N.C.: Duke University Press.
Taylor, Janelle S. 2014. “The Demise of the Bumbler and the Crock: From Experience to Accountability in Medical Education and Ethnography.” American Anthropologist 116, no. 3: 523–34.
Verran, Helen. 2007. “The Educational Value of Explicit Noncoherence: Software for Helping Aboriginal Children Learn about Place.” In Education and Technology: Critical Perspectives, Possible Futures, edited by David W. Kritt and Lucien T. Winegar, 101–24. New York: Lexington Books.