Bodies in Formation: An Ethnography of Anatomy and Surgery Education by Rachel Prentice (review)

In Bodies in Formation: An Ethnography of Anatomy and Surgical Education, Rachel Prentice examines the intellectual, ethical, and technical means through which medical students become surgeons. Prentice’s analysis is based on nearly two years of ethnographic research conducted in two prominent North American medical schools beginning in 2001. With a focus on embodiment—used not as a noun but as a verb—Prentice demonstrates in exquisite detail how the multiple forms of knowledge required to enact the controlled violence of surgery come to be incorporated in the bodies of surgical practitioners. In Prentice’s analysis, embodiment is not only a process by which surgeons develop a feel for the technical practices of cutting, pressing, and moving a patient’s body, it is, at the same time, one in which surgeons cultivate the ethics and discernment necessary to press scalpels into skin and yet “do no harm.” By placing practices of embodied learning and demonstrations of embodied knowing at the center of surgical work, the book engages at once with tradition-bound philosophies of medical education and cutting-edge research into virtual reality surgical simulation. What Prentice makes clear is that in each of these models of surgical education—one looking nostalgically into the past and the other boldly into the future—surgical practice, and thus the education intended to guide it, relies on a unique configuration of intellectual, physical, and ethical cultivation. The book is fundamentally grounded in ethnographic research of surgical training and intimately concerned with the philosophies of care, comportment, and praxis that give it shape.

Bodies in Formation opens with an examination of that quintessential initiation into medical education: cadaver dissection. Students’ meaningful work on cadavers is enabled by the cadavers’ dual status as both a human body and an inanimate object. This ontological duality makes affective and technical demands on students as they confront the ethical status of human life and form, and the unresponsive, lifeless thing through which their textbook anatomy lessons assume the stuff of cadaveric bodies. For many students, the physician’s enjoinder to “first do no harm” finds its first challenge in the dissection lab. In recognizing that learning anatomy through dissection entails the literal destruction of the pedagogical body-object, a critical distinction is drawn between violence and harm. We learn through the experiences of Christie, a young medical student, that while dissection inevitably does violence to the cadaver, it is not done with the “malicious intentions” that define harm (60). The question of what constitutes harm is one to which surgeons attend from the first days of their education through the end of their careers.

While the cadaver lab may be iconic of a traditional biomedical education, its status among medical educators has come increasingly under debate. Pressed by the rising cost of maintaining cadaver donation and management programs, the declining number of trained anatomists, and a philosophical debate about the kind of knowledge cadaver dissection produces, there is a growing push to move anatomical education to digital platforms. Rather than destroying a cadaver through dissection, these digital tools enable students to memorize the names and relations of structures through programs as basic as fill-in-the-blank quizzes, to those as advanced as the interactive Visible Human Project. Proponents of these technologies praise their efficiency and the pedagogical benefit of allowing students to repeat identification exercises over and over again. Repetition is a practice that cadaver dissection does not allow; once a cut is made, it cannot be unmade. As Prentice demonstrates, debates about whether anatomy—the bedrock of a surgical education—is best learned through dissection or digital testing reflect divergent ideas about what anatomical learning does for the student. Further, this is a debate about the nature of the learning that takes place when a student studies anatomy. Proponents of dissection stress the value of the emotional and tactile connection that lead students like Christie to reflect on “harm” when faced with a human body on the...