- Bodies in Formation: An Ethnography of Anatomy and Surgery Education by Rachel Prentice
Over the past few decades, an analytic focus on the body and on embodiment has produced exciting scholarship in the humanities and social sciences. For historians, sociologists, and anthropologists of medicine, this literature has often taken the form of an exploration of the meanings, construction, and treatment of the patient’s body. Less common has been an examination of the embodied practices that, in the course of medical education, turn the layperson into a physician. Rachel Prentice’s outstanding book Bodies in Formation is a much-needed addition to this scholarship. Drawing from vividly recounted encounters with surgeons and surgeons in training at four academic medical centers in the United States and Canada, the author explores some of the ways in which medical students, residents, and fellows learn to discipline and transform their bodies and their selves in order to acquire the skills and the abilities that contemporary surgery requires of them.
This ethnography is divided into three sections, each corresponding to a different professional setting: the anatomical laboratory, the surgical theater, and the technology design laboratory. Within these distinctive physical spaces, the author [End Page 364] highlights the impact that technological innovation has on surgical practice and the medical self. The first section explores dissection as one of the first steps in a future physician’s emotional engagement with the patient. The cadaver, the author argues, possesses an ontological duality: it can be objectified as a “thing,” but it can also be used to “activate the person” that it once was. This duality, which evidently doesn’t exist in the case of the virtual or digital models sometimes employed in anatomical and surgical training, is essential for medical education. The crafting of a physician clearly involves not only the teaching of specific knowledge and techniques, but also what Prentice calls “the development of a medical stance toward patients” (p. 65), which is predicated upon affective engagement. Although the author believes in the importance of cadaver dissection for the development of a medical sensibility and although she notes with regret the recent cuts this training has suffered in the curriculum, the book is not a polemic. Prentice takes a measured and nuanced approach, outlining at length the complexity inherent in different methods of training. For instance, the development of a simulator for minimally invasive gynecological surgery is a marvel of technical but also social intricacy, requiring the collective work of experts in different fields. Nevertheless, the author argues, surgical and anatomical performances have dimensions that simulations cannot replicate, taking place as they do in a different cultural milieu. Digital tools necessarily change practice—for example the digital patient can be “killed” and then “reset”—and thus raise ethical questions in a profession in which training to do no harm has been a historically important pedagogical principle.
Perhaps the richest part of the book is the middle section, which focuses on the changes—in affect, perception, judgment, bodily habits—that surgical residents undergo in their training. Prentice shows how surgical education remakes the self—first the trainee experiences a defamiliarization with her own body as she learns the various steps that are taken in the operating room and the social relationships between the members of the team. Various procedures and techniques become bodily practices and habits that, when integrated with judgment and knowledge, create the elusive “surgical skill.” While anchoring the discussion in concrete and fascinating examples, the author constructs a theoretical framework for understanding the surgeon’s work and the values (foremost among them the value of control) that define it at the present time. Prentice argues persuasively for the central role that emotion plays in the development of clinical judgment, and she lays out a case for the fashioning of the surgical self as being, fundamentally, a process of embodiment. Historians of medicine will be gratified to see the occasional foray into the history of medicine literature to offer, for example, a deeper...