Art, Simulation and Surgical Humanities
Lead Research Organisation:
Imperial College London
Department Name: Surgery and Cancer
Abstract
This proposal responds to the Science in Culture Highlight Notice, framing operative surgery as a domain where science and technology intersect both with individuals and with society. Although surgery is widely perceived as a scientific field, making sense of this intersection is not the province of science alone. This proposal argues that arts and humanities can provide crucial viewpoints that are usually absent within the discourses of surgery, offering a rich interplay of perspectives to illuminate societal challenges and tensions around the balance between patient-centred caring and the demands of technology and science.
The proposal brings together experts from arts, humanities and surgery to explore the operating theatre as a complex site for cultural research. By developing the theme of 'surgical humanities', the project will explore the potential of art as a means of capturing multiple dimensions of clinical experience. Because access to actual surgery is severely limited, immersive simulation will provide a safe setting which offers the promise of a new expressive medium for such exploration, building on pioneering work by the PI. Low-cost yet highly realistic surgical environments (for instance using an inflatable operating theatre equipped with authentic instruments and recorded sounds) can recreate many complexities of actual surgery. This work is already giving rise to widespread interest as an educational and public engagement approach.
By standing as proxy for actual clinical events, simulation can recreate something that closely reflects reality (while providing protection against harm), allowing non-clinicians to 'experience' and start to understand what happens during operations. In a wider sense, however, it may also offer a new expressive medium in its own right, allowing artists to manipulate and experiment in ways which would be unthinkable in the real environment. By interpreting the clinical setting through the eyes and ears of visual artists, musicians and design engineers (working closely with clinicians and patients), we believe that new understandings will be generated.
Our aim is therefore to use expertise in simulation, education, performance art, jazz, multimodal semiotics and engineering design as a framework for illuminating the sociocultural practices of surgery, in the process allowing participants to deepen their understanding of their own domains by reconfiguring their professional practice through new insights. So far as we are aware, the potential of immersive surgical simulation for artistic expression has not been systematically explored.
This project will allow a group of innovative artists, musicians, social scientists and surgeons to explore the creative potential around surgical simulation as an artistic medium. A multidisciplinary collaborative network will generate innovative and unorthodox approaches which, in addition to their own artistic value and interest, may offer important insights into the complex relationships between surgery and our wider society.
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The proposal brings together experts from arts, humanities and surgery to explore the operating theatre as a complex site for cultural research. By developing the theme of 'surgical humanities', the project will explore the potential of art as a means of capturing multiple dimensions of clinical experience. Because access to actual surgery is severely limited, immersive simulation will provide a safe setting which offers the promise of a new expressive medium for such exploration, building on pioneering work by the PI. Low-cost yet highly realistic surgical environments (for instance using an inflatable operating theatre equipped with authentic instruments and recorded sounds) can recreate many complexities of actual surgery. This work is already giving rise to widespread interest as an educational and public engagement approach.
By standing as proxy for actual clinical events, simulation can recreate something that closely reflects reality (while providing protection against harm), allowing non-clinicians to 'experience' and start to understand what happens during operations. In a wider sense, however, it may also offer a new expressive medium in its own right, allowing artists to manipulate and experiment in ways which would be unthinkable in the real environment. By interpreting the clinical setting through the eyes and ears of visual artists, musicians and design engineers (working closely with clinicians and patients), we believe that new understandings will be generated.
Our aim is therefore to use expertise in simulation, education, performance art, jazz, multimodal semiotics and engineering design as a framework for illuminating the sociocultural practices of surgery, in the process allowing participants to deepen their understanding of their own domains by reconfiguring their professional practice through new insights. So far as we are aware, the potential of immersive surgical simulation for artistic expression has not been systematically explored.
This project will allow a group of innovative artists, musicians, social scientists and surgeons to explore the creative potential around surgical simulation as an artistic medium. A multidisciplinary collaborative network will generate innovative and unorthodox approaches which, in addition to their own artistic value and interest, may offer important insights into the complex relationships between surgery and our wider society.
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Planned Impact
This research will benefit various confirmed and potential user groups. The drawing together of active researchers from different disciplines presents an appropriate context for extending the influence of this period of funded research beyond traditional domain limitations.
Medical Humanities Research Communities
Within medicine the critical feedback, reflexive debate and introduction of new perceptions and methodologies from the fields of visual art, music, design and semiotics, will mandate a re-evaluation of the ethical and social impact of surgical simulation research. While this will explicitly affect the iterative exploration of the field undertaken by the Principal Investigator, the dissemination of the findings to the medical humanities community is likely to have an influential effect on the understanding of the intellectual challenges and advantages of external scrutiny of medical procedures, training and environments. This project is intended to support a non-hierarchical peer-to-peer dialogue between science-based and arts and humanities based researchers. The project seeks to evaluate the potential for interdisciplinary critique to form an integral part of research into the efficacy of surgical training and procedures. As a pilot case-study for this method of enquiry, medical humanities research and teaching professionals are expected to reference the questions and conclusions raised through this exploratory period of activity. The findings and contentions arising from this initial research will be collated to develop a journal abstract and conference paper.
Arts and Humanities Research and Practitioner Communities
The investigation of the potential for surgical simulation environments to be accessed and critically engaged with by researchers and practitioners from visual art, music, design and other fields offers real benefit to members of research communities who might traditionally have found that their engagement with surgical environments restricted or instrumentalised. The opening of simulated contexts for surgical research to extra-disciplinary manipulation, critique and influence without compromising actual patient or practitioner experience offers an unusual insight into the potential for shared concerns to be articulated within the territories of non-verbal communication, social dynamics and behavioural analysis. The co-investigator, invited consultant participants and other guests will have the opportunity to challenge pre-conceptions of clinical environments and to incorporate reflections on this territory within their home disciplines. The diverse professional experience of the named participants offers real advantages in engaging wider communities with the enquiry and conclusions of this period of research, through their established audiences within visual art galleries, performance venues and museums.
Patients and Practitioners
This award continues the exploration of the benefits of a multi-disciplinary approach to enhancing the healing environment, actively supported by the Kings Fund and within NHS Trusts since 1993. This proposed period of investigation focusses on the intellectual insights gained in the understanding of external perception of the restricted environment of the operating theatre, the reflections and questions raised during this period of dialogue are intended to encourage an enhanced critical framework to explore empathetical and environmental challenges to an empowered understanding of surgery by those directly involved, whether as practitioners or patients. Medical Humanities research is increasingly incorporated within the formal training of medical practitioners. Knowledge gained within this interdisciplinary research in intended to further enhance understanding of the potential benefits of a engaging a broader reference community in the assessment of the st
Medical Humanities Research Communities
Within medicine the critical feedback, reflexive debate and introduction of new perceptions and methodologies from the fields of visual art, music, design and semiotics, will mandate a re-evaluation of the ethical and social impact of surgical simulation research. While this will explicitly affect the iterative exploration of the field undertaken by the Principal Investigator, the dissemination of the findings to the medical humanities community is likely to have an influential effect on the understanding of the intellectual challenges and advantages of external scrutiny of medical procedures, training and environments. This project is intended to support a non-hierarchical peer-to-peer dialogue between science-based and arts and humanities based researchers. The project seeks to evaluate the potential for interdisciplinary critique to form an integral part of research into the efficacy of surgical training and procedures. As a pilot case-study for this method of enquiry, medical humanities research and teaching professionals are expected to reference the questions and conclusions raised through this exploratory period of activity. The findings and contentions arising from this initial research will be collated to develop a journal abstract and conference paper.
Arts and Humanities Research and Practitioner Communities
The investigation of the potential for surgical simulation environments to be accessed and critically engaged with by researchers and practitioners from visual art, music, design and other fields offers real benefit to members of research communities who might traditionally have found that their engagement with surgical environments restricted or instrumentalised. The opening of simulated contexts for surgical research to extra-disciplinary manipulation, critique and influence without compromising actual patient or practitioner experience offers an unusual insight into the potential for shared concerns to be articulated within the territories of non-verbal communication, social dynamics and behavioural analysis. The co-investigator, invited consultant participants and other guests will have the opportunity to challenge pre-conceptions of clinical environments and to incorporate reflections on this territory within their home disciplines. The diverse professional experience of the named participants offers real advantages in engaging wider communities with the enquiry and conclusions of this period of research, through their established audiences within visual art galleries, performance venues and museums.
Patients and Practitioners
This award continues the exploration of the benefits of a multi-disciplinary approach to enhancing the healing environment, actively supported by the Kings Fund and within NHS Trusts since 1993. This proposed period of investigation focusses on the intellectual insights gained in the understanding of external perception of the restricted environment of the operating theatre, the reflections and questions raised during this period of dialogue are intended to encourage an enhanced critical framework to explore empathetical and environmental challenges to an empowered understanding of surgery by those directly involved, whether as practitioners or patients. Medical Humanities research is increasingly incorporated within the formal training of medical practitioners. Knowledge gained within this interdisciplinary research in intended to further enhance understanding of the potential benefits of a engaging a broader reference community in the assessment of the st
Publications
Kneebone R
(2017)
Materiality and thread
in The Lancet
Kneebone R
(2017)
The individual and the system
in The Lancet
Kneebone R
(2017)
Medicine: Discovery through doing
in Nature
Kneebone R
(2015)
When I say reciprocal illumination.
in Medical education
Kneebone R
(2017)
Performing magic, performing medicine
in The Lancet
Kneebone R
(2018)
Getting back in touch.
in Lancet (London, England)
Kneebone R
(2014)
Escaping Babel: the surgical voice.
in Lancet (London, England)
Kneebone R
(2017)
Making medicine bespoke
in The Lancet
Kneebone RL
(2017)
Bespoke practice.
in Lancet (London, England)
Kneebone RL
(2016)
Performing Surgery: Commonalities with Performers Outside Medicine.
in Frontiers in psychology
Description | The project has uncovered unexpected points of connection between the words of surgery and the visual and performing arts. By using simulations of clinical procedures (including operations), participants from the arts and humanities, alongside other publics, have been able to experience and respond to the practices of clinical medicine. |
Exploitation Route | The concept of using simulation to engage widely about the materiality of a professional domain has wide applicabitiliy, especially in bridging the arts, humanities, clinical medicine and laboratory science. |
Sectors | Agriculture, Food and Drink,Education,Healthcare,Culture, Heritage, Museums and Collections |
Description | The project continues to reverberate in the practice of all the participants. For example, we have explored the concept of parallel perspectives by inviting experts from disparate disciplines to form a growing network. Collaboration with puppeteers has shown striking similarities with the worlds of jazz and emergency surgery, where wordless communication and the highest levels of dexterity and coordination underpin collective expertise. Most recently, a collaboration with kitchen and front of house teams from the Fat Duck Restaurant in Bray used simulation of open and keyhole surgery as a prompt for exploring similarities and differences between the worlds of chef and surgeon. Unexpected resonances for all participants have led to plans for continuing development. This work has led to an AHRC Follow on Funding Award aimed at exploring how insights between fine dining and clinical care can inform one another's practices. The project is ongoing and has resulted in a series of public engagement events across the UK and aimed at creating deeper understandings of the concept of care. Key insights include the following: The engagement discussions prompted by our simulations enabled us to identify overarching themes in how care was experienced. These were collated into recommendations to improve patient experience in healthcare settings. Our participants reported that in relation to information transfer about their care, they wanted to remain 'informed, but not bombarded' with information; they wished to have interactions with clinicians that were like a 'conversation, not interrogation'; they drew attention to the fact that 'environment is part of communication' that could add or reduce their anxieties; and that overall they wanted to be 'met as a person' by attuned professionals. |
First Year Of Impact | 2017 |
Sector | Agriculture, Food and Drink,Education,Culture, Heritage, Museums and Collections |
Impact Types | Cultural,Societal |
Description | Collaboration with Art Workers Guild |
Organisation | The Art Workers' Guild |
Country | United Kingdom |
Sector | Learned Society |
PI Contribution | I have contributed to investigations of the centrality of embodied knowing within crafts |
Collaborator Contribution | My colleagues and I provide access to expertise within clinical and scientific practice within and beyond Imperial College London |
Impact | A series of exploratory workshops between craftsmen, clinicians and scientists |
Start Year | 2012 |
Description | Encounters on the Shop Floor |
Organisation | Victoria and Albert Museum |
Country | United Kingdom |
Sector | Public |
PI Contribution | This collaborative project between Victoria & Albert Research Institute (VARI) and Imperial College London is exploring the 'knowledge of the maker' in science, medicine and the creative and performing arts. My contribution to the collaboration draws upon (in addition to other collaborative work) insights and ideas prompted and generated by this Research Networking Award - and especially the concept of boundary-crossing research between the arts, clinical practice and bioscience. |
Collaborator Contribution | This collaboration with VARI (supported by the Mellon Foundation) includes overall collaborative planning and delivery of the project; access to V&A expertise and space; and ongoing commitment to strategic design |
Impact | The project is in development at present. A number of publications (see attached) are showing evidence of emerging value. The work includes collaboration with conservators, makers and performers |
Start Year | 2015 |
Description | Art, Image & Politics Symposium held at John Hansard Gallery, University of Southampton, March 2012. |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | The group contributed as audience members and as speakers in the first interdisciplinary event - enabled sharing of information and insights into one another's professional worlds A progressive series of discussions has highlighted the boundary-crossing nature of each of these domains of expertise, and the value of mapping new territories of engagement. |
Year(s) Of Engagement Activity | 2012 |
Description | Collaborative invited keynote presentation with Professor David Cotterrell (Co-I of Networking Award) at Association for Medical Humanities Conference, Dartington, July 2015 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | Yes |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation provoked extensive dsicussion and debate during and after the event High level of interest from conference participants |
Year(s) Of Engagement Activity | 2015 |
URL | http://amh.ac.uk/?page_id=90 |
Description | Discussion panel/presentation at Cheltenham LIterature Festival |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Cotterrell and Kneebone presented at the Cheltenham Literature festival and led a panel and public discussion on the relationship between surgery and art and the way in which surgery can be informed by external observers. This sparked questions and discussion between audience and panel. Good feedback from audience who expressed an insight into worlds/parallels never seen before. |
Year(s) Of Engagement Activity | 2013 |
Description | Presentation at Design4Health exhibition at SHU in June 2013 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other academic audiences (collaborators, peers etc.) |
Results and Impact | A prototype display based on the trial recordings was presented at this event allowing sharing of information and further discussion. In addition to discussions within and beyond our core group, we explored the affordances of new visualisation and haptic technologies. For example, 360 degree video capture allowed us to capture multiple perspectives on both open surgery and interventional cardiology. |
Year(s) Of Engagement Activity | 2013 |
Description | Presentation at an AHRC hosted RCUK parliamentary event on Health and Wellbeing in June 2013. |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | The project was selected to be presented at an AHRC hosted RCUK parliamentary event on Health and Wellbeing in June 2013. Documentation of the project was been selected for inclusion within an associated publication to be produced and circulated within and beyond the event. Documentation of the project was been selected for inclusion within an associated publication to be produced and circulated within and beyond the event |
Year(s) Of Engagement Activity | 2013 |
Description | Simulation Training at Bucks New University |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Undergraduate students |
Results and Impact | Student nurses and operating theatre practitioners participated in a day of simulation training and video-based debriefing about communication strategies in the operating theatre. Participants experienced 'hands-on' training and reflective discussion. Participants commented on having gained new insight into the importance of communication and reported afterwards that they have put the new strategies in practice when working in the operating theatre. |
Year(s) Of Engagement Activity | 2013 |
Description | The Big Bang Fair 2013, London, ExCeL, 14 - 17 March 2013. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | This event was used to prototype visual arts and sound-based research methodologies. It facilitated the experimental collection of content to be used in creative responses for further use. |
Year(s) Of Engagement Activity | 2013 |
Description | Thinking With Your Hands |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | 120 people attended this engagement event which brought together experts from different professional backgrounds (creative and performing arts, surgeons, bioscientists), using simulation to investigate commonalities between domains of practice, prompted by simulations of surgery |
Year(s) Of Engagement Activity | 2015,2016 |