Learning, Design and Performance: Towards a Semiotic-Ethnographic Account of Surgical Simulation.

In this chapter I develop a semiotic-ethnographic perspective on medical simulation. I attempt to investigate simulation as a social semiotic practice in its own right and move away from the current focus in medical education on validating simulation in terms of ‘replication’ of and ‘transfer of skills’ to the ‘real’ environment. I propose to make a distinction between ‘simulator’ and ‘simulation’. By a simulator I mean a set of resources –objects and/or places –that are made available for simulation; by a simulation I mean the social interaction that unfolds when these objects are used in situ. A simulator can be relatively static when it is made available for a particular occasion and maintains its shape throughout the simulation, such as the simulator I discussed in my examples. A simulator can also be ‘dynamic’, for instance when objects can be made to respond (manually or by computers) to the unfolding activity. A simulation is dynamic by definition as it is shaped in social interaction. Thus, a simulator can have a life span of many years, or for as long as the objects last, whereas a simulation is ephemeral: it ‘exists’ for as long as its users wish to sustain the simulation.

We can also differentiate between two groups of social actors involved in simulation. Designers include those who make simulators. Performers are those who use the simulator and produce the actual simulation. Together designers and performers co-construct simulation. Designers produce and assemble objects and spaces which performers use as resources for simulation. In any study of simulation the distribution of agency among these groups requires careful attention. One social actor can be both designer and performer, for instance when new simulators are tested out, but they are more likely to be different people whose social relation is pedagogic: by designing a simulator designers can structure simulation, i.e., by providing resources they can steer the performers into certain directions and shape their engagement with the world.

Simulators and simulation both involve designers and performers simulating, yet in different ways and for different purposes, drawing different relations with what is simulated: some foreground what is seen to be typical, others foreground what is a-typical. They use different strategies to work out what is and what is not typical, ranging from ‘systematic’, ‘empirical’ research to ‘idiosyncratic’ ‘recollections’. As they simulate they transform, for instance a performer may re-enact certain hand movements; and they transduct; for instance a designer may transduct a three dimensional object to an image on a banner.

The full chapter will appear in: N. Pachler & M. Böck (eds). Multimodality and Social Semiotics: Communication, Meaning-making and Learning in the Work of Gunther Kress. New York: Routledge.

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