Robotic surgery, human fallibility, and the politics of care

Robotic Surgery, Human Fallibility, and the Politics of Care leverages the methods and theoretical paradigms of performance, visual, and new media studies to explore the contradictions, aspirations, and failures of modern technologized medicine. In particular, I consider the use of robots in the operating rooms of a large research hospital. University Hospital illuminates a contemporary articulation of human bodies and robotic technology that focuses and amplifies existing and emergent tensions and contradictions in modern medicine's investment in providing both care and cure. Intuitive Surgical, Inc.'s da Vinci Surgical System provides a platform for this exploration, both as a concrete, material, and particular assemblage of hardware, software and human wetware, and as a technology that offers a specific and perhaps more productive vantage point--a modest step stool--for understanding the contemporary politics of surgical pedagogy and practice. I locate the dVSS in a broader context of ambivalence that surgeons experience with regard to the manual practices of their craft, an ambivalence amplified by the increasing sophistication and automation of surgical tools and the changing ontologies of surgical practice. The surgical interface of the dVSS prosthetically enhances--as well as displaces and replaces--embodied surgical skill. At a time when all facets of medical care grapple with the problem of medical error, I outline an emergent sensibility of machinic virtuosity, articulated to both human and robotic surgical practice alike, geared toward addressing and overcoming the perceived pitfalls of human fallibility. Rather than simply enacting a technological dehumanization of medicine, robotic surgery suggests a more complicated terrain where the nature of the human and the machine bleed into each other. What I term the becoming machine of the surgeon and the becoming surgeon of the medical device occurs on the cutting edge of the robot-surgeon interface. The implications of this emergent medical sensibility are far from clear or unilateral. In closing, I reflect on the uncertain impact of the ideal of machinic virtuosity on the politics of care. This reflection considers software and machine ethics alongside medicine's aspiration to manage contingency according to the procedurality of medical and surgical protocols

Broadcasting the body: affect, embodiment and bodily excess on contemporary television

In recent years television has seen a notable increase in evocative images of the human body subject to exploration and manipulation.Taking the increasing viscerality of television’s body images as a starting point, the work presented in this thesis asserts the importance of considering television viewing as an embodied experience. Through a focus on displays of the body across a range of television formats this thesis demonstrates the significance and complexity of viewers’ affective and embodied engagements with the medium and offers an alternative to accounts of television which are focussed only on the visual, narrative or semiotic aspects of television aesthetics. This work challenges approaches to television which understand the pleasures of looking at the body as simply an exercise in power by considering the role of the body in fostering the sharing of affect, specifically through feelings of intimacy, shame and erotic pleasure. Additionally, the research presented here accounts for and situates the tendency toward bodily display that I have described in terms of traditional television aesthetics and in relation to conditions within the television industry in the United States and the United Kingdom. Rather than considering the trend toward exposing the body as a divergence from traditional television, this thesis argues that body-oriented television is a distinctly televisual phenomenon, one that implicates the bodies onscreen and the bodies of viewers located in domestic space in its attempts to breach the limitations of the screen, making viewers feel both intimately and viscerally connected to the people, characters and onscreen worlds that television constructs for us. The methodological approach taken in this thesis is based on close textual analysis informed by a focus on affect and embodiment. This thesis relies on the author’s own embodied engagement with televisual texts as well as detailed formal analyses of the programmes themselves. In order to understand the place of explicit body images on television this thesis engages with a broad range of contemporary debates in the field of television studies and with the cannon of television studies. This thesis is also deeply informed by writing about affect developed in film studies and studies of reality television. This thesis is structured around a set of case studies which each explore different dimensions of the trend toward bodily excess across a broad range of genres including reality television, science programming and the drama series. The chapters in this thesis are organised around four tendencies or modes related to traditional television aesthetics: Intimacy, community, public education and melodrama. Each of these case studies examines how the affective body capitalises upon and extends the traditional pleasures of television through an affective appeal to the body

Ethical Challenges of Organ Transplantation: Current Debates and International Perspectives

This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper understanding of some of the most controversial issues in modern medicine

Authentic alignment : toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment.This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment.Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment:the T-icosa

Developing a standardized tool for interpretation of radiology diagnostic accuracy trials

Summary Within the health sciences, action research is a methodology well suited to the goal of collaboratively improving practice. As the Royal College of Radiology recommends the use of published clinical trials as guides for achieving higher standards of accuracy, it is important for radiologists to reflect deeply on the results from diagnostic accuracy studies. When the results of the gold standard (or reference standard) are used to confirm a particular diagnosis or disease by comparing the diagnostic accuracy to a newer or index test, this is referred to as diagnostic accuracy research. In the reporting of all research, every effort must be made to reduce the incidence of bias. In 2003, the STARD (Standards for Reporting Diagnostic Accuracy) tool was developed for clinicians to enhance the quality of reporting diagnostic accuracy studies. Based on previous studies, experiential knowledge, and an extensive review of the literature, this research demonstrates that the STARD tool is not being fully optimized. The overall aim of this research was to conduct a work-based project within the department of radiology to develop a revised tool, based on the current STARD, which could then be used to more accurately report and interpret the results of radiology diagnostic accuracy trials. This study was conducted in accordance with participatory action research. Methods The development of this new reporting tool was conducted in collaboration with a group of physicians, and in two distinct phases. First, a needs assessment was sent to eight radiological experts who had agreed to participate in the study. Based on their responses, and feedback from my mentor and colleagues, the next phase of tool development was done using the Delphi technique, after two rounds of which consensus was met. Each phase and cycle iteration to complete the needs assessment and Delphi technique are synonymous with the cycles of action research. The new reporting tool was named the RadSTARD (Radiology Standards for the Reporting of Diagnostic Accuracy Studies), and an elaboration document was written to provide guidance to the end-user. Radiology residents and Fellows at The Ottawa Hospital were then asked to rate their level of confidence in interpreting a diagnostic accuracy article specific to radiology while referring to the RadSTARD. They were also provided a second diagnostic article, the STARD tool, and an elaboration document for comparison. Data was collected using questionnaires that allowed for additional comments. Findings The validation phase of the RadSTARD tool was completed via triangulation of data, as both a quantitative and qualitative analysis was completed. The results found no significant statistical difference between the two groups as per the Mann-Whitney and chi-square analysis. Likewise, both physician groups indicated that they found RadSTARD increased their level of confidence when interpreting the diagnostic accuracy article. Concomitantly, when combined, 96% of the two physician groups indicated they would use the tool again. Interpretation These results may be interpreted as generalizable, as there was no discrepancy or statistical difference found in the results between the radiology residents’ and Fellows’ scores, despite the differences in their level of training. Both groups found the RadSTARD tool and elaboration document to be beneficial to them when interpreting the literature. RadSTARD is thus a reliable tool that can be used to validate the results of diagnostic accuracy studies specific to radiology. It will aid radiologists in reporting and interpreting radiology diagnostic accuracy studies, impacting their practice for generations to come

Strategic asset management for improved healthcare infrastructure planning in English NHS Trusts

The management of physical healthcare assets is vital for efficient delivery of healthcare services along with improving quality and productivity, amidst significant structural and funding re-organisation within the NHS. Capital allocations are under pressure and advanced strategic planning of healthcare infrastructure is required to maintain services. In doing so, the complexity of multiple interacting systems and mixed stakeholder expectations and competencies need to be addressed. The relationship between stakeholder public consultation and estates strategy development in theory and practice is poorly understood and further theoretical development is required to advance our knowledge in Strategic Asset Management (SAM). This thesis adopts an interpretivist paradigm, and an abductive approach with a case study design methodology. Data were collected from six case studies comprising 91 participants (focus groups and workshops); 6 unstructured interviews; 907 questionnaires; and observations resulting in over 30 hours of transcribed data, along with web-based document analyse (desk studies) within 149 NHS Trusts. The data were further analysed using thematic analyses. Findings reveal how localised conditions within individual healthcare Trusts influence the ways in which national initiatives are interpreted and incorporated; these impact existing ways of developing an estates strategy and in some cases, have implications on the usability of associated healthcare infrastructure spaces. This had clear implications on existing SAM practice, which were diverse, driven by individual project team competencies and associated project management practice. In practice, more focus was given to technical competencies (knowledge of SAM datasets and tools) and behavioural competencies were downplayed. Thus, the integrative Strategic Asset Management (iSAM) framework developed in this research, established a unique baseline to develop SAM plans from a complex interaction of care, estates and transport, providing a valuable resource for healthcare planning teams. Stakeholder consultation should be selective (representative sample) and the content of consultation should be appropriate at various SAM stages. Trusts should clearly indicate how their plans have been influenced, given the feedback from stakeholder consultation. Thus, moving it from a tick box exercise, to one that adds value in the decision making process. Empirical findings revealed that although literature promoted tools and methods to facilitate SAM, in practice, these were hardly used and most teams within English healthcare Trusts were not aware of best practice tools and solutions. Structuration theory was further used as a heuristic device to theoretically triangulate the empirical findings and contribute to a nuanced understanding of SAM within healthcare Trusts. In doing so, a middle range theory for integrative SAM (iSAM) was developed. It revealed that a dynamic system of individual action and organisational structure both constrained and enabled SAM. It was evident that the process of SAM is an open, emergent process of sense making rather than a pre-determined and closed process following prescriptive rules. This thesis has advanced knowledge in SAM and has raised the importance of front end project management within English healthcare Trusts. The new integrative and interdisciplinary iSAM framework facilitates the development of estates strategy and stakeholder consultation decision-making within healthcare Trusts

Authentic Alignment: Toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment. This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment. Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment: the T-icosa