Embedding instruction in practice: contingency and collaboration during surgical training.

In this paper we address the ways in which surgeons, in collaboration with other members of the surgical team, create occasions for demonstration and instruction within the highly complex and demanding tasks of a surgical operation. Drawing on video recordings of surgical operations, augmented by field studies, we examine how particular phenomena and procedures are made accessible and intelligible to trainees and the ways in which brief episodes of insight and instruction enable complex procedures to be followed and understood. We consider the ways in which demonstration and instruction are achieved, whilst preserving the integrity of medical practice, and explore how trainees are provided with the opportunity to witness, and learn from, the contingent deployment of formal procedures in particular cases. We conclude by considering our observations in the light of recent discussions of practice and situated learning in healthcare training.

Monitoring practice and alarm technology in anaesthesiology.

In this article we examine how one of the most pervasive technological implementations in the healthcare domain--the alarm system--is used in anaesthesiology as part of patient monitoring. The utility and appropriateness of alarms in healthcare domains have been widely addressed in the literature. However, we argue that we still know little about the practical use of alarm systems in actual healthcare practice. Studies rarely examine in detail the everyday monitoring practices during normal operations in the absence of, or before, problems become critical and alarming. They have mainly considered how medical professionals manage the interpretation of and response to alarms. Rather than examining how the anaesthesiologist identifies and responds to alarms and critical problems, in this article we focus on how the anaesthesiologist is actively and prospectively engaged in implementing a situated and emergent organization of patient monitoring, using a wide range of different technological and material resources.

Video and qualitative research: analysing medical practice and interaction.

CONTEXT: Video has long been recognised as providing an important resource within medical education, particularly, perhaps, for training in primary health care. As a resource for research, and more specifically within qualitative social science studies of medical practice, video has proved less pervasive, despite its obvious advantages. METHODS: In this paper, we sketch an approach to using video to inform the analysis of medical practice and the ways in which health care is accomplished through social interaction and collaboration. Drawing on our own research, we discuss two brief examples: the first involves the use of computing technology in primary health care and the second concerns informal instruction during surgery. The examples illustrate the multimodal character of medical work, how activities are accomplished through the interplay of talk, the visual and the use of material artefacts. They also illustrate the ways in which video provides access to the complex forms of social interaction and collaboration that underpin health care. DISCUSSION: We reflect upon the research opportunities afforded by video and the ways in which video-based studies of interaction can contribute to the practice and practicalities of medicine.

Technology and medical practice.

One of the most significant developments in healthcare over the past 25 years has been the widespread deployment of information and communication technologies. These technologies have had a wide-ranging impact on the organisation of healthcare, on professional practice and on patients' experience of illness and its management. In this paper we discuss the ways in which Sociology of Health and illness has provided a forum for the analysis of these new technologies in healthcare. We review a range of relevant research published in the Journal; papers that address such issues as dehumanisation and emotional labour, professional practice and identity, and the social and institutional shaping of technology. Despite these important initiatives, we suggest that information and communication technologies in healthcare remain relatively under-explored within the Journal and, more generally, by the sociology of health and illness and point to developments in cognate areas which may have some bearing upon the analysis of technology in action.

Overseeing organizations: configuring action and its environment.

Despite the widespread deployment of CCTV through most major cities and towns in great Britain, and the importance of surveillance to contemporary debates within the social sciences, there remains relatively little detailed research concerned with the practical use of these technologies in the workplace. In this paper, we examine how personnel in the operation rooms in London Underground use CCTV and related equipment to identify problems and events and to develop a co-ordinated response. In particular, we consider how personnel configure scenes to make sense of and interpret the conduct of the travelling public in organizationally relevant ways, and how they shape the ways in which both passengers and staff see and respond to each others' actions. In addressing how personnel constitute the sense and significance of CCTV images, we reflect on the development of information processing systems which are designed to automatically detect conduct and events.