during a class focused upon the spine
touching a complexity
touching a perspective
touching a name
touching to question
touching a relationship
touching to feel
touching to see
touching to know.
during a class focused upon the spine
touching a complexity
touching a perspective
touching a name
touching to question
touching a relationship
touching to feel
touching to see
touching to know.
Here is the very beginning of our paper – background to my involvement with anatomy and a brief summary of our research observations.
Translating the Body: the choreography of representation in anatomy teaching.
Ian Gibbins & Catherine Truman
And so to some invaluable and incidental threads
In 1990, before my Feldenkrais training, when I first began to work across the disciplines of art and science, I remember working with a natural scientist in Darwin and asking him to tell me about the essence of his work and he answered: I name things…if we name something, we know it exists. He was a taxonomist specialising in nudibranchs- soft-bodied, marine mollusks that have no shell.
Ian and I have been working together for about four years now.
This is a wax made by Clemente Susini for the La Specola Museum in Florence in the 1700’s.
Art’s writer, Peter Dormer wrote that: (It is) through the repeated acts of making, the use of specific technical skills, the gradual familiarity with a particular material, (that) over time, the hand comes to communicate directly with the mind at a semi-conscious level….If this is so, then we can surmise that the crafted object is imbued with the learned experiences of the maker- and when the subject matter is the human body –an object hand-made for the purpose of teaching anatomy, then there are some other very interesting layers at play.
I wonder what we can learn of ourselves through these objects hand-made by others in another century, in another culture – of our own bodies, and our shared humanity.
The presentation is two hours long . We are including the history of our collaborative work and summarising last years’ Teaching and Learning innovation project. Ian will also demonstrate some of the neuroscience implicated in the students’ modes of learning.
Here are a few of the observations we’re presenting- this is by no means a comprehensive summary, as we have a long way to go in reviewing the data from this project as well as the new data freshly gathered in the last few months of this Synapse project, however it will provide an idea of our direction:
…finally some observations about how the students internalise the vast amounts of information:
And to sum up the instructors role-
We feel this direct experience and immediate access and focus is crucial in enhancing and accelerating the students’ comprehension and ability to internalize the subject matter more effectively. Consequently Ian has been actively encouraging the second year medical students to use the practical anatomy classes more effectively- advocating a balance between rote learning and exploration of objects and self reference through touch. This approach is proving highly effective.
These observations are well supported by experimental neuroscience, which shows how the complex nature of embodied knowledge underlies much learning.
When I make an object I recognize that the conditions must feel right both internally and externally. But I cannot clearly define, let alone conjure up the ‘perfect’ conditions conducive to a successful making experience in any given moment.
I could attempt to list every aspect that I think might be conducive to a satisfying attempt at making something, but I sense the list would be an incomplete recipe and that it would say more about my habitual patterns and my powers of reflection than any set of conditions I could re-create in reality for future success.
We are highly nuanced beings with highly nuanced needs engaged in a complex world of external conditions not entirely of our making or under our control.
In other words, there are zillions of possible variants in this equation. It would be an impossible task to prescribe a set of conditions that would provide a perfect teaching and learning environment for everyone- as impossible as knowing everything there is to know about the human body from all points of view.
What are the conditions in this particular anatomy classroom that encourage students to engage with the subject matter so directly and so enthusiastically? What is the nature of these experiences and what does an individual gain through this direct engagement? These are big questions worth addressing when considering the relationships between the processes implicated in making art that explores and expresses embodiment and the processes involved in medical education. Even though the catalyst for an initial engagement may vary between individuals there is much to be gained in an exploration of the differences and cross-overs in how and what we embody of the subject matter in the process.
It’s the final week of the musculoskeletal course for 2011. On Friday the 2nd year medical students will attend their last formal lectures, tutorials and prac classes and they will have a chance to attend the final practical anatomy review before exams. It will be my last chance to observe them in the anatomy laboratory for this year. I’ve been able to collect some valuable and unprecedented data. Writing, film and stills- observations of the role that touch and gesture play in the students’ experience of practical anatomy education- documentation of an entire course from a very particular perspective.
Now it’s time for a concentrated review of this material in collaboration with their teacher, Professor Ian Gibbins.
I have just been pondering the relationship between my understanding of the practical anatomy classroom and my practice as an artist.
My practice affords me the chance to both engage and reflect upon my experience of the human body. Conceptually, the works I make are derived from a personal interpretation of anatomy rather than a clinical one- influenced by contemporary and historical anatomical representation and the slippages that occur in translation from person to person, body to body in an attempt to render something of a life lived, questioned, observed.
The processes I choose allow me to interpret and express both ephemeral and long-felt concepts and sensations into tangible forms. I choose to hand-make objects and a single work can take days or months to complete. Nowadays I am much more conscious of the fact that if I really want to engage in the experience in a pleasurable way I must remain aware of the role of my own physicality in the entire process. I must be conscious of my own body whilst expressing notions of the body. In a way it is like being immersed in a multi-sensory feedback loop.
It’s compelling- I make therefore I am and visa-versa
After over thirty years of making objects I realize that there is the potential to become absorbed in exploring something completely new, expanding an understanding of something known or reaffirming something quite familiar.
Also, when I have the privilege of mentoring someone in my own practice I always begin from the premise that there is value in gaining an awareness of the threads that have led that person to the works they currently make. Sounds simple, but it’s always a time of revelation and an aspect of professional arts practise that is somewhat overlooked- the simple process of getting to know oneself a little better and learning ways to review and reflect on a regular basis. It is after all what makes us distinctly human.
Medical students usually learn about human anatomy in quite prescribed ways with specific intention.
At Flinders, over the last three years, I’ve observed that the 2nd year medical students actively engage in learning the body within a teaching and learning environment that focuses upon physical experience. Hands-on interactions between the students and the various forms of representation present in the anatomy laboratory are designed to build a student’s experience and understanding of highly complex forms, physiology and inter-relationships. It is necessary to learn hundreds of names of structures and their reason for being and every individual has a different approach and different learning needs. It is clear that there are many ways to embody the subject matter and that rote learning plays a part but it is not as straight forward as just looking at something, or reading it, or being told the facts and automatically understanding and remembering the information. Comprehension and appreciation of the complexities of human anatomy also require multiple sensory feed-back loops. It is a process of embodiment.
After watching the students handle the wet specimens, feel their weight, turn them over, peel back the layers, squeeze a muscle, cup a skull, trace a nerve, pull apart a plastic model and piece it back together again and again like a jigsaw puzzle, hold a long bone to their own thigh for comparison, and touch the small bones of the hand naming each one as they go- I know that this is a special kind of learning experience. These hands-on experiences are all consuming. My senses tell me they can be likened to the experiences I have whilst translating my thoughts into something tangible whilst I reference my own body to make objects about the body.
Tuesday 19th July
Musculoskeletal Practical Anatomy Class Second Year Medicine
The Prac topic : HANDS
Tuesday 12th July, 2011
Anatomy Laboratory, School of Medicine, Flinders University
2nd year Meds, Musculoskeletal Lecture & Practical Session:
Upper Limb ( bones)
This was no ordinary Tuesday. Ian and I talked about it the following morning.
Here are some of my thoughts and observations…
Of course classes can vary from week to week but we had both noticed a distinct energy amongst the students during Tuesday’s practical anatomy class on the bones of the upper limb. They seemed so absorbed in their individual experiences with the material and especially in the referencing of their own bodies. And I know it’s relatively early days in this course, but usually there’s a sense of urgency and a palpable anxiety amongst the students. This is serious business. Everyone is aware of the huge amount of material that must be learned to get through the exams and that is all there is time for.
I’ve been wondering if the students are becoming a little more comfortable with the material they must learn for this course because Ian is always gently reminding them that their own bodies are totally relevant source material. Yes, I know he always does that but something’s different of late. Is it Ian’s teaching? Is it the students? Is it our awareness?
I’m more aware now of the various kinds of direct and indirect experiences in MMS prac lessons and that they are quite specific to learning human anatomy – the types, combinations and sequencing of experiences and the proximity and accessibility of forms of representation are unique to that teaching and learning environment. There is a constant interplay between internal and external referencing during a class.
I’m beginning to think that even before we get to the subject matter, that a cultivation of awareness is critical. It may seem obvious, but unless each person is directed to engage in these kinds of hands-on experiences – how are they to know what they don’t know?
How are they to know what is possible to know in this way?
The instructor’s physical presence and guidance are critical. But it is not as simple as saying…well it’s all here, get your hands on it! Although this kind of encouragement to handle the objects is important, the critical influence is also in the sequencing of experiences to be had in that special room. For example, there was a moment during Tuesday’s class when Ian suggested that the students have a close look at an Xray of a shoulder joint on a light box at one end of the room. ( I noticed the image was actually displayed at shoulder height). The Xray had a few critical features identified with red code stickers and Ian told the students that this would most likely be in the exam. He then advised them to go to the skeletons on stands and identify the same features and also to feel the corresponding bony landmarks on their own bodies. All the while Ian was casually tracing the bones of his own shoulder.
During the afternoon I began to take in other ‘vignettes’ of action around the classroom. I noticed a student standing directly in front of a skeleton, shoulder to shoulder, one hand on his own shoulder, the other feeling the boney joint of the skeleton and right next to him a group of three students standing close to one another in a circle, simultaneously cupping their own shoulders, fingertips on clavicles and moving their whole arms in large slow arcs in space. I was surprised that they weren’t testing each other by naming the structures as they usually do. They were simply looking at each other rather introspectively, deep in sensation, occasionally nodding. They weren’t rushing, they just seemed to be taking in their own experiences, in their own time.
As per usual, all around on the tables were the loose dry bones of the upper limb, plastic shoulder joints on stands, radius and ulna still under the overhead projector projected on the screens all around the space and the wet prosections of wrist and shoulder joints sitting on the stainless steel trolleys.
The atmosphere was decidedly calm, the students seemed constantly engaged, always in movement and…yes, really enjoying themselves!
Ian tells me that the tutors are reporting that this group of MSS students are grasping the material quite quickly and they say they are enjoying the prac classes in particular because of the hands on experience. Most say the experience clarifies the three-dimensional aspects of the subject matter. The tutors have also noticed that the students have already formed quite close-knit study groups.
I will ponder the subtleties of the day further with Ian next week.
Oh yes…and we have received approval from the Social and Behavioural Research Ethics Committee to document students’ hands during the pracs. The trick will be to remain in the background as much as possible so as not to inhibit the class’s usual unusual behaviour!
Cory, the lab technician has placed a box of bones on a table in the anatomy museum for me to scrutinize. Bones of the upper limb this time. One tattered and bulging carton full to overflowing with scapulae and hand bones strung on fishing line and bundles of the long bones of the arm- each set comprises a humerus, radius, ulna and collarbone held together with a rubber band.
I decide to lay out the wing-like scapulae in a large ordered group on the grey table near the window because I want to look at them together and from a distance. In doing so I know this attempt at pattern will reveal sweet differences.
There are subtle, poignant shifts from one to the other in size, weight, texture, form, density and colour. Some have patches of bone that are impossibly thin and others are surprisingly sturdy and thickened especially at their edges.
One in particular takes my eye. It is quite small and fragile and covered in a fine, spidery lead-pencil taxonomy of words- the names of muscles and various bony delineations.1.
The grain of the bone lends the handwriting a sense of fragility and uncertainty. The scribbles are on both sides and I flick from one side to the other, reading the bone in a search for meaning. Every bump, every recess has a reason for being. Every process has a purpose.
I gather up the strange bundles of long bones and line them up on the table to see them in the natural light of the window. Four sets in a row. Together they create an illusion…a chaotic jumble of meandering sticks with clumsy abrupt endings. They could have been hand-made in low-fired white clay or cast in creamy Plaster of Paris. There’s a whole arm in each bundle and the bones look almost like pale root vegetables wrenched from the earth or even well worn wooden puzzles jumbled and grubby from being handled by countless students. I’m surprised at their childlike chunkiness. The curious bundles seem more like playthings than serious anatomy. But these are extraordinary toys.
They are ambiguous. Just by looking I find it impossible to embody the notion of an arm. I peel off the rubber band and the bones fall, clunk, strewn on the table and I can now see them apart from each other for the first time. I feel compelled to hold each one, one at a time. I grasp, cup, caress, and scrutinise each and every texture, process and depression by touch, tracing each detail with my eyes up close, turning each over in complex directions from end to end, round and round and up and down. I can feel the twist of the ulna and the radius, the robustness of the humerus, the ball of the shoulder and the curious shape of the elbow.
In order to understand what a student may gain from touch I feel I need to do this kind of unbounded exploration for myself. I’ve observed so many practical anatomy classes now and watched countless students interact with these objects that I know in an analysis of my exploration I can’t claim the same imperative to pick these bones up so as to get the names right and embed knowledge. But this experience has been so rich- to sit alone and consider these objects in my own time, simply driven by curiosity and with little or no intention in my exploration but to be open to whatever feels familiar and unfamiliar. To consider, investigate and scrutinize- to bring my touch (noun) into touch (verb).
Obviously context is important in defining the role that touch plays in anatomical education. The learning environment is unique and the formal examination criteria provide the imperative to learn specifics.
We are only beginning to understand the significance of touch when it comes to leaning human anatomy. We have observed that the experience of touch can provide a student with subtle and complex readings of the subject matter. Various qualities of touch can be learnt, particularly in terms of intention and purpose. Ian’s approach and attitude to the subject is amplified in the way he ‘handles’ the various forms of representation in the practical anatomy classroom. He is assured, purposeful and respectful and the students take his lead. But our observations have also revealed that every individual brings unique qualities to touch and that this contributes to their unique approaches to learning. Why does this matter? What differentiates and defines the qualities of touch? This Synapse project is affording Ian and I some critical time to ask these more nuanced questions and explore them in quite personal and creative ways.
The musculoskeletal course began this week and I feel privileged to be able to observe a new group of second year medical students negotiate this immense subject. It is the third year in a row that I have been involved with students undertaking this particular course. Ian has again introduced me to the large group of about 140 students and in the first lecture he has stressed the critical importance of hands on experience in the anatomy lab. This year he emphasizes: In order to get to grips with this material, you have to get your hands on it.
I’m keen to now focus our research more intensely on the role that touch plays in learning the human musculoskeletal system with this fresh group of eager students. We are currently waiting for ethics clearance specifically so that I may document the students’ hands during the practical classes.
The Anatomy Museum July 4TH & 5TH 2011
 This scapula is part of a set donated to the university. The marks were made by someone else but they have been left as is. The senior lab technician says the marks and names on the bones are sometimes made by the students and in a way he doesn’t mind too much because it’s a part of their learning.
I have spent the last few days looking closely at the bones that are in constant use by the students in the anatomy laboratory. One of the technicians who has worked here for years has been sitting along side me and together we have been scanning the surfaces of the long bones of the lower limbs. The places my hands find intuitively seem to be the places which also reveal evidence of the touch of many others before me. I grasp the long shaft of a femur and find it fits my grip perfectly and my fingers slide along the length of a boney ridge to find that it has already been burnished and oiled by someone else’s curiousity. I can shut my eyes and see such fine detail – detail I hesitate to put into words, because my descriptions would fall short. When I have finished I want to begin all over again because I know that each bone is unique and each bone contains the story of a lifetime.
We just don’t seem to have the words to express the depth of understanding gained through touch.
Over the last few years that I’ve been observing Ian teaching anatomy lessons at Flinders it seems clear from the data we’ve collected -including video documentation, student questionnaires and interviews that hands provide a bridge between theory (written and spoken) and a spacial, structural and functional understanding of the body.
Currently we’re following a line of inquiry that focuses on the importance of touch and gesture in learning and communicating the complexities of human anatomy.
The starting point seems simple- I’ve begun to look for evidence of touch amongst the various forms of representation in this learning environment- direct points of human contact with the models.
The ridges around the ends of some of the long dry bones in the anatomy lab show signs wear- the femora and and the humeri, in particular. The internal filligree structures are revealed and the shafts are slightly burnished. These bones are constantly handled and highly valued by the students.
Rounded and ragged processes, areas of discoloration, chipped corners, smooth burnished areas, pencil marks, worn joints, frayed edges can reveal much about the student’s line of inquiry.
During this Synapse6 residency I am focusing on the complexities of learning human anatomy- how we approach this conundrum of embodiment.
Initially during 2008/9 I observed Prof Ian Gibbins teaching a number of classes to medical students in the Anatomy lab. The piece of writing that follows is a piece I wrote whilst observing one of the first year medical students’ classes. This piece was a catalyst for our collaboration on several projects including Not Absolute (an exhibition held at Flinders University Art Museum, 2009) and translating the body: the choreography of representation in anatomy teaching (funded through a Flinders University Teaching and Learning Innovation grant, 2010)
There are many layers to unravel in these simple direct observations. Last year we collected unprecedented data including film, stills and text of a group of second year medical students as they learnt the muscular skeletal system in a series of practical anatomy classes and lectures. At present we’re reviewing this data. Here’s where we began….
A Morning’s Anatomy
I find a stool and position myself out of the way… noticeably apart from the students and I can sense their curiosity about my place in all of this. Who is she? What’s her role? What’s her level of authority? Student? Teacher? And how much does she know? Why is she here? I want to announce myself ‘cause I feel a little like I need to get their permission to observe their vulnerability with this new learning. But they quickly become absorbed in the doings of the day and I am able to merge into the background of the lesson.
The room seems well equipped.
Tables settled with a stock of objects and diagrams mapping the walls.
I’m thinking the room is always like this.
There’s a lone stainless steel trolley at the end of the room. Laid upon it is a long narrow object swathed in pristine cotton cloth resting cushioned and silent on top a layer of absorbent paper.
There’s a level of Magritte-like surrealism.
I’m transfixed on the silent white folds. And my eyes search for hints. A leak. A peek.
An uncovering of some sort.
But I’m left guessing.
Next to it lay several sections of human brain. Grey pink like many layers of paint over-spray from a well-used booth. A melding of every colour you’ve ever known-each cancelling the other out.
There’s a small profound mass lying dense under the scrutiny of a ceiling-mounted camera- the lens is coming down to meet it and Ian and the technician, Geoff, are making the final adjustments to the focus as the room fills with noisy eager students.
I’m a voyeur here today.
It’s definitely like the buzz before a hot performance.
There’s a whiff of something new to be learned. The air is heavy with it.
The students find their seats and the stage is set.
And gradually I realize every item of this interior has been designated a purpose.
An immediate purpose.
All around me is the human nervous system.
Painted, projected, engraved, x-rayed, swathed in cotton, real, fake, digital, photographic, potted, and fresh from the bucket, illuminated.
Ian dons a Madonna-esque mic winds it around his right ear and clips the device to his Khaki shorts. Casual, relaxed in preparation.
He’s light on his feet and skitters from place to place. He seems to be toying with the force of gravity. Compelling subject/object/subject. The students unbalance and balance with the questions and answers. They are well and truly hooked.
Three large screens around the periphery of the room give big vision of the small detail at the end of his pointer.
He has a 1/2 brain a human brain cupped in his gloved hands and spins a remarkable narrative- a practical story about what’s in their heads.
He draws them out – doing brain stuff.
They are busy looking, always busy looking….
Following his dance
On their toes with him
Eyes searching the screens…his hands…the plastic brain puzzles in front of them.
He’s clicking his fingers of his right hand.
“What side of the brain am I using to do this?”
He twists his body, destabilizes his centre, is up on his toes, shifts up a gear, propels forward and lands them again with another trick question.
Simple gestures with profound implications…if they can follow the threads to the brains in their heads.
This kind of unfamiliar ground requires a unique kind of concentration.
….meanwhile half a brain lies on the trolley waiting to be further enlightened.
He plummets towards the computer now and addresses the image on the screen.
A teeny white arrow takes centre stage and they follow it meticulously to learn the taxonomy of the brain.
He’s talking and walking again, up on his feet, leaving another image in his trail…a bisected head sawn through the middle delicate silhouette pink pale and dark intricate internal filigree glows on screen. A profound donation.
In the middle of the room he asks for the difference between grey matter and white matter, debunking old notions of right and left, and suddenly he lets out a sharp piercing squeal into the mic. Raising their heart rates by design, he proceeds to analyse the sequence of their surprise.
Involuntary wide-eyed sub-cortical processes happen all the time.
Global cortical processing…strange floating notions of time…
An on the spot demonstration …he whips his watch on to the overhead projector bed …look at it for a few seconds then look away for a few seconds…do it five or six times…eyes and heads flick…the second hand halts inexplicably and they wait for an explanation.
He’s drawing a diagram spinal cord, sensory motor nerve cells redlines in and out form line to line to spine. Elegant detail. Structural engineering.
He’s in constant movement there’s a massive concentration upon this continuum this choreographed dance between question and answer. The vastness of the unknown alongside the fragility of the known. Magical stories about the thinking organ and it’s nervous system and they believe him. He picks up the metal pointer in his right hand and cups the specimen brain in his left hand and talks about the importance of both functions – the holding and the fine manipulation of a tool and points to the area of the brain he’s holding to tell us what part of his own is allowing these miraculous everyday actions to occur- a very practical demonstration.
Enough talking …he waves his arms and tells them to explore the offerings round the room. Glove up, pick them up, feel their weight, name there parts, turn them over, feel their texture, name their amorphous tracts and upholstery-like fibres
They’re talking themselves through the moving experience -a running narrative, an empty skull, a folded ear. Fingers inside, hands cupping outside, only latex separating their touch from the wetness. I watch them and wonder what they’re thinking… I wonder what she’s feels. I wonder where they take it in. Where they hold it. If there’s empathy.
Back to their seats for another walk through He waves and weaves and walks his talk computer, buzzing, models, drawings, painted surfaces, superficial lines, diagrams colour, life and death.
The specimens sit apart again, strewn like miraculous discarded toys- stories stopped mid-sentence in suspended animation waiting again to be given meaning.
“ You’re aware of certain things in the environment if they have relevance to you…
Consciousness takes a third to a half a second to process
‘The continuous experience of now is a construction which takes time.”
Class ends clatter and chatter last minute questions the technician hurries past and sprays the waiting specimens and restocks the latex gloves.