Learning Communities of Surgeons in Mid-Career Transformation

This chapter describes a study of surgical training workshops, illustrating the nature and utility of anthropological research on teaching and learning in professional communities. Findings are based on ethnographic observation of 35 two- or three-day surgical training workshops. These workshops were offered across six independent training program sites in various regions of the United States and were directed by surgeons who pioneered minimally invasive abdominal surgery in the United States in the early 1990s. The majority of workshop participants were community surgeons in mid-adult life (ages 40–60) with established practices. Other study participants included operating room nurses, medical technicians, and surgical instrument manufacturer representatives. During the course of the study, the researcher interviewed 42 participants about their experiences with laparoscopic cholecystectomy (minimally invasive gallbladder removal). The study provides a venue for exploring (1) the relationship between professional learning through the life span and contextual change, (2) the use of naturalistic inquiry in the study of learning and development in the professions, (3) qualitative research contributions to the study of professional communities and the challenges of “studying up,” (4) the cultural history of video-laparoscopic abdominal surgery, (5) surgical training in mid-career as a ritual process, and (6) knowledge decentralization, risk, and the intensification of professional work. This ethnographic study investigated the impact of new surgical and visualization technologies on the knowledge creation and transmission process within the culture of general surgeons. In this chapter, I explore three themes. First, professional learning is a developmental process occurring throughout the adult life span in response to changing environmental demands and mediated by educational institutions. Therefore, significant change (transformative learning) is best understood in context. Viewing professional learning “in context” means shifting scholarly focus from individual attributes, traits, and psychological processes to the broader societal and cultural domain within which professionals develop and change over time. Researchers must investigate why, where, and how professionals acquire not only explicit but also tacit understandings of their craft (Eraut, 2000, British Journal of Educational Psychology, 70, 113–136, 2002, Teachers and Teaching: Theory and Practice, 8(3/4), 371–379). Second, naturalistic inquiry reframes familiar educational phenomena in new ways––offering both fresh insights and a basis for theory development. Contextual perspectives on identity emphasize the malleability, fluidity, and situated nature of the self. Identity is not a stable set of schemas enduring over time, but resides in the interaction between the individual and changing social and relational contexts (Gergen, 1991, The saturated self: Dilemmas of identity in contemporary life. New York: Basic Books, 2001, American Psychologist, 56, 808–813; Hoffman, 1998, Anthropology and Education Quarterly, 29, 324–346; Strauss, 1997, Cultural Anthropology, 12, 362–404). Significant, transformative professional learning occurs when contextual demands impel the learner to acquire both new skills and schemas, and the dispositions or attitudes associated with them. Thus, professional identities change in response to forces beyond the individual. The structure of the surgical training workshops I observed served cultural (transformational) as well as technical ends. Surgeons were forced by circumstances to acquire new skills, while their “identities” were modified through the ritual process created by the workshop developers. I highlight some of the unique challenges associated with the anthropological study of elite groups (studying-up), noting the dynamic relationship between researcher and subjects. Researchers inevitably exert unknown effects on those studied. Conversely, research participants change forever the way the researcher sees the world. Finally, the early development of minimally invasive abdominal surgery took place in decentralized centers of knowledge production and transmission. The widespread adoption of new surgical techniques in the 1990s required ongoing, dynamic assessment of changing risks, roles, responsibilities, and routines. Whereas new medical technologies proved beneficial for patients, their integration led to an intensification of work (Larson, 1977) for surgeons, other operating room personnel, and those responsible for their training.