Digital Social Interaction (herein: Social interaction) is a small research group within the London Knowledge Lab (LKL), at the Institute of Education. Its’ focus is on interaction and communication in surgical operating theatres and the development of scenarios for simulation-based training. It conducts empirical research in surgical operating theatres and develops training interventions with surgical nurses using simulation techniques including re-enactment. It is also engaged in theoretical and methodological development, notably with respect to video based research. The team brings draws on a range of social interaction approaches with a focus on work-based learning. The team contributes to research methods training at LKL, including data workshops and events for Doctoral and Postdoctoral training and medical training at a London clinical teaching hospital.
Key case study participants included: a Post-doctoral Fellow, and a Reader in social Interaction.
Research and Methods in Digital Social Interaction
Research methods and processes are highly valued and made explicit in this case study. The Digital Social Interaction case study has a strong ethos of empirical micro-scale ethnographic research in which the concerns of the participants and the larger context of communication, continuing professional development, and patient safety in the surgical operating theatre play a significant role in setting the analytical focus of the research. Alongside this research agenda the team develop research-based interventions that focus on improving communication among surgical operating theatre teams.
|Social Interaction||Conversation Analysis, Multimodality, Social Semiotics, Discourse Workplace-based learning, Clinical Ed. studies||
Video observation & analysis
Intervention based methods, Simulation and re-enactment
The Social Interaction CS draw on Interpretative epistemology, that is it assumes a socially constructed reality that is never fully objective or un-problematically knowable and to a lesser extent it is informed by a critical approach to technologies and the social order in which they are experienced. It also draws on critical design epistemology. It offers an exemplar of epistemologies can be crossed to understand interaction and inform application/design: it takes on different epistemologies and therefore methods: moving from ethnographic interpretivist research to critical design of simulation environments and performative re-enactment, e.g. nurses acting as surgeons in research informed re-enactments of events where communication was vital, in order to expose and explore the power dynamics and conventions of communication in the operating theatre in the context of patient safety and effective working.
The research is guided by principles of ethnography and ethnomethodology drawing on notions of interaction analysis and conversation analysis. It also draws on multimodality, and social semiotics specifically to focus on examining and understanding the role modes of interaction such as eye gaze, bodies, body movement, in communication. The research methods used draw on stable traditions and a coherent approach rooted in social interaction and discourse studies, work based studies, in particular theories of clinical education. The studies are conducted over long time spans (several years), and the team have worked with the some practitioners for over five years, with immersion and access to local knowledge brokers (e.g. scrub nurses and surgeons) a vital part of the research process. The ethnographic approach means that while studies are planned the research focus continues to develop and unfold over the duration of the studies. The practice involves examining footage on one’s own, and with research team to focus the analysis: ‘I might find something of interest first and then discuss it as a group’ (Fieldwork interview with PDF). Typically there are data sessions, where the analysis is refined with colleagues, giving new ways of seeing; new ways of understanding.
The research method process comprises the video recording and observation of real interaction settings and there is a desire to maximise objectivity in the data collection process. One aspect of this has been the generation of video data via researchers, as well as the ‘harvesting’ of video recordings made via the surgical equipment in the theatre (e.g. laposcopic cameras and surgical lights). This has required intensive engagement with research ethics boards within the hospital sites. It engages in detailed descriptive work to identify the how teams communicate and interact in their everyday working environment. In this case study, these findings are being used in an applied context, using intervention based methods, as a basis for designing simulation scenarios for nurse training, together with evaluating these training sessions. The research involves observing particular teams working situations in medical contexts, participants are doctors, nurses etc., and applying knowledge gained to support the training of other clinical practitioners. It is situated in the context of interdisciplinary research teams.
Significant features of research approach in this site are a structured, rigorous qualitative process. The analytical process is structured through the application of conversation analysis approaches to excerpts of video/observational data. The preservation of actions in sequence, and therefore time, is of vital import in this context, again pointing to the need to understand the body and interaction as intimately tied to space and time. The starting point of using CA is to refrain from making inferences about people’s mental states. Instead the approach demands that description is grounded in things that are observable. Hence the focus on observing and examining body movement and sequences of interaction in order to analyze interactional phenomena. This method is claimed to enable access to how people organize their activity and communication. As one member of the team explained during field work:
She explains the orientation to these interactional issues is based on people’s responses and interactions with one another rather than what’s going on ‘in the mind’, that is ‘you cannot put some kind of motivation on this. When doing CA, you are always asking ‘Why this thing now?’, with the aim of identifying its interactional relevance. ‘This thing’ may be a word, eye gaze, or body movement. (Fieldnote excerpt)
This underlies a key methodological tension in the site – how to manage observable data that might relate to aspects of communication, like emotion, that are ‘within’ or ‘internal’, without making inferences about affect and the resulting impact on the observed interaction. Another concerns what can and cannot be reported in the context of the research, given the potentially sensitive nature of recording and analyzing detailed communicative interaction in medical contexts such as these. A third tension experienced in this case study relates to the changing researcher disposition required by the different types of work. With respect to the empirical research the presence of the researcher’s body (and its proxies – e.g. video cameras) were backgrounded to be as unobtrusive as possible. One of the researchers was a participant in the simulated interventions, her participation was more personal and subjective, as her body was itself entirely implicated in the research process itself, and mediated the experiences of the other participants. Moving between these dispositions created a productive tension:
‘The researcher position in this site changes from an observer viewpoint during the fieldwork, to an action researcher participatory role during the simulation and debrief training session. She discussed the tension: ‘where is the limit between observing and participating, as you become a member of the community observed?.’ Social Interaction CS Fieldnote.
These multiple roles create tensions, specifically where the boundary between observing and participating lies, as the researcher becomes a member of the community observed.
Body digital in Digital Social Interaction
In this case study the body is conceptualized as a resource for interaction with others with a focus on the social function and contexts of communication rather than individual human experiences. The mind is seen as a part of the body. The body forms a unit of analysis in which the non-verbal and bodily interaction is considered important and on equal terms with talk. This view is contrasted, by the team, with linguistic/CA approaches where talk is taken as the most important or sole form of communication.
Digital as environment
Digital video recording
Bodily communication & interaction
Understanding the meanings of bodily actions is seen as important by the team for effective communication, to train students in the operating theatre via simulation training contexts. Conceptualizing the body in this way corresponds to multimodal CA as a theoretical and methodological approach that highlights the importance of analyzing how people use gaze, gesture, body movement, and talk to communicate. The focus is on action: although objects are seen as part of a communicative act but are not significantly foregrounded they are seen as vital to the communicative environment, and criterial aspects of these are replicated in the intervention scenarios. The body or action in context, the time and space of bodily action/interaction also features strongly in this approach and play a role in simulation to create a realistic environment for participants’ experience. Body is also seen as a site of identity work: the operating theatre teams consist of different professionals, including surgeons, nurses, anaesthetists, trainee doctors and nurses. Each of these individuals has different roles and status, which influences how they ‘act’ in the space they are in, the ways and kinds of communicative acts they engage in, and how they are physically positioned in relation to one another (e.g. nurses are observed to communicate behind the surgeon’s body, precluding the surgeon from being included in the communicative act). Such hidden communication is shown through a focus on body and bodily actions. Alongside this the body of the patient is also conceptualized as a mannequin in the context of simulation, and simulation as an embodied experience; and explored as key to identity/professional roles in the operating theatre.
Digital technologies, as research tools, feature in the work of this case study in relation to recording and analyzing, and the creation of environments. Projects involving observation of the operating theatre and those involving the development and application of simulation scenarios for nursing education use digital monitors with visual displays and medical tools, and the use of simulation in medical education includes virtual reality environments and avatars (e.g. Second Life). A primary use of digital technology in this site is through digital video recording and analysis. The digital therefore occurs on two levels: video for data capturing; and the level of the technology available to replicate a real scenario for simulations of the operating theatre. These technologies are not problematised within this work, the focus is on people’s bodily interaction, in this sense the digital is backgrounded and unexamined.
In the Social Interaction and Education case studies the body is fragmented into observational units: gaze, gesture, hand manipulation, body orientation and so on. Digital simulation, the body is understood as a whole entity in relation to mind and body, space and time, but the analytical focus in on the physical body as a social entity, and it is fragmented analytically into communicative modes that map to micro body parts (eyes, finger, hands, torso). The relationship between the physical and the virtual/digital is understood as part of the communicative environment. Marking distinctions between the physical, and digital/virtual body is another aspect of fragmenting the body. These distinctions are made in Social Interaction and Education, indeed tensions between physical and virtual bodies are a key area of research, notably, how the digital shapes conceptions of and interaction with the body. How Physical-digital Trajectories featured in this site was related to the conception of the digital/body, the research practice and time scales of each. These trajectories are central to the Social Interaction CS as physical-digital trajectories were employed in the context of the application of research findings: significant elements of operating theatre interaction were established through intensive analysis of video data, were used for reenactment of the interactional space in a simulated physical-digital environment.
Digital Simulation makes use of sensory elements thought to be important from the real operating theatre: the visual, tactile, olfactory and auditory experiences are things that are understand only from being in that specific location. These sensory aspects are brought into the simulation setting as trainees need to deal with constant sound, since this context is never silent: bleeps, instruments, equipment, white noise, and music, Specifically in the context of the operating theatre simulation participants need to interact with artefacts as part of their learning experience. In addition, bigger props, such as machines, are there to assist the experience by creating an authentic setting. The artefacts are also a mechanism used in the simulation training scenario to engage trainees in managing typical problematic events they may face in the real operating theatre. For example, the loss of an artefact or change in its usual position is central to creating problem solving experiences in the simulation setting. The simulation designs this sensory environment to affect the senses and emotions.
Contribution to Researching Embodiment
The ideas and findings discussed above informed MIDAS’s generation of exploratory themes for researching embodiment across the arts and social sciences. These are briefly discussed below, and developed more fully in the cross-case study analysis section.
Each of the case study sites conceptualizes the body differently and a key aspect of this is how the body is fragmented. Each is partial, and provides gains and losses for understanding the body in digital contexts. Body Zones have a key role in maintaining disciplinary boundaries and supporting analytical processes. In the Social Interaction case study the body is fragmented into observational units: gaze, gesture, hand manipulation, body orientation and so on. Zoning the body in this way has a number of benefits for researching embodiment in digital environments, it: allows in-depth micro focus bringing parts of the body into view; brings into view the connections to be made between these elements; recognizes the different social roles and functions that body parts have in embodied interaction; and helps to stabilize the methods of research. It is also limited in that it atomizes the body. During the simulation intervention stage, this ‘fragmented’ multiple view of the body is used to design a complete sensory experience for training purposes. This shows how research can fragment the body in order to get at the ‘essence’ or ‘criterial’ aspects of a sequence of actions, and use methods of reconstruction/simulation to create a hyper-real ‘focused’ simulation of the communicational environment. This shift can be understood as a remaking of the body. The extent to which this remaking is made visible is an interesting area for reflection when working across research approaches, including the digital arts and social sciences.
Marking distinctions between the physical, and digital/virtual body is another aspect of fragmenting the body. These distinctions are made in the move between the physical body of the surgical team (and the patient) in the operating theatre, and the simulated patient bodies in this case study. There is a strong reliance on the material, sensory and physical body in this site. The internal physical body of the patient is made visible in the operating theatre fieldwork via screen technologies and digital surgical cameras, while the relationship between the physical and ‘virtual’ bodies is smooth and seam-less, the digital strongly mediates conceptions of and interaction with the body in this space. Understanding the trajectories of attention in this case study – when attention is focused or shifting between the physical and the digital and how these are connected via the interactions of the surgical team and their tools is significant and seen as written on the body via gaze, posture orientation, etc. In the Social Interaction CS physical-digital trajectories were employed in the context of the application of research findings: significant elements of operating theatre interaction were established through intensive analysis of video data, were used for reenactment of the interactional space in a simulated physical-digital environment. Digital Arts practices could be useful for social science in relation to the application of research findings, as in the Social Interaction CS, to test ideas, or verify research findings.
Social Interaction CS makes use of sensory elements to create authentic simulation settings to support staff training. The sensory is also used to critique the digital and the body, for example by exploring how the digital augments and enhances the senses of the physical body. The digital is seen as having a role in accessing and expressing sensory experience, as well as disturbing them. A broad range of senses (e.g. olfactory, touch, kinesthetic, vision, aural) is attended to in the Social Interaction CS. This points to the need to understand the meaning potentials of the sensory within social sciences, and offers methods for doing so, notably in relation to atmosphere and environment.
The values and assumptions underlying how embodiment is researched in a particular context need to be excavated. This case study is strongly engaged in the development of research methods, and the establishment of robust processes of analysis. A systematic and explicit process of looking at the body is highly valued, with attention to detailed procedures that are replicable. The in-situ character of the methods is central to this method, that is, the methods are seen as needing to attune to and respond to the context of the surgical operating theatre participants. The goal of fully understanding the participants’ perspectives on their practices is also central. This gives a multilayered view on the body as it is striving for multiple understandings within a context, and to get at how these views interact in a particular space and time. While observation is at the heart of this case study method, the social character of the method drives beyond the dimensions of physical behavior, in which the gesture of nurses and consultants, for example, show how gestures encode social and communicative power. The focus on the observable body to get at phenomena, such as power, that are often considered to be ‘invisible’ or ‘hidden’ raises the issue of what different disciplines are trying to ‘see’ or understand: where is their research gaze trained and how is the body positioned within this.
The Social Interaction CS offers an exemplar of how epistemologies can be crossed to understand interaction and inform application/design: it takes on different epistemologies and therefore methods: moving from ethnographic interpretivist research to critical design of simulation environments and performative re-enactment (nurses acting as surgeons). This provides an exemplar of ways to experiment with these methodological crossings, and to generate research questions. An epistemological change may increasingly be needed to understand real-world HCI that may not be fully explored and explained by remaining within traditional Social Sciences or Digital Arts methods.
Atkinson, J. M. & Heritage, J. (Eds.) (1984). Structures of social action: Studies in conversation analysis. Cambridge: Cambridge University Press.
Goodwin, C. (1981). Conversational organization: Interaction between speakers and hearers. New York: Academic Press.
Heath, C. (1986). Body movement and speech in medical interaction. Cambridge: Cambridge University Press.
Heath, C., Hindmarsh, J., & Luff, P. (2010). Video in qualitative research: Analysing social interaction in everyday life. Sage, London.
Korkiakangas, T, Weldon, S-M, Bezemer, J & Kneebone, R. (2014). Nurse-Surgeon Object Transfer. Video-Analysis of Communication and situation awareness in the operating theatre. International Journal of Nursing Studies 51, 1195-1206
Korkiakangas, T., & Rae, J. (2013). Gearing up to a new activity: how teachers use object adjustments to manage the attention of children with autism. Augmentative and Alternative Communication 29(1): 83-103.
Korkiakangas, T., Rae, J., & Dickerson, P. (2012). The interactional work of repeated talk between a teacher and a child with autism. Journal of Interactional Research in Communication Disorders 3(1): 1-25.
Sacks, H. (1992). Lectures on Conversation, I–II. Oxford: Blackwell.
Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language, 50, 696–735.
Streeck, J., Goodwin, C., & LeBaron, C. (eds.) (2014). Embodied Interaction: Language and Body in the Material World. Cambridge: Cambridge University Press.