Taking a broader view: exploring the materiality of medicine through cross-disciplinary learning

Quality, safety and efficiency are essential to healthcare. They depend on skilful ‘doing’, on expertise in materiality. This paper shows how exploration across disciplinary borders may enrich our understanding of the materiality of clinical practice.

We use the term ’materiality' to describe our relationship with the physical world and the substances which constitute every object we encounter.¹ Dealing with materiality is part of every healthcare professional’s daily routine. Yet, the role of materiality is often overlooked in the curricula of medicine and science, which focus on factual knowledge and theoretical concepts. In this paper we show how exploration across disciplinary borders can enrich our understanding of this crucial aspect of practice and its role in the acquisition of professional expertise.

To explore this concept, the authors convened a symposium entitled ‘The Art of Performing Science: Analogies across Disciplines’ at Imperial College, London in October 2017. Its aim was to create a platform to explore expertise and encourage new approaches to sharing knowledge. More than 60 clinicians, scientists, artists and performers were invited to demonstrate their work to one another, using materials and tools from their workshops or laboratories. This prompted wide-ranging discussion around similarities and differences. Jewellery designers sat with dentists, nurses and molecular biologists with taxidermists, museum curators with synthetic chemists and surgeons with letter-cutters in wood and stone. It became clear, from these and other groups, that handling material is central to experts’ daily working practice. Yet, although such skills can be demonstrated, they are difficult to express in words.² There is no ‘lexicon’ for materiality which can allow expertise to be shared between different kinds of work. Opportunities for learning between professional groups are often missed.

When materials are precious, the stakes are high, sometimes with only one chance to achieve success or avoid failure. This is obvious in the case of a jeweller who handles gold and precious stones. Yet, a molecular biologist who works with human genetic material, analysing tiny samples of rare tumours from patients who have since died, is also working with irreplaceable materials and knows that she must work with care to preserve her specimen’s integrity and avoid contamination. Daily practice and awareness of how material must be handled builds tacit knowledge which unites people’s experiences, insights, intuition, observations and emotions.³ Sharing such strategies reduces the risk that valuable materials will be wasted, that scientists’ material will be destroyed through insensitive handling or that patients will be harmed through error.

Material is complex, composed of multiple layers or components. Understanding softness, thickness and resistance of such layers is essential. At the symposium an ophthalmic anaesthetist, who had trained as a tailor before entering medical school, explained how he learnt to recognise layers. The haptic skills he had internalised in his apprenticeship underpin his current work when he administers subtenon blocks for eye operations in elderly patients. Recognising layers through feel gives him confidence that he is in the right plane to inject the local anaesthetic. Understanding how much pressure is required on a needle is something one has to experience and cannot be gained from books alone. It is essential to observe each material and recognise its haptic characteristics. Stored in long‐term memory, such knowledge augments those bodily responses and intuitions which often precede reflexive action.⁴ This sensory information is a fundamental component of expertise. Yet, clinicians seldom have the opportunity to tap into insights from other domains.

One symposium participant, a statue conservator at London’s Victoria & Albert Museum, uses controlled pressure when applying thin layers of gold as she restores a medieval carving. She must understand how one material reacts with another, since each layer of material is critical for the next phase. A periodontal surgeon is faced with similar issues—again, a deep understanding of materiality and layers is crucial when gauging the pressure to exert on a tooth and the kinds of materials that are needed for restoration and refashioning.

Mastery of materiality determines the choice and handling of tools and instruments. There are striking similarities between instruments in different professions. Leather cutters, surgeons and chefs all use syringes and scalpel-like blades; taxidermists, frame conservators, dentists and museum curators use forceps and probes. However, it is the interface between tools and bodies that best illustrates expertise. Even when instruments have similar shapes and are designed for a similar purpose, ‘recalibration’ of the hands before using each tool is essential. It is important to ‘feel’ the tool, so that it performs as intended, especially when working with precious samples. This demands an affinity between the material and the person who uses it. In the words of a sculptor at the symposium, ‘to become successful, you must love the material you are working with’. This sympathy and awareness of the physical world, though difficult to capture in words, is central to understanding materiality.

This exploration opened unexpected insights into sensing and working with materials, showing how much can be gained by looking beyond the world of healthcare. A shared understanding between science, medicine and arts about knowing, handling and working with the material world could offer a new reading of simulation, implemented early in education to bridge the gaps between academic knowledge and skills which are becoming increasingly evident in our contemporary society.² As clinicians, materiality is central to how we engage and interact safely with our patients, aligning their bodies and our own with the materials we all depend on.

Elsewhere, we have framed simulation as selection, abstraction and re-presentation of expert practices from one world to another, rather than focusing on surface realism relating to specific domains.⁵ In this sense ’The Art of Performing Science' was an instance of simulation, where the worlds in question crossed traditional disciplinary boundaries between medicine, natural sciences and the visual, plastic and performing arts. This exploration has highlighted aspects of materiality—observation, dexterity, precision and a care for safety—that go beyond any single domain, yet lie at the heart of expert practice.