A Feel for the Clinic: Affect, Embodiment, and Simulation in the Pelvic Exam
thesisposted on 18.02.2018, 00:00 by Kelly E. Underman
Gynecological teaching associates (GTAs) are female-bodied individuals who teach medical students how to perform sensitive and competent gynecological examinations using the instructor's own body. GTA programs emerged in the 1970s and 1980s, and have since become ubiquitous to medical education (Beckmann, et al, 1988). During a teaching session, a GTA walks a group of two to four medical students through a complete pelvic exam, emphasizing correct technique and language, as well as other patient interaction skills. Despite a growing number of computer-based simulation models, which align with the increasing rationalization and science-oriented nature of medical education (Prentice, 2012), GTA programs remain a valued part of medical education. My dissertation considers two questions: 1) what were the processes by which GTA programs came to be a part of medical education, and 2) why are GTA programs sustained in medical education? I focused on the historical development and current use of GTA programs at three major medical schools in Chicago. I combined qualitative interview and archival data from three groups of stakeholders: GTAs, medical students, and medical faculty. Using literatures on embodiment, biomedicine, and science studies, I argue that the GTA program is a type of simulation program that inculcates the medical habitus in medical students. I demonstrate first how crisis in the field of medicine created opportunities for reformers of medical education and feminists in the Women's Health Movement to collaborate. I show how the GTA session allows medical students to rehearse the ethical and emotional dispositions required of physicians. I then explore the development of techniques of the body for physical exam through the GTA session. I conclude by working toward a notion of affective practice, or the repetitive rehearsal of styles of experiencing, expressing, and managing ways of feeling until these become seemingly natural to the body.