Not Just Bones, Organs, and Science

This chapter examines how patient empowerment seeks to train medical students to cultivate behaviors, attitudes, and values through disciplinary work done on physicians’ and patients’ affects. Because of the pelvic exam’s fraught history of rendering patients as passive objects prior to the intervention of the Women’s Health Movement, this exam serves as an interesting example to tease out threads of patient empowerment and professional authority. Patient empowerment is conceptualized as a technology comprised of discourses, knowledges, and practices that constitute patients as “partners”: fully informed subjects who are responsible for and obligated to participate in the maintenance of their own health.

“What Does It Mean to Relax Your Hand?”

Insofar as GTAs train medical students to become attuned to the sensations in their own bodies in order to examine the body of another, this process is particularly interesting in the context of teaching and learning the pelvic exam. There, objects of the medical students’ attention—cervix, ovaries, and uterus—are enclosed on the inside of the whole, fleshy body of another person, and learning to discern organs, healthy or diseased, relies on learning to “read” one’s own bodily sensations appropriately. This creates novel tensions and troubles thinking of the body in terms of subjects and objects, insides and outsides, parts and wholes.

Introduction

The pelvic exam is a fascinating case for understanding medical socialization today, as it involves a two-pronged navigation of feelings. It is about the emotions of physician and patient, but it is also about the embodied experience of sensation for both. The GTA program today has been shaped as well by the legacy of feminist health activism and the science-driven reform efforts of medical educators. While it is surely an exceptional experience—one or several one-to-three-hour workshops during all of medical school—it is embedded in and demonstrative of larger trends in medical education and, indeed, the medical profession.

Conclusion

The conclusion looks at debates about the role of consent in teaching and learning the pelvic exam and what these indicate about affective governance in medical education and the making of physicians. The presence of the GTA program in most medical schools in the United States has meant an enthusiastic embracing of the “patient experience.” And yet, there is still a prioritization of the learning experience of the trainee at the expense of the patient when pelvic exams are performed on patients who are under anaesthesia. The chapter suggests that affective governance in medical education is about producing more efficient workers, and more compliant consumers. In short, it is no longer possible to set aside the important role that emotion and bodily capacities to move and be moved by play in the governance of conduct via expert knowledge.

Practicing Professionalism, Performing Authenticity

This chapter considers the GTA session serves as a first step in the emotional socialization of medical students. It explores the tensions between artificiality and authenticity in order to understand how, through pedagogical work that involves simulation, medical students come to embody medical culture. Considering simulation in the context of other technologies of affect proliferating in contemporary medical education, the chapter argues that simulation produces medical subjects who learn to experience and manage emotion in ways that align with the dominant discourses in biomedicine.

“This Power with My Body”

In this chapter, the focus is on the intimate labor that GTAs do, which relies upon care and attentiveness to their bodies, their coworkers’ bodies, and the bodies and emotions of their students. They stand in for actual patients in this way, providing their bodies for medical students to practice on, even as they work as para-professionals in medical education by providing feedback and assessment. The contradictions inherent in their work is captured by an older term for their role: “patient instructor.” Their work relies on both the intimacy and vulnerability that comes with being a patient and the authority that being an instructor in a medical school entails.

The Pelvic Exam and the Politics of Care

This chapter examines how teaching and learning the pelvic in United States medical education have been transformed by feminist practices of care, even as these same practices have been coopted in order to serve the interests of physicians and medical educators. It focuses especially on the disruptive potential of affect and how they are managed by new strategies of governance in medical education. The chapter is also informed by by ways in which, in the 1960s and 1970s, the Women’s Health Movement, medical education research, and transformations in biomedicine altered one another’s trajectories and changed how the pelvic exam is taught to medical students and, thus, the pelvic exam itself.

From Assessing Knowledge to Assessing Performance

This chapter proposes that GTA programs are part of a larger trend in which medical education expanded its control over the professional socialization of medical students through an increasing array of knowledges and practices—or call “technologies of affect”—that seek to measure, harness, and manage the affective capacities of medical students. As the affective economies of healthcare shifted, new forms of governance via expert knowledges and technologies were necessary in order to prepare physicians-in-the-making for a changing landscape of clinical practice in which emotion figures centrally. Thus, this chapter also shows that reconfiguration of expertise and affect via research on medical education in this way is both highly evident in the GTA session and explains its durability and relevance.