Holding the Scalpel: Achieving Surgical Care in a Learning Environment.

In this article, we show what surgical training looks like in situ. Drawing on fieldwork in a London hospital, we explore how a trainer and trainee jointly achieve surgical care when the trainee holds the scalpel. We make this common pedagogic arrangement visible through transcription and analysis of audio- and video-recorded interaction in the operating theater. Through moment-by-moment analysis of the temporal unfolding of action and speech, we show that the actions performed by the trainee with the scalpel serve as mini-gestures, signaling to the trainer where and when the trainee is going to cut. The trainer “reads” these gestures and prompts the trainee to continue or change his course of action through spoken utterances. We use our ethnographic account as a detailed empirical point of reference for reflecting on the challenges and possibilities of surgical education and patient safety in the operating theater.