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The value of surprise in public engagement

Following the unannounced simulation of a heart attack at the Science Communication Conference, Laura Coates and Rick Hall consider whether surprise is a valuable learning tool.

Laura Coates is enthusiastic

In this age of ‘impact value’, public engagement offers huge potential for involving audiences in previously-veiled research.

In this age of ‘impact value’, public engagement offers huge potential for involving audiences in previously-veiled research. An influential website suggests providing a ‘compelling narrative which could include excitement, shock, surprise, success/failure, death or humour’,1 while the Wellcome Trust seeks to ‘fund programmes that excite, inspire and surprise’.2 But how much surprise is acceptable?

We got the chance to find out when presenting a heart attack simulation at the Science Communication Conference. Our Imperial College London research group has performed many such simulations with audiences including children (Big Bang Fair) and young adults (Science Museum Lates).

Until now, however, we have signposted these as simulations, to make audiences aware that what they will see is not ‘real’. An actor plays the role of a heart attack victim and the audience follows their journey as they are resuscitated before undergoing balloon angioplasty in a simulated cardiology suite. The simulation is followed by opportunities to engage with clinical experts, exploring the science behind heart attacks and simulation technology.

At the Science Communication Conference we broke new ground. During a plenary session an actor stepped onto the stage, ostensibly to make an announcement, then ‘collapsed’ with chest pain. After a few moments Professor Kneebone announced that it was a dramatic presentation, reassured the audience that there was no threat to health, and invited participants to view the rest of the ‘patient’s’ journey, following treatment to its successful conclusion.

There is no doubt that it had impact. For a moment, almost everyone in the audience thought the heart attack was real. Our approach provoked heated controversy amongst delegates, both at the time and in the following days, showing radically polarised views. Some felt manipulated, angry and deceived, while others found the experience energizing and educational. We have since explored both positive and negative reactions in more detail through face-to-face discussions and email conversations.

The approving audience
Our own perception was that the simulation was successful in achieving impact and raising awareness of cardiac disease.

Below we present some of the positive responses (verbatim) which emerged from this audience of science communication professionals: ‘A very effective way of grabbing attention [and] achieving personal investment from the audience.’

‘It is extremely important to feel extreme emotions in order to stimulate the senses. They are not pleasant when they are real, so a simulated version can only help for occasions where one may come across an extreme situation. The exercise, while shocking and disturbing, was absolutely excellent.’

‘There’s a tendency to be terrifically cautious about not wanting to upset anyone. Life’s not like that.’

‘It was the most engaging and impactful demonstration of science of the entire event.’

‘People have to deal with the consequences of real heart attacks every day, so what better way to prepare them, than to help them understand how they are treated (my father actually died as a result of a heart attack, so I have some recent perspective).’

‘It had a much greater impact for being unexpected.’

‘This was by far the best sci com conference I have been to - not boring and mundane, but a little bit edgy and possibly slightly risky too - fantastic! Forewarning would have defeated the object.’

So how should public engagement and real-life experience intersect? Should we push the boundaries of the acceptable in order to grab people’s interest and explore tricky subjects, or should we be bound by political correctness and administrative red tape? Our responses from the audience above would suggest which some would prefer. But clearly the debate is only just beginning.

Rick Hall is appalled

My response to the heart attack simulation at the Science Communication Conference draws on my experience as a director (many years ago) of the form of educational theatre known as Theatre in Education. I am appalled that such an event was staged at the conference.

My response to the heart attack simulation at the Science Communication Conference draws on my experience as a director (many years ago) of the form of educational theatre known as Theatre in Education. I am appalled that such an event was staged at the conference.

No learning
It was not clear what the Imperial College team intended as the learning outcomes of the event. Superficially, you could say that it was designed to ‘show and tell’ what happens when someone suffers a cardiac arrest, but in the confusion this could not be articulated.Whatever the learning outcomes, they were thwarted by the state of the audience after the event. For learning to take place, your audience has to be in a receptive state of readiness, alertness and interest. None of this was possible in the tension and anxiety the audience experienced.

There was no ‘framing’ or warning of the event. In order to create a dramatic framework of ‘as if’ (the man behaved ‘as if’ he were undergoing a cardiac arrest), you have to signal the intention to the audience.

What was confused here was reality and dramatic truth, and the audience were misled. This will at least grow into resentment and at worst anger at being taken in.

Role play is an intricate but potentially valuable learning device in Theatre in Education; many programmes illustrate the learning to be derived by inviting children to role play in a historical or contemporary dramatic reconstruction. The work of Augusto Boal and Forum Theatre are excellent illustrations of what can be learned by placing participants in roles of conflict in order to explore the truth of the complexity of these situations.

When in a recent performance at the National Theatre of DV8’s Can We Talk About This a member of the audience stood up and shouted at the stage in anger and disagreement, and then walked out, the rest of us may have pondered for a brief second whether this was for real. But we quickly appreciated that this too was part of the performance. We were sitting in the Littleton auditorium after all, and the performance had already included direct communication between performers and audience. The dramatic framework was mutually understood.

When an audience is taken in by an event staged as real there is a difference of status, of power that comes with knowledge – those in the know, and those innocent and naïve. If the audience has the opportunity to know that they are entering the world of theatre, they have the choice of how to react. When they are taken in they are disempowered; and that is not a useful imbalance and certainly at odds with a true learning experience.

No presenter of an event can know the susceptibilities of every member of their audience. In the case of the simulation it may have

been the case that someone in the audience had recently experienced a similar health crisis; they may have reacted with confidence (because they knew what to do), or with distress at being exposed to a painful reminder. If the framework of theatre is set first, the audience are empowered and aroused to possibilities.

In my opinion the cardiac arrest event was an ill-judged intervention, designed for benign outcomes but which inadvertently produced an unexpected and unwelcome impact on an unprepared audience. Theatre and drama work on the presumption of the willing suspension of disbelief – but for the audience to be willing they have to understand the context, the setting and to some extent the intention. When it comes down to it, we should all operate on the basis of informed consent.

Dr Laura Coates
Dr Laura Coates is currently a clinical research fellow at Imperial College, London. She will be returning to clinical work at the Bristol Royal Hospital for Children in October 2012.
Rick Hall
Rick Hall is Director of Programmes at Ignite! (and was Director of Theatre in Education, Nottingham Playhouse, 1986-1991)
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