#digitalnatives and #edtech and #woolongong- The ‘digital natives’ debate: A critical review of the evidence. British Journal of Educational Technology, Bennett et al Feb 2008

I blogged the other day on a recent paper on the myth of the digital native. Here is another paper, by Sue Bennett, Karl Maton and Lisa Kervin, from nearly a decade ago, on the same theme – and equally trenchant:

The idea that a new generation of students is entering the education system has excited recent attention among educators and education commentators. Termed ‘digital natives’ or the ‘Net generation’, these young people are said to have been immersed in technology all their lives, imbuing them with sophisticated technical skills and learning preferences for which traditional education is unprepared. Grand claims are being made about the nature of this generational change and about the urgent necessity for educational reform in response. A sense of impending crisis pervades this debate. However, the actual situation is far from clear. In this paper, the authors draw on the fields of education and sociology to analyse the digital natives debate. The paper presents and questions the main claims made about digital natives and analyses the nature of the debate itself. We argue that rather than being empirically and theoretically informed, the debate can be likened to an academic form of a ‘moral panic’. We propose that a more measured and disinterested approach is now required to investigate ‘digital natives’ and their implications for education.

On an entirely different note, the authors are/were affiliated with the University of Woolongong. Recent days have seen the death of Geoff Mack, who wrote the song “I’ve Been Everywhere” Originally a list of Australian placenames :

The song inspired versions internationally – the best known being Johnny Cash’s and The Simpsons’ – but the wittiest alternative version is this (NB – Dapto is a few miles from Wollongong)

Anyway, back the digital natives. Bennet et al begin with a quote from Marcel Proust:

The one thing that does not change is that at any and every time it appears that there have been
‘great changes’.
Marcel Proust, Within a Budding Grove

The authors summarise what a digital native is supposed to be like – and the not exactly extensive evidence base for their existence:

The claim made for the existence of a generation of ‘digital natives’ is based on two
main assumptions in the literature, which can be summarised as follows:

1. Young people of the digital native generation possess sophisticated
knowledge of and skills with information technologies.
2. As a result of their upbringing and experiences with technology, digital natives have particular learning preferences or styles that differ from earlier generations of students.

In the seminal literature on digital natives, these assertions are put forward with limited
empirical evidence (eg, Tapscott, 1998), or supported by anecdotes and appeals to
common-sense beliefs (eg, Prensky, 2001a). Furthermore, this literature has been referenced,
often uncritically, in a host of later publications (Gaston, 2006; Gros, 2003;
Long, 2005; McHale, 2005; Skiba, 2005). There is, however, an emerging body of
research that is beginning to reveal some of the complexity of young people’s computer
use and skills.

No one denies that a lot of young people use a lot of technology – but not all:

In summary, though limited in scope and focus, the research evidence to date indicates
that a proportion of young people are highly adept with technology and rely on it for a
range of information gathering and communication activities. However, there also
appears to be a significant proportion of young people who do not have the levels of access or technology skills predicted by proponents of the digital native idea. Such generalisations about a whole generation of young people thereby focus attention on
technically adept students. With this comes the danger that those less interested and less able will be neglected, and that the potential impact of socio-economic and cultural factors will be overlooked. It may be that there is as much variation within the digital native generation as between the generations.

It is often suggested that children who are merrily exploring the digital world are ground down with frustration by not having the same access to computers in school. This is part of a more general (with familiar rhetoric for the health IT world) demand for transformation (the word “disruptive” in its modern usage had not quite caught on in 2008) As is often the case, the empirical evidence (and also, I would say, a certain degree of common sense) is not with the disrupters:

The claim we will now examine is that current educational systems must change in
response to a new generation of technically adept young people. Current students have
been variously described as disappointed (Oblinger, 2003), dissatisfied (Levin & Arafeh,
2002) and disengaged (Prensky, 2005a). It is also argued that educational institutions
at all levels are rapidly becoming outdated and irrelevant, and that there is an urgent
need to change what is taught and how(Prensky, 2001a; Tapscott, 1998). For example,
Tapscott (1999) urges educators and authorities to ‘[g]ive students the tools, and they
will be the single most important source of guidance on how to make their schools relevant and effective places to learn’ (p. 11).Without such a transformation, commentators
warn, we risk failing a generation of students and our institutions face imminent
obsolescence.

However, there is little evidence of the serious disaffection and alienation among students
claimed by commentators. Downes’ (2002) study of primary school children
(5–12 years old) found that home computer use was more varied than school use and
enabled children greater freedom and opportunity to learn by doing. The participants
did report feeling limited in the time they were allocated to use computers at school and
in the way their use was constrained by teacher-directed learning activities. Similarly,
Levin and Arafeh’s (2002) study revealed students’ frustrations at their school Internet
use being restricted, but crucially also their recognition of the school’s in loco parentis
role in protecting them from inappropriate material. Selwyn’s (2006) student participants
were also frustrated that their freedom of use was curtailed at school and ‘were
well aware of a digital disconnect but displayed a pragmatic acceptance rather than the
outright alienation from the school that some commentators would suggest’ (p. 5).

In 2008 Bennett et al summarised similar issues relating to students actual rather than perceived technical adeptness and net savviness to the 2016 authors:

Furthermore, questions must be asked about the relevance to education of the everyday
ICTs skills possessed by technically adept young people. For example, it cannot be
assumed that knowing how to look up ‘cheats’ for computer games on the Internet
bears any relation to the skills required to assess a website’s relevance for a school
project. Indeed, existing research suggests otherwise. When observing students interacting
with text obtained from an Internet search, Sutherland-Smith (2002) reported
that many were easily frustrated when not instantly gratified in their search for immediate
answers and appeared to adopt a ‘snatch and grab philosophy’ (p. 664). Similarly,
Eagleton, Guinee and Langlais (2003) observed middle-school students often making
‘hasty, random choices with little thought and evaluation’ (p. 30).
Such research observes shallow, random and often passive interactions with text,which
raise significant questions about what digital natives can actually do as they engage
with and make meaning from such technology. As noted by Lorenzo and Dziuban
(2006), concerns over students’ lack of critical thinking when using Internet-based
information sources imply that ‘students aren’t as net savvy as we might have assumed’
(p. 2). This suggests that students’ everyday technology practices may not be directly
applicable to academic tasks, and so education has a vitally important role in fostering
information literacies that will support learning.

Again, this is a paper I could quote bits from all day – so here are a couple of paragraphs from towards the end that summarises their (and my) take on the digital natives:

Neither dismissive scepticism nor uncritical advocacy enable understanding of whether
the phenomenon of digital natives is significant and in what ways education might need
to change to accommodate it. As we have discussed in this paper, research is beginning
to expose arguments about digital natives to critical enquiry, but much more needs to be
done. Close scrutiny of the assumptions underlying the digital natives notion reveals
avenues of inquiry that will inform the debate. Such understanding and evidence are
necessary precursors to change.

The claim that there is a distinctive new generation of students in possession of sophisticated
technology skills and with learning preferences for which education is not
equipped to support has excited much recent attention. Proponents arguing that education
must change dramatically to cater for the needs of these digital natives have
sparked an academic form of a ‘moral panic’ using extreme arguments that have lacked
empirical evidence.

Finally, after posting the prior summary of Kirschner and deBruckyne’s paper, I searched hashtag #digitalnatives on Twitter and – self-promotingly – replied to some of the original tweeters with a link to the paper (interestingly quite a few #digitalnatives tweets were links to discussions of the Kirschner/deBruckyne paper) Some were very receptive, but others were markedly defensive. Obviously a total stranger coming along and pedantically pointing out your hashtag is about something that doesn’t exist may not be the most polite way of interacting on twitter – but also quite a lot of us are quite attached to the myth of the digital native

“The myths of the digital native and the multitasker”

One common rhetorical device heard in technology circles – including eHealth circles – is the idea that those born after 1980, or maybe 1984, or maybe 1993, or maybe 2000, or maybe 2010 (you get the picture) are “digital natives” – everyone else is “digital immigrant” In the current edition of Teaching and Teacher Education, Kirschner and de Bruyckere have an excellent paper on this myth, and the related myth of multitasking.

The “highlights” of the paper (I am not sure if these are selected by the authors or by the editors – UPDATE: see comment by Paul Kirschner below!) are pretty to the point:

Highlights

Information-savvy digital natives do not exist.

Learners cannot multitask; they task switch which negatively impacts learning.

Educational design assuming these myths hinders rather than helps learning.

The full article is via subscription/library online, and this recent post on the blog of Nature discusses this paper and others on this myth. This is Kirschner and de Bruyckere’s abstract:

Current discussions about educational policy and practice are often embedded in a mind-set that considers students who were born in an age of omnipresent digital media to be fundamentally different from previous generations of students. These students have been labelled digital natives and have been ascribed the ability to cognitively process multiple sources of information simultaneously (i.e., they can multitask). As a result of this thinking, they are seen by teachers, educational administrators, politicians/policy makers, and the media to require an educational approach radically different from that of previous generations. This article presents scientific evidence showing that there is no such thing as a digital native who is information-skilled simply because (s)he has never known a world that was not digital. It then proceeds to present evidence that one of the alleged abilities of students in this generation, the ability to multitask, does not exist and that designing education that assumes the presence of this ability hinders rather than helps learning. The article concludes by elaborating on possible implications of this for education/educational policy.

The paper is one of those trenchantly entertaining ones academia throws up every so often. For instance here the authors are on the origins of the “digital native” terminology (and “homo zappiens”, a new one on me):

A

ccording to Prensky (2001), who coined the term, digital natives
constitute an ever-growing group of children, adolescents,
and nowadays young adults (i.e., those born after 1984; the official
beginning of this generation) who have been immersed in digital
technologies all their lives. The mere fact that they have been
exposed to these digital technologies has, according to him,
endowed this growing group with specific and even unique characteristics
that make its members completely different from those
growing up in previous generations. The name given to those born
before 1984 – the year that the 8-bit video game saw the light of
day, though others use 1980 – is digital immigrant. Digital natives
are assumed to have sophisticated technical digital skills and
learning preferences for which traditional education is unprepared
and unfit. Prensky coined the term, not based upon extensive
research into this generation and/or the careful study of those
belonging to it, but rather upon a rationalisation of phenomena and
behaviours that he had observed. In his own words, he saw children
“surrounded by and using computers, videogames, digital music
players, video cams, cell phones, and all the other toys and tools of
the digital age” (2001, p.1). Based only upon these observations, he
assumed that these children understood what they were doing,
were using their devices effectively and efficiently, and based upon
this that it would be good to design education that allows them to
do this. Prensky was not alone in this. Veen and Vrakking (2006),
for example, went a step further coining the catchy name homo
zappi€ens to refer to a new breed of learners that has developed e
without either help from or instruction by others e those metacognitive
skills necessary for enquiry-based learning, discovery based
learning, networked learning, experiential learning, collaborative
learning, active learning, self-organisation and self regulation,
problem solving, and making their own implicit (i.e.,
tacit) and explicit knowledge explicit to others.

The saw that children are invariably more tech savvy then their parents is also a myth:

Looking at pupils younger than university students, the largescale
EU Kids Online report (Livingstone, Haddon, Gorzig, € &
Olafsson, 2011 ), placed the term ‘digital native’ in first place on
its list of the ten biggest myths about young people and technology.
They state: “Children knowing more than their parents has been
136 P.A. Kirschner, P. De Bruyckere / Teaching and Teacher Education 67 (2017) 135e142
exaggerated … Talk of digital natives obscures children’s need for
support in developing digital skills” and that “… only one in five
[children studied] used a file-sharing site or created a pet/avatar
and half that number wrote a blog … While social networking
makes it easier to upload content, most children use the internet for
ready-made, mass produced content” (p. 42). While the concept of
the digital native explicitly and/or implicitly assumes that the
current generation of children is highly digitally literate, it is then
rather strange to note that many curricula in many countries on
many continents (e.g., North America, Europe) see information and
technology literacy as 21st century skills that are core curriculum
goals at the end of the educational process and that need to be
acquired.

Two more recent studies show that the supposed digital divide
is a myth in itself. A study carried out by Romero, Guitert, Sangra,
and Bullen (2013) found that it was, in fact, older students (>30
years and thus born before 1984) who exhibited the characteristics
attributed to digital natives more than their younger counterparts.
In their research, 58% of their students were older than 30 years
who “show the characteristics of this [Net Generation profile]
claimed by the literature because, on analysing their habits, they
can be labelled as ICT users more than digital immigrants” (p. 176).
In a study on whether digital natives are more ‘technology savvy’
than their middle school science teachers, Wang, Hsu, Campbell,
Coster, and Longhurst (2014) conclude that this is not the case.

The authors are not arguing that curricula and teaching methods do not need to change and evolve, but that the myth of the digital native should not be the reason for doing so:

Finally, this non-existence of digital natives makes clear that one
should be wary about claims to change education because this
generation of young people is fundamentally different from previous
generations of learners in how they learn/can learn because
of their media usage (De Bruyckere, Hulshof, & Kirschner, 2015).
The claim of the existence of a generation of digital natives, thus,
cannot be used as either a motive or an excuse to implement
pedagogies such as enquiry-based learning, discovery-based
learning, networked learning, experiential learning, collaborative
learning, active learning, self-organisation and self-regulation or
problem solving as Veen and Vrakking (2006) argued. This does not
mean education should neither evolve nor change, but rather that
proposed changes should be evidence informed both in the reasons
for the change and the proposed changes themselves, something
P.A. Kirschner, P. De Bruyckere / Teaching and Teacher Education 67 (2017) 135e142 137
that ‘digital natives’ is not.
The non-existence of digital natives is definitely not the ‘reason’
why students today are disinterested at and even ‘alienated’ by
school. This lack of interest and alienation may be the case, but the
causes stem from quite different things such as the fact that
diminished concentration and the loss of the ability to ignore
irrelevant stimuli may be attributed to constant task switching
between different devices (Loh & Kanai, 2016; Ophir, Nass, &
Wagner, 2009; Sampasa-Kanyinga & Lewis, 2015). This, however,
is the topic of a different article.

The paper also deals with multi-tasking. Firstly they examine the nature of attention. “Multi-tasking” is an impossibility from this point of view, unless the tasks are automatic behaviours. They cite a range of research which, unsurprisingly enough, link heavy social media usage (especially with the user instantly replying to stimuli) with poorer educational outcomes:

Ophir et al. (2009) in a study in which university students who
identified themselves as proficient multitaskers were asked to
concentrate on rectangular stimuli of one colour on a computer
monitor and ignore irrelevant stimuli entering their screen of a
different colour observed that
heavy media multitaskers are more susceptible to interference
from irrelevant environmental stimuli and from irrelevant
representations in memory. This led to the surprising result that
heavy media multitaskers performed worse on a test of taskswitching
ability, likely because of reduced ability to filter out
interference from the irrelevant task set (p. 15583).
Ophir et al. (2009) concluded that faced with of distractors,
heavy multitaskers were slower in detecting changes in visual
patterns, were more susceptible to false recollections of the distractors
during a memory task, and were slower in task-switching.
Heavy multitaskers were less able than light/occasional multitaskers
to volitionally restrain their attention only to task relevant
information.

The authors specifically warn caution about the drive that students bring their own device to school.

Why is this paper so important? As the authors show (and the author of the Nature blog post linked to above also observes) this is not a new finding. There are many pieces out there, both academic and journalistic, on the myth of the digital native. This paper specifically locates the dicussion in education and in teacher training (they say much also on the issue of supposedly “digital native” teachers) and is a trenchant warning on the magical thinking that has grown up around technology.

There are obvious parallels with health and technology. The messianic, evangelical approach to healthtech is replete with its own assumptions about digital natives, and magical thinking about how easily they navigate online worlds. Using a handful of social medial tools or apps with visual interactive systems does not translate into a deep knowledge of the online world, or indeed a wisdom about it (or anything else)

Information underload – Mike Caulfied on the limits of #Watson, #AI and #BigData

From Mike Caufield, a piece that reminds me of the adage Garbage In, Garbage Out:

For many years, the underlying thesis of the tech world has been that there is too much information and therefore we need technology to surface the best information. In the mid 2000s, that technology was pitched as Web 2.0. Nowadays, the solution is supposedly AI.

I’m increasingly convinced, however, that our problem is not information overload but information underload. We suffer not because there is just too much good information out there to process, but because most information out there is low quality slapdash takes on low quality research, endlessly pinging around the spin-o-sphere.

Take, for instance, the latest news on Watson. Watson, you might remember, was IBM’s former AI-based Jeopardy winner that was going to go from “Who is David McCullough?” to curing cancer.

So how has this worked out? Four years later, Watson has yet to treat a patient. It’s hit a roadblock with some changes in backend records systems. And most importantly, it can’t figure out how to treat cancer because we don’t currently have enough good information on how to treat cancer:

“IBM spun a story about how Watson could improve cancer treatment that was superficially plausible – there are thousands of research papers published every year and no doctor can read them all,” said David Howard, a faculty member in the Department of Health Policy and Management at Emory University, via email. “However, the problem is not that there is too much information, but rather there is too little. Only a handful of published articles are high-quality, randomized trials. In many cases, oncologists have to choose between drugs that have never been directly compared in a randomized trial.”
This is not just the case with cancer, of course. You’ve heard about the reproducibility crisis, right? Most published research findings are false. And they are false for a number of reasons, but primary reasons include that there are no incentives for researchers to check the research, that data is not shared, and that publications aren’t particularly interested in publishing boring findings. The push to commercialize university research has also corrupted expertise, putting a thumb on the scale for anything universities can license or monetize.

In other words, there’s not enough information out there, and what’s out there is generally worse than it should be.

You can find this pattern in less dramatic areas as well — in fact, almost any place that you’re told big data and analytics will save us. Take Netflix as an example. Endless thinkpieces have been written about the Netflix matching algorithm, but for many years that algorithm could only match you with the equivalent of the films in the Walmart bargain bin, because Netflix had a matching algorithm but nothing worth watching. (Are you starting to see the pattern here?)

In this case at least, the story has a happy ending. Since Netflix is a business and needs to survive, they decided not to pour the majority of their money into newer algorithms to better match people with the version of Big Momma’s House they would hate the least. Instead, they poured their money into making and obtaining things people actually wanted to watch, and as a result Netflix is actually useful now. But if you stick with Netflix or Amazon Prime today it’s more likely because you are hooked on something they created than that you are sold on the strength of their recommendation engine.

Let’s belabor the point: let’s talk about Big Data in education. It’s easy to pick on MOOCs, but remember that the big value proposition of MOOCs was that with millions of students we would finally spot patterns that would allow us to supercharge learning. Recommendation engines would parse these patterns, and… well, what? Do we have a bunch of superb educational content just waiting in the wings that I don’t know about? Do we even have decent educational research that can conclusively direct people to solutions? If the world of cancer research is compromised, the world of educational research is a control group wasteland.

#OceanOptimism, powerlessness, hope, and change.

The current BBC Wildlife Magazine has a fascinating article by Elin Kelsey, of the Ocean Optimism Project, on how media-fuelled environmental despair and nihilism ends up demoralising people to the degree that positive action seems impossible. She cites much research on the “finite pool of worry” and the paralysing effect of despair, and the power optimism to reverse this trend. The article isn’t available online, but in the post below from my other blog I highlight relevant passages from a Kelsey piece in Smithsonian Magazine on similar themes.

This article is obviously focused on ecology, but is all too true of our healthcare systems. For similar reasons to those Kelsey ascribes to environmentalists who are wary of being overly focused on good news, frontline workers in the health service naturally tend to focus on what is wrong, what is proving impossible, what needs to change. This is necessary, but can become an overwhelming counsel of nihilism, fostering cynicism and very often helping to entrench negative practices.

This is very relevant to the various themes on valuesmorale, “blame culture”, and possibility of positive change within not only the HSE but any healthcare organisation.

Séamus Sweeney

The current issue of BBC Wildlife Magazinehas a fascinating cover story by Elin Kelseyon hope and optimism versus despair in how we think about they environment. Essentially, much media discourse on the environment tends to be gloomy, doom, and generally despairing. Kelsey cites a wide range of research on how this negativity effects how we think about the environment and our beliefs about what can be done – and therefore what is done – to improve things. The full article is not available online. This article from Smithsonian Magazine is briefer, but captures her idea:

Things are far more resilient than I ever imagined. Me, green sea turtles, coral reefs blown to bits by atomic bombs. In a twist of fate that even surprised scientists, Bikini Atoll, site of one of the world’s biggest nuclear explosions, is now a scuba diver’s paradise. Bikini Atoll located in the Pacific’s…

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Stephen Westaby, “community focus”, and medical education

Not so long ago, surgery and (internal) medicine were the pinnacles of medical school, the final subjects before graduation. Surgery in particular possessed a dark, elitist glamour, its notoriously long hours and intensity attracting rather than repelling many. Of course, being attracted by a perceived mystique is different from having a sustainable career (and life)

In recent years, medical curricula have been reshaped by many factors, including the realisation that most doctors will practice not as surgeons but as general practitioners, and that the bulk of healthcare need is perhaps more mundane than what goes on in the operating theatre. While there is justice to this “community orientation” of medical education, there is also a certain sense of taking the surgeons and physicians down a peg or twenty. Perhaps there is also a certain anti-intellectualism at work – focusing on the behavioural acts that a doctor performs, rather than the academic disciplines (which include clinical disciplines)

Recently I have been reading Simon Westaby’s memoir of his surgical career, Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table. Indeed, the above paragraphs are taken from a first draft of my review (both paragraphs cut for reasons of space and general narrative flow of the review). Westaby’s book is a good read (there, that’s the review bit out of the way) and full of exciting surgical action, described deftly but dramatically. It is also something of an elegy for a certain time of medical and surgical training – an era of overwork and monomaniacal dedication, but also one of intellectual and moral curiosity and rigour, often absent from a modern practice subservient to bureaucratic imperatives. I have already blogged about Westaby’s thoughts (and research) on the impact of league tables on surgical practice. I do wonder whether, for all its manifold faults, “traditional” medical education created a breed of doctor with an espirit de corps to whom a resistance to bureaucratic imperatives came easier?

 

 

Friendship and Work in Medicine and Healthcare

In 2001, Digby Anderson wrote a short book, Losing Friends, about what he described as the decline of friendship. This New York Times “At Lunch With” pieces ummarises his argument:

”All past civilizations have declined, and Western civilization is about due to go,” he said, gamely piling his plate with assorted meats and salads. ”The death of friendship is one symptom of that.”

He says he believes political extremism has rendered friends powerless to help one another. Liberals’ insistence on equal opportunity and impartiality, he said, has led to ”egalitarian bureaucracy,” a muddling of what had once been smooth-flowing business networks based on friendships. Years ago, he said, friends happily helped one another find jobs; today they shy away, lest they be accused of favoritism.

”Even though it makes sense to hire a friend, or even a friend’s friend, there’s this feeling that you have to give everyone an equal chance,” he said.

The blow from the right, he said, has been a constant emphasis on the family as the ”repository of all virtues” — and, thus, the only institution worthy of trust and time.

”The ancient Greeks had a better idea: they considered their friends to actually be their family,” Dr. Anderson said.

My recollection of the reasons he gives in the book why “it makes sense to hire a friend, or even a friend’s friend”, is because of the special knowledge which friendship gives us about someone’s true nature. A friend – a true friend – is also less likely to screw over their friend… or at least thats the theory. I wonder how strong the evidence is for the counter argument, that hiring friends is somehow bad?

I am not sure how much I buy of Digby Anderson’s overall argument about hiring friends etc, but there is definitely something in his reflections on the decline of friendship.

The official blurb is also interesting:

“One loyal friend is worth 10,000 relatives”, said Euripides. Aristotle thought friendship the best thing in the world. Saint Augustine was devastated by the death of a friend, “All that we had done together was now a grim ordeal without him”. For men as different as Dr Johnson, Coleridge and Cardinal Newman friendship was a great, moral love. For Cicero it was a foundation of social order. For Burke “good men [must] cultivate friendships”. To try to lead a good life on one’s own is arrogant and dangerous. In past ages business thrived on the trust of friends; armies won battles on the loyalty of men to their comrades and people were attracted to and schooled in medicine, law and academe by friendship. This friendship of the past was high friendship, a friendship of pleasure but also of shared moral life.

LOSING FRIENDS contrasts this high friendship with the “pathetic affairs” which pass for friendship today. Friendship is in trouble. An institution once as important as the family, has been “diluted to mere recreation…passing an odd evening together…sharing the odd confidence”. It is being outsted from business through fear of cronyism and squeezed between the demands of work and the increasingly jealous family. Fathers neglect their obligations to their friends at the club or pub to bath their children. Many of us will have no friends in illness, in need or at our funerals. Bewildered letters to agony aunts ask how to make friends. Schools are absurdly introducing classes on how to do so. Our society has no public recognition of friendship and cannot even discuss it articulately. When it does it sentimentalizes it. Modern society is wealthy, healthy and long lived. Aristotle would ask what the point of such a life is if lived without friends.

I have (or had) a copy of the book somewhere. I read it in around 2004. The message did resonate, and since I have seen how social pressures that tend to squeeze out friendship intensity.

Healthcare in general, and medicine in particular, is on one level a fertile ground for friendship. One ends up spending a lot of time with other people engaged in what is  a highly intense, demanding role. It is natural enough for some strong bonds to form, as over the hurried coffees and lunches some small talk is exchanged. There has also been a boozy culture around medicine in the past at least, and while one could make many observations on the role of alcohol as a form of self-medication, there was a social side to all this.

And yet the structure of medical training in particular is not conducive to longer term friendships. One spends three, or six, or at most twelve months in a post as a trainee  doctor. The intense friendships of one rotation are suddenly severed. With the best will in the world, and my sense is the unreal interactions of social media have exacerbated rather than ameliorated this, it is hard to keep up. And when one completes training, the camaraderie of the res room is something that is closed to you.

The factors that Dr Anderson discusses – the suspicion of anything that might hint of favouritism, the dulling bureaucratic managerial discourse of healthcare management, a sort of idolatory of the family now as much a left as right wing feature – are present in medicine too.

How does friendship relate to the issues of morale and a healthy work culture I have blogged about before? The importance of “psychological safety” in team interactions is emphasised in Google’s Project Aristotle as key to successful team interactions. Fostering a sense that teams can communicate openly, without fear of recrimination or embarrassment, sounds to me very much like fostering friendship. Of course, perhaps this is falling into some kind of trap where friendship can be subservient to the interests of an organisation, and indeed denigrating friendship as something that needs to be justified in pragmatic, utilitarian terms.

Hickam’s Dictum

While researching the medical saying “When you hear hoofbeats, think of horses not zebras”, I came across Hickam’s dictum – “patients can have as many illnesses as they damn well please.”

It is described as a counter-saying to Occam’s Razor, which has always struck as a a heuristic saying which has been misused many times to suggest that the “simplest” explanation MUST be true. Occam’s Razor can be a valuable tool for cognitive discipline, but it is NOT a normative statement about The Way The World Is

Hickam’s Dictum was a new one on me, but has a reasonable presence in the medical literature. And it is very far from an abstract notion.

There is a whole world of medical sayings and proverbs (a lot of which are new ones on me) out there. On the one hand, they represent a sort of hidden curriculum of heuristic tools. On the other hand, how influential are they really? As I said, I have never come across Hickam’s dictum before – but I think I will end up quoting it quite a bit.