Marcus Aurelius: reflection good enough for an emperor but is it good enough for medicine?

Sati Heer-Stavert very kindly asked my permission to link to the paper I wrote a while back on Marcus Aurelius, stoicism and reflective practice – here is the post that has resulted which I am very impressed by! Certainly Sati has provided an excellent framework to prompt students and learners to reflect on what reflection means and what the obstacles to it are….

UNEXAMINED MEDICINE

Reflection is an important part of training, appraisal and revalidation for doctors based in the UK. However, for many doctors the very thought of reflection can cause feelings of frustration, non-engagement or even rejection. Where did we go wrong?

Learning objectives

1. Consider the definition of reflection used in medicine

2. Understand how reflection can be assessed

3. Encourage you to read Meditations by Marcus Aurelius

Oh no! A patient has complained about your refusal to supply antibiotics for a cold. Wow! This would make a really good entry in your learning portfolio:

“That men of a certain type should behave as they do is inevitable. To wish it otherwise were to wish the fig-tree would not yield its juice. In any case, remember that in a very little while both you and he will be dead, and your very names will quickly be forgotten.”

You have to respond to…

View original post 885 more words

Advertisements

Presentation by Pedro de Bruyckere: Urban Myths about Learning and Technology

An excellent presentation by Pedro De Bruyckere, co author of the recent paper on the myth of the digital native I blogged about before… “I believe in education, I believe in teachers… but do I believe in technology in education? It depends”

Obviously these are slides which can’t compete with the real thing and clearly Pedro de Bruyckere has a rich sense of humour!

From experience to meaning...

This is the presentation I gave at the National ResearchED conference, September 9 2017. The presentation is in part based on our book Urban Myths about Learning and Education and in part based on the recent article I co-wrote with Paul Kirschner published in Teaching and Teacher Education (yes the one that was mentioned in Nature).

View original post

“a tendency to overhype fixes that later turn out to be complete turkeys”

An interesting passage on the contemporary dynamics of the quick fix, from “The Slow Fix: Solve Problems, Work Smarter and Live Better in a Fast World” by Carl Honore:

“The media add fuel to that fire. When anything goes wrong – in politics, business, a celebrity relationship – journalists pounce, dissecting the crisis with glee and demanding an instant remedy. When golfer Tiger Woods was outed as a serial philanderer, he vanished from the public eye for three months before finally breaking his silence to issue a mea culpa and announce he was in therapy for sex addiction. How did the media react to being made to wait that long? With fury and indignation. The worst sin for a public figure on the ropes is to fail to serve up an instant exit strategy.

“That impatience fuels a tendency to overhype fixes that later turn out to be complete turkeys. An engineer by training, Marco Petruzzi worked as a globetrotting management consultant for 15 years before abandoning the corporate world to build better schools for the poor in the United States. We will meet him again later in the book, but for now consider his attack on our culture of hot air. ‘In the past, hard-working entrepreneurs developed amazing stuff over time, and they did it, they didn’t just talk about it, they did it,’ he says. ‘We live in a world now where talk is cheap and bold ideas can create massive wealth without ever having to deliver. There are multi-billionaires out there who never did anything but capture the investment cycle and the spin cycle at the right moment, which just reinforces a culture where people don’t want to put in the time and effort to come up with real and lasting solutions to problems. Because if they play their cards right, and don’t worry about the future, they can get instant financial returns’

The curse of the quick fix

I’ve been reading Simon Garfield’s wonderful book Timekeepers: How The World Became Obsessed With Time. It is a fascinating set of narratives on the modern relationship with time. Towards the end, it slightly turns into a series of lists of conceptual art pieces that sound less Deeply Meaningful than Garfield makes out (oddly reminiscent of Evgeny Morozov’s To Solve Everything Click Here in this regard) and occasionally some of his more jokey passages grate, but most of the time (ho ho) it is a book that makes one see the taken-for-granted of the modern world for what it is. There are very funny passages on time management self-help books and on the world of haut horologie, and extremely thought-provoking ones on our time-poor age (or is it a perception? One of the time management gurus is actually wisest on this…)

Anyway a passage which struck me as especially germane to medicine, health care in general, and health IT in particular was the following – which is actually Garfield citing another author, but there you go:

And can any of these books really help us in these decisions? Can even the most cogently aligned bullet point and quadrant matrix transform a hard-wired mind? The notion of saving four hours every ten minutes is challenged by The Slow Fix: Why Quick Fixes Don’t Work by Carl Honoré. The book set its tone with an epigram from Othello: ‘How poor are they who have not patience! What wound did ever heal but by degrees?’6

The quick fix has its place, Honoré argues – the Heimlich manoeuvre, the duct tape and cardboard solution from Houston that gets the astronauts home in Apollo 13 – but the temporal management of one’s life is not one of them. He reasons that too much of our world runs on unrealistic ambitions and shabby behaviour: a bikini body within a fortnight, a TED talk that will change the world, the football manager sacked after two months of bad results. [<a href=”https://www.ted.com/talks/carl_honore_praises_slowness”>Honoré himself has nevertheless done a TED Talk – SS]

He cites examples of rushed and dismal failings from manufacturing (Toyota’s failure to deal with a problem with a proper solution that might have prevented the recall of 10 million cars) and from war and diplomacy (military involvement in Iraq). And then there is medicine and healthcare, and the mistaken belief – held too often by the media and initially the Bill and Melinda Gates foundation – that a magic bullet could cure the big diseases if only we worked faster and smarter and pumped in more cash. Honoré mentions malaria, and the vague but quaint story of a phalanx of IT wizards showing up at the Geneva headquarters of the World Health Organisation with a mission to eradicate malaria and other tropical diseases. When he visited he found the offices somewhat at odds with those of Palo Alto (ceiling fans and grey filing cabinets, no one on a Segway). ‘The tech guys arrived with their laptops and said, “Give us the data and the maps and we’ll fix this for you.”’ Honoré quotes one long-term WHO researcher, Pierre Boucher, saying. ‘And I just thought, “Will you now?” Tropical diseases are an immensely complex problem . . . Eventually they left and we never heard from them again.’”

As my own practice has developed over the years, I have come to a realisation that quick fixes tend to unfix themselves over time, and the quick fix mentality carries a huge cost over time.

Here is Honoré’s TED Talk. Garfield has a very entertaining passage in the book where he talks at a rival of TED’s, which has a 17 minute limit (TED has an 18 minute one)

#Grief on a #Booterstown plaque: “A particularly bright, holy and gifted child” – the life and losses of Richard Robert #Madden

Richard Robert Madden was one of those polymathic doctors of the 19th Century whose medical career, as I observe in passing here, was almost incidental to a life packed with incident and scholarship (thought clearly some disputed aspects of the scholarship) Nevertheless, he evidently rose through the institutional ranks of medical memberships and fellowships – and became a “convert” to homeopathy to boot (at a time when, after all, “mainstream” medicine was not exactly evidence based itself)

For all these achievements, there is a keen poignancy to this plaque. I’ve read (must track down source) that the common contemporary belief that in previous centuries, because of high child mortality, parents did not have the same emotional reaction to the loss of a child than we do now is in fact a myth (I think it was in a rebuttal to one of the historians cited by
Neil Postman in his The Disappearance of Childhood)

Séamus Sweeney

wp-image-1723125758

In The Church of the Assumption, Booterstown, Dublin we find the above poignant plaque. Here is the text as the above turns out to be a little blurry:

MADDEN. Of your charity pray for the soul of
/Richard Robert Madden, M.D.
/formerly Colonial Secretary
/of Western Australia &c. “A man who loved his Country.”/
Author of “History of United Irishmen” and many other works.
/Remarkable for Talents Piety, and Rectitude, the 21st and last surviving son of/Edward Madden, born in Dublin August 20th 1798 died at Booterstown Feb 5th 1886
/and interred in Donnybrook Churchyard/
also for the soul of his relict Mrs Harriet T Madden, the 21st and last surviving child of
/John Elmslie Esq. Born in London August 4th 1801
/converted by a singular grace to the Catholic Faith in Cuba (circa) 1837
/died at Booterstown Feb 7th 1888/
A woman of rare culture, endowments and piety, a…

View original post 1,043 more words

#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

Helmholtz and the ophthalmoscope, Eurotimes, 2008

DBP_1994_1752_Hermann_von_Helmholtz.jpg
Recently I rediscovered some articles for Eurotimes, the European Journal of Cataract and Refractive Surgeons that I had forgotten I had written. I have posted here before some of my book reviews for Eurotimes. I also wrote some pieces on historical ophthalmological figures – the first on Goethe and his work in optics, the second on Hermann von Helmholtz who was one of those towering, foundational figures in modern physics but who also invented the ophthalmoscope

Figure

In the last article, I considered one of the towering geniuses of world culture, Johann Wolfgang von Goethe. Goethe made enormous contributions to world literature and philosophy, and significant contributions to the nascent sciences of visual perception, linguistics, plant morphology, and felt he would be remembered most of all for his work on optics. Goethe perhaps epitomises the “natural philosopher”, the original term for “scientist” – an individual of boundless curiosity and enthusiasm, a gifted amateur in the true sense. Science owes much to the activities of men and women who operated outside the dynamic of universities and in an age before the research institute or the grant.

Hermann Ludwig Ferdinand von Helmholtz (1821-1894) is a less towering cultural presence than Goethe. His scientific activities have had a more lasting influence. He bridges the worlds of “natural philosophy” and organised, university based science – both in terms of his lifespan (eleven when Goethe died, he lived to directly influence Einstein and Maxwell) and in his professional life (originally training under paternal pressure as a doctor, he was appointed Professor of Physics in Berlin in 1871). Much of his work attacked the speculative tendencies of the natural philosophers, and was grounded firmly in observation and experiment.

Yet such was the breadth of his activity that he reminds one of the multi-talented natural philosopher as much as a contemporary, specialised physicist or physiologist. The Oxford Companion to the History of Modern Science describes him in summary as “physiologist, physicist, philosopher and statesman of science.” This begins to capture the breadth and diversity of his interest and involvement. We will discuss his work on perception, and on ophthalmic optics, below, but it is important to recall he was simultaneously working on conservation of energy, thermodynamics, and electrodynamics, and developed the philosophy of science itself. His writings ranged from the age of the earth to the origin and fate of the solar system.

4141DJ1H1DL._SX340_BO1,204,203,200_

One of the more humbling characteristics of the scientists of the past was their seeming mastery of measurement. We are so used to highly accurate, precise computerised measuring apparatus that we can forget that until relatively recently, researchers often had to build and calibrate their own equipment. And going back only a little further, they had to invent it as well. Most readers of EuroTimes probably use one of Helmholtz’s inventions every day – the ophthalmoscope.

Invented in 1851, the ophthalmoscope is a perfect illustration of Helmholtz’s combination of experimental and inventive skill. The invention made him world famous overnight. Helmholtz was actually independently reinventing a device of Charles Babbage’s from 1847. As so often in science, it was the reinventor who recognised the usefulness and applicability of the invention, rather than the first inventor (Babbage, of course, also managed to invent but not complete the first computer) The handheld ophthalmoscope was developed by Greek ophthalmolosist Andreas Anagonstakis later in the 1850s, and in 1915 William Noah Allyn and Frederick Welch invented the self illuminating ophthalmoscope (and founded Welch Allyn) that is the direct precursor of the modern device.
Potsdam_Gymnasium_Hermann-von-Helmholtz-Gymnasium-seit-1991-S-8DJ-S_770_282961

Who was Helmholtz, this man of so many talents and interests and such lasting influence? Born in Potsdam on 31st August 1821 into a lower middle class family that emphasised the importance of education and cultural activities, his father Ferdinand was a teacher of philosophy and psychology in the local secondary school. His mother was a descendant of William Penn, the founder of Pennsylvania, and her maiden name was Penne. Ferdinand Helmholtz was also a close friend of the philosopher Fichte. The scientific and philosophical worlds of the nineteenth century often seem amazingly small and parochial.

50cd72123b5c8c5972a7a07f41b4b383--scientists

Helmholtz’s natural inclination as a student was to pursue studies in physics – however his father observed the financial support available for medical students and the lack thereof for physics students, and persuaded him into medical studies. He enrolled in the Friedrich-Wilhelms-Institut in Berlin, the Prussian military’s medical training college. After this, the served as a medical officer in the Prussian military for a time, simultaneously publishing articles on heat and muscle physiology. In 1847 he published his treatise On The Conservation of Force, which was the clearest and ultimately most influential account of what would become known as the principle of the conservation of energy. From his observations of muscles physiology and activity, he tried to demonstrate that there is no energy loss in muscle movement, and no “life force” is necessary to move a muscle.

In 1848 he left military service and embarked on an academic career. In 1849, he became an associate professor of physiology in Konigsberg.. Shortly after he announced the invention of the ophthalmoscope and also made another discovery that would seal his fame – measuring the rate of conduction of signals in nerves. It had been believed that sensory signals arrived at the brain instantaneously, and it was considered beyond the capabilities of experimental science to measure the rate of nerve conduction. Using a new invention, the chronograph, Helmholtz measured the difference between stimulus and reaction times at different parts of the body, and found the speed of neural conduction to be comparable to that of sound, not light.

A full account of all Helmholtz’s discoveries and scientific achievements would take volumes. He had an intense interest in visual perception, especially visual illusions. This interest was based on his philosophical position that we are separate from the world of objects, and isolated from external physical events, except for perceptual signals which, not unlike language, must be learned and read according to various assumptions. These assumptions may or may not be appropriate. This philosophy underlay many of his research activities and interests, and also his idea that perceptions are “unconscious inferences.”

Most of what goes on in the nervous system, according to Helmholtz, is not represented in consciousness. Psychological and physiological experimental findings often surprise us for this reason, because we cannot discover by introspection how we see or how we think. We derive a perception from incomplete data, hence “unconscious inference.” This idea influenced Freud’s idea of the unconscious, and Helmholtz’s student Wilhelm Wundt, who took Helmholtz’s work and ideas further. Another of his students, Heinrich Hertz, further developed Helmholtz’s work on energy and electrodynamics.
optics-timeline-1851-2000-4-638

Helmholtz had a huge impact on all areas of perceptual science, and many areas of physics. His name lives in a variety of laws and concepts (Helmholtz illusion, Helmholtz free energy, Helmholtz-Kelvin contaction) and that of an association of research institutes in Germany. And of course, for the humble working ophthalmologist, every day, almost without thinking, Helmholtz’s influence as the originator of the modern ophthalmoscope is literally palpable.