Circadian Rhythms video from Oxford Nuffield Sleep & Circadian Neuroscience Institute

From here

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The myth of digital natives and health IT 

I have a post on the CCIO website on the Digital Native myth and Health IT

The opening paragraph: 

We hear a lot about digital natives. They are related to the similarly much-mentioned millenials; possibly they are exactly the same people (although as I am going to argue that digital natives do not exist, perhaps millenials will also disappear in a puff of logic). Born after 1980, or maybe after 1984, or maybe after 1993, or maybe after 2007, or maybe after 2010, the digital native grew up with IT, or maybe grew up with the internet, or grew up with social media, or at any rate grew up with something that the prior generation – the “digital immigrants” (born a couple of years before the first cut off above, that’s where I am too) – didn’t.

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…

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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).

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“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

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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…

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