The original purpose of this blog was as an entirely personal, reflective project. In the last few weeks (not that the blog has a history before this) it has become a forum for my reflections on events I have attended of a general medical innovation bent -the AMEE Hackathon and a CCIO meeting.  And now it is the turn of the inaugural Clinical Trials Methodology Symposium of the HRB’s brand new Trials Methodology Research Network. I only attended day 1 of this event which is a pity. The hashtag #trialsym15 is being used on Twitter so proceedings can be followed there. I won’t try and summarise proceedings here as it would be a little too much “he said… she said…” but give some reflective thoughts, especially following on from my prior posts.

As a full time clinician with an aspirational interest in research (ie a desire to take part in it that is often foiled) I find the concept of a network very appealing, and having an interest in conceptual issues in mental health and illness the methodology element is also fascinating.   It is rather invidious to select highlights; one was Sir Iain Chalmers , a founder of the Cochrane Collaboration (the logo of which incorporates a metaanalysis performed by an Irish doctor, Patricia Crowley ) who in a fascinating talk showed how, contrary to what is often taught, the randomised controlled trial did not emerge in 1948 from statistical theory but from a much longer history of clinical researchers engaging in fair trials of treatment.

Another was NUI Galway’s John Newell who gave the most engaging talk by a statistician I have ever heard

(his NUIG bio photo is also pleasingly Action Man-y)  john_newell

Newell gave a really honest and inspirational talk on translational statistics, and conveying statistical concepts to non-statistician audiences. I also learned about an egregious misuse of statistics by no less a moral authority than Fintan O’Toole … in a rather self-righteous article decrying the misuse of statistics. “The most entertaining talk I ever heard by a statistician” probably sounds like a set-up for a joke, but actually statisticians in my experience tend to be a wry lot. Newell’s talk really was the most entertaining talk I ever heard by a statistician.

I also enjoyed the total absence of the words “transform” or “revolutionise.” This was a particularly evident absence in Prof Craig Ramsay’s  witty, optimistic-yet-realistic presentation on  implementation science or knowledge transfer or (insert current description of this field here) . I had to pop out for a call towards the end (see the passing comment on not having time to do research above!) and, lurking at the door afterwards, was interested to hear him discuss developing research teams integrated into clinical settings. This chimed with some of my thoughts on the technology-health interface discussed towards the end of my Glasgow Hackathon post

The dynamic between technology and healthcare (and technology and education) is becoming one of the themes of these blog posts. My Glasgow experience made me wonder if the dynamic is, almost irretrievably, biased towards the tech being in the driving seat. I was more reassured by the CCIO meeting and even more impressed today by the amount of thought going into methodology by the likes of Prof Ramsay and the COMET Initiative .

Another highlight was Prof Peter Sandercock’s at times harrowing account of the travails of the International Stroke Trial and an illustration of the downside of social media and healthcare’s interaction. A questioner asked him about his current thoughts on pharma and drug trials. To paraphrase his reply, he said that he worried less about pharma influence, which is now highly scrutinised and regulated, than the medical device industry, which is not to anything like the same degree.

This got me thinking again about the deification of tech, or rather a certain kind of tech. Big Pharma is now a regular movie villain, whereas medical devices are Good Tech and therefore only criticised by fogeys. As it happened, during the day I came across a blog post by my  friend Phil Lawton  which, in dealing with the recent move of the Web Summit from Dublin, captured many of my own thoughts not only about the uncritical adoration of tech, but also about Dublin itself – especially as a Dublin native now happily domiciled a long long way away in Tipperary.

Thoughts on a Hackathon (Tribute)

I plan on continuing to use this blog mainly as an ongoing personal curation project, reviewing my prior medicine related writing and reflecting on my reaction to my former self’s writing. However, occasionally I may break cover and blog in a more “traditional” form.

I haven’t posted here in a few days, because I was in the wonderful city of Glasgow at the wonderful AMEE (Assocation for Medical Education in Europe) Hackathon. The official site of the hackathon is here  and it was organised by the wonderful Hack Partners 

I had a great time, and learned a lot. Here I have written a fairly reflective blog piece on the Hackathon, which contains a certain amount of rumination on the technology-health-education interface. None of this is intended as criticism of the Hackathon, AMEE, Elsevier or anyone else.

Yesterday evening I had (very little) time to kill between the end of the Hackathon and departing for the airport. It was a beautiful sunny evening by the Clyde (not a sentence one is used to reading) and I drafted some profound reflections for a blog post on the Hackathon. However, when I got to the airport and decided to write some more, the draft had disappeared. So this is an effort to replicate my thoughts.

The hackathon and me

I had come across the Hackathon via the AMEE mailing list, put my name forward listing my interest and being upfront about my lack of coding and upfront about my mix of enthusiasm and scepticism about technology’s role in healthcare (brief version: I’m enthusiastic about the positive changes technology can make to both, but sceptical of claims and promises of UTTER TRANSFORMATION BEYOND RECOGNITION)

There are a few disclaimers I should make about my personal Hackathon perspective, that perhaps disqualify me from being too dogmatic about the experience.
Firstly, I missed out on the all nighter element on the Saturday night. In my defence, at 36 with three children, a night’s sleep is one of the major attractions of a weekend away. For non-Hackathon reasons I had poor sleep the week leading up to Glasgow, and I had the option of staying in a hotel as family members were also around Glasgow. At 7 pm on Saturday I availed of the option to lie down for a couple of hours. 12 hours later, I awoke.

Secondly, I don’t use Facebook anymore, and it seems the Hackathon Facebook page was probably the best pre-Hackathon resource. As a neophyte Hackathoner, it would have been good to have done some networking prior and to have had a clearer idea about the structure (particular the pitches and team buildings)

Thirdly, for reasons I’ll discuss, I think our team was a little atypical of the Hackathon participants.

Fourthly, I don’t code, and possibly over the course of the Hackathon realised I’m not that much of a techie of any stripe. And while the Hackathon was welcoming to all, when it comes down to it the tech skills are the prized skills.

Pitching and team building

One aspect of the Hackathon was the initial pitch. I hadn’t intended to pitch, but at the last minute decided to talk about an idea I had a few years back – OSCEbuilder, essentially a way of automating much of the process of developing and running OSCE exams. It isn’t a very exciting idea, and it turned out that a) Dundee are using something like it anyway and b) a poster from NUI Galway at AMEE suggested that examiners actually take longer to examine with a tablet than the pen-and-paper. Not surprisingly, OSCEbuilder wasn’t very enticing to anyone much. I hadn’t even thought of it until five minutes before pitching, so I wasn’t exactly emotionally invested.

However in retrospect I do wish I had come up with a pitch prior to attending that I had some personal investment in – while it probably wouldn’t have been selected, it would have given me a starting point for involvement, rather than being to a certain degree passive in the process.
Anyhow, the pitchers than circulated around trying to get post-it notes from the other Hackathoners. The top 10 would become the nucleus of the team. This process slightly passed me by. In retrospect, I was overly self-conscious about not being able to code.

In ways our team ended up coalescing because none of us, except the original pitcher, had found a team before this. The pitchers idea was for “Ultrascan”, in brief a VR approach to training radiologists in ultrasound. The basic idea of simulation of ultrasound remained, but the focus shifted considerably from training radiologists to training healthcare workers in the developing world. In retrospect I think the technical challenge on our team was one of the most formidable (certainly in terms of getting a working demo in 24 hours) and this factor meant that the team was more about realising one team member’s vision rather than an overall team idea.

The best hackathon moment for me was the mentoring from Prof John Sandars of the University of Sheffield  . We had quickly discovered that someone was doing more or less exactly what the pitch said http://www.medaphor.com/ and were kicking around various ideas on the Saturday morning. John Sandars instilled in us a sense of mission and of hope, and brought to our attention the massive need that ultrasound can meet in the developing world. On Saturday I learnt massively about the lack of access to ultrasound in African nations especially, and the preventable maternal mortality that results. I made contact with Kirsten deStigter of Imaging the World and read about the massive strides her organisation has made in address this issue. I am grateful for her extremely gracious response and I am hoping to further my knowledge of this issue.

There is an inherent arrogance in imagining that in a bit over 24 hours we could manage to solve the problem, especially when so many talented people are working on it already. However this gave us a focus, a sense of social mission, and the impetus to put together a pitch.

The feedback from Alejandro and River from HackPartners was also amazing. They managed to combine realistic, even harsh appraisal with an enthusiasm and encouraging attitude. I realised how tricky this kind of mentoring is. The world of startups and Hackathons is one which blends giddy, nearly manic enthusiasm and ambition with the most hard-nosed, querulous realism. One minute we are encouraged to dream big, to throw around words like “transform” and “revolutionise”, the next we are being closely questioned on just what our business model is. The HackPartners mentors (and the other mentors) were highly skilled at managing this.

Technology and practice

It is nearly a cliche in discussing tech and health (and tech and education) that the technology shouldn’t determine the clinical / educational use, but the clinical (or educational) need should determine the technology approach. I myself have pontificated along these lines  (Before going on, in this section I will use “healthcare” to encompass both clinical and medical-educational needs, otherwise this will all get even more unwieldy)

It was therefore richly ironic when it was I who, on the Saturday morning, was contributing to the team discussion words to the effect “let’s just get something together, and then we can think of the healthcare application.”

In the end, Prof Sandars’ intervention saved us from that possibility. However, this dynamic – of technology determining the healthcare use – is interesting. I reflected later that perhaps there is something subtler going on, if I – whose entire approach to this field is based on the idea that the technology must follow the educational/clinical need, rather than vice verse – was drawn into this line of thinking. The dynamic may be more than just a planning failure to consider or involve clinicians or teachers or service users, but more inherent to the tech/healthcare interface.

I don’t have an answer, even a half formed one, as to what this dynamic actually involves. One train of thought I’ve had involves the possibility that in the encounter between the technologist and the clinician, the technology is concrete, “practical”, while the clinical problem (in the context of this encounter) is something abstracted. I don’t mean that healthcare problems are “abstract” themselves. What I mean is this – all concerned are sitting round a table, laptops at the ready, and at that moment the healthcare problem is something abstract and disembodied. The technological aspects of the challenge become the practical, concrete thing that needs to be done – the healthcare need is abstracted and can therefore be shunted around as the practical technological work is done. The setting is technology-heavy – the laptop is the working tool. The healthcare scenario is abstract, remote.

These are very preliminary thoughts. Essentially the dynamic is more subtle than I previously thought, and perhaps more deeply embedded than I thought. I hesitate to say “inherent”, although I do suspect the cultural valorisation of technology contributes as well.

Would a hackathon located directly in a clinic, or a ED, or coordinated with a beside tutorial or somewhere where healthcare is actually happening, have a different dynamic? Would involving clinicians/teachers with little interest in technology, or even an overt hostility, actually make for a more rigorous dialectic? Or does something else have to happen?

Do “quiet” ideas get shunted aside?

The pitch is clearly a vital part of startup culture. A good pitch requires good discipline, and a clarity of thought about the product or service. Certainly the successful pitches at #ameehacks were both entertaining and informative. It was pretty clear the judges valued a working demo very highly.

I do wonder if quieter ideas can get shunted aside in pitch culture. TED talks are in many ways wonderful, but I have always been concerned that presenters that make a slick show and give the audience what they want can trump more difficult, more genuinely challenging, more meaningful ideas.

There is a tendency for healthcare startups to promise to UTTERLY TRANSFORM HEALTHCARE and education startups to REVOLUTIONISE HOW WE LEARN and so on. The quieter, smaller solution (and perhaps the genuinely revolutionary one) gets lost.

Closing thoughts

I would love to see a Hackathon in my own clinical field, mental health, involving service users as equal participants. I would love to see community hackathons spread. I would love to see the positivity, friendliness and warmth that I witnessed in hackathon culture become a model for wider engagement in ideas and practices. I would love to see hackathons where the hacks were not necessarily technological.

I will think and read a bit more about the interplay between technical innovation and education/clinical practice before further blogging. Any suggestions for reading are warmly welcomed.