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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“Development is always going to destabilize a fragile balance of social forces.”

Via the work of John Adams, I have had some familiarity with the Douglas-Wildavsky Cultural Theory of Risk. Like this reviewer, I find the Douglas/Wildavksy treatment of environmentalism rather crude, while their overall cultural typology of risk stimulating. As the reviewer points out:

Most readers will be struck not by the abstract theory but by its application
to the rise of environmentalism. This emphasis is unfortunate. The
attempt to “explain” environmentalism makes a few good points, but on
the whole this part of the book is crude, shortsighted, and snide.3 On the
other hand, the sections that consider the relationship between risk and
culture on a more fundamental level are sensitive and thoughtful.
Even at its best, Risk and Culture is not entirely successful at explaining
the paradox of risk-the problem of managing the unknown-but
parts of the book deserve to be read seriously by people interested in the
problem of risk, including environmental lawyers.

 

9781446254677

I am now reading Mary Douglas directly, in currently her Culture and Crises.: Understanding Risk and Resolution  Although she has a prose style that sometimes grates, and I am wary of possibly being unaware of technical anthropological issues that may be taken-for-granted, there is much to enjoy and think about.

Here is a brief quote from one essay – Traditional Culture, Let’s Here No More About It, which follows a passage about the occasional pitting against each other of development and “traditional culture” (usually, under western eyes, to the detriment of traditional culture):

Development is always going to destabilise a fragile balance of social forces. The people are understandably reluctant to do the gruelling hard work and accept the diversion of resources if the resulting prosperity will only line the pockets of outsiders. Furthermore, if it going to erode the community’s accumulated store of trust, and dissolve their traditional readiness to collaborate, the well-being of the community may be worse after development than before. There certainly is inherent ambiguity about the moral case. At least we can say that what stops development is not cultural traditionalism so much as the way it arrives, how it is organised.

This applies – in spades – to the many many “cultural change” / “transformation” etc projects that health services become the subject of. The suspicion that sacrifice and hard work on the part of staff will benefit only a narrow few (the Minister getting good headlines, various outside consultancies, higher management) surely underlies some at least of the cynicism about such projects that is undoubtedly prevalent.

 

“actual clinic services with real doctors”

Again, from MobiHealthNews:

A new kind of doctor’s office opened in San Francisco this week: Forward, a membership-based healthcare startup founded by former Googler Adrian Aoun that infuses a brick-and-mortar office with data-driven technology and artificial intelligence.

For $149 per month, Forward members can come to the flagship office that features six examination rooms – equipped with interactive personalized displays – and doctors from some of the Bay Area’s top medical systems. Members are given wearable sensors that work with Forward’s proprietary AI for proactive monitoring that can alert members and their doctors of any abnormalities as well as capture, store and analyze data to develop personalized treatment plans. Members also have 24-7 mobile access to their data, rounding out what Aoun believes is a new type of preventative care.

What is interesting about this piece is that there are various other start-ups whose vision is not based on telemedicine or on “empowering consumers”, but on what is at its core the traditional surgery office except with much slicker tech. It is also interesting that Forward’s approach is based on a personal experience:

The impetus for Forward came from a personal experience of Aoun’s. When one of his close relatives had a heart attack, he found himself sitting in the ICU and realizing healthcare wasn’t quite what he thought it was. Seeing doctors having to obtain health records from multiple sources and wait days or weeks for test results and suffering from all-around communication breakdowns within their health system, he was inspired to create an alternative model – one focused on prevention, efficiency and connected tools to create a increasingly smart healthcare plans based on each individual’s needs and goals.

I took the title of this post from what I found a rather amusing aside in a later paragraph:

It also isn’t the first company to offer a hybrid of physical and digital services. In September 2016, startup Carbon Health opened its first clinic, also in San Francisco, that offers actual clinic services with real doctors

“actual clinic services with real doctors”! – sounds truly revolutionary – and quite a difference from the techno-utopian slant of the Financial Times piece I blogged about earlier in the week. At times readers may detect a certain weariness with the hype that surrounds digital health, the overuse of “revolutionary” and “transformative” and so on, the goes-without-saying presumption that healthcare is bloated and inefficient while tech is gleaming and slick and frictionless.  This is far from saying that healthcare doesn’t need change, and can’t learn from other fields – I look forward to hearing more about Forward.

“evolved strategy”: Online CBT provider Joyable lays off 20, shifts focus from direct-to-consumer to employers, providers

From MobiHealthNews:

“We let a number of talented people and friends go this week,” CEO Peter Shalek said in an emailed statement. “We did this in order to refocus our efforts on partnering with employers, insurers, and providers to increase access to evidence-based mental health care and to reduce costs. We are positioned financially to pursue this new strategy over the next several years. We’ve built a product known for having the best engagement and outcomes of any mental health-focused digital therapeutic, and we believe that our evolved strategy will allow us to reach and help the most people.”

In an interview, Shalek clarified that Joyable’s direct-to-consumer offering, an online cognitive behavioral therapy (CBT) and coaching program for social anxiety, isn’t going away completely: people currently using it will still be able to use it and new sign-ups will still be supported. But the company won’t put any more resources into developing or marketing the direct-to-consumer offering, and most of the staff involved in marketing and support for that product specifically were let go.

Shalek said that the company had always planned to go in this direction anyway and that, while they reached a lot of people, they recognized that the best way to move the needle meaningfully on social anxiety would be to help more people, which the company could accomplish by targeting populations that don’t need to pay for the service directly (the company charges individuals $23 per week for a 12-week course after a seven-day free trial).

With Joyable’s platform, first users are paired with a coach who has been trained in CBT techniques. Before starting the program, users are invited to speak to the coach for 30 minutes on a phone call about how social anxiety affects them and what they want to get out of the program. After that, the program helps consumers identify and understand their social anxiety triggers. Users must complete activities such as challenging anxious thoughts with evidence and developing alternative thoughts that are more helpful. Each activity takes around 10 minutes to complete.

From there, Joyable teaches users techniques to reduce their anxiety by putting themselves in anxious situations and working on applying the skills they learned. The coach supports the user throughout the program through text and email, and the user can also reach out for help whenever they want. The program is available online, and can also be accessed from smartphones and tablets.

One does wonder how much of Shalek’s statement on “evolved strategy” and the assurance “we always intended to go this direction anyway” masks a certain realisation that many online mental health providers are coming to: that, for all the hype and optimistic rhetoric about empowering “consumers”, ultimately engaging providers is a necessity for these technologies to actually reach the potential users who could benefit most.

Financial Times: How smartphones are transforming healthcare

This piece from last weekend’s FT magazine naturally caught my eye. It is rather techno-trumphalist narrative, with a few paragraphs of caveats on data privacy and lack of regulation in this area.However, the first and last quotations are from the CEO of Babylon an “artificially intelligent medical adviser” – the last words being:

But although we will continue to seek out physicians, it will not necessarily be because of their superior clinical skills. “If what you need is to solve a specific clinical problem, a diagnosis, then we can diagnose you better, faster, cheaper than a human doctor can,” Parsa says, with a wry smile. “Five years from now, technologically I do not believe you will have any need to see a human doctor for diagnosis… there is no scientific reason”

He would say that, wouldn’t he?

I’ve written before on the (much superior) Nature piece on “The Wild West of Health” care and have dashed off a few lines to the FT magazine on the lack of mention of the importance of clinical engagement. The piece is worth reading however, my allergy to mention of “transforming” and “revolutionising” healthcare

 

Risk and innovation: reflections post #IrishMed tweetchat on Innovation in Health Care:

riskgame

Last night there was an #Irishmed  tweetchat on Innovation and Healthcare . For those unfamiliar with this format, for an hour (from 10 pm Irish time) there is a co-ordinated tweet chat curated by Dr Liam Farrell and various guest. Every ten minutes or so a new theme/topic is introduced. There’s a little background here to last night’s chat. The themes were:

 

T1 – What does the term ‘Innovation in healthcare’ mean to you?

T2- What are the main challenges faced by healthcare organisations to be innovative and how do we overcome them?

T3 -What role does IT play in the innovation process?

T4 – How can innovations in health technology empower patients to own manage their own care?

T5 – How can we encourage collaboration to ensure innovation across specialties & care settings?

I’ve blogged before about some of my social media ambivalence, especially discussing complex issue. However I was favourably impressed – again – by the quality of discussion and a willingness to recognise nuance and complexity. The themes which tended to emerge were the importance of prioritising the person at the heart of healthcare, and  that innovation in healthcare should not be for its own sake but for improving outcomes and quality of care.

One aspect I ended up tweeting about myself was the issue of risk. In the innovation world, “risk-averse” is an insult. We can see this in the wider culture, with terms like “disruptive” becoming almost entirely positive, and a change in the public rhetoric around failure (whether this is actually leading to a deeper culture change is another question). In healthcare, for understandable reasons, risk is not something one simply tolerates blithely. It seems to me rather easy to decry this as an organisational failing – would you go to a hospital that wasn’t “risk-averse?” The other side of this is that pretending an organisation is innovative if it has very little risk tolerance is absurd. Innovation involves the unknown and the unknown inherently involves risk and unintended consequences . You can’t have innovation in a rigorously planned, predictable way, in healthcare or anywhere else.

I don’t have time to write about this in much detail, but it does strike me that this issue of risk and risk tolerance is key to this issue. It is easy to talk broadly about “culture” but in the end we are dealing not only with systems, but with individuals within that system with different views and experiences of risk. I have in the past found the writings of John Adams and the Douglas-Wildavsky  model of risk helpful in this regard (disclaimer: I am not endorsing all of the above authors views) and perhaps will return to this topic over the coming weeks. Find below an image of a “risk thermostat”: one of Adams’ ideas is that individuals and systems have a certain level of risk tolerance and reducing risk exposure in one area may lead to more risky behaviour in another (his example is drivers driving carefully by speed traps/black spot signs and more recklessly elsewhere)

risktherm.