I was talking to a colleague in the last few days about digital competencies. He wondered if we should be exploring developing a set of competencies for medical students.
I started this blog more than 6 months ago as part of my learning journey on the use of web 2.0 (or whatever term you prefer) technologies and to meet other people who were on the same journey in medical education. I know that I could not yet say what the competencies needed for medicine are. I work with and know many good doctors providing good quality care and they do not blog, or use social networks, or collaborate online in wikis, or use rss feeds, or save or share links in social bookmarking tools. Would they be better doctors if they did?
And if I am not competent yet myself how could I decide that these, or others, are areas which students need to be competent in. How could I assess if they are competent?
Yesterday I was co-ordinating 3rd year exams assessing students skills in clinical examinations. Competency in clinical examination has been regarded as essential for doctors for many years. Maybe in the future it will be irrelevant. But for the moment we, as a profession, hold that it is important.
Will we ever have the same agreement about digital competency?
Thursday, April 30, 2009
Thursday, April 16, 2009
In praise of the walled garden (VLE)....
I have to start this by saying I am not a techy. I struggled a few nights ago to install MS Office on a netbook. But I am interested in how new technology can improve the way that we do things.
Back in 2004 I was invited to go on a Blackboard training session as there were plans that the medical school would use the VLE " increasingly to deliver course information and material". But when I went to the training session it wasn't this that got me excited but the discussion boards. I immediately thought that this would be a good way for me to communicate with and facilitate communication between 300 2nd year students undertaking a course I co-ordinated over 9 months. They were not even based in the same building as me. I've posted more about this here.
This year I used discussion boards, wikis and a course blog. Participation is voluntary. I don't assess contributions to the boards but students seem to find them a good way of accessing me and sharing with each other. The connections that they make through the discussion boards should help them to do better in the assessed written work.
So in my experience VLEs can work.
But many people do not like VLEs, or the way they are used or what they stand for (large, monollithic companies which I don't like either).
Martin Weller said the VLE is dead or dying back in 2007.Instead we will using "Loosely Coupled Teaching"... lots of different, freely available websites pulled together. Yes, that could mean lots of different log-ins and getting to grips with different websites but learning how to use wikis and discussion boards and blogs takes time no matter where they are, and tools such as openID, and facebook connect, might get past the log-in problems.
In 2009, Mike Bogle wrote about Distributed Online Learning Frameworks, now possibly including twitter, and was inspired by the experience of David M Silver.
But talk about moving away from VLEs is not just that they are big and cumbersome and slow, there is also a sense among many that it is the walled garden that is the problem. Access is restricted to those within the course within the institution. It is anti-edupunk and anti-connectivism. Mike Johnston thinks the VLE might be 'killing connections' for the institution's benefit.
But might there not be advantages to a walled garden? Can't students benefit from being able to talk and share in a private place where they can make a mistake and ask or say something stupid. We know the Cisco Fatty story. We're learning about digital identities. Is education in public really better? If institutions have any role in education might it not be the provision of a walled garden or safe space?
Tuesday, April 7, 2009
Emotional perspective taking
Last night my mum phoned to say that Traffic Cops was from Cardiff. Creepers break into houses and steal the keys of cars before stealing the cars. A car was found having rolled over on a road near where I used to work. The driver died. He couldn't be identified as his facial injuries were so severe, and a passenger abandined the car. A liaison office was called to break the news of the drivers death to the family. He called at the house of the owner of the car, to find that the house had been burgled and that the owner was alive and well.
I thought how awful it must be to find out that someone has died in your car, even if it not in any way your fault.
Next we were shown the owner of the car at the police station where he had gone with his father in the middle of the night to make a statement. He said that when he first heard that his car had been stolen and the driver had died in an accident he felt no sympathy. He thought to himself that it was what he deserved, after all he could have came up the stairs and clubbed him to death as these things happen.
I said out loud to my brother who was visiting that his response seemed to be the opposite of mine. My brother said 'maybe you empathise too much'.
So can we empathise too much? What does this mean? And in this case why were my feelings so different to the person who the event had actually happened to?
To read: Empathy Gaps in Emotional Perspective Taking
I thought how awful it must be to find out that someone has died in your car, even if it not in any way your fault.
Next we were shown the owner of the car at the police station where he had gone with his father in the middle of the night to make a statement. He said that when he first heard that his car had been stolen and the driver had died in an accident he felt no sympathy. He thought to himself that it was what he deserved, after all he could have came up the stairs and clubbed him to death as these things happen.
I said out loud to my brother who was visiting that his response seemed to be the opposite of mine. My brother said 'maybe you empathise too much'.
So can we empathise too much? What does this mean? And in this case why were my feelings so different to the person who the event had actually happened to?
To read: Empathy Gaps in Emotional Perspective Taking
Empathy, caring, emotion, communication and learning
Oh, a long time since my last post again. Yet, again I have many things going round in my head and holding my attention for variable lengths of time. It is a chaotic narrative an one which may disturb you if I share it in its entirety:) So instead I will mention some parts.
Today, I got news that a colleague and myself have won an ASME small grant to explore how students might learn from the patient's online voice. We're starting with students- what do they think they learn from reading patient narratives in forums and blogs and what do they think of this process. I wonder if reading the way that people talk to each other about health and illness online will help students develop empathy for patients.
There are a lot of questions around empathy that I would like to be able to answer:
So in my next few blog posts I will endeavour to discuss some interesting papers that I have come across in the last few months and I hope that we can discuss them together.
Today, I got news that a colleague and myself have won an ASME small grant to explore how students might learn from the patient's online voice. We're starting with students- what do they think they learn from reading patient narratives in forums and blogs and what do they think of this process. I wonder if reading the way that people talk to each other about health and illness online will help students develop empathy for patients.
There are a lot of questions around empathy that I would like to be able to answer:
- What is empathy?
- How is empathy different to sympathy?
- How do we feel what another is experiencing?
- Is empathy necessary to be a good doctor?
- Is too much empathy bad?
- Can we help students develop empathy? And should we?
- How do others know we feel empathy with them?
- Can we fool others into thinking that we feel empathy for them when we don't?
- Can we understand an experience we have not been through?
So in my next few blog posts I will endeavour to discuss some interesting papers that I have come across in the last few months and I hope that we can discuss them together.
Tuesday, March 17, 2009
My complex professional identities
We all have complex identities. I am a wife, a daughter, a sister, Irish, from Northern Ireland and more.
But I also have a complex professional identity with several different parts to my job. And sometimes when I come across a paper, a publication, a presentation or a conversation I am not sure which part of my identity is responding. For example, my friend presented about her use of audio-diaries as a method of collecting data for qualitative research this afternoon. I found myself responding to this as a practitioner of medical education, more than as a researcher. The different parts of my professional identity are also valued more or less by colleagues who have more singular identities.
Just some thoughts......
Saturday, February 21, 2009
Collaborative learning- some questions
This is a short post.
Why when we talk about collaborative learning do we usually refer to online activities rather than face-to-face small group work?
Why do students see the value of discussing a topic and learning from each other face to face much more than contributing to a wiki?
Why does everyone, including educators, find online collaboration hard?
Does the interaction that wikis produce actually facilitate learning?
Why do we worry so much about assessing online collaboration when we are happy for students to work in small groups in a tutorial without assessing relative contributions?
Doesn't the focus on assessment rubrics mean that we will make the students focus on external motivators for particpation rather than internal?
I have many more questions but it feels good to get these of my chest for now.
Why when we talk about collaborative learning do we usually refer to online activities rather than face-to-face small group work?
Why do students see the value of discussing a topic and learning from each other face to face much more than contributing to a wiki?
Why does everyone, including educators, find online collaboration hard?
Does the interaction that wikis produce actually facilitate learning?
Why do we worry so much about assessing online collaboration when we are happy for students to work in small groups in a tutorial without assessing relative contributions?
Doesn't the focus on assessment rubrics mean that we will make the students focus on external motivators for particpation rather than internal?
I have many more questions but it feels good to get these of my chest for now.
Thursday, February 19, 2009
Teaching Communication Skills
It's a month since I've last posted on my blog and I am not quite sure why. I've thought about many things and wanted to write about them but I kept thinking that I had to look something more up before I could put fingers to keyboard. And while I do think it would be wonderful if I did have the time to research everything I write and place it within a context, I also think it is good to just get on with sharing reflections on work.
So, I spent this afternoon teaching a 'breaking bad news' session to 3rd year medical students. Our course is undergarduate so these students are in their early 20s. The session is 3 hours long, with 5 students, me and 5 standardized patients(actors) who cycle through the rooms and are with us for about 15-20 minutes.
This is the third of 3 communication skills in 3rd year. I was stepping in for another tutor so had not met the students before and they had bonded quite a lot together as they had been on many placements together not just this class. They were even going out to a pub quiz together.
I want to tell about two of the scenarios we discussed. No. 2 patient/actor has to be told that his long-waited for operation had been cancelled due to emergency admissions. The student psyched herself up because she and the other students had heard on the grapevine that this scenario was particularly confrontational. The others joked that if any of them could cope with this angry man then she could. And so the metaphor of battle for this consultation was set, and it continued throughout. It really did feel that they were on two opposing sides rather than her being there to support the patient. I know from talking to these students that they care deeply about patients, but in this scenario the 'game' of sparring with this actor was too strong. It had been mythologised by previous students and there was little chance for this student to come to it with her own angle. It made me think (again) about who un-natural communication skills teaching can be. I was a bit shocked when I came across this book chapter yesterday.... our exams deconstructed! And I realised that our teaching sessions can be too predictable for students as well. When he had finished acting our actor told how his real-life wife has had an operation cancelled three times in the last month. On the second occasion she had got as far as changing into her gown when she got news it was off. But the news came from the surgeon who left the theatre and came down to sit beside her bed and apologise. It was this story which made the scenario seem real for the students and they thought that perhaps the wrong approach had been taken by their colleague initially. The example of the surgeon who sat alongside his patient, rather than on the other side of the battle lines made sense to them.
We were recovering from this encounter when our next actor/patient arrived. This involved a patient returning for the results of her chest x-ray. It showed an opacity and she was to be referred urgently for a CT scan and to a chest clinic for assessment. She had a high chance of having a lung cancer. I quickly checked with the student if she was prepared as she thought she was going to have another scenario. She made an aside comment about the patient probably going to start crying and I wondered if she was in the right place. I asked her again if she knew what she was going to say and she said yes. The actor/patient was rapping on the door so we moved on. It quickly emerged, to me,that the student after talking about 'shadows' on the scan and the fact that this could mean many things.... but possibly something 'serious', was not going to discuss the possibility of cancer with the patient.
I called time out and asked the student if this was the case. She said it was and said that if the patient asked she would tell them but not otherwise. I said that I didn't think this was the best approach, but the other students said that they thought she was right. It wasn't fair to burden the patient with the possible cancer diagnosis if she didn't want to know. And we had to presume that she didn't want to know if she didn't ask. So they resumed the consultation, and it finished without the patient ever knowing that she was being referred because she might have cancer.
Afterwards the student said that she thought it was the job of the chest clinic to inform her about the possible cancer diagnosis or the actual cancer diagnosis. At the time I was quite strident in my opinion that the patient should have been informed but the students were still not coming round. One did, but just the one.
The next scenario helped us as it was about a young woman presenting with a breast lump. This student mentioned the possibility of breast cancer within her first few sentences. The consultation ran smoothly. The actor shared in the feedback that she felt it was unfair to expect the patient to raise the possibility of cancer and that it was good to get it out in the open. She called it the elephant in the room. We all laughed and told her about our debate with the previous scenario. Some of the others now also started to agree that if the patient was being referred because of the risk of cancer then it was important that they should know and that it was not fair to leave the responsibility of asking to the patients. By the end of the afternoon they all seemed to agree on this.
I framed it in the context of 'informed consent'. Could the patient really give consent to the tests they were to undergo if they didn't know what they were actually checking for?
But I recieved today "The Logic of Care" by Annemarie Mols. I haven't read it yet but I wonder if I will be so sure that I am right when I finish. She compares the logic of choice, which she says is becoming dominant in western healthcare, with the logic of care. Were the students being more caring in wanting to give a woman who has a probable cancer diagnosis her last two weeks without having had cancer overtly referred to, than I with my thoughts of empowering the patient through information? I don't know.
So, I spent this afternoon teaching a 'breaking bad news' session to 3rd year medical students. Our course is undergarduate so these students are in their early 20s. The session is 3 hours long, with 5 students, me and 5 standardized patients(actors) who cycle through the rooms and are with us for about 15-20 minutes.
This is the third of 3 communication skills in 3rd year. I was stepping in for another tutor so had not met the students before and they had bonded quite a lot together as they had been on many placements together not just this class. They were even going out to a pub quiz together.
I want to tell about two of the scenarios we discussed. No. 2 patient/actor has to be told that his long-waited for operation had been cancelled due to emergency admissions. The student psyched herself up because she and the other students had heard on the grapevine that this scenario was particularly confrontational. The others joked that if any of them could cope with this angry man then she could. And so the metaphor of battle for this consultation was set, and it continued throughout. It really did feel that they were on two opposing sides rather than her being there to support the patient. I know from talking to these students that they care deeply about patients, but in this scenario the 'game' of sparring with this actor was too strong. It had been mythologised by previous students and there was little chance for this student to come to it with her own angle. It made me think (again) about who un-natural communication skills teaching can be. I was a bit shocked when I came across this book chapter yesterday.... our exams deconstructed! And I realised that our teaching sessions can be too predictable for students as well. When he had finished acting our actor told how his real-life wife has had an operation cancelled three times in the last month. On the second occasion she had got as far as changing into her gown when she got news it was off. But the news came from the surgeon who left the theatre and came down to sit beside her bed and apologise. It was this story which made the scenario seem real for the students and they thought that perhaps the wrong approach had been taken by their colleague initially. The example of the surgeon who sat alongside his patient, rather than on the other side of the battle lines made sense to them.
We were recovering from this encounter when our next actor/patient arrived. This involved a patient returning for the results of her chest x-ray. It showed an opacity and she was to be referred urgently for a CT scan and to a chest clinic for assessment. She had a high chance of having a lung cancer. I quickly checked with the student if she was prepared as she thought she was going to have another scenario. She made an aside comment about the patient probably going to start crying and I wondered if she was in the right place. I asked her again if she knew what she was going to say and she said yes. The actor/patient was rapping on the door so we moved on. It quickly emerged, to me,that the student after talking about 'shadows' on the scan and the fact that this could mean many things.... but possibly something 'serious', was not going to discuss the possibility of cancer with the patient.
I called time out and asked the student if this was the case. She said it was and said that if the patient asked she would tell them but not otherwise. I said that I didn't think this was the best approach, but the other students said that they thought she was right. It wasn't fair to burden the patient with the possible cancer diagnosis if she didn't want to know. And we had to presume that she didn't want to know if she didn't ask. So they resumed the consultation, and it finished without the patient ever knowing that she was being referred because she might have cancer.
Afterwards the student said that she thought it was the job of the chest clinic to inform her about the possible cancer diagnosis or the actual cancer diagnosis. At the time I was quite strident in my opinion that the patient should have been informed but the students were still not coming round. One did, but just the one.
The next scenario helped us as it was about a young woman presenting with a breast lump. This student mentioned the possibility of breast cancer within her first few sentences. The consultation ran smoothly. The actor shared in the feedback that she felt it was unfair to expect the patient to raise the possibility of cancer and that it was good to get it out in the open. She called it the elephant in the room. We all laughed and told her about our debate with the previous scenario. Some of the others now also started to agree that if the patient was being referred because of the risk of cancer then it was important that they should know and that it was not fair to leave the responsibility of asking to the patients. By the end of the afternoon they all seemed to agree on this.
I framed it in the context of 'informed consent'. Could the patient really give consent to the tests they were to undergo if they didn't know what they were actually checking for?
But I recieved today "The Logic of Care" by Annemarie Mols. I haven't read it yet but I wonder if I will be so sure that I am right when I finish. She compares the logic of choice, which she says is becoming dominant in western healthcare, with the logic of care. Were the students being more caring in wanting to give a woman who has a probable cancer diagnosis her last two weeks without having had cancer overtly referred to, than I with my thoughts of empowering the patient through information? I don't know.
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