Transcript 4th National CPD ConferenceCPD in an Information Age

4th National CPD Conference
CPD in an Information Age
Rachel Ellaway Ph.D.
Assistant Dean and Associate Professor, NOSM
Disclosure statement
I have no involvement with industry or
any other entity that constitutes a
conflict of interest to disclose with
respect to this presentation.
Overview
An information age
What is needed is changing
What is wanted is changing
What is provided is changing
How it is provided is changing
Who provides it is changing
Impact and evaluation is changing
The context is changing
We are changing
Objective
Participants will be perplexed, scared and exultant
in equal measure
Participants will want to rip everything up and start
again
Participants will realise that they are already doing
pretty well
Participants will be able to situate CPD in this
information age …
“the future is already here it’s just not evenly distributed”
William Gibson
Everyware
Internet transforms:
• Ambient and exponential connectivity
• Accelerating speed of action and response
• A reach that defeats geography and
temporality
• Remediation of social conventions hiding, blurring and flattening
• Detailed tracking that changes
accountability, privacy
Virtual Society?
1. The uptake and use of the technologies
depend crucially on local social context.
2. The fears and risks associated with new
technologies are unevenly socially
distributed.
3. Virtual technologies supplement rather
than substitute for real activities.
4. The more virtual the more real.
5. The more global the more local.
Woolgar, Steve (Ed.) Virtual society? Technology, cyberbole, reality. Oxford: Oxford University
Press, 2002.
A Digital Age?
• Organizational change: e-health, elearning, e-research and e-administration
• The digital is not just instrumentation;
external to us and separate from our
identities and values
• We weave the digital into most if not all
aspects of our lives
• The digital weaves itself around us …
• … it becomes a part of us
• … and we a part of it
What is needed is changing
All change
Many areas, but particularly:
• Digital literacy
• e-health
• e-learning and e-teaching
• Digital professionalism
• Limits to training
Digital literacy
• We are currently training the last
generation of physicians who can
remember a time before the Internet
• Do you exist if you’re not online?
• Reappraising medical practice in the
context of a digital society
• Digital literacy a core challenge for CPD
e-health skills
• We are currently training the first generation
of physicians to practice in an e-health world
• e-health investment tends to focus on big
technology rather than humans
• Danger of operator training only
• Underlying need for safety and competence
in an e-health practice environment
• But not clearly identified
• What role CPD?
e-learning and e-teaching
• e-learning (what learners do)
vs
• e-teaching (what teachers do)
• Teaching skills in a post-LMS age
• Example: learners learning with technology
at the bedside
• Digital learners as digital teachers
• Education informatics skills
• What role CPD?
Public and Private
• Social networking tools lay much of our
lives open to public view
• We fluidly, perhaps uncritically, intertwine
our online personas with those of others
• Particular challenges for professionals
• What boundaries remain (if any) between
professional and personal lives
• There is a vacuum of guidance for
professionals in the digital world
Digital Professionalism
Digital Professionalism
• We used to punish poor
communication skills or
professionalism even though we had
never taught it
• We like to think we are enlightened
• Should we not model, assist and
guide professional digital
professionalism?
DP#1
1
• Establish and sustain an on online
professional presence that befits your
responsibilities while representing your
interests … but be selective where you
establish a profile
DP#2
• Your professional identity extends into all
online communities you join, and you are
still a professional there
2
DP#3
3
• Do not make public anything that you
would not be comfortable defending as
professionally appropriate in a court of law
or in front of a disciplinary panel
DP#4
4
• Think carefully and critically about how
what you say or do will be perceived by
and reflect on others, including individuals
and organizations.
DP#5
5
• Almost everything online can be
monitored, recorded or data mined by
multiple groups. Treat every online action
as permanent.
DP# 6
• Do not impersonate or seek to hide your
identity for malicious or unprofessional
purposes.
6
DP# 7
7
• Be aware of the potential for digital attack
or impersonation. Know how to protect
your reputation and what steps to take
when it is under attack.
DP# 8
• Theft and piracy are not acceptable for
any professionals. Work within the law.
8
DP# 9
9
• Patient information = patient
• Do not expose information to unnecessary
risk and consider wisely the potential
impact of any use or exchange of
information you make
DP# 10
0
• Behave professionally and respectfully in
all venues and using all media
• Take responsibility for modeling positive
digital professionalism to others.
• What role Canadian CPD?
Limits to training
• Training is essential – improves competence
• Training is effective at reducing mistakes
• … but not slips (inattention) and lapses
(memory failure)
• We need to accommodate other dimensions
of CPD …
• Human factors
Human Factors
•
Innovations usually do what they are
supposed to do, but often with latent
consequences that can manifest in
unexpected ways
• “human error is not a cause of failure but it
ends up being a symptom of failure” Scerbo, 2012
• CPD needs to consider increasing
awareness and capacity to deal with human
factors issues
• Tied directly to quality improvement:
– mechanism <> outcome <> context
Needs are still emerging
• Social media
• e-research and e-scholarship
• Platform woes have not gone away:
– Was Win vs Mac now IOS vs Android
• Are you asking the right needs assessment
questions?
• Do your respondents know what to ask for?
• Do you need CPD to orient your learners to
their new needs?
What is wanted is changing
Net Generation
CC image: x-ray delta one http://www.flickr.com/photos/x-ray_delta_one/4999806047/
Net Generation
•
•
•
•
•
•
Digital Immigrants and Natives, NetGen etc
Mostly spin
Youth have ++opportunity but low risk
Confidence >> competence
1:1:1
Medical learners very atypical of the broader
population
• Not just a med student issue
• Junior doctors are becoming more senior
• Expectations are changing across the board
Expectations
•
•
•
•
•
•
•
•
•
Low tolerance for poor usability or design
On demand
Ambient
Set down and pick up again
Adaptable
Point of care
Social
Integrated
Experience – convenience - presence
Experience and
convenience
• Convenience economies:
– Ease of use and adaptability the main drivers
– Collaborative peer-peer consumption
– CPD follows organic peer-peer interactions?
• Experience economies
–
–
–
–
–
‘User’ experiences become valorized
Not just the content but the whole experience
‘Authentic’ and exclusive experiences
CPD in unusual but transformative locations?
CPD involving unusual but transformative
activities?
Economies of presence
• Rather than a retreat to the virtual we value
personal and f2f more and more
• Although digital forms are often more
convenient, inconvenience also has value:
• “discussion about our digital future always
assumes we seek more convenience and
fewer obligations. But technologies of
connectivity can threaten stability and
community. We may need a new ethics of
inconvenience”
• Sometimes you really have to be there
Davies, W. (2006). "Digital exuberance." Prospect (119): pp30-33.
Value networks
• Christensen: problem solvers, fixed
service providers, value networks
• Social media is based around value
networks:
– Congregating with your peers
– Convenience, return on effort
• Growth of VNs – CHEC-CESC
• CPD value networks more effective and
sustainable than shopping lists?
Christensen, C, Grossman, J H and Hwang, J (2008). The Innovator's
Prescription: A Disruptive Solution for Health Care. New York, NY, McGraw-Hill.
The Long Tail
Facebook
everyone
else
the
successful
few
Migrant eLearners
• Learners (including the CPD audience) are
often not where you think they are
• Self organizing, supporting, exchange,
creation – but NOT in the institution!
• Social technologies as extensions of
ourselves – gestalt, hive minds, collectives
• Binding and norming
• What is the role of the CPD provider?
• Where do the new CPD consumers go?
• Do they want you there?
Cyborgs
“our tools are not just external
props and aids, but they are deep
and integral parts of the problemsolving systems we now identify
as human intelligence …”
Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5
Cyborgs
“… such tools are best conceived
as proper parts of the
computational apparatus that
constitutes our minds”
Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5
The Cyborg Professional
• information technologies are cognitive
prosthetics
• both professional and profession are
changed
• Communication prosthesis
• Logistical prosthesis
• Knowledge prosthesis
• Social prosthesis
What is provided is changing
From content to activity
• Combination of improved instructional
design and use of technology
• Better understanding of cognitive
behaviours and capabilities
• Beyond content to activity design –
simulation and active learning
• Recognition that availability of information
≠ learning
• Activity design the new challenge
Blended and hybrid CPD
• Many ways of being blended:
– Co-present participants combine online and
offline activities
– Learners are co-present and remote
– Teachers are co-present and remote
• Hybrid when learning is combined with
other activities
– Bursts and microlearning – point of care
Blended learning
f2f
Blended learning
F
S
F
C
S
F
F
S
C
C
S
C
It works best when mixed
• Mearns et al 2009 – e-learning works and
it works best in blended settings
Means, B, Toyama, Y,
Murphy, R, Bakia, M and
Jones, K (2009).
Evaluation of EvidenceBased Practices in
Online Learning: A
Meta-Analysis and
Review of Online
Learning Studies.
Washington DC, U.S.
Department of Education
Provision is changing
Authority …
Authority …
•
•
•
•
•
•
•
Democratization or erosion?
Andrew Keen and Jimmy Wales
Challenges to authority, expertise
Yet crowdsourcing works
Wikipedia works (ish)
How do we do crowdsourced CPD?
Whither expertise and authority in CPD in
an information age?
App economies
• Closed platforms:
– Device
– Environment
– Access to software
• Relationship with the App provider
dominates
• Yet, tablets and smartphones are seen as
personal and personalisable learning
platforms – much more than laptops
• Where does your CPD fit best …
Who provides CPD?
• YouTube – CliniSnips videos
• Millions of views, rich analytics and
feedback but no CME points
• Medical Schools and agencies are
reprising what they and others do
• Balloon debate
• Curriculum and credentialing
• Should CPD concentrate on what it does
best and what only it can do?
Adoption
• Are we too late?
• What’s everyone else doing?
• Can we ever catch up?
How adoption works
Rogers, E.M. (1995). Diffusion of Innovations. New York, USA, The Free Press.
Gartner Hype Cycle
Fenn, J. and Linden, A. (2005). Gartner's Hype Cycle Special Report for 2005, Gartner
Impact and evaluation is changing
Analytics
• Many providers but Google Analytics
dominates
• Data on: users/visitors – where they are, what tools
they are using, where they were before, where they
went to next, which pages visited, how long on a
page
•
•
•
•
Dashboards and real-time reporting
Site optimization and other responses
Analytics tell you what people did
Analytics don’t tell you why they did it
CliniSnips NG Tube
CliniSnips NG Tube
CliniSnips NG Tube
CliniSnips NG Tube
Educational analytics
• Educational data – learner profiles and
trajectories, benchmarks and program
requirements, individual and group patterns
• Activity data – who did what when
• Use for individual learner support and
guidance
• Use to improve tutor awareness of learners’
activity
• Use for program reporting and planning
• How much use do you make of analytics?
And the context is changing
Change is the new stability
DON’T
PANIC
Physicians will have to be smarter …
“physicians will have to be smarter
than ever, and they will have to keep
learning throughout their careers at
accelerating and demanding pace …”
Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New
Information Age. Piscataway, NJ, Rutgers University Press
Physicians will have to be smarter …
“… no matter how smart they are, they
will need a lot of help from organized
systems of care - whether real or virtual
– that keep physicians supplied with
the most advanced usable information
on healthcare diagnoses and treatments
…”
Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New
Information Age. Piscataway, NJ, Rutgers University Press
Physicians will have to be smarter …
“… they will have to be trained to
adapt continually to a changing
informational environment and a
changing health care system”
Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New
Information Age. Piscataway, NJ, Rutgers University Press
Technology directs
“the hold of technologies on us is their
power to channel our attention to those
aspects of reality they were designed
to influence and portray; they are
directive”
Reiser, S. J. (2009). Technological Medicine: the Changing World of Doctors and Patients.
New York, Cambridge University Press.p187
Technology changes us
“technological innovation cannot and
should not be regarded merely as an
improved means to a pre-selected end,
because, while some technology
merely modifies, other technology
transforms”
Graham, G. (1999). The Internet://a philosophical enquiry, Routledge. p168)
CPD in an Information Age
• Future gazing always looks foolish
• Really it is about now, not next
• “the future is already here; it’s just not
evenly distributed”
• Where you position CPD, the skills, tools
and techniques used and its place in an
Information age is up to you
“those who do not learn from
the future are destined to make
mistakes in it”
Warren Miller, 1997
Warren Miller, New Yorker, October 20, 1997 - http://www.condenaststore.com/-sp/Those-who-do-not-learn-from-thefuture-are-destined-to-make-mistakes-in-i-New-Yorker-Cartoon-Prints_i8543217_.htm