Saturday, January 28, 2017

Ideas vs Innovation

Listen to the Ideas and Innovation Podcast - Mp3

Transcript
You've found the Med Student Learning Podcast. Welcome.

This podcast will focus on what seems like a generic topic the difference between ideas and innovations. But since our target audience is full of medically oriented folks who want to change things, this is a crucial difference. So let's get started.

Think of the process of making a change as 5 steps
  1. come up with an idea
  2. turn the idea into a innovation
  3. form the innovation into a project to capitalize on the idea/innovation
  4. develop, test and refine your intended creation,
  5. deploy it to the intended audience.
Step #1 Come up with an Idea: Well ideas come quickly and often. Some are complicated. As an example there is Elon Musk's superfast mini-train traveling in a near vacuum (the hyperloop). Some are simple (a new button color on the home page). But you can't turn an idea into a project or a product - much less deploy it to the target audience. Your audience won't adopt an idea. As an example, a fire needs a spark, but that's all a spark is; it isn't a fire.

Step #2 Turn the Idea into an Innovation: On the other hand creating an innovation is tricky. Let's use the hyperloop concept as our example. For the hyperloop to be an innovation it has to actually do something that prior transportation (like airplanes, trains, cars, and buses) doesn't do. Clearly a hyperloop in California has the potential to be an innovation. One in North Carolina, probably not. How do we figure it out?

Since the final step, (#5) involves the audience, we need consider the audience. At a minimum, innovations require that the audience: 1) recognizes the value and 2) has a need that the value will address. For the hyperloop, the innovation is that folks who travel frequently from LA to San Francisco frequently are frustrated with how long it takes and would love a solution that is faster. For the idea of a new button on the home page, readers of the home page want to learn about some cool new software or game or video, but they can't find it;

So if you are coming up with a new way to address medical student education don't focus on the idea -  that is your new technology, tool, or approach. Instead ask yourself, what are students struggling with,  how can my idea address the problem AND most importantly, will they see my technology, tool, or approach as a solution to their problem? In order words, not just do they need it, but will they want it?

Even better, ask yourself if they desire it?

And once you've convinced yourself you have an innovation not just an idea you can proceed to the see if you can convince someone else. That is key for advancing to Step #3, Creating a project. And the subject of a future podcast.

Bye for now. Keep coming up with ideas on how we can improve medical student learning. But don't forget to turn them into true innovations....


Written and Produced by Brad Tanner, All Rights Reserved
Sound Credit: Escape by soLid Xciter

Thursday, January 26, 2017

What does "Normal Science" look like?

Kuhn's Normal Science concept described slow steady progress WITHIN an existing paradigm. Since this is where we live 99% of the time this aspect is key to understand.
The process is basically:
  1. come up with an idea: 
  2. turn the idea into a innovation: 
  3. form the innovation into a project that can seek support/funding to capitalize on the idea/innovation
  4. develop a idea/project/solution/product,
  5. test the result to establish value
  6. deploy/sell it to the audience.
For an example, look at gamification of interactive online learning. Imagine a gamified online education solution working its way through this process.
And then failing in the market. Why? 
The existing paradigm (lectures, standardized patients, systems approach) doesn't really have a role for interactive online learning (more specifically online stuff that isn't webinars, uploaded files and bboards). So "dressing it up" isn't going to change that. Any curriculum, even a gamified one must be purchased and although a new type of apple may be more tasty, in this case the educators have said that they don't want apples (i.e., educational interventions that they did not create).
  • BTW, that still doesn't mean that gamification is a good idea, just that within the current paradigm it isn't going to be successful.
Buy why don't students demand this new approach? 
The issue is that the job hasn't changed. Students have the job of passing courses and educators have the job of getting them to pass. In both of their minds they are doing the job just fine. After all, students were accepted to health/medical training and educators have a money earning job and a career they are proud of. 
How will gamification of online curricula improve that? 
Gamification and online training are challenging the paradigm. And they aren't attractive or effective enough to succeed.
Take home message: In Normal Science: Incremental change is incremental. Don't expect a revolution or substantial change unless what you have is amazing and someone else can see it.

Wednesday, January 18, 2017

Scientific Revolution and Medical Student Training

Successful Entrepreneurship and Paradigm Shift. Kind of like bread and butter. So it makes sense to hearken back to the creation of the concept before jumping on the overused "Paradigm Shift" bandwagon. Thus I started with a read of:
First off, readers will note that the word paradigm is not in the title and the title uses the rather boring word "Structure." So to start let's look at how "revolutions" [in a scientific sense, not social] occur in a vast oversimplification of this very dense book.
  1. existing paradigm - how we explain things
  2. normal science - the greater process by which we use the paradigm to investigate and explore
  3. puzzle-solving - the acts that normal science engages in
  4. anomaly - the "hmm" moment. Something is not right!
  5. crisis - the "oh no" moment where it's clear that this train won't get us where we want to go
  6. revolution - the battle between old and new and the conflict that ensues as slowly the old (both in terms of concept as well as often in terms of age) gives into the new
  7. new paradigm - the resolution that the old is gone and new paradigm has taken its place
  8. we start again -> with step #2
Although paradigm shift is trendy, it's actually more useful to follow Kuhn's "structure" and see change as a logical mostly slow process rather than some meteorite smashing into the earth, killing off species, and watching new ones take their place.

He focused on physics especially Newton vs. Einstein. I'd prefer to focus on medical education. Historically we could look at the Flexner Report as an clear example. Schools closed and it seemed that most everything changed. More recently we have the conversion from disciplines (anatomy, histology) to systems (cardiac, neurological) or perhaps the rise of PBL - Problem Based Learning and more exploratory learning via standardized patients. And cool anatomy tables have really neat graphics.

I would argue that sadly these don't make it as potential revolutions and haven't really created a new paradigm. What would a revolution look like? Take for example young people staring that their phones rather than actually talking to people (say their parents during dinner). That seems like a revolution. You aren't expected to talk to people directly, you talk to them via a software agent. I know lots of old people who have reluctantly converted to texting and emailing and using technology to connect with young people. That change involved a lot struggle and conflict (anomaly -> crisis) but eventually it was accepted. No, the changes in medical training haven't made the educators equally uncomfortable.

Normal science (of medical education) is teaching us that there is too much to learn now. And that students don't want to memorize. Solving the puzzle of how to train students efficiently is getting more and tricky as we add in the need to treat them like humans, accept their failings, yet ensure they are are competent. 

But I would argue we haven't hit an anomaly stage yet. For that to occur evidence that the system (not the individual) is failing must occur. And when it becomes clear that this is the norm then we will have a crisis which will demand a revolution in student training and new concept of what "medical student education" is - a new paradigm and thus a "shift". Unless the goal is to get people to attend a conference on the changes in medical education, using the term "paradigm shift" for medical education ignores what Kuhn had to say about the topic.

Predicting the future is often foolish but Star Trek did a decent job 50 years ago (and George Orwell 30 odd years, if you look at repressive regimes) so here goes
  1. The standard 4 years, broken up into 2 "pre-clinical", "clinical" and "the 4th year" [while you are waiting to get into residency] is dead. Some folks will need more basic science, others less. Graduation is based on skills demonstration [per #4] not time spent.
  2. Recognition that the human component of medicine is the part that the machines (e.g. Watson) can't do. Picking out the right drug for a set of symptoms and a given history is task designed for big data and deep learning. Why teach it and why learn it?
  3. The end of the "Primary Care" doctor. The movement to specialists, sub specialists and super sub specialists is well on the way. Increased complexity and the rise of machine decision making will eliminate generalists and that aspect of training. Future scope of practice will become more and more limited (as seen now in surgery vs. non-surgery).
  4. Training will be delivered via online learning in the form of exploratory games that simulate medical decision making and intervention, probably in Virtual Reality and with multiple users from multiple disciplines "playing." Yes, the lecture, the lecture hall, standardized patients, written tests, and even PBL will be gone. Perhaps one can do non-patient learning outside the medical school.
Then we have a new paradigm that normal heath education science can explore and use to solve problems ... until the next anomaly shows up that implies ensuing crisis and ... revolution!

Learning Communities for Online Curricula

Zhao1 noted that "participating in a learning community is positively linked to engagement as well as student self-reported outcomes and overall satisfaction with college". In the application of learning communities to medical student training, a review in 2009 of 18 of 124 school identified the following goals2
  • fostering communication
  • promoting caring, trust, and teamwork;
  • helping students establish support networks for academics and social reasons. 
Learning communities in medical education are becoming more and more common. A survey in 2014 in which 126 of medical schools 151 responded3, found that 66 schools (52.4%) had learning communities. Almost half of the remaining schools were considering them.

The specific question I want to address is for those interested in replacing offline curricula with non-moderated online curricula:
  • How does one best implement an online learning community within an online curriculum where there is no identified teacher or director? 
Leaving aside the issue of fostering communication between two such parties, all of the other goals above are not specifically dependent on a course administrator. Just as players in a multi-player game can support each other, an online training experience can potentially provide a peer to peer learning community.

The challenge is not what technology to choose from (messaging, bboards, blogs, wikis, etc) but how to implement this aspect to aid efficiency and target deficiency in the online training. Assuming the training is well designed it is should offer challenge, reflection, motivation and feedback. Thus these not be the target of peer to peer interaction. A well done online multi-user simulation can potentially address teamwork [as seen in games such League of Legends and even CS Go] including communication and trust as well as leadership. That leaves an academic and social support network building tool.

Here, an online solution may actually be preferable. Online interactions can more easily be 24/7 and matched to the individual (age/gender/professional background/special concerns, etc). Well designed training will identified "accomplished" individuals who are qualified to provide academic support. And if necessary they can provide training in providing support (e.g., motivational interviewing, coaching).

In sum, adding learning community concept to quality online training is logical but should first follow more comprehensive development of the online training to ensure it includes challenge, reflection, motivation, feedback, and teamwork opportunity. The community can then be established to provide academic support from successful participants and social support from peers.
  1. Zhao Chun-Mei|Kuh. Adding Value: Learning Communities and Student Engagement. Research in Higher Education. 2004;45(2):115-138. doi:10.1023/B:RIHE.0000015692.88534.de.
  2. Ferguson Kristi J, Wolter Ellen M, Yarbrough Donald B, Carline Jan D, Krupat Edward. Defining and Describing Medical Learning Communities: Results of a National Survey. Acad Med. 2009;84(11):1549-1556. doi:10.1097/ACM.0b013e3181bf5183.
  3. Smith Sunny, Shochet Robert, Keeley Meg, Fleming Amy, Moynahan Kevin. The Growth of Learning Communities in Undergraduate Medical Education. Acad Med. 2014;89(6):928-933. doi:10.1097/ACM.0000000000000239.