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, e-learning, 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

• Establish and sustain an on online professional presence that befits your responsibilities while representing your interests … but be selective where you establish a profile

1

DP#2

• Your professional identity extends into all online communities you join, and you are still a professional there

2

DP#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

3

DP#4

• Think carefully and critically about how what you say or do will be perceived by and reflect on others, including individuals and organizations.

4

DP#5

• Almost everything online can be monitored, recorded or data mined by multiple groups. Treat every online action as permanent.

5

DP# 6

• Do not impersonate or seek to hide your identity for malicious or unprofessional purposes.

6

DP# 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.

7

DP# 8

• Theft and piracy are not acceptable for any professionals. Work within the law.

8

DP# 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

9

DP# 10

• Behave professionally and respectfully in all venues and using all media

• Take responsibility for modeling positive digital professionalism to others.

• What role Canadian CPD?

0

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

the successful

few

everyone else

Facebook

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 problem-solving 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

self-paced

colla

bora

tive

Blended learning

F

S C

F

S C

F

S C

F

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 Evidence-Based 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’TPANIC

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

“… 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

Physicians will have to be smarter …

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-the-future-are-destined-to-make-mistakes-in-i-New-Yorker-Cartoon-Prints_i8543217_.htm