OpenPhysio abstract: Artificial intelligence in clinical practice – Implications for physiotherapy education

Here is the abstract of a paper I recently submitted to OpenPhysio, a new open-access journal with an emphasis on physiotherapy education.

About 200 years ago the invention of the steam engine ushered in an era of unprecedented development and growth in human social and economic systems, whereby human labour was supplanted by machines. The recent emergence of artificially intelligent machines has seen human cognitive capacity augmented by computational agents that are able to recognise previously hidden patterns within massive data sets. The characteristics of this second machine age are already influencing all aspects of society, creating the conditions for disruption to our social, economic, education, health, legal and moral systems, and which will likely to have a far greater impact on human progress than did the steam engine. As AI-based technology becomes increasingly embedded within devices, people and systems, the fundamental nature of clinical practice will evolve, resulting in a healthcare system requiring profound changes to physiotherapy education. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyse and interpret the complex interactions of data, patients and the newly-constituted care teams that will emerge. This paper describes some of the possible influences of AI-based technologies on physiotherapy practice, and the subsequent ways in which physiotherapy education will need to change in order to graduate professionals who are fit for practice in a 21st century health system.

Read the full paper at OpenPhysio (note that this article is still under review).

Is that it? More, better apps?

It seems that much of the literature on the use of technology in education focuses on apps (Instagram, WhatsApp), services and platforms (Google Docs, Facebook) and hardware (tablets, laptops and phones). This is fine, of course. We need to understand how students and teachers use these things in the classroom. But is this really what we mean when we talk about innovation in the classroom?

Consider the changes wrought in society and industry between 1900 and 1970 as a result of the invention and implementation of technologies related to the electrification of cities, national road and railway networks, sanitation, pharmaceuticals, the internal combustion engine, and mass communication (Gordon, 2017). These were the kinds of innovations that changed the lives of hundreds of millions of people in truly significant ways because they changed the physical structures around us. They changed the configuration of space, which determines the kinds of activities that are available in that space. But what counts as innovation today? More, better apps. I came across this quote attributed to Elon Musk (although I can’t find a good source to confirm): “Cellphones distract us from the fact that the subways are old”.

When we look at infrastructure we start to get a sense of what innovation really looks like, as well as the amount of effort it would take to change it in innovative ways. For example, deciding that cities and towns should have green spaces set aside for its citizens is by no means intuitive or inevitable. Town planners could just as easily have decided that that real estate could better serve commercial interests. And how would you go about changing those green spaces, maybe by installing safer playground equipment or rerouting a running track? The point is that infrastructure is old and because it’s old it naturally forms the baseline upon which other things are built. No parks in the city means no green space to enjoy being outdoors and if you want green space you’re going to have to do an enormous amount of work to get it. You can’t just build a new app.

We’re spending a lot of time looking at technology that may improve some superficial aspects of pedagogical work but we spend very little time on anything that would fundamentally change the underlying infrastructure. Maybe this is because we don’t even see the infrastructure anymore? It’s easier to focus on the superficial stuff that everyone can see. For example, there are 4650 studies looking at the use of Snapchat in the classroom at the time of writing but relatively few that question why we’re still in a classroom. With the desks screwed to the floor. Changing infrastructure is the hard work that no-one wants to do but it’s also the important work because that’s what everyone else builds on. We’ve been distracted into thinking that we’re innovating when we’re really just painting over the cracks in the walls.

Would we even recognise innovation in higher education, or would we disreguard it because it doesn’t fit the mental model of what we think it should look like? Maybe we could use this idea as an indicator of innovative work: If we recognise it, it’s probably not innovative. That’s not to say that we should break everything and innovate for it’s own sake. But let’s be clear about what innovation really means. It’s not the consumption of content in new formats. It’s not the use of laptops and tablets instead of books. It’s not the use of Twitter to share resources. These may be good, useful iterations of our practice but they’re not going to change the infrastructure of learning.

In five years time Snapchat will be gone and there’ll be a new #educationapp trending on Twitter, but the desks will still be screwed to the floor.

A critical pedagogy for online learning in physiotherapy education

Earlier this year the Critical Physiotherapy Network published Manipulating practices: A critical physiotherapy reader. The book is a collection of critical writing from a variety of authors dealing with a range of topics related to physiotherapy practice and education.  One of the interesting features of this collection is that it is completely open access, which means that the authors, and not the publishers, have the intellectual property rights to make choices about what is permissable to do with the content of the book. So we get to experiment with what it means to publish something in an academic context. While the entire book is available in different formats, including PDF, HTML, EPUB and XML, there is no audio version.

I’ve therefore taken the liberty of reading and recording my own contribution to the book, a chapter entitled A critical pedagogy for online learning in physiotherapy education, and making it available both here and as an In Beta podcast. I’m interested to know if this is something that might be useful so if you listen and appreciate having an audio version as an option, or even if you just think it’s a good idea (or a bad one), please let me know.

Abstract

In order to graduate physiotherapy students who are able to thrive in increasingly complex health systems, professional educators must move away from instrumental, positivist ideologies that disempower both students and lecturers. Certain forms of knowledge are presented as objective, value-free, and legitimate, while others – including the personal lives and experiences of students – are moved to the periphery and regarded as irrelevant for professional education. This has the effect of silencing students’ voices and sending the message that they are not in control of their own learning. While the integration of digital technology has been suggested as a means for developing transformative teaching and learning practices, it is more commonly used to control students through surveillance and measurement. This dominant use of technology does little more than increase the cost-effectiveness and efficiency of information delivery, while also reinforcing the rigid structures of the classroom. Physiotherapy educators who adopt a critical pedagogy may use it to create personal learning environments (PLEs) that enable students to inform their own learning based on meaningful clinical experiences, democratic approaches to learning, and interaction with others beyond the professional programme. These PLEs enable exploration, inquiry and creation as part of the curriculum, and play a role in preparing students to engage with the complex and networked systems of the early 21st century. While the potential for pedagogical transformation via the integration of digital technology is significant, we must be critical of the idea that technology is neutral and be aware that our choices concerning tools and platforms have important implications for practice.

In Beta: Thoughts on the first session

Yesterday Ben Ellis (@bendotellis) and I hosted the first In Beta session live on Hangouts. In Beta is a project that Ben and I started talking about when we met at ER-WCPT last year and the idea is that we have a semi-regular online group chat about any topic related to physiotherapy education (see this post for more information). Our intention is that the conversations focus on the practical problems that educators may come into contact with when trying out new ideas in the classroom.

The conversation yesterday focused on Ben’s idea for incorporating an inquiry-based approach into a new module with a focus on the management of patients with long-term conditions. Yesterday we were joined by 6 colleagues – mostly from the UK – who were able to share reflections on their experiences when trying similar approaches in their own departments (see bottom of the post). Ben suggested that the new approach would be aimed at shifting students’ thinking away from the details of the conditions that patients have and to focus instead on the people who have them. As Ben said:

I am keen where possible for the structure of the module to not be built around specific conditions, but instead to focus on how approaches which empower people to self-manage long term conditions can be applied across a range of clinical situations.

If you’re interested in inquiry-based learning but haven’t yet had a chance to try it in your own classroom, the Google Doc has some useful ideas and resources. The document will remain available for the foreseeable future and includes more detail regarding Ben’s plans for the module. In addition the recorded audio from our conversation will form part of the collection of resources we want to gather on this topic and will be shared into the In Beta G+ community, which is free for anyone to join.

From my point of view, the conversation was great, especially hearing about the challenges experienced by colleagues at other institutions. It’s always valuable to be reminded that the problems in your own department are almost always not unique. The reflections and insights generated were really helpful for me, at least. It was also wonderful to hear from people who I only know on Twitter 🙂

A huge thank you to Fiona Moffat, Roger Kerry, Amanda Deaves, Jo Pierce, Mark Williams, and Anestis Divanoglou for taking part and making it such an interesting conversation.

We’re all in beta

I was talking to Ben Ellis (@bendotellis) from Oxford Brookes University at the ER-WCPT conference in Liverpool last year and bemoaning the fact that the most interesting conversations – for me anyway – were happening outside of the sessions. This is probably not news for anyone who’s gone to more than a few conferences. We started chatting about how we could take the things “that work” from conferences e.g. sharing ideas, and removing the things that “don’t work” e.g. a few people talking at other people for 10 minutes at a time.

We’ve been toying with a few different options – influenced by unconferences and teachmeets – but always trying to keep the following broad principles around the format in focus:

  • Broad perspectives. Encourage input from a wide variety of expertise, rather than have the “expert” talk to everyone else.
  • Collaborative. Obviously.
  • Multiple activities. The session should include presenting, writing, and discussion, all around an artifact of some sort.
  • Preparation. We wanted the presenter to bring something to the discussion in the form of an idea that the conversation would centre on.

We’ve decided that a Google+ community seems to have the basic features we need to implement the principles described above. We also wanted to reinforce the idea that we’re all constantly learning how to do things better, and that it makes sense to learn from each other. It seems likely that the things we want to do in our classrooms have been done, in some form, somewhere else. And there’s no need to wait until the next conference and hope that your abstract gets accepted. As Ben said in his post on the project:

The idea of In Beta is for physiotherapy educators to bring a teaching and learning idea that they have been working on themselves or with colleagues within their institution to a group of peers in order to spark discussion, feedback and collaboration to improve and develop the original idea prior to releasing it into the classroom or clinic.

In essence, we want to use this space to encourage physio educators to experiment on their own approaches to teaching and learning practices. We have a basic structure for each session, which may change as we experiment with the format:

  1. Members of the In Beta community share an idea for a change in their teaching and learning practice.
  2. Community members choose a topic on a monthly basis, and help the person who submitted the topic develop the idea for presentation.
  3. The presenter shares their idea with the community, probably in a formal presentation (e.g. slideshow), but could equally be something different (e.g. collection of Pinterest images).
  4. There is a discussion around the idea where everyone gets to share their ideas and suggestions for improvement.
  5. During this process, the original submission is open for editing, so the community members present in the session are able to comment, make suggestions, share resources, generate a reading list, etc.
  6. We encourage those who presented to share their experiences back into the community following implementation of the idea.
  7. Finally, we hope that the process generates a collection of shared resources and ideas for other community members who may be interested in similar contexts.

Anyone with an interest in any aspect of physiotherapy education (clinical or practice-based educators as well as academics) can join the Google+ community for In Beta (Google account required).

The first In Beta session will be at 2pm (UK) on Wednesday 19th July 2017. The topic is teaching long term condition management and the background and outline of the teaching idea is available via the In Beta Google+ community. Thanks to Ben for taking the plunge and offering to be the guinea pig in this experiment.

Remember, it’s not defective. It’s in beta.

OpenPhysio | A new physiotherapy education journal

I’m really excited to announce a new project that I’ve been working on together with the folks at Physiopedia. Today we’re launching an open access, peer reviewed journal with a focus on physiotherapy education, with a few features that we think are pretty innovative in the academic publishing space. The journal is called OpenPhysio and represents what we think is a fundamental shift away from traditional ways of thinking about how we share knowledge.

Here are some of the ways we think the journal is different to more traditional publication channels:

  • Immediate publication. Your article is available to the public almost immediately after submission.
  • Peer review is open and transparent. Authors work together with peer reviewers, and the reviews and author responses are published alongside the final article, together with DOIs that make them citable objects.
  • You retain your intellectual property at no cost. OpenPhysio does not require you to transfer copyright to the journal, and there are no page fees for published articles.
  • Articles are first class internet citizens. Your articles can be enhanced with images, audio, tagging, hyperlinks, and video.

We’re still in the early stages of the project (we have no publications yet) and there’s a lot still to iron out, but we’ve decided to make it public nonetheless. This is in line with our broader thinking about publication, which is to share stuff early and then hash it out in the real world. We have Editorial and Advisory Boards and you can have a look at our policies around open access and peer review.

Now, before you write and tell me that there’s no such thing as physiotherapy education (you’d be right, by the way) we want to be clear that this is a journal aimed at physiotherapists with an emphasis on teaching and learning. it’s not about suggesting that the way physiotherapists learn is somehow different to how nurses, physicians and OTs learn. But we do think that there’s a space to explore our context in ways that may not translate well into other domains.

We want to encourage submissions from physios who are interested in learning more about teaching and learning, whether you’re supervising students or less-experienced colleagues in the clinical and community contexts, or if you’re an academic responsible for teaching in undergraduate and postgraduate classrooms. If you’re interested in teaching and learning in a physiotherapy context, we’d love it if you would consider OpenPhysio as a channel to share your ideas.

If you’d like to know more about the journal, please contact the Editor or visit the website.

Critical digital pedagogy in the classroom: Practical implementation

Update (12-02-18): You can now download the full chapter here (A critical pedagogy for online learning in physiotherapy education) and the edited collection here.

This post is inspired by the work I’ve recently done for a book chapter, as well as several articles on Hybrid Pedagogy but in particular, Adam Heidebrink-Bruno’s Syllabus as Manifesto. I’ve been wanting to make some changes to my Professional Ethics module for a while and the past few weeks have really given me a lot to think about. Critical pedagogy is an approach to teaching and learning that not only puts the student at the centre of the classroom but then helps them to figure out what to do now that they’re there. It also pushes teachers to go beyond the default configurations of classroom spaces. Critical digital pedagogy is when we use technology to do things that are difficult or impossible in those spaces without it.

One of the first things we do in each module we teach is provide students with a course overview, or syllabus. We don’t even think about it but this document might be the first bit of insight into how we define the space we’re going to occupy with our students. How much thought do we really give to the language and structure of the document? How much of it is informed by the students’ voice? I wondered what my own syllabus would look like if I took to heart Jesse Stommel’s suggestion that we “begin by trusting students”.

I wanted to find out more about where my students come from, so I created a shared Google Doc with a very basic outline of what information needed to be included in a syllabus. I asked them to begin by anonymously sharing something about themselves that they hadn’t shared with anyone else in the class before. Something that influenced who they are and how they came to be in that class. I took what they shared, edited it and created the Preamble to our course outline, describing our group and our context. I also added my own background to the document, sharing my own values, beliefs and background, as well as positioning myself and my biases up front. I wanted to let them know that, as I ask them to share something of themselves, so will I do the same.

The next thing were the learning outcomes for the modules. We say that we want our students to take responsibility for their learning but we set up the entire programme without any input from them. We decide what they will learn based on the outcomes we define, as well as how it will be assessed. So for this syllabus I included the outcomes that we have to have and then I asked the students to each define what “success” looks like in this module for them. Each student described what they wanted to achieve by the end of the year, wrote it as a learning outcome, decided on the indicators of progress they needed, and then set timelines for completion. So each of them would have the learning outcomes that the institution and professional body requires, plus one. I think that this goes some way toward acknowledging the unique context of each student, and also gives them skills in evaluating their own development towards goals that they set that are personally meaningful.

I’ve also decided that the students will decide their own marks for these personal outcomes. At the end of the year they will evaluate their progress against the performance indicators that they have defined, and give themselves a grade that will count 10% towards their Continuous Assessment mark. This decision was inspired by this post on contract grading from HASTAC. What I’m doing isn’t exactly the same thing but it’s a similar concept in that students not only define what is important to them, but decide on the grade they earn. I’m not 100% how this will work in practice, but I’m leaning towards a shared document where students will do peer review on each other’s outcomes and progress. I’m interested to see what a student-led, student-graded, student-taught learning outcome looks like.

Something that is usually pretty concrete in any course is the content. But many concepts can actually be taught in a wide variety of ways and we just choose the ones that we’re most familiar with. For example the concept of justice (fairness) could be discussed using a history of the profession, resource allocation for patients, Apartheid in South Africa, public and private health systems, and so on. In the same shared document I asked students to suggest topics they’d like to cover in the module. I asked them to suggest the things that interest them, and I’d figure out how to teach concepts from professional ethics in those contexts. This is what they added: Income inequality. Segregation. #FeesMustFall. Can ethics be taught? The death penalty. Institutional racism. Losing a patient. That’s a pretty good range of topics that will enable me to cover quite a bit of the work in the module. It’s also more likely that students will engage considering that these are the things they’ve identified as being interesting.

Another area that we have completely covered as teachers is assessment. We decide what will be assessed, when the assessment happens, how it is graded, what formats we’ll accept…we even go so far as to tell students where to put the full stops and commas in their referencing lists. That’s a pretty deep level of control we’re exerting. I’ve been using a portfolio for assessment in this module for a few years so I’m at a point where I’m comfortable with students submitting a variety of different pieces. What I’m doing differently this year is asking the students to submit each task when it’s ready rather than for some arbitrary deadline. They get to choose when it suits them to do the work, but I have asked them to be reasonable with this, mainly because if I’m going to give them decent feedback I need time before their next piece arrives. If they’re submitted all at once, there’s no time to use the feedback to improve their next submission.

The students then decided what our “rules of engagement” would be in the classroom. Our module guides usually have some kind of prescription about what behaviour is expected, so I asked the students what they thought appropriate behaviour looks like and then to commit as a class to those rules. Unsurprisingly, their suggestions looked a lot like it would have if I had written it myself. Then I asked them to decide how to address situations when individuals contravened our rules. I don’t want to be the policeman who has to discipline students…what would it look like if students decided in advance what would work in their classroom, and then took action when necessary? I’m pretty excited to find out.

I decided that there would be no notes provided for this module, and no textbook either. I prepare the lecture outline in a shared Google document, including whatever writing assignments the students need to work on and links to open access resources that are relevant for the topic. The students take notes collaboratively in the document, which I review afterwards. I add comments and structure to their notes, and point them to additional resources. Together, we will come up with something unique describing our time together. Even if the topic is static our conversations never are, so any set of notes that focuses only on the topic is going to necessarily leave out the sometimes wonderful discussion that happens in class. This way, the students get the main ideas that are covered, but we also capture the conversation, which I can supplement afterwards.

Finally, I’ve set up a module evaluation form that is open for comment immediately and committed to having it stay open for the duration of the year. The problem with module evaluations is that we ask students to complete them at the end of the year, when they’re finished and have no opportunity to benefit from their suggestions. I wouldn’t fill it in either. This way, students get to evaluate me and the module at any time, and I get feedback that I can act on immediately. I use a simple Google Form that they can access quickly and easily, with a couple of rating scales and an option to add an open-ended comment. I’m hoping that this ongoing evaluation option in a format that is convenient for students means that they will make use of it to improve our time together.

As we worked through the document I could see students really struggling with the idea that they were being asked to contribute to the structure of the module. Even as they commented on each other’s suggestions for the module, there was an uncertainty there. It took a while for them to be comfortable saying what they wanted. Not just contributing with their physical presence in the classroom, but to really contribute in designing the module; how it would be run, how they would be assessed, how they could “be” in the classroom. I’m not sure how this is going to work out but I felt a level of enthusiasm and energy that I haven’t felt before. I felt a glimmer of something real as they started to take seriously my offer to take them seriously.

The choices above demonstrate a few very powerful additions to the other ways that we integrate technology into this module (the students portfolios are all on the IEP blog, they do collaborative authoring and peer review in Google Drive, course resources are shared in Drive, they do digital stories for one of the portfolio submissions, and occasionally we use Twitter for sharing interesting stories). It makes it very clear to the students that this is their classroom and their learning experiences. I’m a facilitator but they get to make real choices that have a real impact in the world. They get to understand and get a sense of what it feels like to have power and authority, as well as the responsibility that comes with that.

Give feedback on “A critical digital pedagogy for education in the 21st century”?

Update (12-02-18): You can now download the full chapter here (A critical pedagogy for online learning in physiotherapy education) and the edited collection here.

I finally managed to put together some ideas for my chapter on critical digital pedagogy in the CPN book on critical perspectives in practice. I split the chapter into 4 sections, excluding an introduction and conclusion (because they’re likely to change with future editing), which you can find here:

  1. Background: In which I explain the point of this short series of posts.
  2. Command and control: In which I describe how higher education today revolves around the idea that students should sit still, be quiet, and do nothing that might be considered interesting or creative.
  3. Weapon of mass instruction: In which I argue that technology is being used to reinforce the conditions promoting conformity and  a culture of oppression.
  4. Education as the practice of freedom: In which I discuss critical pedagogy as a way of thinking about teaching that aims to liberate students and teachers from institutionalised education.
  5. Teaching at the edges of chaos: In which I explore some aspects of the open web that may be used to implement a critical digital pedagogy in higher education.

Now that the draft is finished, I thought I’d try a little experiment. In addition to being able to comment on the posts above, I wondered what it would be like to get public feedback on the whole chapter. I’ve shared the document in Google Drive and would love to hear any thoughts you may have on it. If you’d like, you can also download the full document as a PDF here. Please note that this is a first complete draft and so there’s probably going to still be some heavy editing.

As Yeats said: “I have spread my dreams under your feet. Tread softly for you tread on my dreams.”