This is the fourth post in my altPhysio series, where I’m exploring alternative ways of thinking about a physiotherapy curriculum by imagining what a future school might look like. This post is a bit longer than other because this is an area I’m really interested in and spend a lot of time thinking about. I’ve also added more links to external sources because some of this stuff sounds like science fiction. The irony is that everything in this post describes technology that currently exists, and as long as we’re thinking about whether or not to share PowerPoint slide we’re not paying attention to what’s important. This post was a ton of fun to write.

Q: Can you talk a little bit about the history of technology integration in health professions education? Maybe over the last decade or so.

In the early part of the 21st century we saw more institutions starting to take the integration of technology seriously. Unfortunately the primary use of digital services at the time was about moving content around more efficiently. Even though the research was saying that the content component was less important for learning than the communication component, we still saw universities using the LMS primarily to share notes and presentations with students.

The other thing is that we were always about 5-10 years behind the curve when it came to the adoption of technology. For examples, wikis started showing up in the medical education literature almost 10 years after they were invented. The same with MOOCs. I understand the need to wait and see how technologies stabilise and then choosing something that’s robust and reliable. But the challenge is that you lose out on the early mover advantages of using the technology early. That’s why we tend to adopt a startup mentality to how we use technology at altPhysio.

Q: What do you mean by that? How is altPhysio like a startup?

We pay attention to what’s on the horizon, especially the emerging technologies that have the potential to make an impact on learning in 1, 2 and 5 year time frames. We decided that we weren’t going to wait and see what technologies stabilised and would rather integrate the most advanced technologies available at the time. We designed our programme to be flexible and to adapt to change based on what’s happening around us. When the future is unknowable because technological advances are happening faster than you can anticipate, you need a system that can adapt to the situations that emerge. We can’t design a rigid curriculum that attempts to guess what the future holds. So we implement and evaluate rapidly, constantly trying out small experiments with small groups of students.

Once we decided that we’d be proactive instead of reactive in how we use and think about technology, we realised that we’d need a small team in the school who are on the lookout for technologies that have the potential to enhance the curriculum. The team consists of students and staff who identify emerging technologies before they become mainstream, prepare short reports for the rest of the school, recruit beta testers and plan small scale research projects that highlight the potential benefits and challenges of implementing the technology at scale.

We’ve found that this is a great way for students to invest themselves in their own learning, drive research in areas they are interested in, take leadership roles and manage small projects. Staff on the team act as supervisors and mentors, but in fact are often students themselves, as both groups push each other further in terms of developing insights that would not be possible working in isolation.

Q: But why the emphasis on technology in health professions education? Isn’t this programme about developing physiotherapists?

The WHO report on the use of elearning for undergraduate health professional education called for the integration of technology into the curriculum, as did the Lancet Commission report. And it wasn’t just about moving content more efficiently in the system but rather to use technology intentionally to change how we think about the curriculum and student learning. The ability to learn is increasingly mediated by digital and information literacy and we want our students’ learning potential to be maximised.

Low levels of digital literacy in the 21st century is akin to a limited ability to read and write in the past. Imagine trying to learn in the 20th century without being able to read and write? Well, that’s what it’s like trying to learn today if you don’t have a grasp of how digital technologies mediate your construction of knowledge. Integrating technology is not about adding new gadgets or figuring out how to use Facebook groups more effectively.

Technology is an infrastructure that can be used to open up and enhance student’s learning, or to limit it. Freire said that there’s no such thing as a neutral education process, and we take seriously the fact that the technologies we use have a powerful influence on students’ learning.

Q: How do you develop digital and information literacy alongside the competencies that are important for physiotherapists? Doesn’t an emphasis on technology distract students from the core curriculum?

We don’t offer “Technology” as something separate to the physiotherapy curriculum, just as you don’t offer “Pen and paper” as something that is separate. The ability to use a pen and paper used to be an integral and inseparable aspect of learning, and we’ve just moved that paradigm to now include digital and information literacy. Technology isn’t separate to learning, it’s a part of learning just like pen and paper used to be.

Digital and information literacy is integrated into everything that happens at the school. For example, when a new student registers they immediately get allocated a domain on the school servers, along with a personal URL. A digital domain of their own where they get to build out their personal learning environment. This is where they make notes, pull in additional resources like books and video, and work on their projects. It’s a complete online workspace that allows individual and collaborative work and serves as a record of their progress through the programme. It’s really important to us that students learn how to control the digital spaces that they use for learning, and that they’re able to keep control over those spaces after they graduate.

When students graduate, their personal curriculum goes with them, containing the entire curriculum (every resource we shared with them) as well as every artefact of their learning they created, and every resource that they pulled in themselves. Our students never lose the content that they aggregated over the duration of the programme, but more importantly, they never lose the network they built over that time. The learning network is by far the most important part of the programme, and includes not only the content relationships they’ve formed during the process but includes all interactions with their teachers, supervisors, clinicians and tutors.

Q: Why is it important for students to work in digital space, as well as physical space? And how do your choices about online spaces impact on students’ learning?

Think about how the configuration of physical space in a 20th century classroom dictated the nature of interactions that were possible in that space. How did the walls, desks and chairs, and the position of the lecturer determine who spoke, for example? Who moved? Who was allowed to move? How was work done in that space? Think about how concepts of “front” and “back” (in a classroom) have connotations for how we think about who sits where.

Now, how does the configuration of digital space change the nature of the interactions that are possible in that space? How we design the learning environment (digital or physical) not only enables or disables certain kinds of interactions, but it says something about how we think about learning. Choosing one kind of configuration over another articulates a set of values. For example, we value openness in the curriculum, from the licensing of our course materials, to the software we build on. This commitment to openness says something about who we are and what is important to us.

The fact that our students begin here with their own digital space – a personal learning environment – that they can configure in meaningful ways to enhance their potential for learning, sends a powerful message. Just like the physical classroom configuration changes how power is manifested, so can the digital space. Our use of technology tells students that they have power in terms of making choices with respect to their learning.

To go back to your question about the potential for technology to distract students from learning physiotherapy; did you ever think about how classrooms – the physical configuration of space – distracted students from learning? Probably not. Why not?

Q: You mentioned that openness is an important concept in the curriculum. Can you go into a bit more detail about that?

Maybe it would be best to use a specific example because there are many ways that openness can be defined. Our curriculum is an open source project that gives us the ability to be as flexible and adaptable as a 21st century curriculum needs to be. It would be impossible for us to design a curriculum that was configured for every student’s unique learning needs and that was responsive to a changing social context, so we started with a baseline structure that could be modified over time by students.

We use a GitHub repository to host and collaborate on the curriculum. Think of a unique instance of the curriculum that is the baseline version – the core – that is hosted on our servers. When a student registers, we fork that curriculum to create another, unique instance on the students personal digital domain. At this moment, the curriculum on the student’s server is an exact copy of the one we have but almost immediately, the students’ version is modified based on their personal context. For example, the entire curriculum – including all of the content associated with the programme – is translated into the student’s home language if they choose so. Now that it’s on their server, they can modify it to better suit them, using annotation and editing tools, and allowing them to integrate external resources into their learning environment.

One of the most powerful features of the system is that it allows for students to push ideas back into our core curriculum. They make changes on their own versions and if they’d like to see that change implemented across the programme, they send us a “Pull” request, which is basically a message that shows the suggested change along with a comment for why the student wants it. It’s a feedback mechanism for them to send us signals on what works well and what can be improved. It enables us to constantly refine and improve the curriculum based on real time input from students.

On top of this, every time we partner with other institutions, they can fork the curriculum and modify it to suit their context, and then push the changes back upstream. This means that the next time someone wants to partner with us, the core curriculum they can choose from is bigger and more comprehensive. For example, our curriculum is now the largest database of case studies in the world because most institutions that fork the curriculum and make their own changes also send those changes back to the core.

Q: You have a very different approach to a tutorial system. Tell us about how tutors are implemented in your school.

The tutors at altPhysio are weak AI agents – relatively simple artificial general intelligence algorithms that perform within very narrow constraints that are linked to basic tasks associated with student learning. Students “connect” with their AI tutors in the first week of the programme, which for the most part involves downloading an app onto their phones. This is then sync’d across all of their other devices and digital spaces, including laptops, wearables and cloud services, so that the AI is “present” in whatever context the student is learning.

As AI has become increasingly commoditised in the last decade, AI as a service has allowed us to take advantage of features that enhance learning. For example, a student’s tutor will help her with establishing a learning context, finding content related to that context, and reasoning through the problems that arise in the context. In addition, the AIs help students manage time on task, remind them about upcoming tasks and the associated preparation for those tasks, and generally keep them focused on their learning.

Over time the algorithms evolve with students, becoming increasingly tied to them and their own personal learning patterns. While all AI tutors begin with the same structure and function they gradually become more tightly integrated with the student. Some of the more adventurous students have had the AIs integrated with neural lace implants, which has obviously significantly accelerated their ability to function at much higher levels and at much greater speeds than the rest of us. These progressions have obviously made us think very differently about assessment, obviously.

Q: What about technology used during lectures? Is there anything different to what you’ve already mentioned?

Lectures have a different meaning here than at other institutions, and I suspect we’ll talk about that later. Anyway, during lectures the AI tutors act as interpreters for the students, performing real time translation for our international speakers, as well as doing speech-to-text transcription in real time. This means that our deaf students get all speech converted to Braille in real time, which is pretty cool. All the audio, video and text that is generated during lectures is saved, edited and sync’d to the students personal domains where they’re available for recall later.

Our students use augmented reality a lot in the classroom and clinical context, where students overlay digital information on their visual fields in order to get more context in the lecture. For example, while I’m talking about movement happening at the elbow, the student might choose to display the relevant bones, joints and muscles responsible for the movement. As the information is presented to them, they can choose to save that additional detail into the point in the lecture that I discussed it, so that when they’re watching the video of the lecture later, the additional information is included. We use this system a lot for anatomy and other movement- and structure-type classes.


Q: That sounds like a pretty comprehensive overview of how technology has some important uses beyond making content easier to access. Any final thoughts?

Technology is not something that we “do”, it’s something that we “do things with”. It enables more powerful forms of communication and interaction, both in online and physical spaces, and to think of it in terms of another “platform” or “service” is to miss the point. It amplifies our ability to do things in the world and just because it’s not cheap or widely distributed today doesn’t mean it won’t be in the future.

In 2007 the iPhone didn’t exist. Now every student in the university carries in their pocket a computer more powerful than the ones we used to put men on the moon. We should be more intentional about how we use that power, and forget about whatever app happens to be trending today.


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