Who is planning for the future of physiotherapy?

In the middle ages, cities could spend more than 100 years building a cathedral while at the same time believing that the apocalypse was imminent. They must’ve had a remarkable conviction that commissioning these projects would guarantee them eternal salvation. Compare this to the way we think about planning and design today where, for example, we don’t think more than 3 years into the future simply because that would fall outside of this organisational election cycle. Sometimes it feels like the bulk of the work that a politician does today is to secure the funding that will get them re-elected tomorrow. Where do we see real-world examples of long-term planning that will help guide our decision-making in the present?

A few days ago I spent some time preparing feedback on a draft of the HPCSA minimum requirements for physiotherapy training in South Africa and one of the things that struck me was how much of it was just more-of-the-same. This document is going to inform physiotherapy education and practice for at least the next decade and there was no mention of advances at the cutting edge of medical science and the massive impact that emerging technologies are going to have on clinical practice. Genetic engineering, nanotechnology, artificial intelligence and robotics are starting to drive significant changes in healthcare and it seems that, as a profession, we’re largely oblivious to what’s coming. It’s dawned on me that we have no real plan for the future of physiotherapy (the closest I’ve seen is Dave Nicholls new book, called ironically, The End of Physiotherapy).

What would a good plan look like? In the interests of time, I’m just going to take the high-level suggestions from this article on how the US could improve their planning for AI development and make a short comment on each (I’ve expanded on some of these ideas in my OpenPhysio article on the same topic).

  • Invest more: Fund research into practice innovations that take into account the social, economic, ethical and clinical implications of emerging technologies. Breakthroughs in how we can best utilise emerging technologies as core aspects of physiotherapy practice will come through funded research programmes in universities, especially in the early stages of innovation. We need to take the long-term view that, even if robotics, for example, isn’t having a big impact on physiotherapy today, one day we’ll see things like percussion and massage simply go away. We will also need to fund research on what aspects of the care we provide are really valued by patients (and what they, and funders, will pay for).
  • Prepare for job losses: From the article: “While [emerging technologies] can drive economic growth, it may also accelerate the eradication of some occupations, transform the nature of work in other jobs, and exacerbate economic inequality.” For example, self-driving cars are going to massively drive down the injuries that occur as a result of MVAs. Orthopaedic-related physiotherapy work is, therefore, going to dry up as the patient pool gets smaller. Preventative, personalised medicine will likewise result in dramatic reductions in the incidence of chronic conditions of lifestyle. The “education” component of practice will be outsourced to apps. Even if physiotherapy jobs are not entirely lost, they will certainly be transformed unless we start thinking of how our practice can evolve.
  • Nurture talent: We will need to ensure that we retain and recapture interest in the profession. I’m not sure about other countries but in South Africa, we have a relatively high attrition rate in physiotherapy after a few years of clinical work. The employment prospects and long-term career options, especially in the public health system, are quite poor and many talented physiotherapists leave because they’re bored or frustrated. I recently saw a post on LinkedIn where one of our most promising graduates from 5 years ago is now a property developer. After 4 years of intense study and commitment, and 3 years of clinical practice, he just decided that physiotherapy isn’t where he sees his long-term future. He and many others who have left health care practice represent a deep loss for the profession.
  • Prioritise education: At the undergraduate level we should re-evaluate the curriculum and ensure that it is fit for purpose in the 21st century. How much of our current programmes are concerned with the impact of robotics, nanotechnology, genetic engineering and artificial intelligence? We will need to create space for in-depth development within physiotherapy but also ensure development across disciplines (the so-called T-shaped graduate). Continuing professional development will become increasingly important as more aspects of professional work change and over time, are eradicated. Those who cannot (or will not) continue learning are unlikely to have meaningful long-term careers.
  • Guide regulation: At the moment, progress in emerging technologies is being driven by startups who are funded with venture-capital and whose primary goal is rapid growth to fuel increasing valuations. This ecosystem doesn’t encourage entrepreneurs to limit risks and instead pushes them to “move fast and break things”, which isn’t exactly aligned with the medical imperative to “first do no harm”. Health professionals will need to ensure that technologies that are introduced into clinical practice are first and foremost serving the interests of patients, rather than driving up the value of medical technology startups. If we are not actively involved in regulating these technologies, we are likely to find our practice subject to them.
  • Understand the technology: In order to engage with any of the previous items in the list, we will first need to understand the technologies involved. For example, if you don’t know how the methods of data gathering and analysis can lead to biased algorithmic decision-making, will you be able to argue for why your patient’s health insurance funder shouldn’t make decisions about what interventions you need to provide? We need to ensure that we are not only specialists in clinical practice, but also specialists in how technology will influence clinical practice.

Each of the items in the list above is only very briefly covered here, and each could be the foundation for PhD-level programmes of research. If you’re interested in the future of the profession (and by that I mean you’re someone who wonders what health professional practice will look like in 100 years), I’d love to hear your thoughts. Do you know of anyone who has started building our cathedrals?

Emerging Technologies and Authentic Learning in Vocational Higher Education conference

Last week I attended the Emerging Technologies and Authentic Learning in Vocational Higher Education conference at the UCT Graduate School of Business, which had a pretty impressive lineup of keynote speakers:

The general theme of the conference was the idea of “learning and play”, with Professor Dick N’gambi opening the event with the following statement: “The creative adult is the child who survived”, referring to the fact that the formal educational system doesn’t encourage innovation and creativity. How do we prepare students for a world that we can’t predict, unless we encourage within them an attitude of exploration and discovery.


The conference was linked to a Special Issue of the British Journal of Educational Technology, to which I’ve submitted the following paper: Rowe – Developing graduate attributes in an open online course (note that this is currently under review). Here are my slides from the workshop I ran on setting up and running an open online course:

…and here is the Twitter feed for the event.

Activity Theory, Authentic Learning and Emerging Technologies

Selection_001For the past few years I’ve been involved in an NRF-funded research project looking at the use of emerging technologies in higher education. One of the products of that collaborative project was an edited book that has recently been published. Professor Denise Wood, one of the editors, describes the book on her blog:

This edited collection seeks to fill the current gap in understanding about the use of emerging technologies for transformative learning and teaching by providing a nuanced view, locating higher education pedagogical practices at an intersection of emerging technologies, authentic learning and activity systems.

The book, which is edited by Professors Vivienne Bozalek, Dick N’gambi, Denise Wood, Jan Herrington, Joanne Hardman and Alan Amory, includes case studies as examples, and draws from a wide range of contexts to illustrate how such a convergence has the potential to track transformative teaching and learning practices in the higher education sector. Chapters provide the reader with a variety of transformative higher education pedagogical practices in southern contexts, theorised within the framework of Cultural Historical Activity Theory (CHAT) and tool mediation, while using authentic learning as a pedagogical model upon which this theoretical framework is based.

I made a small contribution to the book in the form of a case study that emerged from my PhD work as part of the project. Professor Jan Herrington wrote the introduction to the section on the Case Studies:

Moving from theory to practice in higher education is deeply challenging. While exploring pedagogical models in the literature may lead to tacit understanding of general principles, actually implementing these principles in practice can be an entirely different matter. Authentic learning is a pedagogical model that is sometimes misunderstood, such as when teachers believe that in order for authenticity to be achieved, learning must occur outside the classroom in the real world. In fact, authenticity – as described in this model – can readily be achieved within the regular classrooms and lecture halls of the university environment. Providing examples of successful cases of such authentic learning environments offers an opportunity to explore the practical application of a theoretical model, and provide concrete instances of implementation in different subject areas. This chapter provides three such cases. The cases presented here provide international examples of authentic learning in practice across different discipline areas, using different technologies, and focusing on different aspects of the approach. The first case (Case study 14.1) describes the use of reflective analysis and role play in the study of obstetrics, using the model of authentic learning described in Chapter 5 (Herrington, 2014). It focuses on the use of technology as a mediating vehicle for authentic learning through the use of practice dilemmas. The second case (Case study 14.2) describes specific tasks developed within an authentic learning environment, using characteristics of authentic tasks (Herrington, Reeves, Oliver, & Woo, 2004). This case describes the use of complex contexts and the development of case notes in the study of physiotherapy. The final case (Case study 14.3) explores the use of wikis and blogs to mediate authentic learning in sport science education. All the cases represent authentic learning in action, and include details of the context, the tasks, and the problems that inevitably arise when teachers necessarily relinquish their more traditional role to allow students to take primary responsibility for learning. They are also effectively works in progress, where solutions are refined and improved in successive iterations. But above all, they are visible and tangible exemplars of theory in action.

While my own contribution was small, I’m really proud that I could be part of the initiative. The book is available on Amazon in a variety of formats.

Emerging ICTs in South African higher education

book cover
Click on the image above for the download page.

For the past few years I’ve been involved in an NRF-funded research project that looked at the use of emerging ICTs in South African higher education. In addition to the range of conference presentations, publications and postgraduate student progression, we also recently saw the first draft of a set of guidelines for South African lecturers who are interested in incorporating emerging technologies into their teaching and learning.

These case studies are drawn from seven South African HEIs, both resource-rich and resource-poor, from diverse disciplines such as Teacher Education, Nursing and Media Studies, covering a variety of tools and technologies, such as traditional learning management systems (LMSs), but also a wide range of social media applications, such as discussion forums, Facebook groups, Google Drive and blogs, to address a variety of educational challenges. These challenges include: managing large classes, enhancing interaction and collaboration among geographically dispersed students, facilitating critical reflection, developing digital literacy skills or creating safe online spaces to practice professional skills.

Here is the cover of the guidebook, which is going to be released under a Creative Commons license and which will be available for download in the next couple of days. Thanks to Daniela Gachago and Cheryl Brown for their amazing work in getting this guide to press.

Click here to download the guide.

Twitter Weekly Updates for 2011-12-05

  • @dgachago17 it was a wonderful week, i learned so much from everyone I spoke to, must chat about collab project #
  • @LenSteenkamp Staying at the Beach Hotel, SAA paying for everything, so thats not too bad. Was just a disappointing end #
  • Flight home canceled, spending another night in PE. A bit pissed off with #SAA for stuffing up what had been a good week at #heltasa11 #
  • #pencilchat on Twitter has been a lot of fun. Thank you everyone for making the point in a way that I can only describe as delightful 🙂 #
  • RT @timbuckteeth What if the students break them? They won’t be able to write! #pencilchat #
  • RT @philipgreen #pencilchat Give me a pencil and a place to stand, and I could move the world #
  • RT @timbuckteeth Pencils will dumb down education. Keep the oral traditions alive! #pencilchat #
  • #pencilchat Just bought an accessory to look flash in meetings – a pencil grip – boss is asking where I got it #
  • RT @sangsterphil: Students at our school spend more time customising their pencils than writing with them #pencilchat #
  • RT @GuyJudge: @timbuckteeth Pencils criticized in plagiarism study. They make it too easy to copy. #pencilchat #
  • RT @GuyJudge: Don’t press down too hard when you use a pencil as you may leave an imprint that other people can read #pencilchat #
  • RT @johnmayo: I sure hope someone is going to use all these #pencilchat tweets in a presentation at some stage What about copyright? All CC? #
  • RT @GrahamBM: We have found that 1:3 pencil sharing has improved learner collaboration #pencilchat #
  • @timbuckteeth Poets among early pencil adopters. Now even builders use them. #pencilchat #
  • RT @HeidiSiwak: Pencils: anywhere, anyone, anytime on anything writing! The future is now! #pencilchat #
  • RT @briankotts: There is no evidence that the pencil makes learning faster, easier or better. #pencilchat #
  • RT @aangeli: RT @dughall: 2B or not 2B? That is the question. #pencilchat #
  • RT @noblerod: #pencilchat privacy concerns arise when students discovered using pencils to record friend’s antics during lunch #
  • @sandynay sorry, http://t.co/rVfBYAee #
  • RT @heidisiwak: RT @mgraffin: Check out the #pencilchat trend map 🙂 http://t.co/VKvzjHEE… #
  • RT @wholeboxndice: RT @delta_dc: Give a man a fish and he eats for a day. Give him a pencil and he can draw a fish. #pencilchat #
  • #pencilchat is what Twitter was invented for #
  • RT @johntspencer: Violent games do not lead to violent people. I played hang man numerous times and I’ve never hung anyone. #pencilchat #
  • RT @edutechhannah: I’ve doubled my productivity by sharpening both ends #pencilchat #
  • RT @ekendriss: RT @pammoran: Can pencil immigrants teach pencil natives? #pencilchat #
  • RT @ekendriss: RT @bhsprincipal: Pencils are always broken. They never work when I need them. #pencilchat #
  • RT @raventech: Anyone know if the added weight of an external eraser slows down todays graphite pencils? Concerned re. mobility #pencilchat #
  • RT @ronhoutman: @timbuckteeth If you didn’t grow up with pencils, then you will find them too hard to learn how to use. #pencilchat #
  • RT @webenglishteach: If we start using pencils, when will the kids learn keyboarding or the value of different fonts? #pencilchat #
  • RT @erinneo: refuse to use pencils in my classroom until manufacturers figure out a way 2 limit what [they] can write with them #pencilchat #
  • RT @vghathaway: RT @timstirrup: have you seen the things kids write about each other using pencils? this just HAS to stop! #pencilchat #
  • RT @heidisiwak: My school is adopting pencils but going to keep them in 1 room, each class allowed 40 minutes a week to use them #pencilchat #
  • RT @edutechhannah: Just spotted a student ‘doodling’ with one in class. Surely this will just become another distraction? #pencilchat #
  • RT @rebeccaradics: RT @Justgosailing: We are preparing students for pencils that have not yet been made. #shifthappens #pencilchat #
  • RT @tmartinowen: Time to drop pencils out of helicopters on all villages -one pencil per child #pencilchat #
  • RT @timbuckteeth: I’m resisting pencils at present. If I adopt them, I’ll have to change the way I teach. #pencilchat #
  • RT @heidisiwak: RT @markuos: #pencilchat Apparently you can use one ‘pencil dock’ at the front of the class to keep 30 pencils updated #
  • RT @dgree132: #pencilchat I’m worried about my son, he sits writing or drawing by himself for long periods of time. I think he’s addicted. #
  • RT @johnmayo: Data recovery for erased data with a pencil is very difficult #pencildata #
  • Apple marketing appeals to emotion, not features. That’s why everyone loves them. You need to switch off your heart to be immune #heltasa11 #
  • I hate it when marketers (esp. from #Apple push something without context i.e. iPad = good for education with no validation #heltasa11 #
  • @ronaldarendse To be fair, it’s only 1 person from #UCT who isn’t keen on sharing. I’m sure it’s not an institutional policy to censor 🙂 #
  • This “panel discussion” is actually a series of short presentations by 5 people. There’s no discussion happening? #heltasa11 #
  • @ronaldarendse Isn’t the point of coming to a conference to share practices so that we can all learn? What’s going on at #UCT #heltasa11 #
  • @ronaldarendse @LenSteenkamp So, attendance = success. Students say they attend. Therefore intervention = success? Mmm, seems shaky to me 🙂 #
  • @ronaldarendse What are you talking about, I’m in a great mood #
  • @ronaldarendse Maybe the student attendance figures were a minor component of the study. Was attendance relevant for the conclusions drawn? #
  • @ronaldarendse Sorry, let me help you…sarcasm = “The use of irony to mock or convey contempt” #
  • So far the panel discussion at #heltasa11 has been about (insecure) researchers trying to justify what they do. Am I missing something? #
  • @ronaldarendse There’s nothing wrong with basing conclusions on self-report. Students always tell me they “learn a lot” #heltasa11 #
  • @ronaldarendse Are you saying that the UCT presenter isn’t sharing? Sounds about right 🙂 #heltasa11 #
  • @ronaldarendse Always sets off alarm bells when someone tells me that I’m about to be amazed with something I’ve never heard before #
  • @ronaldarendse Never mind, it was meant for the moment, which you clearly missed 🙂 #
  • @ronaldarendse How can you not like this guy? #
  • Check out http://t.co/zv6lAUQx: interesting way for students to present information in an online poster. Uses flash tho & no collaboration #
  • This looks like a useful tool for student collections of content around a topic? http://t.co/qwUTDE9B #
  • RT @alexisangelus: @LenSteenkamp Congratulations on ur 2011 Award in National Excellence in Teaching & Learning!!! Bravo! Bravo! #HELTASA11 #
  • RT @ronaldarendse: Prof Delia Marshall of the Faculty of Science wins the teaching and learning excellence award! #HELTASA11 #ProudlyUdubs #
  • RT @jackiesredpath: Big shout out to @LenSteenkamp! Congrats on winning the award! From Dine and the NWU ladies #HELTASA11 #
  • Daily Papert: should encourage a deeper understanding of technology, beyond searching for information and communication http://t.co/rw7R1WFo #
  • Congratulations to Prof Delia Marshal from #UWC on her T&L award at #heltasa11 #
  • @carinavr No problem, glad to know that someone else finds them a little bit useful #
  • @dgachago17 Cool, will stick with the Laurillard book for now, otherwise I’ll just end up with 20 that I never read #
  • @dgachago17 Any suggestions? Too much to browse, need to have specific things to look for #
  • @dgachago17 Just got the book you mentioned, thanks for pointing it out. Will have a look at it later #
  • Excellent presentation by @dgachago17 on the disruptive nature of emerging technologies #heltasa11 #
  • @LenSteenkamp not at all, it’s just semantics 🙂 #
  • @LenSteenkamp good point, but then you’re not replacing an LMS with G+, you’re talking about using Google as a platform #
  • @dgachago17 They’re not equivalent & therefore 1 can’t replace the other. U can’t use G+ for admin, & an LMS has little to do with learning #
  • @ronaldarendse Not saying that’s my opinion, but why would they say anything different? We need to decide if it’s a viable / useful tool #
  • @LenSteenkamp I think they have different functions. G+ is social / communication. LMS is about management #heltasa11 #
  • @lensteenkamp I use G+, never liked FB much. We use a WordPress/Buddypress social network for coursework, I don’t intrude on students’ SN #
  • @dgachago17 Google will say: “Use Google+ because it will fulfill all of your educational needs and it is a magical experience” 🙂 #
  • @dgachago17 Why wait for Google? What are we doing to promote it’s use? Are we even sure it has a use? #heltasa11 #
  • #heltasa11 day 2 is proving to be intellectually stimulating. Loving the presentations so far #
  • Naude: challenge students to imagine a future that doesn’t exist, then help them develop knowledge & skills to create it #heltasa11 #
  • 1st speaker of the day says using technology in teaching isn’t as good as a good lecturer. Clearly he’s missing the point #heltasa11 #
  • @RonaldArendse I think it is viable #
  • @vivboz some people think he’s a big name, judging from comments I’ve heard. Not my opinion #
  • @RonaldArendse sorry, typing mistake, just pointing out Jansens ignorance…or was it a lie 🙂 #
  • If students can pass without attending class, you have failed as a teacher. Best point of #heltasa11 so far #
  • @RonaldArendse Brian O’ Connell is a trained teacher. He’s not a VC though 🙂 #
  • @dgachago17 a bit caught up in his own story though #
  • @dgachago17 @RonaldArendse battery going to die soon, will see you around #
  • @dgachago17 first keynote presenter was a “big name” #heltasa11 #
  • @RonaldArendse Maybe because the wifi doesn’t work? Or maybe because it’s not interesting? #heltasa11 #
  • @RonaldArendse Try to find one take away message from each presentation. Agree that this could be a challenge 🙁 #
  • Thought we’d moved the conversation away from Prensky’s millenials? Why are we still talking about about how they’re “different”? #heltasa11 #
  • Interactive workshop on web-based clickers using cellphones with. Low cost approach for resource constrained environments #heltasa11 #
  • Everyone at #heltasa11 #heltasa – lets choose 1 hashtag for consistency. I vote for #heltasa11 Thoughts? #
  • I prefer “relationships” rather than “networks” #heltasa11 #
  • After Gutenberg learning was about “place”. After the 60’s it was about “technology”. Now it should be about “networks” #heltasa11 #
  • Disappointing keynote at #heltasa11 Too much “management”, not enough “learning” involved 🙁 #
  • Here’s a post on some of my thoughts on my PhD process. I’m not sure how (or even if I can) push posts from my blog… http://t.co/w5uGnJE0 #
  • I’m at a meeting for a research project that is looking at the use of “emerging technologies” in higher education.… http://t.co/WN8Fjp1o #
  • @mah_asf40 no problem, maybe next year. Come spend some time in cape town 🙂 #
  • @mah_asf40 it’s a conference for a group of south african educators to discuss approaches to teaching & learning in higher education #
  • @mah_asf40 it’s a higher education conference in Port Elizabeth #
  • Theoretical frameworks are just different ways of looking at the world. You can use different frameworks to look at… http://t.co/AuB7LWlG #
  • #heltasa11 begins tomorrow, anyone want to meet up? #

Twitter Weekly Updates for 2009-05-03

  • Getting tons of spam and self-promotion lately. Never blocked anyone before but now I do it on principle. Do I want them following me? #
  • Anyone on #mozopenedcourse know anything about webex and problems with kubuntu 9.04? Maybe issues with Sun’s java not being installed? #
  • Interview with G. Siemens, (author of Handbook for emerging tech in ed), very interesting http://bit.ly/uihBJ #
  • Loving FF 3.5 b4, a few addons I miss, but speed (startup and rendering) is amazing http://bit.ly/6Y1ew #
  • Finished day 2 of the SA physio conference. Some interesting presentations, will blog notes over next week or so http://bit.ly/d17IT #

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