Comment: Could robots make us better humans?

This is one of his arguments for listening to AI-generated music, studying how computers do maths and…gazing at digitally produced paintings: to understand how advanced machines work at the deepest level, in order to make sure we know everything about the technology that is now built into our lives.

Harris, J. (2019). Could robots make us better humans? The Guardian.

Putting aside the heading that conflates “robots” with “AI” there are several insightful points worth noting in this Guardian interview with Oxford-based mathematician and musician, Marcus du Sautoy. I think it’ll be easiest if I just work through the article and highlight them in the order that they appear.

1. “My PhD students seem to have to spend three years just getting to the point where they understand what’s being asked of them…”: It’s getting increasingly difficult to make advances in a variety of research domains. The low-hanging fruit has been picked and it subsequently takes longer and longer to get to the forefront of knowledge in any particular area. At some point, making progress in any scientific endeavor is going to require so much expertise that no single human being will be able to contribute much to the overall problem.

2. “I have found myself wondering, with the onslaught of new developments in AI, if the job of mathematician will still be available to humans in decades to come. Mathematics is a subject of numbers and logic. Isn’t that what computers do best?”: On top of this, we also need to contend with the idea that advances in AI seem to indicate that some of these systems are able to develop innovations in what we might consider to be deeply human pursuits. Whether we call this creativity or something else, it’s clear that AI-based systems are providing earlier insights into problems that we may have eventually arrived at ourselves, albeit at some distant point in the future.

3. “I think human laziness is a really important part of finding good, new ways to do things…”: Even in domains of knowledge that seem to be dominated by computation, there is hope in the idea that working together, we may be able to develop new solutions to complex problems. Human beings often look for shortcuts when faced with inefficiency or boredom, something that AI-based systems are unlikely to do because they can simply brute force their way through the problem. Perhaps a combination of a human desire to take the path of least resistance, combined with the massive computational resources that an AI could bring to bear, would result in a solution that’s beyond the capacity of either working in isolation.

4. “Whenever I talk about maths and music, people get very angry because they think I’m trying to take the emotion out of it…”: Du Sautoy suggests that what we’re responding to in creative works of art isn’t an innately emotional thing. Rather, there’s a mathematical structure that we recognise first, and the emotion comes later. If that’s true, then there really is nothing in the way of AI-based systems not only creating beautiful art (they already do that) but of creating art that moves us.

5. “We often behave too like machines. We get stuck. I’m probably stuck in my ways of thinking about mathematical problems”: If it’s true that AI-based systems may open us up to new ways of thinking about problems, we may find that working in collaboration with them makes us – perhaps counterintuitively – more human. If we keep asking what it is that makes us human, and let machines take on the tasks that don’t fit into that model, it may provide space for us to expand and develop those things that we believe make us unique. Rather than competing on computation and reason, what if we left those things to machines, and looked instead to find other ways of valuing human capacity?

altPhysio | Creating value

This is the second post in a series of exploring what a next-generation physiotherapy school might look like. Many of the ideas are not fully formed and some have very little evidence to support them. This is OK. Push back is welcome. Here’s the second interview.

Q: Now that you’ve provided the background and context for why the school was necessary, tell us what the first step was. Where did you begin?

As with all things in learning we knew we had to start with the students and their perceptions of the curriculum. The curriculum is a series of signals we send students about what we value but how those signals are mis/interpreted is important. We know that people’s beliefs inform their behaviour so we asked our students what they believed was important. Lecturers believe everything they do has value but students make their own judgements about about what is valuable independently of what lecturers say. The conventional wisdom in the past was that everything a lecturer said was valuable and it was valuable simply because they had said it.

However, if the student doesn’t see the value proposition of what you’re saying or asking them to do then its utility is limited. When we tell students to pay attention because what we’re saying will be important one day (e.g. in clinical practice in the third year) the message we’re actually sending is that they don’t need to pay attention now. If the information is only useful later then that’s when they’ll look it up. Why waste resources in the present if the benefits are only useful at some future, undetermined time?

Like it or not, students are doing a cost-benefit analysis for every task you set them. They evaluate the cost of the task in terms of time and effort, against the perceived benefits of doing the task. For example, what is the cost of attending a lecture versus the benefit? If the cost (time and effort) is perceived to be higher than the benefit, they might skip the lecture. And in many cases they are probably right to do so. If classroom time is spent sharing content then the student is making a strategic decision about better allocation of their limited resources (i.e. time and effort) because they can get content anywhere at any time.

Q: So what did you do about that? How did you correct the students’ reasoning?

We didn’t try to correct it. We tried to understand it and work with it. Now we’re always asking, “How is this task going to help to change our students’ thinking and behaviour in ways that are useful for them today?” In the case of a lecture we make sure that attendance has real world value today and don’t simply offer the promise of future value or threat of immediate punishment.

What would happen if there was no requirement to attend class and no negative consequence for being absent? Would students attend? If the answer is no, then you should think carefully about the value you think you provide.

At altPhysio we don’t take roll call and there is no attendance requirement in any part of the programme. Once we had taken that decision the pressure was on us to make sure that the time we spend with students has  measurable value for them. We begin by assuming that students come to altPhysio with ambition and the capacity to achieve great things. Then we help guide them to open up their thinking and give them space to take responsibility for their learning. Everything we do in the curriculum is about empowering students and developing their agency to act in the world. We give them challenging tasks that force them to go beyond what they believed they were capable of and in doing so, set up conditions that show them how far they can go.

Students don’t hate working hard; they hate being bored. It turns out that they really do care about learning, it’s just that we force them to care about marks instead.

Q: How do we get students to care about their learning, as opposed to caring about marks?

Learning happens in the mind of the student and only in the mind of the student. A learning environment is therefore just a series of contexts to try and get students to value their learning. An intrinsically motivated student could probably get through our exams with nothing but a curriculum outline and an internet connection. So we asked how to get our students intrinsically motivated rather than satisfy a set of external conditions that were not always tied to outcomes that they valued. The problem was that most of our curricular interactions sent very strong signals that 1) we were in charge, and 2) what we valued was all that mattered.

The locus of control for (almost) all students sits outside themselves. We tell them where to go, when to get there, what to read, what would happen if they pushed back, etc. In the past our students had no control over their learning and it was clear in every aspect of the curriculum that lecturers had all the power. It’s hard to be internally motivated when you have no power. For example, if classroom attendance is compulsory (i.e. there is a mandatory cost) and students perceive that it has little value, but they have no option to make a choice about attending, then you’re sending a signal that they have no power in the domain of their learning.

Q: What is wrong with students being externally motivated? Does it really matter, as long as they get the work done? Pass the exams?

The problem with an external locus of control is that it sets up a context where students are responding to a system of reward and punishment that is determined by others, rather than responding to what they value. “Success” in that system is determined by how well you learn the rules for gaining rewards and avoiding punishment. It has nothing to do with what students believe is important for their own learning. Our old curriculum – as the expression of what lecturers value – only required that students passed a series of assessment tasks. Their own beliefs about what was important were not integrated into the system. In effect, it didn’t matter what was important to them.

Q: OK, so you realised that the curriculum was “telling” students to think and behave in ways that were not consistent with what you valued. What next? How did you get students’ values to align with lecturers’ values?

We asked ourselves what conditions would help students think and behave in ways that would most likely approximate the patterns of thinking and behaviour we expected to see in qualified professionals. In other words, how do you get students to think and behave like professionals? To come to class; to show up on time; to put maximum effort into their assignments; to do extra reading?

Once we had a better idea of students’ strategic thinking about the curriculum and how they assigned value to tasks, it gave us insight into how we designed those tasks. Our curriculum therefore had to describe a learning environment where thinking and behaving like a professional had a higher value for students who aligned with it, than for those who didn’t. For example, if we said that attending class was important, then there had to be something that happened in that class that gave a strategic advantage to those who attended compared with those who did not.

Q: What is the take home message here about providing value for students?

We used to look at students’ learning needs as a series of physical, social, financial and psychological factors that would positively influence their learning. And those things are obviously important. But we realised that a missing piece in our framework for understanding students was their rationalisation for compliance (or non-compliance) with the curriculum requirements. What were the underlying beliefs they had with respect to the inherent value of the tasks we were asking them to complete?

We needed figure out how to design our curricular interactions in order to maximise the utility of that time for students. We could no longer expect them to comply with our instructions simply because we told them that they should. The curriculum does not have any inherent value simply because we say it does. We need to intentionally design activities so that the value proposition for students outweighs the costs.

We want students to do what we ask them but we want them to do it because it has real value for their current and future practice, not because of a system of reward and punishment that we control. We can no longer afford to take students’ presence and attention for granted.

PHT402: What is the value of a human life?

This is my fourth contribution to a series of weekly posts related to the #pht402 Professional Ethics course. This week’s topic is specifically about torture, but the general principle concerns the rights of the individual vs the rights of society, as well as asking about the relative value of a human life.

free-humanityI’m going to begin by answering the question in the title: “It depends on who’s life you’re talking about”.

When preparing this course I thought that the topic of torture could be used to move a conversation beyond the specific example of torture and look at the broad principle, which concerns the rights of an individual human being weighed against the rights of society. Or, to put it another way, how do we ascribe value to human life? I hadn’t really considered the possibility of a physiotherapist being asked about a patient’s physical condition in order to determine whether or not they could be hurt by someone else. It shouldn’t have surprised me though, since in South Africa we have a long history of our medical profession being complicit in human rights abuses that include torture (as highlighted in one of the readings for this week).

Even though the topic of torture has been questioned as part of this course, I think that the principles that emerged from the week’s discussions are relevant to other areas of our practice. For example, how many lives is one life worth? What value do we place on human lives? Are all human lives valued the same? These questions bring us back to the idea of equality and morality. Are we all equal? In what ways are we equal? How different are our boundaries of what is “right” and “wrong”? Is torture ever the “right” thing to do? The United Nations says it never is. But, there are times when your personal morality might say that torture absolutely is necessary. Wendy expressed this nicely when she asked about actions that may be morally wrong but which are morally justifiable.

I think that these are interesting questions that don’t need to be answered, but talking about them may help us to figure out some things about ourselves.

Naom makes two good points in her post, which are that your thinking around this topic is influenced by how you value human life, and whether the value of lives from those within your group is higher than those outside of it. As noble as we like to think we are, we do inherently place more value on certain lives than on others and this is where the importance of context comes in. My daughter’s life is more valuable to me than any other child in the world because she is my  daughter. She doesn’t need to have any special skills, knowledge or potential in order for me to value her more. As much as I like to think that we’re all equal, I have to acknowledge that we don’t all have the same value.

Um’r makes the point that for thousands of years, human beings have consistently looked for more and more ingenious ways to inflict pain and suffering on each other. He also links this week’s topic back to the questions of equality and morality, and then goes on to day that as much as each of us may abhor violence towards others, he asks how far he would go in order to protect those closest to him. This is challenge, to live the life we believe is right, even when faced with difficult choices. If every life is equal (Janine has a simple exercise that explores this), then torture can never be OK.

In the comments on Janine’s post there’s a question about how age could be a deciding factor in determining if a life could be sacrificed to save others.  In one context, age may be an appropriate reason to sacrifice a life but not in every context. For me, this is one of the most difficult skills that we need as health care professionals…the ability to modify our decision making processes depending on the unique context we find ourselves in. There are no universally correct answers to morally ambiguous situations.

Everyone I’ve read so far has focused on the military use of torture, but what about the other reading that briefly looked at the use of torture (or at least complicity in it’s application and cover up) by medical professionals? Tony has explored this by asking how medical professionals can be involved in torture.

I think that one of the most interesting aspects of Week 4s topic has been the emergence of side topics…conversations that were peripherally associated with torture but which became something else. Discussions about the value of life, morality, equality, moral boundaries, etc. all began happening in the comment threads, which was great to read. I think it really highlighted one of the benefits of a course with weak or flexible boundaries and participant-led discussion.

Finally, I’m going to point you to Chantelle’s blog, where she did a great job in relating the week’s broad topic to the South African context, as well as providing a reflective overview of the posts from Week 4. She opened her first post with this quote and I’m going to end with it:

The argument cannot be that we should not torture because it does not work. The argument must be that we should not torture because it is wrong.

Exposing the culture of professional practice

I often forget that learning is not only mediated by social relationships, but by cultural relationships as well. To a large degree we are the products of influence that emerge from interactions between thousands of variables within our families, groups of friends, communities, religions and countries. The process of becoming a physiotherapist is also embedded within a culture of the profession, and we forget that our system of values, social norms, belief systems and language is largely hidden to the student when they first arrive on campus. Not only is the world of academia a new culture for most of them, but then within that system is the sub-culture of physiotherapy education.

We spend a long time developing ways and means of teaching students the technical components of physiotherapy, but have very little in place to explicitly and intentionally induct them into the culture of the profession. We expect them to “pick it up” over time by a process of osmosis. Technical skills are relatively easy to teach: “Put your hands here, press this hard, so many times”. Knowing when to do that particular mobilisation, and why, is a lot harder to teach. Without knowing the when and the why, we’re little more than trained monkeys.

I believe that part of coming to know when and why to do certain techniques is partly related to the culture of the profession. Students must feel a sense of belonging to something that is more than the sum of a set of knowledge and techniques – a sense of becoming someone who is more than a trained monkey. I think that we can achieve this in some part by making explicit our social norms, values and belief systems, thereby exposing students to the culture of the profession.

The problem is that there isn’t much room in the curriculum for these aspects of professional practice, so we need a space for informal conversation in a way that the ideas and culture of the professional community can be shared in a normative way. We often make assumptions about what students (don’t) know and understand. As practitioners, we have developed a professional literacy over many years, but since our current state of knowing is tacit (it’s just part of who we are), we forget how we came to this point. We often forget that our students have not had the many years of experience that leads to the development of patterns of thinking and ways of being that we just know, and so we have expectations around performance that they cannot match.

I think that we can use online social spaces (i.e. social networks) to externalise and  make explicit the culture of the profession, exposing the hidden, tacit knowledge that students can use to orientate themselves to professional practice in a process of becoming a physiotherapist.

Results of my Delphi first round

I’ve recently finished the analysis of the first round of the Delphi study that I’m conducting as part of my PhD. The aim of the study is to determine the personal and professional attributes that determine patient outcomes, as well as the challenges faced in clinical education. These results will serve to inform the development of the next round, in which clinical educators will suggest teaching strategies that could be used to develop these attributes, and overcome the challenges.

Participants from the first round had a wide range of clinical, supervision and teaching experience, as well as varied domain expertise. Several themes were identified, which are summarised below.

In terms of the knowledge and skills required of competent and capable therapists, respondents highlighted the following:

  • They must have a wide range of technical and interpersonal skills, as well as a good knowledge base, and be prepared to continually develop in this area.
  • Professionalism, clinical reasoning, critical analysis and understanding were all identified as being important, but responses contained little else to further explain what these concepts mean to them.

In terms of the personal and professional attributes and attitudes that impact on patient care and outcomes, respondents reported:

  • A diverse range of personal values that they believe have relevance in terms of patient care
  • These values were often expressed in terms of a relationship, either between teachers and students, or between students and patients
  • Emotional awareness (of self and others) was highlighted

In terms of the challenges that students face throughout their training:

  • Fear and anxiety, possibly as a result of poor confidence and a lack of knowledge and skills, leading to insecurity, confusion and uncertainty
  • Lack of self-awareness as it relates to their capacity to make effective clinical decisions and reason their way through problems
  • A disconnect between merely “providing a service” and “serving”
  • They lack positive and supportive clinical learning environments, have poor role models and often aren’t given the time necessary to reflect on their experiences
  • The clinical setting is complex and dynamic, a fact that students struggle with, especially when it comes to dealing with complexity and uncertainty inherent in clinical practice
  • Students often “silo” knowledge and skills, and struggle to transfer between different contexts
  • Students struggle with the “hidden culture” of the professional i.e. the language, values and norms that clinicians take for granted

These results are not significantly different from the literature in terms of the professional and personal attributes that healthcare professionals deem to be important for patient outcomes.

The second round of the Delphi is currently underway and will focus on the teaching  strategies that could potentially be used to develop the attitudes and attributes highlighted in the first round.