AI clinical

Comment: Will robots make doctors obsolete? Nothing could be further from the truth.

The problem of overdiagnosis is often mentioned in relation to two common cancers: breast and prostate. In both cases, enhanced technology is already detecting small abnormalities that may never result in harm during a lifetime. Machine-learning may trump human interpretation but merely making a diagnosis does not bring us closer to the truth about the impact of the finding. In other words, will the cancer ever cause symptoms, and crucially, will the patient die from it? How will the knowledge of cancer alter the rest of a person’s days?

Srivastava, R. (2020). Will robots make doctors obsolete? Nothing could be further from the truth. The Guardian.

I’m not a fan of the way the author starts the article; it feels a bit contrived and unlikely to reflect the patient experience of healthcare around the world. But I think that the point the author is making is that there are certain aspects of healthcare that AI and robots aren’t going to replace (she could probably have just said that?).

So yes, AI is already “better” than human beings in several different areas (e.g. diagnostics, interpretation of findings, image recognition, etc.). But no, that doesn’t mean that healthcare professionals will be replaced. Because being a doctor/physio/nurse means that we are more than interpreters of results; we are human beings in communion with other human beings. While the features of AI in clinical practice don’t mean that we’re going to see the replacement of professions, they do mean that we might see the replacement of tasks within professions.

Unfortunately, the article doesn’t get to this point and simply concludes that, because all the tasks of a doctor can’t be replaced, the question is moot. But it’s the wrong question to ask. We’re not going to replace health care providers with smart humanoid robots but we’ll definitely see changes in professional training and in clinical practice.

The implications of this are that, in order to remain relevant, professions in the near future will need to demonstrate an ability to take advantage of the benefits of advanced technologies while adapting and expanding the relationship-centred aspects of health care.

AI clinical research

Survey: Physiotherapy clinicians’ perceptions of artificial intelligence in clinical practice

We know very little about how physiotherapy clinicians think about the impact of AI-based systems on clinical practice, or how these systems will influence human relationships and professional practice. As a result, we cannot prepare for the changes that are coming to clinical practice and physiotherapy education. The aim of this study is to explore how physiotherapists currently think about the potential impact of artificial intelligence on their own clinical practice.

Earlier this year I registered a project that aims to develop a better understanding of how physiotherapists think about the impact of artificial intelligence in clinical practice. Now I’m ready to move forward with the first phase of the study, which is an online survey of physiotherapy clinicians’ perceptions of AI in professional practice. The second phase will be a series of follow up interviews with survey participants who’d like to discuss the topic in more depth.

I’d like to get as many participants as possible (obviously) so would really appreciate it if you could share the link to the survey with anyone you think might be interested. There are 12 open-ended questions split into 3 sections, with a fourth section for demographic information. Participants don’t need a detailed understanding of artificial intelligence and (I think) I’ve provided enough context to make the questionnaire simple for anyone to complete in about 20 minutes.

Here is a link to the questionnaire:

This project has received ethics clearance from the University of the Western Cape (project number: BM/19/3/3).

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Our students succeed despite their education, not because of it

Note: Thank you to Dave Nicholls from the Critical Physiotherapy Network for his insight and comments that helped inform this post.

Foucault said that the most dangerous ideas were the ones that we’re not even aware of; the ones we accept as being fundamentally true. He emphasised the need to examine our everyday practices and to critically analyse the discourses that make these practices possible. He believed that the most powerful disciplinary ideas are the ones that are most benign – the ones that we readily accept. This post is an introduction to a series of critiques (some might say, rants) against the ideas that we most take for granted in our teaching practices. The things that we readily accept as being self-evidently true.

These ideas form the foundation of every professional education programme, yet I will argue that they are also the most dangerous obstacles to real learning. I think that our current educational system not only prevents students from working towards deeper understanding with open minds but actually provides incentives to do the opposite. In this series of posts I’ll present some of the ideas that we accept to be foundational in the undergraduate curriculum but which actually lead students away from developing the outcomes we say we value.

I think that our students succeed despite their education, not because of it.

After decades of research in the fields of cognitive psychology and neuroscience we can be confident of one thing…we can do better. If I look at what a modern health system needs – creative problem solvers, innovative leaders, collaborative team players, critical thinkers – it seems evident that these are exactly the characteristics that our current programmes cannot provide. Our legacy systems are broken, outdated and unfit for the purpose of graduating clinicians with the attributes necessary to address the complex health needs of people in the the 21st century.

What if we designed a curriculum from scratch using everything that we’ve learned from the research into learning and cognition? What would a curriculum look like if we critically questioned every aspect of it, asking if those components lead effectively towards the achievement of our goals? How would we choose the curriculum configuration if we were not constrained by what the institutional LMS and the timetable required? I wonder what a curriculum might look like if it didn’t have to conform to the requirements of a system that hasn’t changed much in 500 years. I think that that it could be an exciting and inspiring thing of beauty.

As a thought experiment I’m going to write a series of posts looking at the ideas that we simply accept as being fundamental to the curriculum, and then argue for why those are the very things that need to go. In each post I’ll take a future position where we have already implemented the changes that I think are necessary, and then argue for why the changes were made. The series is called altPhysio.

Research is about pushing and extending the boundaries of knowledge in order to create new spaces for practice. But despite all the evidence that change is necessary we continue teaching in much that same way that we always have. We’re creating the conceptual spaces for new and innovative practices in physiotherapy education…it’s time we started occupying them.


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PHT402: Empathy and professional practice

This is my first post for the #pht402 professional ethics course that I’m participating in for the next few weeks. The topic for the first week is to explore personal objectives related to empathy and professional practice in the health care context.

384002I’ve been teaching the Professional Ethics course at UWC for five years and have always found it to be both deeply stimulating and deeply unsatisfactory. It’s stimulating because the classroom conversation around morally ambiguous situations is challenging and invigorating. I love seeing the different ways that students think about and respond to ethical dilemmas. However, I was always disturbed when the same students who could tell me about the SASP Code of Conduct and the HPCSA ethical rules of conduct were unknowingly unethical in their treatment of patients. I realised that knowing about ethics was different to being ethical.

As I delved into the problem I became increasingly interested in the concept of empathy and it’s role in both patient care and student learning and have recently begun to explore it in more detail. It turns out that “the roots of morality are to be found in empathy“, conveyed nicely in the quote that Lauren used at the start of her post this week:

When you think like this, when you choose to broaden your ambit of concern and empathise with the plight of others, whether they are close friends or distant strangers; it becomes harder not to act; harder not to help.

I think that this is the crux of what it means to care in the context of health care. To really come to an understanding of what the other person is experiencing. I think that some of these ideas come out really nicely in the conversation happening in the comments on Chantelle’s blog. I can’t imagine a more distressing situation than a mother who is worried about her child. How do you connect with someone who is going through something that you haven’t? How do you say to them, “I understand”, when you don’t? Chantelle talks about the value of human connection and I have to agree with her completely. You can have all the knowledge and skills in the world but if you can’t connect to other human beings, you’re going to be a pretty mediocre physiotherapist.

My own interest in the role of empathy is less about patient contact and more about my interactions with students. As much as I know (and research has shown) that having an emotional connection to your learning is essential, most students have the same challenges as Umr does when it comes to “sharing”. However, even though moving into these personal spaces is difficult, I believe that it is only through developing relationships between people that human beings can truly flourish. As Marna suggests in her post, if you’re oblivious to this patient’s life beyond your doors, it’s unlikely that you’ll make any progress with them. I also believe, as Charde has learned for herself, that connecting with patients goes beyond the simply technical “compliance” rationale and helps to develop a sense of professionalism and deeper, more meaningful engagement with others.

During this course I hope to learn more about how physiotherapy students at the University of the Western Cape think about, and respond to, morally ambiguous situations. I believe that universities are the places where we need to develop the human capabilities that will enable transformative social change and I like to think that this course is one small space where we can give it a go. I will be following as many blogs as I can, reading and commenting where possible, in an attempt to get a better understanding of how students think, so that I can learn how to be a better teacher.

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Complexity theory: learning in unfamiliar contexts

The following are notes I took while reading Fraser, SW & Greenhalgh, T. (2001). Coping with complexity: educating for capability.

During the past 6 months or so I’ve found myself thinking more and more that the way we teach health professionals (at least, in my experience) has had too much of a focus on technical competence, a mix of pure technical skill applied in contexts defined by the students’ basic knowledge base. I’ve suggested in various presentations and conversations that students need far more than the ability “to do” and that we need to shift the emphasis of our training to develop the underlying practice knowledge that’s often hidden in a professional culture obscured from the student. In clinical situations that are often complex, dynamic and multi-faceted, I’ve seen many academically strong students fall apart as they struggle to adapt to the changing context of patient management.

Recently I came across  complexity theory and how it’s use in education could help students move from simple competence (technical skill, knowledge and attitudes) to capability (ability to adapt to change, generate knowledge and continue to improve), and its really helped me in terms of structuring my thinking around the subject. The aspects of complexity theory that appeal to me are that:

  • Systems are constantly changing
  • Those changes are uncertain and paradoxical
  • Individuals within the system are independent and creative
  • Even if problems cannot be solved they can nonetheless be “moved forward”
  •  Solutions may only need minimal specification
  • Small changes can have large effects

I’ve observed these principles in practice but now I have a framework and a language to help structure the observations. So, how can principles of complexity be applied in an educational context? Fraser and Greenhalgh discuss 4 areas that it could be useful, and I was surprised to discover that I’ve been doing some of this already. Below are examples of how I’ve been teaching during this year and how it relates to complex systems.

The first area is in developing capability through transformational learning. One of the biggest problems I’ve faced is in trying to figure out how to teach something that can’t really be taught e.g. changing students’ thinking patterns from “passive-receptive” to “active-interactive”. One of the options is to provide the student with unfamiliar problems or contexts in a meaningful way (this isn’t about throwing the student into the deep end without support). In the Movement Science module I taught earlier this year, I gave the students practical problems that they hadn’t seen before and then asked them to solve the problems using theory (knowledge) and practical techniques (competencies) that had recently been covered in class. There were many acceptable solutions to these problems and many students figured out different ways to get to “the answer”. I’d move between groups to give guidance and answer questions that arose (immediate, contextual feedback is an important component of transformational learning). At the end of the class I asked one group to demonstrate their solution and then showed them how I would’ve solved the problem. I wanted to show them that even though we both used different approaches, and that we applied our knowledge and understanding in different ways, we still managed to “solve” the problem. I haven’t measured the outcome but anecdotally the students seemed to leave with a good understanding of the difficulties involved in clinical problem-solving. I wanted them to see that there isn’t an “A+B=C” solution to managing movement dysfunction.

The second area in education that can be understood through the lens of complexity theory is in relational learning. In the past, expertise derived from “having knowledge”. In an ever-changing world in which you can’t know a fraction of what’s available, expertise has become more about accessing knowledge from different sources. In other worlds, expertise is about forming relationships between concepts from possibly different fields. The relationships between concepts are just as important as the concepts themselves. Again, I’ve used this principle earlier in the year when I gave a concept mapping assignment, also in the Movement Science module, in which students had to demonstrate an understanding of complex relationships between concepts in a clinical context. I realised that although students had a good grasp of the concepts in the module, they weren’t familiar with the relationships between them. Of even greater concern was that many of them were unable to apply their knowledge clinically, even though they had a good understanding of the theory. After the assignment was over, one student told me that this was the most challenging assignment she’d ever done, and then thanked me for it! I’ve read somewhere that students want to be challenged, it’s just that they’ve become used to a system in which being passive can be successful. Without meaningful challenges, passively consuming content is easier than actually trying to understand. I’m hoping that through providing learning activities that push students out of their comfort zones we can help to begin a cultural mindshift within our department.

Non-linear learning. Check lists and clinical guidelines undoubtedly have their place but the problem is that they can only be used after the problem has been identified. It sometimes takes creativity and deep understanding to get to the point where a guideline can be applied. Einstein may have been right when he said that “imagination is more important than knowledge“. The real world is complex and difficult to navigate even with the right competencies, and yet we often don’t equip students to deal with the real world. Often when we try, the simulated environments we use don’t (can’t) come close to what will be expected of them in the rapidly changing clinical environments they will encounter after graduating. Our assessments / practical scenarios are too controlled and standardised. In fact, it’s almost impossible in our curriculum to present the students with non-linear problems because the curriculum is linear. It’s designed as a series of “blocks” of facts that build on each other, which doesn’t take into account the fact that life (and healthcare) aren’t that simple. There might be some way to incorporate non-linear teaching practices through the use of stories and case-based learning. I’m excited about the latter, as we’re introducing some aspects of case-based learning and PBL into a few of our module streams next year.

Process techniques. Building capability can be aided with minimal structuring, which is especially important as we move from mass education to individualised learning spaces. There is a focus on the process of learning, with protected time for reflection (not often seen in healthcare curricula), identified personal needs expressed through a learning plan and some kind of record of progress e.g. a portfolio. In addition, there is evidence that the effects of small group learning can amplify the knowledge of individuals so that the learning experience is greater for the group when trying to solve complex problems. One of the points made by the authors is that emergent learning will not occur merely because the group is formed. I learned this a few years ago when I created a wiki-based assignment with the goal of collaborative learning. Students worked as individuals within the group, not paying attention to each other at all. In retrospect this is probably because I didn’t provide the structure to guide them through the process.

Ultimately, Fraser and Greenhalgh emphasise the importance of shifting healthcare education from competency-based to capability-based assessment. We need to change our assessment focus from knowledge and technical skill to rather measure students’ ability to adapt to changing, complex clinical environments. It’s not enough for students to know what to do and how, they need to know when to do it and why.

physiotherapy research technology

First article published

I just had my first research article published. It’s based mainly on the literature review I did for my Masters degree last year, with a few updates. It’s strange, but when I submitted it about 6 months ago, I thought it was a reasonable piece of work. Reading it now, I feel like taking it back and editing the hell out of it. Does anyone else look back at their earliest work and feel like hiding under a table?

I’m putting the abstract up here in case anyone is interested. The title of the article is “Information and communication technology in health: a review of the literature”.


Information and communication technology has been shown to be increasingly important in the education andprofessional practice of healthcare workers. The World Health Organisation (WHO) discusses the benefits of using ICT in the Primary Healthcare setting in terms of better access to information, improved communication between colleagues, facilitating continuing professional development and providing learning tools for healthcareprofessionals, patients and the community as a whole. This review of the literature describes the role of information and communication technology (ICT) in the education and professional practice of healthcare workers and goes on to outline the challenges facing the widespread adoption of ICT. The conclusion is that ICT does indeed have a positive role to play in both the education and professional practice of healthcare workers, including physiotherapists, as long as it is implemented as an adjunct to established and proven practice, and not a replacement.