4 th National CPD Conference CPD in an Information Age

1. 4th National CPD ConferenceCPD in an Information Age Rachel Ellaway Ph.D. Assistant Dean and Associate Professor, NOSM

2. Disclosure statement I have no involvement with industry or any other entity that constitutes a conflict of interest to disclose with respect to this presentation.

3. Overview An information age What is needed is changing What is wanted is changing What is provided is changing How it is provided is changing Who provides it is changing Impact and evaluation is changing The context is changing We are changing

4. Objective Participants will be perplexed, scared and exultant in equal measure Participants will want to rip everything up and start again Participants will realise that they are already doing pretty well Participants will be able to situate CPD in this information age …

5. “the future is already here -it’s just not evenly distributed” William Gibson

7. Everyware Internet transforms: • Ambient and exponential connectivity • Accelerating speed of action and response • A reach that defeats geography and temporality • Remediation of social conventions - hiding, blurring and flattening • Detailed tracking that changes accountability, privacy

8. Virtual Society? • The uptake and use of the technologies depend crucially on local social context. • The fears and risks associated with new technologies are unevenly socially distributed. • Virtual technologies supplement rather than substitute for real activities. • The more virtual the more real. • The more global the more local. Woolgar, Steve (Ed.) Virtual society? Technology, cyberbole, reality. Oxford: Oxford University Press, 2002.

9. A Digital Age? • Organizational change: e-health, e-learning, e-research and e-administration • The digital is not just instrumentation; external to us and separate from our identities and values • We weave the digital into most if not all aspects of our lives • The digital weaves itself around us … • … it becomes a part of us • … and we a part of it

10. What is needed is changing

11. All change Many areas, but particularly: • Digital literacy • e-health • e-learning and e-teaching • Digital professionalism • Limits to training

12. Digital literacy • We are currently training the last generation of physicians who can remember a time before the Internet • Do you exist if you’re not online? • Reappraising medical practice in the context of a digital society • Digital literacy a core challenge for CPD

13. e-health skills • We are currently training the first generation of physicians to practice in an e-health world • e-health investment tends to focus on big technology rather than humans • Danger of operator training only • Underlying need for safety and competence in an e-health practice environment • But not clearly identified • What role CPD?

14. e-learning and e-teaching • e-learning (what learners do) vs • e-teaching (what teachers do) • Teaching skills in a post-LMS age • Example: learners learning with technology at the bedside • Digital learners as digital teachers • Education informatics skills • What role CPD?

15. Public and Private • Social networking tools lay much of our lives open to public view • We fluidly, perhaps uncritically, intertwine our online personas with those of others • Particular challenges for professionals • What boundaries remain (if any) between professional and personal lives • There is a vacuum of guidance for professionals in the digital world

16. Digital Professionalism

17. Digital Professionalism • We used to punish poor communication skills or professionalism even though we had never taught it • We like to think we are enlightened • Should we not model, assist and guide professional digital professionalism?

18. DP#1 • Establish and sustain an on online professional presence that befits your responsibilities while representing your interests … but be selective where you establish a profile 1

19. DP#2 • Your professional identity extends into all online communities you join, and you are still a professional there 2

20. DP#3 • Do not make public anything that you would not be comfortable defending as professionally appropriate in a court of law or in front of a disciplinary panel 3

21. DP#4 • Think carefully and critically about how what you say or do will be perceived by and reflect on others, including individuals and organizations. 4

22. DP#5 • Almost everything online can be monitored, recorded or data mined by multiple groups. Treat every online action as permanent. 5

23. DP# 6 • Do not impersonate or seek to hide your identity for malicious or unprofessional purposes. 6

24. DP# 7 • Be aware of the potential for digital attack or impersonation. Know how to protect your reputation and what steps to take when it is under attack. 7

25. DP# 8 • Theft and piracy are not acceptable for any professionals. Work within the law. 8

26. DP# 9 • Patient information = patient • Do not expose information to unnecessary risk and consider wisely the potential impact of any use or exchange of information you make 9

27. DP# 10 • Behave professionally and respectfully in all venues and using all media • Take responsibility for modeling positive digital professionalism to others. • What role Canadian CPD? 0

28. Limits to training • Training is essential – improves competence • Training is effective at reducing mistakes • … but not slips (inattention) and lapses (memory failure) • We need to accommodate other dimensions of CPD … • Human factors

29. Human Factors • Innovations usually do what they are supposed to do, but often with latent consequences that can manifest in unexpected ways • “human error is not a cause of failure but it ends up being a symptom of failure” Scerbo, 2012 • CPD needs to consider increasing awareness and capacity to deal with human factors issues • Tied directly to quality improvement: • mechanism <> outcome <> context

30. Needs are still emerging • Social media • e-research and e-scholarship • Platform woes have not gone away: • Was Win vs Mac now IOS vs Android • Are you asking the right needs assessment questions? • Do your respondents know what to ask for? • Do you need CPD to orient your learners to their new needs?

31. What is wanted is changing

32. Net Generation CC image: x-ray delta one http://www.flickr.com/photos/x-ray_delta_one/4999806047/

33. Net Generation • Digital Immigrants and Natives, NetGen etc • Mostly spin • Youth have ++opportunity but low risk • Confidence >> competence • 1:1:1 • Medical learners very atypical of the broader population • Not just a med student issue • Junior doctors are becoming more senior • Expectations are changing across the board

34. Expectations • Low tolerance for poor usability or design • On demand • Ambient • Set down and pick up again • Adaptable • Point of care • Social • Integrated • Experience – convenience - presence

35. Experience and convenience  • Convenience economies: • Ease of use and adaptability the main drivers • Collaborative peer-peer consumption • CPD follows organic peer-peer interactions? • Experience economies • ‘User’ experiences become valorized • Not just the content but the whole experience • ‘Authentic’ and exclusive experiences • CPD in unusual but transformative locations? • CPD involving unusual but transformative activities?

36. Economies of presence • Rather than a retreat to the virtual we value personal and f2f more and more • Although digital forms are often more convenient, inconvenience also has value: • “discussion about our digital future always assumes we seek more convenience and fewer obligations. But technologies of connectivity can threaten stability and community. We may need a new ethics of inconvenience” • Sometimes you really have to be there Davies, W. (2006). "Digital exuberance." Prospect (119): pp30-33.

37. Value networks • Christensen: problem solvers, fixed service providers, value networks • Social media is based around value networks: • Congregating with your peers • Convenience, return on effort • Growth of VNs – CHEC-CESC • CPD value networks more effective and sustainable than shopping lists? Christensen, C, Grossman, J H and Hwang, J (2008). The Innovator's Prescription: A Disruptive Solution for Health Care. New York, NY, McGraw-Hill.

38. The Long Tail Facebook everyone else the successful few

39. Migrant eLearners • Learners (including the CPD audience) are often not where you think they are • Self organizing, supporting, exchange, creation – but NOT in the institution! • Social technologies as extensions of ourselves – gestalt, hive minds, collectives • Binding and norming • What is the role of the CPD provider? • Where do the new CPD consumers go? • Do they want you there?

40. Cyborgs “our tools are not just external props and aids, but they are deep and integral parts of the problem-solving systems we now identify as human intelligence …” Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5

41. Cyborgs “… such tools are best conceived as proper parts of the computational apparatus that constitutes our minds” Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5

42. The Cyborg Professional • information technologies are cognitive prosthetics • both professional and profession are changed • Communication prosthesis • Logistical prosthesis • Knowledge prosthesis • Social prosthesis

43. What is provided is changing

44. From content to activity • Combination of improved instructional design and use of technology • Better understanding of cognitive behaviours and capabilities • Beyond content to activity design – simulation and active learning • Recognition that availability of information ≠ learning • Activity design the new challenge

45. Blended and hybrid CPD • Many ways of being blended: • Co-present participants combine online and offline activities • Learners are co-present and remote • Teachers are co-present and remote • Hybrid when learning is combined with other activities • Bursts and microlearning – point of care

46. Blended learning f2f self-paced collaborative

47. Blended learning F F S C S C F F S C S C

48. It works best when mixed • Mearns et al 2009 – e-learning works and it works best in blended settings Means, B, Toyama, Y, Murphy, R, Bakia, M and Jones, K (2009). Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies. Washington DC, U.S. Department of Education

49. Provision is changing

50. Authority …