Wednesday, December 07, 2011

Elearning and digital (not)natives

I read an inspiring piece at Online College the other day: Emergence of the new learner.   It suggested that the characteristics of the new learner are that they create and broadcast content, they are connected and networked, that they are used to critique and need feedback. Furthermore the new learning environment is peer-to-peer collaborative and process-oriented. This is great stuff and it describes in  nutshell some of the key features of 21st century learning.

Inspiring as I say. Or it would be if I'd ever met a learner like that. OK, I exaggerate a tiny, tiny bit. I've tutored several hundred students in the last ten years, and I've lost count of the thousands who've been in forums I have moderated. I reckon I could count the new learners, as described above, on the fingers of both hands. I have no criticism personally of any of the students I have taught or moderated over the years: it's the way they've been taught.  As the Online College article goes on to say: “We are brought up, educationally speaking, sitting in neat rows and columns of chairs, listening to instructor-driven lectures, and completing multiple-choice exams at pre-determined intervals.” So people do what they have always done. And it's comfortable to do that. This is connected with my previous post about deep and surface learning. Surface learning is alienated learning, in my opinion – it is personally distant, irrelevant, useful only for jumping through hoops and is often jettisoned as soon as the hoop has been jumped. It's boring and the student can often be resentful and less than fully engaged in a task that is necessary because one is in school, but otherwise meaningless. On the other hand, the student is given little opportunity to explore ways in which the tasks might become meaningful, and no incentive either – surface learning is monotonous and featureless, but on the other hand it makes no personal demands. Real learning can shake your soul, and that is a step too far for many people.

Paradoxically, I don't think I can blame their teachers either. Primary and secondary teaching in the UK has improved greatly since I was at school decades ago. My children were much better taught than I was, which suggests that the teachers and the methods are better. But I don't think many teachers get a chance to teach as they are capable of teaching because they like everybody else in the primary and secondary education system, are focused on grades and league tables. It doesn't matter how good or bad a teacher you are, your one and only job is to get good grades, and as many as possible. So they teach for the exam, which is not necessarily the same as teaching for the learning. And that rubs off on the children who get the message that learning is a) not under their control b) not interesting in its own right and c) aimed at getting grades rather than having any intrinsic value. Perhaps I exaggerate. I'm sure I'll upset many a secondary school teacher if they read this. I don't intend to; I think they are genuinely trying to do a good job, but in a situation that militates against children ever being able to take control of their own learning – a key prerequisite for deep learning, and for thinking.

Also, learning happens in the context of a person's whole world. It's not just the teachers that are responsible, but the whole of society. Teachers don't stand a chance if the child they've been teaching goes home and hears what the teacher is doing rubbished by their family, their friends and their media. Our society teaches us how to do things and what things to do – and by “our society” I mean us, not some mythical thing for which nobody can take any responsibility. Driving is a good example. We get taught the mechanics,and a bit about manners, then we go off and drive the way everybody else does, which causes both chaos and carnage on the roads. More on that here and here. I don't want to get into the ins and outs of how we learn to drive, just to use it as an example of how powerful the learning is that we do from those around us.

I teach level 1 modules for the Open University. Most of my students have done no formal learning since school, regardless of what age they are. We get more and more young-ish people coming to us. Out of 25 current students 7 are under 25. That is they left school less than ten years ago. They, like everyone else, still need to learn how to learn. That is the first and most important aspect of my teaching relationship with them. Linked to that is the fact that they do not know how to learn online, and in fact are completely unfamiliar with the online environment as a place of learning. So I need to address both of these issues – learning how to learn, and learning how to learn online.

Learning how to learn is relatively easy to deal with. Every student arrives with their own motivation. There are some who will listen to me and some who will not. I don't mind that, as long as they get what they want. I can enthuse and inspire those who will listen and are open to being inspired. And I can start to teach them the benefits of critical thinking – the ability to look for the bigger picture, the habit of always asking why, the habit of never taking the taken-for-granted for granted, the habit of questioning everything, habits of honesty and objectivity, openness to new ideas, learning to base judgement on evidence. Interesting, isn't it, how many of these characteristics are personal rather than intellectual ones. It's hard work, it's a tough job, but it's relatively easy to conceptualise.

The elearning thing is a bit trickier though. Generally speaking students are not taking to elearning like ducks to water. They do what they have to, and they otherwise tend to ignore it. This is treated by some as a bit of a puzzle, particularly if you subscribe to the digital natives theory, which says that new generations of learners grow up with the online world. They're used to it, so they should naturally be able to learn in it. Doesn't seem to be the case with my students. Doesn't seem to be the case with other students either – there is an interesting survey from Canada – If Students Are Digital Natives, Why Don’t They Like E-Learning? – the conclusions of which are summed up by the title. And in fact the idea doesn't hold water, for a couple of reasons.

First of all, assuming that they know how to learn online assumes that they know how to learn. This doesn't seem to be the case. That is to say, they use a method of learning (everybody does) – usually the surface method, unless they have a reason for getting involved in something when they may well switch to the deep method. But using the deep method involves developing the skills and practices mentioned earlier on, and if people haven't developed those skills through repeated practice, then they won't be as good at it as they could be. That will be less satisfying for them, and it may be that they will drop back to the old, less effective but less demanding ways of learning. Unless they're consistently and enthusiastically taught to learn in this way. (I'll return to that.)

Secondly the assumption is made that if people are comfortable “being” online,  they will be comfortable “learning” online.  It ain't necessarily so. Being online for many people is about chatting and pursuing leisure interests. It is specifically not a place to engage the brain. Engaging the brain involves an entirely different set of habits and attitudes, and it takes an effort of will to move from one to the other – until you get used to it, and then the students will switch from Facebook friends to Facebook tutor groups with the same facility with which I do it. But the point is that they have to learn how to do it, and if they are not given the room and motivation to do it, they won't.

And there I think we academics in higher education, with some notable exceptions, are failing our students. There is not enough alignment in our teaching practices, and not enough acknowledgement of the basic skills that need to be learned by most university entrants. Alignment in teaching practice has been a problem for a long time, and remains a problem. Back in the 70s it appeared that lecturers looked for critical thinking, but taught and assessed conformity in ideas and the acquisition of detailed factual knowledge. (Entwistle, N. (2005) 'Introduction'. In: Marton, F., Hounsell, D. and Entwistle, N., (eds.) The Experience of Learning: Implications for teaching and studying in higher education. 3rd (Internet) edition. Edinburgh: University of Edinburgh, Centre for Teaching, Learning and Assessment. p6.

And now I teach two courses where the importance of working online and collaboratively is acknowledged, and the tutors are required to offer online tutorials, but all the marks are given for traditional written assignments. If you think it's important, you should mark it.

Secondly, we don't acknowledge the need for the majority of our students, of whatever age or background, for a proper introduction to what learning online really means – the ability and the need to both control and juggle the sources and the motivations of our learning. When to put effort into working collaboratively so as to get the benefit out of it and when and how to put the effort into and learning critically so as to be able to take full control of their own lives.

The only question that remains is – is it really that important? If students can still learn satisfactorily in the traditional ways, why not let them do it? Because, rather like all those schools that are only “satisfactory”, it's not good enough. Surface learning is an old skill, suited to a world in which you could be a good worker and a good citizen without ever thinking too much. Deep learning has become a necessity for surviving in this world, both as a worker and as a human being. Students can get by making use of their education in a second rate way just as they always have done. And in some ways governments would rather they did – they don't want questioning, persistent, well-informed citizens, they want compliant ones. But for us as individuals, we have two choices, we can stagnate, or we can take control of both the style and the environment in which we learn. That means getting on top of the manifold ways in which data and information are spread across the internet, and learning how to evaluate, manipulate and deploy them. Doing any less means second tier jobs for second tier citizens. So, yes, it is important – important enough for us to insist that our students get the best they can out of both learning and elearning.

Deep and surface learning

We've been considering issues about deep and surface learning on H812. Good course, H812, but deceptively quick. It's very part time,  takes two years, one assignment every three months or so – it's a doddle, I thought. But the weeks fly past with a new topic each week; blink and you miss one, and at my age I blink a lot. Deep and surface learning attracted a lot of chat, and at least one misconception.

There's a very good summary of deep and surface learning at the HEA: Deep and Surface Approaches to Learning.   It gets the distinction right between deep learning being critical and surface learning not. The misconception I referred to above was that some people thought that wide learning entailed surface learning, e.g. For a law student who needs to learn by heart a number of not very well connected cases, it would perforce be surface learning. I don't see it that way at all, and I don't think inventors of the distinction thought so either. Even if you're skating the surface, you can learn deeply. It's not about what you're learning so much as the way you do it. To take the law student example above, learning case law is a gritty but necessary undertaking. Broadly speaking, you can either learn a series of unconnected names, dates,  principles and applications, or you can learn each case as a contribution towards a (probably fuzzy) understanding of an area of law that may connect eventually to other areas, where you can see the principles operating in similar ways, although in completely different spheres. The first student may well turn into a competent lawyer. The second is likely to turn out to be better,because they understand better the way the law works.

It's interesting that the HEA page concentrates on the meaning of deep learning rather than surface learning. It has a list of the characteristics of surface learning, but, other than that, doesn't go into much detail about it. I would have thought that the primary concern for teachers was how to turn surface learning into deep learning wherever possible. For that we need to understand what surface learning is – what motivates it and embeds it into a student's practice.

For me the key characteristic seems to be that it is a disengaged form of learning, learning that does not involve the student, that is kept at a distance from the student's being. It enters their mind, in a special compartment, marked “Nothing to do with me”, and sits there until the student has been examined on it or leaves school, whereupon it instantly self destructs. But it never enters their soul.

In my view, far too many people learn to learn in a surface way. I'll sketch the reasons why this is in another post, but for now I'll just take it as a given – to go into the reasons in detail would take far too long. Regardless of what the reasons are, that fact is a big influence in determining how we need to teach. One of the big debates of course will be whose responsibility it is – there will be those who say that if a student is learning in a disengaged way, it's only their own fault – they should take responsibility for themselves. And there is a tendency then to say that they should dig themselves out of their own hole. I don't think that follows. To me it doesn't make any difference whose fault it is; we still have to teach in a way that will re-engage them if it is possible.

There are two elements. One is attitude, one is skill. To learn at a deep level, you need an attitude of engagement, and you need the skills to learn. Your attitude can be influenced by your teacher, and the skills can certainly be learned under your teacher's tutelage. So that's our job as teachers sorted.

Saturday, October 29, 2011

Identity, place and Eastbourne

More pics from Eastbourne, this time of interest to DD101 students, on the creation of identity and difference. In this case what we're looking at is the manufacturing of identity, and of difference, through the artificial creation of individuality. I came upon this gated housing estate being built while I was out for a walk.

First, they picture the beach and the sea at Eastbourne. This estate is miles from the sea. The word "Heights" in the name is a bit of a giveaway.

This manufactured community is intended for the over 45s only. No audible children or music etc. (Click on the image to expand it, and you will see the legend on the side of the van.)

This is where it gets really artificial. The estate is still being built while some people are already living there. The bungalows are being built and sold with their own "individuality" already established. This one is sold with its Chinese themed decoration ready installed. The next one, difficult to see here, has, with calculated incongruity, a Beatrix Potter theme. And so on down the street.

I don't know how long this shed has been in place, but not long enough to grow all the creeper. That was installed along with the shed.

Part of this is about the manufacture of community by putting up buildings, putting a (admittedly porous) fence around them and artificially delineating who should live in them. All of those are grist to the mill of the social science student. But in this case there's a specific application to the first few chapters of DD101, where the theme is difference and inequality. In this case the developers, as well as manufacturing community, are manufacturing difference - or to put it another way, manufacturing individuality. Treat it as a street, like the streets you've been examining so far in DD101. But note that this time any differences or individualities you see in the exterior of the bungalows has been put there deliberately and randomly by the developers.

The seaside

Just some shots I took at Eastbourne the other day.

They make a different class of beach hut there (running water and gas supplied).

They have their own tea chalet round the back. The Union Jack provides an extra touch of something.

And a Dotto train.

There's a very nice pier, and some winches. These are not like the winches at Hastings, which will be illustrated later.

Judging from the rust on the wire, these winches don't get used much.

This is an exercise in the creation of a seaside place and experience. The tea chalet, the train, the pier, and the winches all recall the nineteenth century creation of the seaside atmosphere. It's soggy with nostalgia, to quote Tom Lehrer. For AA100 students there's a lot here than resonates with the material in Book Four.

Monday, September 19, 2011

International Teach Like A Pirate Day

I'm very disappointed that nobody responded to my eloquent post in the #change11 Facebook group about International Talk Like A Pirate Day. So I thought I'd up the ante by blogging about teaching like a pirate. I don't mean charging into the room shouting "'Zwounds", and "Harrrr", and "Shiver me timbers", complimenting all the women on their buxom figures, and crossing swords with all the men. Though that has a certain appeal compared to some tutorials I've been involved in.... I just wondered how far we might get by looking at piracy as a metaphor for teaching. First of all, piracy is a subversive activity, and a lot of teaching nowadays is subversive. Is that a good or a bad thing? I'm sorry to say that in most circumstances it is a thoroughly good thing. Sorry because I wish it didn't have to be. But we live in a world where more and more people seem to be concerned to tell people what to think rather than telling them how to think. For me the essence of teaching and learning is that the learner ends up with their own view of the world and the mental equipment to analyse and evaluate any situation they are faced with. It doesn't matter how many A stars you get; if you can't do that, the learning has failed. Pirates live by their own rules. There are many examples of pirate codes. And teaching nowadays involves many collaborative activities, and many classrooms, particularly online ones, in which the rules are negotiated rather than laid down by a person in charge, thus this part of the method seems to fit quite aptly. Anyone can be a pirate. You just need to know how to buckle a swash. And anyone can be a teacher. Not all are called teachers by any means, and not many go through the qualification process to get a certificate that says you know how to teach, but we now demand a lot more from our students in terms of being teachers as well as learners. Two sides of the same coin, and for far too long we've only let students be one side of the coin. Pirates like dressing up in funny costumes and blowing things up. Well, OK, not all teachers would go that far, but we do stretch the boundaries of what's expected from time to time. Actually some of my best teaching has involved dressing up. That's part of transporting the students into a situation where they live the history they're learning. (As for blowing things up, I took a science course a couple of years ago, at the age of fifty-ahem, to fill in some of the gaps left by my lamentable approach to science when I was at school. It was the OU's S104 Exploring Science, and I loved every minute of it. I have only one regret about it, which is that we didn't get to blow anything up, though I very nearly did with my potato in the microwave experiment.) Pirates don't flinch from a challenge. Teaching is a profession of being constantly challenged. Oh, yes, those long holidays, the easy life, regurgitating the same lecture every year..... If only. Our own learning is a constant challenge, and every bunch of new students is a new challenge as to how to get the message across, how to get them learning and being responsible for their own learning in their own way. Pirates never known where they're going to be tomorrow. Nor do teachers. Any class you start may take you in an entirely different direction to the one you intended. Sometimes you have to bring the class back to the learning outcomes, but even so the way you get there can be astonishingly varied. So, are teachers like pirates? We are quietly subversive, and, more and more, we make our own spaces in the world. Rather as there is a public sphere and a private sphere, perhaps what we have, or can occasionally create, as we do with this MOOC, is a collaborative sphere, in which we agree our own rules, make up our own journeys, and have a jolly good time.

Saturday, September 17, 2011

MOOC thinking #change11

I am a teacher and a lifelong learner. I learn when I teach. I learn sometimes in the interstices of teaching. Sometimes I learn for teaching. Sometimes I learn just for the sake of it. I've signed up for #change11, the MOOC to end all MOOCs. Though I shall be disappointed if there are no more MOOCs.
I still have no idea what I'll be focussing on when the MOOC happens. I've been thinking about my academic priorities for this year (apart from making sure all the students pass...). Here's a short list:

To enable students to be proficient learners whenever and wherever is appropriate
To change their view if the world, to include critical questioning of the taken for granted
To enable students to communicate clearly and purposefully
To link the purposes of education - work and citizenship

Surrounding all these ideas is the issue that technology is changing the way we learn and teach, and shifting us towards more co-operative, more collaborative ways of working with a much more nuanced attitude towards knowledge and authority. These inevitably change people's reactions to the authority and knowledge found in the workplace and in the political sphere. So I want to examine what difference that makes.

I think my third and fourth points will be priorities for the MOOC. Enabling students to communicate is for me about academic voice, finding their own way to communicate with academic language rather than just taking on the words and producing alien writing - how to be themselves as academics. (While refusing to contemplate the horrors I just visited on the English language in that last phrase.) Working online gives learners more and different ways of expressing themselves, and thus changes the way in which learners develop their voice.

The fourth has been a bother to me for a long time. On issues like this I often find myself to be an uneasy liberal. I much prefer people to learn because they want to, not because they have to. And because it improves them, not because it improves somebody else's profit margins. Apart from anything else, it's more effective. But I have no problem teaching people to be good workers. I concede there may be a difference between what I mean by a good worker (thoughtful, critical, purposeful) and what governments and employers mean by a good worker (skilful, compliant). If I'm teaching someone to use their brain, their critical faculties, I'm teaching them to be a better worker, whether their boss likes it or not.

I also think that learning in formal and semi formal settings must usually have some purpose beyond the student. It can be very satisfying to learn something for my own sake, but given that we are usually spending someone else's money, I don't find it sufficient to say that learning for its own sake is justifiable. (or if the learner is a net tax payer, then a lot of other people are spending their money.) I like the idea of learning for citizenship. People who hone their brains become better citizens, because they can better judge the options before them and their governments, question more cogently the evidence put before them by experts (and by charlatans posing as experts), and arrive more conclusively at decisions that need to be made. (again probably less to the liking of the powers that be than to me.)

So the two purposes amount to the same conclusion about what and how to teach and how people should learn. There's no contradiction, but rather a unity between the purposes. That sounds very nice as a statement, but I want to be able to back it up with better evidence and argument. So that's what I think I'll be focussing on in this MOOC: a small sector of how technology affects the methods and the purposes of learning.

The force of water

This is a splendid example of the force of water in action. The place is Crackington Haven in Cornwall, where a very small river runs down a steep valley and into a pool near the beach. The water in the pool seeps through a bank of sand and pebbles, and trickles out onto gently sloping sand which stretches seawards several hundred yards when the tide is out. It faces west so low tide on a sunny evening is the essence of holiday. In October 2010, after some steady rain, the pool filled and burst through the pebble bank. On the first night it cut a channel about two feet deep through the top of the beach. By the next day it was three feet.

Here is the pool at the bottom right and the new river flowing upwards to the left.

This and the last shot show the river flowing. It's not very fast which makes the shifting of sand and gravel even more impressive

These two shots show the river at about three feet deep 24 hours after the breakthrough

And on the next day the depth of the channel is six feet. So it's taken a not very fast flowing river 48 hours to cut a six foot channel through some pretty hefty building aggregate. (note: the people in the shots make it look a lot more than that – they are out of proportion. I didn't have a friendly victim with me who was prepared to stand in the river to give a proper impression of the scale.)

It didn't take the sea long to put it back together over the winter though. Here is the beach today, once again filled in.

And to finish some rock formations with a difference.

And another, particularly appealing, rock from a few miles up the coast at Widemouth Bay.

Thursday, July 14, 2011

The Tao of spelling

Conclusive proof that spelling matters arrives in the form of an analysis done by Charles Dunscombe and highlighted by the BBC. He says that spelling mistakes cost companies business on the net. For instance, the specific impact on one company was that sales doubled after a spelling mistake on the sales page was corrected.  If it has such an effect on internet sales, we can extrapolate the effect on job applications, for instance, or reports.

I am forever telling my students to check their spelling. I don't expect people to actually be able to spell nowadays (more's the pity) but I do expect them to take a tiny (I emphasise the word "tiny") amount of trouble to use their spell check and to take a little more trouble to get used to things like apostrophes - check whether they're using "it's" meaning "it is" or "its" meaning "of it". I even give them a very limited set of handy hints (behind the OU firewall). I am usually talking to a brick wall - I make the same corrections at the end of a course as I do at the beginning. I need different strategies.

I am thinking of rules:

1) If I find mistakes a spell check would have picked up, you will lose marks
2) If I tell you a rule, like how to distinguish "it's" and "its", you will lose more marks.

But basically the  skills for students are simple:
a) if it doesn't matter to you, make it matter, because it does
b) use the spell check before submitting the assignment
c) make a note of mistakes you make regularly and keep it pinned by your monitor
d) get to know my wiki, or another site like the University of Bristol's Improve Your Writing and make continuous use of it.

Meanwhile I can link to another story here, the one about the Swiss political party that has been set up with only one policy objective, to ban PowerPoint. Read the article here, and check the first line of the story.*



*If you don't see it, check the spelling of "soul".

Tuesday, March 22, 2011

The Tao of “incredibly”

I have only recently begun to pay proper attention to the conventions of academic writing. It's not something that I have covered systematically with my students. I tend to take my cue in this regard from the material in the courses I am teaching. But recently I have begun to realise how important it is. Academic writing has its own conventions and its own style. It is important for students to develop their own academic voice as they progress through their studies. I do believe, firmly, that it should be their “own” voice, not just one in which they have taken on the jargon of whichever academy they're in, made completely impersonal. There's a debate about whether academic writing should be impersonal. I tend towards the view that it should be formal but not necessarily impersonal. I know many will disagree with me, but the search for impersonality eventually removes the soul. In my opinion. It's very important, I think, for academics, among whom I include students, to speak in their own voice, although with the register of the academy.

The key characteristics of academic writing are that it is:
- formal. It uses proper sentence and paragraph construction and relatively formal language – not colloquialisms etc
- precise – where description is concerned it must be accurate
- tentative – when conclusions are being drawn, they should not be too definite – in academic study all conclusions are hypotheses, there to be tested, ready to be disproved. Thus we say, for instance, “This suggests that...” rather than “This demonstrates that...”

The reason that I have been thinking about this just lately is that I have noticed more of my students using the adverb “incredibly” in their assignments. I have begun to score it through and write “No, it is not” beside it. This word alone has finally made me decide to pursue the issue of academic voice properly.

Note to students. If you have used “incredibly” in one of your assignments, you have used it in a place where it cannot possibly mean what it says. For instance, “The Benin bronzes are incredibly beautiful”. The bronzes are there in front of you, they are beautiful. Their beauty is, self evidently, credible, otherwise they would not be there. The word “incredibly” is not just loose, it is actually self contradictory, and completely useless in this context.

The reason students use it is that, of course, it is popular in common parlance. I don't mind that. Ordinary language uses words loosely, metaphorically, poetically, and develops with them all the time. What it gains in mood, spontaneity and timeliness it loses in precision. You do need to lose some of the spontaneity in order to gain precision. But if you gain precision, your vocabulary expands, because the riches of the English language lie within your reach. Think of the words you could use to describe the beauty of the Benin bronzes:

amazingly, astonishingly, especially, fabulously, strangely, uncommonly, abundantly, conspicuously, eminently, emphatically, exceedingly, exceptionally, extremely, highly, immeasurably, immensely, incalculably, incomparably, inimitably, intensely, notably, powerfully, remarkably, strikingly, superlatively, supremely, surpassingly, tremendously, extraordinarily, greatly, highly, noticeably, particularly, profoundly, superlatively, surprisingly, truly, unusually, wonderfully....

You could even use “very”.

But do not use “incredibly” in an assignment. Ever.

Tuesday, March 15, 2011

Tool and use

While at ICEW, I heard two presentations in succession about the benefits of mhealth – what the use of mobile phones, particularly 3G, could be for patients. All sorts of ideas mentioned and all sorts of benefits. I found it very exciting but a colleague sitting next to me found it difficult because there were so many problems of implementation in the way. One he suggested, which I agreed with, is that so much depends on how medical personnel use the technology, which made me instantly think of my own surgery back home. This is good activity theory territory; how people use the tool determines the object of the exercise.

One person here talked about emailing his doctor and getting a reply back by text. I can't do that. I live in the richest corner of one of the richest countries in the world. Our doctors refuse to use email with patients, and haven't even heard of texting. They have a wonderful patient appointment system, but the patients aren't allowed to use it. They have to go to the surgery or phone in to make an appointment. If you're ill you don't want to go to the surgery just to get an appointment, so you phone up first thing in the morning along with everybody else, and you have to keep phoning or leave the phone on ring back for 20 or 30 minutes till you get through. And this is to a village surgery with six doctors and about as many nurses and support staff. They even now have a computerised arrival system, a big plate by the front door with a note on it that say “Touch the screen to arrive”, (which is a bit disconcerting because I have arrived, otherwise I wouldn't be standing there reading the screen).

When I'm in the surgery, I get to know a lot of other people's business. The receptionist takes phone calls and starts talking to the patient about what the condition is. Often the receptionist has to speak loudly and clearly, so everybody in the waiting room can hear and can deduce the caller's identity and condition. There is plenty of technology available that could reduce that loss of privacy, screens round the phone, boosters for the voice so that the signal could be increased rather than the receptionist having to shout but the surgery has never considered installing any of it. (I have great respect for one of the receptionists who has developed a linguistic and grammatical technique that enables her to get information from the caller without telling the rest of the room what that information is.)

All of this technology has been used in this surgery for the benefit of the staff, not for the patient. The communications technology is used to keep the patients at arm's length. Technology that could be used to protect patients' privacy is simply not used. It's a clear lesson that technology never works by itself. If you make a piece of technology available, you always have to take into account how people are going to subvert your intentions for their own purposes.

Monday, February 21, 2011

Patient safety

Our first speaker, Uma Nambiar, noted that clinical engineers have to make their value obvious in the medical hierarchy. She suggested that one way to do this would be to make clinical engineering patient oriented, specifically to assert that clinical engineering is about patient safety. Another speaker mused about how the Indian clinical engineering profession might get there, given that he thought Indians had a cultural problem with safety, using the way Indians drive as an example. This gave me pause for thought on the basis of what I had already concluded about Indian driving. There are two ways to approach safety. One is to prevent accidents happening, and the second is to deal with the consequences. Our second speaker mentioned people not using safety belts and cycle helmets – that's minimising the consequences. There is some evidence that minimising consequences actually makes people drive less carefully as they begin to believe they will not get hurt. My view is that it's not a cultural thing so much as an economic thing – safety features in cars, good maintenance of buses, proper replacement of tyres, rebuilding of roads all prevent accidents but don't happen unless they can be afforded. In terms of culture, if anything it goes the other way – Indians, possibly because of their culture, are, in my view, better drivers than people in the UK are.

In terms of patient safety that made me think that there is probably an Indian way of doing patient safety. It will be different from the western way, it will have different strengths and different weaknesses, but it will work better in India becvuase it will be specifically Indian. Western patient safety is based on two principles which are not encessarily the most effective. The first is the highly materialistic Judaeo-Christian life model of western culture in which everything that can be done must be done regardless of the cost in money or the patient's dignity. The second is that a lot of safety features, devices and practices are not about patient safety so much as about doctor safety – there for the purpose of vitiating litigation. It may even work against patient safety in the long run. I would not like to see either of those features replicated in other countries.


My first impressions of India are of a country that I really enjoy and that will continue to grow on me. I've been here two days and seen only urban India in Delhi and Pune. Many things strike me; it's not as hot as I expected – I came at the right time of year. The food has been good, and I have found so far, as I expected, that Indian food in India is very different from Indian food in the UK. All the Indian people I have met so far speak to each other in Hindi, and to us in English. All of the big advertisements round about are in English. I have found some things quite disconcerting. I haven't been bothered about the juxtaposition of poverty and wealth; that is so well known already that direct exposure to it is not a surprise. The way in which streets and spaces are organised was a bit disconcerting but I am getting used to it. I can't quite get my head round the sudden appearance of a shack or a sales pitch in the middle of rubble.

I have had just a surface view of India so far – I have seen a small group of students, professionals and intellectuals. I have mixed with hotel and restaurant staff, and I have seen life on the streets – the driving, the way people walk, the selling of wares on small scales in Hindi and large scales in English.

I feel a clear sense of Indian identity very present to me. I have not been able to define it but there seems to be something very specific and Indian about the way everything is – the way they dress, particularly the colours, the way they talk, the way children behave, the language they use in advertisements and newspapers and on television, their sense of their own history, their sense of themselves, a certain way of mocking their own weaknesses. The history was also very present and real to me, in the tourist places I visited. At Qutb Minar I felt I could see how it would have been when it was built, how the whole place would have been when alive and functioning. At India Gate I felt a sense of profoundness at the guarding of the memory of those who have fallen in India's wars. The memorial was so like others in Britain, France, Germany, the USA, and yet it had an Indian stamp. At best I can express it as a certain sense of warmth and centredness about the people I see all around me. It made me wonder about the relationship between India and the force of globalisation. It seems as if cultural globalisation has just bounced off the surface. The McDonalds, the Costas and the Dominos Pizzas are there but they haven't wormed themselves into the Indian identity the way they have done in some countries. So there is a very different relationship here, it seems, one in which the Indian identity is maintained and vibrant. Some things are the same all around the world. People in India want to get rich and want to have a good time. They are attracted towards certain western products, and lifestyle – I see it in the apartments, the clothing, the cars, the lifestyle that is offered on the big advertisements, but I see no danger that it will ever suck their soul away.

India, driving and order

I really like India. Our schedule left us time to sightsee in Delhi on Saturday afternoon, and in Pune on Sunday morning. In Delhi we saw the Lotus Temple, the Qutab Minar and the India Gate. In Pune we went for a long drive to a monument and found the road to get there was shut. But we spent a lot of time driving, and that was really fun. The first thing that strikes the English ear is that they use their horns a lot. The second thing is that they need to because lane discipline is an alien concept here. To the English sensitivity the whole thing seems to be entirely chaotic, and possibly quite intimidating, but after looking for a bit longer, I realised that it is very definitely order, just not as we know it.

I've only experienced urban driving in India so I don't know what it's like on the motorways. But urban driving in India is alert, purposeful and highly collaborative. They are better drivers than most UK drivers. Not just because they have to be; I think there's an element of choice about it too. First of all, to describe it.

They drive very close together, both side to side and front and back, much closer than would be tolerated in England. If there is a gap they go into it, regardless of how narrow it is or whether it is between lanes. They drive on the wrong side of the road, even when traffic is coming directly towards them; by the time it gets there they have melted back on to the right side of the road. If they want to pull out into the traffic, either from the roadside, or a minor road, they do. The oncoming traffic flows around them. They hoot for information, not out of vexation. They hoot to let people know they are there. Auto rickshaws and trucks often have painted on their back “Please hoot”. I've never yet heard someone hoot in anger, despite all the manoeuvring and proximity. In Britain we use our horns to tell people they have annoyed us, though my British readers might be interested to know that the official meaning of a horn sounding, as in the Highway Code, is “I am here”, exactly as they use it in India. That was the first thing I really noticed, that the sounding of horns was not an argument as it would be in the UK, but more like a constant conversation. When they drive into a space other people may hoot at them, but it's to let them know that they are very close. They are often driving at 30 mph about 3 inches apart, they are constantly manoeuvring to avoid things ahead of them, and things behind are constantly manoeuvring to avoid them.

So they have to be alert to what is going on around them all the time, they have to anticipate things happening from any direction, they have to be purposeful to make progress, and they have to drive with restraint in order to let all the other drivers around them make progress as well. And they have to be capable of driving inches apart from everything else on the road. They do so very successfully, and I don't think many British drivers would do nearly so well.

Possibly one of the reasons is the different forms of transport. There are cars buses and lorries as in England, there are more motorbikes and scooters, and more bicycles. And of course pedestrians. There are also bicycle rickshaws usually pulling large and heavy loads very slowly, and auto rickshaws, which are little more than 3 wheel scooters. So there's a combination of small and slow vehicles for everyone to negotiate.

The second reason is that very few people are concerned to get to their destination as quickly as possible. In the UK we tend to regard everyone else on the road as an encumbrance. In India they seem to recognise that everybody is trying to get somewhere, and they aren't the most important person on the road. There may be a cultural element in there somewhere, something to do with British culture being very individualistic, whereas Indians are by and large more attuned to collective responsibilities. Although we don't think of it as such, road driving is a highly collaborative activity. Watching traffic at a busy roundabout, say, you can see how drivers co-operate with each other to get everybody through in an apparently random but reasonably fair way. It may also be noticeable that the driver who tries to jump the queue, of whom we have many in the UK, slows a lot of other people down. Individualism can actually prevent people getting what they want in the most effective and efficient way. In a way, seeing how others drive is most influential as a way of reflecting back on how we drive.

The final factor, I think, is about awareness. I have no idea about conscious awareness in Indian drivers. It is certainly high in practice as the lack of accidents in Indian driving. In UK drivers it is lamentable for the most part. Whatever we're taught in driving lessons we forget as soon as we have passed the test; I have met very few British drivers who feel any need to actually concentrate on their driving when they are driving. I get the impression many think that would be a waste of time they could much better use chatting to their passenger, talking on their mobile, whether legal or not, listening to the radio or just day dreaming.

But to return to my original theme, that of order, I see in the Indian situation something that in British eyes would be simply chaos, but which is in fact very well ordered behaviour by thousands of people all in a very small space. It is, in fact, ordering of the highest quality, just different to the we do it in Britain. That in itself raises different questions about how we perceive order. There are very clear and powerful cultural influences on what counts as ordered and as disordered in different situations.

Friday, January 28, 2011

Egypt / AL Jazeera / media power

I'm watching events unfold on the streets of Cairo on Al Jazeera. They have just put up a side by side feed of what their camera is showing, and what Egyptian state television is showing. It's a very good illustration of the power of the media.

The reproduction here is not so good. The one on the left is Al Jazeera showing a police vehicle that has been set on light by the protesters, and is part of a rolling montage of clips of crowds, destroyed vehicles and burning buildings. The local commentators are also referring to explosions and the sound of gunfire. The picture on the right is Egyptian state TV, taking film, according to Al Jazeera, approximately two hundred yards from the Al Jazeera camera. It shows peaceful scenes across Cairo with no sound feed.

The average Egyptian citizen, if they can't hear the sounds from their own windows, might be forgiven for thinking that nothing is going on. There is the power of the media.

Meanwhile, media or no, protests are widespread across urban Egypt (there is no word of what is happening in the countryside), and the regime has taken time to catch up. Now there is an internet black out, and much mobile coverage is down. But it appears to be too late. People are on the streets, it appears, not because they have been called out by opposition parties, but because they are fed up. The regime has not been able, or has not felt able, to instruct the police to be violent. The army has just moved in to Suez and Alexandria, and is being welcomed by the protesters. Neither police or army is making any effort to enforce the nighttime curfew that was ordered today.

Perhaps they're too busy wondering how to react to Hillary Clinton's statement this afternoon that there has to be reform in Egypt. A mainstay of their international political support is detaching itself, and they have nothing to replace it with. I'm guessing right now that mubarak will be gone very soon.