I have observed that great clinicians
Pay attention to the fundamentals
in their Knowledge base AND
Pay attention to details
in Patient care
Wednesday, May 30, 2012
Sunday, April 29, 2012
Choosing Wisely
Laboratory tests and imaging studies came in as extensions
of our sensory system. Technology came in to extend the reach of these tests to
smaller and smaller dimensions and to deeper and deeper parts of the body and
to explore individual organs with the least amount of invasiveness. They have certainly
made it possible to look and touch areas of the body we can never hope to see
or touch in a living person.
Laboratory and imaging technologies have made it possible to
study the structures and functions of every organ of the body and recognize
abnormalities earlier. However, technologies come with their own sets of
problems. False negative results are inherent and the frequency of false
negatives increases with increasing sensitivities of tests. These lead to
further testing and procedures, many of them costly, unnecessary, invasive, and
painful. These in turn increase the anxiety of patients and may even lead to
major adverse events.
Motivated by several factors, physicians order tests even
when they know they are not necessary. Part of the blame has to go to the
advertisements, motivated by commercial interests, which glorify tests and
procedures. The public is informed poorly and believe that sophisticated tests
are needed to make every diagnosis. They demand tests to be performed and are
willing to shop around. Free standing test centers are easily available.
Someone else is there to pay for these tests.
Physicians are also trained to look for certainty in
diagnosis and are concerned about malpractice suits. Media do not help since
they publicize the rare diagnoses that were missed since that is what makes
news. The result is a proliferation of tests and procedures. If our system has
to pay for each of these tests that are already there and the future ones, the
country will go bankrupt in no time.
As pointed out by Garret Hardin in his article on the
Tragedy of the commons (Science 162:1243-1248, 1968), we look for technical
solution to every problem in this era of technology. The reality is that there
are no technical solutions for some problems. Human behavior has to be
modified. That is easier said than done.
We all know that medical care is getting prohibitively
expensive and needs fixing, that soon. But who is to "bell the cat"? Considering
that almost quarter to one-third of health care expenditure is due to overuse
of medical resources and that the decisions by physicians account for major
portion of health care expenditure, it is appropriate that physicians take a
lead in reducing unnecessary tests and procedures.
It is heartening to know that nine medical societies have
done exactly that. Initiated by the American Board of Internal medicine, these
nine professional organizations have started a campaign called Choosing Wisely
(www.choosingwisely.org). They are:
American Academy of Allergy, Asthma and Immunology
American Academy of Family Physicians
American College of Cardiology
American College of Physicians
American College of Radiology
American Gastroenterological Association
American Society of Clinical Oncology
American Society of Nephrology
American Society of Nuclear Cardiology
Each one of these societies has prepared “a list of 5 tests,
treatment or services that are commonly used in the specialty and for which the
use should be reevaluated by patients and clinicians”. This list is available
via internet by accessing www.choosingwisely.org
and following the links to the site of the individual societies. This list
includes for example, “Do not obtain imaging studies in patients with
non-specific low back pain” (American College of Physicians), “Do not perform
imaging studies for uncomplicated headache” (American College of radiology) and
“Advise patients not to use cough and cold medications” (American Academy of
Pediatrics).
It is estimated that more than 5 billion dollars could be
saved by following the suggestions in the “top 5 lists”. It is good to learn that the popular journal Consumer Reports is working with this
project and plans to disseminate consumer friendly versions of these lists to
the public.
References:
Cassel CK, Guest JA.
Choosing wisely. Helping physicians and patients make smart decisions
about their care. JAMA online edition
April 4, 2012
The “Top 5” lists in Primary care: meeting the
responsibility of professionalism. From The Good Stewardshi Working Group. Arch Intern Med 2011; 171(15): 1385-1390.
Monday, March 26, 2012
“The New Language of Medicine”
That was the title of an editorial by Pamela Hartzband and
Jerome Groopman, in a recent issue of the New England Journal of Medicine
(October 13, 2011). I am full agreement with the authors. Unfortunately, we as
a society lean towards health care as a commodity, not as a basic human need. Therefore, business principles and business ethics
are dominating the discussions.
My writing skills are no comparison to those of Hartzband
and Groopman. But I have been as passionate on this issue as they are and have
been so for over 50 years. Here is what I wrote several years back, as a
handout for my yearly Seminars on Being a Clinician. This is now part of my book on Handbook of Clinical Skills (2010).
Can We
Agree on the Fundamentals?
Patient (as in pati - to suffer) is the one who is
suffering.
Therefore, patient is the
primary focus.
Patient is NOT a customer; NOT a
consumer either.
Patient is NOT owned by anyone -
not by the physician, not by the
HMO, not by the national health
systems.
Physician is called a clinician
because he works at the bedside
(klinikos, bed) of the sick person.
Patient and the physician make a
dyad.
The patient-physician
relationship is a covenant; not just a contract.
Medicine is a Profession with
focus on healing and helping, caring and
counseling.
Medicine is NOT a business.
Medical care is NOT a commodity to be
traded.
Sunday, January 1, 2012
Informed Consent
Is it truly an informed consent when a piece of paper is given to you to sign on your way to the operating room? The first insult is that the Consent Form is presented at an awkward time when you are so scared you do not even know what to ask. Next, the “informed consent form” is written in such a “legalese” you will need a lawyer to interpret what it says – preferably the same one who wrote it! Finally, the consent form goes into such great detail on everything that can go wrong, that if you really start thinking about each one of them, you may choose to suffer than sign that paper!!
It is sad that what should have been done to involve patients in a thoughtful decision making process has been made into a “risk management tool”. These consent forms do not even perform that function well. Evidence accumulated over the past several years has shown that the “informed consent” forms fail to truly inform the patients. They do not help avoid malpractice suits either.
A study that analyzed the consent forms collected from several US hospitals showed that some of them were “short and vague”, some of them “long and confusing”, many of them used legalistic language and only 25% of them went beyond just the description of the procedure to include information on risks, benefits and alternatives.
The status of informed consent was the topic of an essay on “Uninformed Consent” by Ms.Debra Franklin in the March 2011 issue of the Scientific American. She describes new tools of technology that are being developed to include and involve patients in the process of obtaining informed consent. These tools formalize and organize the components of Informed Consent and emphasize “education” of the patient so that when the patient signs a consent, it is truly an “informed” consent. Although these tools have not been tested, this is a good start.
These “software” tools of technology are interactive and are either aimed at doctors or at patients. I looked at two of them, mentioned in the article by Ms.Debra Franklin. They are Emmi Solutions and iMedConsent.
Emmi Solutions is patient centered, interactive, uses images, written at a level most people can understand, is in English and Spanish and is based on input from patients and doctors. The program I opened was on Angioplasty. The topic is presented under seven headings: Your Body, Your Condition, Pre-Procedure information, details of the procedure, Post-procedure recommendations, Risks and benefits and Alternatives.
iMedConsent is for physicians. Templates with details on several hundred procedures are available. They can be modified to suit the specific needs of individual patients. The program I looked at was on Cholecystectomy. This also followed the same format as the Emmi in explaining the body, the condition, preparation, procedure, post-operative instruction, risks and benefits and alternative.
Obviously these tools need testing. Also, what about patients who do not have computers or cannot interact with computers?
Ultimately, face-to-face “communication is essential no matter what the approach”. The computer will help to make sure the conversation did take place and all the elements of truly informed consent were covered. It will also assure us that the interaction is documented. Prudent, “compulsive” clinicians have been doing these all the time. Machine can only formalize the details and the process and inform everyone that it was done.
It is sad that what should have been done to involve patients in a thoughtful decision making process has been made into a “risk management tool”. These consent forms do not even perform that function well. Evidence accumulated over the past several years has shown that the “informed consent” forms fail to truly inform the patients. They do not help avoid malpractice suits either.
A study that analyzed the consent forms collected from several US hospitals showed that some of them were “short and vague”, some of them “long and confusing”, many of them used legalistic language and only 25% of them went beyond just the description of the procedure to include information on risks, benefits and alternatives.
The status of informed consent was the topic of an essay on “Uninformed Consent” by Ms.Debra Franklin in the March 2011 issue of the Scientific American. She describes new tools of technology that are being developed to include and involve patients in the process of obtaining informed consent. These tools formalize and organize the components of Informed Consent and emphasize “education” of the patient so that when the patient signs a consent, it is truly an “informed” consent. Although these tools have not been tested, this is a good start.
These “software” tools of technology are interactive and are either aimed at doctors or at patients. I looked at two of them, mentioned in the article by Ms.Debra Franklin. They are Emmi Solutions and iMedConsent.
Emmi Solutions is patient centered, interactive, uses images, written at a level most people can understand, is in English and Spanish and is based on input from patients and doctors. The program I opened was on Angioplasty. The topic is presented under seven headings: Your Body, Your Condition, Pre-Procedure information, details of the procedure, Post-procedure recommendations, Risks and benefits and Alternatives.
iMedConsent is for physicians. Templates with details on several hundred procedures are available. They can be modified to suit the specific needs of individual patients. The program I looked at was on Cholecystectomy. This also followed the same format as the Emmi in explaining the body, the condition, preparation, procedure, post-operative instruction, risks and benefits and alternative.
Obviously these tools need testing. Also, what about patients who do not have computers or cannot interact with computers?
Ultimately, face-to-face “communication is essential no matter what the approach”. The computer will help to make sure the conversation did take place and all the elements of truly informed consent were covered. It will also assure us that the interaction is documented. Prudent, “compulsive” clinicians have been doing these all the time. Machine can only formalize the details and the process and inform everyone that it was done.
Thursday, December 1, 2011
Like the gold
Looking at my old journals (daily dairy), I found several observations based on my personal experience as a pediatrician. I plan to re-write some of them for these blogs. Here is the first one.
She comes from a horrible social background. She is past the age of innocence. God knows what all she had been up to. But, now….
She is a pathetic looking girl - sick, seriously sick with lupus. Has lost all her mental faculties, so it seems. She cannot remember what happened yesterday. Her legs have become useless, cannot even hold her up to stand. She has no bladder and bowel control.
The mother is mixed up. She is so mixed up she cannot even come to see her daughter. But she is a mother with feelings, full of them. A helpless woman. Each time there is sad news (and she gets plenty of them everyday) she disappears. No one knows where she goes to. Is escaping her way of coping? Does she go wandering to forget her miseries?
Coming back to this young girl, she gets sudden and brief moments of clarity. At that moment, she knows what is happening to her and gets scared. Won’t you? You can see her face and read her fears. Amidst those sunken eyes, bald head, dried lips, is a mouth full of ulcers through which a pathetic cry comes out. She has tears in her eyes. Then comes a special spark in her face and with a gentle and pathetic smile she says: “Dr………. I am scared; will you pray for me?”
I hold my tears but hold her hands and say: “Of course, I will T…., I will pray for you”. For that one moment I see the Divine Spark in her eyes, the same Spark that lit me, and lit all of us. With that, the technician wheeled her to the operating room. Ms. T….. never saw her personal, miserable world again!
Yes, even in the midst of suffering, hopelessness, helplessness and sadness, the Spark of Life can be seen, even if for only a moment.
She comes from a horrible social background. She is past the age of innocence. God knows what all she had been up to. But, now….
She is a pathetic looking girl - sick, seriously sick with lupus. Has lost all her mental faculties, so it seems. She cannot remember what happened yesterday. Her legs have become useless, cannot even hold her up to stand. She has no bladder and bowel control.
The mother is mixed up. She is so mixed up she cannot even come to see her daughter. But she is a mother with feelings, full of them. A helpless woman. Each time there is sad news (and she gets plenty of them everyday) she disappears. No one knows where she goes to. Is escaping her way of coping? Does she go wandering to forget her miseries?
Coming back to this young girl, she gets sudden and brief moments of clarity. At that moment, she knows what is happening to her and gets scared. Won’t you? You can see her face and read her fears. Amidst those sunken eyes, bald head, dried lips, is a mouth full of ulcers through which a pathetic cry comes out. She has tears in her eyes. Then comes a special spark in her face and with a gentle and pathetic smile she says: “Dr………. I am scared; will you pray for me?”
I hold my tears but hold her hands and say: “Of course, I will T…., I will pray for you”. For that one moment I see the Divine Spark in her eyes, the same Spark that lit me, and lit all of us. With that, the technician wheeled her to the operating room. Ms. T….. never saw her personal, miserable world again!
Yes, even in the midst of suffering, hopelessness, helplessness and sadness, the Spark of Life can be seen, even if for only a moment.
Tuesday, November 1, 2011
Socrates had objections to Written words
In Sanskrit there is a statement: “sahasram vada; ekam abhi ma likha” which means “Say 1000 words; but do not write even one”. Vedic tradition grew up on verbal recital and memorization. Greek tradition was also following the same course – until written words appeared at about the time of Socrates. It appears that Socrates was worried that students will obtain information from written words, but will not know how to think critically. We know he was wrong.
At present, we the “digital immigrants” worry the same way about our young “digital generation”. We worry that in the midst of these images and bits and “bytes” of information, the next generation may have problems with critical thinking skills. There are a few studies to substantiate such a concern.
The new generation of “technology-assisted” learners, are somewhat akin to the “book-assisted” learners that Socrates worried about. Our young ones learn from images and sound-bites and rapid summaries. There is no helping hand. Students multitask. They skim through information. They want instant answers. They forget that information is not knowledge and that they have to take an active part in making knowledge out of this information.
As pointed out by Maryanna Wolf in her book on Proust and the Squid (HarperCollins 2007) and in a recent issue of Science (August 19, 2011), writing and learning from written words was not natural for the human brain. It took at least 2 millenia for the human brain to evolve and adapt its structures and networks to this uniquely human activity. Will the neural networks developed over the past two millenia be useful in the new learning environment? Or, will the brain evolve new strategies to adapt to the new world of learning through images and streaming bits of information? How can we help the new young generation develop their reasoning and analytical skills and improve the so-called executive functions of the brain?
Socrates was of the opinion that spoken words are full of meaning and emotions, with added stress and nuances during the delivery. Written words are rigid. Written words “cannot talk back” if you ask a question. Nor can it offer clarification. Written words can be mistaken for reality if not examined critically with the help of a teacher, he thought. Decoding the words and their meanings is not the same as knowledge acquired by thinking about the thing words stand for with all their connections and implications. Socrates thought that reading from books might lead to superficial, false knowledge and “empty arrogance”.
The second objection was that written books will be harmful to memory formation. We all know that it is true to some extent. It does not destroy memory; but there is less need for it. It is not all bad. Computers can store memory better than we humans can. They can store lot more facts and more important, they can recall in fraction of a second and without ever forgetting. So why use the brain like a “filing cabinet”?
The benefit of the arrival of written words and books was that the brain needed less territory and energy to store memory. That allowed the brain to develop its correlative and analytical functions. The other advantage of written words was that accumulated knowledge could be transmitted to the next generation. Clearly, the arrival of written words is the basis of human civilization.
With information technology, we can store more information in less space than in books. We can look for correlations and patterns with simulations and complex calculations. However, information is not knowledge. By focusing on information, looking at moving images and disappearing screens and with the use of immediate feedback and quick rewards, are we losing our ability to stay focused and think through a problem?
The answer to this last question happens to be “yes’ and “no”. Yes, our youngsters are not focused, they multi-task and are quick with joy-sticks but not with executive functions. At the same time, children’s ability to think analytically and creatively and to stay focused can be improved with the use of the same technology. It is interesting to note that working memory is an important component of creative and analytical thinking and this can be enhanced by specially developed computer programs.
What are the executive functions of the brain? These are the qualities needed to control our impulses, focus on a problem, think creatively, assign priorities, make proper judgments and plan for a course of action. These functions depend on development of neural networks which connect the sensory, motor, emotional and rational parts of the brain. Many of the circuits are not fully connected till late adolescence.
All of (Most of us) develop these functions over the course of our young lives. Can we facilitate the developments of these functions in children? Sure, we can. Recent studies on helping young children to develop executive functions show that approaches that seem to work include “computerized training” with specially developed lessons, hybrid computer-noncomputer programs, special “Tools of the mind” and classroom curricula. (Science 333:959-964, 2011). Yes, information technology can be used to maintain those functions which we are afraid our younger generation may lose.
Finally Socrates thought that written words will result in loss of control over language. I do not know what he meant. Socrates probably thought that learning from written mode will lead to superficial understanding since there is no teacher to push the student to ask questions and ask for clarifications, make sure the student understands the meaning of words and the structure and the beauty of the language. The student is likely to move on with incomplete knowledge (not looking up the dictionary and ask for clarification) and thus lose control over knowledge. He said that “Once a thing is put in writing, the composition, whatever it may be, drifts all over the place, getting into the hands not only of those who understand it but equally of those who have no business with it…..”. In essence, we know how when a word is put on print, we lose control over it. We do not know who will use it and for what purpose. Is it not true even more when something is written into cyberspace?
As a physician-educator, I know that those concerns are still valid. Look at text messages, e mails and Twitter. There is no need for spelling or grammar. In medicine, when a clinical question arises, the students are able to get a reference or two about the subject in a second by signing into Pubmed or Google Scholar. They read the abstract but only a few go to the original and read it carefully and critically to assess the quality of research and the validity of the conclusion. Much less time is spent on deciding whether the “information” in that article is relevant to the specific situation.
This problem is even worse when patients search the internet and come up with everything that can go wrong with their condition. They do not realize that most of the material is unfiltered and untested and there may be even some dangerous ideas. The anxiety generated becomes worse than the disease itself.
We all know that Socrates was wrong in opposing written words and “books”. If he were alive he would admit his mistake. We also know that his concerns are of relevance once again. However, the age of information is here to stay. It has unleashed an explosion of available information. But information is not knowledge. The technology of acquiring information should not become an end in itself. Like all new technologies, information technology comes with its strengths and weakness. Like all new technologies, we will not know the full impact of this technology on individual learning and on the society for several decades to come. We do not know how this will alter the need for our brains to rearrange its circuitry for analytical thinking.
We have to adapt the information technology and adapt to it wisely and with prudence.
References:
Proust and the Squid. Maryanne Wolf. HarperCollins, New York 2007.
Science Issue of August 19, 2011
At present, we the “digital immigrants” worry the same way about our young “digital generation”. We worry that in the midst of these images and bits and “bytes” of information, the next generation may have problems with critical thinking skills. There are a few studies to substantiate such a concern.
The new generation of “technology-assisted” learners, are somewhat akin to the “book-assisted” learners that Socrates worried about. Our young ones learn from images and sound-bites and rapid summaries. There is no helping hand. Students multitask. They skim through information. They want instant answers. They forget that information is not knowledge and that they have to take an active part in making knowledge out of this information.
As pointed out by Maryanna Wolf in her book on Proust and the Squid (HarperCollins 2007) and in a recent issue of Science (August 19, 2011), writing and learning from written words was not natural for the human brain. It took at least 2 millenia for the human brain to evolve and adapt its structures and networks to this uniquely human activity. Will the neural networks developed over the past two millenia be useful in the new learning environment? Or, will the brain evolve new strategies to adapt to the new world of learning through images and streaming bits of information? How can we help the new young generation develop their reasoning and analytical skills and improve the so-called executive functions of the brain?
Socrates was of the opinion that spoken words are full of meaning and emotions, with added stress and nuances during the delivery. Written words are rigid. Written words “cannot talk back” if you ask a question. Nor can it offer clarification. Written words can be mistaken for reality if not examined critically with the help of a teacher, he thought. Decoding the words and their meanings is not the same as knowledge acquired by thinking about the thing words stand for with all their connections and implications. Socrates thought that reading from books might lead to superficial, false knowledge and “empty arrogance”.
The second objection was that written books will be harmful to memory formation. We all know that it is true to some extent. It does not destroy memory; but there is less need for it. It is not all bad. Computers can store memory better than we humans can. They can store lot more facts and more important, they can recall in fraction of a second and without ever forgetting. So why use the brain like a “filing cabinet”?
The benefit of the arrival of written words and books was that the brain needed less territory and energy to store memory. That allowed the brain to develop its correlative and analytical functions. The other advantage of written words was that accumulated knowledge could be transmitted to the next generation. Clearly, the arrival of written words is the basis of human civilization.
With information technology, we can store more information in less space than in books. We can look for correlations and patterns with simulations and complex calculations. However, information is not knowledge. By focusing on information, looking at moving images and disappearing screens and with the use of immediate feedback and quick rewards, are we losing our ability to stay focused and think through a problem?
The answer to this last question happens to be “yes’ and “no”. Yes, our youngsters are not focused, they multi-task and are quick with joy-sticks but not with executive functions. At the same time, children’s ability to think analytically and creatively and to stay focused can be improved with the use of the same technology. It is interesting to note that working memory is an important component of creative and analytical thinking and this can be enhanced by specially developed computer programs.
What are the executive functions of the brain? These are the qualities needed to control our impulses, focus on a problem, think creatively, assign priorities, make proper judgments and plan for a course of action. These functions depend on development of neural networks which connect the sensory, motor, emotional and rational parts of the brain. Many of the circuits are not fully connected till late adolescence.
All of (Most of us) develop these functions over the course of our young lives. Can we facilitate the developments of these functions in children? Sure, we can. Recent studies on helping young children to develop executive functions show that approaches that seem to work include “computerized training” with specially developed lessons, hybrid computer-noncomputer programs, special “Tools of the mind” and classroom curricula. (Science 333:959-964, 2011). Yes, information technology can be used to maintain those functions which we are afraid our younger generation may lose.
Finally Socrates thought that written words will result in loss of control over language. I do not know what he meant. Socrates probably thought that learning from written mode will lead to superficial understanding since there is no teacher to push the student to ask questions and ask for clarifications, make sure the student understands the meaning of words and the structure and the beauty of the language. The student is likely to move on with incomplete knowledge (not looking up the dictionary and ask for clarification) and thus lose control over knowledge. He said that “Once a thing is put in writing, the composition, whatever it may be, drifts all over the place, getting into the hands not only of those who understand it but equally of those who have no business with it…..”. In essence, we know how when a word is put on print, we lose control over it. We do not know who will use it and for what purpose. Is it not true even more when something is written into cyberspace?
As a physician-educator, I know that those concerns are still valid. Look at text messages, e mails and Twitter. There is no need for spelling or grammar. In medicine, when a clinical question arises, the students are able to get a reference or two about the subject in a second by signing into Pubmed or Google Scholar. They read the abstract but only a few go to the original and read it carefully and critically to assess the quality of research and the validity of the conclusion. Much less time is spent on deciding whether the “information” in that article is relevant to the specific situation.
This problem is even worse when patients search the internet and come up with everything that can go wrong with their condition. They do not realize that most of the material is unfiltered and untested and there may be even some dangerous ideas. The anxiety generated becomes worse than the disease itself.
We all know that Socrates was wrong in opposing written words and “books”. If he were alive he would admit his mistake. We also know that his concerns are of relevance once again. However, the age of information is here to stay. It has unleashed an explosion of available information. But information is not knowledge. The technology of acquiring information should not become an end in itself. Like all new technologies, information technology comes with its strengths and weakness. Like all new technologies, we will not know the full impact of this technology on individual learning and on the society for several decades to come. We do not know how this will alter the need for our brains to rearrange its circuitry for analytical thinking.
We have to adapt the information technology and adapt to it wisely and with prudence.
References:
Proust and the Squid. Maryanne Wolf. HarperCollins, New York 2007.
Science Issue of August 19, 2011
Tuesday, October 18, 2011
Technology affected Learners
The American Academy of Pediatrics conducts a survey of graduating residents each year. Results of a survey conducted between May and September of 2010 showed that a majority of them use IT tools for acquiring medical information, patient care and for personal communication. They use photos and video clips for both personal and professional purposes. Wisely enough, they use physicians-only social networking sites for professional purposes. (AAP News September 2011, page 17)
The current generation of learners is called the digital “natives”. They acquire information and use it effortlessly. Their learning style and skills are different. Teachers have to be aware of it.
In a lecture given by Prof.Krishnan at Hyderabad, India, young folks growing up with technology are called “Technology affected learners”. He makes SIX points about technology assisted learning. I list them here together with my comments (in italics) on what teachers can do to make the learners think.
1.Knowledge is free. (“Information is free”. You have to create knowledge out of it. We do not have to use the brain like a filing cabinet. Computers do a better job of “remembering” vast amount of data. Our brains are better used to think with the information)
2.Learners have less time to learn. (You have to make the time to learn)
3.We shape our own learning. ( Develop your own tools for thinking)
4.Peer network is the new expert. (Beware of the self-appointed “expert”)
5.Knowledge sources are always suspect (Check out the source for yourself. Make sure you know who is sponsoring it and why)
6.Newton’s Third law of Learning: For every point of view you find on the internet, there is an equal and opposite point of view. (You can find an article to support your point of view on any clinical problem! Beware and keep an open mind)
To this I will add what Margaret Mead said many years back. The days of vertical learning are over. These are the days of horizontal and parallel learning. You can learn from your students and the younger ones. You do not teach and/or learn. You share information and knowledge.
Wisdom – that is another story.
The current generation of learners is called the digital “natives”. They acquire information and use it effortlessly. Their learning style and skills are different. Teachers have to be aware of it.
In a lecture given by Prof.Krishnan at Hyderabad, India, young folks growing up with technology are called “Technology affected learners”. He makes SIX points about technology assisted learning. I list them here together with my comments (in italics) on what teachers can do to make the learners think.
1.Knowledge is free. (“Information is free”. You have to create knowledge out of it. We do not have to use the brain like a filing cabinet. Computers do a better job of “remembering” vast amount of data. Our brains are better used to think with the information)
2.Learners have less time to learn. (You have to make the time to learn)
3.We shape our own learning. ( Develop your own tools for thinking)
4.Peer network is the new expert. (Beware of the self-appointed “expert”)
5.Knowledge sources are always suspect (Check out the source for yourself. Make sure you know who is sponsoring it and why)
6.Newton’s Third law of Learning: For every point of view you find on the internet, there is an equal and opposite point of view. (You can find an article to support your point of view on any clinical problem! Beware and keep an open mind)
To this I will add what Margaret Mead said many years back. The days of vertical learning are over. These are the days of horizontal and parallel learning. You can learn from your students and the younger ones. You do not teach and/or learn. You share information and knowledge.
Wisdom – that is another story.
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