How Digital Technologies Act as Cognitive Prostheses for Health Professionals and Health Professional Learners Dr Rachel H Ellaway Northern Ontario School of Medicine Cumming School of Medicine University of Calgary ID: 272508
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Extended MindHow Digital Technologies Act as Cognitive Prostheses for Health Professionals and Health Professional Learners
Dr. Rachel H. EllawayNorthern Ontario School of MedicineCumming School of Medicine, University of CalgarySlide2
Conflict of InterestNot evil … if only
Photographic images used under Fair Use – not my copyrightSlide3
for MartySlide4
What just happened?Internet/information revolutionEverything changed and nothing changedWe are still humans, living in human societies
But our actions and ability to act has been transformedThe Internet grants us (super)powers …Slide5
Internet powers: remediation multiple channels of expression and interactionblurring and flattening social conventions
breaking down barriers, encouraging communicationSlide6
Internet powers: speed accelerating speed of action… and response
instant global knowledge - the Twitter wavealways ‘on’, always ‘now’Slide7
Internet powers: connectivityeverything is connected …the Internet of things
from 6 to 3 deg-frdm?everything is connected, dependent …Slide8
Internet powers: reach defeating geography and temporalityinteracting with friends, family, colleagues around the world
synchronous and asynchronous communicationSlide9
Internet powers: observationall actions can be observed, trackedgreater accountability, deniabilitypanopticism?
a post-privacy age?Slide10
Internet powers: memoryknowledge on demandnothing is forgottenyour actions are foreverSlide11
Digital ProfessionalismDespite digital misdemeanours and risks …
“Digital media are not an intrinsic threat to medical professionalism”Ellaway RH, Coral J, Topps D, Topps MH. 2015. Exploring digital professionalism. Medical Teacher (in press).Slide12
Digital Professionalism“Professionals should use digital media for positive purposes in ways that support principles of patient care, compassion, altruism, and trustworthiness”
Ellaway RH, Coral J, Topps D, Topps MH. 2015. Exploring digital professionalism. Medical Teacher (in press).Slide13
Digital Professionalism“Professionals should be aware of the shaping nature of their relationships with digital media and they should maintain the capacity for deliberate, ethical, and accountable practice”
Ellaway RH, Coral J, Topps D, Topps MH. 2015. Exploring digital professionalism. Medical Teacher (in press).Slide14
?
How did you feel when you lost a digital device?
Ecstatically happy
Quite pleased
Mildly annoyed
Major disaster
It was like losing a loved oneSlide15
More than tools …Digital technology is not just instrumentation; external and separate We weave the digital into all aspects of our livesThe digital weaves itself around us …
… it becomes a part of usSlide16
CyborgsWe are cyborg‘cybernetic organisms’ - Clynes and Kline, 1960Slide17
Clark
“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 PressSlide18
Cyborgs and augmented cognitionExtended mind theory“epistemic actions alter the world so as to aid and augment cognitive processes such as recognition and search”“
pragmatic actions, by contrast, alter the world because some physical change is desirable for its own sake”Clark A, Chalmers DJ. The Extended Mind - http://consc.net
/papers/extended.htmlSlide19
Epistemic actions
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S
Q
T
E
USlide20
Epistemic actions
SE
D
Q
U
E
TSlide21
Epistemic actions
QU
E
S
T
D
ESlide22
External cognitionEpistemic actions are the starting point for external cognitionIf the process had been done in your head then clearly cognition
But if done outside your head then is it also cognition?Clark A, Chalmers DJ. The Extended Mind - http://consc.net
/papers/extended.htmlSlide23
External cognitionA human “linked with an external entity in a two-way interaction, creating a coupled system that can be seen as a cognitive system in its own right”
Clark A, Chalmers DJ. The Extended Mind - http://consc.net/papers/extended.htmlSlide24
The cyborg physicianIs Dr. Smith here:Using a mobile device?
… orA coupled human-device system?A cognitive agent not limited to biological boundariesSlide25
The cyborg physicianMany implicationsWhat is it we train?
What is it we assess?What is the moral and accountable health professional?Slide26
The cyborg learnerIf medical practice is increasingly cyborgThen we need to be engaging cyborg learners to prepare to be cyborg professionalsWhat does that look like?Slide27
Cyborg medical educationIs already assumed …We no longer require students to remember everythingWe require our students to know how to knowHow to access and appraise information and apply it to their practice
Knowledge in databases, devices, patients, peersTheir cognition is distributedSlide28
Cyborg medical educationBut also resisted …Current practice:Use of digital media discouragedClose your laptops …
Put that phone away …No cellphones or other devices in class and particularly in examsWe actively deny the cyborg entities (coupled human-resource systems) that will go on to practice medicineSlide29Slide30
Cyborg medical educationTo teach and assess the cyborg professional:We need to teach them with their cognitive prosthetics… and without them
We need to assess them with their cognitive prosthetics… and without themSlide31
DependenceMany contemporary students + recent grads would struggle to function without their devicesThis reflects a dependence on extended cognition
Is this a concern?Is this any better than complete abstinence?How can we approach this challenge in a meaningful way?Slide32
Vygotsky’s ZPD
Source: WikimediaSlide33
ZPDs and competency continua
unguided learnerno mobile device
guided learner
with a mobile device
competency
continuumSlide34
ZPDs and competency continua
unguided learnerno mobile device
guided learner
with a mobile device
Teaching and
assessment
without cognitive
augmentation
Teaching and
assessment
with cognitive
augmentation
competency
continuumSlide35
ZPDs and competency continualearner
without amobile devicelearner
with a
mobile
device
teaching and
assessment across
the continuum
competency
continuumSlide36
ZPDs and competency continualearner
without amobile device
learner
with a
mobile
device
competency
continuum
traditional
exam
observed practice
with no device
open
exam
observed
practice
with device
teaching and
assessment across
the continuumSlide37
With and without …Mobile devicesInternet
A consultPeersA crash team, any kind of teamDrugs, equipmentSpace, time
Power, light, heat, water (too much, too little, wrong kind)
Everything (roadside/wilderness)
…Slide38
Socially distributed cognition?Our cognition socially distributed?Other people a part of our cognitive aparatus
?Depends on “a high degree of trust, reliance, and accessibility”Such as a
multiprofessional team, a PBL group, a CTUAs trust, reliance and accessibility fall, so does distributed cognition
We need to teach and assess across this continuumSlide39
ZPDs and competency continualearner
without cognitiveaugmentation
learner
with cognitive
augmentation
competency
continuum
Learner in
the wilderness
Learner in
rural and remote
Learner in
community
hospital
Learner in
AHSC
teaching and
assessment across
the continuumSlide40
Implications?Technology enhanced learning is not about what the technology can doOr about what the learner can do with the technology
It is about the agency of coupled human-technology systemsEducational technology is relational rather than instrumentalSlide41
Implications?Rise and rise of competency-based medical educationCompetence needs to be assured across a continuum ranging from augmentation to isolation
Based on the degree of trust, reliance and accessibility of the external resourceWhither EPAs?Slide42
Implications?It’s not what you use but what you becomeSlide43
Change is – Gordon Graham“technological innovation cannot and should not be regarded merely as an improved means to a pre-selected end, because, while some technology merely modifies, other technology transforms”
Graham, G. (1999). The Internet://a philosophical enquiry, Routledge. p168)Slide44
Implications?Using technology in medical education is a moral and ethical concernFor all of usSlide45
Challenges“certain forms of social activity might be reconceived as less akin to communication and action, and as more akin to thought”“in some cases interfering with someone's environment will have the same moral significance as interfering with their person”
Clark A, Chalmers DJ. The Extended Mind - http://consc.net/papers/extended.htmlSlide46
ChallengesThis is a hotly contested conceptWhat is mind? E
thical and metaphysical concernsValue as a model vs a reality (cf system 1-2)?What are individual responsibilities, accountabilities?
What is a moral agent?Slide47
Challenges‘What is a human’ is one of the key debates of our ageSlide48
InconclusionWe are responsible for creating and sustaining capable, safe and caring health professionalsUse of digital technologies will inform and direct much of their/our careers
… and the healthcare system, society, and the nature of the health professionalAre we preparing them properly? Do we even appreciate what it is we are preparing?Slide49
InconclusionPhysicians, students, and patients employ extended cognitionDependent on trust in
, reliance on, and access to resources that extend the individualThe design, use, evaluation of ed-tech needs to be recast to reflect this reality
More importantly we need to rethink our response to extended cognition in the design, use, evaluation of medical educationSlide50
ConclusionTeaching with and without cognitive prostheticsAssessing with and without cognitive prosthetics
Enabling practice with and without cognitive prosthetics (practitioner and patient)Technology a matter of becoming rather than usingTechnology a moral and ethical concern, not just instrumentationSlide51
“once the hegemony of skin and skull is usurped, we may be able to see ourselves more truly as creatures of the world” Clark A, Chalmers DJ. The Extended Mind - http://consc.net/papers/extended.htmlSlide52
Thank youDr. Rachel H. Ellaway
Northern Ontario School of MedicineCumming School of Medicine, University of Calgary