Inaugural Scottish Threshold Concepts Conference: TCs in Action [i]

Never having been to Dundee but being keen on Threshold Concepts for reasons to follow, I headed North stopping off at Glasgow the day before.

Some thought had clearly gone into the 'conference pack' which included a local comic , marmalade and a caramel biscuit (appreciatively consumed while writing this!).

[Earlier in the week, on twitter someone had pointed to the paper and pens laid on all the chairs in Manchester it appeared - questioning the sustainability. The organisers duly took note and a message for all.]

The first keynote was:

Threshold Concepts on the Edge by
Emeritus Professor Ray Land, Durham University and subtitled: 'Learning, risk and difficulty'.

As an initial co-author of the work on Threshold Concepts, Prof. Land is engaging and facilitating further research. The references flowed and were absorbed by a ready audience taking photos and notes. Next time, if there is one, I may rely on notes more. The presentations should be made available. The etymology of our language(s), liminality, complexity the experience of learning negotiated through variously safe and unsafe spaces were explored. As a concept itself threshold might indicate edge(s) and boundaries, referring also to knowl-edge. The presentation brought home the need for balance in education. Balance that in a way cannot be attained if learning is to occur? What should students be exposed to - in drama, literature as preparation for a [health] career, a life?

Through Timmermans (2010, Changing Our Minds) Prof. Land highlighted how even knowing something presents limits. I read this as the context internal or external calling into question this knowing. Complexity and chaos were inevitably added to this mix.

I thought of lacuna here. There are gaps in knowledge, but a nearby concept might just afford a stepping stone. This ability to 'step' begs a question. In what can become the domestic chaos of  unsupported care for people with dementia, I frequently have to empathise with the carers, relatives and close friends. These individuals will encounter 'gaps' appearing in their world. How they perceive, experience, interact and recall it. I temper this account depending on the situation. The changes to perception it is thought can be quite marked and disturbing, contributing to agitation. This is an edge fragmenting.

'Edges' are evident in Hodges' model:

Most obviously where the model's axes demarcate the care (knowledge) domains and additionally:

Sciences: Skin, touch, (surgical-knife) edge, cognitive map (home, locality), location - built environment, scientific thresholds as in blood tests, visual - auditory ... cues*
Intra- Interpersonally: identity, personal belief systems and schema, personal ethics, biases and prejudices (which may go 'unchallenged'), empathy - rapport, transference, *triggers perceived, incisive argument.
Sociology: Personal space, (Second...) language skills, breaking bad news, intimacy, nuclear - extended families.
Political: Negotiation, cross-party, consensus, debt, criminal activity, public disorder

I've some reflections on the image below to follow.

The citations of Waldrop (1992, p.12) and Zygmunt Bauman (2000) dissolving, turbulence and 'liquid modernity', prompts me to think of students [ and others ;-) ] getting stuck in minima and recall the work of Serres on Lucretius and non-linear dynamics. Prof. Land noted much more - supplantive and lost learning. We learn that the safety of education is unsurprisingly related to education (and its systems) becoming stronger. As it does there is a price, since learning involves weakness (Gert Biesta, 2013). The active debate on trigger-warnings, safe spaces and deplatforming gives me further reason to champion #h2cm. The model provides a blank, agnostic space, that can address all forms of truth, reality and if the situation requires disturbed experiences of reality.

I can clearly envision how student mental health nurses could find certain lectures challenging. Prof. Land weaves the point (Barnett, 2004) that we cannot reduce uncertainty for new students through a 'predictable' form of curriculum. For the MH students to learn they must be challenged personally. If not it is education that is failing them. Linking his themes it seems we can equate weakness with uncertainty but education must learn to appropriate and be comfortable with this. Contrasting uncertainty v. ambiguity I can see how Hodges' model can assist in understanding these relations and relationships from the lived - situated - experience - of a person, to the interpretation by several people, or the same person through time (frames of Hodges' model).

This was a marvellous start to the conference, about which more to follow.


See also:
http://nu2018.se/wp-content/uploads/2018/10/Keynote-abstract-Vasteras-October-2018.pdf

Pihl, O. V. (2015). Hidden realities inside PBL design processes: Is consensus design an impossible clash of interest between the individual and the collective, and is architecture its first victim? . Journal of Problem Based Learning in Higher Education, 3(1), 20-45. https://doi.org/10.5278/ojs.jpblhe.v3i1.1201

- and on W2tQ:

Inaugural Scottish Threshold Concepts Conference: TCs in Action [ii]

Inaugural Scottish Threshold Concepts Conference: TCs in Action [iii]

Threshold Concepts: Reflection on chaos, complexity and AI

The Adrian Piper Foundation Berlin Multi-Disciplinary Fellowship 2020 ...

individual - self

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group- population

"The APRA Foundation Berlin Multi- Disciplinary Fellowship has the purpose  of promoting research on the conception,  constitution and structure of the self,	surviving and flourishing  in a global environment; and
with the educational goals of (i) increasing knowledge and public awareness of individual and societal strategies for	(ii) discovering, identifying and promoting the cross-disciplinary and cross-cultural flexibility through which these strategies are expressed."

Text: http://www.adrianpiper.com/foundation/M-DFellowshipMission&Guidelines.shtml

http://www.adrianpiper.com/index.html

http://adrianpiper.com/foundation/M-DFellowshipMission&Guidelines.shtml#guidelines

3rd Healthcare Digital Technology Congress: Manchester

I greatly enjoyed Convenzis's Congress in Manchester at etc.venues. The early train journey (as 'us' Northerner's know very well) was not pleasant. Upon arrival I worried I might behave like a sardine in the lift up to the 8th floor. The venue is very convenient near Oxford Road and Piccadilly (I got off early at O. Rd). Manchester and Liverpool are well served for conference venues.

The journey was quickly forgotten, with a welcome coffee and breakfast. Networking started immediately thanks to a 'clear' twitter profile picture and some 'homework' with tweets the night before. Despite breakfast the exhibitor stands whetted the appetite for information at the breaks to follow.

These events are not just a help keep up-to-date #HealthIT #DigitalHealth wise, but a way to try to maintain some sense of balance as things are read while not experienced first-hand. Digital health is diverse and a reference during the day to juggling and its architecture was quite apt.The balance comes in countering the social media bubbles that (as users) we inhabit and are influenced by.

I'm not going to do a blow-by-blow account but Richard Price set the digital tone referring to technology development through the course of NHS's history:

- and The Topol Review (February 2019) and the digital future through Dr Eric Topol and a video:

As a scholar of literacy in its many forms I appreciated Richard's slide on the digital form. (Is this the same as 'information', or informatics' even?) This is interesting in being person-centred which at an individual level is not necessarily the same thing. Hopefully any e-careplan is formulated and constructed based on this, with time for data entry and practitioner-patient(person) engagement?

My thoughts or social media concerns here are based on tweets I have read which are often politicised and tied to related policy and the NHS Long Terms Plan. Health and Healthcare IS political, as previous posts have indicated. In contrast days like this and technical evangelism are a great experience for the optimism, technology, skills, problems solved and ongoing progress.

There was a question at the end of the day about AI artificial intelligence and how perhaps its role can be proven in less clinically applications. I was going to reply with the case of 'robotic process automation' which is gathering pace in other 'industries' such as insurance, recruitment and document management. Having experienced in the past new starters from universities have to retro-learn old applications and operating systems I was surprised to hear mention of 'Windows XP'. History - future all rolled up together.

In March I noticed a tweet andwell before I attended RCN Congress for the first time:

1 in 40 doctors participating in research compared to 1in 1, 000 nurses says Lord Willis @councilofdeans @JessicaCorner @KingsNursing @theRCN what can we do /enhance access and participation?

— anne marie rafferty (@annemarieraffer) March 13, 2019

Also on twitter I've wondered about wards, clinical teams having a 'research question' sitting on the shelf, if not a 'live' research project. Perhaps a ward could have three proposed questions that are revisited and even picked up by students. This could be part of the introduction to the placement and help raise awareness on several levels. At this event I spoke to InPhase and within the 'single assurance system' which was demonstrated to me there would be scope to incorporate such an initiative. Beyond this though ward managers, matrons and senior managers can have the tools such that 'data' about wards and even individual practitioners is available. While crucial (think CQC), this data turned into information and intelligence should not just be inspection fodder. There must be a clinical and research dividend to routine records. Also noted previously is the need for practitioners to manage their cases, their caseload.

A representative for Checkware explained their approach of patient involvement through self-reporting, self-management and long-distance follow-up. In terms of low-hanging fruit for computerisation this has long been one of them. The original box-ticking exercise that now seems to define the success or otherwise (mere completion?) of activities that it really shouldn't. After discussing copyright, patient engagement and the company's background I thought of Hodges' model (of course). I wanted to ask "What is the most general assessment tool you have?" There are many possible responses, but I didn't.

As a registered nurse I've always been defensive about patient data and what happens to it (IT). Consequently I've paid interest to data protection and public initiatives for e-records over the decades. It may be me, but I picked up a sense that a consensus within the public may be emerging? It's not even that the public were represented as such, just a sense from what was said. I may be wrong... and any optimism regards the maturity of the public's attitude to health e-record, does not equate to the maturity of the technology?

Hadleigh Stollar from NHSDigital explained the progress and plans of the National Record Locator Service, it’s success so far and benefits! This is pivotal for the experience of people with mental health problems in crisis and ambulance services. This is just the start. There was a phrase, LHCRE (which became 'lycra') that's "Local Health Care Records Exemplar" sites. There was a lot more with the Personal Health Record, a key example, as the event website indicates. The offerings of PureAV go far beyond the prompt for me to use video. Clinical Emergency Medicine Books - CEMbooks brought back some nursing memories. This was a very well organised, clearly well-planned Congress, informative, practical, with time for the exhibition and networking. Leaving at 1610 I even had a much better return journey.

Thanks to the Convenzis Team and etc.venues.

Book: The AI Does Not Hate You

You don't need to deploy AI strategies...

"Indeed, there are already glimpses of dangerous, unpredictable thinking in our AI. One AI learnt to win noughts and crosses tournaments against other computers by creating impossible moves billions of squares away from the board. This forced all the other computers to try to represent a board billions of squares across in their memory - but they didn't have the capacity and crashed. The cheating algorithm won by default.". James Marriot. Saturday Review, The Times, 1 June, 2019, p.13.

- to be a healthcare professional...*

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The AI Does Not Hate You
-

*for the moment at least... 

You don't even need 3x3!

Marriott, J., Why the nerds are nervous, Saturday Review, The Times, 1 June, 2019, p.13.
[Book cover - The Times.]

Q. "How can Technology Save the NHS?"

A. It can't - on its own.

Image: Sept 18 2018 The Times Tech Summit Supplement
https://the-dots.com/projects/google-cloud-tech-summit-cover-249662

"On 20th October 2008 50 members of the UK Faculty of Health Informatics attended a master class entitled: "10% Technology 90% Business change - Maximising the added value of new technology for the NHS."




"At the event itself, and afterwards using a post-event wiki, members tried to address the question of: What should be done to make, what is often called a "sociotechnical" or "user-centred" approach to the delivery of technology projects the norm in Health and Social Care?"



Ref.UK Faculty of Health Informatics.(2008) 10% technology, 90% business change; maximising the added value of new technologies for the NHS. Discussion Paper, NHS, London.

A. Anyway, if by 'save' you really mean 'save' then pay and support the necessary staff first then consider the 'technology': socio-technically.

Critique Issue 6: The Wartime Quartet Special Issue, 2019

(Elizabeth Anscombe Iris Murdoch Mary Midgley Philippa Foot)

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Elizabeth Anscombe Iris Murdoch Mary Midgley Philippa Foot	Time
Voices -	Wartime

In June 2019, Durham University Philosophy Society’s journal, Critique, will publish a special edition on the Wartime Quartet – Elizabeth Anscombe, Iris Murdoch, Mary Midgley and Philippa Foot – all of whom were peers and friends at Oxford during the Second World War, going on to become extraordinary philosophers in their own right. Midgley records in her memoir that when the men left for the war, the Quartet were free from the conventions of traditionally male-dominated philosophy. She attributed the Quartet members’ later success to this sudden amplification of their voices.

The members of the Quartet continued to associate, work, and live together long after their undergraduate years. In the thanks, dedications and references of each member’s work you are certain to find the other members too!

2019 will mark the centenary of the group and sees a series of lectures on the Quartet delivered at the Royal Institute of Philosophy – these can be viewed on YouTube: https://www.youtube.com/channel/UCEQRhXQwUe-1ZKIJmnBvHsw

In consideration of this, the theme for this edition of Critique is the Wartime Quartet. [Up to 26th of May 2019] submissions were sought based on a range of topics on the Quartet, including, but not limited to:

• The work of individual members of the Quartet (e.g. the relevance of Anscombe’s critiques of ‘modern moral philosophy’). 
• The relations between the Quartet’s work (e.g. their shared rejections of the separation between fact and value). 
• The ways in which the Quartet’s work manifests in contemporary moral philosophy, and lasting effects that the Quartet’s scholarship had on the discipline.

This edition of Critique is particularly poignant due to the recent passing of Mary Midgley and will be dedicated in her memory.

Durham is one of the institutional homes of the In Parenthesis project which has a vibrant community of student researchers and interns. For more information see www.womeninparenthesis.co.uk

If you have any questions about the submission process, please feel to get in touch by emailing us at du.critique AT gmail.com or its editor, Sebastián Sánchez-Schilling, at sebastian.a.sanchez-schilling AT durham.ac.uk

n.b. With some editing as submission closed. PJ

My source:
Philos-L "The Liverpool List"
https://www.liverpool.ac.uk/philosophy/philos-l
https://www.facebook.com/PhilosL
@PhilosL
@LiverpoolPhilos

The Art & Science of Health: [conceptual scraps iii]

In clinical administration and informatics the question of 'ownership of information' is one of what I've described as legacy problems. Here's a stab at a definition:

A legacy problem is characterised by being:

An aspiration that presents as a problem due to its scale, complexity, and the fact that they are passed-on from one generation of professionals to another. As such legacy problems are common across disciplinary and professional groups. They are embedded within professional education, teaching, learning, practice, management and are expressed in successive  policy developments and within public and media discourse. In scale legacy problems are inherited by new learners and governments.

This is admittedly a broad brush treatment - and a work in progress (I focus upon and list the characteristics). Here, I'm not concerned with the whys and wherefores, or the minutiae. (Perhaps this post is a result of not burn-out(!?) but professional and organisational exposure otherwise known as experience?)

Clinically then legacy problems include:

• integrated care;

- across physical, mental health and social care
- between disciplines (location, co-working - teams)
- as experienced by the patient, carer (as proxy)
- financially

• holistic care;
• person centred care;
• reflective practice;
• critical thinking;

To these we can add:

• the electronic health record
• and as mentioned above 'ownership' of the record (as a whole and the data within).

The question is - are the above being miscategorised? Are they problems or features of healthcare that no matter how much you might wish you cannot dodge them?

Records are critical to the definitions of being a professional and professionalism - public safety, care planning and delivery, accountability, responsibility, research... Perhaps though the existence and consequent longevity of the above are bound to give rise to their analogues and not just their solution, but how they are framed?

Comprehensive record anyone and is that a computer before me...?

What are your thoughts - h2cmng@yahoo.co.uk I'd be pleased to hear from you. Can you add to the list?

To be continued ... [ and there's the legacy conundrum that is the National Health Service? ]

See also:

Daniel Bayley: The problem with Patient Online and the NHS App
Related posts i & ii:

The Art & Science of Health: [conceptual scraps i]

The Art & Science of Health: [conceptual scraps ii]

RCN Congress 2019 i

Last month I finally attended a Congress of The Royal College of Nurses. The time was my own: from the Sunday evening to the Thursday. I'm really grateful to the NW Branch for some financial support as I did stay over, even though it was on my doorstep being in Liverpool. I live between what is the city of my birth (L9, Longmoor Lane) and Manchester.

I knew beforehand that it was unlikely that my proposed item for discussion was unlikely to be accepted. This was immediately obvious when I read the final agenda. Even then there were additions as I could see the mechanics of Congress. There were many more important, timely, critical issues to discuss and debate. What stands out though is not just the funding support but the fact of being encouraged to write something, which wasn't wasted as I posted my item in February (a living draft - that may have a long tail). The human side was inevitably in evidence too: accessibility issues, misunderstandings, things said, things apologised for and vulnerable and minority groups acknowledged and championed. This isn't nursing navel-gazing either. From local experiences, to national there was also an international and global view. Students, the future: were very much in evidence and Congress learned - or more likely were reminded - that they can be disruptive, unpredictable, energetic and they have a voice.

As I watched, listened and learned, the organisation (that's the event itself...) is equally and variously: tried and tested, slick, flexible, responsive, progressive, accepting, friendly, caring!, strident, testing, emotional (yes, moving), celebratory, tiring, educational, inspiring, social and potentially a bit overwhelming ... As you may of gathered - the adage; "you get out of things what you put in" applies. As is often the case I did not do as intended and 'network'. Congress acknowledged the overwhelming/isolating sense in extolling people to reach out to the people around them. If nurses cannot do that then we are in trouble. I kept meeting the same people and it was a great support to have that connection and company. That said, the lack of places to sit at an evening social did not lend itself to getting know fellow members. Standing at a narrow bar eating a hot meal was helped by having to share the ergonomic challenges; an unfortunate but helpful ice-breaker. This was raised as an issue at Congress itself.

There was a political undercurrent with several references and overheard comments pertaining to the RCN's role in negotiating the last pay deal and last year's Extraordinary General Meeting. There is unfinished business here. Not just for the RCN, but the government too. This debacle undermines trust on so many levels, especially after the past decade as experienced by nurses on the 'shop floor'. If that is not painful enough, this matters because it is corrosive generally. While choice matters and yes, health care is an 'industry', the vast majority of us do not want to work in a 'shop'.* We know where to find all the concepts associated with politics in Hodges' model. But, as the social and intra- interpersonal (mental health) domains have atrophied, we must ask where is the NHS on the political grid? A grid that also impacts the whole NHS workforce, social care (don't ask!) and vitally the shaping of career choices for would-be future nurses.

Post ii to follow ...

* How times change? I smile ruefully of how over several decades nurse colleagues have rhetorically suggested that they may look for a job at M&S or John Lewis. What price the retail sector now..? Another post ...?

Joaquín Sorolla ~ "Another Marguerite!" [ Prison Health ?]

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	Sorolla: Another Marguerite! 1892. 129 x 198cm

My source: National Gallery, Exhibitions: Sorolla - Spanish Master of Light

See also:
https://www.kemperartmuseum.wustl.edu/collection/explore/artwork/1351

Image: Wikimedia Commons: Joaquín Sorolla [Public domain]

Book: "Climate Change and the People's Health" i

Climate Change and the People's Health

"Chapter 3 looks forward. It begins by calling for a wider conceptual and methodological toolkit among public health researchers - one that includes systems science as well as a focus on policymaking processes." p.xxxvi

Friel, S. (2019) Climate Change and the People's Health, Oxford University Press, New York.

Review to follow ...

Book: The Heartland - Finding and Losing Schizophrenia

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The Heartland: Finding and Losing Schizophrenia	The Heartland - Finding and Losing Schizophrenia

See also:
https://hodges-model.blogspot.com/2019/01/book-review-i-critical-mh-nursing.html


My source: Foyles, Charing Cross Road, London, 31st May 2019.