Saturday, May 28, 2011

Why Medical School Needs to be Taught with Mobile Apps

Medical students in their third and fourth years, like the doctors they are emulating, are mobile. So too must be the content of their education.

Many (most?) knowledge workers today exercise their knowledge at a desk in front of a computer. However, the medical world is mobile, requiring answers and decisions on the go.

The old-fashioned method of having knowledge on hand was to learn it, to memorize it. Once it's stuck in your head, it can go anywhere. But now, with mobile devices, it simply need not be memorized to have the knowledge on hand, literally.

So what about medical education?

Think about the current model of medical education for a moment- it mobilizes information simply by stuffing groups of the best and brightest into memorization sweatshops (with an odd emphasis on competition). Once in their heads, students can take that info with them around on the hospital floors for the second two years. The sedentary classroom is used because it was the most efficient way to mobilize information.

That's no longer true. Today, that info can be mobilized with mobile apps. (My favorite example is Dr. Joshua Steinberg's ABG Eval)

If we want to revolutionize medical education (or at least help it try to keep up with innovation in healthcare) I propose we make as much of the medical school curriculum as we can mobile without using the sweatshop model.

It has to happen in medical education in particular because it's a knowledge profession that moves.


The Kids Are Alright

I just read "A Generation of Slackers? Not So Much" by Catherine Rampell in the NYTimes and it got me bothered.

Of course the next generation always looks lazy, for a few good reasons:

1- Each generation has better technology than the last. Is the World War II generation more lazy than the hunter-gatherers because their technology afforded them free time to relax in front of the radio? I'd imagine a hunter-gatherer would kick his or her feet up to listen to Edward R. Murrow if he or she had the time.

2- Each generation reprioritizes its own values. While it may look horrifying that kids these days are engrossed in their online personas, would today's elders rather our youth prioritize the racial superiority and classism of the 1800's? The elders will always be horrified that the youth see their different world differently. Should the youth really look at smartphones the same way that their elders looked at rotary phones?

3- Humans nature abides. We have the luxuries of today because previous generations wanted them. Today's youth was provided with their smartphones and social networks by the industry of their parents. How can their parents feel justified in denigrating the youth's propensity to dwell in these advances. I don't think it's reaching to say that, given the chance, any human generation would relish the consuming social tools of today.

I really wonder how the current generation of medical students is going to apply these tools to healthcare if they come of age in a system that demands "hard work."

Saturday, May 21, 2011

Ethics and the Extended Mind: My Abstract for the American Society of Bioethics and Humanities


Title: The Ethics of Neuroenhancement Reframed: Applying the Extended Mind Hypothesis

Neuroenhancement refers to the elective use of medical interventions to enhance neurologic functions such as cognition, mood, and attention. Many find such interventions acceptable, and consider it foolish to eschew them. However, others view neuroenhancing interventions morally troubling because of the fundamental way they can affect an individual’s personhood and autonomy.
                                                                                                   
The ethical debate is shaped by how deeply the enhancement is thought to alter an individual. Supporters consider these alterations to differ merely by degree from other ubiquitous interventions, such as ingesting caffeine for attention and wakefulness. Detractors characterize neuroenhancement as a fundamentally different kind of alteration compared to other attempts to optimize or improve authentic human performance; some call for new ethical guidelines regarding what they consider neuroenhancement’s unique moral challenges. Therefore, progress toward an ethical analysis of neuroenhancement can be made by effectively characterizing it in either the degree or kind camps.

The extended mind theory (EXTENDED), principally defended by Clark, supports characterizing neuroenhancement as a difference of degree from acceptable interventions. EXTENDED claims that the mind does not stop at the skin and skull, nor does it merely lean on external objects for data storage and processing, but actively inhabits extracorporeal objects and processes. According to Clark, EXTENDED considers any process out in the world to be cognitive if, were it done exclusively in the head, we would not hesitate to consider it a cognitive process. Therefore, technologies that facilitate external cognition, from the pen to the smartphone, are examples of genuine augmentation of mind.

If EXTENDED characterizes some tool use as genuine neuroenhancement, then human experience with technology offers many ethical precedents, which range in degree of alteration. We present Chatterjee’s four crucial ethical concerns about medical neuroenhancement, and then reframe them in light of some of these precedents. (1) Individuals’ safety—Medical neuroenhancements must balance the burden of even mild side effects against the benefit to the otherwise healthy subject. However, “side effects” of extended mind enhancements, such as multitasking and attentional load, are widely considered acceptable for the otherwise functional individual. (2) Character—Medical neuroenhancement threatens to alter an individual’s sense of identity or of what gives meaning to a human life. But, since external enhancement involves tool use, which has been described as uniquely human, shunning neuroenhancement may in fact deny an essential feature of human nature and identity. (3) Justice—The access to and distribution of medical neuroenhancements are inherently inequitable. However, since emerging technologies can produce increasingly powerful tools at lower costs, neuroenhancement may therefore be a mechanism for the less affluent to “catch up.” (4) Autonomy—Some participants, competing for high stakes at narrow margins, feel coerced to use medical neuroenhancements. Nevertheless, the required use of assistive technology (e.g. autopilot devices) has been considered a welcome enhancement to one’s native abilities and the safety of others.

Ultimately, EXTENDED stands to reconcile the degree and kind camps. By placing neuroenhancement on an historical continuum that varies by degrees, EXTENDED offers a unique kind of ethical approach to these new concerns.

Friday, May 20, 2011

Clinical Connections with Social Media: Proposed Medical School Elective

Clinical Connections with Social Media                                                                   1-2 Credits
Instructor: Dr. Robert West

Prerequisites: Successfully completed second year of medical school.

Weekly Activities: Video or physical attendance to MSI and/or MSII core curriculum class sessions, researching current clinical applications of these concepts (via online sources, personal clinical experience, correspondence with clinical faculty, or otherwise), writing up short descriptions of these clinical connections, and posting them to various online sources. Depending on student preferences, these sources will consist of blogs, Twitter, Quora, Youtube, Facebook, and others. Students will synthesize exposure to three arenas: Basic science curriculum, clinical applications, and academic social media tools.

Elective Description: Because they have processed sizeable portions of the fundamentals of medicine, third and fourth year medical students will use social media to connect these basics to their clinical applications in a format that additionally benefits first and second year students. Students will choose a theme, and then attend to 10 relevant classes from the MSI and MSII curriculum. They will then research and write up the clinical relevance of the material in these class sessions, amalgamating their personal experiences with the medical literature and the experiences of the clinical faculty. Students will then publish these write-ups in a social format that promotes access by interested MSI’s and MSII currently taking those classes. Additionally, these connections will be available for other stakeholders to weigh in, such as clinical faculty, students and faculty of the school of graduate studies, and the wider medical public. Instruction will be provided for students’ use of their preferred social media tool: Blogging, Twitter, Quora, Youtube, Facebook, and others. With this elective, students will gain experience with social media applications in medicine, deepen the student’s grasp of basic sciences by integrating it with clinical practice, and synthesize students and faculty experiences from different places in the process of medical education. Write-ups will be assessed by the teaching faculty before being posted. Posts will require word limits, inclusion of hyperlinks, and a minimum number of references.

Reading: Self-directed.

Criteria for Evaluation of Performance: One credit hour will be awarded for the successful completion of ten class session write-ups. A maximum of two credit hours will be offered in this way. The write-ups will be evaluated by a clinical faculty member, and criteria for satisfactory write-ups will be reviewed.

Wednesday, May 11, 2011

e-Cigarettes and the Meaning of Life

There's an article in the NYTimes today about a social networking device for smokers- a smokeless electric cigarette maker is introducing e-cigarettes that alert the user to the presence of other e-cigarette users nearby, allowing them to meet and share personal information.

(This is a great example of what I recently described here as the game-changing health possibilities of the web of things.)

This post is really just a sidecar to David Brooks's recent work "The Social Animal," which is a commentary on how modern science (mainly neuroscience) is truly unlocking many of the ancient questions central to the meaning of life.

Brooks's title says a lot: Humans are at heart social animals in search of meaningful connections with other humans.

A lot of criticism is directed towards the de-humanizing impact of modern social media. This criticism usually laments how we replace genuine, face-to-face interactions with cheap, virtual exchanges on Facebook and Twitter.*

The social e-cigarettes are a perfect counter argument.

Rather than replace, social media augments genuine human interaction. It is well known that a major reason people smoke is because the process forms a bond between smokers. It's a massively social activity with a complex set of features and rituals. In short, smoking is an excellent example of the human search for meaningful connections with other humans.

The makers of e-cigarettes are aware of this. In a previous age, they'd launch a massive advertising campaign akin to ads for conventional cigarettes. Today, these manufacturers can use social media platforms like Facebook that are already in place, and free.

Genuine humans in search of genuine connection with other genuine humans can do so easier and cheaper than ever before.

That is the tale of progress from the dawn of humanity right through to the information age and beyond. Rather than an interesting technology sideshow, social media is making the information age personal. All the powers of advanced information technology deeply enrich our lives, not only through medical and engineering breakthroughs in comfort and longevity, but in social breakthroughs that broaden and deepen the meaning in our lives.

Friday, May 6, 2011

The Web of Things and Healthcare

Recent developments like the paperphone flexible computers that can be stacked up like paper, always on, ready to be used, raises the important idea of the "web of things."

The idea is pretty simple- in the not too distant future, a large number of important objects will be online, meaning that some simple data about them will be available for access and processing via RFID tags. For example, all of the food items in your pantry will be talking to your smartphone, and you can be updated on your grocery list while in the supermarket without having to inventory beforehand. (Most exciting for me, this info would obviate the need to even GO to the grocery store. Rather, someone, or some thing, can just bring the necessary goods to your house.)

The healthcare repercussions are dramatic, particularly for behavior modification.

Consider the central goal of diet and exercise: correlating calories consumed with calories burned. What if sensors on your food delivery sites (fridge, restaurant, cafeteria) counted your intake, and sensors on your body counted your exercise, and the balance was presented to you in a simple format: "Run 2 miles, do Zumba for 20 minutes, or play Wii tennis for 40 minutes."

I'm venturing out on a limb here, but I just don't see how this could not happen. If the web of things is inevitable, then it seems we can begin to take stock of it now by adopting some of these tools and playing around with them. 

I'm loving my fitbit.