Managing Uncertainty

It’s often said that GPs are the jazz musicians of doctors: improvisation and managing uncertainty are part of daily professional life in primary care, and this is what makes the job so rewarding. But this year things got significant more uncertain: national politics have created a such a dense metaphorical fog around the future that makes that makes it hard to plan for the future of the NHS and primary care on both macro and micro level. The BMA poll last year showed half of the UK’s 12,000 EU doctors are considering to leave, while one in three of my colleagues in primary care are considering hanging up their stethoscope within the next five years, independent of their nationality. Then there are the concerns around the sustainability of provision of medicines (at present there don’t seem to be any naproxen and 40mg furosemide tablets available), isotopes for imaging machines, the severe shortage of nurses and paramedics. The list is endless. My beloved NHS -and particularly primary care – is getting severely battered, and it feels like it is only kept (barely) working by the good will of its workforce. Which seems to be wearing thin. I find it unlikely that the ban on fax machines is going to change this.

After so much moaning let’s just remind ourselves how important the GP model of the NHS is for the communities they serve: Barbara Starfield, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore consistently showed that having a primary care practice in your community, even after correction for socioeconomic factors, results in lower all cause mortality; lower mortality from cancer, heart disease, and stroke; increased life expectancy and better self reported health; lower rates of admission to hospital; lower infant mortality; reduced health inequalities; and reduced costs (Caley, M. (2013) BMJ). I find it unlikely that you can deliver these benefits if you shift consultations to online providers.

/rant over. If you’re lucky and you have a few days off over the primary gifting season, enjoy them. If you -like me – have to work between Christmas and New Year, I wish you luck, nerves of steel and understanding patients.

Great ideas, no followup

As suggested by the course facilitator, I had a look at some of the e-learning projects that the OU is associated within the OER movement. Unfortunately the majority seem to be dying a slow death by lack of funding and uptake, as the seem not to have been updated for a few years. xDelia, Cloudworks, Coherere and Compendium all must have felt like a good idea at the time, but it looks like their websites are now all gathering dust. This reflects the fickle world of open educational resources: it’s not enough to rent some domain space and plonk some content in there. You have to have both the funds, the manpower and the motivation to keep these up to date and relevant. So many excellent e-learning content, devised with good intentions and a lot of money, is now languishing in abandoned directories on web servers, but even making them available for free doesn’t make them more attractive (or easy to find). That’s why the RCGP invests in regular update cycles of their courses and their content management systems: there is no point in having a few gigabytes of learning lying around, gathering dust. It needs to be curated, edited and updated regularly, otherwise it will end like one of the previously mentioned projects.

Sad really.

A New Year, A New Challenge

Last year I thought I had finally finished my Open University studies. After more than a decade of on and off studying this and that module (from Linux to child development and onwards to innovative design) I had finally gathered enough credits to get the OU’s special BSc Open. That’s it I thought. No more weekends in front of the computer. But then I found out that they also offer a masters in e-learning. That was it, I was sold. So here I am, being forced to blog regularly for “H817 Openness and innovation in elearning” and use this blog as a diary to reflect on the learning that has been achieved the previous week. This does not come easy, as the actual physical process of sitting down in front of a computer and coming up with something noteworthy for me is a rather painful one (as you can see from the previous entries on the website), especially after a day in the surgery. But it can’t be helped. So, for today’s exercise I had to read this 6 year old paper from Educause Review by Seely Brown and Adler, the magazine of a nonprofit with the task to “to advance higher education through the use of information technology”. The authors state that ‘the most profound impact of the Internet is its ability to support and expand the various aspects of social learning’, which with my e-learning hat on is of course is a wise and accurate truism, although the captains of the adult industry and the peddlers of cute pictures of cats and possums would – on hearing this – likely have a prolonged attack of the giggly fits. For them (in 2008) the most visible impact of the internet on education was the Open Educational Resources movement, an initiative by the Institute for the Study of Knowledge Management in Education that attempts to make access to high quality learning material and course free and easy. To my shame I’d never heard of them and wasn’t aware that the principles of OER had now been taken up by national and multinational organisations. Live and learn. The authors go on and praise the benefits of social learning – something I am doing this very moment by blogging to a -admittedly small – audience as a step forward from the traditional Cartesian method of learning, in which one only engages with one’s peers after years of studying. This being an article from 2008, the authors get quite excited about the then severely hyped ‘second life’ virtual environment in which -if I remember correctly – one walked around and looked at blocky buildings built by corporate sponsors who fell for the model and tried to dance awkwardly to music from bands who thought that streaming audio to SecondLife was a hip thing to do. Another example used by Seely Brown and Adler is the ‘Decameron Web‘, a collection of resources around a seminal 14th century text, hosted by the Brown university. The site was to be used an example on how academics interact and how content is created. Interestingly, the initiative created its own trail of papers on the impact of social, web based learning with an impressive list of publications using the decameron web as a particularly noteworthy example of e-learning. Mach and Bhattacharya for instance pick up on both Seely Brown/Adler’s paper and the Decameron Web in their 2009 review ‘Social Learning Versus Individualized Learning‘.  It’s interesting to see how the Open University attempts a similar model with this course, which seems all around creating, sharing and comparing content around the course work. It will be interesting to see whether the impact is as different as promised.

Lipoedema On The Radio

I have been lucky enough to work with the amazing people from Lipoedema UK for the last 12 months, curating and authoring a joint project for the RCGP’s elearning site, the Online Learning Environment. For some reason outside my realm of understanding, this has suddenly brought me in front of the dashing Dr Mark Porter, his producer and a microphone to talk about Lipoedema on Britain’s best medical radio programme, ‘Inside Health’.

Thanks to an amazing editing job by the show’s producer, it actually turned out quite ok. It was great fun to walk around the hallowed halls of Radio 4, almost trip over Terry Wogan and feel incredibly glamorous for exactly 14 minutes.

Thanks to the team of ‘Inside Health’ for making my 5 minutes of limited fame sound for once quite professional.

And another step.

I was handed my Fellowship certificate by Iona Heath last week. A lovely event, hosted by one of my favourite people in the College, the amazing Amanda Howe. Having your name read by her feels like you just won the Nobel peace prize. I felt a bit humbled by the achievements of my fellow nominees, but I think that might just be intended.

Only downside: Only 3 of the dozens of other nominees were from Essex faculty.

Still. Being recognized for your work by your peers does feel good.