Introduction

I find myself at the end of 15 weeks of academyEX’s Digital and Collaborative Teaching and Learning micro-credential. I am also in the tenth year of running the Palliverse virtual community of practice which has been one of my longest-running educational endeavours. It is time to reflect on all that has come before. Time to look ahead as to what could be as I find myself asking in this blog post, “What’s Next?”

Describe the context and rationale for your plan of integrating digital and collaborative learning into your practice 

Education is what remains after one has forgotten everything he learned in school.

Albert Einstein

The subject that I have taught most in my career is Palliative Care, the care of people who are dying. Despite being one of the few certainties in life, death is not a subject that is taught well in the medical undergraduate and post-graduate curricula. Palliative care is only allotted a tiny amount of teaching time. In New Zealand’s standard six-year undergraduate medical degrees a student only has one or two palliative care lectures. They may have only one day of clinical exposure to palliative care environments. The curriculum is packed full of competing interests and in order to stand out from hundreds of other lectures or clinical days the Palliative Care offering must be different. It needs to be memorable as it is important for students to learn about how important care for the dying will be in their careers. As soon as a doctor joins the workforce they will be involved in providing care to dying patients, no matter what specialty they end up working in. All patients will die at some stage.

The old didactic teaching approach is no longer fit for purpose. Memorizing the textbook which is already out of date before the publisher hits the print button will no longer do. Digital and collaborative learning techniques have great potential for better engagement of the students. The more interested they are the more they are likely to retain information that could be useful to their future patients. Medical students are not the only target audience for Palliative Care teaching. The knowledge and skills also need to be transferred to other healthcare trainees including nurses, pharmacists, social workers, counsellors, physiotherapists and occupational therapists. As Palliative Care literacy is low, other target audiences include patients, their families and members of the general public and government agencies.

In 2014 my co-founders and I started the virtual community of practice Palliverse. We all worked full-time jobs and we worked on Palliverse in our ever-decreasing spare time. We curated Palliative Care materials on the http://www.palliverse.com website and on other social media platforms. We wanted Palliverse to be a “one-stop shop” for all things in the Palliative Care universe. Despite our best efforts, including trying to keep up with technological change, we were unable to make it as interactive as we would have liked it to be.

Explain how you plan to develop and apply digital technology into your practice

Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius – and a lot of courage – to move in the opposite direction.

Albert Einstein

As the 10-year anniversary of the launch of Palliverse approaches it is time for a rethink and redesign. A lot has changed since 2014, for most people in the world smart devices have become ubiquitous in daily life. Though the students we teach these days are mostly digital natives, they still have to be reminded to turn their cameras on during video teaching sessions. Their attention spans have become limited and they are likely multi-tasking on a number of different apps or platforms whilst attending teaching sessions. What kind of learning experiences will stand out in these over-stimulated, over-connected student minds? They have to be something really different and outstanding. Something which can capture the imagination.

It is no longer enough just to be digital curators, we need to become digital creators as well. A decade ago it would’ve been expensive and out of reach for most people to create online content that can now be created by young children with freely available resources that we have been exposed to during this micro-credential.

Despite my Palliative Care colleagues and my best efforts healthcare practitioners still have difficulty identifying when a person needs to be considered a palliative care patient. This can affect many aspects of a person’s last half to half year of life, from financial implications to missed opportunities to create better memories. I would like to develop an app aiming to teach these skills in a memorable fashion. Another important diagnosis that does not get made which can lead to dire consequences is the diagnosis that someone is reaching the final stages of life, that they are dying. Could a diagnosis of dying game be created? Could it also include prognostication advice e.g. if a person is deteriorating over months, they might have months left to live, if it’s weeks, they might have weeks, if it’s days…How could the use of Artificial Intelligence (AI) enhance diagnostics and prognostication?

What does it feel like to die? Could an online available dying simulator be created? This is how it feels to die in full HD/3-D/state of the art immersive virtual reality with haptic feedback. This is what it feels like to die from kidney failure. You can compare this to a death from malignant bowel obstruction. Which would you prefer?

Explain how you plan to develop and apply collaborative learning into your practice

We can’t solve problems by using the same kind of thinking we used when we created them

Albert Einstein

What can we do to foster collaborative learning amongst the target audiences for Palliverse and Palliative Care education? As mentioned previously the potential audience is all humans on the planet. Could we start by running online debates on Kialo-Edu? Teams work to explore all sides of an argument. Real-time interactive homework with other students across the globe. Asynchronicity means you don’t have to be in the same classroom to be able to learn with and from each other. Different healthcare workers could express their points of view, so they each learn each other’s roles in providing care as a team. Shared case-based learning with an emphasis on engaging with other’s specialised viewpoints could provide rich learning.

What can the students create together? Games, stop motion animation, works of art?

Could there be a special Wikipedia – the death and dying edition? All you need to know about death, dying and the care required to reduce suffering. Freely available to anyone in the world with internet access.

Patient portals are increasingly accessible by patients, and encourage people to engage with their own healthcare. What could our students teach patients about Palliative Care? What could the patients teach the students about Palliative Care and life in general? People’s lived experiences could inform the co-design of our student’s curricula.

Could a crowd-sourced AI become a helpful healthcare navigator? Could citizen scientists map local and national care networks? Learning together to form a real community of practice. Everyone learns from each other and expresses their opinions for a more wholesome discourse. The classmate of today becomes the colleague of tomorrow and the collaborative teacher of future students. Interdisciplinary teams are brought together for a common cause. United we stand for the benefit of all.

Analyse how your plan would address relevant aspects of sustainability

A person who never made a mistake never tried anything new

Albert Einstein

People don’t know what they don’t know. For many healthcare practitioners and people in general, Palliative Care remains an unknown. What isn’t known can be scary, is not discussed and is avoided. Society in general does not know how to deal with the dying. It doesn’t have to be that way.

The current medical culture when it comes to death and dying is unsustainable and causes unnecessary suffering. People do not know what problems occur as a person is dying, as they are nearing the end of their life. Suffering goes unanswered. People feel helpless and powerless. They avoid these situations and the suffering is paid forward to the next case and the next one. The cycle of suffering needs to be permanently prevented from occurring again. Life-long learning needs to extend to end-of-life learning. The first time you do something it can be scary, the second time less so. For a graduating medical student, the end of their university degree is the start of their life-long learning journey.

Embrace ideas from other fields. From the lens of Lean Thinking what waste can be prevented or reduced? Palliative care needs to be agile in its response to human suffering. If our patient suffers, so do their loved ones. Dying people’s time is running out and becomes the most precious of resources. No matter how financially wealthy you are, you cannot buy back time. We need to be economical in our choice of investigations and treatments. Will it provide benefits? At what cost? Is it worth it? Can it be tolerated?

What can we automate? Outsource? Are there safer less wasteful ways to do things? Transfer of knowledge can occur via recordings. Medical procedures could be done via VR devices, with haptic feedback. Surgeons can control surgical instruments from thousands of miles away. Could conversations that count be had via virtual means? Over how far a geographical distance can two human beings have a heart-to-heart conversation?

Conclusion

At the end of this micro-credential, I find myself enriched by the knowledge transmitted to me. I am left with more questions than answers, with still more left to learn. My eyes have been opened up to the possibilities that are out there. I think I have just written the work plan for the second decade of Palliverse.

References

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