May 17, 2015

The Craft of Usable eHealth

Posted in research tagged , , , at 6:19 pm by mariawolters

On the surface, usability is simple. “If the user can’t use it, then it doesn’t work at all”, as Susan Dray likes to say. But what does that mean in practice?

In health care, you have a large number of patients, a very small, finite number of health care practitioners, the cost of looking after these patients and providing them with the medications and therapy they need, and an empty purse.

And the demand for care is growing ever stronger. Thanks to the wonders of modern medicine, prevention, sanitation, and vaccinations, more people live longer, more people survive illnesses that would have otherwise killed them, and more people survive lifestyle choices that would have killed or crippled them fifty years ago.

eHealth promises to help. When the demand for skilled labour far outstrips its availability, technology can close the gap.

But eHealth technology will only work if people use it, and people will only use it if it works for them.

What does it mean for an eHealth system to be usable? In this post, I want to look at a somewhat iconoclastic discussion of the term usability by Gilbert Cockton, because it questions what I believe to be a dangerous myth in eHealth advocacy, the myth that people are the biggest barrier to successful implementation of telehealth.

They are not a barrier – they are the key.

Cockton summarises the standard view of usability thus:

  1. “Usability is an inherent measurable property of all interactive digital technologies

  2. Human-Computer Interaction researchers and Interaction Design professionals have developed evaluation methods that determine whether or not an interactive system or device is usable.

  3. Where a system or device is usable, usability evaluation methods also determine the extent of its usability, through the use of robust, objective and reliable metrics

  4. Evaluation methods and metrics are thoroughly documented in the Human-Computer Interaction research and practitioner literature. People wishing to develop expertise in usability measurement and evaluation can read about these methods, learn how to apply them, and become proficient in determining whether or not an interactive system or device is usable, and if so, to what extent.”

Vendors of eHealth systems who subscribe to this definition of usability will therefore (ideally) do the following:

A. Define a set of metrics that characterises the usability of their system

B. Conduct studies with all people who will use the system using appropriate methods in order to establish the usability of their system in terms of the specified metrics

The problem is that this is only the beginning. eHealth systems are used by people in specific contexts. Many of these contexts have features that cannot be foreseen by the original developers. People will adapt their use of those systems to the context and their own needs, a process that is known as appropriation in Human Computer Interaction.

Take for example a videoconferencing system that links people with their health care providers from the comfort of their own homes. The system has passed all objective and subjective metrics with flying colours, is easy to use, and has a mobile version, but requires a fast broadband connection.

User Jane McHipster lives on the waterfront in a loft with high ceilings. She has excellent broadband, so her GP can always see her clearly, but the sound is another matter. When the conversation turns to Jane’s mental health, the GP can barely hear her properly. But Jane is too ill to leave her house and come to the practice.

User June McHuckster, on the other hand, lives on a remote croft. Her Internet access comes through her smartphone contract, with the only provider who has good coverage of her home village. Her GPs used to call her regularly, but switched to the video system so they could see her, too. The picture quality is bad, and conversations often stop and start. June is so frustrated with the system that she will often tell the GP she’s fine just to cut the conversation short. This also leaves more of June’s limited broadband capacity for Skyping with her family, who live thousands of miles away.

Jim McSweeney is June’s next door neighbour. He also has family a thousand miles away, and the same smartphone contract. He has the same issues with conversations stopping and restarting, but for him, they don’t matter. He enjoys the banter with his GP when the connection breaks down yet again, loves being able to show instead of having to tell, and thanks the system for saving him from many a long and boring trip to the GP surgery.

*** *** ***

After thorough discussion of the literature on usability and usability evaluation, Cockton concludes in Section 15.5.3 that

  1. There are fundamental differences on the nature of usability, i.e., it is either an inherent property of interactive systems, or an emergent property of usage. There is no single definitive answer to what usability ‘is’. […]

  2. There are no universal measures of usability, and no fixed thresholds above or below which all interactive systems are or are not usable. […]

  3. Usability work is too complex and project-specific to admit generalisable methods. What are called ‘methods’ are more realistically ‘approaches’ that provide loose sets of resources that need to be adapted and configured on a project by project basis.”

Jane, June, and Jim have shown how usability emerges from the context in which the system is being used. In Jane’s case, the system works fine, but there are unexpected difficulties due to her living space. In June’s case, the system is hard to use, and it’s not worth it for her. In Jim’s case, the system is his salvation.

But if there is no one clear usability metric, then what are practitioners to do?

The first step is to genuinely listen to people’s concerns. Next steps and solutions will again vary by context.

For example, Jane could order a headset online, which would make her much easier to understand. June could shut off the video component of the consultation software, which consumes bandwidth and leads to most crashes, and only switch it back on again if the GP really needs to see her.

No rarely means never – in most cases, it means not specifically this, not right now, not right here. It is up to us to decipher it, and to design the interaction between human and eHealth system so we can get from no to yes.

The Promise and Perils of Computerised Prescription Systems

Posted in research tagged , , , , , , at 2:00 pm by mariawolters

Prescribing medications to sick people is a difficult task. The person prescribing needs to choose the right medication, choose the right dose, choose the right timing for delivering those doses, and check whether the medication will interact with any other medications that the patient might already be on.

Clearly, computerised prescription order entry systems (or CPOE) systems have vast potential benefits here. Computers are much better than humans at storing masses of information. In principle, computer systems allow much faster and better access to all kinds of records, which means no more rustling through paper records distributed across several locations.

What’s more, CPOE also allows better stock management. Once medication has been ordered, the system knows exactly how much is needed, how much is still in stock, and can create valuable data sets that can be used to optimise stock management and anticipate demands.

CPOE also generates a data stream that can make it easy to audit prescription patterns and compare those patterns to best practice and evidence-based guidelines.

In short, CPOE is a win-win proposition, and if there is a module that fits with an existing medical record system, there’s no reason why it should not be implemented quickly and efficiently.

That’s what one children’s hospital thought. They were linked to a University Hospital System and treated many children who required urgent access to top specialist medical care. So they rolled out CPOE.

And then, the children died.

In the words of Han and coauthors:

Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables.“ (from the abstract)

The authors looked at the data first. They surveyed all children who were transferred to their hospital’s Intensive Care Unit from other hospitals within a time span of 18 months, 12 before and 6 after CPOE introduction. Then, they looked for the reasons.

These children were a special case. They needed the correct treatment, fast. Over the years, the hospital ICU team had evolved procedures that enabled them to be as fast as possible. They were as finely tuned as the team changing the wheels on a Formula 1 racing car.

The new system destroyed these processes, because it was slow. Before, doctors would pass quick written notes to nurses, who were always on the lookout for new instructions. Now, it took up to ten clicks to enter a medication order. Low bandwidth then added another delay until the order was transmitted to the pharmacists. Before, everybody was free to help tend to the patient, if needed. Now, one member of staff had to be at the computer, tending to the CPOE system. Before, staff could just grab what they needed to stabilise the patient. Now, everything went through central ordering.

With hindsight, it is easy to criticise the hospital team for what seems to be a rushed introduction of a system that was not ready for prime time. But if you look at the hype surrounding much of telehealth and telemedicine (“Act now! We know it works! You OWE it to your PATIENTS! (And to the taxpayers …)“), it is easy to see how this might have happened.

You will often hear telemedicine and eHealth evangelists say that the world could be so much better and brighter if it weren’t for those pesky practitioners who are clinging on to the old way of doing things.

In this case, the old way of getting medication to very sick children on arrival in the hospital ICU was actually working very well. Speed, and having as many hands as possible on deck, were essential.

The new way, with its ten clicks to achieve a single order, was more suitable for a situation where prescriptions were not urgent, where safety was paramount, and where there was spare personnel to focus on data entry.

In short, the new way was not usable.

Usability is far more than “do people like it?”. At the very minimum, per ISO 9241 definition, a usable system has to do what it is designed to do (effectiveness), and it has to do so with an appropriate speed (efficiency). If the users like it, that’s nice (user satisfaction), but it’s far from the whole story.

The key point where the CPOE system that Han and colleagues describe fell down was efficiency, which made it unsuitable for the task.

In theory, CPOE is a great idea, but it has to be usable in practice. Otherwise, it just won’t work. Han, Y. et al. (2005). Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System PEDIATRICS, 116 (6), 1506-1512 DOI: 10.1542/peds.2005-1287

May 16, 2015

So, What is Psy Like as a Keynote Speaker?

Posted in Uncategorized tagged at 7:56 pm by mariawolters

At the recent CHI 2015 conference on Human-Computer Interaction in the heart of Gangnam District, Seoul, South Korea, we had a somewhat unexpected keynote speaker: Park Jae-Sang, also known as Psy, probably most famous for a certain song called Gangnam Style.

Why did I say Park Jae-Sang spoke? Because that’s who came. No glasses, no kooky clothes, no props, no silly dance. Just a man in a business suit and a microphone.

Park Jae-Sang is an ambitious man who is very conscious of the image he projects. At the same time, he tries to be himself. His constant jokes about his weight made it clear that he chose to stay his chubby self, despite K-Pop pressures to be slender and beautiful. His constant jokes about his English (which was excellent) showed his insistence on his Korean roots.

The tale he told was not of a Social Media Ninja, but of a shrewd business man whose associates told him about this YouTube thing – they convinced him, so he decided to explore it.

Then, he explored fame, and what it means to have a global hit. He concluded that Gangnam Style was a one-off, and the way forward for him is to be who he is – Park Jae-Sang, composer, businessman, artist, Korean, uniquely himself.


April 29, 2014

Medication Reminders – What is the Minimal Effective Dose of Technology?

Posted in Uncategorized tagged , , , at 2:14 pm by mariawolters

As I type this, I am sitting on a park bench in Toronto’s Roundhouse park, a sanctuary for old steam and diesel engines in front of the state-of-the-art Metro Toronto Convention Centre.
I’m here with my daughter, who is currently busy repurposing a steam train playground installation as a boat. Behind me, traffic crawls along the Gardiner Expressway which cuts off the Waterfront and its condos and building sites from Downtown.

I am at the 2014 CHI conference on Computer-Human Interaction, which is one of the largest conferences on making technology useable.

On Monday morning, the conference opened with a very thought provoking keynote by Margaret Atwood on robots, technology, and humans. One of the many points she made was about unexpected perspectives on familiar technologies. Just as my daughter converted a train into a boat, technology is invented for one purpose, but then can serve many others. The true potential of a thing is an unknown unknown, in Donald Rumsfeld’s words. It’s a wide open space, limited only by creativity and serendipity.

At alt.chi (on Tuesday before lunch), I’m going to argue that what helps us remember to take our medications is not shiny new purpose built apps – rather, we need to delve into the unknowns and be creative, so that remembering medications is as little work as possible.

(The mathematically inclined readers among you can now imagine using your favourite approach to minimising a differential equation.)

As Juliet Corbin and Anselm Strauss argued in a series of seminal papers, there are three layers of work associated with illness. First, there’s the illness work proper – taking medications, doing prescribed exercises. Then, there’s everyday work – roughly, getting on with your life while being ill. Finally, there’s biographical work – work on your own identity and values. Not to mention that being ill means that you are drained and, by definition, not able to function at your best.

Illnesses create additional everyday and biographical work. Take people with diabetes. They need to schedule regular checkups with their health care providers, take prescribed pills, and remember to refill their prescriptions on time. They may need to overhaul the way they eat. This can mean spending more time preparing and sourcing foods that won’t aggravate their illness – so more everyday work. Finally, they need to come to terms with their diagnosis. Often, they will need medication for the rest of their lives. They need to cut back radically on cakes and sweets. What’s worse, in public discourse, people with diabetes are often stigmatised as fat slobs who ate themselves sick.

So, assume they forget their pills. Let’s just install a smartphone app, shall we? But what about people who struggle to work their phones (and they’re not all elderly)? What about people who rarely use their phones (again, they’re not all elderly)? There are many reasons why smartphone apps can and will fail – and a common denominator of many of them is that using those apps (indeed, using a smartphone) is too much work.

Work on top of work, while the person who has to do the work is not at their best.

Let’s be honest – how do you remember to take your medication? Do you use technology? If it works for you, great.

But what if it doesn’t?

What if the most effective dose of technology is not one app, but none?

People, we need to talk.


1. Corbin, J., and Strauss, A. Managing chronic illness at home: Three lines of work. Qualitative Sociology 8, 3 (1985), 224–247

Maria Wolters (2014). The Minimally Effective Dose of Reminder Tehcnology Proceedings of CHI 2014 – alt.chi DOI: 10.1145/2559206.2578878

March 29, 2013

Archiving without the Clutter – We Need Your Help!

Posted in research tagged , , , at 3:02 pm by mariawolters

Archiving our digital life without clutter is a dream for many of us, as we accumulate a steady stream of data, pictures, books, and videos and have to rely on intelligent searching and serendipity to find what they need.

Can we do better than this? A group of European researchers and companies hopes that we can.

I’m looking to interview people via email as part of an EU project, Forget IT (very preliminary home page), that aims to develop intelligent archiving solutions. The premise of the project is that forgetting, far from being a scourge of humankind, is actually useful, because it allows us to remember what’s relevant and filter out what is not so relevant. When we forget something, that doesn’t mean that all traces of it are wiped from our brain. Old memories can resurface in unexpected moments given the right cue.

One of the scenarios we are looking to explore is managing digital photo collections. With the advent of digital cameras and camera phones, the practice of photography has changed. People take more photos in more situations, but how do they store, archive, and access the mass of images? Can we learn tricks from human memory that allow us to ensure that relevant photos are easy to find, while irrelevant photos can be safely forgotten and eventually deleted?

Although there is a lot of scientific research on this topic, some of which I will blog here in the following months, nothing beats hearing from people directly. What should a photo archive that allows intelligent forgetting look like? How would you like to access these photos? What about privacy issues?

If you are interested in taking part in the study, contact me at mariaDOTwoltersATedDOTacDOTuk (replace AT with @, DOT with .). The interview should not take more than an hour of your time all in all. You will be able to respond as and when you like. Participants will receive a “Thank You” eCard for their participation. I am happy to answer any questions about this piece of research either in the comments or via email.

And if you’d like to hear more about the project and the research we’re exploring, watch this space! I may even attempt to explain the difference between back ups and archives.

The Small Print: The interview will take place via my university email account, which is held in the UK. Interview emails will be deleted from my account as soon as they are completed. All email text will be fully anonymised and stored on a secure drive on University of Edinburgh servers before making them accessible to other researchers in the project. The only parts of the original email headers that will be kept will be the date and time emails were sent. You are free to end the interview at any time and withdraw your contributions at any time after the interview has finished.

This study has Ethical Approval from the Psychology Research Ethics Committee, University of Edinburgh, Reference No 145-1213/3. The local principal investigator is Prof Robert Logie, my postdoctoral accomplice is Dr Elaine Niven, and we’re all part of the Human Cognitive Neurosciences group in the School of Philosophy, Psychology, and Language Sciences at the University of Edinburgh. (I’m only partially assimilated; most of my time is still spent at the School of Informatics)

Edited to fix link and Robert Logie’s first name.

June 27, 2012

Building a Network Means Knowing Who You Talk To

Posted in Uncategorized at 9:33 am by mariawolters

Why do people follow others on Twitter, only to require them to validate with a service like TrueTwit when they wish to follow back?

When I follow somebody, I make that decision based on interacting with them, having a look at their timeline, or finding them in follower lists of people I rate. I will also follow back everybody who follows me who is not a bot and who is not purely a professional social media marketer. (I don’t even care whether I speak their language. I’m a linguist, I love seeing Babel in my timeline.) I’m not online to promote my research or my business, I’m online to build relationships with people. My timeline is a wonderfully diverse crowd, from Tories to Greens, from strict Catholics to adamant atheists.

So if you take a considered decision to follow somebody, then why would you require the new addition to your timeline to confirm that they are not a bot? The only situation I can see is people adding followers automatically through online services. But if you add people automatically, that’s usually a sign that you don’t interact. And broadcasting is not what social media is about. It’s an interaction, as Robert Fondalo, perhaps the only marketer I have ever followed back, expresses this succinctly in this post

Looking at somebody’s timeline is also important because this, to me, is the primary context in which tweets need to be interpreted. Tweets are 140 character messages, so much of the meaning and nuance needs to be implied. It’s usually quite clear how to read a tweet after having seen the person tweet for a couple of weeks. Failing to take such context into account is one of the major sources of fights and hissy fits on Twitter. At its worst, it can even lead to a two and a half year fight with the courts when a tweet that went out to 600+ followers, a tweet whose author regularly jokes and banters with the people on his timeline, and a tweet for which the contextually appropriate reading is “(bad) joke”, is taken completely out of context.

Social media is not broadcasting. It’s talking to people. Know your audience, and get to know people a little before you follow. It’s that simple.

June 9, 2012

Exercise and Depression – A Tale of Misreporting and A Ray of Hope

Posted in research, sport at 9:22 am by mariawolters

There has been a lot of fury about a randomised controlled trial that showed “exercise did not help with depression”

Except that it showed no such thing, and the authors acknowledge this openly in the conclusions of their paper.
(Martin Robbins traces the Chinese Whispers succinctly at the Guardian.)

So What Was That Study About?

Many people report that exercise helps them keep the black dog of depression under control. If your depression is so severe that you can’t even get out of bed, exercise coaching does not make much sense, but for people who can still be active, exercise might work.

How do you implement exercise programmes? Do you shackle each participant to a treadmill for thirty minutes a day? Not if you would like people to take up regular exercise for the rest of their lives. What you do instead is provide advice and coaching. There’s an old saying: “If you want to feed a person for a day, give them a fish. If you want to feed them for the rest of their lives, teach them to fish.” This is how the intervention was designed.
What keeps people from exercising? What motivates them to get out and get active? What kind of exercise can people best fit into their own lives? The TREAD coaching programme covered all of this and more. People who went through TREAD coaching were able to work out a plan that allowed them to be more active. Roughly half the people in the study received TREAD coaching in addition to their usual care (i.e., antidepressants, counselling, or other exercise programmes, if available), the other half received usual care.

Did TREAD increase activity levels? It did – even after controlling for antidepressant use, baseline physical activity levels, and depression severity. No matter how bad participants were initially, they got more active, and the increase in activity often lasted for a year after treatment had finished. That’s impressive.

Did this increase in activity help with depression? Not really; any change in levels was small. After four and twelve months, people in the usual care group and people who got TREAD coaching got slowly better at a similar rate. The main measure was the Beck Depression Inventory, which goes from 0 to 63. Scores were 16.1 for the TREAD group versus 16.9 for the usual care group at four months, and 13.0 vs 13.5 at twelve months. A score from 0 to 13 is considered minimal, scores from 14 to 19 point to mild depression.

That could be a fluke due to a badly designed study, right?

How Good is the Study?

The study itself is sound – there’s no doubt about that. The physical activity coaching programme was carefully designed to incorporate effective strategies for changing people’s habits. It was brief and combined self-help elements with one-to-one coaching, which would have made it easy to implement within the NHS. People were followed up for much longer than usual (a year instead of four months). The statistical analysis is sound. TREAD worked very well in getting people to be more active.

For a more detailed, accessible evaluation of the study, see the summary prepared by the ever brilliant NHS Choices

So, Does That Mean Exercise Doesn’t Work?

Well, first of all, we are talking about physical activity – whatever that may mean for people. As the researchers found, definitions can vary greatly, from getting out of bed to running. Most physical activity was self-reported, because objective measures of how active people are in their daily lives are very difficult to get. The variety of activities people engaged in is actually a strength of this study, because different types of exercise are suited for different people. What’s more,
in the qualitative study, many participants talked about the way in which activity helped them. Again, it varies a lot. For some, it distracts from negative thoughts, for others, it builds self-esteem. The researchers also looked in detail at what physical activity means to people, and explored their experiences of TREAD in an interview study. Some people chose walking, others started rock climbing. Some took up gardening, others mention running.

Why didn’t exercise “work” then? There are several possible explanations. One is that it may only work for a certain type of person who can obtain mental benefits from the activity they have chosen. The other is the dose – maybe people need more intense activity more often. Finally, it’s worth emphasising again that TREAD was designed to promote physical activity per se, not regular sport or vigorous exercise that provides a good aerobic or anaerobic work out. People’s definitions of physical activity vary, and TREAD was designed to persuade people to be more active – whatever that might mean for them.

Don’t Forget – TREAD Itself Works!

In all the excitement about the lack of effect on depression, don’t forget one fantastic finding that is bound to be overlooked in the hoo-haa about the exercise and depression misreporting – TREAD works. People became more active, and they remained more active after one year. In addition, if there’s anything that will work systematically in the health system, it will be a coaching intervention like TREAD, because there is no one size fits all, everybody needs to find out for themselves what works for them.

So, if you’re a GP and want your patients to move more, look at the TREAD material; and if you have depression and would like to try and get more active, have a look, as well. It’s all in this lengthy report – the manual is at the end, but I would also recommend reading the report of the interview study.

The Limits of the RCT Paradigm

The study has raised the ire of many of us with depression who use exercise effectively (we think) to regulate our moods. But maybe it’s not physical activity as such that helps. Rather, activities such as walking, running, rock climbing or weightlifting might be embedded in a whole self-care package of things that work for us. What’s more, in order to exercise regularly, you need to prioritise it, which means that you need to care about yourself and your health. What if the key is to do not just any old activity, but to systematically train one or two activities that reliably shut down your racing thoughts and calm you down?

So let’s step away from the systematic reviews and formal trials for a moment. Let’s go back to the qualitative data, to the interviews and anecdotes, the observations and self-reports, and figure out where exercise sits within self-care, how often people who say exercise helps them are active, and what exactly it is that they do. In short, let’s revisit our hypotheses and look again.

An Anecdote (or Case Study)

I’ve had low moods for most of my life. I was diagnosed with depression at age 35. I was 37 when I discovered the right exercise prescription (weightlifting) and the right dose (2-4 times a week for at least an hour). Weightlifting works for me because

  • it is an activity I can do – my gross motor dyspraxia prevents me from playing team sports, because any team that contains me will lose.
  • it prevents me from ruminating, which means that the weight room becomes a safe space. This is something that no other physical activity can achieve.
  • I can draw on gaining physical strength to replenish mental strength
  • body image, something I have a major problem with, is not something lifters emphasise. What matters is how much you can lift, and the way you look will be a function of how and where you put on muscle.
  • if you take lifting seriously, i.e. if you train, you also change other aspects of your life – you make sure to get enough rest and adequate nutrition, so that the musculoskeletal system can respond to the stimulus and grow strength.
Chalder, M., Wiles, N., Campbell, J., Hollinghurst, S., Haase, A., Taylor, A., Fox, K., Costelloe, C., Searle, A., Baxter, H., Winder, R., Wright, C., Turner, K., Calnan, M., Lawlor, D., Peters, T., Sharp, D., Montgomery, A., & Lewis, G. (2012). Facilitated physical activity as a treatment for depressed adults: randomised controlled trial BMJ, 344 (jun06 1) DOI: 10.1136/bmj.e2758

May 26, 2012

Science Defies Stereotypes

Posted in Uncategorized at 9:28 am by mariawolters

In a recent post, Athene Donald argued that an overemphasis on “geekiness” and associated cultural stereotypes might turn many girls off science.

I agree with her. Although I’m a proud geekette, there are many paths to science, and many ways of living as a scientist. You don’t have to conform to anybody’s stereotype; all you need is a passion for finding out how stuff works.
But I would widen that approach to all genders and youth subcultures.

Turned off because boys who are into science are weak dweebs? Look at this geologist, and this computer scientist (double amputee and expert climber).

Think that female scientists are colourless and boring? Look at this computer scientist.

Do you feel disdain for people with a scientific bent because they don’t get the humanities? Look at this feminist and exercise scholar and think again.

Whoever you are, whatever you are, there will be a scientist out there who is just like you.

May 22, 2012

How Can We Help Researchers For Whom English is a Second Language Write Good Papers?

Posted in Uncategorized at 10:18 am by mariawolters

Neuroskeptic pointed out one instance where plagiarism may be forgivable – when authors whose first language is not English copy small passages from papers to put together their literature review

Now, if authors are clever enough to write an academic paper, their English should be good enough to summarise complex papers in a few words, right?

Wrong. Writing in a foreign language is very difficult, and writing a complex text such as an academic paper in a foreign language is a highly specialised skill. Native speakers of English, most of whom would not be able to write a paper in another language, don’t realise just how difficult this is. My own English is passable, but then I won a Second Prize in the Federal German Foreign Language Contest (there were several first and several second prizes) with English as my primary competition language, have been living in Scotland for 10+ years. And I still make mistakes.

Writing skills need to be maintained I entered the Contest as a 17-year-old with French as my second language. For my Abitur (A-levels), I wrote a long essay about the writer and philosopher Albert Camus in French – today, I can hardly string a blog post together, even though I can still read and understand Camus just fine. In fact, English is the only foreign language in which I can write papers; I would be utterly out of my league if I had to write in Spanish or French.

Now imagine that you don’t spend a lot of time writing English. All of a sudden, you need to put together a paper in the language. Writing well in one’s mother tongue is hard; finding the right turns of phrase in a foreign language is even harder, especially when there are strict page limits, and your field does not have very rigid structures for academic papers.r What do you do?

And, most importantly, as a reviewer, how do you help authors who struggle with their writing?

My own strategy represents a trade-off between time required to review the papers I’ve taken on and diligence. I point out major errors, in particular where terms are used in ways that prevent an English speaker from understanding what is meant, but I let most of the small things slide, in particular when my verdict is “revise and resubmit”. I then provide detailed feedback on the resubmission.

Ideally, journals would have mentors or specialised, paid editors that can help people who struggle with writing English; in the absence of such resources, I often recommend that authors have their papers proofread by a native speaker of English. I know that this can come across as condescending, especially if the authors have worked very hard to write an acceptable paper.

So, what can we do to address this problem as a community? Turning a blind eye to small instances of plagiarism? There are a couple of other options that are relatively inexpensive

  • Develop clear language standards, and enforce them when reviewers whose native language is English expect literary masterpieces.
  • Put together links on field-specific English for Academic Purposes that authors can access.
  • Provide guidance on rewording results and findings from papers for the literature review that helps authors negotiate the line between reporting and plagiarism
  • Provide reviewers with the option of submitting annotated PDFs of the paper together with their review – it’s very cumbersome to make a long list of page, line, and paragraph numbers, copy the bad wording, and type out the correction, especially if line numbers do not line up properly with the lines in the text (or when there are no line numbers at all)

What are your suggestions?

May 15, 2012

Knowledge Pyramids in Telecare

Posted in Uncategorized at 12:26 pm by mariawolters

In circumstances where it can take clinicians and therapists a long time to reach the patients who need them, or where patients need to travel long distances in order to see a specialist, telemedicine comes into its own. Telecardiology or teleradiology allow specialists to receive and assess data from remote locations, giving instant feedback if the communication infrastructure is in place. Thus, telemedicine bridges a gap in knowledge and expertise.

This can be extended to medical education, as Mark Barr from Intel showed at the recent Med-e-Tel conference in Luxemburg. In his presentation, he drew up a knowledge pyramid, where specialists have the highest level of knowledge, followed by generalists, medical nurses, and health workers. Medical education was one of the ways of bridging this knowledge gap.

However, I think that there are really two knowledge pyramids – one of medical knowledge required to help the patient, and one of implementation knowledge required to make sure the patient can get the help they need and implement the required measures. Fitting them both together leads to a continuum where one source of knowledge increases and the other decreases.

For example, if the specialist recommends regular exercise, such as brisk walking for thirty minutes a day, the local health worker can tell people about good routes and point them to local walking groups, if they exist. If the specialist recommends a healthier diet, the health worker can help with suggestions of cheap, nutritious meals, local sources of good ingredients, or cookery classes.

The specialists do not need the local knowledge just like the health workers don’t need the specialist knowledge, but both ends of the continuum need to work together for best results. A top-down conceptualisation of telemedicine, where education just flows along the medical knowledge path, but not back along the implementation one, is – to my mind at least – deeply flawed.

Next page


Get every new post delivered to your Inbox.

Join 2,213 other followers