Max Ugaz's List: Educacion Siglo XXI

• We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.
• The places that get the best results are not the most expensive places. Indeed, many are among the least expensive.
• And the pattern seems to be that the places that function most like a system are most successful.
• They are coordinated by design. They are pit crews.
• To function this way, however, you must cultivate certain skills which are uncommon in practice and not often taught.
• For one, you must acquire an ability to recognize when you’ve succeeded and when you’ve failed for patients. People in effective systems become interested in data. They put effort and resources into collecting them, refining them, understanding what they say about their performance.
• Second, you must grow an ability to devise solutions for the system problems that data and experience uncover.
• working on things like checklists
• They turn out, however, to be among the basic tools of the quality and productivity revolution in aviation, engineering, construction—in virtually every field combining high risk and complexity. Checklists seem lowly and simplistic, but they help fill in for the gaps in our brains and between our brains. They emphasize group precision in execution.
• Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients.
• different values than the ones we’ve had
• They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.
• • La clave del artículo. Los valores que hoy se requieren son contrarios a los que nos inculcaron para la economia industrial.
• These values are the opposite of autonomy, independency, self-sufficiency.
• But nothing says teams cannot be daring or creative or that your work with others will not require hard thinking and wise judgment. Success under conditions of complexity still demands these qualities.
• Resistance also surfaces because medicine is not structured for group work.
• “I’m not paid for this!”
• You are the generation on the precipice of a transformation medicine has no choice but to undergo
• The revolution that remade how other fields handle complexity is coming to health care, and I think you sense it. I see this in the burst of students obtaining extra degrees in fields like public health, business administration, public policy, information technology, education, economics, engineering.
• Of some two hundred students graduating today, more than thirty-five are getting such degrees, intuiting that ordinary medical training wouldn’t prepare you for the world to come.
• You’ve recognized faster than any of us that the way we train, practice, and innovate has to change.
• Recently, you might be interested to know, I met an actual cowboy. He described to me how cowboys do their job today, herding thousands of cattle. They have tightly organized teams, with everyone assigned specific positions and communicating with each other constantly. They have protocols and checklists for bad weather, emergencies, the inoculations they must dispense. Even the cowboys, it turns out, function like pit crews now. It may be time for us to join them.

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•  I wish that the bald eagle had not been chosen as the representative of our country, he is a bird of bad moral character, he does not get his living honestly, you may have seen him perched on some dead tree, where, too lazy to fish for himself, he watches the labor of the fishing-hawk, and when that diligent bird has at length taken a fish, and is bearing it to its nest for the support of his mate and young ones, the bald eagle pursues him and takes it from him.... Besides he is a rank coward; the little kingbird, not bigger than a sparrow attacks him boldly and drives him out of the district. He is therefore by no means a proper emblem for the brave and honest. . . of America.. . . For a truth, the turkey is in comparison a much more respectable bird, and withal a true original native of America . . . a bird of courage, and would not hesitate to attack a grenadier of the British guards, who should presume to invade his farmyard with a red coat on.

• For those of you who have e-mailed me wondering if it's true that an eagle goes into seclusion, plucks out all of its feathers, sheds its beak and talons, and then renews itself, is a myth/legend. It's possible the eagle renewal myth/legend was derived from a biblical metaphor. I didn't deduce it is a myth/legend from the contents of a book. Both science and logic indicate an eagle can not survive for any length of time without his/her feathers, beak and talons. Exposure and starvation would overcome the eagle long before a physical renewal could occur. An eagle's beak and talons grow continuously, because they are made of keratin, the same substance as our hair and fingernails. Eagles molt in patches, taking almost half a year to replace feathers, starting with the head and working downward. Not all feathers are replaced in a given molt.

• One of the central elements of cybergogy is the intent to combine fundamentals of both pedagogy and andragogy to arrive at a new approach to learning
• At the core of cybergogy is awareness that strategies used for face-to-face learning may not be the same used in the virtual environment.
• learner’s active engagement in the learning process affects their learning outcomes
• students must also be comfortable with the learning environment and feel a strong sense of community and social commitment.
• The Cybergogy model values affective learning as highly as cognitive learning,
• current educational systems must value the learner over the curriculum
• must tolerate learning outcomes that may be less predictable but highly worthwhile.
• There are four motivational conditions
• First, cultivating learners’ competence about being effective in learning valuable things; second, creating a respectful and connected learning atmosphere; third, helping learners develop favorable attitudes toward the learning experience through personal relevance and choice; and fourth, creating challenging and thoughtful learning experiences that are consistent with learners’ perspectives and values.
• The key features of this systemic view
• a) putting the right people, elements and resources in place to succeed; b) evaluating results through learning outcomes; and c) providing feedback and taking action to maintain alignment with established educational and societal goals.

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