A Matter of Trust: Online Proctored Exams and the Integration of Technologies of Assessment in Medical Education

Technical Difficulties: Teaching Critical Philosophical Orientations toward Technology

Issue: Technological innovation is accelerating, creating less time to reflect on the impact new technologies will have on the medical profession. Modern technologies are becoming increasingly embedded in routine medical practice with far-reaching impacts on the patient-physician relationship and the very essence of the health professions. These impacts are often difficult to predict and can create unintended consequences for medical education. This article is driven by a main question: How do we prepare trainees to critically assess technologies that we cannot foresee and effectively use technology to support equitable and compassionate care? Evidence: We translate insights from the philosophy of technology into a proposal for integrating critical technical consciousness in medical curricula. We identify three areas required to develop critical consciousness with regard to emerging technologies. The first area is technical literacy, which involves not just knowing how to use technology, but also understanding its limitations and appropriate contexts for use. The second area is the ability to assess the social impact of technology. This practice requires understanding that while technification creates new possibilities it can also have adverse, unintended consequences. The third area is critical reflection on the relationship between 'the human' and 'the technical' as it relates to the values of the medical profession and professional identity formation. Human and technology are two sides of the same coin; therefore, thinking critically about technology also forces us to think about what we consider 'the human side of medicine'. Implications: Critical technical consciousness can be fostered through an educational program underpinned by the recognition that, although technological innovation can create new possibilities for healing, technology is never neutral. Rather, it is imperative to emphasize that technology is interwoven with the social fabric that is essential to healing. Like medication, technology can be both potion and poison.

An Entangled Pedagogy: Looking Beyond the Pedagogy—Technology Dichotomy

‘Pedagogy first’ has become a mantra for educators, supported by the metaphor of the ‘pedagogical horse’ driving the ‘technological cart’. Yet putting technology first or last separates it from pedagogy, making us susceptible to technological or pedagogical determinism (i.e. where technology is seen either as the driving force of change or as a set of neutral tools). In this paper, I present a model of entangled pedagogy that encapsulates the mutual shaping of technology, teaching methods, purposes, values and context. Entangled pedagogy is collective, and agency is negotiated between teachers, students and other stakeholders. Outcomes are contingent on complex relations and cannot be determined in advance. I then outline an aspirational view of how teachers, students and others can collaborate whilst embracing uncertainty, imperfection, openness and honesty, and developing pedagogical knowledge that is collective, responsive and ethical. Finally, I discuss implications for evaluation and research, arguing that we must look beyond isolated ideas of technologies or teaching methods, to the situated, entangled combinations of diverse elements involved in educational activity.