Lisa Neal

As hard as it is to be sick, it is harder when you are an atypical patient. An atypical patient is someone who has a disease and does not come from the population of people who typically get that disease. An example is the former US Senator from Massachusetts, Edward Brooke, who, in 2003, “was diagnosed with breast cancer and worked to raise awareness that the disease also affects men.” (This was just in the news because Barbara Walters revealed on “The Oprah Winfrey Show” that they were more than just friends.) Other examples are young women with heart disease and teenage boys with anorexia.

Atypical Patients Struggle to Find Information and Support Online

When someone is concerned about a disease, the internet is an easy place to turn for information and support. In fact, 80% of people in the US who use the Internet search for health information for themselves or a loved one.

Online information and support are generally targeted to the typical patient. While many people don’t know what to search for or what to call a disease, these difficulties are compounded for an atypical patient whose search results may not be relevant. A friend of mine asked me to help her find an online health community for a friend diagnosed with apraxia. Most of the sites I found supported the needs of parents whose children have apraxia. Finally, I asked a speech therapist, who suggested looking at stroke sites, since apraxia in adults often results from a stroke. Even with a diagnosis, it was hard to find relevant information and support.

One of my students last fall designed an online health community for young women with osteoporosis and osteopenia, diseases that typically strike older women. My student believed that a young woman concerned about her bone density or diagnosed with osteoporosis needs information targeted to, support from, and a site designed for people her age.

Patients – and Doctors – Are Less Likely to Know Risks and Symptoms

People are notoriously bad about following medical advice about self-exams and healthy behaviors. When the warning signs of a disease are publicized, it is only the symptoms experienced by typical patients and, furthermore, the publicity is targeted to that population.

Atypical patients are less likely to know that they are at risk or how to detect a disease; thus men rarely perform breast self-exams. Sen. Brooke ignored early warning signs and “assumed the discomfort was simply his aging body’s way of slowing him down.” When his wife noticed a lump, he mentioned it to his doctor and ended up having a double mastectomy. Because of his own experience, he has worked to encourage doctors to perform breast exams on men and to encourage men to perform self-exams. Furthermore the symptoms of some diseases can be different in an atypical population, such as those of a woman experiencing a heart attack.

It is not just patients who lack awareness of risks and symptoms, but doctors as well. Furthermore, treatment for an atypical population can be more difficult since medications are less likely to have been tested on this population.

The Stigma of Disease Is Greater

Finally, an atypical patient may feel more of a stigma, or perceived stigma. Sen. Brooke, a private man, had trouble disclosing the disease even to his children initially. When an atypical patient discloses a diagnosis, the reaction is likely to be shock or disbelief, thus perpetuating the silence about these diseases.

Health Sites Need to Meet the Needs of Atypical Patients

Most health sites are designed for the populations who typically get that disease. It is important to design for these atypical patients as well in order to better meet their needs and to increase general awareness. In some cases, targeted sites are necessary since the information and support needs, diagnosis, and treatment of an atypical patient are so different from those of the populations more commonly afflicted.

Advancing from Atypical to Typical - The Name of a Disease and the Name of this Category of Disease

If a disease starts to become more common in a specific demographic, it gets its own name as well as greater recognition, such as early-onset Alzheimer’s disease. Although the symptoms are similar to Alzheimer’s disease in older patients, the patient’s age may impact both treatment and family support needs. Male menopause is a very different type of example, since it refers more to a collection of symptoms than a disease.

I thought there might be a term for diseases that strike an atypical population. Every term I tried had a different meaning, such as outlier or differential. Is there an accurate description in medical or lay terminology for this category of diseases?

Given that the length of a day can’t be extended, it is a challenge for many people to get their work done. This is especially true when the work in question requires concentration. Ironically, the office is often the worst environment for getting work done because of the multitude of distractions and interruptions. So here’s what to do: take a trip! Here are the reasons why:

1. You get things done in preparation for a trip so that you don’t have to think about them while away. The bills are paid, the children’s schedule is in someone else’s hands,… and you have everything with you you need. How refreshing - and mind-clearing.
2. You are in transition. While you are actually someplace at all times, the place you are in while traveling is inconsequential. Thus you don’t have to think about it. (Have you noticed how the monitors on trans-Atlantic flights are constantly reminding you where you are? It’s a great reason to travel first class: to have control over what you view - or don’t view.)
3. You have few distractions. I know someone who met her husband in the seat next to her on a plane, but, in general, most people I know ignore their traveling companions unless they are ones they selected themselves. Ellen Goodman, a syndicated columnist, wrote - in 1984! - about how terrible it was when planes first added phones: “Now even this refuge has been violated.” But most people don’t talk on the phone on planes and even trains have their quiet cars.

Agatha Christie captured the glamour of travel in her books (although some of her passengers did not arrive at the destination they intended, if you know what I mean). But few of the people in her books were working while traveling, with the notable exception of detecting. Irene McAra-McWilliam, who gave the opening plenary at CHI 2008 in Florence, in an interview for eLearn Magazine, said, “Many places are excellent spaces for thought” and mentioned train travel as one of her optimal work environments. I agree, and find the Amtrak’s Acela from Boston to New York the perfect place to work. I wonder if anyone has studied the impact of the ambient noise or rhythmic motion on thought processes?

It’s my birthday today and, for the first time, I received more birthday wishes from businesses and associates than I did from friends. Bette Midler sang, “You got to have friends,” and I have many friends who kindly remembered my birthday. But when site registration includes a date of birth, birthday messages with15% off coupons can result. (If I receive a 25% off coupon, does that mean we have a stronger relationship?)

MCI’s widely advertised Friends & Family calling program in the early 90’s introduced me to the commodification of friendship. This loyalty program provided “a lower rate for calls made to customers that they had included in their calling circle,” and, furthermore, increased switching cost since a departing customer’s former calling circle had to pay more for calls to that person. This program ended when a flat-rate plan was introduced, allowing people to call their friends without having to designate people as members of their circle.

Marilyn Monroe sang, “Diamonds are a girl’s best friend,” and obviously friendship has varied meanings. Social networking is stretching the definition of friendship even further as sites use different terminology to describe the people one is connected to. LinkedIn asks me to “Add friends or colleagues to your network?” “Friend” appears 29 times on my Facebook profile - and some of my Facebook “friends” are not people I even know well. In contrast, I really like it that twitter calls the people I follow “people”!

I believe that this overuse of “friend” can dilute the word’s meaning. Dionne Warwick’s “That’s what friends are for” is the title of a RevolutionHealth post about how “Good friends hold you together when you are falling apart, even if it’s over the silliest, most minute things.” A friend is “a person attached to another by feelings of affection or personal regard,” while social networking contacts are acquaintances or - perhaps a better word - associates: “a person united with another or others in an act, enterprise, or business; a partner or colleague“.

“Studies show that people with close confidants have healthier immune systems, stronger hearts, and less depression and anxiety — not to mention more fun.” While people certainly form tight bonds in online health communities with others who are in a similar situation, I imagine these studies more likely refer to friends in the traditional sense. A study by Dr. Will Reader at Sheffield Hallam University found that most people “have, on average, five really close friends,” whether or not they use social networking sites. (I wonder how many people think that their stature is increased by the number of connections they have in a social networking site.)

It is not surprising that I was happier with the phone calls and cards from my friends, rather than those from businesses and my social networking associates. And what about that e-card from my dentist’s office - it’s hard to get a warm, fuzzy feeling. I can certainly think of more perfect ways to celebrate - in fact, already have! - than “A perfect way to celebrate: 25% off the regular price of…” And, if you are my friend, please come join us!

I love James Bond movies. I have never read Ian Fleming’s novels or even thought much about him. I was therefore interested to read that the Imperial War Museum London recently launched an online exhibition exploring “the early life of Ian Fleming, his wartime career and work as a journalist and travel writer and how, as an author, he drew upon his own experiences to create the iconic character of James Bond that continues to have global appeal.” I am often hesitant to click on links, partially due to time constraints and partially due to some disappointing experiences with must-see websites, must-watch videos, and must-listen podcasts.

The virtual “sneak peek” exhibit used a gallery metaphor to depict some objects from the exhibit with audio explanations - complete with dozing guards. I didn’t find it particularly interesting or informative or even a good teaser for the actual exhibit. However, as an educational experience, it was successful in two ways. One was that, before giving up completely, I found some fascinating materials about Ian Fleming on the museum’s exhibition site. The other is that I read about Ian Fleming and about “For Your Eyes Only,” the exhibit name. Since I liked Casino Royale or any 007 movie with Sean Connery better, I read about other movies as well, including trivia, goofs, quotes, and the gadgets Q invented.

Suppose you were teaching a class and one of your students tactfully told you that your lecture was boring but that he or she spent hours researching the topic out of class. Would you ask for constructive criticism, be happy since you spurred self-directed learning, or say, as Bond did, “Well you can’t win them all”?

My latest mental mash-up is about email and the presidency. Donald Knuth does work that “takes long hours of studying and uninterruptible concentration” and thus chose to no longer use email. Now, if the White House had the same policy, then the White House CIO would not need to claim “that email messages from 2003 to 2005 either can’t be produced because they’re not missing, because the computers they were on have been destroyed, or because it’s too hard to find them.” Not only are tax dollars spent on controversies such as this, but government officials are spending time writing and reading emails instead of focusing on the country’s needs with uninterruptible concentration.

I don’t know what Knuth’s politics are, but his books are brilliant and I appreciate his stance on email. I spend too much time every day on email and, even then, it’s never enough. (Am I the only one who has ever started off an email with “Sorry I didn’t respond sooner but…”?)

Instead of “a chicken in every pot and a car in every garage“, Knuth can institute a moratorium on email. Benjamin Franklin said, “Time is money“, and Knuth’s platform can be “Email is time”. “Time is the only thing we have in our lives” and through email we allow strangers to take it away from us and destroy our concentration. How is this any different than a phone call from a telemarketer interrupting dinner (before the do not call registry)?

Tech populism, a term coined by Forrester Research, refers to people bringing the technology they use in their personal lives into the workplace where traditionally tools have been provided to them and their use prescribed. Employees may, for example, have access to online courses they are supposed to take, but they may prefer to search for and use information available on the web instead of utilizing these courses. Another example is when there is a corporate knowledge management initiative but employees find and contact each other through LinkedIn or other social networking services.

Tech populism is revolutionary in that the traditional tight controls on workplace behavior are violated - often to everyone’s benefit. And a revolt can occur when employers attempt to suppress tech populism.

“Bona fide revolutions—whether political, cultural, or spiritual —occur infrequently in history” and one is certainly taking place in the workplace today. This revolution parallels what was arguably the biggest revolution in music, dancing, and nightlife: the discotheque.

The American Heritage Magazine article goes on to say that “the discotheque originated as a den of resistance in Nazi-occupied France” and, from the 1960s to the 1980s, impacted all aspects of culture in the US and other countries. “Discotheque dancing followed the 1960s pattern in which teenagers invented pop-culture trends and discarded them soon afterward, at which point they were taken up by adults,” just like Facebook today!

“Saturday Night Fever propelled disco fever to epidemic proportions: By 1978, 40 percent of all the music on Billboard’s Hot 100 was disco. Meanwhile the discofication of America proceeded: There were disco lunch boxes, disco “Snoopy” bed sheets and pillows, disco belt buckles, disco records by old-timers like Frank Sinatra and Ethel Merman, an estimated two hundred all-disco radio stations, disco dance courses, disco proms, books about the proper makeup to wear to discos—and an estimated twenty thousand discotheques nationwide.”

I coined discotheque populism to refer to how this “discofication” still lives in the music, lighting, and dance moves found in any club. Even the clothes, makeup, and hairstyles periodically return to popularity. Tech populism is no different - the Facebook of yesterday is the Twitter of today. Tomorrow will bring new applications that will be adopted (and even created) by teenagers first, become mainstream, and then be abandoned by the original adopters just when managers are developing policies for their use.

Steve Denning wrote previously about The democratization of knowledge: anyone can know anything:

“This phenomenon is particularly notable in the spontaneous formation of global communities of interest in the field of medical problems. Patients who were once at the mercy of doctors who had unique access to esoteric medical knowledge now find themselves able to contact other doctors and patients and explore their particular subject, gather new data, discover new leads for treatment, and learn how to cope with side effects. The emerging communities are global in nature. A patient in the US may be able to learn from a doctor in China or a suffering patient in Argentina and vice versa. The sufferers of rare diseases, where perhaps only a few victims exist around the world, can now make contact with each other and share experiences…”

I had an email discussion with Steve yesterday, in which he provided the following update on the Democratization of Health Knowledge:

• the rising resentment of some “experts” to the re-emergence of amateur knowledge, and a certain degree of unwarranted elitism involved in such “expert” attitudes. This resentment seems most marked in fields where the expert’s claim to superior expertise is most shaky e.g. political journalists.
• the reluctance of some “experts” to share if they feel that the knowledge risks being misused or abused.
• the gratitude of other “experts” who often see the amateurs as helpful partners.
• the risk that a little knowledge is a dangerous thing. Alexander Pope: “Drink deep or taste not at all from the Pierian spring.” (That risk is however not limited to amateurs. The radical specialization of medicine means that someone can be an expert in a tiny field, but a real ignoramus in areas of their expertise and make egregious blunders.)
• the reduction of such risk in cases where people have taken on the task of lifelong learning. They become adept at getting up to speed in a completely new field and remain curious, open-minded, imaginative, and rigorous in their exploration of a new field of knowledge. This is important both for amateurs and experts. Atul Gawande’s books document some of these issues in the medical field.

My more recent work has tended to move towards the area of things that are already very well known but are not acted on: what can be done about this?

The irony is that the larger knowledge problem since time immemorial has always been one of demand for knowledge, rather than one of supply of knowledge. Unless this is addressed, increased supply of knowledge doesn’t change things all that much. We don’t need a lot of esoteric web research to know that diet, exercise, smoking, or substance abuse are critical determinants of health and well-being. Yet how many people fail to act on this knowledge?

In organizations, people often know all too well what needs to be done, but often they can’t get others to listen and act. (In the medical field, you don’t need to be a genius to see that the overall cost-effectiveness of the US health system is far from optimal. So why hasn’t change happened?) My work is now aimed mainly at helping people overcome resistance to obviously needed change. I’ve spoken on occasion at medical conferences and discussed the issue with dentists.

Marcus Welby, MD is an anachronism. The family doctor who pays house calls no longer exists except for some anachronists or doctors working in a few specific situations. The show, which ran from 1969-1976, predates the web. Hence Marcus Welby and his assistant probably got most of their medical updates from their monthly JAMA.

The amount of medical knowledge that exists and the amount that medical professionals need to know is constantly growing. Medical literature doubles every 19 years and, for AIDs, every 22 months, according to Tonya Hongsermeier, MD.

How can anyone possibly stay current? This is especially important because of the criticality of the information, not just the amount. As Tonya points out, doctors can be aided by tools that assist them, for example, alerting them to possible negative interactions between medications and other medical risks. Initiatives to codify knowledge and increase patient safety are taking place at Partners Healthcare.

Patients, who had limited access to medical knowledge in Marcus Welby’s days, now have a wealth of information available online - in fact, can access most of what physicians read. However, patients generally lack the basic knowledge and frameworks to understand and make sense of this abundance of readily accessible knowledge and, even more importantly, how to apply it. This is primarily due to lack of medical training and poor health literacy.

This democratization of medical knowledge, according to Larry Prusak, is a double-edged sword. Doctors struggle to stay on top of advances and, at the same time, patients increasingly try to acquire medical knowledge about their own or their loved one’s health. The disconnect between patients and doctors can be attributed in part to this democratization, which has changed the relationships between patients and their providers. The notion of empowered patients is one few could argue with; however an important component of expertise is knowing what you don’t know, knowing what to ignore, and knowing what is important. “There’s so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore,” but many patients, understandably, lack that expertise as well as the necessary detachment. In fact, even doctors don’t treat themselves.

Not to digress, but I wrote about health and media recently and was interested that Marcus Welby, MD had an episode that focused on the diagnoses of breast cancer in two women, aired when “the wives of two public political figures” had been diagnosed with breast cancer. “The most motivational moment of this episode is James Brolin’s emerging from character to talk about diagnostic and early-detection tools for breast cancer. Such is the hallmark of television that [it] is not only entertaining but informative.” (This also goes to show the amazing information you can find on the internet when you aren’t even looking for it.)

I am at a Working Knowledge conference on “Judgment and Decisions” at Babson College today, organized by Larry Prusak and Tom Davenport. Bob Thomas, Accenture and Fletcher School of Law and Diplomacy at Tufts University, just spoke about “Crucibles, Judgment and Leadership”. One of his main points is that people have to learn how they learn best, and crucible experiences can be pivotal for many people.

The five key ingredients for going from novice to adept expert performer are having talent, ambition, grasp of method, a great teacher, and feedback. Practice can trump talent, as research on expert performance shows. Outstanding performers devise a personal learning strategy that goes beyond practice to understanding how they learn best - and what their passion is. One way Bob learns what people love to do is by asking what they are doing when they lose track of time - what is often called a flow state.

While this talk focused on how businesses grow leaders, I believe Bob’s insights are valid for anyone in any role, including children with learning disabilities, who are explicitly taught how they learn and strategies to accommodate their learning disability. Many people, however, never reflect on their own learning style.

Bob offered a number of examples of crucible experiences in disparate organizations. The Peace Corp drops people into a developing country and expects, with minimal training, they will not only survive, but will learn and grow. The Mormon Church’s major crucible experience is the mission all members go on, which includes dealing with rejection, learning how to resolve conflicts with the person they are on the mission with, and learning what it means to be Mormon in a non-Mormon world. Hell’s Angels’ crucible experience is the run, a long ride where the leader negotiates the passage from one location to the next, making it more challenging than last year’s run.

Tom Davenport led a discussion focused on if - and should - crucible experiences be institutionalized. He gave examples of team-building experiences such as people falling into each other’s arms and fire-walking, but it is arguable if these are crucible experiences.

Even the examples from the Peace Corps, etc., above are orchestrated in a sense. Bob showed videos of two people discussing crucible experiences and they were serendipitous ones, and also ones where it was easy to see that another person, in the same situation, would have been devastated instead of inspired. Part of what I learned from this discussion is that you can prepare people for, and to be receptive to, learning experiences, but can’t necessarily orchestrate them. I would like to better understand the role of reflection and the extent it can be encouraged or scaffolded, since that seems to me to be a major difference between how people learn from a crucible - or any - experience.

Stephen Downes was kind enough to allow me to publish this here. I was especially interested in it because FranklinCovey was one of my clients when I worked at EDS. Watch for a version of this to appear in eLearn Magazine later this month!

With apologies – and all due credit – to Stephen Covey.

1. Be Reactive

There’s a lot of talk about user-generated content on the web. That’s great. But if publishing your own stuff comes at the expense of reading, and commenting on, other people’s stuff, that’s not so great.

The first thing any connected person should be is receptive. Whether on a discussion forum, mailing list, or in a blogging community or gaming site, it is important to spend some time listening and getting the lay of the land.

Then, your forays into creating content should be as reactions to other people’s points of view. This will ensure, first of all, that they read your comment, and second, that your post is relevant to the discussion at hand.

Posting, after all, isn’t about airing your own views. It’s about connecting, and the best way to connect is to clearly draw the link between their content, and yours.

2. Go With The Flow

We all know those people in our online community who are out to Prove Something, to Get Things Done, or to Market Themselves.

These are people we tend to avoid. Because no matter what the topic of discussion, they’ll weigh in with their pet project, peeve or talking point.

When connecting online, it is more important to find the places you can add value rather than to pursue a particular goal or objective. The web is a fast-changing medium, and you need to adapt to fit the needs of the moment, rather than to be driving it forward along a specific agenda.

This doesn’t mean you shouldn’t have any goals or principles for yourself. You should; that’s what will inform your participation. It’s just a reminder that your goals are not the same as other people’s goals, and therefore that your online participation needs to respect that fact.

3. Connection Comes First

People talk about not having time for email, of not having time for blogs. Sometimes they even talk about working without an internet connection.

It’s good to take a break and go out camping, or to the club, or whatever. But the idea of replacing your online connecting with busy-work is mistaken.

In almost all fields, connecting with others online is the work. The papers you write, the memos your read and toss – all these have to do with connecting with people. Even if you work with your hands, making cabinets or rebuilding engines, all your contacts with customers and suppliers are about connecting with people.

If you don’t have enough time for reading email, writing blog posts, or posting discussion lists, ask yourself what other activities you are doing that are cutting in to your time. These are the things that are often less efficient uses of your time.

If you are spending time in meetings, spending time traveling or commuting to work, spending time reading books and magazines, spending time telephoning people (or worse, on hold, or playing phone tag) then you are wasting time that you could be spending connecting to people online.

If you make connecting a priority, you can take that walk in the forest of vacation in Cadiz without feeling you are not caught up.

4. Share

We’re all heard the advice to “think win-win”. Forget that advice. If you follow that advice, you will always be looking at things and saying, “what’s in it for me?” That’s exactly the wrong attitude to have in a connected world.

The way to function in a connected world is to share without thinking about what you will get in return. It is to share without worrying about so-called “free-riders” or people taking advantage of your work.

In a connected world, you want to be needed and wanted. This will, over time, cause resources to be sent to you, not as a reward for some piece of work, but because people will want to send you stuff to help you to be even more valuable to them.

When you share, people are more willing to share with you. In a networked world, this gives you access to more than you could ever produce or buy by yourself. By sharing, you increase your own capacity, which increases your marketability.

5. RTFM

RTFM stands for ‘Read The Fine Manual’ (or some variant thereof) and is one of the primary rules of conduct on the internet.

What it means, basically, is that people should make the effort to learn for themselves before seeking instruction from others.

Almost everything a person could need to know has been recorded somewhere online (by people who are sharing their knowledge freely). Taking the time and effort to look at this work is not merely respectful, it demonstrates a certain degree of competence and self-reliance.

For example, if your software fails to install, instead of calling customer service or posting a note on a bulletin board, copy the error message into the Google search field and look for answers. Almost every software error has been encountered (and documented) by someone before you.

Finally, when you do ask for help, you can state what you’ve read and tried, and why it didn’t work. This saves people from giving you advice you don’t need, and helps them focus on what’s unique about your problem.

6. Cooperate

Offline people collaborate. They join teams, share goals, and work together. Everybody works in the same place, thy use the same tools, and have the same underlying vision of the project or organization.

Online, people cooperate. They network. Each has his or her own goals and objectives, but what joins the whole is a web of protocols and communications. People contribute their own parts, created (as they say in open source programming) to ‘satisfy their own itch’.

This is probably the consequence of distance. Online, it is not possible to enforce your will or (beyond a limited extend) to get your way by shouting and intimidation. This means that online communications are much more voluntary than offline communications. And successful online connectors recognize this.

To cooperate, it is necessary to know the protocols. These are not rules – anybody can break them. But they establish the basis for communication. Protocols exist in all facets of online communications, from the technologies that connect software (like TCP/IP and HTML) to the ways people talk with each other (like netiquette and emoticons).

7. Be Yourself

What makes online communication work is the realization that, at the other end of that lifeless terminal, is a living and breathing human being.

The only way to enable people to understand you is to allow them to sympathize with you, to get to know you, to feel empathy for you. Comprehension has as much to do with feeling as it does with cognition.

People who use online communications ‘only for business’ – or worse, feel that other people shouldn’t be posting cat photos or playing Scrabble on Facebook – are employing only a small part of the communications capacity of the internet.

Learning and communicating are not merely acts of sending content over a wire. They are about engaging in (what Wittgenstein called) a ‘Way of Life’. Having a cat is as important for a physicist as having an advanced research lab. These common everyday things form the mental structure on which we hang the highly theoretical structure.

The idea behind ‘being yourself’ is not that you have some sort of offline life (though you may). Rather, it’s a recognition that your online life encompasses the many different facets of your life, and that it is important that these facets all be represented and work together.

Sometimes a juxtaposition is more powerful than a mashup. This morning I was at a public high school and later at a private school. While I was at each for different reasons, I was struck by the talent and devotion of the people at both schools. While I don’t know their salaries, compensation to attract and retain teachers and education support professionals is lower in the US than in other countries and lower than comparable professions. Teaching for many, myself included, is a labor of love and a chance to use one’s skills and knowledge to help others. Because of this juxtaposition I find myself wondering what triggers this devotion in people and what causes them to flourish in their profession, albeit in the very different environments I was in today. (The mental mashup here, by the way, was trying to understand the impact of salary after reading a press release about the Economic Policy Institute’s new study.)

Online teachers and adjunct faculty are typically compensated less, and have less prestige, than other teachers. While online teachers may have fewer advising or administrative responsibilities, they work very hard, sometimes harder, than teachers in the classroom because they have to master technologies and be available more hours. I wonder not only what triggers devotion in such teachers but what causes it to whither and even dissipate - and what role compensation plays in this.

Learning to detect counterfeit currency or diagnose and treat a disease in time to save a patient’s life hardly sound frivolous. Yet “serious games” are increasingly being used for training for bank employees, medical students, and others as a way of making learning more compelling and simulating reality. Clark Quinn and I wrote a column in eLearn Magazine addressing if the design of a game, or even the fact that a game is being used, induces a sense of frivolity that lessens the impact of the learning for serious topics.

Ten reasons podcasts don’t work for education are:

1. It is faster to read than to listen to text.
2. It is difficult to skim a podcast (fast-forward can sometimes be used) while most people skim text and carefully read the parts that interest them.
3. It is easier and quicker to reread text than to replay part of a podcast.
4. Interesting passages of text can be highlighted or, if online, copied into notes.
5. Text can be illustrated.
6. Most people, when driving, working out, etc., do not have the concentration to stay focused on an educational podcast.
7. When a podcast is of high quality and slickly produced, it seems like entertainment, especially when it starts with music.
8. When a podcast is of poor quality, the background noise or pauses and speech fillers are annoying to listen to.
9. It is easier to get into a flow state when reading text because you are less likely to be multitasking.
10. Deeper learning, as Don Norman says, “takes time and thought”, and it is harder to have deep thoughts when listening passively or when multitasking.

I developed this list after talking to some of Jared Spool’s students, who sent me an e-learning scenario centered on the use of podcasting. While writing this, I listened to a podcast that Jared made, just to make sure that my list was accurate. Part way through, my son called and I dropped off his cleats and then stopped at the track and ran because it is a sunny day and I had been sitting too long. When I got back, the podcast was still playing. Voice can convey nuances that text does not, and Jared is an entertaining speaker, but I prefer text and am unlikely to ever make podcasts for my students.

Why sit at home when you can be out dancing? Not only is it fun and good exercise, it can reduce your risk of dementia according to a research study conducted by Dr. Joe Verghese. Dr. Verghese theorizes the underlying reason is that “Dance is a complex activity. You have to follow the music, remember the steps and improvise.” Dance is also a social activity, typically done with a partner.

Dancing with the Stars and the knock-off shows are increasing interest in dance, in much the same way Nick/Tuck increased interest in cosmetic surgery. Of course, just like staring in the mirror at your wrinkles doesn’t mean you will have surgery, watching dancing doesn’t mean you will get off the sofa.

Knowing the potential health benefits may prove to be an incentive. Since “roughly 18%, of the USA’s 79 million baby boomers can expect to develop Alzheimer’s or some other form of dementia in their lifetime“, according to a newly released report 2008 Alzheimer’s Disease Facts and Figures.

If you are going to give a talk, you might as well be a brilliant orator, a phrase that has been used to describe Julius Caesar, Barack Obama, and many in between. Here are 10 things you can do to improve your oratory performance:

1. Have an interesting message to convey. It sounds simple, but, if it was that easy, why doesn’t everyone do it?
2. Have a conversation with your audience. Orating does not mean lecturing or preaching. It means conveying a message to people. Since each person took the trouble to be there to hear you, talk to him or her.
3. Do not read your slides or notes. If you do, I guarantee someone (if not many) will think, “I can read that myself so why am I listening to this person?”
4. Don’t say “umm”. Pause instead. Or breathe. (Well, always breathe.)
5. Look friendly and approachable. You know how people like babies and cute animals? You want people there to like you because they will get more out of your presentation.
6. Use self-deprecating humor, which will never offend people. Surely there is something funny you can say about yourself!
7. Tell a story to illustrate to illustrate your point. Stories tend to be memorable and thus a good reminder of your message. They are also fun to tell and if you are having fun your listeners are more likely to as well.
8. If someone asks a question, don’t be nervous because you are the expert. Worst case , if you don’t know how to answer the question, answer a different question that you do know the answer to that is at least related.
9. Have a plant in the audience to ask a question that you want to answer. This way you will look good and you avoid having to wonder why no one asked a question. Usually after the first question you will get others (see #8).
10. Tape a practice session and actually watch or listen to it. It is very painful to do! A few years ago I gave a talk that was streamed on the internet and it took me 3 months before I could watch it, but it was pretty good except I said “umm” too much (see #4).

The funniest emails caught in my spam filter are the ones that offer me degrees in various enticing ways. Since I am on a “top 10″ kick this week, my favorites in my last perusal are the following charmingly ungrammatical ones (#2 reminds me of Porgy and Bess: “Is you is or is you ain’t my baby?”) or the ones that cause doubt (such as #1: can a degree ever expire?):

1. Expired academic qualification
2. Is your skills about to expired?
3. Without books and education process call now
4. MBA the hottest most sought after degree
5. Receive PhD that you deserve from an Established Prestigious Institution
6. Receive MBA very fast
7. Nominated for a Ph.d
8. Celebrate your life-long achievements
9. Start earning the salary you deserve by obtaining the approopriate University Degree
10. Your Degree shipped by Fed-Ex

In Degrees by Mail: Look What You Can Buy for only $499, I wrote about reading these online degree offers “more carefully than other unsolicited emails to find out how much the degree costs, how long it takes to ‘earn’ it, and what the plausible-sounding name of the institution is”. Now I just read the subject lines. But I still worry that these ads make it harder for the high quality online programs to move away from the déclassé correspondence schools that used to be so common. The biggest issues to me are how students find the high quality programs while avoiding the ones advertised above, and how employers know which online degrees are legitimate and from reputable institutions.

Eliot Spitzer, the governor of New York, is embroiled in a scandal and announced that he “failed to live up to the standard I expected of myself”. His alleged actions are more notable because of his anti-corruption stance. (I also heard that governor was his stepping stone to the White House, which may never happen now.)

Not ever wanting to be accused of not practicing what I preach, I went to my list of Ten Things You Can Do in Ten Minutes To Be a More Successful e-learning Professional and did #8, to contact an e-learning expert. Actually, it was my own spin on #8, but creativity and designing for our target audience are part of our profession!

Here’s what I did: I emailed Don Norman, who is an expert at many things, including e-learning, and is one of the people I most admire. I will add a caveat here that I know him and have asked him for advice before so I felt hopeful that he would respond. Don gave me brief feedback on the issue I asked him about, promising more since he was preparing for a trip, and detailed feedback on my blog, in particular, on my recent post on The Disconnect Between Patients and Doctors. As a result of this, I am writing a new post since I agree with his points.

Hence I have practiced what I preach and am better off for it since the insights I received will make me more successful. I bet Governor Spitzer wishes he had listened to his own advice.

You need a break and, instead of heading to the coffee pot, what can you do in 10 minutes that will refresh and energize you and increase your job satisfaction and career success?

1. Find an e-learning conference to go to and send an email to your manager giving 10 reasons why this will help you perform better. If travel is a problem, find a local seminar to go to.
2. Find an e-learning conference to submit to. It is much better to go to a conference as a speaker and the process of figuring out what you want to talk about and writing an abstract will be a valuable reflection process.
3. Write a short description of what you learned at the last conference or seminar you went to or the last article or book you read and circulate it to your colleagues. They will appreciate it and it will reinforce what you learned. It might also help your chances of getting funding for your next conference (see 1).
4. Do a search on “e-learning”, “instructional design”, “online degrees”, or another topic related to your job and see what people find. Refine your search and try again. Maybe you’ll find something you want to look at, maybe not. If not, use the rest of your ten minutes and search on something totally different, like “swing dancing”, and see if you like the results better.
5. Write a note your manager with 10 reasons why you deserve a 10% salary increase. Don’t send it unless you came up with the reasons quickly. If you struggled with the list, rewrite it as the 10 things you need to do to deserve a 10% salary increase. Then act upon it.
6. Take an online course - or at least part of one- and think about how it is designed rather than the content. What are 10 things you would do to improve it? (What would colleagues say if it was your class they were going through?)
7. Read 10 current e-learning job descriptions and see how many you are qualified for. Write down 10 ideas for your own professional development just in case you ever want to go job hunting.
8. Email the e-learning expert you most admire and ask him or her to schedule a 10 minute phone call with you to discuss your three most important questions about e-learning. Write up what you learn (when you have the call) and circulate it to your colleagues (see 3). Also, make sure you introduce yourself to that person at your next conference (see 1).
9. Do a search on “learning technology trends” or “Web 2.0″ and identify at least one new technology you know little about that has the potential to improve what you do. Read one or two articles about it.
10. Ask a colleague the most exciting e-learning idea he or she has had or read about recently and discuss it why it is exciting. You can do this by phone or email, but over coffee is best. See, you get to go to the coffee pot after all!

Finally, think of your own idea for a 10 minute activity that can renew and improve your e-learning practice and post it as a comment to this article so others can benefit.

Thanks to Mark Notess for suggestions 7-9 and to CIO Magazine for inspiring the idea.

MySpace has over 300 million accounts as of 2/3/08 and was the #1 website in the US at least one week in 2006. If someone is a regular user of MySpace and has a health question, it is easy to turn to one’s community for help. MySpace Forums have a Health and Fitness section with exercise, general, and nutrition forums. The most active discussion under Nutrition is a thread on diets started 6/9/05 and it includes a post from someone who offer 59 ways to eat less of which many are potentially extremely dangerous. The 1300 replies range from serious posts about anorexia to advertisements. The other forums are similar, with a mix of serious, frivolous, and seemingly harmful discussions about bodybuilding, natural remedies, steroids, etc. There is a broader mix of comments than in most health forums and the amount that are off topic or what I perceive as far from helpful is far greater than in other forums I have looked at. Most other health forums tend toward highly supportive comments or advice. Are there different social norms in MySpace that lead to less empathic behavior?

In yesterday’s talk, Patient, Heal Thyself: How to Succeed with Online Consumer Health Sites, I started off by asking if I should lose 10 lbs. on the Atkins diet or by joining Weight Watchers. Melanie Zibit answered that I would lose the weight more slowly with Weight Watchers but would be more likely to keep it off. Most people agreed that this was good advice (the wisdom of crowds). I then asked if knowing anything about the weight loss experience or medical credentials of the advice-giver would have an impact, which people agreed with. Using sites like Amazon.com, a book-purchasing decision can be made based on the wisdom of crowds (ranking and ratings), expert opinions (from professional reviewers or well-known people in the field), or other readers (whose reviews are themselves rated). But a poor book choice has few ramifications, while health decisions can have severe consequences.

Many people get weight loss or any other type of health advice from strangers or friends, often knowing little about their experience or credentials; from books or magazines (every celebrity seems to have a weight loss secret or problem, based on a perusal at the supermarket check-out); from ads in magazines or television; or even from spam (I get frequent offer for weight loss drugs without a doctor’s prescription). People also learn about weight loss online - 49% of U.S. internet users search for diet or nutrition advice and 80% search for health advice. A search for “weight loss” returned 75,000,000 results, with “diet” and “fat” getting even more, and “weight” returning 1/2 billion results! Weight loss is certainly a common concern, but searches on other health topics also yield millions of results.

The results range from the Mayo Clinic to herbal remedies “As Seen on Oprah”. Most health seekers gather “health advice online without consistently examining the quality indicators of the information they find“. Information and health literacy impact the search results people select and the sites they use. Poor information literacy skills impact people’s ability to discern the quality of information. Poor health literacy skills - the lack of understanding about health coupled with the emotional burden of health concerns - make it far too easy for people to desire and seek magical cures or easy solutions. There are few reliable indications of quality; the only “Good Housekeeping Seal of Approval” in health is HONcode.

Sites vary in their usefulness, accuracy, branding, presence of advertising, and amount of interactivity, to name a few attributes. The most heavily used sites are WebMD.com and RevolutionHealth.com, both covering all diseases and conditions. Other sites are more specialized, such as Leroy Sievers’ heavily commented cancer blog at NPR.org, the very focused discussions on the Road Back Foundation bulletin board, and the well-segmented and very active community message boards at Weightwatchers.com. There are millions more examples, well-designed and dreadful, heavily used and ghost towns, frequently updated and unchanged in 10 years.

With consumer-directed care, patients are being asked to play a greater role in their health care. Providers are putting considerable effort into Electronic Health Records, Pay-for-Performance - countless initiatives to improve quality, reduce errors, and cut costs. But when a someone lies in bed at night worrying about their own health or that of a loved ones, EHR privacy is unlikely to be what is on their mind. Turning to the internet is easy with the constant availability - no need for an appointment or co-pay.

Consumer health sites have a significant impact on the quality of life of their users who turn to them before - or instead of - seeking medical help. Many doctors don’t know what their patients are doing online, and many dread the patient who arrives at an appointment armed with search results. “There’s so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore,” but patients often lack that expertise.

That is where the disconnect lies between patients and doctors: that the time spent online is invisible to or an annoyance to a doctor but is a lifeline for many patients. Doctors need to understand and learn from their patient’s information seeking behaviors. And there is a lot to learn since what patients communicate online is a very different lens on their concerns and needs than what a doctor hears during a consultation, which is a small snapshot of how the patient is feeling, provided in a location much less comfortable than the patient’s home. And doctors need to “prescribe” sites with reliable and useful information, and online health communities where peer support is available.

Technology is not the answer, even good design is not the answer - although both can help. So can better information and health literacy skills. The greatest impact will come from bridging the chasm between what patients are currently doing online and what takes place during the doctor-patient consultation.

I spoke today at the Massachusetts Technology Leadership Council Healthcare Lunch & Learn Series on Patient, Heal Thyself: How to Succeed with Online Consumer Health Sites. My co-presenters were John Lester (also known as Pathfinder Linden) who left Second Life for Waltham and Amir Lewkowicz, co-founder and Vice President for Partnerships at Inspire. I will post my notes shortly but until then, here is the abstract:

With consumer-directed care, patients are being asked to play a greater role in their health care. Moreover, those with chronic diseases often get better counsel from other sufferers than they do from physicians. This talk will cover the most effective ways to design and evaluate online health communities.

Changes in the health care system and the pervasiveness of the Internet have led to an increased use of the Internet by health care consumers. 80% of people in the US who use the Internet are using it for health searches.

Health web sites and online health communities provide a means for patients and their families to learn about an illness and seek support. The importance of online consumer health is evidenced by the popularity of sites such as WebMD and RevolutionHealth. Consumer health sites have a significant impact on the quality of life of their users who turn to them before seeking medical help.

Health web sites and online health communities raise difficult design challenges. These challenges include wide variability of participant’s medical expertise, health literacy, and technology literacy. A major risk is the potential consequences when poor advice is taken or when professional treatment is not sought.

By participating in this interactive discussion you will learn:

1) How online communities benefit consumers and businesses
2) How the nature of the disease or illness impacts site design
3) How innovative Web 2.0 technologies can enhance participation
4) What is necessary to start and sustain successful sites

At a course I taught on Online Health Communities, one of my students described how he investigated and tracked down a person who had a dozen personas in the community he managed. MIT Technology Review reported how a social networking site, Moli, allows (and encourages) users to develop multiple profiles and control access to them. The issue here is that everyone has multiple facets and it is difficult to portray and maintain multiple personas online, whether for honest or fraudulent purposes. I may not want the readers of eLearn Magazine to know that my passion in life is swing dancing (oops!) or to package my consulting skills to fit a profile form. LinkedIn, for instance, only allows you to select one industry. I selected “e-learning”, but could have accurately chosen “higher education” or “health, wellness, and fitness”. “Dance” isn’t even listed.

Thomas Jefferson said, “One travels more usefully when alone, because he reflects more.” Robert Davison, in Learning through Blogging: Graduate Student Experiences, finds that blogs help his students at City University of Hong Kong reflect on what they are learning and on the applicability of it to their jobs. He has them blog both in class and on their own. I think the very prolific Thomas Jefferson would have been an active blogger (although not Twitter or other social networking tools), and, like Robert’s students and me, would have found it aided reflection.

Disintermediation was a buzzword of the past decade when people saw how the internet could essentially remove the middleman. This led to more empowered consumers (another buzzword) with a wealth of resources at their fingertips (via their keyboard). In other words, someone with a problem becomes a knowledge seeker, wading through the results of searches, but due to the volume and uneven quality of information and pervasive poor information literacy skills, many don’t find useful help. Internet-based intermediaries have had limited success.

The solution is information funnels. These are people who

• have domain expertise
• understand consumer psychology: how consumers think, feel, reason, and select between different alternatives
• know the resources, regulations, and options available
• guide someone towards solutions.

We all give advice based on our experiences caring for a child or aging parent, dealing with a health problem, changing careers, or finding love. However, many of us have tunnel-vision since our expertise is based on limited experiences. This is where the information funnel comes in.

Here is an example: my friend, Joanne Rosenthal, is a social worker specializing in elder care. She offers a consultation with someone whose aging parent is no longer able to live alone and unassisted. She steers them to the services they need now and may need in the future, including the web sites that she has vetted. I just did a search on elder care and got 4,600,000 results, and who knows if I even even used the best term. Another example: for clients who want to move into e-learning but don’t know where to start, I teach them about the range of possibilities for online courses, the terminology, and the technologies, and map out a strategy for them. Whether Joanne or I do the actual work, we funnel the most useful information to our clients.

I believe this is true for all domains and is arguably the growth job in 2008.

Thanks to Larry Prusack for inspiring me over a coffee at Starbucks!

In Presidential Programming Languages, Mike Gualtieri hypothesizes about what programming language the next President of the United States of America would use if he or she was an application developer. But what programs they would write?

Charles Simonyi, who Richard Dawkins calls a “combination of International Renaissance Man, Playboy of the Scientific World, Test Pilot of the Intellect, and Space-age Orbiter of the Mind as well as of the Planet,” said, “a computer program sets the processor on an inexorable future course,” which is what presidents do - set the country on a future course. Possibly even one that is related to their campaign platform.

Richard Dawkins (who can’t run for president since he wasn’t born in the U.S.) would clearly program the Game of Life. Barack Obama would write a social user-generated site for political issues. Hillary Clinton would write her own version of HealthVault. George Bush (not that he’s running) would write a single-serving site. And Michael Dukakis (not that he’s running either) would just do a formative evaluation of Amtrak’s web site.

Acknowledgments: thanks to my 16 year old son, I learned all about single-serving sites on such topical issues as Paris Hilton, Twitter, The Empire State Building, and Barack Obama.

If I was a screenwriter and needed an au courant health problem to feature, I know where to turn. The Winter 2008 issue of Real to Reel provides a synopsis from media sources and leading health agencies, including how malaria-infected mosquitoes are being used to develop a new vaccine and how a door-to-door salesman donated a kidney to someone he tried to sell a vacuum cleaner to. It’s easy to imagine the taken-from-real-life dramas that could result and to furthermore see the opportunities to increase health literacy and awareness.

Hollywood, Health & Society (HHS), part of the USC Annenberg Norman Lear Center, helps entertainment writers with medical and health storylines. Their Sentinel for Health Awards “recognize exemplary TV storylines that best inform, educate and motivate viewers to make choices for healthier and safer lives. Past recognition has been given for storylines about breast cancer, diabetes, HIV/AIDS, alcoholism, disability, fetal alcohol syndrome, car crashes, organ donation, and safe sex.” The award was started by the CDC for soap operas and has been expanded to include “daytime drama, primetime drama, primetime minor storyline, primetime comedy and telenovela.”

While I am focused primarily on the use of health web sites and online health communities, I realize the strong influence of print, TV, plays, and movies. I wrote earlier this month about Ellen Goodman’s column about conflicting health messages and the difficulty of knowing what to do - or which study to believe - to stay healthy. The influence of TV, plays, and movies is more powerful since the message is more visual and designed to engage the viewer’s emotions (my heart was pounding the last time I watched Nip/Tuck). According to O Magazine, the CDC reports that 88% of Americans learn about health issues from TV and I imagine that the number is high for movies, plays, novels, and other creative media: virtually all include someone who is ill, dying, or dies during the course of the story.

Where is the line between accuracy and creative license? The CDC and other agencies are at the accuracy end, but efforts like HHS certainly increase the accuracy of the abundant creative outlets. On the one hand, Forbes reports that “a new study by researchers at the University of Southern California, published this month in the Journal of Health Communication,… shows viewers of an ER storyline about teen obesity, hypertension and healthy eating habits were 65% more likely to report a positive change in their behavior after watching.” And on the other hand, WebMD reports that the number of people having cosmetic surgery is increasing and that many people have inaccurate perceptions of the recovery process and the impact of the surgery on their lives due in part to television makeover shows like The Swan and Extreme Makeover.

Health web sites and online health communities share many of these problems in terms of their accuracy and potential impact, the primary difference being that they are not designed for entertainment.

Ron Baecker has a research project to find “powerful and flexible electronic cognitive aids… to help people, including individuals who are aging and who have cognitive impairments, carry out activities of daily living”. Writing about ideas in a blog serves as an ideal “cognitive prosthesis” for me, with advantages over other techniques that include the ease of soliciting feedback. While corporate blogs are largely communication and marketing vehicles, there are many personal blogs in which people reveal details of their lives - perhaps largely as an aid to memory or an indicator of progress or achievement.

Katie Gibbs, also known as Katharine Gibbs School or Gibbs College, is closing in Boston when the current students graduate. The school, founded in 1911, started off as a finishing school for women who were entering the working world. The original focus was on office skills, but other programs such as digital media were added in recent years. Before Katie Gibbs goes away, I have an idea for its resurrection, and there couldn’t be a better savior.

Donald Trump has a blog now, and writes in it about topical issues such as how a man “can get migraines, feel less satisfied with his overall life, and even get clinically depressed” if his wife earns a larger salary. This particular post includes a link to research and advice, including the concluding “if you still can’t deal with it, then go out and get a better job.”

While the blog states that there are other contributors, this particular one was posted by Donald Trump. I have trouble imagining him writing this himself. Does he go through the process of having an idea, jotting down a few notes, running the idea by a colleague, checking for grammatical errors - it’s not that I think he’s lazy, it’s just that I imagine more likely that there is a staff tasked with posting interesting blog entries, possibly based on his initial idea, or, more likely running a few ideas by him and scurrying off to write up the ones he doesn’t grunt at.

But who are these employees? Here’s my idea: Donald Trump could make Katie Gibbs a new school within Trump University. Most universities have multiple schools within them; Harvard University has the Medical School, the Graduate School of Arts and Sciences, etc. This new online school could teach the skills needed to help CEOs succeed - not teach the CEOs, but teach their assistants, like the original Katie Gibbs did. There would be “Blogging 101″ to teach how to write blog posts that make your boss sound like an insightful person, “Inbox Management”, and the other skills necessary to survive today. Since so many involve technology, how perfect that the school will be online.

Rick Kellerman, M.D., wrote in Cosmopolitan Magazine that “a man often goes to the doctor for one of three reasons: He’s noticed a growth, he’s in pain, or someone close to him was just diagnosed with or died from an illness and he’s worried he might be suffering from the same thing.” In Men’s Health, Dr. Kellerman said “men often wait until a crisis occurs before they see us.” Marshall Goldsmith wrote that people don’t ask questions when they are afraid of the the answers. He gave the example of how, at 58, he knows that “one type of input that I should ask for every year comes from my doctor. It is called a physical exam. I managed to successfully avoid asking for this input for seven years. What did I tell myself for seven years? I will get that physical after I begin my ‘healthy foods’ diet. I will get that physical after I get in shape.” He changed his mind “after a close friend who had ignored his health died prematurely as a result”. I don’t think it is so different for women: fear and crises are powerful motivators.

I wanted to call this Fear and Crises in Las Vegas but that seemed more appropriate for gambling. But health is a bit of a gamble, isn’t it?

I saw an amazing production of Julius Caesar yesterday and was struck by Brutus‘ speech, “So we are Caesar’s friends, that have abridged His time of fearing death” (Act III, Scene 1). While Brutus’ motives seem self-serving, fear is a huge component of health and wellness. Many advertisements use subtle and not so subtle tactics to scare people into changing their behavior. Ellen Goodman pointed out the constant dilemma we are all in about how to use “the newspaper stories in front of me full of the latest food health bulletins” and how, unfortunately, what is reported to cure one disease causes another - if you believe the latest study.

According to CNET News, many people are embarrassed to admit that they use dating sites, even though the numbers indicate heavy use. Many people use Wikipedia too, but a well-known researcher sheepishly admitted in an email to me that he uses it all the time for “basic science stuff”. And many people read the Dummies book series, but don’t boast about it, as I discovered in an email confession, “I hate to admit my secret: WordPress for Dummies.”

If the embarrassment end of the spectrum is the use of certain types of web sites and sources of information, then at the pride end are thin devices (yes, people still proudly display their phones and cameras), successful social networking (lots of connections and recommendations), and being invited to tape a Comedy Central segment after posting YouTube videos. Personally, I am proud to have authored a Wikipedia entry (but that might be different than using Wikipedia as a reference) and to carry a thin phone.

A friend and colleague, Kay Aubrey, and I just discussed some techniques she learned through focus group moderator training. She recommended Moderating to the Max for both running focus groups and energizing lectures. I was especially interested in this because I recently offered advice to a retired elementary teacher who wants to run focus groups. Her classroom skills seem ideal: listening, pulling out the ideas behind the words, and making sure everyone is heard.

I run strategic planning sessions, which is a great way to refine moderation skills, since otherwise you can’t accomplish the group’s goals. Before this conversation with Kay, I never consciously thought about how many of the skills for teaching, moderating, and presenting overlap. The introduction to the book (courtesy of Amazon’s Search Inside!) says that moderators need to know how to lay the ground rules for participation, help people feel comfortable, encourage responses, ask questions, probe for clarification, segue between topics, and stay on course. This is the same as teaching and presenting.

Kay offered me some further insights into these overlapping skills based on her experience teaching:

“I teach qualitative research skills to my classes as part of teaching usability and design. I use my class time as a way to improve my overall moderating skills and have found that it helps me develop stronger bonds with the students. I encourage each person to express their thoughts at least once during every class, which keeps the students’ attention more focused on the class as they never know when I will call on them. As they talk, I listen very intently to what they say, probing to get them to clarify their thoughts. The best classes are when the students ‘go on a roll’ which in focus group parlance means the moderator steps back and lets the group run the discussion, as long it meets the study objectives.

“Sometimes when I am teaching a group of people who seem to be able to handle a bit of whimsy, and the class energy level dips, I use exercises from Moderating to the Max. One of my favorites is ‘pass the doodle’. I ask each student to take a blank sheet of paper. I announce a topic that most will have a definite opinion on but that won’t create strong negative emotions. I ask them to doodle a quick picture to express their thoughts. After two minutes I ask them to pass their doodle to a person to their right, who adds to it, passes it along, and so on until everyone has doodled on each page. Then we post the pictures and as a group interpret the meaning of the drawings. This is not only a fun activity for adults, but it also is a valid qualitative technique that you can use in a focus group!”

Kay went on to say that she has used techniques from her training in focus group moderation to control disruptive students. I assume she uses more sophisticated techniques than time outs.

I have been wanting to write a column entitled “Is e-learning Green?” but have not yet located the data to show the differences in energy consumption between taking a course at home or in a classroom. Instead, after just reading an article about personal safety and about how a woman killed two students and herself at Louisiana Technical College, I started to wonder about the differences in safety between home and the classroom.

The personal safety article discusses how to “Be Smart When You Park”, “Drive for Life”, and other ways to stay safe. This resonated with me since I talk on my cell phone while walking at night from the building I teach in to my parking garage. While I have never seen campus violence, an article in response to the Virginia Tech murders says that “fatal mass shootings in our nation’s elementary schools, middle schools, high schools and colleges number just over 250 killed in the past 80 years. While shooting violence is worsening, it does not approach the toll of other violence on our college youth. We all seem unable to assimilate the fact that thousands of college students are dying violently each year.”

I can not find evidence of deaths or violence in online courses, so, domestic violence and natural disasters notwithstanding, being home seems safer. The flip side is the satisfaction of being with other people, which has also been shown to have health benefits. In a WebMD article, Prof. Thomas Glass found that “Social engagement was as strong as anything we found in determining longevity,… stronger than things like blood pressure, cholesterol, or other measures of health.” Marriage also has health benefits, such as lowered incidence of Alzheimer’s disease. Are you more likely to meet your spouse on campus or in an online course?

CIO Magazine lists tech populism as a trend for 2008, a term that refers to the use of consumer technologies in the workplace. Teachers, students, and subject-matter experts are all bringing everyday tools to learning. Teachers want to use the same tools to teach that they are using in the rest of their lives, and may feel constrained by the tools a school has in place although it may be easier for students to have consistency between their courses. Students similarly may have many tools they use for personal communication that can’t be used with their teachers. And despite the greater understanding of the value of informal learning, subject-mater experts may not want to learn complex tools to capture their expertise.

My own recent experience with tech populism is that, after starting to use WordPress last month, I immediately saw how to reformulate the final project in my Online Health Communities course. Since only some of my students know Photoshop, html, etc., WordPress will make it easy for all of them to do their projects online, which will in turn give them a better learning experience since it will be easier to get feedback from each other as well as from me. The biggest danger I see with tech populism is if chaos ensues, for instance, if I offer a default tool but my students can choose any tool they know, for those who prefer to use Facebook or ning. There will always be a trade-off with tech populism, since what is easiest for one group, say my students, may create more work for another, in this case me.

I love to give talks and jump (no pun intended, read on to see why!) at the chance, but I know many people who do not gleefully anticipate giving a talk. Tonight I spoke at the Greater Boston Chapter of ASTD, and was one of a number of presenters speaking on Effective Presentations Skills. In this fantastic session, I learned a lot from the other presenters, most notably (this is off the top of my head) to breathe deeply to be calmer, to jump in place repeatedly (before a presentation, not on stage!), to have a conversation not give a presentation, to crave feedback to improve presentation skills, to use humor at the start of a presentation, and to use storytelling to make presentations more compelling and memorable.

The last one comes from me, and I learned the benefits of storytelling from teaching online. Storytelling at a Distance goes into many of the reasons why storytelling is effective and, personally, I have more fun and am more relaxed telling a story than addressing bullet points on a slide. While storytelling is generally what a presenter does, it is often beneficial to elicit stories from the audience to make a point that resonates with the audience (or should I say the people I am having a conversation with?) However, it is helpful to have a plant in the audience in case no one volunteers or if you want to have a sense in advance of what someone will say or how long they will talk for.

Finally, I learned last night that, when in PowerPoint, “B” turns the screen black and “W” turns it white for those times when you want to hide your slides but not put everyone in the dark. I can’t wait for my next talk so I can try that and the other tips I received.

George F. Colony, CEO of Forrester Research, wrote in his blog about the process of using a blog to hone and get feedback on ideas, which he called “Social Sigma” (and I commented sounded too close to “Social Stigma”). I loved his notion of using feedback to perfect something, be it an idea or a product.

My favorite writer, Agatha Christie, wrote a few short stories that seemed to be the basis, with modifications, for novels. Thinking about that made me wonder if Agatha Christie would blog if she were alive today. If so, what would she say? Would she use the wisdom of crowds to solicit or get feedback on her ideas?

The Super Bowl is all you hear about these days in Boston, where our sports teams are doing great (how ’bout those Red Sox!) I’m not a huge football fan, but I read reports of how Tom Brady practiced yesterday and his right ankle was not taped, swollen or discolored. And I stock up on Diet Coke at Super Bowl sales.

Technology is playing a greater role every year in sporting events. Social networking is being used by Nielsen to rate Super Bowl ads. “Nielsen Online also will provide real-time analysis of messages and opinions from 70 million blogs, message boards, online communities, video-sharing sites and sports enthusiast sites.” Their site, Hey! Nielsen, is “a way for you to influence the TV and movies you watch, the music you listen to, and more… all while making a name for yourself.” Clearly someone at Nielsen saw that Time Magazine’s Person of the Year for 2006 was You. I’d like to learn more about the technology they use for text analysis and drawing meaningful conclusions from these millions of messages.

But what does this have to do with e-learning? I kept hearing on the radio “blah blah University of Phoenix Stadium blah blah” before it hit me - the 2008 Super Bowl is being held at University of Phoenix Stadium! The University of Phoenix’ home page doesn’t mention this, but it can’t hurt enrollment. Does this mean e-learning has reached a tipping point?

My biggest take-away from all this has nothing to do with sports (although I might look for an online course to finally understand football). What I learned was linguistic. Today’s Boston Globe reported that “Plaxico Burress went Joe Namath on us Tuesday and got a lot of headlines.” Joe Namath? I’m going to use that 3 times in a sentence today.

Jeff Johnson told me about his experiences doing a usability review of the American Cancer Society’s Cancer Survivor Network. I was interested in his process and the impact of his findings because design and usability are arguably more important in a health site than any other type of site because of health literacy. Most interestingly to me is that cancer survivors were not involved in the design or evaluation process by the design firm even after Jeff’s recommendation. Jeff wrote a description of the process and the impact of his findings:

Paul English, a fellow U Mass Boston alumni, set up a site to get human assistance when calling a toll free number. While a useful service, there is also the problem of what to do while on hold. Generally you’re stuck listening to music that you would not normally add to your playlist, to say the least. With a speakerphone or wireless headset, it is easy to do something else while waiting. But instead, why not make it a teachable moment?

I was on hold today, trying to reach someone at the Delray Medical Center, and listened to their “Health News Network”. I learned about the signs of diabetes and the advantages of early detection, anxiety disorders and their symptoms, what a heart attack feels like, and other medical information. Each snippet ended with a phone number to learn more, get a physician referral, or join a support group (I think that was for diabetes). While it was ultimately advertising, the emphasis was on being informative. Since I was on hold for a while, I got to hear it repeated a few times, which can aid learning. Furthermore, anyone who is calling a medical center has or has a loved one with a health concern and is likely to be a receptive audience.

Note: Stephen Downes and I turned this into a column, Advertising or Education? Sometimes It’s Hard To Tell.