Olivia Wu - Reflective Journal

Hi everyone, I'm Olivia and I'm a 2nd year studying Arts/Medicine majoring in Political Economy & Physiology. Fun fact - I can't wait to get back to international travel!! :')

Can't wait for international travel either !! 🗺️

Hi @olwu3220 Welcome to the project! looking forward to working together!

Hi Olivia, looking forward to working with you :)

Insulin I just completed the 3 challenges for my first medicine, insulin, last night. I chose to pick just one drug that I had some background knowledge in to familiarise myself with the challenges and then use that experience to inform my choices of the other 4 medicines to use in the challenge that I didn't know much about. Hopefully, this will enable me to go beyond my comfort zone and also just broaden my knowledge of the medicines around me, given that this is in my future field/career. The challenges required me to consider where I had seen medicine in my everyday life, particularly in the media, as well as focus more specifically on insulin as a life-saving, yet often unaffordable drug in America through considering the trajectory of insulin's price as well as the factors that contributed to it. The experience was surprising because I initially expected the "gamification" to be a bit more engaging as I went into the challenges with a pre-conceived notion from other extra-curricular experiences of how gamification has been adopted for businesses. I thought that using the gamification tool was actually a little bit "clunky" because the research process is not as linear or structured as the gamification tool suggested. Still, the gamification resource prompts made me laugh sometimes 😄 However, I found that the challenge resource did provide extra details and pointers to remind myself of good research "etiquette" such as looking for reputable sources and refining my search. After completing the full challenge setup, I found that I had a greater appreciation of the complexity surrounding the economic, business and social aspects of drug development, rather than just considering the pure scientific aspect of it. I also found myself being influenced by my background knowledge and interests in regulation and structural reform when researching insulin so I will be choosing medicines I have never heard of to complete the later challenges to prevent any researcher confirmation bias. Apart from this, my action plan is also going to include following the gamification resource more closely particularly with each of the sub dot points. Looking forward to the next one!

Over the past few days I have completed the challenges for three of the medicines: praziquantel, methadone and carbamazepine. I have some general reflections for the three medicines with some specific references to certain ones included.

I think this suits my reflecting style because I tend to be more of a “big picture” type of person. Although I had my frustrations with specific aspects of researching for a particular medicine, I found that these were very fleeting and not what I wanted my reflections to focus on, given that I think there is also a skill in being selective about what reflections are presented and what will have the biggest impact - the 80/20 rule in the context of reflections if you will. Therefore, I have instinctively approached my experience with researching these three medicines with a more “issues-based” approach where I wanted to see some kind of recurring or repeated issue before reflecting on it more broadly. I think there are limitations as it might mean that I am repeating the same mistake or waiting for a pattern/trend in the research when it is actually a very specific phenomenon e.g. companies not releasing financial details of specific drugs but rather groups/sectors of drug types. I think this comes from my very formative experiences in debating and being an arts student. In fact, I can already see that this section of reflection may seem quite vague and broad, however, I have really focused on making my reflections on the challenges itself more specific and directed (hopefully!) Also, I am hoping that my greater involvement in the sciences throughout university will offer me a greater balance in also focusing on finer details. Therefore, in line with this, although I have broadly grouped my reflections for three medicines in one, I will reflect more closely with my final medicine.

Anyways, enough about the rationale of my reflections!

Limitations of Gamification. The presentation of the game was, in my view, just a reiteration of the questions posed in the survey but with arbitrarily assigned points and a story. I found that there was a paradoxical relationship in that, I had a preconceived notion that gamification was supposed to improve engagement of learning yet I actually found that because I was repeatedly using the same resource, that I had a confirmation bias against the gamification resource and would actually get frustrated at consistently having to return to the resource, add points, and pretty much get the same range of scores and therefore "story outcome" each time. Although I can recognise this bias, I found it very difficult to actually remove that bias which I actually think was compounded by the fact that the researcher of learning processes (i.e. me) was also the subject or participant in the actual learning! Ultimately, for the final medicine, the aspect I would like to address in my action plan would be an adjusted use of the gamification resource by completing the “blocks” of tasks and then assigning points, rather than doing each individual task with the points system. Secondly, given that I am in lockdown, my older brother and I spend a lot of time together so I may ask him to research alongside me and also “evaluate” how I have gathered information in order to also self-assign points according to the resource. These two improved aspects should address the issue of desensitisation to the gamification resource and also the bias involved in the dual researcher-participant role.

A lot of research that was more industry focused rather than academic, such as specific price changes of drugs seemed to have been tracked by business or consultancy firms. Often, this information seemed to be hidden by a pay wall (e.g. Micromedex) which I actually think reinforces the purpose of the challenges in that there is a lack of transparency regarding the price of medicines given that pharmaceutical companies are privately owned. I found that this was an issue usually isolated to the US given the structure of their healthcare system. Contrastingly, I was pleasantly surprised to learn about the PBS lookup system provided in the Price Hike challenges which demonstrates the positive transparency of Australia. In a similar vein, I’m not sure whether this was a result of my research or whether it was a product of the businesses themselves, but I found the Circle of Life challenge particularly difficult for my 3 chosen medicines because some of them (e.g. praziquantel) had very limited business ownership related information and the sources I did find often didn’t provide citations or some reference to academic literature which makes me think that this is not a common area of focus. However, with my final medicine, I think I will actually work backwards so rather than begin with casting a wide net with internet searches, I would like to start with researching the FDA or relevant national institution to find when a drug was approved, and any changes it went through in the past (particularly with transfer of patent ownership). Hopefully, this adjusted approach will yield more fruitful results or just be a less consuming research process.

I look forward to researching the final medicine (and making the difficult decision of which one to pick!) with these action plans in mind.

I also found that with the additional infographic resource I was using, it seemed to become less useful with each time I returned to it. Perhaps, if survey participants are repeatedly taking the same challenges, a wide variety of additional resources to use with each medicine may be more useful than using the same resource over and over. Although, I'm unsure of how different the information within those resources would have to be to be useful? It seems that both the infographic and the gamification reiterated much of what was already instructed by the survey. I also found the Circle of Life challenge the most difficult because of the limited information - or if there was information, it seemed to be from non-reputable sources. Working backwards from the FDA sounds like a good idea - I'm interested to see if this worked out!

Hi Daisy, thanks for reminding me - looks like I completely forgot to actually click "Comment" on my Digoxin reflection!!

Digoxin I chose Digoxin because I had done an initial search of some of the other medicines but found this one to be really unfamiliar and in particular I was curious to see whether the fact that there were no patents on it would affect the price or its life cycle.

News Flash: My friend Jacqui is currently part of the SMS and is helping us organise a Med Students Networking Event. She told us about a lecturer who was extremely passionate about endometriosis and shared an article about a treatment idea that was a non-hormonal option. I must say, it was pretty satisfying to be able to understand most of the general articles on the topic after doing reproductive physiology last semester. One of my goals for this unit was to become more acquainted with scientific communication in an academic setting which I previously have found really daunting but I can already see that the more exposure I have to science (both at uni and outside of it) is really building that skill!!

Many of my friends have reproductive related conditions such as really painful periods and I am aware of the stigma and under-diagnosed nature of endometriosis as often the symptoms are dismissed as part of the typical menstrual cycle pain. Usually I find this quite disheartening and in fact I hope to counter some of this through my future career as a female in STEMM. The new drug is just an idea at the moment but the research has found that endometriosis might be attributed to genetic variations of the NPSR1 gene and this might be a target for future research. This update seemed very excited to me, particularly as I recently attended a conference held by the SMS Student Society where a physician argued that the future of medicine is very much headed towards gene manipulation and targeted, individualised medicine so it was really rewarding to be able to see that prediction playing out in action. It has also made me even more excited for my further studies in medicine where I hope to contribute. In particular, I was especially impressed with the level of international collaboration involved in research, which again reminded me of a Women in Science Conference I participated in last night where the female academics highlighted international travel and research as one of the best parts of being in academia so it was very rewarding to see that continue despite physical border closures.

Ultimately, the News Flash activity and my news item has really made me appreciate how prevalent science is in my everyday life, and how I can constantly find linkages between my extra-curricular interests, university study and current news in science.

Price Hike: Throughout my research of Digoxin, I was surprised to learn that it is still classified as an essential medicine even though it is considered “3rd-line” and not used as often given the safety concerns and the emergence of better alternatives. Nevertheless, I found that this may actually be one of the reasons that it experienced a price hike due to less companies producing it to supply a decreased demand.

In fact, a recurring theme throughout my research (and from previous medicines) has been the dominance of market competition as one of the defining factors that influences why a price hike has occurred. Although I seemed to really resonate with the personal stories of individuals facing much higher medicine costs, I was cautious to fall into the binary trap of solely “blaming” or antagonising pharmaceutical companies for the price hikes. Whilst my research definitely compelled me to agree that often these companies are engaging in anti-competition practices and predatory pricing, I thought there may also be some exacerbating factors such as the presence of PBMs in the US and a flawed insurance system that should also be analysed in tandem.

I think I have also been influenced by my experience studying economics, and a former Chemistry teacher who had worked at a pharmaceutical company. Their perspectives were very different to my (probably naive) view that it was “all the big pharma’s fault!!” when in reality it was far more complex for example we need to provide the right incentives for innovation, these firms are operating in a capitalist structure that creates market compulsions for profit/revenue maximisation among other theoretical economic concepts. Nevertheless, my research on the generic drug Digoxin has cemented my view that the need for incentives, innovation etc. is true for a regular business or industry but given that healthcare is (or should be) more of a public good, I think that these same economic principles should not apply and there should be less of an emphasis on innovating for profit through the heavy corporatisation of medicine.

Overall, I found that many stakeholders play a role in price hikes and subsequently mitigating them. Our responsibility should be to use all of these competing perspectives to appropriately regulate the sale of medicines in a way that respects the fact that they are essential for everyone and should be immune to predatory corporatisation.

Circle of Life: Finding research for this section was initially quite frustrating because every time I put a different iteration of my search request, google would always give me papers about the molecular mechanisms of Digoxin, or a comparison to newer treatments and not about the history of the product. I think this is one of those insidious but pervasive elements of doing research which is that, although the internet provides centralised and greater views of knowledge available, it is always shaped by your previous interactions e.g. Google uses search algorithms to provide search results that are consistent with the past few years of me googling heaps of scientific, biology related information - not about the history of a Pharma company! I found almost a strange paradox or conflict between trying to mitigate this by searching the later pages of google yet being disheartened by the search results. Another related issue which I discussed in an earlier reflection was that of paywalls as a limiting barrier to the access to knowledge. Luckily, we students have access to the Usyd library but members of the general public usually do not and this negatively impacts the transparency and accessibility of scientific knowledge, particularly for something as universally relevant as medicine.

I really enjoyed picking this particular medicine because it was originally derived from a plant called Foxglove which overlapped with one of my OLE’s this semester about Ethnopharmacology looking at how contemporary medicines have often found their roots in traditional medicines of cultural communities. We studied a range of medicines but not this one so it was really rewarding to see the interdisciplinary connection. The essential medicine challenges really exemplified that as it was at the intersection of health, sociology, economics and other universal factors that control how we access medicine which I think has renewed my passion for Arts and Medicine as my university area of study.

Hi Olivia!!

I found your journal incredibly interesting to read through. So initially, I read through the gamification resource as I hadn't until now and wasn't really sure what it was and what it was adding to our task. I definitely agreed with a lot of your reflection on the gamification resource itself as just reading through it made the task seem much more convoluted and confusing than it actually was. Personally, though, I did find that the initial story for the gamification was very attention-grabbing and tugged at my pathos. If I were someone not enrolled in the Dalyell class and stumbled upon that story separately, I definitely see myself wanting to contribute to this project and really realising the weight of the issues that stem from price hikes. I wonder if there is a way to combine resources, or improve upon them, to make them even more effective for future groups, and maybe even tailor them to their specific audiences (eg trying to capture the attention of a stranger on the internet vs someone who is completing a task in relation to a class). Though, I will say that the Pomodoro Technique would've saved me several hours of scouring the internet 😅

As for your reflection itself, I really liked the approach you took as it was very different to mine. I love that it was very self-aware with a focus on self-reflection and personal connection. I think you did a terrific job of relaying your own feelings and emotions, checking your own bias, and exposing your own learning process and style. It was really cool to see you relating the information you found to other things you were learning and incorporating your own development into your task about learning about other medicines. I also found it interesting to see that your reflection style even changed slightly throughout this process—though it might've just been when you approached your last medicine differently that it slightly affected how you were reflecting on your process!

All in all, it was interesting to see our different approaches, not only to the task but the reflection itself, and I wonder if it had to do more with our own personal learning styles or our additional resources! I'm excited to hear more about your journey on Friday!!

Hi Olivia, it was super interesting reading your reflections! I actually found quite a bit of similarity between our experiences and our thoughts (especially about the price hikes), but you also gave a lot of insight on the gamification resource which I’m completely unfamiliar with, and your personal experiences with medicines. I really appreciate the holistic approach that you took with your reflections, I feel like it brought together a lot of the trends and repeating issues we identified in our research process (lack of transparency, market monopoly etc). Reading your reflections, I do feel as though you’ve organised what you’ve learnt and felt in connectedness with broader real-life phenomena, which aligns with the ambition of this project.

Likewise, I also found that many of the more dramatic instances of price hikes occurred in the United States, often as a result of anti-competitive behaviour and market monopoly. I’m really glad that you pointed out that the “all the big pharma’s fault!!” perspective is an oversimplification of the complex issue, and shifts the responsibility of government regulation and economic motivation onto individual pharmaceutical companies. I felt like the research really compelled me to swing to one side, especially with the personal anecdotes of people who were struggling to pay their medical bills like you mentioned. It’s definitely important to look at the bigger picture and perhaps see that it is the lack of government interference that is causing holes in the US health system.

Your evaluation of the gamification tool was very insightful to read as I was in the stream with no resources. I definitely feel that this was the biggest difference in our experiences. It was interesting to read that resource was essentially a double-edged sword for you. It seemed to give you some direction for your research, but also confined the scope and perspectives that you could explore. For me, it was more of a free and developing process where I’d experiment with different keywords and articles, and then adapt my research process as I progressed. I can understand how the gamification resource could have become quite repetitive and mind-numbing over time. The points you raised were really interesting and are probably great starting points to think about how this process could be improved and made more engaging.

Your reflections were really perceptive and well-developed, and I honestly got a lot out of reading them. Just as a final thought, I love the personal anecdote you raised for the News Flash challenge on Digoxin. It was super in touch with our everyday lives and motivating to read!

https://www.jmir.org/2019/3/e12994//pdf Systematic Review of gamification methods in medical education, including dental, nursing and medical students. Most methods studied were virtual simulation-type games, board games or "First-person shooter games" usually targeted towards a particular curriculum aspect. Several studies reported no difference between gamification and other digital learning modalities, a similar amount recorded varying degrees of improvement in satisfaction and knowledge. The review was limited by an inability to compare between different types of gamification tools but a general trend suggested the gamification had to be targeted to "cognitive" or "manual dexterity", nor was there a comparison between playing alone or in a group. Gamification has only been studied in HIC and in wealthier populations within them particularly because of the high initial capital cost if consoles are involved. It should be a supplement to other modes of instruction but there is potential to be used as an "active" form of learning, as well as a way to improve well-being of players.

"Revealing the theoretical basis of gamification: A systematic review and analysis of theory in research on gamification, serious games and game-based learning" by Jeanine Krath, Linda Schürmann, Harald F.O. von Korflesch .

Systematic literature review (and meta analysis) on the theoretical psychological frameworks behind gamification of learning where the main aspects are motivation and valence. Game mechanics are effective when they partially or satisfy autonomy (e.g. picking costumes) and feelings of confidence e.g. a leaderboard. Some theories e.g. ARCS model of motivation for instructional design, identifies a combination of factors – attention, relevance, confidence and satisfaction. A particularly compelling note was that gamification should have adaptive content that adjusts complexity to the user and, while seemingly obvious, should results in a simplified user experience. Although this article had a heavy reliance on theoretical frameworks, it acknowledge that a combination of theories are relevant to the effectiveness of gamification, and is also dependent in different contexts.

https://ajet.org.au/index.php/AJET/article/view/2232/1376 Randomised controlled trial based in Australia investigation with qualitative data from both instructor and participant perspectives, and with a focus on gamification in higher education. Supports existing research that gamification is most effective in improving "practical competencies" rather than hard knowledge, particularly with decreasing effectiveness as educational tasks increase in complexity. Researchers note that their study used "remembering" whilst higher cognitive requirements such as "assessing" and "evaluating" are more difficult to apply gamification effectively. Although it extends existing knowledge to Australian higher education students, its key limitations is the short time frame (3 days) of gamification and the small sample size (n=22)

TheBreakingGoodProject / Dalyell-Projects

Olivia Wu - Reflective Journal #14