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Ann Bergin Posts

Scope of practice: a careful borrowing from medicine to agile

Update: turns out Esther Derby and Sal Freudenberg wrote this much better than I did in their blog post Guidelines and Guardrails back in April 2018, including ten very useful questions to ask yourself to see if you are indeed extending beyond your scope of practice.

When I’m not too scared to go to the gym (because COVID-19 + everyone breathing heavily + mask wearing not mandated = a whole lot of nope from me), I squat, bench, and deadlift for the good of my health. Chief among my guides to the art and science of lifting heavy objects and setting them back down again without hurting myself are the good Drs Feigenbaum and Baraki at Barbell Medicine, my pals* Eric Trexler and Greg Nuckols at Stronger by Science, and Omar Isuf and Eric Helms of Iron Culture.

Lifting has been a major theme in my life for nearly three years now, and I’m #grateful for everything my hours under the bar have taught me; it’s one of those things where the benefits just keep on compounding so long as you commit to the practice. Being able to listen to podcasts, watch Youtube, and follow the Instagram lifting of the major experts in several different parts of the field is one of the great privileges of our connected age, and it adds considerably to the learning I get from my own practice.

One of the reasons I admire and appreciate the folks I choose to follow in the lifting world so much is that despite their having deep expertise they all very actively recognise where their expertise ends. For example, on their podcasts they all conciously and routinely call out when they’re reaching the limits of their own knowledge. As I understand it from listening to them, self-knowledge and reflection is really important for sports and health professionals given their power over others with regard to programs of training and treatment, and it is from the Jordan Feigenbaum at Barbell Medicine that I first came across the concept in medicine of scope of practice.

The UK Health and Care Professionals Council, who regulate the use of a number of protected job titles in health care, define scope of practice as

[…] the limit of your knowledge, skills and experience. It is made up of the activities you carry out within your professional role, provided that you have the knowledge, skills and experience to do them lawfully, safely and effectively.

UK Health and Care Professionals Council

A good example of a medical practitioner working within their scope of practice would be your GP choosing to refer you to a specialist for further treatment. If you needed heart surgery, both you and your GP would like it to be performed by a heart surgeon with the necessary knowledge skills and experience to have the best chance for it go well. Scope of practice is a regulatory and legal concept within medicine, and GPs performing heart surgery would be prosecuted for doing so while unqualified.

Which brings me to thinking about how as agile coaches we love a new technique, and how eager we often are after conferences or meetups to try new techniques on our teams. Folks in the software development industry tend toward being early adopters: we like shiny new things and it is literally our job to be innovative and foster innovation. With this, I think, comes an adjacent tendency towards borrowing from other fields. Sometimes we do this well, but frequently we do this without sufficient regard to the contexts of those fields, and much too often we fail to appreciate the years of training and practice needed to develop expertise in those fields. In trying to think a lot more about the importance of both context and expertise, I have been deeply influenced by Dave Snowden’s work, and also the blogs of What’s the Pont (Chris Bolton) and Complex Wales.

In particular, I fear that I have seen many agile folks use therapy-type techniques on other people without knowing what they’re doing, and it greatly worries me. One of the main risks scope of practice aims to mitigate is an individual’s ability to harm others in applying techniques they are unqualified to perform, and I’m afraid that some of the things I’ve seen advocated by agile coaches recently have the potential to cause harm.

Here in the UK it takes the better part of 10 years to become a registered counselling psychologist, a job title regulated by the aforementioned Health and Care Professionals Council. Professionals in this field have spent three or four years working towards an accredited undergraduate degree, and graduated with a 2.1 or above. Following this they’ve completed either a doctorate or a postgraduate qualification, which takes another three or four years. Let’s further note that both of these qualifications have significant mandatory ethics components, something which is currently missing from many Comp Sci and other science degrees. Once qualified, psychologists are required by their regulatory bodies to undertake continuous professional development in order to maintain their skills as a practitioner.

And so, unless you are in fact a qualified and practicing psychologist keeping up their CPD in addition to being an agile coach, you are an agile coach and not a psychologist! Same goes for not being a therapist: retros are not and should not be group therapy, because you are not a trained and experienced therapist. Techniques used in marriage counselling are probably not appropriate for use in the context of the workplace. In particular, and this is really what has prompted this whole blog, I very strongly suspect that the recent trend of inserting enforced giving and receiving of appreciation into team ceremonies does not work the way you think it does for creating connections among teammates. I’m really pushing the bounds of my own scope of practice here, so I’ll caveat this, but if this technique were being inflicted on me the bonding with my teammates would likely come from the complaining about it in the queue for the coffee machine afterwards.

Medical practitioners and allied professions spend a lot of time and effort balancing risks of treatment against the benefits. As agile coaches, even if we see the benefits I think we really need to stop using therapy techniques we don’t fully understand the risks of on our colleagues! And in a not entirely unironic fashion, I think we can carefully borrow the concept of scope of practice from medicine to help us think about this. To be really clear, I’m not saying that we should regulate our profession, although you can insert your own joke about Certified Scrum Masters here. What I am saying, though, is that I think we might all be better, more ethical, and more people-centred agile coaches if we take some time for personal reflection about where the boundaries are (or should be) of our own practice, and start recognising and respecting those boundaries in our work.

Ann 🦉

*Disclaimer: Eric and Greg are alas not my pals IRL, but I sure wish they were.

Upon having my identity as a dyslexic “debated” in the Grauniad

My name’s Ann, and I’m a 33 year old dyslexic woman. Because of COVID-19, I’ve decided to be a 33 year old dyslexic woman on the Internet writing things much more often. This past week the Guardian published a long read article by writer Sirin Kale called “The battle over dyslexia“, and I have some things to say about it as it pertains to me, an adult dyslexic person.

To summarise, the general gist of Kale’s article is that there’s a scientific battle raging as to whether dyslexia is even a thing. Her argument hinges on disagreements between notable academic educational psychologists, specifically on their having differing views on how to solve the complex problem of how local authorities provide support for children struggling to read within the social and political context of the UK. I’m not a parent and I’m not involved in the world of SEND, so this blog isn’t about addressing the specifics of this argument. However, before I write more, I want to sincerely extend my compassion to the parents of all children struggling to read and access education, dyslexic or not. Our education system shouldn’t be failing anyone, but fighting about dyslexia isn’t how we solve this problem and Nancy Doyle has already responded about this on LinkedIn.

What I do want to address in this blog is the whole “dyslexia, is it even a thing?” being published in a publication of the standing of the Guardian, and having the argument underpinning this assertion be based solely on how dyslexia manifests in childhood. Questioning whether dyslexia is really a thing at all is a major take-home of Kale’s article, and I think this is clear from many of the responses on social media. As such, I think Kale’s writing is actively harmful to dyslexic people of all ages and all backgrounds because in questioning dyslexia she is taking from us the ability to describe ourselves to other people and be understood. She is, in particular, taking from adult dyslexics the ability to be understood as a dyslexic adult. This is an injustice to us as knowers of our own lived dyslexic experience.

To the best of my knowledge, the only actual dyslexic Kale spoke to in the year she took to carefully research and write her article was Lord Addington who is quoted as saying:

“If you’re telling me that dyslexia doesn’t really exist, I’m afraid my everyday experience of life says you’re wrong.”

Lord Addington, quoted in Kale’s article

I’ve never met Lord Addington, and given that I’m not a hereditary peer I have a pretty different background and life experiences, but I for sure feel him on the lived experience of being dyslexic.

Being dyslexic isn’t all of me, but it is in every part of me and it affects all of my lived experiences. It is literally all about the way I am able to think. It is intimately connected with my relationship with my family because it’s exceedingly likely that I inherited it. It has had a role in absolutely everything I’ve ever done, from my childhood right up to being 33 years old today.

And so you might see why I don’t appreciate having my identity “debated” in a national newspaper. Quite aside from badly misrepresenting current science, it’s just not cool to write an article for a whole year about dyslexia and largely fail to talk to adult dyslexic people about their lived experiences of being dyslexic. Lord Addington is only really quoted in his professional capacity as a politician and advocate, and his lived experiences aren’t explored; as far as I’m able to tell, everyone else quoted is a professional working in education or a parent of a dyslexic child. Kale needed to hear the voices of many more actually dyslexic adults to learn about the dyslexic experience, which extends far beyond that of learning to read.

Almost every adult dyslexic to whom I’ve spoken openly about the marginalizing effects of dyslexia has a story about the time they failed in school and a story about the time they failed in a job. These stories are, for better or worse, part of the culture of being an adult dyslexic. My own stories of failing in education and in paid work are, frankly, not low stakes tales; and this is despite my very significant race, class, and educational privilege. Like Kale, I’m a graduate of the University of Oxford, and I’m lucky to have many positive stories about achieving educational and career success, but not every dyslexic has these. My own difficulties did not stop when I learned to read, they happen every day and especially every time I learn something new. They’re happening as I write this and organise my thoughts. I sure hope that the next person at my work I need to explain my dyslexic struggles to hasn’t read Kale’s article, because if they have I think they’re much less likely to be sympathetic to me.

Kale’s article misses all the truly good and joyful parts of the dyslexic experience too. The other part of dyslexic culture is in fact just culture in general and especially visual culture and technology, because without dyslexic thinking connecting the seemingly unconnected there isn’t progress. We might not be the super greatest at the reading or the short term remembering but we’re here for a very good evolutionary reason. On the scale of human history reading happened incredibly recently, and differently thinking neurodiverse brains are a human survival tactic. I could reel off a great long list of famously successful dyslexics here, but perhaps a more grounded testament to this is that Kale’s article ended-up on the front page of Hackernews (a notable or notorious depending on who you ask tech news aggregator) and has 74 comments at the time of writing. This is a pretty high level of engagement, and speaks to so many folks working in tech and start-ups because they’re dyslexic. We have a pretty unenviable collection of wicked problems to solve in the next ten years or so if Earth is to remain habitable, and we need everyone to be able to contribute to solving these problems. We won’t solve them without the contributions of dyslexic people.

So, to conclude. The year is 2020. Writing about a group of marginalized people without having really spoken to or listened to those people shows you’re not reading the room, and your writing is likely to do real harm to those people. The science of dyslexia is not in the state it was 44 years ago in 1976. Dyslexic people are real, dyslexic children become dyslexic adults, and our lived experiences as adults go far beyond our experiences of learning to read. Our stories deserve to be heard and understood.

Ann 🦉

This blog is dedicated to anyone who has ever had their identity questioned or erased by writers in the Guardian, I hear you and I see you 💖.

Featured image of a squid swimming slowly via the Creative Commons.

My new home on the Internet

Greetings from a warm autumn evening in Cambridge.

I think I’ve had “make new website, but properly” on my to-do list ever since I abandoned the my previous WordPress site some time back in 2014.

What has finally made me do it? Very deep frustration with myself; this, I find is the dyslexic way and this blog is a much needed creative avenue. And then, in early September, Dave Snowden upon blogging once more quoted Harold Jarche on writing in your own voice, and in turn Harold Jarche quoted Ton Zylstra, who said:

Your blog is your avatar, a full representation of yourself, made manifest online in HTML texts.

Ton Zylstra

So it’s blogs all the way down, and here’s mine.

Ann 🦉

Hello world!

Hi everyone!

After a long period of yak shaving, umm-ing and ah-ing … I finally have a new home on the Internet! And I think it’s a keeper this time.

Stay tuned for agile software development, dyslexic connections, forays into anthrocomplexity and much much more!

I won’t be defining the how or the why of the chaos owl, but I think you’re gonna get the idea …

Ann 🦉