Saturday, 3 May 2014

Why social media is not a waste of time for a doctor - infographic, slides, video and paper!

In Decemeber 2013 - Professor Matt de Camp and I were asked to debate whether social media was a waste of time for doctors in the Journal of the Royal College of Physicians of Edinburgh. You can read the full paper here and see some discussion on PubMed commons about it here. This is my part of the paper with hyperlinks. I should mention that JRCPE is an open access journal who allowed me to retain my copyright. This is therefore published here, along with the infographic and my slides, under a creative commons license so feel free to reuse and remix as you wish.

These are the slides I used when giving my talk on this at #Dotmed13 in Dublin last December. You can watch a video of the talk below.


Should you have a strong social media presence? I am going to give you ten reasons why I think you need one. Social media provides an opportunity to publish your thoughts and ideas and to share your experiences without having to go through a middleman. And many people are taking advantage of this. Globally half a billion tweets are posted every day. (1) Surely it must be possible to find something of value that could make it worthwhile for a doctor to start exploring these spaces? It is not nearly as difficult as you might think, because these pieces of information are not just floating unconnected to each other; they are disseminated and linked to through networks of your peers. Developing networks, and figuring out who and what to pay attention to, are some of the key learning skills we need in the twenty-first century. (2) I will convince you that it is worth developing these skills.

10 Reasons to have a social media presence

To connect 

The landmark report on ‘Health professionals for a new century’ suggested that we need ‘locally responsive but globally connected teams’ 3 but lamented that ‘most institutions are not sufficiently outward looking to exploit the power of networking and connectivity for mutual strengthening’.(3) But this is changing. It is now rare to attend a forward-thinking event without being encouraged to tweet with the conference hashtag. We are our institutions, and we are leading the way; we are making the connections.

To engage 

Social media is not just about getting your message out. It is also about listening. We can learn with patient leaders.( 4 )As Gilbert and Doughty, co-directors of the Centre for Patient Leadership, describe ‘[w]hen patients can both manage their own health and go on to develop the confidence and skills to lead and influence others, something special happens: new collaborative systems of healthcare take shape and positive solutions emerge to healthcare problems, locally and nationally.’ (4) Through their blogs and tweets you can engage with them.

To inform 

If you are trying to do things differently, changing the way you and your team work, where can you tell people about this? Consultant endocrinologist Partha Kar uses his blog, NHS Sugar Doc, to communicate how an award-winning team is involving patients in redesigning their service, meeting the challenges of modern healthcare.(5)

To reflect

Elin Roddy is a respiratory consultant. She also tweets (@elinlowri). During ‘dying matters’ awareness week, and prompted by discussions of end-of-life care on Twitter, she decided to write her first blog post: a reflection on how, during her working life, she has ‘been involved with death in many different guises and in many different ways.’ (6) Thirty eight people – health professionals and patients – left comments to say how they had been moved by her eloquent writing. She is now lead for end-of-life care in her trust and says this would not have happened without her learning through social media.

To share 

In a hospital in London a patient has the wrong foot operated on because they put a compression stocking on the wrong side. The checks and balances which the nominally implemented surgical checklist should have provided did not happen. (7) Fortunately the other foot needed operating on too. After investigations were completed the medical director of the trust gave permission for an account to be shared through social media. The story ‘Wrongfooted’ by anaesthetist Helgi Johnannson has been viewed more than 17,000 times. (7) When surgeon and medical director, Dermot Riordan, read the story he wrote on his blog that he felt ‘déjà vu, sadness and even anger’. (8)
A year ago nearly exactly the same mistake had occurred where he works. He describes the transparent and open approach that his team took to learning about this incident but he personally regrets that he did not share this learning with others in the way that ‘Wrongfooted’ showed it could be done. Social media is changing how we conceive of dissemination.

To be challenged 

Often the best way to learn is to be challenged. Earlier this year people who had experienced mental health care started tweeting their experiences using the tag #DearMentalHealthProfessionals. (9) Along with appreciation and thanks there were also tweets which expressed how it felt to be let down by a system that is supposed to help. To be able to change systems for the better we need to work towards understanding, and that starts with shifting our perspectives. Social media can help us to do this.

To be supported 

Sometimes we just need to know that we are not alone. #TipsForNewDocs are short messages of advice for newly graduated medics from doctors, other health professionals and patients. Like many social media activities it is hard to say who started this trend but Guardian healthcare(10)and the GMC(11) have both used the tag to support this important transition.

To lead 

How much impact can you achieve through social media? NHS Change Day has been lauded as the ‘biggest ever day of collective action to improve healthcare that started with a tweet’. (12) A conversation between some junior doctors on Twitter was the catalyst for a project which saw 189,000 people take action on 13 March 2013 to improve the care of the patients they served. (12)

To learn 

Free open access medical education – otherwise known as FOAMed (13) is on the rise. In the past we used databases to store and find these resources, but now we are increasingly depending on the power of distributed networks to help filter the best content for our needs. New educational initiatives are starting every week in social media. The case-based discussions of ECGclass (14) and Gasclass for anaesthesia (15) can give you a flavour of what is achievable.

To inspire 

Kate Granger is a doctor training in elderly medicine; she is also terminally ill with a rare aggressive abdominal sarcoma. During a recent hospital admission (16) she noticed that too many of the staff she met did not introduce themselves. She decided that something needed to be done, so she wrote a blog post with a simple idea – when health professionals meet patients they should say ‘hello, my name is’. (17) People started talking about her idea and doing what she asked. The campaign has reached so many people that it is mentioned in the Government’s response to the Francis Inquiry. (18)


Is social media a professionalism quagmire? Could your professional reputation hang on as few as 140 characters? Yes, norms are still being established but that means you can shape them. The truth is that if you respect your patients and your colleagues, like these pioneering physicians, you have little to fear. Instead, you should be feeling optimistic and excited that you can now easily tap into a global community who can help you to be a better doctor in a better system with your patients.


1 Naughton J. What’s Twitter’s real value? Don’t ask an economist. The Observer.2013 Nov 24.
2 Rheingold H. Net smart: how to thrive online. Cambridge: MIT Press; 2012.
3 Frenk J, Chen L, Bhutta ZA et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet2010; 376:1923–58. http://dx.doi. org/10.1016/S0140-6736(10)61854-5
4 Gilbert D, Doughty M. Quality: why patient leaders are the new kids on the block. Health Serv J2012; 122:26–7.
5 Kar P. Game-changer III: ward priority and transparency[Internet}. Partha Kar 2013 Nov 16 [cited 2013 Nov 27]. Available from: http://
6 Lowri E. Dying matters[Internet]. Elin Lowri 2013 May 13 [cited 2013 Nov 27]. Available from: dying-matters/
7 Wrongfooted[Internet]. 2013 Oct 13 [cited 2013 Nov 27]. Available from:
8 O’Riordan D. Failure to learn[Internet]. Dermot O’Leary 2013 Oct 20 [cited 2013 Nov 27]. Available from: files/Failing%20to%20learn.html
9 Betton V. #DearMentalHealthProfessionals[Internet]. Victoria Betton 2013 Aug [cited 2013 Nov 27]. Available from: http://
10 Guardian Healthcare. #TipsForNewDocs[Internet]. 2012 [cited 2013 Nov 27]. Available from: tipsfornewdocs
11 General Medical Council. #tipsfornewdocs[Internet]. 2013 [cited 2013 Nov 27]. Available from:
12 Bevan H, Roland D, Lynton J et al. Biggest ever day of collective action to improve healthcare that started with a tweet [Internet]. 2013 June 14 [cited 2013 Nov 27]. Available from: http://www.
13 Life in the fastlane. FOAM – Free Open Access Medical Education [Internet]. 2013 [cited 2013 Nov 27]. Available from: http://
14 Wetherell H. Keeping ECGs simple[Internet]. 2013 [cited 2013 Nov 27]. Available from:
15 Gasclass. Gasclass: the web school of anaesthesia[Internet]. 2013 [cited 2013 Nov 25]. Available from:
16 Granger K. The other side live![Internet]. Kate Granger 2013 Aug [cited 2013 Nov 27]. Available from: the-other-side-live
17 Granger K. #hellomynameis[Internet]. Kate Granger 2013 Sept 4 [cited 2013 Nov 27]. Available from: http://drkategranger.
18 Department of Health. Hard truths: the journey to putting patients first. Volume one of the Government response to the Mid Staffordshire NHS Foundation Trust Public Inquiry[Internet]. London: Department of Health; 2013 [cited 2013 Nov 27]. Available from: https://www. file/259648/34658_Cm_8754_Vol_1_accessible.pdf

Wednesday, 2 April 2014

PollEverywhere Higher Education License Pricing

PollEverywhere is a 'bring your own device' audience response system. Your audience can respond by SMS or web (or Twitter!). Although we have access to clickers we found that they were not used as much as they could be - in part because of the extra effort of getting the clickers, handing them out and then getting them back. Last year one of my colleagues suggested that we look into PollEverywhere as it had been used by the university for public engagement events.

A free PollEverywhere license allows up to 40 responses to any question or poll. But we have over 300+ students in the 5 years of our undergraduate course so I approached PollEverywhere last year to find out how much a HigherEd license would be for 1500 students. I was advised that pricing was based on maximum number of responses not on students. This made sense since we would not actually be registering or tracking individual students on the system. So we purchased a license which allowed us to have up to 330 responses to each poll. This was priced at $3.50 per student response. The pricing model made sense because it felt as if we were buying 330 virtual clickers. This license allowed us to have an unlimited number of tutor accounts. We started with 50 but haven't needed to go beyond that yet.

We've been learning a lot as we have gone through the year about the pros and cons of using the various question types and I and others have used this license at various public events with great success. Last week we were contacted by PollEverywhere to inform us that we had gone outside the terms of our license. I have spoken to the PollEverywhere team today and they estimate that we have had 829 unique responders/students  to our polls in the last 2 months. They do this by applying an algorithim looking at IP addresses and unique mobile numbers. This isn't in any way surprising as we had a public engagement event a few weeks ago and have also been demonstrating PollEverywhere at teaching events and conferences.

PollEverywhere say that there has been a misunderstanding and that we have been purchasing unique accounts for our students not a maximum number of responses to a given poll. I asked about public engagement activities- would be need to purchase a separate license for these? They say that we don't need to if we email them in advance and let them know that we will be using the license to a public audience.

By the end of the week PollEverywhere are going to clarify the terms of the Higher Education license to us in writing. This documentation is being written now. They don't plan to put this on their website as they say that there has not been a need as there have been no other misunderstandings about this. Since I told many people about what I thought was the terms of our existing license I thought I would write this blog post to explain that my understanding of the license has now changed.

We now have to decide whether we want to purchase this license again considering that it will be 3-4times as expensive next year as this year. We will review other options such as Participoll. It may be back to clickers after all!

Thursday, 20 March 2014

very quick survey about Facebook in education

social media in medical education... it's all about the network

What is the role of Twitter in medical education?

I started using Twitter (and this blog) because I wanted to connect with people who I didn't know how to connect with otherwise. I wanted to connect to people who worked in medical education but I got a lot more than I bargained for. I found a wonderful network of people who I continually learn from. I can share, and get feedback, dip in and out, refine my thoughts, and the rest.

But do I think that we should use it in our courses? What for?

Last week I attended a workshop lead by Claudia Megele on social media in higher education. She has done tremendous work in establishing several 'knowledge networks' including #mhchat (mental health chat). She then introduced a group of social work students to social media including Twitter. They used pseudonyms but participated in regular Twitter chats and discussed topics online.

It seems to me that the most powerful thing that Claudia did was to introduce her students to her networks. She helped them to become part of a community discussing mutual topics of interest online.

So how can we, committed to health professional education, help our students? I think we can do the same thing. We can give our students access to our knowledge networks.

Wednesday, 12 March 2014

The challenge of feedback and the burden of accountability in clinical medical education

Have you received good feedback in a clinical setting as a doctor or medical student?

Some of the best feedback I received was during my GP reg training year when my trainer reviewed most of my consultations with me every day for the first 4 or 5 months. I knew it would be a chance to ask what he thought about a patient, and also that I would have to justify some of the decisions I had made or hadn't made. It was above and beyond any feedback I have ever had before or since on my clinical work.

We know what makes good feedback. Here is a great paper about this from 31 years ago. There was no talk about eportfolios or skills logs or apps at that time. 16 years later when I was during my GP trainee year we didn't have the burden of documenting our feedback either.

So do current moves to use technology, including smart phones, to try and document feedback in clinical settings enhance the quality of feedback given? Do they make it more likely to happen? If they don't why do we do them?

Is there a risk that in an effort to be accountable, we are making it harder for learners to achieve good feedback because of the burden of documentation? If you want to read more about this I strongly recommend Onora O'Neill on 'Intelligent Accountability in Education'.

Thursday, 27 February 2014

Politicians badly briefed about data issues too?

At the end of the Parliamentary meeting on 'Patient rights and access to NHS data',
Parliamentary Under Secretary of State for Public Health, Jane Ellison MP made the following statement:

"I should actually just before we close put on the record Mr Emerson, forgive me, but I think it is useful for colleagues, just in regard to the Faculty of Actuaries and the data there, and I think actually the Shadow Minister also alluded to this; just to put on the public record that the data that they used was publicly available, non-identifiable and in aggregate form."

This data as described in this blog post was not publicly available or in aggregate form. It was individual-level data that had to be specifically asked for from the NHSIC. 

Jane Ellison may have been referring to the report generated from the research done which is indeed publicly available, with aggregate analyses from which it would be impossible to identify an individual. But no one has concerns about the report.

You can watch her statement here at 16.16.30