Wednesday, 14 January 2009

PLEs and Medical Students....

I started this blog with the aim of recording my web 2.0 learning journey and also in the hope that I would find a community of people interested and participating in medical education. Today this bore some fruit as I participated at a distance in an online seminar about these topics.

The presentation by @ajcann, University of Leicester, reported on courses to help students develop skills in the use of web 2.0 and information literacy. The slides and document give a good summary of the findings. Students appeciated tools, like customised google searches and a Pageflakes page, that helped them find resources more quickly. But they did not use the social aspects of tools provided. There was not evidence of the formation of a community of practice.

There was no audio-visual streaming of the seminar, so I could only pick up on the talk in the room through the tweets of those present. You can find them here: #UOLTAN. I am sure that this means that I have missed out on a lot of valuable interaction and responses to the material presented. I commented that I was not surprised that medical students did not use social bookmarking because despite looking for the past few months I have only managed to find one doctor who uses social bookmarking to record sites that are cliically relevant. And if I was looking for information on how to manage stable COPD, see last night's post, my instinct would not be to start searching delicious to see what others in my network had saved.

So what does that tell me? Well, if clinicians are not yet using web 2.0 to help them with their day to day clinical work, is there any point in us worrying about whether or not sudents are interested in developing these skills? I don't mean that only 10% of GPs or hospital doctors are using social bookmarking and blogs to keep up to date. Or even that only 5% are. I doubt that even 1% are. Early adopters of web2.0 tools for clinical practice do not seem to exist yet.

One of the report conclusions reached was that "Students are reluctant to change their habits unless there is a clear tangible benefit to them. If we believe literacy skills are worth developing, we must make them a requirement not an added extra."

I think that before doing that we need to figure out if these tools actually deliver something that is useful to medical students and to doctors. What gap are they actually filling? Medical education can certainly be improved. But we need to describe the problems before we come up with the solutions.


  1. This is a problem we are also struggling with in science education in general - we are facing the same lack of leadership and mentors in bioscience. We have taken the approach of looking for solutions to this from the ground up - providing opportunities for new PhD students to create a community of practice and research network amongst their peers that will permeate upward to their supervisors eventually (even if we have to wait for them to become the supervisors!). That is what the smallworlds project was about that I have been involved in with Alan Cann (see It hasn't worked so far (see Alan's blog: but that won't stop us trying!
    Looking for other clinicians is worthwhile, keep looking and keep asking for them to join you. Others will find you eventually!

  2. I am actually wondering if the model of 2.0 does not fit with the way we need info in clinical medicine. It may be more than just lack of leadership. I'm not sure about the use in wider scientific communities.
    At the moment there is a LOT of 2.0 hype. But we can't keep ignoring negative feedback or we do so at our peril. Why is it not working?

  3. I thinks it's just a matter of time before people realise the benefits to be gained from these types of interactions. As I'm sure you will agree, most health professionals I know are very busy and haven't been exposed to the web2.0 phenomena. It will be the medical digital natives (facebook generation) who I think will drive this forward not only because they have more time but also they understand the potential for educational/ clinical benfits from using other social networks.

    Ultimately, I think it's different tools for different people. These tools work for me because of there ease of use and ability to find information quickly which is important in a clinical setting when you're already overloaded with information.


  4. I'm convinced the answer is that we keep working at it, so that we can role model the benefits to colleagues. And as for students, they have got to see what in it for them.

  5. Thank you!
    @sb You are my ONLY doctor using delicious to store sites that are useful for your clinical work. I may have to talk to you more about how you use it, day to day. And also have you actually found that replies to your twitter stream on clinical work are useful? It's another aspect of 2.0 that I see lots of talk about but little evidence that it works.

    @SarahStewart Because I am using these tools for a few months now and I can see little relevance to learning for my day-to-day clinical work, I am reluctant to advocate widely. I've shown them social bookmarking but if it isn't for them....
    Anyway, I want to find more examples of people actually finding something useful through social bookmarking. Even @allergynotes (the most high profile doctor sharing clinical sites on twitter) does not use social bookmarking but google bookmarks instead. That's what we need to understand. Why do people not use these tools?

  6. Hi guys, FWIW, I think we have to do a bit more to burst our own techno-bubbles. Just because we have 'seen the light' doesnt mean anyone else will or indeed has to. The benefits of being an insider in the NET generation are over sold. I strongly recommend Neil Selwyn's work in this area... check delicious for tags or at least start with this (now dated) paper Another important contribution is this book

  7. Sorry that the hyperlinks didnt show automatically... I also wanted to add that we need to consider a richer, more rounded, view of people, the base-level activity affected and their environment(s), before we attempt to jut our favourite technology into their (personally and culturally developed) way of working; a way of working which they have generally found to work OK for them, to the extent that they have carried on their lives pretty well up until I pops up and suggest some technology or another.

  8. I experienced the same when following a library 2.0 course (13 weeks). We all learned web 2.0 tools, but we didn't (explicitly) learn the social and sharing aspects, see this post.

    It is not enough to learn tools or to hear about it, you have to experience the advantages when doing it. For instance some fellow students tried Twitter, but after a few tweets (like "I'm going home now"), they quit and conclude that twitter is useless.

    Web 2.0 training should not only teach the tools but show/learn the philosophy as well and the "tangible benefit". I agree.

    I think tagging works fine if you follow tags of people who you know give valuable information on certain subjects or if you want to browse what others collected. NOT if you want to find the best evidence on a specific topic. The way you search depends on what you're looking for. Social bookmarking might work better in science (and Cann is a scientist).

    I don't know of many doctors in my hospital that use web 2.0 tools either. But that is not a good reason not to learn the young. Many older physicians do not know how to properly search PubMed etc, but that is not a reason not to learn students. Quite the opposite. We learn them early in the curriculum now, and they often beat their supervisors. But I agree it must add value and we know it does.

    There are clinicians who use web 2.0 tools: @symtym, @sandnsurf, @allergynotes, @berci @ivorkovic @drshock on twitter for instance. @berci (medical student and author of scienceroll) has set up a web 2.0 course for medical students. I think he is quite successful in that.Perhaps contact him. Undoubtedly he will know several benefits of the web 2.0 approach.

    I think that sharing knowledge and experience is the most important aspect of web 2.0. It doesn't seem very suitable for EBM though (see your own post and mine about the web 2.0-ebm medicine split).

    p.s. reading your posts for the 2nd time, I see you explicitly talk about Delicious. I don't see many differences with other bookmarking tools as long as you tag and share it. Delicious and me never became friends, possibly because I didn't try hard enough.See Dutch post: Delicious Google Toolbar.

    BTW the link to the presentation of AJ Cann doesn't seem to work.

  9. @mike Thank you very much for pointing me towards Neil Selwyn's work. I have been trying to think over the past few weeks about the way that I and my colleagues do work when in practice. This is the benefit of straddling a few camps. You don't get too carried away by the hype... hopefully:)

    @Laika Yes, there are a few doctors/students using web2.0 but they are very few in the whole scheme of things! Where are all the others who don't have such a high profile.
    It's interesting that you don't seem to think that social bookmarking is so useful to doctors either. It is the conclusion that I am rapidly drawing:)

  10. Patients use it for their research. I do.

    I know quite a few others do, too.

    While it's discouraging there doesn't seem to be many doctors who do, my big question (as a patient) is "Does this mean doctors really don't research/keep up with new information?" Or do they just not share?


  11. Hi Robin
    Thank you very much for posting on my blog. Although we are all patients in one way or another, it is good to have your e-patient opinion.
    I am a primary care physician, or GP, in the UK and I can only speak for myself on this count. Your question addresses what I have been considering a lot in the last few weeks. How do I keep up-to-date?
    (This actually needs a complete post. But I'll start here anyway!)

    The latest research on a topic, say diabetes, rarely affects my practice straight away. My management of diabetes is determined by the protocols that I have agreed with my colleagues, based on the guidance we receive from national bodies, and the experience and choices of the patient before me.

    With less common illnesses (well, all really) I am very happy for and encourage patients to research topics and ask me, or their secondary care doctor, about their management.

    With all progress in care, new research or guidelines, the key is actually implementation. I work within a system... GP colleagues, nurses, health care assistant, community menat health teams, social services, secondary care, community care.... and ideally we would all work together to make sure that the best way of managing any condition was worked out together.

    At the moment web 2.0 tools are not being used to help with those problems. If I tried to read 20 journals a week and saved all those relevant to primary care in my delicious account, and even managed to get others to do the same, it would not be likely to lead directly to any improvements in quality of care. But if I could talk and share information with those who work in all levels of health care within 25 miles of me.... now that would be helpful!

    I will try to think and write more about this. But thank you for moving the conversation on.

    Anne Marie

  12. I found this following your comment on the @DrShock blog.

    I'm neither a doc nor a medical student, but interested in social media and its role in health care communications because I'm director of communications for Washington State University Spokane, which has health sciences/professions as its core focus.

    Coming at this as an occasional patient and a social media user/student, I'd ask practitioners to think about who ELSE is out there tagging, bookmarking, StumblingUpon, and so forth to point patients to (quasi-) medical/health care info on the web.

    If I hit Google and the top sites are those that have been flagged by people trying to sell me an unproven supplement or therapy, is there any credible info from trusted sources there as a balance? The people selling something are the ones with the motivation to spend time pushing information up in search engine results.

    Not that I think docs can personally "police" web content, but I see this as an issue. Desperate people will find and act on all kinds of information, and social media networks allow both good and bogus info to spread widely and rapidly.

    I haven't gone looking around yet to see if this is already happening, but I'd suggest that perhaps at least at the practice marketing level, a set of trusted/recommended sites could be linked from a practice or hospital home page to point patients towards reputable information sources, along with a caveat about the info they'll find if they just hit Google and type in "cancer cure" or some such search string.

    This doesn't address the clinical side or evidence-based medicine, just the consumer health education side a bit.

    Mgr of @WSUSpokane on Twitter

  13. Thanks for the great response, Anne Marie. I would love to hear from other physicians in other places/countries, too.

    You said, "At the moment web 2.0 tools are not being used to help with those problems. If I tried to read 20 journals a week and saved all those relevant to primary care in my delicious account, and even managed to get others to do the same, it would not be likely to lead directly to any improvements in quality of care."

    I can only see what is being discussed here from my perspective, which is 1) as a patient and 2) as a Cushing's patient who suffered for 25+ years before being diagnosed. If my doctors had bothered to read the research as it came out and had followed the protocol for the symptoms, perhaps I would have been diagnosed sooner. Maybe.

    And the "maybe" comes from finally being told by my wonder PCP that whatever was wrong with me was "endocrine related" but she didn't know what it was. It comes from researching "endocrine" diseases myself and realizing I had symptoms of Cushing's but still could not get doctors locally or even at a larger medical/teaching hospital to investigate it. Supposedly they helped write the latest literature but certainly did not practice it.

    The "maybe" comes from keeping up with the literature myself, conversing with top pituitary/endocrine specialists in the U.S. and realizing even most of them didn't read the research. (When I found one who not only read it, but helped research it, I went to him on the opposited coast from where I live.)

    My point is, there is wonderful research which has been consistently done over and over, well-documented, and approved by intelligent, highly respected medical folks. But a large majority of the front-line physicians who need to read it and use it never see it.

    How do we change that? I can see how Web 2.0 could be used. Patients are embracing it in a big way. But it does us no good diagnostically except to educate, inform, and support each other.

    How do we escalate the movement of knowledge from the page to the medical community's "brain"?

  14. BTW...interesting discussion from a U.S. point-of-view at

  15. As a occupational therapist I feel strongly that web 2.0 offers amazing opportunities to harness the collective clinical knowledge of professionals. I am working with the World Federation of Occupational Therapists to develop an online volunteer project to allow clinicians in different countries to work collboratively on projects to enhance clinical skills and develop the profession but also as a manageable "carrot" to entice clinicians to engage with web 2.0 be producing tangible work which is motivating.

  16. Hello everyone! I am really glad to see the debate we have started. It fitted in nicely with the debate on Phil Naumann's blog about his 140 siggestions for using twitter in healthcare:

    @coug2008 With regards to pointing patients in the right direction for information, well, I initially try to do that by giving them information leaflets in the surgery. These often have trusted websites listed. I also think that the NHS choices website is getting to be a very good starting point for patients in the UK. I'm not sure if it can be accessed from elsewhere. But if you can see it, I would argue that it is a reasonably good model of how these things should be done.

    @Robin. Thank you for getting back to me again. I am, of course, sorry to hear that you had such a hard time getting diagnosed and accessing treatment. I haven't had time to read all your blog, but I think it is a fantastic resource for doctors and patients alike. As a primary care doctor I might never see a new case of Cushings, and your latest post about your conversations with another physician on having a 'zebra' illness resonates a lot with me. A lot of my work is about preventing illness and helping patients with chronic illness to manage their condition as best as possible. There is a lot of other stuff as well, but diagnosing less common illnesses happens rarely... even a new case of hypothroidism is relatively rare, diabetes is much more common.
    It will be super if technology can help us realise when a group of symptoms or signs makes a diagnosis such as Cushings more likely.
    With regards to the surgical checklist, it may surprise you to read that a simple intervention that is 'common sense' was not happening before. But if anything that shows us that technology is not the be all and end all. It just takes people sitting down, thinking about what the problems is and coming up with a solution. Even better if it is a low tech solution that can be accessed equally all over the world.

    @buckeyebrit Great to hear from you. Your work sounds really interesting and it will be great to learn more about it. I don't doubt that there are possibilities for 2.0 by clinical professionals. I'm just wondering where the good examples are now.

    Thanks all!
    Anne Marie

  17. Hi again, and thanks for the response. Not to be a pest, but I believe you see more "rare" diseases than you know. I truly am not trying to be argumentative. Let me just leave you with these:

    Article 1

    Article 2

    Article 3

    Article 4

    All of them talk about the prevalence of the disease being much higher than once thought and why each is so often missed by physicians.

    I have a lot more, but won't inundate you with it.

    Warm regards

  18. Hi Anne Marie, I can add some information that is emerging from my recent wiki project with first year MSc PT students. A couple of reasons they are reluctant to use the social networking aspects of the Web 2.0 tools is they don't yet trust others with their information (they are competitive students) and secondly, they don't yet feel they have anything of worth to offer. Therefore, they are really saying they will collaborate with people they respect and trust! Interesting!
    Cheers, Anita.

  19. @Anita Thank you for that! I must catch up with your blog again:)

  20. This comment has been removed by a blog administrator.


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