tag:blogger.com,1999:blog-41499573158103481522024-03-13T02:19:13.779+00:00Wishful thinking in medical educationAnne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.comBlogger203125tag:blogger.com,1999:blog-4149957315810348152.post-76597642453296667882015-06-28T21:46:00.000+01:002015-06-28T21:46:04.642+01:00New horizons...<a href="https://www.flickr.com/photos/amcunningham72/299006195" title="IMG_0959 by Anne Marie Cunningham, on Flickr"><img alt="IMG_0959" height="480" src="https://c1.staticflickr.com/1/117/299006195_6101782a8e_z.jpg?zz=1" width="640" /></a><br />
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In the next few months I will be leaving my post as a clinical lecturer and academic lead for elearning in the undergraduate medical course in Cardiff University to become a primary care clinical director in Aneurin Bevan University Health Board.<br />
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I am absolutely delighted that I will be joining a fantastic clinical leadership team (including <a href="https://twitter.com/RslewisSally" target="_blank">Sally Lewis</a> and <a href="https://twitter.com/ARoeves" target="_blank">Alastair Roeves</a>) and having the chance to participate in many different levels of the health board's work to help make sure that we can deliver sustainable primary health care.<br />
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Many years ago I didn't know whether I wanted to be a GP or a public health physician. I had a wonderful GP trainer in Belfast, <a href="https://twitter.com/fergusdonaghy" target="_blank"> Fergus Donaghy</a>, who is I think still the most committed clinician educators that I have ever met. But I was still uncertain so I came to Bristol to do a six month SHO job in public health in Avon Health Authority. After a few months working in public health I realised that I did not want to leave clinical work behind.<br />
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A chance came to join the Department of General Practice in the then University of Wales College of Medicine in an innovative new <a href="http://medicine.cf.ac.uk/primary-care-public-health/about/clinical/academic-fellows-scheme/" target="_blank">Academic Fellow </a>scheme with the twin aims of developing general practice in the South Wales valleys and also developing young academic GPs. I decided not to return to Northern Ireland My head of department was Professor Helen Houston, who is still a wonderful colleague, and has provided much support to me in the last 13 years.<br />
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In Wales I was very lucky to meet and work in Professor Jonathan Richard's practice in Merthyr Tyfdil. In his incredibly generous and nurturing way, when Jonathan realised that I was interested in Public Health he invited me to come along to one of the meetings of a Public Health and Primary Care Steering group of the Welsh Assembly. It helped me to realise that my interests in primary care and public health could sit well together and shortly afterwards I started my Masters in Public Health.<br />
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I then moved to Gelligaer Practice and have worked there as a salaried GP ever since. <a href="https://twitter.com/KathrinJThomas" target="_blank"> Kathrin Thomas</a> was also a big inspiration to me. Welsh, she moved back from Liverpool to work with us and always managed to keep a balance between the perspectives of caring for individual patients and for populations in her work. It wasn't really a surprise when she later trained as a public health specialist, and she is now lead for public health primary care in Public Health Wales.<br />
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Gradually I became more involved in medical education in the medical school which merged with Cardiff University in 2004. For the past few years as we have been developing a new curriculum I got to use my interest in the use of tech to develop our use of technology in the course.<br />
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Back in 2008 I started my social media journey with this blog and a twitter account. I have learnt so very much from those I have met online and face-to-face in this time. I will be very sorry to leave my good colleagues throughout Cardiff University but as<a href="http://www.irrodl.org/index.php/irrodl/article/view/2158/3343" target="_blank"> Bon Stewart writes </a>these days our membership of academic networks does not have to depend on membership of institutions.<br />
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In short, I am very lucky because when I was a medical student a role with the scope of a primary care clinical director in Wales, and which would allow me to continue working as a GP, did not exist. But if it did I would have aimed to get here. And I am very lucky to have been able to work with many wonderful people through the university, and to learn and share my learning with people all over the world through social media. Thank you every one!<br />
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<br />Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com0tag:blogger.com,1999:blog-4149957315810348152.post-45776539651017715062014-10-09T01:03:00.002+01:002014-10-09T12:46:20.158+01:00The ethics of health organisations monitoring social media...#justiceforlb <a href="http://twitter.com/sarasiobhan" target="_blank">Sara Ryan</a> is a learning disabilities researcher. She is also a mother. She <a href="http://mydaftlife.wordpress.com/" target="_blank">kept a blog</a> about the joy that her son, Connor, who was affectionately called LB (Laughing Boy) brought into her family's life. Last year, Connor became unwell and was admitted to an assessment and treatment centre. 107 days later he drowned in the bath. He had epilepsy and Sara had noticed an increase in his seizures and alerted staff. But he was allowed to bathe unsupervised. Now her blog is about what Sara is learning since his death.<br />
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This is Sara talking about LB and the campaign for <a href="http://107daysofaction.wordpress.com/" target="_blank">#justiceforLB.</a><br />
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<a href="http://mydaftlife.wordpress.com/2014/10/08/background-briefing-on-mothers-blog/" target="_blank">Today's post </a> on Sara's blog is about the memo that was circulated the day after Connor's death by the communications department of the health trust, to brief staff about Sara's blog and provide a summary of posts with the aim that it might "help in shaping a tailored media response". Sara obtained this memo today through a Freedom of Information request. It details how Sara's blog had been monitored by the comms team from as soon as they were aware of it in March 2013 shortly after his admission to the unit. It specifically mentions <a href="http://mydaftlife.wordpress.com/2013/05/21/the-unit-day-63/" target="_blank">this post in May 2013</a> just over half way through Connor's admission, where Sara described her distress at realising that Connor had a seizure but not being able to convince the staff that this was the case.<b> Last week Sara was told by the Chairman of the Board that there had been no monitoring of her blog. </b><br />
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Four years ago there were blog discussions in the UK about the ethics of monitoring social media. There was a particular case of a patient who had had a renal transplant, described <a href="http://www.rmmlondon.com/rmm-sector-story/the-case-of-the-twittering-kidney-patient-healthcare-and-the-ethics-of-social-media-monitoring/" target="_blank">here</a> by Dan O'Connor. I made comments here, and in another blog (it was on posterous but hopefully has been rescued and is retrievable elsewhere) that I thought that health organisations should not monitor social media unless they had clear policies agreed by staff throughout the organisation on what they would do in various scenarios, including if a matter came to attention which needed clinical input. I think that Sara's post in May describing Connor's seizure is such a post.<br />
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If a health organisation is monitoring social media they should consider in whose interests they are undertaking this monitoring and how they will respond to posts like Sara's.<br />
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Connor's death was a tragedy. As <a href="http://www.bbc.co.uk/news/uk-england-oxfordshire-26334445" target="_blank">the independent report</a> into his death found, it was preventable. This should never happen again.<br />
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Link: <a href="http://2040infolawblog.com/2014/10/09/a-tailored-media-response/" target="_blank">An excellent post by Tim Turner</a> on the data protection aspect of this social media monitoring.Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com11tag:blogger.com,1999:blog-4149957315810348152.post-55420287353742825742014-10-08T18:50:00.001+01:002014-10-08T22:17:23.470+01:00The unwritten rules of stethoscope placement....and what you wear when.<blockquote class="twitter-tweet" lang="en">
Learned that because doctors and medstudents don't wear uniform in UK, you can identify one from t'other by stethoscope position. Who knew?!<br />
— AnneMarie Cunningham (@amcunningham) <a href="https://twitter.com/amcunningham/status/519894701366063105">October 8, 2014</a></blockquote>
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I'm quite fascinated by the culture around what different health professionals wear in hospital, and also what different health professionals wear around campus. In the UK, medical students do not wear uniforms on placements; they wear their own clothes. They no longer wear white coats. When I was a medical student I am sure we were identifiable on wards by our ill-fitting white coats, before anyone saw our university name badges.<br />
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Cardiff University medical students are given lanyards to hold their university IDs, and I heard recently that there may be an unwritten rule that this lanyard should not be worn around campus... or people might just think you were showing off.<br />
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Of course doctors in the UK don't wear white coats now either, so fitting vs not fitting white coats are not a way to quickly visually distinguish doctors from medical students. Instead, I learnt today that the position of your stethoscope is now an unwritten rule about your seniority in the medical profession. Some (doctors and students) think that only doctors should wear stethoscopes around their necks. Some have even suggested that the unwritten rule might be that you shouldn't wear a stethoscope around your neck until you are a little bit further up the ranks... maybe having <a href="https://twitter.com/LobeckDR/status/519901952143265792">passed professional exams</a>! Even more curious, there is a rumour that this unofficial way of distinguishing medical students from doctors may be <a href="https://twitter.com/JonJHilton/status/519912025603178496">sabotaged by infection control guidance</a> preventing ANYONE from wearing a stethoscope round their neck.<br />
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It's also worth noting that from a patient's perspective just knowing someone is a doctor is not enough.<br />
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<a href="https://twitter.com/amcunningham">@amcunningham</a> Stethoscope meant DR, but emergency med, or general med, or cardiology, or haematology? When parked/oncology ward? Confusing.<br />
— Tricia Murphy-Black (@Pogster) <a href="https://twitter.com/Pogster/status/519917932718333952">October 8, 2014</a></blockquote>
We need to remember to always say <a href="http://hellomynameis.org.uk/">#hellomynameis</a> and explain who we are and why we are talking to the patient on this occasion.<br />
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So I was wondering... should it be easier to identify medical students? Should doctors and medical students wear uniforms too? How do patients visually distinguish medical students from doctors, as I'm sure they are pretty unlikely to know these rules, and does it matter? And has the significance of stethoscopes to doctors in the UK gone up as <a href="http://www.hospitaldr.co.uk/blogs/careering-ahead/theres-a-lot-to-be-said-for-a-uniform-approach" target="_blank">they've stopped wearing white coats</a>?<br />
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Edit : Some doctors in the UK do wear uniform! <a href="https://twitter.com/sally_bobs" target="_blank">@sally_bobs</a> is a respiratory consultant in Chesterfield. All doctors and medical students in <a href="https://twitter.com/royalhospital" target="_blank">@royalhospital</a> wear navy scrubs which indicate if they are consultants.<br />
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<a href="https://twitter.com/amcunningham">@amcunningham</a> <a href="http://t.co/z6yu8PlmM5">pic.twitter.com/z6yu8PlmM5</a><br />
— HellomynameisSally (@sally_bobs) <a href="https://twitter.com/sally_bobs/status/519923355634659328">October 8, 2014</a></blockquote>
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And ENT consultant, John McGarva, @<a href="https://twitter.com/IamChirurgicus" target="_blank">IamChirurgicus</a>, even designed his own which highlights his specialty.<br />
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<a href="https://twitter.com/amcunningham">@amcunningham</a> <a href="https://twitter.com/sally_bobs">@sally_bobs</a> I unilaterally invented my own when moved to new build. Saves hassle but am yet to see copy <a href="http://t.co/0qFpmJ8jk5">pic.twitter.com/0qFpmJ8jk5</a><br />
— John McGarva (@IamChirurgicus) <a href="https://twitter.com/IamChirurgicus/status/519927417717424128">October 8, 2014</a></blockquote>
More about the importance of the lanyard... some have colour coding to distinguish role. <a href="https://twitter.com/respirologist/status/519957443754086400" target="_blank">In this particular case</a> they were brought in to help distinguish staff at the time of a cardiac arrest. But interestingly<a href="https://twitter.com/the_learnaholic/status/519958417495306240" target="_blank"> lanyards are seen as an infection control risk</a> in some trusts as well.<br />
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.<a href="https://twitter.com/e_hothersall">@e_hothersall</a> <a href="https://twitter.com/amcunningham">@amcunningham</a> So do we (& colour coded): dark blue for cons, light blue ST3+, yellow CT1-2, green Fs <a href="http://t.co/8TOFTDgSG1">pic.twitter.com/8TOFTDgSG1</a><br />
— Philip Pearson (@respirologist) <a href="https://twitter.com/respirologist/status/519955685250179073">October 8, 2014</a></blockquote>
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<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com11tag:blogger.com,1999:blog-4149957315810348152.post-52193711126402409592014-10-04T16:48:00.000+01:002014-10-04T18:11:21.445+01:00Let's not medicalise exercise. Inactivity, not exercise, is risky! <br />
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Have you ever been told by a gym to check with your GP first if it is OK to exercise? Wondering how common this is.<br />
— AnneMarie Cunningham (@amcunningham) <a href="https://twitter.com/amcunningham/status/518376843272286208">October 4, 2014</a></blockquote>
I asked this because it is <a href="http://www.telegraph.co.uk/health/healthnews/11136122/Doctors-tell-Health-Secretary-they-are-exhausted-drowning-and-furious.html">reported</a> that gyms ask many people, but particularly those with long-term conditions to get advice from a health professional before starting exercise. The wiki 'GANFYD' (Get a note from your doctor) even has a <a href="http://www.ganfyd.org/index.php?title=Get_a_note_from_your_doctor#Text_for_letter_when_requested_for_gym.2Fsporting_activities">template letter</a> for GPs to use when gyms seemingly insist on a letter from a GP to say that exercise is safe.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWPHAYsb1tIk7w2dkexJ0MWqUgnKBEZ7BxvhartLXNXkW-j4r6XcACmRenovjJcVhByM3fP97BlbiPe3aTOZ3WcSUDG40yYQ6mhxT-v4xuT0x-ZF6tFifSvLtOgb_85iAbh-r5_pm5MPg/s1600/exerciseworks.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWPHAYsb1tIk7w2dkexJ0MWqUgnKBEZ7BxvhartLXNXkW-j4r6XcACmRenovjJcVhByM3fP97BlbiPe3aTOZ3WcSUDG40yYQ6mhxT-v4xuT0x-ZF6tFifSvLtOgb_85iAbh-r5_pm5MPg/s1600/exerciseworks.PNG" height="160" width="640" /></a></div>
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The above statement is taken from <a href="http://issuu.com/foxcreate/docs/ew__booklet_lo?mode=embed&layout=http%3A%2F%2Fskin.issuu.com%2Fv%2Flight%2Flayout.xml&showFlipBtn=true&autoFlip=true&autoFlipTime=6000">a leaflet </a>published by <a href="http://www.exercise-works.org/">ExerciseWorks</a>. The leaflet starts by giving advice on how to start exercising but just over half way through is what seems like a disclaimer advising all who are new to exercise to check with a health professional before starting any new exercise activity.</div>
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When I asked @exerciseworks why they advised this, because I could find no basis for it, they said that it was 'industry standard' advice.</div>
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<a href="https://twitter.com/amcunningham">@amcunningham</a> that's because that is the industry's guidance. I am not risk averse and covered in liability anyway by insurance...<br />
— Exercise Works! (@exerciseworks) <a href="https://twitter.com/exerciseworks/status/518402666511466497">October 4, 2014</a></blockquote>
I could not establish where this industry standard advice is published but if it becomes available I will publish the link. (edit: thanks to <a class="g-profile" href="https://plus.google.com/111545113031184912337" target="_blank">+Lindsay Jordan</a> for directing me to <a href="http://www.fbpt.co.uk/PARQ.pdf">PAR-Q</a>, and info on how its use is suggested by <a href="http://www.eteacher.pro/Portals//2/Documents/PortfolioGuidance/L2GymLAP.pdf">industry training</a>. Note this does not suggest that all people increasing physical activity should see a health professional.) But I am concerned because this not fit with general advice from the NHS or from the Chief Medical Officers of Wales, Scotland, Northern Ireland and England on the safety of exercise. In their document <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf">"Start Active, Stay Active'</a> they state that previously inactive people who increase their activity are unlikely to encounter significant risks.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkzJjPGWHLNYp2aHp2r3oCz785ov8jrevuh_aMXnpiiphMmMhD3ncUlkEMrtmowT0m7Jpx6HjfdGiMhvtJ3pb1QHmPfxxyjfGVgeZcrmYdZE1zE6lNKfpJMbjjIDaSKTnHTibfCoJf5ec/s1600/rsikofphysicalactivity.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkzJjPGWHLNYp2aHp2r3oCz785ov8jrevuh_aMXnpiiphMmMhD3ncUlkEMrtmowT0m7Jpx6HjfdGiMhvtJ3pb1QHmPfxxyjfGVgeZcrmYdZE1zE6lNKfpJMbjjIDaSKTnHTibfCoJf5ec/s1600/rsikofphysicalactivity.PNG" height="298" width="400" /></a></div>
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There is therefore no justification for the advice that all who are new to exercise, or even those with longterm conditions, should see a health professional before starting to increase their activity.</div>
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If you want to start exercising follow the advice on the <a href="http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx">NHS Choices website.</a> Exercise in not risky, but inactivity is. If the fitness industry really is advising that you need to see a health professional before starting exercise they need to catch up with the NHS!</div>
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EDIT : The Faculty for Sports and Exercise Medicine discuss risk stratification for exercise in<a href="http://www.fsem.co.uk/media/43891/exercise-prescription-in-health-and-disease-booklet.pdf"> this document</a> but this is not referred to in the CMO guidance. I will attempt to update as I find out more!</div>
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<a href="https://twitter.com/amcunningham">@amcunningham</a> <a href="https://twitter.com/FSEM_UK">@FSEM_UK</a> yes. CMO can't detail all the risk...inactivity is the issue. More support for LTC patients where risk is higher<br />
— Niall Elliott (@dundeesportsmed) <a href="https://twitter.com/dundeesportsmed/status/518444374452350976">October 4, 2014</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com3tag:blogger.com,1999:blog-4149957315810348152.post-33002423144888549732014-09-23T01:57:00.000+01:002014-09-23T01:57:40.715+01:00What should open educational resources (aka #FOAMed) 'replace' in university education?<blockquote class="twitter-tweet" lang="en">
. <a href="https://twitter.com/AmboFOAM">@AmboFOAM</a> asked if <a href="https://twitter.com/hashtag/FOAMed?src=hash">#FOAMed</a> should be incorporated into uni degrees. <a href="https://twitter.com/hashtag/spa2014conf?src=hash">#spa2014conf</a> <a href="https://twitter.com/hashtag/PAIC2014?src=hash">#PAIC2014</a><br />
— Jess (@EMS_Junkie) <a href="https://twitter.com/EMS_Junkie/status/513220241363464193">September 20, 2014</a></blockquote>
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I thought that all of us agreed on the answer to this question. Surely... surely... it must be acceptable for Open Educational Resources (OER) to be incorporated into university education? But this tweet produced a lot of discussion. You can see many of the tweets <a href="https://storify.com/amcunningham/foamed-oer-and-teachers/">here</a> but some of the issues raised were :<br />
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1.<a href="https://twitter.com/ketaminh/status/513223871541940224"> Is it acceptable for students to pay for a course where free content is used?</a> My first thought was why wouldn't it be? But I suppose this question is hinting at a similar distinction to a creative commons license which allows reuse for commercial purposes and one which does not. It used to be that we thought of OER as coming primarily from institutions (and possibly being re-used by them too) whilst social media tools have allowed more and more OER to be produced by individuals and disseminated through networks. Some of this is #FOAMed and it is maybe not surprising if the individuals producing it don't feel so happy about institutional re-use.<br />
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2. <a href="https://twitter.com/Brent_Thoma/status/513232082764455936">Can we identify the best lecture on congestive heart failure (CHF) in the world? </a> This supposes that across the world we have shared concepts of what is the best lecture? Treatments and management might vary throughout the world but maybe we could find the best 'lecture' on pathophysiology? Maybe it is this 13 min long video from Vanderbilt University?<br />
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Maybe the students and teachers on your course could get together to try and identify some of the best resources for their course as we are doing <a href="http://www.scoop.it/t/case-1-i-ve-hurt-my-knee-doctor">here</a> with our curation project.<br />
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3.<a href="https://twitter.com/jvrbntz/status/513283328171331584"> Is the reuse of materials like the lecture above a threat to local pedagogical practice?</a> I struggled most with this question. I happen to think that reuse of materials like the short video above opens up so many possibilities for local pedagogical practice. The video could be remixed using <a href="http://ed.ted.com/">TedEd </a> with questions relevant to local practice, and links to local guidelines or formularies. It could be remixed using Mozilla Popcorn maker in an infinte number of ways. And the remix could be remixed again by other local colleges or by students. We are not talking here about people sharing content through MOOCs <a href="http://opencontent.org/blog/archives/3557">which often aren't really very open at all</a>, though of course <a href="https://class.stanford.edu/courses/Education/OpenKnowledge/Fall2014/about">there are exceptions</a>! .<br />
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4. <a href="https://twitter.com/jvrbntz/status/513290783269863424">What can OER replace?</a> If lectures (like textbooks) were about information transmission then OER selected (and remixed) for local relevance might replace them. And do a better job. But I can't see why teachers will be replaced.<br />
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Thank you to everyone who participated in the discussion so far. What other questions should be be asking about OER and do you have any different answers to those I have asked above?Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com6tag:blogger.com,1999:blog-4149957315810348152.post-54594669600247605172014-05-28T13:18:00.002+01:002014-05-28T13:19:21.881+01:00The need for a #1care forum... who will lead?<div class="storify">
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Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com3tag:blogger.com,1999:blog-4149957315810348152.post-62353219045880720332014-05-03T18:35:00.000+01:002014-05-03T19:30:56.061+01:00Why 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 <a href="http://www.rcpe.ac.uk/sites/default/files/decamp_cunningham_curr_cont.pdf">here</a> and see some discussion on PubMed commons about it <a href="http://www.ncbi.nlm.nih.gov/pubmed/24350316">here</a>. 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.<br />
<h3>
<iframe allowfullscreen="" frameborder="0" height="496" mozallowfullscreen="" msallowfullscreen="" oallowfullscreen="" src="https://www.flickr.com/photos/amcunningham72/11341496574/player/" webkitallowfullscreen="" width="640"></iframe><br />
<br />
<iframe allowfullscreen="" frameborder="0" height="356" marginheight="0" marginwidth="0" scrolling="no" src="http://www.slideshare.net/slideshow/embed_code/28958530?rel=0" style="border-width: 1px 1px 0; border: 1px solid #CCC; margin-bottom: 5px; max-width: 100%;" width="427"> </iframe> <br />
<div style="margin-bottom: 5px;">
<strong> <a href="https://www.slideshare.net/amcunningham/why-does-a-twittering-doctor-tweet-10-reasons-for-a-social-media-presence-28958530" target="_blank" title="Why does a twittering doctor tweet? - 10 reasons for a social media presence">Why does a twittering doctor tweet? - 10 reasons for a social media presence</a> </strong> from <strong><a href="http://www.slideshare.net/amcunningham" target="_blank">Anne Marie Cunningham</a></strong> </div>
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.<br />
<br />
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<br />
<br />
Introduction </h3>
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. <a href="http://www.theguardian.com/technology/2013/nov/24/twitter-value-gdp-economists-naughton">Globally half a billion tweets are posted every day.</a> (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. <a href="http://rheingold.com/netsmart/">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</a>. (2) I will convince you that it is worth
developing these skills.<br />
<br />
<h2>
10 Reasons to have a social media presence</h2>
<h3>
To connect </h3>
The landmark report on ‘<a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61854-5/fulltext">Health professionals for a new century</a>’ 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.<br />
<br />
<h3>
To engage </h3>
Social media is not just about getting your message out. It
is also about listening. We can learn with <a href="http://www.hsj.co.uk/resource-centre/leadership/why-patient-leaders-are-the-new-kids-on-the-block/5046065.article#.U2Ufy_ldX4s">patient leaders.</a>( 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.<br />
<br />
<h3>
To inform </h3>
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, <a href="http://nhssugardoc.blogspot.co.uk/">NHS Sugar Doc</a>, to communicate
how an award-winning team is involving patients in
redesigning their service, meeting the challenges of
modern healthcare.(5)<br />
<br />
<h3>
To reflect</h3>
Elin Roddy is a respiratory consultant. She also tweets
(<a href="https://twitter.com/elinlowri">@elinlowri</a>). During <a href="http://dyingmatters.org/page/awareness-week-2014-you-only-die-once">‘dying matters’ awareness week</a>,
and prompted by discussions of end-of-life care on
Twitter, she decided to write <a href="http://elinlowri.wordpress.com/2013/05/11/dying-matters/">her first blog post</a>: 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.<br />
<br />
<h3>
To share </h3>
In a hospital in London a patient has<a href="https://storify.com/traumagasdoc/wrongfooted"> the wrong foot</a>
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 <a href="https://storify.com/traumagasdoc/wrongfooted">‘Wrongfooted’ </a>by anaesthetist <a href="https://twitter.com/traumagasdoc">Helgi Johnannson</a> has been viewed more than 17,000 times. (7) When surgeon and medical director, <a href="https://twitter.com/dermotor">Dermot Riordan</a>,
read the story <a href="http://oriordan.co.uk/blog/files/Failing%20to%20learn.html">he wrote on his blog</a> that he felt ‘déjà vu,
sadness and even anger’. (8)<br />
<blockquote class="twitter-tweet" lang="en">
.<a href="https://twitter.com/traumagasdoc">@traumagasdoc</a> This make me both sad & cross. We had near identical case. Reported externally but no learning dissemination by <a href="https://twitter.com/NHSEngland">@NHSEngland</a><br />
— Dermot O'Riordan (@dermotor) <a href="https://twitter.com/dermotor/statuses/391700839083298816">October 19, 2013</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>
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.<br />
<br />
<h3>
To be challenged </h3>
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
<a href="https://storify.com/VictoriaBetton/dearmentalhealthprofessionals-part-2">#DearMentalHealthProfessionals</a>. (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.<br />
<br />
<h3>
To be supported </h3>
Sometimes we just need to know that we are not alone.
<a href="https://twitter.com/search?q=%23tipsfornewdocs&src=hash">#TipsForNewDocs </a>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
<a href="https://storify.com/GdnHealthcare/tipsfornewdocs">Guardian healthcare</a>(10)and <a href="https://storify.com/GMCUK/tips-for-new-doctors">the GMC</a>(11) have both used the
tag to support this important transition.<br />
<br />
<h3>
To lead </h3>
How much impact can you achieve through social
media? <a href="http://changeday.nhs.uk/">NHS Change Day</a> has been lauded as the
‘<a href="http://www.mixprize.org/story/biggest-ever-day-collective-action-improve-healthcare-started-tweet-0?challenge=14226">biggest ever day of collective action to improve healthcare that started with a tweet</a>’. (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)<br />
<br />
<h3>
To learn </h3>
Free open access medical education – otherwise known
as <a href="http://lifeinthefastlane.com/foam/">FOAMed</a> (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 <a href="http://hcwetherell.blogspot.co.uk/">ECGclass </a>(14) and <a href="http://gasclass.wordpress.com/">Gasclass</a> for anaesthesia (15) can give you a flavour of
what is achievable.<br />
<br />
<h3>
To inspire </h3>
<a href="https://twitter.com/GrangerKate">Kate Granger</a> is a doctor training in elderly medicine;
she is also terminally ill with a rare aggressive abdominal
sarcoma. <a href="https://storify.com/katemgranger/the-other-side-live">During a recent hospital admission</a> (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 ‘<a href="http://drkategranger.wordpress.com/2013/09/04/hellomynameis/">hello, my name is</a>’. (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 <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/270368/34658_Cm_8777_Vol_1_accessible.pdf">Government’s response to the Francis Inquiry</a>. (18)<br />
<br />
<h3>
Conclusion</h3>
<b>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.</b><br />
<br />
<h3>
References</h3>
1 Naughton J. What’s Twitter’s real value? Don’t ask an economist.
The Observer.2013 Nov 24.<br />
2 Rheingold H. Net smart: how to thrive online. Cambridge: MIT Press;
2012.<br />
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<br />
4 Gilbert D, Doughty M. Quality: why patient leaders are the new
kids on the block. Health Serv J2012; 122:26–7.<br />
5 Kar P. Game-changer III: ward priority and transparency[Internet}.
Partha Kar 2013 Nov 16 [cited 2013 Nov 27]. Available from: http://
nhssugardoc.blogspot.co.uk/2013/11/game-changer-iii-ward-priority-and.html<br />
6 Lowri E. Dying matters[Internet]. Elin Lowri 2013 May 13 [cited 2013
Nov 27]. Available from: http://elinlowri.wordpress.com/2013/05/11/
dying-matters/<br />
7 Wrongfooted[Internet]. 2013 Oct 13 [cited 2013 Nov 27].
Available from: http://storify.com/traumagasdoc/wrongfooted<br />
8 O’Riordan D. Failure to learn[Internet]. Dermot O’Leary 2013 Oct
20 [cited 2013 Nov 27]. Available from: http://oriordan.co.uk/blog/
files/Failing%20to%20learn.html<br />
9 Betton V. #DearMentalHealthProfessionals[Internet]. Victoria
Betton 2013 Aug [cited 2013 Nov 27]. Available from: http://
storify.com/VictoriaBetton/dearmentalhealthprofessionals<br />
10 Guardian Healthcare. #TipsForNewDocs[Internet]. 2012 [cited
2013 Nov 27]. Available from: http://storify.com/GdnHealthcare/
tipsfornewdocs<br />
11 General Medical Council. #tipsfornewdocs[Internet]. 2013 [cited
2013 Nov 27]. Available from: http://storify.com/GMCUK/tips-for-new-doctors.<br />
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.
mixprize.org/story/biggest-ever-day-collective-action-improve-healthcare-started-tweet-0<br />
13 Life in the fastlane. FOAM – Free Open Access Medical Education
[Internet]. 2013 [cited 2013 Nov 27]. Available from: http://
lifeinthefastlane.com/foam/<br />
14 Wetherell H. Keeping ECGs simple[Internet]. 2013 [cited 2013 Nov
27]. Available from: http://hcwetherell.blogspot.co.uk/<br />
15 Gasclass. Gasclass: the web school of anaesthesia[Internet]. 2013
[cited 2013 Nov 25]. Available from: http://gasclass.wordpress.com/<br />
16 Granger K. The other side live![Internet]. Kate Granger 2013 Aug
[cited 2013 Nov 27]. Available from: http://storify.com/katemgranger/
the-other-side-live<br />
17 Granger K. #hellomynameis[Internet]. Kate Granger 2013 Sept 4
[cited 2013 Nov 27]. Available from: http://drkategranger.
wordpress.com/2013/09/04/hellomynameis/<br />
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.
gov.uk/government/uploads/system/uploads/attachment_data/
file/259648/34658_Cm_8754_Vol_1_accessible.pdfAnne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com4tag:blogger.com,1999:blog-4149957315810348152.post-43653303487158219362014-04-02T19:06:00.001+01:002014-04-02T19:30:20.046+01:00PollEverywhere Higher Education License Pricing<a href="https://polleverywhere.com">PollEverywhere</a> 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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 <a href="http://www.participoll.com/">Participoll</a>. It may be back to clickers after all!<br />
<br />
<br />Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com9tag:blogger.com,1999:blog-4149957315810348152.post-24288996511961748472014-03-20T18:14:00.003+00:002014-03-20T18:33:07.322+00:00very quick survey about Facebook in education<iframe frameborder="0" height="400" marginheight="0" marginwidth="0" src="https://docs.google.com/forms/d/1CYfu4NqPKsQVG0c3L2Ds85J4tBK5sLljylZH7QdInUE/viewform?embedded=true" width="760">Loading...</iframe>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com2tag:blogger.com,1999:blog-4149957315810348152.post-84398573098992987652014-03-20T00:01:00.001+00:002014-03-20T00:16:06.529+00:00social media in medical education... it's all about the network<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsimgxi0kgvrOPGLc96GZ-HrZCwhPWmWJApx0QniQ_Hvode2CqXdV_YECNLStrloqg8ae160x8G5lEhgzMFv2AbqZhjOV1MsW_v-zHTsPF4xJEpPVefqSzc4PSYy1_nG9EpNRPTGiWPwo/s1600/star-209371_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsimgxi0kgvrOPGLc96GZ-HrZCwhPWmWJApx0QniQ_Hvode2CqXdV_YECNLStrloqg8ae160x8G5lEhgzMFv2AbqZhjOV1MsW_v-zHTsPF4xJEpPVefqSzc4PSYy1_nG9EpNRPTGiWPwo/s1600/star-209371_640.jpg" height="240" width="320" /></a></div>
<br />
What is the role of Twitter in medical education?<br />
<br />
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/24350316"> rest</a>.<br />
<br />
But do I think that we should use it in our courses? What for?<br />
<br />
Last week I attended a workshop lead by <a href="https://twitter.com/claudiamegele">Claudia Megele </a>on social media in higher education. She has done tremendous work in establishing several 'knowledge networks' including <a href="https://twitter.com/MHchat">#mhchat</a> (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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsimgxi0kgvrOPGLc96GZ-HrZCwhPWmWJApx0QniQ_Hvode2CqXdV_YECNLStrloqg8ae160x8G5lEhgzMFv2AbqZhjOV1MsW_v-zHTsPF4xJEpPVefqSzc4PSYy1_nG9EpNRPTGiWPwo/s1600/star-209371_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsimgxi0kgvrOPGLc96GZ-HrZCwhPWmWJApx0QniQ_Hvode2CqXdV_YECNLStrloqg8ae160x8G5lEhgzMFv2AbqZhjOV1MsW_v-zHTsPF4xJEpPVefqSzc4PSYy1_nG9EpNRPTGiWPwo/s1600/star-209371_640.jpg" height="240" width="320" /></a></div>
<br />Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com4tag:blogger.com,1999:blog-4149957315810348152.post-12980436191232623582014-03-12T21:12:00.000+00:002014-03-12T22:32:56.327+00:00The challenge of feedback and the burden of accountability in clinical medical educationHave you received good feedback in a clinical setting as a doctor or medical student?<br />
<br />
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.<br />
<br />
We know what makes good feedback. Here is a <a href="http://www.hms.harvard.edu/pallcare/PCEP/PreCourseMaterials/EndeFeedback.pdf">great paper</a> 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.<br />
<br />
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?<br />
<br />
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 '<a href="http://eric.ed.gov/?id=EJ1012328">Intelligent Accountability in Education</a>'.Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com7tag:blogger.com,1999:blog-4149957315810348152.post-78936093459907852382014-02-27T17:08:00.002+00:002014-02-27T22:36:47.119+00:00Politicians badly briefed about data issues too? At the end of the Parliamentary meeting on 'Patient rights and access to NHS data', <br />
Parliamentary Under Secretary of State for Public Health, <a href="http://twitter.com/janeellisonmp">Jane Ellison MP</a> made the following statement:<br />
<div>
<br /></div>
<div>
"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."</div>
<div>
<br /></div>
<div>
This data as described in this<a href="http://wishfulthinkinginmedicaleducation.blogspot.co.uk/2014/02/we-need-data-literate-journalists.html"> blog post </a>was not publicly available or in aggregate form. It was individual-level data that had to be specifically asked for from the NHSIC. </div>
<div>
<br /></div>
<div>
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.</div>
<div>
<br /></div>
<div>
You can watch her statement here at 16.16.30</div>
<script src="http://www.parliamentlive.tv/Embed/js.ashx?14922 460x322"></script>
Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com1tag:blogger.com,1999:blog-4149957315810348152.post-74649531112352332382014-02-26T15:52:00.001+00:002014-02-27T15:07:31.831+00:00We need data literate journalists.So what do you think happened recently with NHS data? Do you think that the NHS handed over the records of millions of patients to insurers who then looked up their credit records and suggested that their insurance premiums should be changed?<br />
<br />
That would be awful wouldn't it? Just as well it didn't happen.
<br />
<br />
I came back from visiting family on Sunday night to see the <a href="http://www.telegraph.co.uk/health/healthnews/10656893/Hospital-records-of-all-NHS-patients-sold-to-insurers.html">Telegraph </a> story "Hospital records of all NHS patients sold to insurers" being tweeted. It was picked up by many other papers including the <a href="http://www.theguardian.com/society/2014/feb/24/hospital-records-nhs-patients-insurance">Guardian.</a>
<br />
<br />
<div>
<div>
<span style="font-family: inherit;">The story is about research done by a group of actuaries, the<span style="background-color: white; color: #222222; line-height: 19px;"> </span><em style="background-color: white; color: #222222; line-height: 19px; margin: 0px; padding: 0px;">Critical Illness Definitions and Geographical Variations Working Party</em><span style="background-color: white; color: #222222; line-height: 19px;"> . You can find the full report<a href="http://www.sias.org.uk/siaspapers/listofpapers/view_paper?id=SIASDec2013Paper"> here. </a> It's a 200 page plus document written to explain to other actuaries how 'geodemographic' data might help predict how likely someone is to develop a critical illness. If you have ever applied for life insurance or critical illness cover or an income protection policy you would know that you your policy is priced based on what your risk is... your age, weight, smoking status, what illnesses you have. If you know anything about health inequalities you will know that beyond our own personal risk factors( age, weight etc) our social circumstances are important in determining how long we will live and if we will get sick. And you can tell a lot about our social circumstances from where we live. The relationship is so strong that there is a <a href="http://www.theactuary.com/archive/old-articles/part-6/mortality-3A-the-last-post/">postcode mortality lottery</a> Your postcode *might* reflect your lifestyle, your wealth, your education- all the things that predict how likely you are to get sick or to live long.</span></span><br />
<span style="font-family: inherit;"><span style="background-color: white; color: #222222; line-height: 19px;"><br /></span></span>
<span style="font-family: inherit;"><span style="background-color: white; color: #222222; line-height: 19px;">Geodemographics , CACI's Acorn, and Experian's Mosaic , classify postcodes into strange-sounding groups like 'happy families' and 'twilight subsistence' based on information obtained from public and commercial sources. The research by the actuaries was about whether these postcode classifications could predict when people developed serious illnesses. You can read the report to find out more but the short answer is that they do.</span></span><br />
<br />
You may disagree with the idea that you postcode should be used to predict your risk to insurers. Is it a smart way of doing things? You can read some discussion of this in Tony Hirst's blog post <a href="http://blog.ouseful.info/2014/02/25/demographically-classed/">here</a>.<br />
<br />
Most of the discussion was not about this though. It was about the fact that 'hospital records' were given to insurers.<br />
<br />
<h4>
So what actually happened in the research? </h4>
</div>
<blockquote class="twitter-tweet" lang="en">
"patients' medical histories, identified by date of birth and postcode, were combined with credit ratings data" <a href="http://t.co/oRhzGgazvt">http://t.co/oRhzGgazvt</a><br />
— roger kline (@rogerkline) <a href="https://twitter.com/rogerkline/statuses/437855472628948992">February 24, 2014</a></blockquote>
<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>
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<div>
The above tweet by Roger quotes the Guardian's coverage of this story. Are Acorn and Mosaic 'credit ratings data'? Well, yes, they may have been originally developed to predict how likely you were to be able to pay back a loan. But as we can see they can also predict how likely you are to get sick or to die.<br />
<br />
What did the hospital records look like? There were Hospital Episode Statistics. This is what the data looked like (<a href="http://www.actuaries.org.uk/research-and-resources/documents/sessional-research-event-extending-critical-path">from this presentation</a>)<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgUt6p3fUk6Qpvo0Iz30RJ3Gs8_AqDebSwbQQ_12loo3J1RW1oMqX3Bnvlp2UIIU7XyTOCP59DxcGUATtmm2AO8eW2Ueu-eep8AuSCB5rJHTITjveQOUK9nmq4mVdhaFEPBQ-tlVElcM/s1600/Capture2.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUgUt6p3fUk6Qpvo0Iz30RJ3Gs8_AqDebSwbQQ_12loo3J1RW1oMqX3Bnvlp2UIIU7XyTOCP59DxcGUATtmm2AO8eW2Ueu-eep8AuSCB5rJHTITjveQOUK9nmq4mVdhaFEPBQ-tlVElcM/s1600/Capture2.PNG" height="460" width="640" /></a></div>
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<div>
Is that what you thought the 'hospital records' would look like?<br />
<br />
Did the researchers have full postcodes and dates of birth? It was a bit hard to tell this from the report. I presumed they didn't because I didn't see why they needed it. And I didn't think that the NHS was likely to give away information that would make it easy for individuals to be re-identified. But the full postcode was needed to be able to assign a 'geodemographic profile' to each person in the dataset. The following screenshot is from page 10 of the report.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkH6K1ZnIcbjFLM_ysxY-W2ckeKO2mnXN4C0PdGz3PTjWYdv1ZtHqVvwXR0qT6pzSELM3-1AJxa0N8Vvs0fdESQmvsZ061eEE2qzV3FshSuz1CNDlCSmy_dVT5vkfK6bKMzGt2CtPtR9U/s1600/Capture.PNG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkH6K1ZnIcbjFLM_ysxY-W2ckeKO2mnXN4C0PdGz3PTjWYdv1ZtHqVvwXR0qT6pzSELM3-1AJxa0N8Vvs0fdESQmvsZ061eEE2qzV3FshSuz1CNDlCSmy_dVT5vkfK6bKMzGt2CtPtR9U/s1600/Capture.PNG" height="150" width="640" /></a></div>
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I read this as meaning that the geodemographics were added to the HES dataset by the NHSIC who provided the dataset to the insurers. But others, including <a href="http://blog.ouseful.info/2014/02/25/demographically-classed/">Tony Hirst,</a> first read this as meaning that it was the researchers that did the datalinking. <span style="font-size: large;">Who did the datalinking was important because who ever did it needed the full postcode. </span></div>
<br />
Today after reading an article by <a href="http://www.wired.co.uk/news/archive/2014-02/26/demand-transparency-from-nhs">Wired </a>in which it is stated the hospital data was given to the Institute and Faculty of Actuarie IFOA and "was then combined with secondary sources, including Experian credit ratings data, in order to influence insurance premiums." I decided that I had to find out. So I phoned the press office of the Institute and Faculty of Actuaries (IFOA) on the number I found on <a href="http://www.actuaries.org.uk/news/press-releases/articles/telegraph-article-rebuttal">the press release</a> of their rebuttal to the Telegraph article.<br />
<br />
I got straight through. The press officer directed me to page 10 above. I asked who had done the datalinking and they said it was the NHSIC. This made sense and fitted with their statement that they had no identifiable information for the individuals in the dataset. They only had an age group, and the 1st part of their postcode. <br />
<br />
So how many people do you think contacted the IFOA to try and make the same clarifications as me? Every journalist that had written a story about this perhaps? No 3 people. The BBC and two bloggers. I was one of them. </div>
<div>
<br />
Why didn't other journalists get in touch with them? Didn't they understand the significance of this? Didn't they care?</div>
<div>
<br /></div>
<div>
In the next few months and years we are going to be having many conversations about big data. We need to have journalists who know how to ask the right questions. And at the moment it looks as if we haven't.<br />
<br />
If you think that the problem is that actuaries were given NHS data at all then see <a href="http://storify.com/amcunningham/is-nhs-health-data-available-to-actuaries-now-yes">this</a>.<br />
EDIT In the past GPRD data was provided to actuaries. This is no longer the case although at least one application was made recently to CPRD. They rejected this.<br />
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Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com21tag:blogger.com,1999:blog-4149957315810348152.post-50393037396862432922014-02-20T09:34:00.004+00:002014-02-20T09:37:13.711+00:00The benefits of social media for researchers...You can vote <a href="http://www.polleverywhere.com/multiple_choice_polls/ltIQIbaMwCD4B6C/web">here </a><script language="javascript" src="http://www.polleverywhere.com/multiple_choice_polls/ltIQIbaMwCD4B6C/web.js?height=250&results_count_format=percent&width=300" type="text/javascript"></script>
Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com2tag:blogger.com,1999:blog-4149957315810348152.post-4496783228170444122014-02-16T17:31:00.000+00:002014-02-16T17:31:50.430+00:00How to create a great curriculum map without wasting a lot of time : Repost from @mededportal by @one45softwareAll of MedEd Portals resources are creatives commons licensed but you have to register for a free account and log-in to license them. I thought I would share this brief 'fact sheet' on curriculum mapping because it is something that has come up a lot in the<a href="http://www.linkedin.com/groups/eLearning-in-Undergraduate-Medical-Education-4248189"> LinkedIn group on technology in medical education</a> that I started. Here are <a href="https://delicious.com/wishfulthinker/curriculummapping">some of the threads</a> discussing curriculum mapping from that group.<br />
The factsheet is written by Brian Clare, CEO of One 45 software. I like the style that it is written in and the acknowledgement that curriculum maps are rarely started from the desire to make it easier for students to find content which seems a downright tragedy.<br />
What are your thoughts on what he says?<br />
...................................................................................................................................................................<br />
<a href="https://www.mededportal.org/icollaborative/resource/920">From MedEd Portal </a><br />
<br />
Curriculum mapping is a process that holds the
potential for great rewards, but it carries many
risks. One of the biggest risks is that it will be
a giant waste of time. In our work with clients,
we often see ambitious curriculum mapping
projects fail because the final result was just
not useful enough. In this guide we will share
some practices that will help ensure your
curriculum map is not only LCME-compliant,
but is continually updated and useful too.<br />
<h3>
Make the curriculum map
useful for students</h3>
To some, the curriculum map is purely
administrative overhead to ensure LCME
compliance. To others it is a useful planning and
reporting database used to inform curriculum
changes. But almost never is it a tool for students
to find and reference content and learning
objectives.<br />
This is a mistake. In our experience, schools that
make their curriculum map useful for students
enjoy a map that is more comprehensive,
updated more frequently, and used more by
faculty and administration. This occurs because
of the natural adjustments that faculty and
administration make to match their processes up
with student behavior.<br />
To begin making your map more useful to
students, a great place to start is with exam
objectives. Survey your students and ask them
which reports about the curriculum would help
them study for their exams. Or, ask them which
parts of finding curriculum content they find
frustrating. These answers will help you discover
valuable curriculum mapping changes to make.
You could include a question about this on your
end-of-course survey.<br />
Once you’ve got an idea what students are
looking for, try mapping a course or two to its
exam objectives. Have a small group of students
report and search before their next exam and
see if the new mappings addressed their issues.
After a few rounds of this process, you’ll have
an idea of a valuable set of curriculum mappings
to make. This will lower the risk of creating
mappings that no one uses.<br />
<br />
<h3>
Use data on report usage to
drive updates to the curriculum
map </h3>
Our data shows that users perform curriculum
searches far more than they navigate the
curriculum. If your system allows for it, gather
data on the types and frequency of searches
users are performing. Periodically, ask the users
doing these searches what other data they’d like
to find. This feedback is invaluable at curriculum
committee meetings as it provides qualitative
and quantitative data to help justify changes to
the curriculum map.<br />
For example, if someone suggests linking
competencies to session objectives, and the
usage data suggests this might be a good
idea, start small. Link the competencies to the
objectives for one course and see if the changes increase search usage or user satisfaction. If they
do, fantastic! You have a compelling reason to
change your map. If not, fantastic! Now you can
work on a different initiative that will have more
value and you haven’t wasted any time.<br />
<br />
<h3>
Add more detail in small
increments </h3>
If you focus on making the curriculum map valuable
for stakeholders at every step, you’ll have an
enviable problem: people will want you to make the
system even more valuable for them. For students
and faculty, this may mean making reports easier
to generate, or more specific. For your curriculum
committee, this may mean adding more detail to the
map.<br />
If you are considering changes to your curriculum
map, focus first on testing that the changes will
produce value for your users at a small scale before
rolling them out full-scale. This means mapping
one course instead of 10, or having a few students
generate reports while you watch them work, or
creating a test installation of your curriculum map
where you can play around without worrying about
making mistakes. Your goal with these small scale
experiments is to get the users excited about the
results. Whenever a suggestion is made to change
the curriculum, try and ask “how can we test that this
will add value?”<br />
Proceed carefully, and try and match your curriculum
mapping efforts with the most valuable use-cases
for those efforts. We hope that by doing this you’ll
find greater success and buy-in from students,
faculty, and administrators. Good luck!Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com3tag:blogger.com,1999:blog-4149957315810348152.post-89536439987951211722014-02-09T16:53:00.000+00:002014-02-10T21:31:38.027+00:00Asking women to speak at events...<br />
<div>
I have been involved in organising a few events recently - <a href="http://thedigitaldoc.co.uk/">Digital Doctor</a> and <a href="http://nhshackday.com/">NHS Hack Day</a> Both are a bit techy and geeky - and I have been acutely aware of issues of gender balance. Men tend to volunteer to speak. Women more often have to be asked.<br />
<br />
People are doing something about this. Last year <a href="http://wishfulthinkinginmedicaleducation.blogspot.co.uk/2013/08/300seconds-talk-on-health-professionals.html">I spoke</a> at the first <a href="http://300seconds.co.uk/">300 seconds</a> -an initiative to get more women speaking up on tech- started by <a href="http://sharonodea.co.uk/">Sharon O'Dea</a>, <a href="http://twitter.com/annkempster">Ann Kempster</a> and <a href="http://twitter.com/hadleybeeman">Hadley Beeman</a>. It was a great experience. It took me out of my comfort zone. Speaking to a digital/techy audience about why I was personally driven to engage in a social media as a doctor was a new challenge, but the audience and atmosphere was supportive and all I had to do was volunteer (after being tipped off about by the lovely <a href="http://twitter.com/loulouk">Louise Kidney</a> who I have still to meet).</div>
<div>
<br /></div>
<div>
My friend Nicholas Whyte, an independent diplomat, <a href="http://nwhyte.livejournal.com/2095308.html">wrote last year</a> about his awkwardness at turning up at a conference, chairing a session and finding that no women were amongst the 22 panelists and moderators at the event. So he says that he will not participate in an event where this happens again. There have been <a href="http://m.theatlantic.com/technology/archive/2013/01/a-simple-suggestion-to-help-phase-out-all-male-panels-at-tech-conferences/266837/">other calls</a> for men to take this action.</div>
<div>
<br /></div>
<div>
The biggest medical education conference in Europe is <a href="http://www.amee.org/conferences/amee-2014">AMEE</a> in Milan this summer. <a href="http://www.amee.org/getattachment/Conferences/AMEE-2014/AMEE-2014-Provisional-Programme.pdf">The provisional programme</a> includes 3 plenary sessions with 7 speakers. All the speakers are men. Only one of the 3 plenary sessions is chaired by a woman: Trudie Roberts, President of AMEE.</div>
<div>
<br /></div>
<div>
I think that as women we have to take responsibility for this too. We have to make the organisations that we are part of aware that we think that having women prominently represented at the events that we attend is important. If we are organising events we should make clear to our co-organisers that having women speaking is important.</div>
<div>
<br /></div>
<div>
And if we are asked to speak we should try and say yes. It is easy to think that we are not qualified, or there is someone better. Say yes and have a good chat with the organiser; ask them to tell you about why you will be a great person to speak to their audience.</div>
<div>
<br /></div>
<div>
This isn't about having women speaking just for the sake of it. It's about having the best people speaking. The best people are very likely to be women so if your event doesn't have women speakers something has gone wrong.</div>
<div>
<br /></div>
<div>
Everyone who speaks at 300 seconds deserves a wider audience. And it's not just the tech sector that have to think about this. Watch Lily Dart!</div>
<div>
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<embed src="//www.youtube.com/v/-nOcEl2_2Wo?version=3&hl=en_US&rel=0" type="application/x-shockwave-flash" width="560" height="315" allowscriptaccess="always" allowfullscreen="true"></embed></object><br />
<br />
Edit: Response from AMEE twitter feed<br />
<br /></div>
<blockquote class="twitter-tweet" lang="en"><p><a href="https://twitter.com/e_hothersall">@e_hothersall</a> <a href="https://twitter.com/amcunningham">@amcunningham</a> Careful consideration is given to the choice of speakers from nominatations, we aim to balance gender if we can.</p>— AMEE Online (@AMEE_Online) <a href="https://twitter.com/AMEE_Online/statuses/432804040078925824">February 10, 2014</a></blockquote>
<script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
<blockquote class="twitter-tweet" lang="en"><p><a href="https://twitter.com/e_hothersall">@e_hothersall</a> <a href="https://twitter.com/amcunningham">@amcunningham</a> We are sorry that male plenary speakers have dominated the <a href="https://twitter.com/search?q=%23amee2014&src=hash">#amee2014</a> prog. We are reviewing for <a href="https://twitter.com/search?q=%23amee2015&src=hash">#amee2015</a></p>— AMEE Online (@AMEE_Online) <a href="https://twitter.com/AMEE_Online/statuses/432804512672129024">February 10, 2014</a></blockquote>
<script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
And 'female conference speaker' bingo
<a href="https://pbs.twimg.com/media/BgHAVu3CIAIJkIh.jpg" imageanchor="1" ><img border="0" src="https://pbs.twimg.com/media/BgHAVu3CIAIJkIh.jpg" /></a>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com4tag:blogger.com,1999:blog-4149957315810348152.post-9959938743598913652014-01-13T18:36:00.002+00:002014-01-13T18:48:20.530+00:00Social media and medical professionalism : Commentary in Medicial Education February 2014<div style="border-bottom: solid #4F81BD 1.0pt; border: none; mso-border-bottom-themecolor: accent1; mso-element: para-border-div; padding: 0cm 0cm 4.0pt 0cm;">
This is a pre-publication version of the <a href="http://onlinelibrary.wiley.com/doi/10.1111/medu.12404/full">following paper</a>. <span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 15.596590995788574px;">Cunningham, A. (2014), Social media and medical professionalism. Medical Education, 48: 110–112. doi: 10.1111/medu.12404 </span>
</div>
<div style="border-bottom: solid #4F81BD 1.0pt; border: none; mso-border-bottom-themecolor: accent1; mso-element: para-border-div; padding: 0cm 0cm 4.0pt 0cm;">
<br /></div>
<div class="MsoNormal">
In this issue, Jain et al. <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE <EndNote><Cite
ExcludeAuth="1"><Author>Jain</Author><RecNum>2476</RecNum><DisplayText>(1)</DisplayText><record><rec-number>2476</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2476</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Jain,
Anuja</author><author>Petty,
Elizabeth</author><author>Bjaber,
Reda</author><author>Tackett,
Sean</author><author>Pukiss,
Joel</author><author>Fitzgeral,
James</author><author>White,
Casey</author></authors></contributors><titles><title>What
is Appropriate to Post on Social Media? Ratings from Students, Faculty and the
Public</title><secondary-title>Medical
Education</secondary-title></titles><periodical><full-title>Medical
Education</full-title></periodical><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_1" title="Jain, 2013 #2476"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">1</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> are undoubtedly correct when they
suggest that the focus on social media in the medical education literature to
date has been a worry about threats to professionalism. In conducting their
study, they set out to explore how students, faculty and university staff (presumed
to represent the public) view the posting of certain materials to public Facebook
profiles. They found agreement on the most serious transgressions such as breaching
patient confidentiality. There was more disagreement, however, about other issues
such as appearing in photographs with alcohol, or as part of what the authors
described as ‘same sex couples’. In
general, students were more tolerant than their faculty or the public. <o:p></o:p><br />
<h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;"><br /></span><span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;">The focus on social media in the medical education literature has concerned threats to professionalism</span></h3>
</div>
<div class="MsoNormal">
What does this research on online professionalism tell us
about our deeper uncertainties about what it means to be a doctor in the 21<sup>st</sup>
century? Hafferty has described the
confusion between the various conceptions of professionalism <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Hafferty</Author><Year>2009</Year><RecNum>2482</RecNum><DisplayText>(2)</DisplayText><record><rec-number>2482</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2482</key></foreign-keys><ref-type
name="Book
Section">5</ref-type><contributors><authors><author>Hafferty,
Frederic William</author></authors><secondary-authors><author>Cruess,
Richard</author><author>Cruess,
Sylvia</author><author>Steinert,
Yvonne</author></secondary-authors></contributors><titles><title>Professionalism
and the socialization of medical students</title><secondary-title>Teaching
medical
professionalism</secondary-title></titles><periodical><full-title>Teaching
medical
professionalism</full-title></periodical><pages>53-73</pages><section>3</section><dates><year>2009</year></dates><pub-location>New
York</pub-location><publisher>Cambridge University
Press</publisher><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_2" title="Hafferty, 2009 #2482"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">2</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->, indicating that to some
professionalism is an identity and set of values, whereas to others it is a set
of attitudes and behaviours. Medical students also employ different discourses
when considering professionalism with some focussing on more superficial
aspects such as how they act or appear, whilst other students have more complex
and embodied understandings<!--[if supportFields]><span style='mso-element:
field-begin'></span> ADDIN EN.CITE
<EndNote><Cite><Author>Monrouxe</Author><Year>2011</Year><RecNum>2436</RecNum><DisplayText>(3)</DisplayText><record><rec-number>2436</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2436</key><key
app="ENWeb"
db-id="">0</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Monrouxe,
L. V.</author><author>Rees, C. E.</author><author>Hu,
W.</author></authors></contributors><auth-address>Division
of Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
monrouxelv@cardiff.ac.uk</auth-address><titles><title>Differences
in medical students&apos; explicit discourses of professionalism: acting,
representing, becoming</title><secondary-title>Med
Educ</secondary-title><alt-title>Medical
education</alt-title></titles><periodical><full-title>Med
Educ</full-title></periodical><alt-periodical><full-title>Medical
Education</full-title></alt-periodical><pages>585-602</pages><volume>45</volume><number>6</number><keywords><keyword>Attitude
of Health
Personnel</keyword><keyword>Australia</keyword><keyword>*Curriculum</keyword><keyword>Education,
Medical, Undergraduate/*methods/standards</keyword><keyword>England</keyword><keyword>Ethics,
Clinical/*education</keyword><keyword>Humans</keyword><keyword>Moral
Development</keyword><keyword>Perception</keyword><keyword>Physician&apos;s
Role/*psychology</keyword><keyword>Professional Competence/*standards</keyword><keyword>Students,
Medical/*psychology</keyword><keyword>Wales</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1365-2923
(Electronic)&#xD;0308-0110 (Linking)</isbn><accession-num>21564198</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21564198</url></related-urls></urls><electronic-resource-num>10.1111/j.1365-2923.2010.03878.x</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_3" title="Monrouxe, 2011 #2436"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">3</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. <o:p></o:p><br />
<br />
<h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;">To some professionalism is an identity and set of values, whereas to others it is a set of attitudes and behaviours</span></h3>
</div>
<div class="MsoNormal">
Let us consider the portrayal of alcohol consumption by medical
students in social media. We know that excessive alcohol consumption has a long
history in the culture of medical schools.
The Pithotomy Club, a John
Hopkins Medical School student society formed in Sir William Osler’s time<!--[if supportFields]><span
style='mso-element:field-begin'></span> ADDIN EN.CITE
<EndNote><Cite><Author>Jarrett</Author><Year>2011</Year><RecNum>2483</RecNum><DisplayText>(4)</DisplayText><record><rec-number>2483</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2483</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Jarrett,
William
H</author></authors></contributors><titles><title>The
Pithotomy Club: RIP</title><secondary-title>Proceedings (Baylor
University. Medical Center)</secondary-title></titles><periodical><full-title>Proceedings
(Baylor University. Medical
Center)</full-title></periodical><pages>35</pages><volume>24</volume><number>1</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_4" title="Jarrett, 2011 #2483"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">4</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->, had a cherub on a beer keg
as its emblem, and an annual revue, the Pithotomy Show, which ended in a ‘beer
slide’<!--[if supportFields]><span style='mso-element:field-begin'></span>
ADDIN EN.CITE
<EndNote><Cite><Author>Harrell</Author><Year>2009</Year><RecNum>2484</RecNum><DisplayText>(5)</DisplayText><record><rec-number>2484</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2484</key></foreign-keys><ref-type
name="Web Page">12</ref-type><contributors><authors><author>Harrell,
Robert</author></authors></contributors><titles><title>History
of The Pithotomy
Club</title></titles><number>29/9/2013</number><dates><year>2009</year></dates><urls><related-urls><url>http://www.pithotomy.com/history.html</url></related-urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_5" title="Harrell, 2009 #2484"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">5</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. (Forthcoming) research by Black and Monrouxe <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Black</Author><Year>in
press</Year><RecNum>2492</RecNum><DisplayText>(6)</DisplayText><record><rec-number>2492</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2492</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Black,
Lori</author><author>Monrouxe, L.
V.</author></authors></contributors><titles><title>‘Being
sick a lot, often on each other’: students’alcohol-related
provocation</title><secondary-title>Medical
Education</secondary-title></titles><periodical><full-title>Medical
Education</full-title></periodical><dates><year>in
press</year></dates><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_6" title="Black, in press #2492"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">6</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> finds that some medical
students in the UK feel compelled or coerced by their fellow students to drink
alcohol or take more than they had intended. Although there are concerns about
the alcohol consumption of medical students and doctors <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE <span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE.DATA <![if gte mso 9]><xml>
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</xml><![endif]><span style='mso-element:field-end'></span><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_7" title="Boland, 2006 #474"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">7-9</span></a>)<!--[if gte mso 9]><xml>
<w:data>3C456E644E6F74653E3C436974653E3C417574686F723E426F6C616E643C2F417574686F723E3C596561723E323030363C2F596561723E3C5265634E756D3E3437343C2F5265634E756D3E3C446973706C6179546578743E28372D39293C2F446973706C6179546578743E3C7265636F72643E3C7265632D6E756D6265723E3437343C2F7265632D6E756D6265723E3C666F726569676E2D6B6579733E3C6B6579206170703D22454E222064622D69643D22657430746164783564706172657865737A3564357470766172767A617077306177706476223E3437343C2F6B65793E3C2F666F726569676E2D6B6579733E3C7265662D74797065206E616D653D224A6F75726E616C2041727469636C65223E31373C2F7265662D747970653E3C636F6E7472696275746F72733E3C617574686F72733E3C617574686F723E426F6C616E642C204D2E3C2F617574686F723E3C617574686F723E4669747A7061747269636B2C20502E3C2F617574686F723E3C617574686F723E5363616C6C616E2C20452E3C2F617574686F723E3C617574686F723E44616C792C204C2E3C2F617574686F723E3C617574686F723E4865726974792C20422E3C2F617574686F723E3C617574686F723E486F7267616E2C204A2E3C2F617574686F723E3C617574686F723E426F75726B652C20472E3C2F617574686F723E3C2F617574686F72733E3C2F636F6E7472696275746F72733E3C7469746C65733E3C7469746C653E5472656E647320696E206D65646963616C2073747564656E7420757365206F6620746F626163636F2C20616C636F686F6C20616E6420647275677320696E20616E20497269736820756E69766572736974792C2031393733E28093323030323C2F7469746C653E3C7365636F6E646172792D7469746C653E4472756720616E6420416C636F686F6C20446570656E64656E63653C2F7365636F6E646172792D7469746C653E3C2F7469746C65733E3C706572696F646963616C3E3C66756C6C2D7469746C653E4472756720616E6420416C636F686F6C20446570656E64656E63653C2F66756C6C2D7469746C653E3C2F706572696F646963616C3E3C70616765733E3132332D3132383C2F70616765733E3C766F6C756D653E38353C2F766F6C756D653E3C6E756D6265723E323C2F6E756D6265723E3C6B6579776F7264733E3C6B6579776F72643E616C636F686F6C3C2F6B6579776F72643E3C6B6579776F72643E6D65646963616C5F73747564656E743C2F6B6579776F72643E3C6B6579776F72643E70726F66657373696F6E616C69736D3C2F6B6579776F72643E3C2F6B6579776F7264733E3C64617465733E3C796561723E323030363C2F796561723E3C2F64617465733E3C6973626E3E30333736383731363C2F6973626E3E3C75726C733E3C72656C617465642D75726C733E3C75726C3E687474703A2F2F64782E646F692E6F72672F31302E313031362F6A2E64727567616C636465702E323030362E30332E3031363C2F75726C3E3C2F72656C617465642D75726C733E3C2F75726C733E3C656C656374726F6E69632D7265736F757263652D6E756D3E63697465756C696B652D61727469636C652D69643A393239333234333C2F656C656374726F6E69632D7265736F757263652D6E756D3E3C2F7265636F72643E3C2F436974653E3C436974653E3C417574686F723E4B656C6C65723C2F417574686F723E3C596561723E323030373C2F596561723E3C5265634E756D3E3437353C2F5265634E756D3E3C7265636F72643E3C7265632D6E756D6265723E3437353C2F7265632D6E756D6265723E3C666F726569676E2D6B6579733E3C6B6579206170703D22454E222064622D69643D22657430746164783564706172657865737A3564357470766172767A617077306177706476223E3437353C2F6B65793E3C2F666F726569676E2D6B6579733E3C7265662D74797065206E616D653D224A6F75726E616C2041727469636C65223E31373C2F7265662D747970653E3C636F6E7472696275746F72733E3C617574686F72733E3C617574686F723E4B656C6C65722C20532E3C2F617574686F723E3C617574686F723E4D6164646F636B2C204A2E3C2F617574686F723E3C617574686F723E4C61666F7267652C20522E3C2F617574686F723E3C617574686F723E56656C696365722C20572E3C2F617574686F723E3C617574686F723E4261736C65722C20482E3C2F617574686F723E3C2F617574686F72733E3C2F636F6E7472696275746F72733E3C7469746C65733E3C7469746C653E42696E6765206472696E6B696E6720616E64206865616C7468206265686176696F7220696E206D65646963616C2073747564656E74733C2F7469746C653E3C7365636F6E646172792D7469746C653E416464696374697665204265686176696F72733C2F7365636F6E646172792D7469746C653E3C2F7469746C65733E3C706572696F646963616C3E3C66756C6C2D7469746C653E416464696374697665204265686176696F72733C2F66756C6C2D7469746C653E3C2F706572696F646963616C3E3C70616765733E3530352D3531353C2F70616765733E3C766F6C756D653E33323C2F766F6C756D653E3C6E756D6265723E333C2F6E756D6265723E3C6B6579776F7264733E3C6B6579776F72643E616C636F686F6C3C2F6B6579776F72643E3C6B6579776F72643E6D65646963616C5F73747564656E743C2F6B6579776F72643E3C6B6579776F72643E70726F66657373696F6E616C69736D3C2F6B6579776F72643E3C2F6B6579776F7264733E3C64617465733E3C796561723E323030373C2F796561723E3C2F64617465733E3C6973626E3E30333036343630333C2F6973626E3E3C75726C733E3C72656C617465642D75726C733E3C75726C3E687474703A2F2F64782E646F692E6F72672F31302E313031362F6A2E6164646265682E323030362E30352E3031373C2F75726C3E3C2F72656C617465642D75726C733E3C2F75726C733E3C656C656374726F6E69632D7265736F757263652D6E756D3E63697465756C696B652D61727469636C652D69643A393239333235333C2F656C656374726F6E69632D7265736F757263652D6E756D3E3C2F7265636F72643E3C2F436974653E3C436974653E3C417574686F723E5468616B6F72653C2F417574686F723E3C596561723E323030393C2F596561723E3C5265634E756D3E323438363C2F5265634E756D3E3C7265636F72643E3C7265632D6E756D6265723E323438363C2F7265632D6E756D6265723E3C666F726569676E2D6B6579733E3C6B6579206170703D22454E222064622D69643D22657430746164783564706172657865737A3564357470766172767A617077306177706476223E323438363C2F6B65793E3C2F666F726569676E2D6B6579733E3C7265662D74797065206E616D65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</xml><![endif]--><!--[if supportFields]><span style='mso-element:field-end'></span><![endif]-->,
the culture in medical schools which facilitates this is rarely examined. An online survey of medical students in the UK
in 2012<!--[if supportFields]><span style='mso-element:field-begin'></span> ADDIN
EN.CITE
<EndNote><Cite><Author>Rourke</Author><Year>2012</Year><RecNum>2474</RecNum><DisplayText>(10)</DisplayText><record><rec-number>2474</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2474</key></foreign-keys><ref-type
name="Electronic
Article">43</ref-type><contributors><authors><author>Rourke,
Emma</author></authors></contributors><titles><title>Work
hard, play hard: Medical students; and schools&apos; attitudes to
alcohol</title><secondary-title>Student BMJ</secondary-title></titles><dates><year>2012</year><pub-dates><date>29/9/2013</date></pub-dates></dates><urls><related-urls><url>10.1136/sbmj.e5326</url></related-urls></urls><electronic-resource-num>10.1136/sbmj.e5326</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_10" title="Rourke, 2012 #2474"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">10</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> found that only 22% thought
that their medical school promoted a healthy attitude to alcohol. Is it surprising
that some of the students thought that medical schools were more concerned
about image than student well-being given the preponderance of messages about
not sharing images of alcohol consumption through social media combined with a
tacit acceptance of a pro-alcohol culture? Students sensed that being seen to behave
badly may be considered worse than actually behaving badly. That is, the portrayal of a ‘professional
demeanour’<!--[if supportFields]><span style='mso-element:field-begin'></span>
ADDIN EN.CITE
<EndNote><Cite><Author>Snyder</Author><Year>2012</Year><RecNum>2481</RecNum><DisplayText>(11)</DisplayText><record><rec-number>2481</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2481</key></foreign-keys><ref-type
name="Journal Article">17</ref-type><contributors><authors><author>Snyder,
Lois</author></authors></contributors><titles><title>American
College of Physicians Ethics ManualSixth
Edition</title><secondary-title>Annals of Internal
Medicine</secondary-title></titles><periodical><full-title>Annals
of Internal Medicine</full-title></periodical><pages>73-104</pages><volume>156</volume><number>1_Part_2</number><dates><year>2012</year></dates><isbn>0003-4819</isbn><urls><related-urls><url>http://dx.doi.org/10.7326/0003-4819-156-1-201201031-00001</url></related-urls></urls><electronic-resource-num>10.7326/0003-4819-156-1-201201031-00001</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_11" title="Snyder, 2012 #2481"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">11</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> was seen as more important
that the actual behaviours of medical students. So when we consider the
portrayal of alcohol by students in social media, might students have a more
complex understanding of this than the restricted discourses often promulgated
by their schools?<o:p></o:p><br />
<br />
<h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;">Is it surprising that some students think that medical schools are more concerned about image than about student well-being?</span></h3>
</div>
<div class="MsoNormal">
Next let us consider whether we should be concerned that
personal information, not usually revealed in the consultation, may be
self-disclosed through social media profiles. Thompson et el. <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Thompson</Author><Year>2008</Year><RecNum>1127</RecNum><DisplayText>(12)</DisplayText><record><rec-number>1127</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">1127</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Thompson,
Lindsay</author><author>Dawson,
Kara</author><author>Ferdig, Richard</author><author>Black,
Erik</author><author>Boyer, J.</author><author>Coutts,
Jade</author><author>Black,
Nicole</author></authors></contributors><titles><title>The
Intersection of Online Social Networking with Medical
Professionalism</title><secondary-title>Journal of General Internal
Medicine</secondary-title></titles><periodical><full-title>Journal
of General Internal
Medicine</full-title></periodical><pages>954-957</pages><volume>23</volume><number>7</number><keywords><keyword>Medicine</keyword></keywords><dates><year>2008</year></dates><publisher>Springer
New
York</publisher><isbn>0884-8734</isbn><urls><related-urls><url>http://dx.doi.org/10.1007/s11606-008-0538-8</url></related-urls></urls><electronic-resource-num>10.1007/s11606-008-0538-8</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_12" title="Thompson, 2008 #1127"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">12</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> in their 2008 study of the
Facebook profiles of medical students and residents in Florida were the first
to postulate that the revealing of sexual orientation and political views
through social media could be construed as unprofessional. Professional boundaries are normally seen as
either crossed (when no harm is done to the patient) or violated (where harm
does occur), but we have no evidence that online self-disclosure through social
media profiles affects subsequent consultations <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Mostaghimi</Author><Year>2011</Year><RecNum>2475</RecNum><DisplayText>(13)</DisplayText><record><rec-number>2475</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2475</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Mostaghimi,
Arash</author><author>Crotty, Bradley
H</author></authors></contributors><titles><title>Professionalism
in the digital age</title><secondary-title>Annals of internal
medicine</secondary-title></titles><periodical><full-title>Annals
of Internal
Medicine</full-title></periodical><pages>560-562</pages><volume>154</volume><number>8</number><dates><year>2011</year></dates><isbn>0003-4819</isbn><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_13" title="Mostaghimi, 2011 #2475"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">13</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. Still, the warnings persist. In the study reported this month, Jain et al.
<!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE <EndNote><Cite><Author>Jain</Author><Year>2013</Year><RecNum>2476</RecNum><DisplayText>(1)</DisplayText><record><rec-number>2476</rec-number><foreign-keys><key
app="EN" db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2476</key></foreign-keys><ref-type
name="Journal Article">17</ref-type><contributors><authors><author>Jain,
Anuja</author><author>Petty,
Elizabeth</author><author>Bjaber,
Reda</author><author>Tackett,
Sean</author><author>Pukiss, Joel</author><author>Fitzgeral,
James</author><author>White, Casey</author></authors></contributors><titles><title>What
is Appropriate to Post on Social Media? Ratings from Students, Faculty and the
Public</title><secondary-title>Medical
Education</secondary-title></titles><periodical><full-title>Medical
Education</full-title></periodical><dates><year>2013</year></dates><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_1" title="Jain, 2013 #2476"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">1</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> looked at perceptions of the
expression of sexual orientation. We know that homophobia exists within medical
cultures <!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Rose</Author><Year>1994</Year><RecNum>2449</RecNum><DisplayText>(14,
15)</DisplayText><record><rec-number>2449</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2449</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Rose,
Lynn</author></authors></contributors><titles><title>Homophobia
among doctors</title><secondary-title>BMJ: British Medical
Journal</secondary-title></titles><periodical><full-title>BMJ:
British Medical
Journal</full-title></periodical><pages>586</pages><volume>308</volume><number>6928</number><dates><year>1994</year></dates><orig-pub>BMJ:
British Medical
Journal</orig-pub><urls></urls></record></Cite><Cite><Author>Kan</Author><Year>2009</Year><RecNum>2550</RecNum><record><rec-number>2550</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2550</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Kan,
RWM</author><author>Au, KP</author><author>Chan,
WK</author><author>Cheung, LWM</author><author>Lam,
CYY</author><author>Liu, HHW</author><author>Ng,
LY</author><author>Wong, MY</author><author>Wong,
WC</author></authors></contributors><titles><title>Homophobia
in medical students of the University of Hong
Kong</title><secondary-title>Sex
Education</secondary-title></titles><periodical><full-title>Sex
Education</full-title></periodical><pages>65-80</pages><volume>9</volume><number>1</number><dates><year>2009</year></dates><isbn>1468-1811</isbn><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_14" title="Rose, 1994 #2449"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">14</span></a>, <a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_15" title="Kan, 2009 #2550"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">15</span></a>)<!--[if supportFields]><span style='mso-element:field-end'></span><![endif]-->
and that young people use social media to form networks to support them in
dealing with the homophobia they meet in offline life <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Hillier</Author><Year>2012</Year><RecNum>2487</RecNum><DisplayText>(16)</DisplayText><record><rec-number>2487</rec-number><foreign-keys><key
app="EN" db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2487</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Hillier,
Lynne</author><author>Mitchell, Kimberly
J</author><author>Ybarra, Michele
L</author></authors></contributors><titles><title>The
Internet As a Safety Net: Findings From a Series of Online Focus Groups With
LGB and Non-LGB Young People in the United
States</title><secondary-title>Journal of LGBT
Youth</secondary-title></titles><periodical><full-title>Journal
of LGBT
Youth</full-title></periodical><pages>225-246</pages><volume>9</volume><number>3</number><dates><year>2012</year></dates><isbn>1936-1653</isbn><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_16" title="Hillier, 2012 #2487"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">16</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. It would, therefore, be
quite concerning if we were to recommend without good reason that medical
students should be cautious about expressing their sexual identity online.<br />
<h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;">We have no evidence that online self-disclosure through social media profiles affects subsequent consultations</span></h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;"><br /></span></div>
<div class="MsoNormal">
More generally,
discomfort over the disclosure of personal information is in
keeping with the tensions Frost and
Regehr <!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Frost</Author><Year>2013</Year><RecNum>1329</RecNum><DisplayText>(17)</DisplayText><record><rec-number>1329</rec-number><foreign-keys><key
app="EN" db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">1329</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Frost,
Heather D</author><author>Regehr, Glenn</author></authors></contributors><titles><title>&quot;
I AM a Doctor&quot;: Negotiating the Discourses of Standardization and
Diversity in Professional Identity
Construction</title><secondary-title>Academic medicine: journal of
the Association of American Medical
Colleges</secondary-title></titles><periodical><full-title>Academic
medicine: journal of the Association of American Medical
Colleges</full-title></periodical><dates><year>2013</year></dates><isbn>1938-808X</isbn><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_17" title="Frost, 2013 #1329"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">17</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> describe between the
discourses of standardisation and diversity in medical professional
identity. Is concern over releasing
one’s sexual orientation or other personal information evidence that those
leading medical schools, implicitly or otherwise, believe we can (or desire to)
produce ‘neutral doctors’ <!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Beagan</Author><Year>2000</Year><RecNum>1333</RecNum><DisplayText>(18)</DisplayText><record><rec-number>1333</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">1333</key><key
app="ENWeb"
db-id="">0</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Beagan,
Brenda L.</author></authors></contributors><titles><title>Neutralizing
differences: producing neutral doctors for (almost) neutral
patients</title><secondary-title>Social Science &amp;
Medicine</secondary-title></titles><periodical><full-title>Social
Science &amp;
Medicine</full-title></periodical><pages>1253-1265</pages><volume>51</volume><number>8</number><keywords><keyword>Medical
education</keyword><keyword>Gender</keyword><keyword>Race/ethnicity</keyword><keyword>Canada</keyword></keywords><dates><year>2000</year><pub-dates><date>10/16/</date></pub-dates></dates><isbn>0277-9536</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S0277953600000435</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/S0277-9536(00)00043-5</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_18" title="Beagan, 2000 #1333"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">18</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> or ‘vanilla physicians’<!--[if supportFields]><span
style='mso-element:field-begin'></span> ADDIN EN.CITE
<EndNote><Cite><Author>Duffin</Author><Year>1996</Year><RecNum>2458</RecNum><DisplayText>(19)</DisplayText><record><rec-number>2458</rec-number><foreign-keys><key
app="EN" db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2458</key></foreign-keys><ref-type
name="Book
Section">5</ref-type><contributors><authors><author>Duffin,
J</author></authors><secondary-authors><author>Wear,
Delese</author></secondary-authors></contributors><titles><title>Lighting
candles, making sparks and remembering not to
forget.</title><secondary-title>Women in medical education: An
anthology of
experience</secondary-title></titles><pages>33-46</pages><dates><year>1996</year></dates><pub-location>New
York</pub-location><publisher>State University of New York
Press</publisher><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_19" title="Duffin, 1996 #2458"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">19</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> who are able to leave behind
their own personal values and socio-cultural backgrounds? If so, then it is no wonder that social media
is seen as a threat to a process of socialisation which Beagan <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE
<EndNote><Cite><Author>Beagan</Author><Year>2000</Year><RecNum>1333</RecNum><DisplayText>(18)</DisplayText><record><rec-number>1333</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">1333</key><key
app="ENWeb"
db-id="">0</key></foreign-keys><ref-type
name="Journal Article">17</ref-type><contributors><authors><author>Beagan,
Brenda
L.</author></authors></contributors><titles><title>Neutralizing
differences: producing neutral doctors for (almost) neutral
patients</title><secondary-title>Social Science &amp;
Medicine</secondary-title></titles><periodical><full-title>Social
Science &amp; Medicine</full-title></periodical><pages>1253-1265</pages><volume>51</volume><number>8</number><keywords><keyword>Medical
education</keyword><keyword>Gender</keyword><keyword>Race/ethnicity</keyword><keyword>Canada</keyword></keywords><dates><year>2000</year><pub-dates><date>10/16/</date></pub-dates></dates><isbn>0277-9536</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S0277953600000435</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/S0277-9536(00)00043-5</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_18" title="Beagan, 2000 #1333"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">18</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> describes as in part
involving isolation from all wider networks who might remind students of their
previous identities. <o:p></o:p><br />
<br />
<h3>
<span style="background-color: white; font-family: Arial, 'Lucida Grande', Geneva, Verdana, Helvetica, 'Lucida Sans Unicode', sans-serif; font-size: 11.818181991577148px; line-height: 17.99715805053711px;">Discomfort over the disclosure of personal information is in keeping with tensions between the discourses of standardisation and diversity in medical professional identity</span></h3>
</div>
<div class="MsoNormal">
When we are online, just as when we are offline, we must
always respect the dignity of our patients and colleagues. Beyond this,
regulating and advising on behaviour in social media risks appearing, as Lerner
states, ‘alarmist’<!--[if supportFields]><span style='mso-element:field-begin'></span>
ADDIN EN.CITE
<EndNote><Cite><Author>Lerner</Author><Year>2013</Year><RecNum>2552</RecNum><DisplayText>(20)</DisplayText><record><rec-number>2552</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2552</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Lerner,
B. H.</author></authors></contributors><titles><title>Policing
online professionalism: Are we too
alarmist?</title><secondary-title>JAMA Internal
Medicine</secondary-title></titles><periodical><full-title>JAMA
internal medicine</full-title></periodical><pages>1767-1768</pages><volume>173</volume><number>19</number><dates><year>2013</year></dates><isbn>2168-6106</isbn><urls><related-urls><url>http://dx.doi.org/10.1001/jamainternmed.2013.9983</url></related-urls></urls><electronic-resource-num>10.1001/jamainternmed.2013.9983</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_20" title="Lerner, 2013 #2552"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">20</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. There are alternatives.
McCartney suggests that ‘doctors, like other citizens, are entitled to express
opinions online and one effect of the undoing of the medical god-complex has
been to humanise medicine and populate it with doctors who are fallible but professional’<!--[if supportFields]><span
style='mso-element:field-begin'></span> ADDIN EN.CITE
<EndNote><Cite><Author>McCartney</Author><Year>2012</Year><RecNum>2551</RecNum><DisplayText>(21)</DisplayText><record><rec-number>2551</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2551</key></foreign-keys><ref-type
name="Journal Article">17</ref-type><contributors><authors><author>McCartney,
Margaret</author></authors></contributors><titles><title>How
much of a social media profile can doctors
have?</title><secondary-title>BMJ</secondary-title></titles><periodical><full-title>BMJ</full-title></periodical><volume>344</volume><dates><year>2012</year></dates><isbn>0959-8138</isbn><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_21" title="McCartney, 2012 #2551"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">21</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. Ballick describes such an approach as ‘rather
thoughtful and subtle’ and acknowledging of ‘the complexity of online life’ <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE <EndNote><Cite><Author>Balick</Author><Year>2014</Year><RecNum>2493</RecNum><DisplayText>(22)</DisplayText><record><rec-number>2493</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2493</key></foreign-keys><ref-type
name="Book">6</ref-type><contributors><authors><author>Balick,
Aaron</author></authors><secondary-authors><author>Bainbridge,
Caroline</author><author>Yates,
Candida</author></secondary-authors></contributors><titles><title>The
Psychodynamics of Social Networking</title><secondary-title>Psychoanalysis
and Popular
Culture</secondary-title></titles><dates><year>2014</year></dates><pub-location>London</pub-location><publisher>Karnac</publisher><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_22" title="Balick, 2014 #2493"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">22</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]-->. <o:p></o:p></div>
<div class="MsoNormal">
If we recognise that ‘becoming a professional is a<span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">n interpersonal
and complex activity’</span><!--[if supportFields]><span style='mso-bidi-font-family:
Arial;color:black;background:white'><span style='mso-element:field-begin'></span>
ADDIN EN.CITE
<EndNote><Cite><Author>Monrouxe</Author><Year>2011</Year><RecNum>2436</RecNum><DisplayText>(3)</DisplayText><record><rec-number>2436</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2436</key><key
app="ENWeb"
db-id="">0</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Monrouxe,
L. V.</author><author>Rees, C. E.</author><author>Hu,
W.</author></authors></contributors><auth-address>Division
of Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
monrouxelv@cardiff.ac.uk</auth-address><titles><title>Differences
in medical students&apos; explicit discourses of professionalism: acting,
representing, becoming</title><secondary-title>Med
Educ</secondary-title><alt-title>Medical
education</alt-title></titles><periodical><full-title>Med
Educ</full-title></periodical><alt-periodical><full-title>Medical
Education</full-title></alt-periodical><pages>585-602</pages><volume>45</volume><number>6</number><keywords><keyword>Attitude
of Health Personnel</keyword><keyword>Australia</keyword><keyword>*Curriculum</keyword><keyword>Education,
Medical, Undergraduate/*methods/standards</keyword><keyword>England</keyword><keyword>Ethics,
Clinical/*education</keyword><keyword>Humans</keyword><keyword>Moral
Development</keyword><keyword>Perception</keyword><keyword>Physician&apos;s
Role/*psychology</keyword><keyword>Professional
Competence/*standards</keyword><keyword>Students,
Medical/*psychology</keyword><keyword>Wales</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1365-2923
(Electronic)&#xD;0308-0110 (Linking)</isbn><accession-num>21564198</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21564198</url></related-urls></urls><electronic-resource-num>10.1111/j.1365-2923.2010.03878.x</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span></span><![endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">(</span><a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_3" title="Monrouxe, 2011 #2436"><span style="background: white; color: black; mso-bidi-font-family: Arial; mso-no-proof: yes; text-decoration: none; text-underline: none;">3</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">)</span><!--[if supportFields]><span
style='mso-bidi-font-family:Arial;color:black;background:white'><span
style='mso-element:field-end'></span></span><![endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;"> then we should aspire to research and
guidance on social media and professionalism which reflects this. </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Key quotes:<o:p></o:p></div>
<div class="MsoNormal">
So when we consider the portrayal of alcohol by students in
social media, might students have a more complex understanding of this than the
restricted discourses often promulgated by their schools?<o:p></o:p></div>
<div class="MsoNormal">
It would, therefore, be quite concerning if we were to
recommend without good reason that medical students should be cautious about
expressing their sexual identity online. <o:p></o:p></div>
<div class="MsoNormal">
Is concern over releasing one’s sexual orientation or other
personal information evidence that those leading medical schools, implicitly or
otherwise, believe we can (or desire to) produce ‘neutral doctors’ <!--[if supportFields]><span
style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.CITE <EndNote><Cite><Author>Beagan</Author><Year>2000</Year><RecNum>1333</RecNum><DisplayText>(18)</DisplayText><record><rec-number>1333</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">1333</key><key
app="ENWeb" db-id="">0</key></foreign-keys><ref-type
name="Journal
Article">17</ref-type><contributors><authors><author>Beagan,
Brenda
L.</author></authors></contributors><titles><title>Neutralizing
differences: producing neutral doctors for (almost) neutral
patients</title><secondary-title>Social Science &amp;
Medicine</secondary-title></titles><periodical><full-title>Social
Science &amp;
Medicine</full-title></periodical><pages>1253-1265</pages><volume>51</volume><number>8</number><keywords><keyword>Medical
education</keyword><keyword>Gender</keyword><keyword>Race/ethnicity</keyword><keyword>Canada</keyword></keywords><dates><year>2000</year><pub-dates><date>10/16/</date></pub-dates></dates><isbn>0277-9536</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S0277953600000435</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/S0277-9536(00)00043-5</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_18" title="Beagan, 2000 #1333"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">18</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> or ‘vanilla physicians’<!--[if supportFields]><span
style='mso-element:field-begin'></span> ADDIN EN.CITE
<EndNote><Cite><Author>Duffin</Author><Year>1996</Year><RecNum>2458</RecNum><DisplayText>(19)</DisplayText><record><rec-number>2458</rec-number><foreign-keys><key
app="EN" db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2458</key></foreign-keys><ref-type
name="Book
Section">5</ref-type><contributors><authors><author>Duffin,
J</author></authors><secondary-authors><author>Wear,
Delese</author></secondary-authors></contributors><titles><title>Lighting
candles, making sparks and remembering not to
forget.</title><secondary-title>Women in medical education: An
anthology of
experience</secondary-title></titles><pages>33-46</pages><dates><year>1996</year></dates><pub-location>New
York</pub-location><publisher>State University of New York
Press</publisher><urls></urls></record></Cite></EndNote><span
style='mso-element:field-separator'></span><![endif]-->(<a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_19" title="Duffin, 1996 #2458"><span style="color: windowtext; mso-no-proof: yes; text-decoration: none; text-underline: none;">19</span></a>)<!--[if supportFields]><span
style='mso-element:field-end'></span><![endif]--> who are able to leave behind
their own personal values and socio-cultural backgrounds? <o:p></o:p></div>
<div class="MsoNormal">
When we are online, just as when we are offline, we must
always respect the dignity of our patients and colleagues.<o:p></o:p></div>
<div class="MsoNormal">
If we recognise that ‘becoming a professional is a<span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">n interpersonal
and complex activity’</span><!--[if supportFields]><span style='mso-bidi-font-family:
Arial;color:black;background:white'><span style='mso-element:field-begin'></span>
ADDIN EN.CITE
<EndNote><Cite><Author>Monrouxe</Author><Year>2011</Year><RecNum>2436</RecNum><DisplayText>(3)</DisplayText><record><rec-number>2436</rec-number><foreign-keys><key
app="EN"
db-id="et0tadx5dparexesz5d5tpvarvzapw0awpdv">2436</key><key
app="ENWeb" db-id="">0</key></foreign-keys><ref-type
name="Journal Article">17</ref-type><contributors><authors><author>Monrouxe,
L. V.</author><author>Rees, C. E.</author><author>Hu,
W.</author></authors></contributors><auth-address>Division
of Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
monrouxelv@cardiff.ac.uk</auth-address><titles><title>Differences
in medical students&apos; explicit discourses of professionalism: acting,
representing, becoming</title><secondary-title>Med
Educ</secondary-title><alt-title>Medical education</alt-title></titles><periodical><full-title>Med
Educ</full-title></periodical><alt-periodical><full-title>Medical
Education</full-title></alt-periodical><pages>585-602</pages><volume>45</volume><number>6</number><keywords><keyword>Attitude
of Health
Personnel</keyword><keyword>Australia</keyword><keyword>*Curriculum</keyword><keyword>Education,
Medical,
Undergraduate/*methods/standards</keyword><keyword>England</keyword><keyword>Ethics,
Clinical/*education</keyword><keyword>Humans</keyword><keyword>Moral
Development</keyword><keyword>Perception</keyword><keyword>Physician&apos;s
Role/*psychology</keyword><keyword>Professional
Competence/*standards</keyword><keyword>Students,
Medical/*psychology</keyword><keyword>Wales</keyword></keywords><dates><year>2011</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1365-2923
(Electronic)&#xD;0308-0110
(Linking)</isbn><accession-num>21564198</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21564198</url></related-urls></urls><electronic-resource-num>10.1111/j.1365-2923.2010.03878.x</electronic-resource-num></record></Cite></EndNote><span
style='mso-element:field-separator'></span></span><![endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">(</span><a href="file:///C:/Users/Anne%20Marie/Dropbox/Social%20media%20and%20medical%20professionalism%20final.docx#_ENREF_3" title="Monrouxe, 2011 #2436"><span style="background: white; color: black; mso-bidi-font-family: Arial; mso-no-proof: yes; text-decoration: none; text-underline: none;">3</span></a><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">)</span><!--[if supportFields]><span
style='mso-bidi-font-family:Arial;color:black;background:white'><span
style='mso-element:field-end'></span></span><![endif]--><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;"> then we should aspire to research and
guidance on social media and professionalism which reflects this. </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<!--[if supportFields]><span style='mso-element:field-begin'></span><span
style='mso-spacerun:yes'> </span>ADDIN EN.REFLIST <span style='mso-element:
field-separator'></span><![endif]--><a href="https://draft.blogger.com/blogger.g?blogID=4149957315810348152" name="_ENREF_1">1. Jain A, Petty E, Bjaber R, Tackett
S, Pukiss J, Fitzgeral J, et al. What is Appropriate to Post on Social Media?
Ratings from Students, Faculty and the Public. Medical Education. 2013.</a><o:p></o:p></div>
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<a href="https://draft.blogger.com/blogger.g?blogID=4149957315810348152" name="_ENREF_2">2. Hafferty FW. Professionalism and the socialization of
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People in the United States. Journal of LGBT Youth. 2012;9(3):225-46.</a><o:p></o:p></div>
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Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com6tag:blogger.com,1999:blog-4149957315810348152.post-46522941188035649592014-01-09T01:03:00.000+00:002014-01-22T02:42:07.580+00:00I'm proud to be hacking the NHS. Come and help me. In a few weeks <a href="http://wishfulthinkinginmedicaleducation.blogspot.co.uk/2013/10/digital-healthcare-road-paved-with-good.html">James Morgan</a> and I are hosting <a href="http://nhshackday.com/">NHS Hack Day</a> in Cardiff. Over 100 'geeks who love the NHS' will be coming together on January 25th and 26th to come up with tech solutions to the problems facing NHS patients and staff. Whoever you are, if you care about making the NHS better then you can help at NHS Hack Day. <a href="http://www.eventbrite.co.uk/e/nhs-hack-day-cardiff-tickets-9340783535">Sign up here</a>.<br />
<b><br /></b>
<b>Hacking the NHS? Isn't that a bad thing to do?</b><br />
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No! Hacking is a good thing. It's about making things better and solving problems.Back in the day people at MIT started using the wo<span style="font-family: inherit;">rd hack: <a href="http://sugru.com/blog/the-origin-of-the-word-hacking"><span style="background-color: whitesmoke; color: #1f1f1f; font-size: 14px; line-height: 24px;">"</span><em style="background-color: whitesmoke; color: #1f1f1f; font-size: 14px; line-height: 24px;">When one did something ingenious and clever and unthought of with some technology, it was known as a good hack.</em><span style="background-color: whitesmoke; color: #1f1f1f; font-size: 14px; line-height: 24px;">"</span></a> Hacking is NOT about breaking into databases and stealing your information (that's <a href="http://www.techrepublic.com/blog/it-security/hacker-vs-cracker/">'cracking' </a> not hacking).</span> We will be using databases of information at NHS Hack Day. But the databases will have been made freely available to all of us because people know that when you set data free then people can do great things with it. The databases won't be health records of individuals, but information about services so that we can figure out ways to solve problems. This is called "civic hacking"- and you can learn more about it in this short video and <a href="http://www.huffingtonpost.com/lily-liu/when-hacking-is-actually-_b_3697642.html">this article</a>.<br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/kDFhzNfd-bg?rel=0" width="560"></iframe>
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<b>What is NHS Hack Day? </b><br />
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First of all, NHS Hack Days are two days- a Saturday and a Sunday. They happen 3 times a year. So far there have been hack days in London, Liverpool, Oxford and Cambridge. We are very proud that this is the first NHS Hack Day in Wales. NHS Hack Days are non-profit events. The people who attend are all giving up their time for free because they love the NHS and want to make things better for all of us who use the NHS.<br />
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<b>Who should come to an NHS Hack Day?</b><br />
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Two kinds of people are needed. First of all we need people with IT skills- techies- people who can write computer programmes and make different computer programmes work together. You will hear these people being called coders or developers. We need people who can design. Designers make it easier for us to use things whether services or software.<br />
But we also need people who know what kinds of problems we need to solve- people who understand the systems of the NHS. These people are 'domain experts'. Some of these people will be health professionals- nurses, physios, health care assistants, doctors, students. But there are other people who understand the systems of the NHS- the people who have to use it, patients and the public. We need you too. You are also a 'domain expert. You can tell us what problems we need to solve. And you can help to solve them as well.<br />
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<b>What happens at NHS Hack Day?</b><br />
There are three stages:<br />
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<b>Pitches </b>What do you think we could do better? What problem would you like us to solve in less than 2 days? You have 1 minute to tell others about it. So no slides. Just stand up and tell everyone what you want to do. Does that sound nerve-wracking? What happens if you are not sure if your idea might be achievable, or if someone has done it already (they might have- but that means you might be able to make their solution even better)?<br />
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All the people who come to NHS Hack Days are very nice and friendly but I think it can be a little bit scary to stand up in front of everyone and ask them to work on your idea so if you think you have an idea and you want to chat it over with some other people first why don't you come along to our 'Library Meeting'. It's in Canton Library at 7pm on Wednesday 22nd January. If you would like to come to this please sign up <a href="https://docs.google.com/forms/d/1xnD_UuQ0RFG4oO9Xl9SvwzdgBACNIRQEnHtMta4zRps/viewform">here</a><br />
After the meeting we will be going to <a href="http://www.chapter.org/">Chapter cafe bar</a> at 8.30pm so you can come and join us there if 7pm is too early. We will be organising a pre-meet in London as well.<br />
<br />
You can also join the<a href="https://groups.google.com/forum/#!forum/nhshackday"> email list</a> and write about your idea or solution there.<br />
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<b>The Hacking</b><br />
From about 11am on Saturday until 3pm on Sunday people will be trying to solve these problems sitting around tables with laptops in front of them and chatting with each other. We will form teams - those who know what the problem is and those who can help to solve it- working together. This is a form of <a href="http://allinthistogetherwales.wordpress.com/allinthistogether/coproduction/">co-production. </a><br />
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<b>The Presentations</b><br />
From 3-5pm on Sunday teams will present the solutions to the problems they have been working on. This session is amazing because it is incredible what smart people can achieve in just over a day when they put their mind to it.<br />
<br />
Below is a video made at the NHS Hack Day in Liverpool in 2012 that shows you what all of this looks like together. If you think that NHS Hack Day might be for you then you should come. <a href="http://www.eventbrite.co.uk/e/nhs-hack-day-cardiff-tickets-9340783535">Sign up here</a>.<br />
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Any questions? Just ask!<br />
<br />Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com0tag:blogger.com,1999:blog-4149957315810348152.post-33657194408245831132013-12-13T02:17:00.001+00:002013-12-13T09:32:04.655+00:00Social media as part of a new professionalism : #GMCConf<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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Two years ago I attended a GMC education conference in the London. The conference had no hashtag so I and some others decided to use <a href="http://www.symplur.com/healthcare-hashtags/gmced11/">#GMCEd11</a> . The GMC didn't have their <a href="http://twitter.com/gmccuk">@gmcuk</a> account at that time but they did have a @gooddoctoruk account launched around the time of initial consultation on the updating of Good Medical Practice. Altogether there were just over 300 tweets made on the day and about half of those were by me. Most of this activity probably bypassed those who were attending except when I had a chance to ask a question to an afternoon panel on behalf of Alastair McLellan, editor of the Health Services Journal. <a href="http://storify.com/amcunningham/gmc-education-conference-2011/preview">Alastair had posed the question to me in a tweet</a>. I remember a frisson of laughter that a question was coming via twitter and I think that it was Fergus Walsh who joked that at least 140 characters created usefully brief and succinct questions.<br />
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Fast forward to 2013 and the first national GMC conference on 'Medical professionalism : whose job is it anyway?' is held today in Manchester with 400 attendees- over 50% of them medical students and jobbing doctors, but with other stakeholders including patients well represented. There is an official conference hashtag <a href="http://www.symplur.com/healthcare-hashtags/gmcconf/">#gmcconf</a> and it is used more than 1500 times today. Throughout the day there is reference to taking questions from tweets and no-one seems to be in any way surprised.<br />
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I make about 1/2 the tweets I do at the last event, in part because this time I was giving a lunch-time seminar with Gareth Williams from the <a href="http://www.gmc-uk.org/about/wales.asp">GMC office in Cardiff </a>on the social media in practice. A strong conference theme is the nature of professionalism in a post Berwick and Francis report world and so my part of the session focussed on how social media is being used to drive improvement and ensure patient safety by doctors in the UK today.<br />
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<a href="http://www.flickr.com/photos/amcunningham72/11341496574/" title="10 reasons why any doctor should explore social media by amcunningham72, on Flickr"><img alt="10 reasons why any doctor should explore social media" height="496" src="http://farm8.staticflickr.com/7358/11341496574_62e644a81b_z.jpg" width="640" /></a><br />
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I concentrated on a few stories - <a href="http://twitter.com/elinlowri">Elin Roddy</a>'s experiences of learning and reflecting in social media which lead to her taking on the role of lead for End of Life care in her trust ; raising patient safety through openness and transparency of sharing the <a href="http://storify.com/traumagasdoc/wrongfooted">#Wrongfooted storify</a> ; <a href="http://www.mixprize.org/story/biggest-ever-day-collective-action-improve-healthcare-started-tweet-0">NHS Change Day</a> ; the FOAMed initiatives of <a href="http://twitter.com/ecgclass">ECGClass</a>, <a href="http://twitter.com/gasclass">Gasclass</a> and <a href="http://twitter.com/teamhaem">TeamHaem</a> ; and <a href="http://twitter.com/grangerkate">Kate Granger</a>'s <a href="http://drkategranger.wordpress.com/2013/09/04/hellomynameis/">#HelloMyNameIs</a> campaign.<br />
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A few years ago I was not confident that I could justify urging every doctor to explore social media. But it is now beyond doubt that some of the most innovative, creative and transformative conversations about improving the care of and with our patients are happening within social media.<br />
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We must ask ourselves what we can do to help our colleagues and students be part of these conversations.<br />
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<script async="" charset="utf-8" src="//platform.twitter.com/widgets.js"></script>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com5tag:blogger.com,1999:blog-4149957315810348152.post-39392435513713011162013-12-12T04:15:00.001+00:002013-12-12T04:26:52.275+00:00Reflections from #DotMed13<object height="300" width="400"> <param name="flashvars" value="offsite=true&lang=en-us&page_show_url=%2Fphotos%2Famcunningham72%2Fsets%2F72157638519643935%2Fshow%2F&page_show_back_url=%2Fphotos%2Famcunningham72%2Fsets%2F72157638519643935%2F&set_id=72157638519643935&jump_to="></param>
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The last year has been very good for meeting great people. I first met Irish rheumatologist <a href="http://twitter.com/ronantkavanagh">Ronan Kavanagh</a> in Dublin in this year. That was in February when <a href="https://twitter.com/drohanlon">Shane O'Hanlon</a> got us both to take part in a pre-conference workshop on social media at <a href="http://www.ucd.ie/medicine/news/february2013/title,162809,en.html">INMED</a> (the annual scientific meeting of the Irish Network of Medical Educators). Next we met as a rheumatology conference in the UK- this time brought together by <a href="http://twitter.com/philipgardiner">Philip Gardiner</a>.<br />
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We Banjo 3 at #dotmed13</div>
Last week I was back in Dublin for #dotmed13 - a conference curated by Ronan and <a href="https://twitter.com/muirishouston">Muiris Houston</a>, a GP and medical journalist. It was a fascinating event. I ruminated this morning that it was like #med2 ( a tech driven conference) meets #mu13voice (medicine unboxed- a conference that seeks to explore ' a view of medicine that exceeds the technical' - Alexa Miller had similar thoughts in her <a href="http://www.artspractica.com/2013/12/dotmed-mixing-medical-futurism-with-humanism/">blog post about the day</a> and I think she explains it a lot better than me.<br />
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So at #dotmed13 we had banjo music and some of the most powerful storytelling I have ever heard- <a href="https://twitter.com/jordangrumet">Jordan Grumet</a> told some of the stories he tells in <a href="http://jordan-inmyhumbleopinion.blogspot.co.uk/">his blog</a> of how medicine broke him and how he got back together again. Architect Ed Gavagan told us how life had broke him but how he got life back together again - helped in no small part by the bartender who took the time too listen when others didn't - and who eventually became his wife. I see many patients who have not been through exactly what Ed experienced but they have been unlucky and experienced hard and tragic lives. I must find the time to listen to them.<br />
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<iframe allowfullscreen="" frameborder="0" height="315" mozallowfullscreen="" scrolling="no" src="http://embed.ted.com/talks/ed_gavagan_a_story_about_knots_and_surgeons.html" webkitallowfullscreen="" width="560"></iframe><br />
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And after watching Alexa Miller speak at the Millenium Medicine conference in Texas earlier this year (it was live-streamed- I was at home in Cardiff- and it's well worth catching the video <a href="http://www.medicalfutureslab.org/videos/">here</a>) I was really excited about taking part in her workshop on how exploring art works could expand our creative approaches to medicine. She couldn't really stop us talking about Picasso's 'Girl before a mirror'!<br />
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Of course we had the techy stuff too.<a href="http://twitter.com/lucianengelen"> Lucian Engelen </a>could not fly to Dublin because of bad weather but wowed us all by taking a picture of the audience through Google Glass from the Netherlands! It was a great pleasure to finally meet<a href="http://twitter.com/berci"> Berci Mesko</a> and <a href="http://twitter.com/doctor_v">Bryan Vartebedian </a>who I have known for years through their blogs and twitter. They were both talking about their visions of the future of healthcare and the part that doctors would play in it. Medical student Mahmood Mirza and recent graduate <a href="https://twitter.com/alancorbett8">Alan Corbett</a> talked about social media and medical education- and presented a very balanced view of what students see as the pros and cons.<br />
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My own presentation revisited an idea about 10 reasons for a social media presence. In the past my orientation had been medical education alone- but I was able to share some great examples which I think make it reasonable for me to say that any doctor should explore social media. You can find the slides below.<br />
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<iframe allowfullscreen="" frameborder="0" height="355" marginheight="0" marginwidth="0" scrolling="no" src="http://www.slideshare.net/slideshow/embed_code/28958530?rel=0" style="border-width: 1px 1px 0; border: 1px solid #CCC; margin-bottom: 5px;" width="425"> </iframe> <br />
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<strong> <a href="https://www.slideshare.net/amcunningham/why-does-a-twittering-doctor-tweet-10-reasons-for-a-social-media-presence-28958530" target="_blank" title="Why does a twittering doctor tweet? - 10 reasons for a social media presence">Why does a twittering doctor tweet? - 10 reasons for a social media presence</a> </strong> from <strong><a href="http://www.slideshare.net/amcunningham" target="_blank">Anne Marie Cunningham</a></strong> <br />
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If you get a chance to go to a conference like #dotmed13 then go. </div>
Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com1tag:blogger.com,1999:blog-4149957315810348152.post-72153725172606083262013-12-12T01:25:00.000+00:002013-12-12T01:31:50.558+00:00#1carejc - Primary Care Journal ClubThis was an idea that started last summer- why don't we have an online primary care journal club?<a href="http://www.twitjc.com/"> #twitjc</a> - Twitter journal club is still going strong, but <a href="http://primarycarejournalclub.wordpress.com/about/">we always had the idea that wanted to try something different </a>and try different forms of social media. A few weeks ago I spoke to <a href="http://twitter.com/drpeterasloane">Peter Sloane</a>, an Irish GP, on google plus and he mentioned that he wanted to explore the potential of G+ for education so I suggested that <a href="http://primarycarejournalclub.wordpress.com/about/">#1carejc</a> would be a great thing to try and get going.<br />
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We picked a<a href="http://annfammed.org/content/11/2/122.full.pdf+html"> paper on osteopathy in primary care</a> that was suggested by <a href="http://memorial.yourtribute.com/davidlewismd/">David Lewis</a> a few weeks before his death last summer. On our panel we had primary care researcher <a href="http://twitter.com/butlerceri">Ceri Butler</a> who has also lived with chronic back pain for many years. Joining us from Australia was <a href="http://twitter.com/brookmanknight">Karen Price</a>, an Australian GP and educationalist who knew David Lewis well. I was just off the train from Cardiff to Manchester. Unfortunately we couldn't get Prof John Licciardione, the 1st author of the paper to join the conversation- but we hope to catch up with him again.<br />
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Was it a success? Well yes, we had a good discussion about the context of this research on back pain- the experience of GPs and of patients. We had a little bit of time to discuss the research itself but we were missing the voice of the researcher. Our teething technical problems limited the amount of time we had to discuss the paper but it was only ever intended that the google plus hangout should be one part of a wider discussion about the research topic.<br />
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We hope that the discussion can continue in the <a href="https://plus.google.com/u/0/communities/114817289373782526614">google plus community</a> we have started. And that the videos will be a resource that people can look back on. We'd appreciate any feedback you have especially if you can leave it in the <a href="https://plus.google.com/u/0/communities/114817289373782526614/stream/a67dd0e7-75e5-45a5-9b31-b95c207e106d">google plus community</a>.<br />
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So here it is! Skip the 1st part (technical mishaps) and start at about 27 mins in - or even at 32 mins in when Ceri starts speaking very powerfully about her experiences.<br />
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<object height="315" width="560"><param name="movie" value="//www.youtube.com/v/Rw5sCIRVm0U?hl=en_US&version=3&rel=0"></param>
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<embed src="//www.youtube.com/v/Rw5sCIRVm0U?hl=en_US&version=3&rel=0" type="application/x-shockwave-flash" width="560" height="315" allowscriptaccess="always" allowfullscreen="true"></embed></object>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com0tag:blogger.com,1999:blog-4149957315810348152.post-77818639994461785932013-12-09T19:01:00.000+00:002013-12-09T19:01:12.918+00:00Confessions of a Lazy Blogger....<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ3H9mE6JZ6NJ4_a_wk6Lv992-QiU_XBrOLGCsqXQ18KtTdBregKIucJWGIuLExZc7zQS0YlzyBx0sQtoq8VmDO4MTFOl4xG3BnDhaUaGOSaCECQKRRRkRQv-UdSEqPVn6KZbAfW_BSp4/s1600/DSC00017.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ3H9mE6JZ6NJ4_a_wk6Lv992-QiU_XBrOLGCsqXQ18KtTdBregKIucJWGIuLExZc7zQS0YlzyBx0sQtoq8VmDO4MTFOl4xG3BnDhaUaGOSaCECQKRRRkRQv-UdSEqPVn6KZbAfW_BSp4/s400/DSC00017.JPG" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Terminal 2 Dublin Airport<br /><div style="text-align: left;">
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I'm just back from a lovely weekend in Ireland. I had the chance to speak at <a href="http://dotmedconference.ie/">#DotMed13</a> (of which more later) and also to travel up North to see my family. On Friday night we went out for dinner after the conference and <a href="https://twitter.com/Berci">Berci </a>was telling me that hos definition of a lazy blogger was one who didn't post twice a week. By this reckoning I have always been a lazy blogger. Since I've started my blog I've averaged just over 30 posts a year -a few posts a month rather than each week.<div>
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I aim to write when I have something to share. So has there been less to share in the past year? No, there has probably been just as much as in the other years but I haven't been giving as much time to doing that as I should have been. So by my definition I have been a lazy blogger and I aim to try and make it up before the end of the year.</div>
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Year ends are always good for reflection so I'll try and make sure that I end the year having got many more of the things I have been thinking about and experiencing down <strike>on paper</strike> in html.</div>
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Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com8tag:blogger.com,1999:blog-4149957315810348152.post-41898696989079739022013-11-07T02:41:00.000+00:002013-11-07T20:16:08.430+00:00Burlesque medical student calendar... unprofessional or not?<div class="separator" style="clear: both; text-align: center;">
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Here is again the picture that caused all the controversies. <a href="http://t.co/5PQJpp6Q7X">pic.twitter.com/5PQJpp6Q7X</a><br />
— Ling (@LillianeNguyen) <a href="https://twitter.com/LillianeNguyen/statuses/398340251313516544">November 7, 2013</a></blockquote>
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A brief post. The above image is on the <a href="https://www.facebook.com/medemoiselles">Facebook page</a> for a 2014 charity calendar, <a href="http://www.medemoiselles.com/">Medemoiselles</a>, and features female medical students. Last year the calendar featured <a href="http://blogues.radio-canada.ca/originel/2013/11/05/calendrier-sexy-les-etudiants-en-medecine-recidivent/">male medical students</a> in their underwear.<br />
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This morning it was tweeted by one of the medical students pictured. Here are her own thoughts on the response to the calendar.<br />
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I don't like being all political and participating in debates but I have to express my feelings about the calendar.. <a href="http://t.co/nLioVnLaWd">pic.twitter.com/nLioVnLaWd</a><br />
— Ling (@LillianeNguyen) <a href="https://twitter.com/LillianeNguyen/statuses/398339547798728704">November 7, 2013</a></blockquote>
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<blockquote class="twitter-tweet"><p>MEDemoiselles and all the big drama all the social medias and news have brought on these past 48 hours. <a href="http://t.co/7kVd6kadr9">pic.twitter.com/7kVd6kadr9</a></p>— Ling (@LillianeNguyen) <a href="https://twitter.com/LillianeNguyen/statuses/398339736949227520">November 7, 2013</a></blockquote>
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<blockquote class="twitter-tweet"><p>I am proud of our work and I appreciate all the support so far but here it is for the criticism on twitter: <a href="http://t.co/kztBA2oDeu">pic.twitter.com/kztBA2oDeu</a></p>— Ling (@LillianeNguyen) <a href="https://twitter.com/LillianeNguyen/statuses/398340048141451264">November 7, 2013</a></blockquote>
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Is the calendar unprofessional? Is it inappropriate for medical students to take of their clothes for a charity calendar? What are your thoughts?Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com24tag:blogger.com,1999:blog-4149957315810348152.post-68690487242109157432013-10-11T01:49:00.000+01:002013-10-11T01:51:36.419+01:00Digital healthcare - a road paved with good intentions?<iframe allowfullscreen="" frameborder="0" height="281" mozallowfullscreen="" src="//player.vimeo.com/video/69226226?color=ffffff" webkitallowfullscreen="" width="500"></iframe> <br />
<a href="http://vimeo.com/69226226">Digital healthcare - a road paved with good intentions?</a> from <a href="http://vimeo.com/user6187901">Richard Stanton</a> on <a href="https://vimeo.com/">Vimeo</a>.<br />
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A treat for all those interested in the use of technology in healthcare, this is a lecture that <a href="http://www.cardiff.ac.uk/optom/contactsandpeople/academicstaff/morgan-james-overview_new.html">Professor James Morgan</a>, who leads the implementation of the open-source electronic health record, <a href="http://www.openeyes.org.uk/">Open Eyes</a>, gave in Cardiff earlier this year. You can find out more about the Science in Public series of lectures <a href="http://medicine.cf.ac.uk/event/science-in-public-health-lectures/">here</a>.Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com0tag:blogger.com,1999:blog-4149957315810348152.post-37119117501371033622013-10-06T12:09:00.001+01:002013-10-06T12:49:46.435+01:00Is your conference really 'trending'?I've attended quite a few conferences (virtually and physically) in the last year since Twitter introduced <a href="https://blog.twitter.com/2012/tailored-trends-bring-you-closer">'tailored trends'</a>. At nearly every conference someone will make an announcement that the hashtag is 'trending worldwide'. Usually it isn't and in fact the person who has thought this is instead looking at tailored trends. These are based on who you follow and where you are; so that you see topics which are popular amongst the people you follow. It means that if you are at a conference with many of the people you follow, then it is quite likely that you will see that hashtag trending as a 'tailored trend'.<br />
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How do you know you are looking at a 'tailored trends'? If you just see 'trends' then this is 'tailored trends'. If a geographical area is specified eg 'UK trends' then you are not seeing tailored trends.<br />
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It can be a little bit more difficult that this to tell, so I made this screencast last week which I think explains why sometimes people are confused.<br />
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At the end of the day it doesn't really matter if your conference hashtag is trending across the nation or not! If it is trending amongst the people you follow that is probably a much more important metric.<br />
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<iframe frameborder="0" height="396" src="http://www.screenr.com/embed/6LkH" width="650"></iframe>Anne Marie Cunninghamhttp://www.blogger.com/profile/05289974924032448531noreply@blogger.com0