Thursday, 18 March 2010

Managing RSS feeds from journals/databases etc

Following on from my last post about how to get e-alerts (to your inbox) I wondered about what is really the best way to manage RSS feeds from journals and cuctom searches of databases. I didn't think Twitter would be a good way to have the conversation so I tried Friendfeed. Here is the discussion:

The most important thing I have learned (so far!) is that you can get Google Reader to send to CiteULike. Here is the link to show you how. Later I might do a screenr to show how I NOW manage RSS feeds:)

Wednesday, 17 March 2010

E-alerts for Medical Education... are you listening #meded journals?

One of my colleagues when I was a medical student at Queen's University, Belfast got in touch today. He does some really interesting work in Medical Education, though he doesn't blog or twitter. This morning he sent me a message on Facebook:"Can I ask you a quick question? Do you know any good 'e-alert system' in medical education? I thought of no better person to ask! "


I wasn't sure that I knew what an e-alert system was so I asked if he meant RSS feeds. No, he meant getting an email alert from a journal when new content was published.He pointed out that the journal Medical Education did provide this but the service "a) isn't working and b) restricted to Med Ed journal only. My reason for this is that there are many good papers published in other journals (jama etc) that if you are not actively looking for - you can miss".


So the challenge: How can we aggregate medical education research in useful ways?


First I thought about people as filter! We are already sharing useful information on Twitter using the #meded tag. It isn't all about research though. And then there are people using meded and medicaleducation as tags on Delicious. And then there is content saved to the Medical Education group in CiteULIke. So I decided to make a Yahoo Pipe to aggregate these feeds. I was thinking about ways to get that RSS feed sent to email (through Yahoo's alert itslef or though a service such as Feed My Inbox) when my friend sent me another message further describing his vision
 "My general idea is that a user can choose (+filter) what particular topics interest them. Then once a week you are sent an email with a range of new papers in your desired area (more digestable than getting several journals sending you then abstract lists). Maybe there is a general one that already does and you just have to set it to medical education."


Umm. My solution hadn't really addressed specifically finding medical education research. Content posted to any of the feeds I had included may not be very recent, and may be links to interesting resources which are not research. Alerts can be set up for various journals in PubMed, and for specific searches. Is this the solution?


What is the best way (today) of making sure that you do not miss out on research relevant to the topic you are teaching or researching? What will be the best way of doing this in the future?







Thursday, 18 February 2010

Social Media and Medicine: Let's get #hyperlocal!

So after 16 months of blogging, twittering and social bookmarking how do I find social media to be useful to my work as a GP? Ummm. Well, I don't really....yet. Let me explain.

Early 2009: Phil Bauman's post on 140 Healthcare Uses for Twitter caused a lot of excitement. Then there was talk about surgeons twittering from operating theatres. It all left me a little bit cold. I couldn't see how I would use social media to support my work as a GP. But then I came across a review by Richard Smith from the BMJ in 1996, "What Clinical Information do Doctors Need" which helped me understand my resistance and the potential. To summarise there are three kinds of informations that doctors need
  1. Information about the patient
  2. Information about disease and management
  3. Information about local services to help manage the patient's condition.
I could (and might) do a whole other blog post about how social media might be useful in direct interactions with patients. In medicine we are trained almost exclusively for synchronous communication with patients. When I am in the same room as a patient we can usually communicate so much better. Speaking on the telephone is the next best thing and has the added bonus that it is much more convenient for the patient.  But as I say this needs a lot more room to explore so I'm not going to focus on this now, but safe to say, I am unclear as to see social media could help me gain information about patients at the moment.

Next, there is information about diseases and management. I'm a generalist, and I work in the UK and in a practice with several other doctors. For many conditions such as diabetes or cardiovascular disease, my management is determined by national guidelines, which are then tailored to individual patients through shared decision making. I will often look for information about these more common and less common conditions, and I will use sites such as TripDatabase which will find me relevant research papers and guidelines quickly. But I don't bookmark the information I find there. Why would I? The next time I need some information about that condition, which may not be for a few months, I will search again because the evidence may have changed. Now, this is different to how I use social bookmarking for my work as an educator or as a student (I'm registered for an EdD). Social bookmarking is useful for infomation that I have come across through serendipity (perhaps through Twitter), or because I am specifically looking for information that I don't have time to completely study now but want to be able to find again. But my infomation needs in clinical medicine tend to be more just-in-time. I don't think that I am so alone in this and it probably explains why I have found it hard to find delicious doctors
(Should I be reading generalist journals to keep up to date? The RSS feeds of the BMJ, NEJM and the Lancet swamped my google reader and made me feel inadequate! But here is somewhere where social media is useful. If you have any interest in what is happening in the big medical journals sign up to the RSS feed from Richard Lehman's Journal Watch blog. He writes with wit, and cuts to the chase.)

And lastly there is how social media could be useful with regards to information about healthcare services locally. This is where I currently feel the largest gap, and not uncoincidentally, where I feel social media could contribute most. Back in 1996, Richard Smith pointed out that this information is often diffuse and rapidly changing. Doesn't that sound like something that social media could grapple with? Well, next month I am going up to Glasgow to meet people interested in gathering information that is diffuse and rapidly changing and that could help people living with long-term conditions. 


I'll tell you more about the ALISS project and what they are hoping to achieve when I get back. Then we can start thinking about how we can all get useful #hyperlocal information. What do you think?

PS. By last summer @drves was referring to me as a "Web 2.0 sceptic". But I was so enthused about this last year that I actually started a new blog to try and get some discussion going.

Monday, 1 February 2010

What is more important: behaving badly or being seen to behave badly?

Doctors behaving badly
Yesterday, CNN carried a story ("Photos of drinking, grinning aid mission doctors cause uproar")
that doctors from Puerto Rico, volunteers in Haiti, may be disciplined because pictures of them holding soldiers' guns, drinking alcohol and with patients (possibly without their consent) have been posted on Facebook. The comments on the story are interesting, as some say the doctors are being treated too harshly. They may be traumatised by events and should be allowed to relax. Others who have seen all of the photos are in no doubt that the activities of the doctors are unprofessional. But in nearly all cases, commenters are talking about the act of taking the photo, rather than the sharing of the photo in social media.I have not read all 1411 comments but there does not seem to be anyone advocating that the photos could be OK in private, but inappropriate in public.


Medical students behaving badly
The conduct of medical students in social networking sites has been recieving increasing press. In September 2009,  Chrieten et al. published the reults of a survey in JAMA which found that the majority of US medical schools has had to take disciplinary action against some students because of their activities on social networking sites. And in November 2009, Farnen et al. described a case where first-year medical students posted a sketch from a medical talent show on YouTube. The sketch was of a hip-hop song accompanied by medical students playing  with plastic skeletons and  body bags. It was removed when a more senior student complained that it portrayed the medical school poorly, although there was student resistance to that action as the video had been very popular with students. The author's state:
" Our students' video has become our digital liaison. Prospective medical school applicants often comment on viewing it before their interview day. Alumni and senior faculty responded with significant concerns about the video's representation of the medical profession and how patients may react to this depiction of physicians' training. " (my emphasis) Students do not seem to have been disciplined for any unprofessional conduct in the production of the video,instead it is the sharing of the activity through social media which is the focus of the article. This seems to suggest that activities may be acceptable in private but not in public. In a further response to letters on their work, Chrieten et al. state "the medical profession is responsible for maintaining the public's trust. It is necessary to understand how online behavior is viewed by the public and how that affects trust in the medical profession."
Hayter (2006) has wrote about the medical student show. He says that it has various functions including "the collective ventilation of emotional reactions to the process of becoming a doctor". There are links to some of the skits from these shows in this Slate article. What we do not know is how the general public views these shows. Did they know of them? Did they think the conduct was appropriate? Since medical faculty often participate, and attend, they may be seen to approve of the content. If this is the case then why is it not appropriate to share the content publicly.


What does it mean to bring the profession into disrepute?
In the UK, both nursing ("You must uphold the reputation of the profession at all times") and pharmacy (where one should report any circumstances that may "bring the pharmacy professions into disrepute") bodies imply that not upholding the reputation of the profession is in itself something that a member may be disciplined for. For UK doctors, the GMC document "Good Medical Practice", states that "You must make sure that your conduct at all times justifies your patients' trust in you and the public's trust in the profession." But it is not clearly stated what conduct may contravene that trust. Older GMC guidance, prior to the first publication of Good Medical Practice in 2005, states that "convictions for drunkenness or other offences arising from misuse of alcohol (such as driving a motor car when under the influence of drink) indicate habits which are discreditable to the profession". Although this terminology is no longer used in Good Medical Practice, when discussing the case of a doctor convicted of driving with a blood alcohol level three times above the upper legal limit, it is stated that, "Public confidence in the medical profession is likely to be undermined by such conduct." The doctor was suspended for three months, in order to "send the right message to the public". In the case of medical students, GMC guidance states that drunk driving and "alcohol consumption that affects clinical work or the work environment" is unacceptable.There is no mention of drunkenness away from patients.


What do patients think?
Research conducted by Mori for the Royal College of Physicians in the UK consistently shows that doctors are the profession thought most likely to be telling the truth. This is routinely reported as "Public Still Trust Doctors". Smith (2001) distinguishes between trust, which exists at the level of individual interaction, and confidence, which relates to abstract systems.  Boudreau et al (2008) asked members of the public about the attributes of the ideal physician. They were reformulating the medical curriculum and wanted patient input. Patients wanted doctors who listened to them and didn't treat them as a 'number'. When asked "If I said to you that a doctor was very professional, what would that mean to you?", some patients responded negatively suggesting that it might mean someone 'stuffy-nosed' or who didn't want to bother with 'menial things'. But generally being professional was associated with behaviours that concerned individual interaction with the patient: bedside manner and interpersonal skills. 
But what of trust (or confidence) in the wider medical profession?  It is understudied. Hall et al.(2002) found, using a new scale, that trust in one's own physician is higher than trust in the physicians generally. They say that might not be a surprise as one might settle with a doctor one trusts, after experience of others who are less good. Calnan and Sanford (2004) in the UK, sudied general trust in the healthcare system rather that trust in the 'medical profession', and found that trust that patients would be provided with patient-centred care, was strongly associated with trust in the system. 


Conclusions
Professional bodies still talk about individuals conducting themselves at all times in a way that does not reduce trust in the profession. But the very limited studies which look at how the public view the medical profession suggest that it is the interactions with individual doctors in the healthcare setting which determine trust. Patients value patient-centred doctors.
Pattison and Wainright (2010) suggest that the ethics of a profession should be determined in conjunction with the wider public. It is not something that a profession can do alone. But I think that after that  behaviour is either unacceptable because it is unprofessional, and therefore should be disciplined, or it is acceptable. If it is acceptable it can be shared through social media.The use of social media is a secondary consideration.


Questions
But what do you think?
  1. How do you feel about medical student shows?
  2. Are medical student shows appropriate to share online?
  3. Would seeing photos or videos of doctors, nurses or pharmacists in a state of drunkenness on Facebook affect your view of the profession as a whole?
  4. Would it affect your view of the individuals involved as professionals?
  5. What determines your trust of the medical profession as a whole?
Feel free to answer these questions or leave any other comments.


(This post resulted from a rather long discussion with @psweetman, @bitethedust, @drmarcustan and @mtnmd earlier today. I am currently studying for a module on Changing Modes of Professionalism for my EdD course, and writing an essay on deprofessionalisation in medicine. This writing is only tangentially related... as yet!)




References
Boudreau JD, Jagosh J, Slee R, Macdonald ME, & Steinert Y (2008). Patients' perspectives on physicians' roles: implications for curricular reform. Academic medicine : journal of the Association of American Medical Colleges, 83 (8), 744-53 PMID: 18667888
Calnan MW, & Sanford E (2004). Public trust in health care: the system or the doctor? Quality & safety in health care, 13 (2), 92-7 PMID: 15069214
Checkland K, Marshall M, & Harrison S (2004). Re-thinking accountability: trust versus confidence in medical practice. Quality & safety in health care, 13 (2), 130-5 PMID: 15069221
Chretien KC, Greysen SR, Chretien JP,  Kind T (2009). Online posting of unprofessional content by medical students. JAMA : the journal of the American Medical Association, 302 (12), 1309-15 PMID: 19773566
Chretien KC, Greysen SR,  Kind T (2010). Medical Students and Unprofessional Online Content—Reply JAMA : the journal of the American Medical Association, 303 (4) 329
Farnan JM, Paro JA, Higa JT, Reddy ST, Humphrey HJ,  Arora VM (2009). Commentary: The relationship status of digital media and professionalism: it's complicated. Academic medicine : journal of the Association of American Medical Colleges, 84 (11), 1479-81 PMID: 19858794
Hall MA, Camacho F, Dugan E, & Balkrishnan R (2002). Trust in the medical profession: conceptual and measurement issues. Health services research, 37 (5), 1419-39 PMID: 12479504
Hayter CR (2006). Medicine's moment of misrule: the medical student show. The Journal of medical humanities, 27 (4), 215-29 PMID: 17123173
Pattison, S., Wainwright, P. (2010). Is the 2008 NMC Code ethical? Nursing Ethics, 17 (1), 9-18 DOI: 10.1177/0969733009349991
Smith, C. (2001). Trust and confidence: possibilities for social work in 'high modernity' British Journal of Social Work, 31 (2), 287-305 DOI: 10.1093/bjsw/31.2.287
ResearchBlogging.org

Saturday, 30 January 2010

How I made a slidecast....with a twitter support team.

At the end of last year I took delivery of a Zoom Q3. It's a little video camera with exceptional audio.... stereo condenser microphones. In January I gave a lecture to second year students and decided to record the audio. I had the vague notion of sharing it somehow on Blackboard. I decided to have a go on Thursday night and tweeted the following:


Solutions suggested were


  • Camtasia .... either as powerpoint plug-in or by exporting ppt as images and importing to Camtasia
  • Slideshare
  • Garageband (for a Mac and with benefit of possibility of publishing as a podcast from @nlafferty)
I was working on a PC so ruled out garageband. I had downloaded a trial version of Camtasia and spent a while trying to figure out if I could manage it. It seems to be a great product and I should spend longer with it, but I couldn't see how I would be able to do this without very carefully changing slides in time to the recorded audio. It's worth noting that Powerpoint itself doesn't seem to have an option to add existing audio to a presentation.

So I started investigating Slideshare in greater detail. @jobadge had sent me a link to this slideshare presentation explaining the process. It suggested I download Audacity, so I did and 'crunch down' the file.I couldn't see what I was actually to use Audacity for as I already had an existing audio file, and I wasn't clear about how to do the crunch down. I got very confused at this stage. I was trying to figure out how to reduce file size, then looked at the Slideshare's own latest guidance and saw that they would host the mp3 and it didn't matter what size the file was. Yay! But how did I convert .wav to mp3. Cue lots more confusion on my part!

Several people suggested that this was possible in itunes. But could I get it to work? No! (here is a screentoaster documenting my frustration! And to follow-up. Yes, you can convert to mp3 in iTunes. I searched help this afternoon and found the solution. Here is a screenr explaining how.) Special thanks to @egrommet and @paul_cooney who suggested that Audacity and the (poorly named) LAME plug-in would word. It did! I had an mp3 file.

The actual process of linking the audio to presentation in Slideshare is joyously simple! I set Slideshare to divide my 50 minutes of audio equally between my 16 slides and then adjusted them to the correct points.

The quality of the audio is high, and students can fast forward to hear the points that I made in different sections of the lecture. I think that it sounds more dynamic than if I had just recorded it sitting at my desk. So I will do it again.

Working with a twitter support team is always fun. I got there in the end, even though it was well after mid-night and my patience had grown a little thin.


For all your help and encouragement, a very big thank you to @stujohnson, @cathellis, @nlafferty, @jobadge, @bonnycastle, @clairebrooks, @keithunderdown, @adapeck, @suzanakm, @birdiecanfly, @doc_rob, @inimitablyfree, @ohsuneuro, @paul_cooney, @thelongmile, @jobrodie, @caspararemi, @acmcdonaldgp, @welshitgirl, @sboneham , @mrgunn who are all part of my twitter support team!



So in summary:

  1. The zoom q3 records very good audio.
  2. Slideshare is  the easiest way to synch existing audio to a presentation.
  3. Slideshare needs an mp3 file. iTunes will do the conversion. 
  4. You can upload the mp3 directly to Slideshare. No need to host elsewhere.
  5. Synching is a doddle!



Oh.... and here is the screenr explaining how to convert to mps in itunes.

Tuesday, 26 January 2010

How to sign up to Diigo from a group invitation.

Diigo could make responding to a group invitation easier.



Inviting students to Diigo was a bit of an effort. But what was it like receiving an invite? I invited myself. The answer is confusing. Above is a screen-shot of the email. It looks like I should click to join the group, but then the note tells me that I should join Diigo first. But how? Where is the link to join diigo???