very quick survey about Facebook in education

#300seconds talk on health professionals and social media

What is #300seconds about? Getting more women to speak about digital and tech issues. I was one of the 12 speakers at the 1st event in May 2013. The event was hosted in the Facebook London offices.

Speaking to digital experts was challenging.I decided to focus on some of the non-technical issues around the healthcare and social media. Thanks for watching.

Things I mention:
'Trust is the God particle' - Fugeli 2001
The Digital Doctor conference
The story behind Regina Holiday's painting 'Office Hours'
danah boyd on privacy, control and context

Please think about signing up to speak at the next #300seconds event in September.

For students, can any social platform compete with Facebook?

Facebook like button by Sean McEntee

At #amee2012 last week Facebook was talked about a lot. It came up in the excellent  social media workshop that was lead by students and in several posters and short communications. Search this 500+ page book of abstracts to see how often!

But as might be expected there was not agreement on whether Facebook should have any place in medical education. Whilst there were reports of it being used to support student learning in informal and formal ways Imperial College, London, other students and faculty argued that Facebook is a social space and not a learning space. In the past any mention of Facebook at a medical education conference usually concerned being unprofessional, so the fact that people were starting to consider the possibility that it might be educational platform was very interesting in itself.

It was also suggested (including by me) that we might have responsibility to provide  safe spaces for students and faculty to model and develop digital professionalism. Quite a few of the issues I heard discussed were raised in the comments of two blog  posts I had written last April.

This post is also a  follw-up to a discussion on our LinkedIn group 6 months ago. It was started by Bernadette John asking if any medical schools were looking into developing  and supporting social platforms for students. King's had just started a project with Elgg but was also thinking about Mahara. Why would a medical school want to do this? Some suggested that the VLE should support social learning interactions. But they don't. Blackboard does not feel social, certainly not social like Facebook.

Today a colleague told me that the University of Wales, Newport (who don't have a medical school) had started using NING , a 'social community tool', in 2008 to support first year students. How might we use something like NING in a medical school? What value would it have? My thoughts are that it would be useful to have a space where students and staff could get to know each other in a semi-formal way. Most of the NHS staff who our students meet do not have profiles on the university site, but it might be useful for students to know some more about what their special interests are clinically, and in research. And vice versa, it would be excellent if teachers could know more about the students they meet on placements.

But later I found out that Newport had stopped using the NING. It was only used by students in the first few weeks of the course to make contacts with each other before they migrated to their own Facebook groups. And if you can't beat 'em, join 'em!! This year Newport is setting up a Facebook page for students to like and post to throughout their university careers.I imagine that even if activity does tail off over the next few months this might still be quite a good channel for the university to communicate with students through.

So can any social platform compete with Facebook? Is there any merit in trying to encourage students to use another 'social learning' platform? A separate platform would mean that students are at less risk of being accused of digital unprofessionalism because they minimise their contact with faculty there *although I would rather see a re-calibration of what is considered unprofessional in the first place- if my ears did not deceive me I think I even heard a medical student volunteer that they were urged not to like a One Direction page on Facebook for fear that it may be seen as unprofessional*.

A separate platform would also mean that faculty with Facebook antibodies could avoid it. Other faculty might be just as concerned as students about mixing personal and professional presences online. There was some talk of dual profiles at AMEE but that is against Facebook terms and conditions. Facebook would rather see professionals create 'pages' to project their work-relate personae.

So some questions. Would students or staff see value in a social platform? For more ideas on how that might work see this post on location and learning.  If yes, could that platform ever be Facebook?

(Edit: Here's an interesting post by Donald Clark in January, "7 reasons why Facebook is front runner in social media learning"

Facebook and educators- "There be dragons!"

Do students use Facebook for social learning? YES! 

Yesterday was interesting. I listened to an interview with Jon Scott, a researcher/educator in Cardiff University about the need for social academic platforms- that would support collaborative learning, for example students working on group projects together, annotating documents, question and answer forums. Theoretically VLEs like Blackboard can support this. But either they aren't used this way or attempts to use them this way fail. The discussion that followed on Twitter considered that whatever platform was developed should be like Facebook. It should seem as easy to use. It should be somewhere that students wants to be and were anyway. Afterall as a student your social and academic life do often collide in any case. But then it was suggested that Facebook wasn't that easy to use. Most people didn't understand the privacy settings. They probably were not using it for academic work.

So I wrote a blog post asking students if they 'used' Facebook for learning and lo and behold they do!
The uses cover:
1. Private messages (as an email replacement?)- to ask close friends questions and to work on projects in a groups as documents can be attached.
2. The use of peer-led academic content groups where students can ask each other questions particularly in the run-up to exams.
3. Following pages from BMJ learning, eMedicine, medrevise to help with revision
4.The use of private (even secret) groups to work on group collaborative tasks by sharing documents. The notifications side-bar is particularly useful for letting students know when something new has happened.
5. For sharing information from face-to-face small group activities. There is no additional task to be shared but the content is useful to others.
6. Instant messaging! If VLEs were set up with instant messaging this would be a big win. It is one of the features that students like most about Facebook.

And why are people using Facebook?
-Privacy - this is a space that does not belong to the university so the chances that what is being said will be seen by a member of staff are reduced
-Accessibility- there is a lot less clicking on Facebook than in the VLE and it is faster than the VLE
-People are there- most people go in to Facebook every day. There is every likelihood that you will get a fast response to a query. This is in contrast to asking a question in a discussion forum to support learning on the VLE. As one student said; " if I asked a question on there, it would be as useful as talking to a brick wall as there's no one else on there!"

I also asked students if they felt pressure to be on Facebook in order to be able to keep up with peers. Would students miss out if they didn't have a Facebook account?

One student described how a colleague stopped using Facebook whilst they were in the middle of working on a project. That meant a lot more to-ing and fro-ing for the others in the group. Another student said that they weren't aware of anyone objecting to Facebook but if they did then they could manage as long as someone else kept them in the loop by sharing what was on Facebook.

There was also an interesting point made that some students thought that there university might not approve of the sharing of notes within these communities. The same might go for the sharing of exam questions. This reminded me of a post by Dave White on the Learning Black Market. 

Did students worry about their privacy using Facebook? Some did mention disliking the fact that they had to use Facebook but it worked. It was a trade-off they were prepared to make. 

If students use Facebook for social learning then should educators be there too?

Remember yesterday's blog post had emerged out of a discussion about whether an additional social academic platform was necessary and whether Facebook was already acting as that platform. It appeared that to a certain extent it is. The next question is should educators be there too in order to support the social learning that is taking place?

That conversation had been progressing rapidly in tandem! Alan Cann had started a discussion on google + about my post. His opinion " Allow Facebook to be a student owned space. if you want to set up groups to support learning, do it elsewhere". Now in ways this is a little surprising from Alan. His general mantra is "Build networks, not destinations." In Facebook the network is there! The students are there! Trying to take them to another destination that isn't about their network seems slightly doomed.

I'd come across a post by Cristina Costa titled "Why Facebook and teaching don't go together". She makes a few points here. Her strongest contention is that Facebook is not a pleasant organisation and that we don't know how or can not understand how they are using our data. If students wish to organise themselves there then that is up to them, but if educators have a presence on Facebook then they could be seen as giving tacit approval to Facebook. They might also be seen as encouraging students to set up a Facebook account. 

On the other hand, Natalie Lafferty shared a post that Donald Clark had written earlier this year giving 7 reasons why Facebook was posed to become THE social learning platform. But as Natalie pointed out, in a survey in Dundee University, there was a 50:50 split when students were asked if they wanted an institutional presence on Facebook. So the university held back.

At this stage I'd like to state that my attitude to Facebook is pragmatic. I have an account. It is personal. Nearly everyone that I am friends with are people who I have went to school with, worked with, met on holiday, met at university. Oh and family! We have a secret group where we can share pictures and videos and updates that we don't wan't to share with others.

But I have also used Facebook as an academic. I have been involved in using a Facebook group to help recruitment to a student research project. I've set up a Facebook page in the past to share content that I was already posting to Blackboard. A few hundred students liked the page. No one asked to become by Facebook friend and I didn't ask them to become mine. These uses of Facebook did not seem to present any kind of boundary confusion. It didn't stop students using Facebook to support their learning in the ways that they had already been doing.

"There be dragons!"

My fear is that as educators we have ended up demonising Facebook. And we've done this in a few different ways. 

Particularly in medicine, Facebook has been presented as a place where bad things happen and a challenge to professionalism. Have a look at the references on Pubmed. In the piece I wrote for the GMC in advance of the publication of their social media guidance I made the point that the reactions to Facebook seem to approach moral panic, when in fact most people are using it in very civilised ways.

All of this has meant that some, maybe many, students do not trust us to be anywhere near them on Facebook. Jon Hilton has left a great comment which illustrates that the very accessibility that makes Facebook great (2 clicks and you're there!) is also what makes it feel risky. What if a student posts a drunken photo to the wrong group? What if they say something about a lecturer that they wouldn't have said otherwise? Can educators be trusted to respond responsibly to those events? Can we? I would hope that we could. Mistakes are made. People learn. Students and educators both need to learn about digital literacy and digital professionalism, and I think it would be great if we started as we meant to go on and learnt together.

But what about the accusations that it is irresponsible to lead students to Facebook, or to give tacit approval to the organisation. This is a decision that educators need to make themselves. My instinct is that students have decided that they know they are the product. This is a free service and they are paying for it by handing over their information. But it is a trade-off that has value for them. They are prepared to put up with ads for topics they mention in passing. Being off the grid isn't really an option for them. Yes, we don't know how all this information will be tied together and made sense of in the future. 

I also sense that there is a fear amongst educators that their presence on Facebook will be desperately uncool. Private groups that an educator might set up in Facebook might be seen as 'creepy treehouses'. The concept of the creepy treehouse emerged in 2008 just as people were starting to explore the possibilities of social media for learning. But 4 years later how has our understanding shifted? Is it time to explore the opportunities of Facebook in a mature and confident way? Actually, Melanie McBride was arguing that we should do this back then:
"If we do not all venture into these spaces together – as a guided and pedagogically relevant tour – we will become even further disconnected from a student population who are being corporatized at every turn."

We have to be clear to not ask too much of any platform. Can Facebook work with the VLE? Could it be used to support specific pieces of work or just for a big private year group to answer student queries in the way that students are already using it? Any new uses of Facebook by educators shouldn't step on the toes of students who are already doing a great job. 

And because I like to put my money where my mouth is, I decided last night to start a Facebook group to try and learn together with Cardiff University students how we could use technology/elearning better in the course. This could have been done through the VLE. I could have set up different forums for each year group. The students would have been less certain about who was reading their posts. The first thing I posted was the YouTube above which gives quite a very negative view of Facebook. The next item I posted was this screencast about how to check how your timeline looks to members of the public.

Is it time that educators started making timid expeditions into the scary land that is Facebook? What do you think?

So students- how do you 'use' Facebook for learning?

facebook business by Sean McEntee

I've been listening to a discussion about whether we need to get more social in learning in higher education. Cardiff University currently uses Blackboard as its VLE (virtual learning environment- we brand it as Learning Central- which is rather aspirational) and like every other VLE there is the potential to be social there. Staff and students can form their own groups and set up their own forums and blogs and wikis. But these social dimensions are not often used.

For staff the university is rolling out the use of an IBM product Connections to encourage us to work in more social ways. And there are some people wondering if there is a place for this to be rolled out to students as well to give them another place to collaborate.

In the past I have tried to integrate the use of web 2 tools into Blackboard- using screencasts social bookmarking - to enhance the functionality of the social tools in Blackboard. You can see a presentation I have about this here. Now, I no longer lead that part of the course and have moved on to thinking about how we can best use technology in the course in general.

But one thing we keep hearing is that students do most of their collaboration in Facebook. So I was wondering if you could tell me about how you use Facebook for learning? Does this really happen? Or is Facebook a place that you organise nights out, and then share the photos afterwards?

Do you feel pressure to participate in Facebook as a student? Or is it just something that is a natural part of your life- you don't even think about it.

Please do comment and share- it would help us all to learn from you.

EDIT: Initial comments are that the social aspects of Facebook, and the fact that it is somewhere that you are already, that make it a clear winner against the VLE. I know this is hypothetical but if the VLE could be like Facebook do you think that might catch on? Or is the fact that Facebook is 'your' space, and that your lecturers are not there, one of the big attractors?

EDIT 2: How would you feel if your lecturers set up a private Facebook group to support an aspect of your course? Would you think that was creepy? That your lecturers were trying to keep an eye on you? Or would you think it was useful?

EDIT 3: I've found this blog post by Cristina Costa saying that Facebook should not be used for teaching. One reason she gives is that we don't know how Facebook uses information so we should be very cautious about encouraging students to use it. She includes this YouTube in her post.

I'll not be leaving Facebook yet either...

Below is my Facebook profile. It's a little bit secret. If you google my name you will not find it. And if you search for me in Facebook you will not find it. My privacy settings exclude me from search. So you can only find my profile if you know one of my friends already (or you click on the link in the networked blogs widget at the side!). I've always keep my privacy settings high on Facebook. I get all green lights from the privacy scanner (http://www.reclaimprivacy.org/facebook). And yes, I have no choice but to have a public profile, but I don't mind the level of information it gives about me.

My Facebook Profile

Sarah Stewart has blogged saying that she won't be leaving Facebook on "Quit Facebook Day". She connects with many midwives there that she would not otherwise. My use of Facebooks is more personal. But in the last few days I also decided to start a Facebook page to support my teaching. I was worried that it would come across 'creepy treehouse', so I sent an email to students making clear that it would only aggregate content that they could already find through Blackboard. I don't expect this page to be interactive as I already use the walled garden discussion forums of Blackboard heavily. And this piece of work involves contact with patients so discussion on Facebook would be completely inappropriate. 

As Matt Assay has shrewdly observed, the geek elite may be moving on, but the mainstream (including me) are just settling in.

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