#1carejc - Primary Care Journal Club

This was an idea that started last summer- why don't we have an online primary care journal club? #twitjc - Twitter journal club is still going strong, but we always had the idea that wanted to try something different and try different forms of social media. A few weeks ago I spoke to Peter Sloane, an Irish GP, on google plus and he mentioned that he wanted to explore the potential of G+ for education so I suggested that #1carejc would be a great thing to try and get going.

We picked a paper on osteopathy in primary care that was suggested by David Lewis a few weeks before his death last summer. On our panel we had primary care researcher Ceri Butler who has also lived with chronic back pain for many years. Joining us from Australia was Karen Price, 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.

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.

We hope that the discussion can continue in the google plus community 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 google plus community.

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.

Digital healthcare - a road paved with good intentions?

Digital healthcare - a road paved with good intentions? from Richard Stanton on Vimeo.

A treat for all those interested in the use of technology in healthcare, this is a lecture that Professor James Morgan, who leads the implementation of the open-source electronic health record, Open Eyes, gave in Cardiff earlier this year. You can find out more about the Science in Public series of lectures here.

Hanging out with Eve Purdy

"The future is already here – it's just not evenly distributed." - so said William Gibson in 2003. If you want to see the future of medical education then talk to students like Eve Purdy. She is a 3rd year medical student in Kingston, Ontario. She blogs and tweets. This morning I grabbed her for a quick chat. You can watch our 'google hangout on air' below. 

Balancing personal and professional presence in social media.

During the week I was talking to some of the doc2doc team and they asked me what I thought about the GMC guidance on social media.

I think that the guidance is good in that it states that the use of social media can very positive and worthwhile for any doctor. I think that it is likely to increase engagement with social media for doctors, and through that provide many opportunities for learning. It doesn't provide guidance on some of the issues which I think are important, for example, what responsibilities does a doctor have before encouraging patients to engage in a social media space. We will have to wait for future iterations to deal with these scenarios.
But within the twittersphere and blogosphere the reaction has been dominated by controversy over the  statement that "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name."
I still hear people talking about the guidance being impossible to operationalise because how will the GMC identify these pseudonymous doctors? But why would they be trying to? No one would know if that person was really a doctor or not. The GMC have clearly said that the guidance does not "change the threshold for investigating concerns about a doctor's fitness to practice". This means that being anonymous/pseudonymous will never be an issue in itself. But if it was established that a doctor was for example bullying a colleague, or breaking patient confidentiality, then the fact that they were doing this without revealing their identity might be seen as being an aggravating factor.
Some people say that the guidance can't protect the public from charlatans who represent themselves as doctors when they are not. Well, in a way it does. If it is good practice to identify yourself then we can tell the public that they should not trust the authority of any one who represents themselves as a doctor, but  does not identify themselves, and then tries to give them advice.

When I tweeted the link to this interview earlier, Phil replied

@amcunningham @scoopit interesting - raises issue of @gmcuk believing drs can separate their medical & personal presence on twitter
— Phil Williams (@scottishphil83) May 4, 2013

Is it possible to separate medical and personal presence on Twitter? Why would you want to? Are doctors concerned that their personal interests or feelings will affect their relationships with colleagues or patients? If so then they may wish to try and separate our these different parts of their identity by setting up more than one account. But personally  I'm happy enough to tweet about going to a gig from my @amcunningham twitter account. Why would or could a tweet like the one that follows be an issue?

The very lovely @efterklang at the @fleecebristol twitter.com/amcunningham/s…
— AnneMarie Cunningham (@amcunningham) April 21, 2013

A few weeks ago I was asked to write a few paragraphs on how I think about how I present myself online for this ebook on "Social Media and Mental Health Practice".

How do I present myself online?

I first started using social media because I wanted to network so that I could do my job in medical education better. Yes, I am also a GP but I did not see social media as something that would help me to be a better doctor. I’m still not sure that it does, although I certainly do not think that it makes me a worse one. But I am very aware that most of what I say and do within social media is public. I want it to be that way. I do not aim what I say at my patients (or students) but I’m aware that they might read it, and I do not want them to be shocked or upset or worried by anything that they see me write. I aim to be professional, and I aim to respect professional boundaries.


When I am in the consulting room I reveal very little personal information. I doubt that patients are really interested. They walk in to see me and want and need to talk about them, not me. They often politely ask how I am. If I’m running late, I might smile and say, ‘Busy!’ But I would not share my own personal woes and worries with a patient. It would be wrong for me to burden them with my personal concerns. Of course, if they ask did I enjoy my holiday we might chat briefly about that. I don’t close down these conversations but I would never initiate talk about myself.

I share very little personal information online. I do not usually talk about my friends or family publicly online, and this is often to protect their privacy. However, this year I am sharing a photo that I take every day. In some ways this often reveals more personal information about me that what I write. It is something that I am aware of but rarely feel constrained by. I think that in many ways I am quite a private person, so this maybe more than being ‘professional’ defines how I am online.

Of course I might share some difficulties online, for example struggling to make technology work just the way I want it to! I don’t think that is a problem. It shows a different side of me and it is unlikely to impact in any way on the professional relationships which are important to me.I have thought about how I present myself online over the years. I try to be calm, collected, honest and independent. I hope that I come across as I do when I am offline. I am proud that when I meet people offline, who have first known me through social media, they often say that they feel as if they know me already. I would be unhappy if my online presence was considered inauthentic, so this pleases me.

 How do you manage the boundaries between personal and professional? What are the issues for you?

What you need to know about Twitter...

What you should know about twitter..... from Anne Marie Cunningham

This morning I had the great pleasure of giving this talk at a workshop on mobile learning in medicine and dentistry as part of the Changing the Learning Landscape project.

Arriving at the venue I thought it would be useful to record the audio of my session and share it on Slideshare. I didn't have my Zoom Q3 audio recorder with me so decided to record the audio on my iPhone. I downloaded an app Audio Memos and set it running.

When I got home I set about figuring out how to get the audio file off the iPhone and on to my computer. I tried emailing it but it was too big and I was advised to purchase the full version for 69p, But it was still too big to email. I tried and failed to enable servers but the solution was to send the file to google drive and then download it to laptop. It then needed to be converted from a .wav to mp3 file. Fortunately I had written a blog post about the first time I had made a slidecast, so I was able to refer to the screencast I had made in 2010 to remind myself how to use iTunes to do this! (Yay for self-archiving!)

It is still as easy as ever to sync audio with slides in Slideshare so the last stage was easy.

I think the end result is worth the effort. And I do think that when you are using mainly images in slides, hearing what someone is actually saying is pretty essential to understanding the point of the presentation. So I will try to do it again as I do more presentations this year.

Thanks to Jane and the team behind today's workshop for the great organistation, and to all the other really interesting presenters and such an engaged audience. A special plug for my colleague Duncan Cole for his great prezi on Digital Curation

My first podcast!

You might have noticed that I took a little break from blogging. I've been very busy though and one of the things that I was involved in was organising the first Digital Doctors conference that took place last December. The team have been producing a series of podcasts which you can find here and iTunes. All those which I have listened to have been excellent so I strongly recommend them.

Last week it was the turn of Jeremy Walker, technical director at Meducation (@ihid) and I to join Stevan Wing, neurology registrar and digital doctor (@stevancw) for a chat about social media. Here is the result. Hope you enjoy!

 

GMC guidance- doctors online should reveal their identity

"je digitale alter ego" by verbeeldingskr8

Yesterday, March 25th the GMC published the updated version of Good Medical Practice.  And for the first time, supplementary explanatory guidance on the use of social media is also included. The "doctors and social media" guidance was issued in draft last year, was relatively uncontroversial and didn't provoke a lot of discussion. This is what I wrote prior to the publication of the draft guidance.

One line in the final version has received a lot of attention on the twittersphere : "If you identify yourself as a doctor in publicly
accessible social media, you should also identify yourself by name."

Below is the full section from which this comes, followed by the wording of the draft guidance.

Final
17  If you identify yourself as a doctor in publicly accessible social media, you should also identify
yourself by name.Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.
18  You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.

Draft
17 If you are writing in a professional capacity, you should usually identify yourself. Any material written by authors who represent themselves as doctors are likely to be taken on trust and/or to represent the views of the profession more widely. You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.

Why has the wording been changed? The GMC have tweeted that the guidance applies "if you are tweeting as a doctor.Then you should identify yourself. Being open+honest helps maintain trust."

The draft guidance was more ambiguous. What was writing in a 'professional capacity'? And you should 'usually' identify yourself. The final guidance is very clear. For people who have not yet started a blog or joined Twitter this clarity may be useful.

But I don't think that many of us who are online already expected this. The RCGP published the final version of its social media highway code last week where they say that as a general principle doctors should use their professional name online if portraying themselves as a registered doctor, but that use of a pseudonym might be reasonable in some circumstances eg moderating a forum, writing about a sensitive subject, or for when comedy or satire.

What happens if a doctor is currently tweeting under a pseudonym and does not start using their real name before April 22nd when the guidance is enacted? Will they be disciplined or reported? How will the GMC respond? Usually most doctors are confident that they are working within the bounds of good medical practice but this is making some with existing pseudonymous twitter accounts, or blogs, feel uncomfortable. They are now deciding what steps they should take.

I have seen some doctors who tweet in their own names suggest that some might use the anonymity of the internet to raise concerns about patient safety or whistle-blow. Personally, I think that writing a blog post to raise concerns about patient safety would be a last resort after taking the steps which the  GMC recommend.
.
What does this guidance mean to you? I allow anonymous comments on this blog.

(By the way, I was glad to see that doctors are not going to be obliged to 'encourage' ill patients back to work -this had been one of the consultation controversies.)

EDIT: reaction from around the web
@GilulaArc, an orthopaedic surgeon, feels that anonymity is essential to protect those dissenting. She wrote a letter to a magazine in her own name which she feels stalled her career. Read more here.
@JobbingDoctor writes that the government sees the professions as people to be controlled. Ensuring doctors only contribute to social media in their own name is part of this. Read more here.
Other reaction collated here.

reddit for #meded

Reddit is one of those sites that seems to have been around for ever but that I have not understood. More recently it has been popping up in my Twitter timeline and elsewhere more often. So in the interests of learning by discovery I became a redditor a few hours ago and promptly set up a #meded subreddit.

Why?

Well, there seems to be a few good things about reddit.

It allows threaded discussions. 

It contributes to altmetrics on research articles. 

It allows community members to vote up and down content so adding a filter to the masses of new content we come across.

It might allow deeper engagement with content that tweets. 

And there has been some good discussion so far. What do you think? 

What I have learnt about blogging

I blog... by alamodestuff

So if you have known me on Twitter or elsewhere for a while you will know that I am a big fan of blogging and I encourage everyone to start keeping one. Why? You will learn a lot and you will help others learn too!

I started my blog just over 4 years ago. Sometimes I will write a few posts in a week and at other times I leave it for a month or two. How often you write is up to you. It shouldn't feel like a chore.Write when you have something to share, a question to ask.

Blogging is public writing. Think about who your audience is. For me a massive strength is that all kinds of people read and comment here. This means that I can learn about many more different perspectives than if I was to walk down the corridor and ask my colleagues at work what they thought of the random idea I'd just had. But sometimes people won't understand what you say, the language you use or where you are coming from. That's OK. Just as in any communication, if someone doesn't understand you then don't get angry, just try and explain in a different way.

Writing helps me to develop my thoughts and get some way to understanding what has been perplexing me. Usually I ask a question at the end so that people who read the blog know that I didn't just want a soap box but that I am really interested in what they might add.  If no one comments on your blog, and you have wanted them to, then maybe people who were reading didn't know what kind of response you hoped for. Questions really help with this. If you are writing the post because you are developing an idea that arose out of a conversation somewhere else, then make sure that you let the other people involved know so that you can continue the conversation there. If there is someone whose insight you would really like then email them or send them a tweet with the link and ask them to leave a comment. And get into the habit of commenting on other people's blogs too. They will appreciate your feedback.

Sometimes people ask about ethics. Are there any particular ethical concerns? If you were writing for a journal or a magazine you would most likely have an editor who would tell you if what you were writing was really off for some reason. But you don't have an editor on a blog so you do have to take a bit more care and consider what you are writing. My own rules are that I don't mention a patient on my blog without asking their explicit consent. In fact, I don't often write about anything relating to my clinical work on this blog. If I am teaching and I realise that I would like to write a post about something which has come up then I would let the students know when I am with them. Sometimes, I don't realise at the time that I want to write about the episode but I always try to make sure that I at least let anyone involved know that I have written the post later. So I don't think there is anything particularly ethically troublesome about blogging, but if you have any doubts then don't be afraid to pass what you are going to write by someone else first.

Should you blog in your own name? I do. That doesn't mean that you have to. But I think that writing in your own name leads to a richer experience because you can make stronger links between your online and offline worlds.

And some practical tips? You can set your blog up on any number of sites. This is on Blogger, which is owned by Google and is really very easy to use and rarely down. Lots of other people choose Tumblr or Wordpress. Have a look around and see what you think will suit you.

Do make sure that you enable sharing buttons on your blog so that people can easily share it with others. And let people subscribe by email too.

I usually add a picture to my posts because it brightens them up and hopefully helps with understanding too.

I allow anonymous comments here but I moderate all comments, mainly to stop spam getting through. It's easier than deleting.

And you'll hear people say every now and again that blogging is dead. But that's nonsense. How could it be when you have just started? Enjoy!

Ethical responsibilities of leaders of tweetchats?

That way by justinbaeder
Over a year a go, Natalie Lafferty and I hosted the first #meded chat on Twitter. Ours was between 9-10pm UK time, and 5 hours later a similar chat was held for participants in the US.

We had some really great and very wide-ranging discussions. In the UK we had a lot of participation from students and doctors in training. This made for particularly rich and informative debates, for example on portfolios and competency. Over the summer we wound the chats down and didn't get them started again, although the US chat has kept running. But thanks to some calls on Twitter we have got some momentum building again and it looks as if our first session will be announced soon.

In advance of this I wanted to clarify what someone who participates in these chats could expect. I am not so interested in etiquette. We didn't really have any problems before, and participants seemed to be relatively sophisticated users of Twitter, so saying 'be nice' would seem to be a bit superfluous, and a little prissy.

But there are some other issues that I think we should address. The first is the issue of archiving. Anyone can archive anything on Twitter, but I think we should be clear with users that we ourselves will be archiving tweets and the implications of that. Up to now we had been using Symplur's archiving tool but we need to check whether individual tweets can be removed if they breached the confidentiality of patients or others. Again this did not arise before, but it is a serious enough governance issue that I think we should draw attention to it.

Next is the issue of research. As we are forming a community with the participants we would not consider researching the community without making participants aware. However, others outside our community might make us an object of research without making us aware. We can not do anything to stop that but we can make participants aware at least.

So given all that, here is a first draft. It is a fully editable document so please leave a comment here or directly on the document. What else do you think we need to add?

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"