Wishful thinking in medical education

Doctors getting people back to work

2012-02-02T05:43:00.000-08:00

The YouTube video above was shared by the GMC as part of their pre-consultation on updating the guidance on Good Medical Practice(GMP).

Reward to doctors for getting patients back to work is not mentioned in the draft version of Good Medical Practice. However, for the first time the GMC guidance to doctors includes specific mention of encouraging patients to stay in or to return to employment. I am not aware of the reason why this has been included at this time. The wording is

"51 You must support patients in caring for themselves to empower them to improve and maintain their health. This may include encouraging patients, including those with long-term conditions, to stay in or return to employment or other purposeful activity. You may also advise patients on the effects of their life choices on their health and well-being and the possible outcomes of their treatments."
(my emphasis)

This is specifically raised in the consultation questionnaire:

"At paragraph 51 of this section, we advise doctors that they must support patients in caring for themselves to empower them to improve and maintain their health. This is essentially the same as GMP 2006. But we also now say that such support may include ‘encouraging patients, including those with long term conditions, to stay in or return to employment or other purposeful activity’.
30 Do you agree this is a reasonable expectation of doctors "

What do you think of this guidance to doctors? The consultation closes on Friday 10th February 2012. Any member of the public can take part. Find out more here including the link to the e-consultation.

"Doctors to encourage long-term sick to return to work" Daily Mail 1/11/2011
"Who is in charge of doctors and consultants- the DWP?" Twisted News 1/11/2011

"New section of the Department of Health" Jobbing Doctor 1/11/2011

"Work guidance for long-term sick" Guardian 1/11/2011

More thoughts on doctors' morals

2012-01-31T13:31:00.000-08:00

Moral Compass by psd

I wanted to write a quick post to follow-up last week's discussion on the GMC consultation on Good Medical Practice. Several doctors commented that they were concerned that the line which said that they should act "at all times" in a manner that would not reduce trust in themselves or other doctors left them open to possible persecution over lifestyle choices.
For example Ditzy wrote:
"Most of us are up in arms over the ambiguity of what activities, in their private lives, the GMC felt was appropriate for them to regulate. A one off drunken dancing on the tables at the village pub? An affair with a married person? Multiple sexual partners? Frequenting the bookmakers? Falling out of nightclubs every Friday night? There simply is no guidance and any of these actions could, potentially, be said to bring the doctor and the profession into disrepute although none of them are illegal. "

I decided to go back and find out what the reaction was to the introduction of this clause in to the 2006 version of Good Medical Practice. The results of the official consultation are available here. This includes feedback from doctors and the wider public on the 2005 draft document (which unfortunately I can not locate). They note that:
"While honesty and trustworthiness within the doctor-patient relationship are perceived as important by the public, most people no longer appear to expect doctors to demonstrate moral excellence in all aspects of their lives, and it is widely recognised that they are ‘only human’. Some doctors also felt that expectations of probity, as set out in the draft document, are no longer appropriate."

So the GMC recognised in 2006 that the public did not expect 'moral excellence' of doctors.

But when the guidance was published it was reported in the Guardian, by Sarah Bosely, as being a "tougher ethical code". Why was this? Jane O'Brien, Head of Standards and Ethics for the GMC, is reported as saying that the GMC had been criticised for not giving clear enough guidance to doctors in the past, for example, about how long after a professional relationship ends would it be appropriate to start a sexual relationship with a patient. But Good Medical Practice was not intended to be a rule-book.
"The guidance encourages doctors to think through their behaviour, and is not a set of rigid rules by which they can be judged - which may leave the GMC open to criticism. "We don't think there is a way of making guidance that would provide that absolute boundary," Ms O'Brien said."

An article by the writer Dea Birkett in the Health Services journal, commenting on the 2005 draft policy was very clear that she did not want to know what doctors got up to when they were not at work. Her suspicion was that the guidance had been updated to make it more 'politically correct'.

But what has the reality been? Are doctors being sanctioned for legal sexual activity that might be frowned upon by the public? I haven't reviewed all the Fitness to Practice procedures which are published on the GMC website but there are some accounts in the press. A trainee anaesthetist was suspended for 9 months after accessing (legal) hardcore porn on a hospital computer. Another doctor who had an 'inappropriate' relationship with a patient for several years, and who was cautioned for kerb-crawling, was not suspended.

In the past year, 43 doctors were referred to a GMC hearing for 'indecent behaviour' but the outcomes are not described. Having reviewed some fitness to practice proceedings it seems likely that these are serious events such as the sexual assault of patients. It seems that it would be very unlikely that having an affair would be deemed 'indecent behaviour'.

In summary, when the current version of Good Medical Practice was introduced there were concerns from the doctors and public that it would involve holding doctors to an exceptional moral standard. However, there is no evidence that doctors are being reprimanded for the types of behaviour which Ditzy has raised in her comment.

Does this reassure anyone?

"at all times..."

2012-01-26T11:44:00.000-08:00

The Passage of Time by TonyVC

The GMC, the body which regulates doctors in the UK, is consulting on the next version of Good Medical Practice. The consultation ends on Friday, 10th February, 2012 and you can learn more here. Since 2005 Good Medical Practice has been the core guidance for doctors on how they should act professionally. In a previous post written almost exactly 2 years ago I discussed the fact that the guidance states "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 does not make clear what kind of conduct might be expected to reduce confidence in a doctor or doctors as a whole. It is perhaps deliberately vague.

The last version of Good Medical Practice was issued in 2006. Times have changed since 2006 and in this consultation the GMC have started using social media to spread the word about the consultation and get some informal feedback. They have started a Facebook page and a twitter account, @gooddoctoruk.

There has been a lot of discussion of the consultation on Twitter, primarily around how much doctor's lives outside their hours working as a doctor should be regulated. Do we have to be professional "at all times"?

To get the debate going Shree Datta, co-chair of the British Medical Association's Junior Doctor's Committee wrote a piece on her thoughts around the current guidance on conduct outside of work. She thinks that in the current guidance there is "little reassuring detail" about what might be considered appropriate or inappropriate. She says: "The simple fact is that people make mistakes and it is unrealistic to expect doctors alone to remain flawless at all times in every aspect of life. Yet the current guidance suggests that that is what is expected of doctors and arguably does not ringfence our privacy or allow for our personal autonomy."

The GMC then asked the question "Do you think the GMC should regulate doctors lives outside medicine?" This was the response from 1167 people. 94% said No.

The GMC have responded to this saying:

"Most commonly fitness to practise cases citing this paragraph arise where doctors are convicted of criminal offences, accept cautions or equivalent sanctions across the UK. But occasionally we also take action on doctors’ registration as a result of doctors’ behaviour in the public sphere, which while not illegal, may undermine patients’ or public trust in the profession.

The rationale for this has always been that patients need to trust their doctors absolutely. Many patients will be vulnerable when they seek medical care and need to be able to trust doctors implicitly.

For the doctor/patient relationship to be successful, patients must trust doctors to be honest and to act with integrity in their patients’ interests. Patients do not want their doctors to have criminal convictions, particularly for violent or sexual offences, and they may not want to be treated by a doctor whose conduct they find morally repugnant or unacceptable. For example, many people would not want to confide in, or agree to be examined by, a doctor found guilty of crimes relating to child abuse or child pornography, even though there was no evidence that the doctor was clinically incompetent."

The comments that the GMC have shared from people who said No in the poll suggest that they thought that there were being asked about the regulation of activities which would usually be considered legal. But by their response it seems that the GMC think that this question also relates to taking action if a doctor is convicted of illegal activity.

Now we have gotten to the stage of the official consultation. Here is the question that doctors and others are asked to respond to:

"In September 2011, 1,167 people responded to our online poll asking how far the GMC should go in regulating doctors’ behaviour outside medicine. The vast majority (94%) thought the GMC should not take action against doctors for their conduct outside medical practice. We think that if a doctors’ conduct undermines trust in the profession. It should, in some cases, lead to action on their right to practise medicine. (This approach is also taken by other health regulators in the UK). We therefore think it is important to make this clear in Good Medical Practice (see paragraphs 67–8 of the consultation draft).

Do you agree that the guidance achieves a fair balance in terms of the GMC’s role and remit?

Yes No Not sure"

This is section 67-68

67 You must be honest and trustworthy in your professional practice.

68 You must make sure that your conduct at all times justifies your patients’ trust in you and the public’s trust in the profession.

This wording is actually very similar to the current version which can be seen here.

On Twitter some have suggested that since the GMC "did not get the answer they wanted" in the pre-consultation they have simply asked the question again. The GMC have responded through twitter that the pre-consultation activity was just that; a full consultation was still needed. But it is interesting that the strength of feeling about the question above has made it into the official consultation documents.

So are we experiencing a shift in how doctors think they should be regulated? Do we think that as long as we conduct ourselves appropriately during the working day then it does not matter what we do out of hours? Should the GMC take any action against those who receive a criminal conviction? What does it mean to be professional in the 21st century?

It's certain that this topic is going to be discussed for a long time.

By the way, if you look at my old post you'll see that whether patients trust doctors seems to be based on their interactions with them as a professional. We don't know what impact other factors have.

EDIT: Initially this post stated that the poll was of 1167 doctors. This was wrong. The poll was open to anyone and it is not known how many respondents were doctors.

exploring sliderocket

2012-01-26T07:43:00.001-08:00

I came across sliderocket today and thought it looked very interesting. I found it browsing chrome extensions and it can be used as a Google app. There is also education licensing. There are interesting features like extensive analytics, feedback and polling allowed in presentations. But ... not in the free version. So this shows some of the more limited features.

What do you think? Any experience with this?

Using patient decision aids in the consultation

2011-11-22T09:04:00.001-08:00

A few months ago I asked Jon Brassey of Tripdatabase, a clinical search engine or metasearch, if he could ask patient decision aids to the database. Patient decision aids (PDAs) are tools that are made with the aim of helping patients make decisions about treatment options through considering the risks and benefits of options. They are produced by the UK National Prescribing Centre (NPC) and NHS Direct, amongst others. The advantage of having them listed in a metasearch is that I don't have to go round several sites checking if they might have a decision aid on the topic I am interested in.

Tripdatabase is a small but dynamic organisation and it makes great use of social media. Jon uses a Facebook page to get feedback from users, and I was able to give him my suggestion my sending him a tweet. You can see how quickly he responded here, but the short version is that in less than 3 weeks PDAs were added to Trip!

I've recorded the following screencast to show how I used Tripdatabase to share decison making with a patient. In this case the decision to start warfarin to reduce the risks of stroke in atrial fibrillation had been made in secondary care but we were able to review the evidence for this together. We also used the NPC patient decision aid to review the risks and benefits of warfarin treatment.

As you can see the NPC decision aid is not perfect. I don't think that a PDF is the ideal format for exploring this information online. And I don't have access to a colour printer in the surgery so if printing it might be good to have the option to print a version that was not so dependent on colour graphics.

Have you any thoughts on how PDAs can be incorporated into consultations? Please leave a comment!

On being public : How social media reshapes professional identity.

2011-11-05T09:29:00.000-07:00

This was my presentation at ALT-C (conference of the Association for Learning Technology) earlier this year. It sums up in 20 minutes a lot of the thoughts and ideas that are covered in this blog. But of course it raises more questions than answers- I hope!

Social Media Monitoring in Healthcare

2011-10-30T09:49:00.000-07:00

Search Privacy by Mushon

One year ago a story was shared on the nhssm (NHS social media) blog. The story was about what happened when St. George's trust in London started monitoring Twitter for mention of their name. Social media monitoring is a practice that is becoming increasingly common for businesses and it is not surprising that there is increasing discussion about this in healthcare.

Generally talk about the use of social media in the NHS tends to be driven by people who work in communications teams. This is evident from the programme of the first joint conference between NHSSM and Guardian healthcare, Social Media in Healthcare. None of the presenters are from a clinical background although I believe that another conference is possibly being planned. It is my belief that clinicians (doctors, nurses and other health professionals) and patients should be involved in developing social media strategies for any healthcare organisation.

Back to the St. George's story. When the team started monitoring they came across tweets from a patient who had recently had a renal transplant. Something in his tweets concerned the communications team and because no policy had been devised on how to handle a situation like this they were uncertain what next steps to take. Eventually the patient's clinical team were made aware of the patient's tweets. The patient only became aware of all of this when his consultant mentioned the tweets to him in a consultation.

The story provoked a lot of discussion with 39 responses and a follow up post by Dr. Dan O'Connor on the ethics of social media monitoring in healthcare. I urge you to read both of these posts and have a look at the comments. I've made several comments on both.

Generally I have not come across a lot more discussion of this topic in the last year. I'm not sure if many NHS organisations have developed policies on social media monitoring and I'm not sure how many have involved clinical staff or patients in developing these policies. In fact, I might not have thought a lot more about this if I hadn't attended a breakfast meeting at Evidence 2011 by Ben Breeze of Dell. He talked about how individual members of staff, outside the comms team as far as I understand, were being trained to represent the organisation.

So I am wondering what you think about this. What would be gained from an NHS organisation monitoring social media for mention of their name? Who should be involved in developing policies? How should clinical staff be involved? What are the risks and benefits?

Governmentality and Professionalism

2011-09-24T04:37:00.000-07:00

This is an essay that I wrote last year on changing concepts of professionalism for a module on the Cardiff EdD. The ideas need a lot more work but there may be some parts that are of wider interest including a history of medical professionalism in the UK.
Governmentality refers to a Foucauldian concept of the "art of governing". If you have any thought on what I have written then please leave a comment. I'm publishing it today as a follow-up to some discussion with Cl are Gerada.Governmentality and Medical Professionalism

Social media, black humour and professionals...

2011-09-14T13:02:00.000-07:00

Last week I presented at #altc2011 (the Association for Learning Technology Conference). My topic was "On being public.... how social media reshapes professional identity". One of my main points was that social media almost necessitates a reflexivity which we can get by without in face to face encounters. The pace of interaction is fast, we're dealing with people we may not otherwise come across, and norms are still being established. In fact we may never even get to the stage of having 'social norms'. Probably the only way to operate in these spaces is by having internalised your own values, but also being able to step outside of those values and to see what has shaped who you are and what you think, and to afford the same courtesy to others.

A few days later I came across a discussion between several male doctors on twitter which caused me to reflect on this very topic. The doctors were using slang, which I have not come across before, to refer to the wards in which they might have been working. The terms used were 'labia ward' and 'birthing sheds' to refer to the delivery suite where women give birth, and "cabbage patch" to refer to the intensive care ward where many patients are unconscious.

I was shocked at this and angry and did query the doctors about some of the other things they said, but I felt I couldn't challenge them directly at that time about this language. One of the doctors referred to midwifes as 'madwives' and was challenged by a medical student to justify this position. In the meantime I pulled together the tweets using a curation tool and informed the doctors involved that I had done this. I did not tweet the link publicly and did not endeavour to have a conversation in public about this. However I did feel the need to check with others how they felt about this exchange so I sent them a link to the collated tweets by private message. I wanted to find out if my own shock and revulsion was typical and also to gain some advice on what to do about this.

Almost all replies stated that they found the discussion insensitive. Doctors seemed to be as likely to be offended as non-doctors. Some thought that this was risky behaviour because regulators may take action. I personally think this is very unlikely and do not consider these tweets a disciplinary offence.

But what happened in public? A few others (mainly other doctors) did challenge the use of this language. The protagonists explained that they thought their tweets should be interpreted as a conversation between medical professionals. One expressed that he did not want to cause offence and that he perhaps had misjudged sending the tweet.

How did I feel?
I was surprised at the strength of my reaction to this. I wanted to let it pass but I also felt that this was not appropriate. I felt that the language objectified women and was misogynistic. I privately told one of the doctors this and asked that he removed the tweets but he refused to do so and suggested that my feelings of offence were my problem.

Some doctors have thought that I am concerned that this kind of talk will 'bring the profession into disrepute'. But I am not. I believe that patients make assessments of us as individuals. I don't believe that the public will think less of doctors after this. As has been pointed out, programmes like "Cardiac Arrest" have portrayed doctors as cold and callous individuals. But there has been no corresponding fall in trust in the "profession".

The doctors involved in the initial discussion have suggested that my views to their use of slang are atypical. Only a very small number of their followers have raised any kind of objection to their use of this language. Perhaps inside more women are offended but they feel that they can not speak up because to have your views dismissed publicly is humiliating. I don't know. But I don't think that this is an issue of numbers.

My account of this episode, so far, has been very personal. But I also want to place this story in a wider context within the medical education literature on professionalism and black humour. Is the use of derogatory humour or slang by medical professionals inappropriate? Berk thinks that ;
"Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerlessin the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion."

Berk was writing this in response to research by Wear and colleagues on medical students and residents attitudes to this kind of humour. It is interesting to note that usually it is referred to as being performed behind closed doors. Some accounts suggest that it is about establishing insider and outsider groups if performed in public.

Wear suggests that doctors "throughout academic medicine might begin candid discussions of derogatory and cynical humour in their particular cultures in order to become better aware of their participation in it and their responses to it when they overhear it from others".

And so I am writing this. Social media- blogs and twitter- are my culture. I want to raise this topic here- in this public space- so that I can think about how I respond to it in the future when I 'overhear' it. The next time I may choose to ignore it. Despite Wear's suggestion that incidents like this provide 'teachable moments', and should be challenged, the spaces of social media are much more exposed than a hospital corridor.

But at the same time my blog is also a relatively safe place for me. I await your thoughts.

My #altc2011 presentation.

2011-09-11T16:20:00.001-07:00

View more presentations from Anne Marie Cunningham

If you view this directly on slideshare the speaker notes might make my points much clearer I hope. When the video of the presentation becomes available I will upload that too.
Enjoy and any questions/comments please post them here!

A story needs a story-teller...

2011-09-11T07:35:00.000-07:00

On September 11th 2001 I was working in Bristol as a doctor training in public health, I had arrived in Bristol less than a month before and still hadn't found anywhere to stay. Some friends said I could house-sit for them, whilst they were on holiday.

I watched the tragic events that day on a computer screen at work. I went back to the empty house and felt very alone. I hoped to hear that my friends in the US were OK. I felt powerless.

Today Twitter is full of many sharing their personal reflections of that day. Atul Gawande has been writing about how it was to be a doctor in New York. He is sensitive. But an account @911tenyearson by the Guardian, which was tweeting the factual series of events 'as it happened' has stopped. There are many tweets describing that stream as "bad taste" and "distasteful", but I think that it is the comment that these tweets were "blunt and faceless" when a "story needs a storyteller" which perhaps gets closest to why so many were annoyed.

Many expect social media presence to show sensitivity today. Many don't want cold hard facts. But others can't see why the stream ended.

"What is evidence?" - tweets from a #amee2011 symposium

2011-09-10T07:10:00.000-07:00

After 2 weeks of conferences I have a lot of SoMe activity to catch up with! This storify is for @mikey3982. Luckily I had set up a tweet archive of #amee2011 tweets with FoxePractice. I then have a scoopit chrome plugin that makes it quite easy to move tweets from the archive to a storify. A lot of my tweets contain images of slides but scoopit doesn't detect and embed these automatically as keepstream does- BUT- keepstream doesn't embed nicely (last time I checked anyway) and there isn't a chrome plugin.

I've also added in some tweets from the afternoon synposium on the contribution of the social sciences to medical education research. Greenhalgh was also present for this.

Social media, organisations, identity and anonymity- an interview

2011-09-09T13:21:00.000-07:00

Steve Wheeler interviewed me at the ALT-C conference on Wednesday just after my presentation on social media and professional identity. I will blog that shortly but here is the interview in the meantime.
Watch live video from jamesclay on Justin.tv

So you're a public service organisation thinking of starting a twitter account?...

2011-08-03T01:47:00.000-07:00

Although this story is about a police account - who have been very quick to start using social media, very well- I think it is also equally applicable to health organisations who might make the move.

Crowd Sourcing Medical Education

2011-07-30T07:27:00.000-07:00

Today I received the following tweet from a Maltese medical student, @karambinu :
" i need help in finding web tools for medical education....do you have any ideas I could start off with?"

So how can we find and share the best resources for medical education online? There are lots of great curation tools emerging like scoop.it but where to find the best content to put there?

A database might be useful. But how to crowdsource it? Below is a google form which I've just set-up. You can see the results here. And here is a scoop.it for cardiology in #meded which shows how you might want to use the results. This is only a start. What would be a better way of doing this? If you have any ideas please leave a comment. And if you use the spreadsheet to curate leave a link. And don't be afraid to publicise your won work!
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Study author joins #twitjc discussion

2011-07-09T17:59:00.001-07:00

Near-patient googling.... any thoughts?

2011-07-09T12:23:00.001-07:00

Hello to #asme11!

2011-07-09T09:48:00.000-07:00

This is a quick introduction to who I am and why I am interested in the use of technology in medical education, and especially the benefits (and risks) of social media and networks.

I've written a quick post over on the Med Ed Connect blog asking for those coming to our workshop on social media and networks in medical education to leave a quick introduction so that we could start to get to know each other. So here is my own quick introduction. Really looking forward to meeting you.

Blurred boundaries for health professionals online...

2011-07-02T11:29:00.000-07:00

The following exchange took place on Thursday night. @celticchickadee isn't my patient, and as far as I know, neither is the person, she is talking about. This exchange is very incomplete compared to how I would have handled this situation offline. I could just have said 'No, I don't respond to medical questions online'. But I didn't. Sooner or later, I'm guessing that a patient in my practice will start following me on Twitter. Perhaps there already are some. Should I interact less with patients than I would with another member of the public? I have a lot more questions about this but I'm interested in your thoughts. I post this as a follow up to my last one.

By the way, I asked @celticchickadee if she minded me blogging about this, as I realise that although our exchange was completely public this would amplify it a lot.

I'm still sceptical about health professionals and social media...

2011-06-30T16:57:00.000-07:00

Here's a short video put together to stimulate discussion about the threats and opportunities that social media provides for doctors (and other health professionals). The case is made that we (health professionals) have a responsibility to engage with social media so that we can guide patients to good resources. But does guiding to good content really necessitate the production of content? Does it need tweeting or blogging or just a good website? Do we really need web 2.0 for what is described in this video or wouldn't web 1.0 get us most of the way?
Would I encourage colleagues to set up a blog or a twitter account or a Facebook page with the aim of generating content for their patients? No. I've been in these spaces for a few years and I still wouldn't try this myself. I admire those practitioners who feel they can negotiate the boundaries of privacy, and openness with patients but I don't feel that I am there yet.
So I look forward to continuing the conversation. I've written more on my thoughts about health professionals and social media here, here, here and here. All of those posts have benefited from very rich comments for which I am very grateful.

Why I realised the importance of the psychosocial in medicine...

2011-06-12T10:23:00.000-07:00

Women of the world by robynejay

Students often don't seem to understand why the social sciences are important to understanding health and the way that we organise health services. The relevance has always seemed rather obvious to me but then I have to wonder if this doesn't have something to do with my own personal circumstances. Or else wouldn't all medical students think the same? So a few facts about me, the person who entered medical school in Belfast aged 18:

I grew up on a small farm in Northern Ireland
I'm the eldest of 4 children
My maternal grandmother died in childbirth
My mother's aunt started living with us when I was 6. My mother cared for her for 25 years until she died aged 103
My family had a great interest in politics and my father was elected as a local councillor
My father died suddenly when I was 14
The family income fell as a result of my father's death but we were no longer entitled to free school meals
I took a GCSE in sociology when at school. My coursework project considered why although the school was predominantly female, we only made up 1/3 of the a-level physics class.

I don't usually write about personal things here and there is a lot more I could say about what might have shaped my identity as a doctor. I am left wondering if many students don't question the structures and practice of medicine (insights that can be gained from the social sciences) because nothing in their own personal lives has sensitised them to the way that we organise society.

If this is so, what can we do about it? If I am wrong, then what can we do about it? Either way we need to do something to shake things up.

How education could learn from games.....

2011-06-04T10:12:00.000-07:00

Many thanks to Dom Rodwell, a first year medical student at UEA for sending me the link to this. There are lots of comments here. But how do you think any of the lessons here might be relevant to medical education?

Clinical learning in the open: the strengths of social media.

2011-06-04T06:25:00.000-07:00

Image: Open by Justin Marty

Last night I had quite a few learning episodes on Twitter. It started with Christian Assad's post about how Twitter could be used for learning. He is training in cardiology and is aware that troponin (a protein measured to assess damage to the cardiac muscle) levels are often elevated in those with poor renal function. But seemingly this is still a hot topic, and is not acknowledged yet by labs or many doctors. So Christian tweeted an eminent cardiologist to see what he thought and got an ambivalent response. But the key was that it was ambivalent. He didn't just state that, 'No, there is no evidence that renal function is related to troponin levels', he hedged his bets.

Christian saw this as an illustration of how cardiologists could learn on Twitter. But I think it tells us a lot more about learning in the open. I am not a cardiologist. I'm a generalist. I don't diagnose NSTEMI ( a type of heart attack in which diagnosis is partly dependent on troponin levels) but I do manage little old ladies who are discharged on multiple medications after having NSTEMI diagnosed in hospital. So I was interested in this and through commenting on Christian's blog I was able to discuss this issue with him.

And of course patients and the wider public will also be able to gain insights into how many of the things which seem certain in medicine are perhaps not so certain. And that I hope can only be for the good.

I was just recovering from that clinical learning experience when I saw a medical student from Manchester tweet that she had found a tablet somewhere that she didn't recognise. Neil Mehta has done a great job of documenting the learning that came out of that episode on his blog, which you can read here.

There was a suggestion that the pink, oval tablet with EC stamped on it might be aspirin. Out of this rose a very interesting discussion with Jessica Ote, who is training as a family doctor. She asked if there was any evidence that taking NSAIDs (drugs like ibuprofen) with food helped to protect the stomach. I've saved our twitter discussion here using Keepstream, but unfortunately it doesn't embed well (you need greater customisation of embedding, Keepstream!), so you'll have to go to the site directly.

What these examples show is that social media allows us to document our clinical learning, and more importantly the questions we are asking, in the open. These questions don't have to remain in our heads. Next our networks can help us to answer these questions. And then the real benefit is that the learning is there in the open for everyone else to access. These networks can cross medicine (specialists and generalists), other professions (pharmacy, nursing, midwifery, OT), students and the patients and public.

We might even go and find the relevant wikipedia articles and decide to make them better!

PS Another great example of clinical learning in the open is Twitter Journal Club (#TwitJC) which starts tomorrow evening Sunday, 5th June.
And if you want a simple way to record your clinical learning that is happening in the open, have a look at TILT (Today I learned that...) from Jon Brassey, and the Tripdatabase team.

And I should point out that in the initial version of this post I stated that troponins were hormones. This was lazy. I was thinking of kinases (which are also measured to determine cardiac damage, but in any case are enzymes not hormones.) Christian kindly sent me a private message through Twitter pointing out that troponins are proteins, which along with actin and tropomyosin, are needed for cardiac muscle contraction. I've now corrected above (and added the wikipedia link so you can learn more) but I thought in the spirit of openness that I should document my mistake. Thanks Christian!

Digital professionalism... if only it were that easy

2011-06-02T12:36:00.000-07:00

Image: Doctor reading articles by rosefirerising

The longer I am online and the more I become immersed in being online the more complex this existence seems.

I want to talk about some principles for "Digital Professionalism" which have been put forward by Rachel Ellaway in the journal Medical Teacher last year. The journal is paywalled so I am going to give the principles here.
The 7 principles are:

Principle #1: establish and sustain an on online professional presence that befits your responsibilities while representing your interests. Be selective in which channels and places you establish a profile.

Principle #2: use privacy controls to manage more personal aspects of your online profile and do not make anything public that you would not be comfortable defending as professionally appropriate in a court of law.

Principle #3: think carefully and critically about how what you say or do will be perceived by others and act with appropriate restraint in online communications.

Principle #4: think carefully and critically about how what you say or do reflects on others, both individuals and organizations, and act accordingly.

Principle #5: think carefully and critically about how what you say or do will be perceived in years to come; consider every action online as permanent.

Principle #6: be aware of the potential for attack or impersonation, and know how to protect your online reputation and what steps to take when it is under attack.

Principle #7: an online community is still a community and you are still a professional within it. The call for ‘is there a doctor. . .’ may come online as well as on a ‘plane or in a theatre’.

To me these are good starting points, but as someone active in the space, I can see that these principles only take me so far. I'll write more in my next post but I wonder what you think of them now. Please comment.

Chatting on Twitter about Medical Education

2011-06-02T11:18:00.000-07:00

Image: Coversations at Vermillion by JeanineAnderson

A few years ago when I started blogging and tweeting my aim was to try and connect with other people interested in medical education. It was hard to find people, and still the bulk of those involved in medical education- educators, students and doctors are not active in social media.

But there are enough of us here to make it reasonable to consider sketching out some spaces to interact and find each other. For the past year or so I've been pulling together people who are interested in medical education into a twitter list which you can find here.

There has also been talk over the last year or so about having a #meded chat. What is a tweetchat? It's a set time when people try to come together, usually over an hour, to discuss different topics which are usually agreed in advance. Medical education happens all over the world, so time zones (as well as language) become issues when trying to organise synchronous social media events.

In the US, Ryan Madanick is hosting the first #meded chat at 9pm EST or 1am UK time. Many of us will be in bed by then so we thought that it would be sensible to have a very informal chat at 9pm BST (8pm GMT) tonight about what the way forward might be for those of us in this timezone.

Personally, I think that tweetchats have quite a few limitations. Think of the limitations of twitter as a communication medium- 140 chts, unthreaded- and then square that for a tweetchat! They can seem noisy and confusing. So why bother? The main benefit is that you might get to know people who are interested in the same things as you, or who have different perspectives to you. You can decide to follow them on twitter, to visit their blog, to catch up on Skype, to meet up at a conference, or to write a paper together. The possibilities are endless, but essentially this is about networking.

If you want to join in the discussion just add #meded to your tweets between 9 and 10 pm tonight. I've tentatively started a google spreadsheet where we might enter topics that we want to discuss, but I'd be happy for us to discuss what way we want to run this tonight. Here is the spreadsheet.

Please feel free to leave any comments here, or just join in!

Health professionals, social media and identity- more thoughts.

2011-05-21T14:25:00.000-07:00

Talking to medical students about social media and medicine

2011-05-17T09:57:00.000-07:00

This afternoon I had a short session with about 25 medical students talking about social media and medicine.We had a general chat and discussion around twitter and blogs and I also used this short presentation.

Policing YouTube: Medical Students, Social Media and Digita Identity

View more presentations from Anne Marie Cunningham

A few snippets from the discussion:
-all students had a Facebook account
-most had adjusted privacy settings, some hadn't because they didn't know how or weren't worried as they rarely used
-some had heard about FB profiles being checked by recruitment firms but were unsure if that happened in medicine
-all thought it was inappropriate to become friends with a patient on FB.
-there was a lot of discussion about how or why we might keep different aspects of our identity separate from our professional identity, eg being political
-no students used Twitter
-we thought that @shazmo showed great ingenuity in using her Twitter learning network, as described here.
-there was surprise that doctors sharing pictures of the 'lying down' game on FB had made it to the press, but were not surprised that they were 'let off'.
-there was a feeling that students did not need guidance about how to use FB for example. This was 'common sense' and there was a feeling that guidelines may represent the more general encroachment of medical education in to apsects of life outside medicine, in the same was as other discussions of 'professionalism'.
- thinking about the paper of Farnan et. al, there was surprise that the medical school changed its mind over what was appropriate. We thought this reflected general ambiguity over how to use social media.
-they wondered what it was like to be a medical student before the internet. I told them about Index Medicus.
-we wondered how technology would affect our work in the future. Would we be skyping with patients. This was thought to be unlikely but it was thought that when with a patient we might use video-calling to access a sepcialist opinion for a patient.
-the main reasons for not thinking that telemedicine would be useful were: duplication (time spent discussing remotely and then face-to-face), not being able to examine the patient, and why bother as doctors and patients are local so why not benefit from richness of face-to-face communication
-there was mention of this New Scientist article on 'digital souls'
-the TV series Junior Doctors told a story, as all media do. The difference is that with social media you might be able to tell your own story.

A big thank you to the group. I learnt a lot from you. If I've forgotten anything- let me know!

"Who needs med school when you have Twitter?;-)"

2011-05-17T08:43:00.001-07:00

"I'm sorry to have to tell you this...."

2011-05-15T06:43:00.000-07:00

Empathy by The Shopping Sherpa

Another Sunday morning, another stimulating conversation about medical education on Twitter.

It started with a tweet from Dr. Jonathon Tomlinson “To say you cannot learn insight and empathy is like saying you cannot learn science or a new language. Possibly true, but very sad.”

So can we teach empathy? What do we mean by empathy? A good review of the complexities was published earlier this year by some researchers from the University of East Anglia. They suggest that we might be better to step away from the concept of empathy and instead just focus on etiquette. It's a provocative read.

I wonder if teaching empathy isn't like teaching clinical reasoning. We need to first think of empathy as a disposition before concentrating on the skills. The following quote comes from a just-published study on how physicians think about clinical reasoning in students, is it an ability or a disposition? : "The ability-disposition distinction highlights the difference between teaching knowledge and skills, referred to as teaching-as-transmission, versus teaching attitudes, modifying personality and changing behaviour, referred to as teaching-as-enculturation."

So how can we transmit what we think is important to others about empathy? A few years ago, I blogged about a communication skills session that I was teaching. I was aware of how this session on "breaking bad news" had to some become formulaic. But an interesting discussion did occur and we all questioned our thoughts and approaches to the topic.

Just as Krupat et. al suggest that in order to develop clinical reasoning we need to focus on "encouraging self-awareness and mindfulness, modelling open discussion and inquiry, accepting doubt and uncertainty", I'd suggest that the same is true of developing empathy.

What we do not want is for students to leave thinking that empathy is just a set of behaviours. As this doctor tweeted: ""Empathy by rote" is a ridiculous concept. It's like teaching somebody to be "happy". Faked empathy is insulting."

Another doctor replied that to his mind one of the worst examples of this was: “ to score on 'empathy' student said 'sorry it has to be me to tell you this'”. The doctor was shocked as he saw this as the student putting “professional discomfort before patient distress”. It’s this kind of situation that we exactly need to tease out when talking to students about empathy and communication.

In a comment on a blog post by a doctor about breaking bad news, a patient writes of her feeling when she was told she had a serious condition. She explains how the doctor “As he spoke, he began to sip little bits of air in between his lips. This suggested to me he was feeling emotions as well. It made him more human and incredibly compassionate. I loved him for that.”

For some patients showing that we are human and have emotions to will be right. For others it might be seen selfish. They might want us to have ‘professional distance’, to just get on with the job. How with someone that we don’t know well can we figure out how to be? Do we have to accept that sometimes we will just get it wrong and that etiquette is the best we can aim for?

I don’t expect to reach the answers to those questions through this blog. But they are the kind of issues we should discuss with students when we are in real-life situations, so that we can help them to start developing their sensitivity to communication and their inclination to becoming good communicators.

More tweets can be seen in the storify here.
Regina Holliday tells the powerful story of a doctor who seems to lack all empathy here.
Excellent post on empathy by oncologist, Robert Miller, here.
Previous posts on medical students' thoughts about teaching and learning about empathy:
A medical student's thoughts on empathy and #meded
A twitter conversation with UK medical students about empathy

Reflection and Portfolios

2011-05-14T09:52:00.000-07:00

Do you agree with these medical students and young doctors?

What happens when you have a brilliant website but you don't have search and google doesn't seem to know about you?

2011-05-11T09:19:00.000-07:00

Answer: your content can't be accessed and most people don't know about your website. EDIT Unless they search tripdatabase.

Behind the headlines is an excellent service. Here you can find the background to the latest health stories that you find reported in the UK press. The problem is that it is hard to find what is there. The NHS Choices website seems to exclude BtH from its search. Google doesn't seem to know about the content of the BtH website. Infact, the only way of getting to BtH content seems to be through Tripdatabase, the excellent metasearch.

But, BtH does have it's own twitter feed! Yes, you can follow @NHSNewsUk!

Maybe NHSChoices thinks that content in BtH is of no interest after a few days and that no-one will ever want to look past what is on their front page. They are wrong.

To me this is evidence why anyone who produces content should think about search first and social media later. Get the basics right.

New Post

2011-05-10T09:37:00.000-07:00

I'm very pleased to announce that I have been offered a part-time secondment within Cardiff University School of Medicine to look at how we can make best use of technology to support learning throughout the undergraduate medical course.

I go into this post having learned so much from my personal learning network. In the next few years I hope to keep learning and sharing with you.

Thanks.

Storify: the story of a single tweet

2011-05-08T04:47:00.001-07:00

Location and Learning

2011-04-20T13:38:00.000-07:00

Image: SP Nurse on the Job by dharder9475
In the last few weeks I've been thinking about how we can support the learning that takes place when medical students are on placement. We know that entering wards can be a daunting experience for students. They don't feel part of a team. They don't know who everyone is. They don't understand what is happening. They don't want to interrupt nurses attending to patients or junior doctors catching up with paperwork at desks.They see other members of the team wandering in and out of the ward but they don't know what their role is. They don't recognose the social worker or the pharmacist or the OT. They might not even know what their own role is. They miss out on opportunities to attend meetings and teaching sessions because they don't know they are happening. In fact they spend too long waiting around for someone else to turn up to teach them, and on activities that have little educational value. They generally have a haphazard learning experience.

But placements are very rich environments with many unique opportunities to learn.

So what can we do?

Imagine instead that before coming to the ward the students had access to a network which let them find the profiles of all the staff who worked on that ward. They could see the timetables for teaching. They could even see what the last students who had been on this placement had seen and learnt. They can select what they would they would particularly like to gain from the placement, and this will become part of their profile which will also be available to all the staff on the ward. The network will also contain links to information about initiatives that are happening in the ward to address patient safety and quality improvement. They students can see if there are opportunities for them to get involved in this work and learn about the input their colleagues have had in the past.

When they turn up on the ward the students check in. They can see the profiles of the staff who are working there and when they should be finishing, when they will be on call and what clinics or theatre sessions they will be doing that week. Their calendar updates with activities that are happening that day that they should know about.

The network that they are tapping into is the same one that all the staff in the hospital use to keep themselves up to date. The students can record their learning and their thoughts about how the ward works. Their input is valued by the staff on the ward and their fellow students from other disciplines.

Do you think this will happen soon? Why hasn't it happened already? And how could patients use this network?

Lies, damned lies and statistics: How do you turn 61% into 95%?

2011-04-16T11:03:00.000-07:00

Image from "Working together for a stronger NHS" Crown Copyright

Edit: 13/05/11 An analysis of the BSA 2007 dataset by Siobhan Farmer, Mark Hawker and myself has been published today in the new publication Lancet UK Policy Matters. You can find it here. We conclude that it is not possible to conclude that 95% of respondents wished for more choice. Using the kind of suppositions given below it may be possible to infer that between 61% and 72% may have thought there should be more choice, but the survey was not designed to answer this question.

..........................................................................................................................................................

Edit: 17/4/11 I and a colleague have independently tried to verify Mark's analysis. We have reached similar conclusions but they don't corroborate Mark's results. Unfortunately he is currently outside the UK. We will update with our own results in the UK. We are in agreement that there is still no justification for claiming that "95% of people want more choice in healthcare".

..................................................................................................................................................................

Today many of you will have read Ben Goldacre's excellent analysis of the leaflet which the Department of Health issued last week to help the public understand why they were pursuing reforms of the NHS which are facing widespread opposition.

Page 11 of the leaflet contains the graphic above stating that 95% of those surveyed in the 25th British Social Attitudes Survey wanted MORE choice in the NHS. When Ben looked at the published reports he found that 'Do you want more choice in the NHS?' was not a question in the survey. Instead respondents were asked 'How much choice do you think you should have?' and 'How much choice do you actually have?' But if you could establish how many people thought they should have choice but who currently think that they don't have choice then you might be able to say how many people think that they should have more choice. As Ben points out to answer this you would need to have individual level data. When he asked the DOH for the dataset they unfortunately pointed him to a book chapter.

But fortunately the day this leaflet was published, April 6th, 2011, Mark Hawker started wondering if he could find out more about this dataset. And he did find more. The individual level data is available to download. So Mark did that. Then he analysed it. And what did he find? Well, you can read a lot more in the blog post that he published on April 7th but here is a summary.

13% thought they had more choice that they thought they should have.

46% thought they had just the right amount of choice.

41% thought they should have more choice that they had.

So how did the DOH manage to get this so wrong? How did they confuse 41% with 95%? Why weren't they able to direct Ben Goldacre to the correct data source? And why have they decided not to fund this survey in the future?

Hopefully someone can help make the correct data look just as pretty as the incorrect infographic in the leaflet. In the meantime I think I'd like to thank Mark for his work, and to agree with this tweet:

#1care : crowd sourcing a hashtag for primary care

2011-03-29T06:49:00.001-07:00

hashtags, a photo by halfbrown on Flickr.

Don't Think Websites, think data

2011-03-10T12:43:00.001-08:00

What the non-geeks including me, need to understand. Check out this SlideShare Presentation:

Don't Think Websites, think data

View more presentations from Mike Ellis.

A medical student's thoughts on empathy and #meded

2011-03-09T10:22:00.001-08:00

Patient + Wife a photo by polaroid667 on Flickr.

Today during the twitter conversation Gautam went back to one of my old blog posts on empathy and left a comment that I think deserves its own post, so I have posted it below. Much of what he writes strikes me as very true and accurate. What is the solution?

"I think the crux of the problem is the practitioners that medical students train with. I'm a final year in Sheffield and even though we have 12 weeks of general practice over two separate sessions, that leaves around 2.75 YEARS of training in hospital.

My own opinion is that in-hospital practitioners are less empathic because the prevailing attitude is that patients are problems to be solved. The 'House MD' way of looking at things still prevails amongst many practitioners - particularly surgeons but equally amongst medical physicians. Students are 'taught' empathy but equally, are (not overtly) dissuaded from feeling it, talking about it and dealing with it. The pressure is to deal with the 'real' problems - the broken leg, the tweaking of medication doses - and ignore the 'BS' - the trauma of losing a child or partner (unless they can be referred for CBT).

Contrasting hospital care to general practice, the existence of a lasting relationship between doctor and patient means that these concerns have to be taken more seriously simply because the patient is a recurring figure in the doctor's professional life. In other words, it makes sense to deal with these patients as people, rather than as problems.

Now, this theory of mine (as weakly-backed by evidence as it is!) holds some water, I feel, since patients who are seen in clinic regularly are treated differently by consultants. These patients' problems are listened to, their concerns are heard and dealt with as much as is possible. Time constraints exist with patients on the ward, as well, but for some reason, (perhaps worries about confidentiality and privacy?) they are not covered as completely.

Medical students can be taught to reflect and encouraged to empathise by the medical schools as much as possible. But while they are taught as apprentices by overworked and jaded physicians and surgeons who may not have time to empathise as much as they'd like to, true empathy remains out of reach."

Thank you, Gautam.

A twitter conversation with UK medical students about empathy

2011-03-09T10:10:00.001-08:00

Antidepressant prescribing in England: variation may not be as great as Guardian map suggests.

2011-03-05T20:13:00.000-08:00

The Guardian published a story on March 5th, 2011, showing that the crude rate of anti-depressant prescribing in some areas of England was more than 3 times higher than in others.The highest rate of prescriptions was in Blackpool, and the lowest in Kensington and Chelsea.
The data was from publicly available sources and is linked to from the Guardian website. The journalists give this description of their method :
"How did we arrive at our figures? First, we gathered prescription data from the online database managed by the NHS Information Centre.

This quarterly information was compiled to get annual numbers covering 1 April 2009 to 31 March 2010 – the most recent full year with available data. In order to make the numbers comparable, we then linked the raw prescription numbers to the ONS mid-year population estimates.

This allowed us to calculate the prescriptions per 100,000 figure in the data below, which controls for the different sizes of PCTs, if not their different levels of wealth, employment and general illness."

The data is also not age standardised. In the comments section some have suggested that in areas with low numbers of prescriptions doctors may be prescribing several months prescriptions at one time. I have looked at the most recent data set available (July-August 2010). Data is available on the total cost of the prescriptions as well as the number of prescriptions and these are plotted below.

This shows a clear correlation between number of prescriptions and cost. However when one looks at individual PCTs the average cost of an antidepressant prescription in Kensington and Chelsea PCT is £7.01, whilst in Blackpool PCT it is £3.48. This does suggest that either more expensive antidepressants are being prescribed in Kensington and Chelsea, or more months prescriptions are being given at one time. Since the absolute number of prescriptions in Kensington and Chelsea is so much lower than in Blackpool, it may be that more antidepressants are being prescribed in each prescription.

When looking at datasets it's good to make use of all that is available.

You can find my spreadsheet here.

EDIT 4.20pm 6/3/11 I've calculated a rate of prescribing of antidepressants per 1000 of population over 19. (This is not ideal as some teenagers may be prescribed antidepressants, but more accurate than using the total population including children). This has been plotted against average cost of antidepressant prescription. This shows that Blackpool and Kensington and Chelsea are outliers.

There is not a strong relationship between cost of prescriptions and number of prescriptions. This may explain some of the variation between north and south of England, but the long-established relationships between deprivation and depression are likely to have greater explanatory power.

Here is a link to some papers on that relationship and a very interesting report (via @coxar) on the relationship between antidepressant prescribing, poisoning by antidepressants and deprivation.

If something is shared do you value it less?

2011-02-01T12:07:00.000-08:00

Image: Sharing the juice by zummersweet

If you listened only to those I know online, who are interested in learning, you would think that the world believed in trying to make and share educational content as easily as possible. But that is not always true. I have participated in discussions where it has been suggested that students might think that a course has less value if the content is freely available. The usual response is that a student should sense more value in participating in a course, than that which can be derived from easily shared online content. There should be more to it than a few lectures.

This morning I saw a tweet about a lecture on health inequities in the London School of Hygiene and Tropical Medicine. My immediate thought, which I tweeted back, was that it was a pity that the lecture wasn't more widely available (recorded, shared and able to be embedded in a blog) since the topic is so important. The things is that I've started getting a little spoiled. Last week I was able to watch sessions from the Foundation for Informed Medical Decision Making (FIMDM) conference in Washington DC here, live as they were being streamed, and for free. Last year, I watched many of the sessions in a 2 day conference on "Innovation in the Age of Reform" and you can too now, because those sessions are still available here. That conference was organised by Swedish . I had never heard of them before but I have now and so have you.

Lecture capture is becoming so easy to do that most universities have started already. And if you have the lecture then why not share it? Many are. iTunesU is one way of sharing your content freely with others. Cambridge, Oxford, Harvard and Yale are some of the universities already sharing with iTunesU. MIT have a whole website devoted to sharing 2000 of their courses. So all of these institutions have decided that there is something to be gained from making some of their content freely available. Maybe they believe that it is morally right to share, or that is will garner them positive coverage, or attract future students.

Anyway, the doctor I was speaking to thought that it wouldn't be appropriate to share material from a post-graduate course that someone was paying for. I asked if she thought it would devalue the course and she said yes. So, away from the echo chamber that I seem to inhabit more often I wanted to ask how you would feel about paying to attend a course where some of the materials were made freely available to others. Would it put you off? Would you feel proud that others could see the high standard of teaching you were receiving? Would you feel glad that your fees were helping to share knowledge around the world? Or would you feel cheated?

Intimate examinations without consent- it's still happening.

2011-01-26T11:39:00.000-08:00

Image: Exam Room by Maggie Osterburg

Having an intimate examination can be uncomfortable enough, but the thought that a medical student might be examining you without your clear consent is hard to accept in 2011.Although Canada only introduced guidance that explicit consent from patients was needed for pelvic examinations less than six months ago (and following much dissent in the press), in the UK and Australia this has been established policy for many years. But researchers from Cardiff and Dundee universities who were exploring UK and Australian medical students 'professionalism dilemmas' found that the students often told stories of performing intimate examinations without consent. Sometimes they challenged being asked to perform an examination by a doctor-tutor, but more often the stories were of going along with requests despite knowing it was against their school's policy.
The researchers conclude that having a policy is not enough to change the behaviour of doctors who request students to practice examinations of patients without consent despite clear guidance which says this is wrong.
So where next? To try and quantify how common some of the professionalism dilemmas such as this are, the researchers are now carrying out a survey of all medical students in the UK which can be found here, and have set up a Facebook group to support the research. They also hope to study why the policies have not had the impact on doctor-tutors that would be expected.

Press Release from University of Dundee.

EDIT: Annabel Bentley has suggested that action needs to be taken. What do you think?

Rees CE, & Monrouxe LV (2011). Medical students learning intimate examinations without valid consent: a multicentre study. Medical education PMID: 21251051

You can see some of the discussion about this on twitter via @storify here.

What I have learnt about Twitter.

2011-01-23T10:53:00.000-08:00

Image: Greenfinch singing - Carduelis chloris by Rob Baldwin

A week or so ago I was listed in a BMJ Careers article as a "health professional to follow". That's quite an honour, so I thought I should write a short post to share my Twitter learning.

My first tweet is recorded here. It was on 27th May 2008 and was "preparing for a seminar on medicine and the media- thinking about health 3.0". I had just received an invitation to Twitter from a friend who works in IT. He has never quite got the twitter bug and I didn't for a few more months either.

Twitter was just one of the strategies that I chose to use to try and find (and develop) a community of people interested in medical education online. I had been to two medical education conferences in the summer of 2008 and I wanted to keep talking and sharing. My first move was to start this blog back in October 2008.(Lesson no1: If you want to get the most out of twitter then start a blog. It doesn't matter if you don't write anything for months, you will have somewhere that allows you to share your ideas in a longer form. Twitter lets you find people but for real conversations and learning you need something that allows for discussion and that is a blog.)

I started following two distinct groups on Twitter- those interested in learning and education, and those interested in health - much wider areas than the narrow field of medical education that I was first searching for. This has been a "good thing". Having a network which is diverse by interest and geography has maximised what I have got out of twitter. (Lesson no2: Don't just follow people like yourself on twitter. Diversify your network.)

I have tweeted a lot! But there are some things that I don't tweet about, namely anything that could break the confidentiality of the students I teach or the patients I care for. Now and again I mention something personal but rarely. I am aware that my tweets are there forever and I want to be comfortable with anyone from my mother to my boss reading them. (Lesson no3: Twitter is always public).

Lastly, twitter is good for bite-sized conversation. Don't try to make it do more than that. Tweet chats like #nhssm (NHS and social media) are good for finding people but unwieldy for learning. If you find yourself getting into a long conversation on twitter then you probably need to write a blog post instead! Then you will have the record of your thoughts and those who comment forever. Tweets can be hard to archive and find again. (Lesson no4: Twitter has limitations)

I hope that is helpful. Do you have any questions about how I use Twitter or anything you would like to share?

Sharing hashtags for upcoming medical/health conferences.

2010-10-28T09:01:00.000-07:00

Earlier Annabel Bentley, @doctorblogs, was wondering if it was possible to find a list of upcoming medical or health conferences- and more importantly the hashtags that would be used to cover them on twitter.

Anyone got recommendations for following medical conferences on Twitter? My eg: follow #ev2010 1-2Nov! http://bit.ly/afFXVF @bmj_latestless than a minute ago via webannabel bentley
doctorblogs

I'm not aware of a solution yet so I made this google form and spreadsheet. Get sharing! Oh- and if a better resource exists already, then share that too!

EDIT: 16/11/10 I've just been shown Lanyrd by @helenpullen - it's the perfect solution!

<p>&amp;amp;lt;p&amp;amp;gt;&amp;amp;lt;p&amp;amp;gt;&amp;amp;lt;p&amp;amp;gt;&amp;amp;lt;p&amp;amp;gt;&amp;amp;lt;p&amp;amp;gt;Loading...&amp;amp;lt;/p&amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;</p>

Should the NHS be on Yahoo Answers?

2010-10-19T17:26:00.000-07:00

Last week Leigh Blackall and I agreed that patients needed access to high quality information on the internet but we disagreed on how that would happen. He mentioned Yahoo Answers and I and many of those I know on twitter responded sceptically. Why would ANYONE look to Yahoo Answers??!! But my experience of looking for information online is most often centred around knowing the diagnosis. If you are trying to make sense of your symptoms then it is a whole different ballgame. So I decided to make a short screencast to show what the experience might be like.
What should we do about this? Make the existing NHS websites more user-friendly when checking symptoms? Develop better tools for symptom sorting? Make sure that the relevant NHS pages are serach optimised? Or should the NHS be patrolling Yahoo Answers?
I'd love to know your thoughts and feel free to share any stories. But remember this is a public site and others will be able to read it after you!
EDIT: After Fi's comment below I feel I should add that I think it is unlikely that patients will find a diagnosis online but they should in a sense get good triage information. Is this a serious symptom that I need to go to the doctor with, or can I leave it for a few months to see if it goes away?
I've blogged about fear of Dr Google before. We should be helping Dr Google to perform better, and we should be able to give guidance to patients on where they can get sensible information online.

Chris Anderson: How web video powers global innovation

2010-09-30T17:11:00.000-07:00

A powerful talk by Chris Anderson. TED curator, where he describes the effect that he thinks the rise of online video could have globally. If we open up and build CROWDs, help shine LIGHT on the content they produce, and build DESIRE to do even better then we can share and learn quickly.
Let's hope!

"Don't Lecture Me"- but do watch Donald Clark

2010-09-29T17:04:00.000-07:00

Donald Clark gave this highly engaging lecture on why we should not be using lectures at the ALT-C (Association for Learning Technology Conference) 2010. Many medical schools in the UK, at least, have moved away, or are moving away, from the lecture format. But just in case we forget why that is a good idea, Donald Clark gives us a few good reasons.

My experience using social bookmarking with medical students: #fail?

2010-09-23T05:02:00.000-07:00

Experience with Delicious...
I have about 300 second year medical students independently researching topics related to families who they are visiting. 2 years I ago I started using Delicious to share resources with them- often forums where patients were discussing topics such as living with diabetes or being a parent.The advantage was that Delicious was public. It made it easy to share a group of links in Blackboard. I encouraged students to sign up and share their own links so that they could develop ideas about curating and sharing, but this was a secondary aim. I was aware of 15 students who actually signed up to Delicious, and about half of those saved at least one bookmark. But they didn't really understand tagging and obviously didn't find use in it for themselves as they haven't done so again. I was also a little frustrated that I couldn't comment on or discuss with students why they had identified a particular source.

Interestingly I have showed Delicious to two of my personal tutees and they have continued to use it. But I introduced this to them in a one-to-one meeting. How can I manage to show the benefits of social bookmarking to 300 students in a lecture (in 5-10 minutes)?

...then Diigo....
Last year I decided to try Diigo. This was because it had richer features and would allow discussion around a topic. I am perhaps over-protective of students, but because this task was around the families they were visiting, I was keen to make this a private community so that if they did inadvertently break patient confidentiality then less harm was done. I've written more here about the the process of setting up the group and some of the hiccups along the way. Towards the end (after 3 months) some students (three!) did start saving bookmarks (one saved 7 to his diigo account, and shared 3 of these with the group, the other two only saved one bookmark each).
58 students signed up to Diigo - and these are the only ones who could access the 187 items that had been saved to the group- mostly by me. If I shared a link like this http://groups.diigo.com/group/familycasestudy/content/tag/breastfeeding on Blackboard I was guaranteed to get a response from students saying that they couldn't access Diigo as they weren't a member. The process to join a closed group made it all more onerous.

Lessons learnt

The rich features of Diigo including the ability to use an avatar were not used by students.
A closed group makes things very much more complicated- and there was no evidence that students used the site in an inappropriate way- so open is better.
Few students saved links themselves, but it is very useful for me to be able to easily share materials with them.

This year?

I need to be clear about why I am introducing social bookmarking to students. This is not (yet) part of a programme in digital literacy. I started using Delicious in the course simply because it was an easy way for me to share information with students. My expectations then started increasing which was why I chose to use Diigo in a much more complex way the next year. I don't think that I can say that the use of Diigo was a success. I don't actually use it myself very much despite these rich features so it is hard to recommend to others.

Should I go back to using Delicious. Yes- students will need to set up a Yahoo account in order to save links- and the features are not as rich.

Or, I continue to use Diigo but open it up- it might take off this year.

Or, I try out using Scholar, a social-bookmarking tool which is built into our VLE. So far I don't understand it which means I am unlikely to use it. (Why did they pick a name so close to Google Scholar which is completely different??)

It is perhaps harsh to call this a failure. I didn't set out with the deliberate aim of teaching students about social bookmarking. If I was then I would probably force them to set up accounts and to save and comment on others links.But, I would like students to understand what social bookmarking is about- and to see that it might be useful to them.

In this situation what would you do? I will report back!

EDIT: Martin Weller writes about similar issues in encouraging researchers to adopt social media here http://www.typepad.com/services/trackback/6a00d8341c0c0e53ef0133f47b6207970b

Quality measures and the individual physician: A UK perspective

2010-08-22T16:55:00.000-07:00

A few weeks ago, Dr. Danielle Ofri, published her personal view in the NEJM of receiving individual feedback on how patients attain certain performance targets. On his personal blog, Dr. Kent Bottles wrote a rebuff, where he suggested that Dr Ofri was implying that because she and other doctors cared about their patients, these scorecards were irrelevant. My reply stated that Dr. Ofri was not against feedback per se, but that she believed it should be at the level of the institution. Kent's thoughts are now reposted on the Health Care Blog where it has created much debate. I’m sure that Dr. Ofri doesn’t really need defending but here is my take on what she has written.

She starts by pointing out the silliness of treating success in reaching targets as a binary outcome and particularly mentions blood pressure control in diabetes. This is a good point. Treating hypertension in diabetes is about treating a risk factor in a population; one can never know the benefit for any individual patient. The original UKPDS study which looked at the impact of ‘tight BP control in diabetes’ compared targets of 150/85 (tight control) vs 180/105 (less tight control). The tight control group managed a mean BP of 144/82 whilst the less tight control group averaged 154/87. The tight control group had reduced all cause mortality and also lower rates of nephropathy and stroke. However, the tight control group were given a regimen including an ACE-inhibitor (a treatment that we now know to decrease all cause mortality in diabetic patients, and to be protective of kidneys) while the less tight control group were to be deliberately not given this. So we don't really know how much of the benefit was down to the actual blood pressure attained, or the treatment used.

But back to Dr. Ofri's point; looking at how many patients achieve a target might, but doesn't necessarily, tell you about how the overall BP in the population has changed. And that is what matters. An aggregate measure of how much change has been produced in the BP of all patients might be a better way of describing how well BP is managed in any practice. She could spend all her time trying to get the patients with a BP of 145/85 down to 130/80 to meet the target, but completely ignore the patients with much higher blood pressures because they will be so much harder to get to the target. I doubt that Dr. Ofri would ever be so cynical as to take this approach because as she says most doctors have the good of their patients at heart, and are not just trying to make a fast buck as quickly as they can. I work in the UK, so I can't say if Dr. Ofri is seeing her colleagues through rose-tinted glasses. She afterall has chosen to work in Bellevue Hospital, the oldest public hospital in the US, where 80% of patients come from under-served poulations.

Some of the discussion has been around what are meaningful endpoints for quality measures. We might presume that reducing blood pressure is always good, but it seems to be more complicated than that. Atenolol, which was one of the agents used in the tight control group in the UKPDS trial above, does decrease blood pressure but not overall mortality so it isn't a sensible choice for first-line treatment. And in diabetes achieving even lower blood pressures through aiming for a target of 120/80, is associated with more side-effects from medication but no benefits for patients. Dr. Ofri's failure to get her patients' blood pressures below 130/80may be a good thing for some of them.

But her main complaint about these scorecards for individual doctors is not about the choice of targets, although I hope I have helped you to understand what she meant when she said it is easy to pick fault with them. No her main issue is that the scorecards place responsibility with individual doctors for the outcomes of their patients. She doesn't have a problem with tracking outcomes, and says she would be keen to see how her institution compared to others. She cites a systematic review which shows that this kind of feedback may work at the level of the organisation but not at the level of the individual. She also cites an opinion piece in JAMA where the authors suggest there may be unintended consequences to publicly sharing feedback on the performance of individual doctors, and organisations. These consequences may include "causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve "target rates" for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment."

Could that be true? Only this evening I came across the following tweet

Pay-for-performance quality measures will result in docs firing noncompliant patients. I know I don't want a dipshit diabetic to sink me.less than a minute ago via HootSuiteThe Suburban Doctor
BurbDoc

In the UK, we have already introduced pay-for-performance in primary care. When this was introduced in a new GP contract in 2003, it was lauded by Paul Shekelle, as "the boldest such proposal on this scale ever attempted anywhere in the world". But he was also worried about unintended consequences. One was that areas which were not assessed in the performance measures would suffer. This is hard to assess, and new areas have been added in each annual review in any case, but it is thought that there has been no impact. The other was that the relationship between doctor and patient would change, with loss of some of the holism thought to define UK general practice. We can gain some insights in to how that might have been realised through the ethnographic work of Checkland et al. who documented the changes that the contract brought to two UK general practices. There was an increased focus on recording 'hard' biomedical data over 'soft' patient-centred data. But the staff involved did not see any change in their practice. It is well worth reading this and their other work to gain insights in to some of the impacts that pay for performance may be having in the UK.

Primary care doctors in the UK can not choose their patients. If their 'list is open' (they think that they have spare capacity) then they must take any patient that wants to join. So there is no risk that an individual patient may not receive care because of pay-for-performance. However, unlike in the US, patients may be excluded from denominators if they are having 'maximally tolerated treatment'. This may reduce some of the frustrations that doctors in the US feel about such performance measures.

Secondary care in the UK does not have pay-for-perfomance, or even publicly accessible feedback on performance, but evidence exists that there is a tension between protocol-driven care and tailoring care to the needs and preferences of patients. Sanders et al. have done some excellent work describing how this plays out in specialist heart failure clinics.

Getting back to Dr Ofri's concerns, it is worth noting that the feedback on achievement of targets in UK general practice is at the level of the practice, not the individual doctor (although there is still a size-able number of single-handed GP practices). How does this feedback play out in real life? Here is the prevalence data of disease areas covered by the contract for my own practice in South Wales. The practice is in a deprived area, so unsurprisingly the prevalence of diabetes is 34% higher than the UK average, and the prevalence of hypertension is 32% higher. In our patients with chronic disease the prevalence of smoking is 26% compared to a UK average of 22%. This next link shows how well we compare to other practices in the area in meeting the target of having BP readings of less than 145/85 in our patients with diabetes. Despite the higher than average burden of disease in our practice, we have managed this in 75% of our patients. However, this puts us only on the 25th centile for performance within the area. Through a process of internal peer review we try to figure out how we can improve our success in these targets. We are continually reviewing our recall systems for patients, and how we can share work within the practice team.

Dr. Ofri does not say that doctors should not be subject to performance measures just because they are good people. Instead she points out that the measures should be sensible, and that they should probably be applied at the level of the institution and take in to account wider systemic issues, for example availability of cheap medications. She has drawn attention to the complexity of such an apparently simple process.

Finally, I would ask you to watch this short video of Dr. Julian Tudor Hart, a doctor who inspires many in primary care with his research and work in South Wales. He has demonstrated what can be achieved when caring for underserved populations, and the mindset and caring attitude required.

EDIT: 24/8/10 I came across this YouTube "Can we tell physicians apart without better scorecards?" I find it interesting because it starts with talking about feedback from patients about empowerment. shared decision making etc. Next, the comment is made that if this could be done by email it would significantly reduce costs, however no-one has the email addresses of patients. Lastly, the point is made that although institutional/system measures 'should' be the way to address quality improvement in real life it doesn't work that way, and individual physicians seems to be a key determinant themselves. However, this fits with the notion of process measures- not the outcome measures described by Ofri. The debate continues!

Paying for Privacy? : Patient organisations and Facebook

2010-08-19T10:14:00.000-07:00

A few weeks ago I wrote about my concerns about health professionals using free public social media platforms such as Facebook and Twitter to interact with patients. Concerns about Facebook and privacy are widespread, and we are beginning to appreciate how public information about us online can be used to build up a profile telling much more than we might think.

danah boyd in some excellent research on young people and Facebook privacy, challenges the idea that they just don't care. They do. She also states, citing Goffman, that "managing social situations and navigating impression management require understanding one’s audience."

This was one of my concerns with health professionals encouraging the use of public channels by patients/clients. How can we be sure that those who participate understand their audience? How much responsibility do we have to make sure that they know these interactions are in public?

But it isn't just health professionals who are using Facebook as a platform. Patient organisations often also have Facebook fan pages too. Diabetes UK has one and it is popular! There are currently 16, 593 fans as I post but there will surely be more by the time you read this. There is much interaction. People are leaving messages on other's wall posts asking that they are added as friends so that they can talk about diabetes. Others are posting their results and getting positive feedback. There are some wall posts saying to avoid the wall posts of some fans who are claiming 'miracle cures'. All of this is public. I can click on any fan's picture and find out more about them. Very few seem to have their privacy settings as closed as mine, I am sharing even less since I wrote this post.

So would I encourage patients to join the Diabetes UK Facebook page to get support for their condition? Should I join myself and start giving advice to patients who are posting there? The info page for the Fan site makes no mention of the public nature of any discourse there. I guess it presumes that everyone knows, but is that sufficient? I then had a look at the Diabetes UK website. There is a private place to network on the Diabetes UK site, but it is open to members only. To be fair to Diabetes UK, anyone wishing to join is able to decide themselves how much they can afford to may for membership (of which access to this private network is one benefit). The suggested membership is £24/year but other amounts are possible. The payment does have to be made by debit/credit card or direct debit, and as I work in a deprived area I can see the payment method alone being a barrier to some of my patients. I'm not sure how closely membership of Diabetes UK, reflects the socio-economic distribution of people living with diabetes.

(24/8/10 EDIT: Diabetes UK also support another forum which is free to anyone, http://www.diabetessupport.co.uk/index.htm. Although this is a public/open forum it is not linked to a Facebook profile with the risks associated with that. In the guidanceI can not see any discussion of the public nature of the site or advice to consider disclosure of personally identifying information.)

I'm on record as being concerned about the impact of the digital divide on health, but once the disadvantaged get online they will increasingly face other hurdles. The end of the free web and the rise of paid-for apps is predicted in a much discussed Wired article. Are we already seeing examples of this in health?

A comment on my blog suggested that privacy is a concern of 40-something Guardian readers, not young people. We know that this is not true. I haven't seen the research, but I'll hazard a guess that poor people value their privacy too. However, they might not be able to afford it.

What do you think?

IMAGE: Horizon "Defining Minimum Privacy".

EDIT: 24/8/2010 6.30pm I've just noticed that Diabetes UK have added the following information to their info page:
"Please remember that this is a public page where posts can be seen by anyone who likes this page. Also anyone will also be able to see your personal profile unless you have changed your privacy settings accordingly. For more inforamtion about privacy and staying safe on Facebook, visit:

http://www.facebook.com/privacy/explanation.php"

Learning Styles don't exist.

2010-08-12T08:19:00.000-07:00

I came across this brilliant example of how to use YouTube through @samuelwebster. Do you talk about learning styles when teaching?

My thoughts on Health Professionals and Social Media

2010-08-04T20:04:00.000-07:00

Health professionals and social media

View more webinars from Anne Marie Cunningham.
What do you think? If you are short of time you may wish to skip to slide 16.
EDIT 29/9/2010 : At 6min10sec I refer to 'social marketing' when I actually mean the use of social media for marketing. "Social marketing" is a different concept and is well explained here. Near the end when I talk about the possible public health benefits of using social media to influence social networks, this would be a true use of 'social marketing'.

AMEE offers virtual participation in September conference

2010-08-02T08:29:00.000-07:00

"Dear Colleague

Problem - Are you unable to attend the AMEE 2010 Conference due to funding issues, time constraints or travel problems?

Solution - The AMEE 2010 Conference will be available Live Online.

Join key conference sessions live online:
get the best seat in the house without leaving your home or office and take part in the plenary presentations by international experts, on your own or with your colleagues, through webstreaming. Comment or submit questions by texting or phoning. A theme of the conference is the future of medical education from an international perspective. If the time is not suitable, join a transmission of the session later in the day.
meet the plenary speakers along with the other online conference participants, following the plenary presentations in a dedicated interactive question and answer sessions. All you need is a broadband connection. If you have a webcam and microphone you will also be seen and heard when you ask a question or comment.
participate, through webstreaming, in conference symposia on important topics including updates in medical education, team-based learning, self-assessment, research in medical education, medical education in the 21st C, the future doctor and the future curriculum. Comment or submit questions by texting or phoning.
access an on-demand recording of a review of 7 years of AMEE Fringe sessions highlighting some of the most innovative and somewhat different ideas about medical education.
access an on-demand recording of the final Spotlight sessions where six speakers highlight key take-home messages from the conference, in particular relating to the new learning technologies, research in medical education, interprofessional education, undergraduate education, postgraduate and continuing education and a student perspective
access online abstracts of the 450 short communications and 600 posters.
access recordings of the sessions to watch at your leisure if you can’t participate live.

Perhaps not as good as being there in person but certainly the next best thing. Join online and hear about and share key developments taking place in medical education.

Please look at the programme for the online conference to see the exciting range of contributions and topics covered at http://www.amee.org/index.asp?lm=129

Enrol for AMEE 2010 live online at www.amee.org for only £99. This entitles you to one login with the sessions viewed by an individual or multiple users at one computer.

Participants registering by 22nd August will be entered into a draw for a free registration for AMEE 2011 in Vienna"

What are the risks in sharing PhD findings before completion?

2010-07-27T05:58:00.000-07:00

Last week I was at the ASME conference. The conference abstracts are available online but the conference does not facillitate or encourage the sharing of actual presentations ar this stage. It occurred to me whilst there that rather than having posters displayed in quite a small space and often lacking the opportunity to engage with the presenters, wouldn't it be much better to have these online in advance so that comments could be left for the authors.

I am suspecting that I am increasingly growing in distance from my medical education researcher colleagues. And this is the reason why. One of the presentations I attended was so good that before it ended I emailed the presenter (during the presentation!) and asked if I could have a copy and encouraged that it could be placed by them on Slideshare. This was work leading to a PhD but as yet unpublished in any other form. Today I gratefully received an email with a PDF of the presentation. But the accompanying message stated that the author had been advised not to upload the work as it contained unpublished material. They were happy for me to have it personally and share it informally.

I know that my audience here may well disagree that it is dangerous to share work in this way. But how do we manage to change perceptions? How would you counsel a PhD student you were supervising on this? Is it up to organisations such as ASME to lead the way in this? Or should institutions have policies? Is there any proof that sharing work does lead to better outcomes for students and the wider community?

I feel this is at the very edge of 'open science' and makes me realise how far there is to go.

Image: CC by Jacockshaw, Flickr.

EDIT: Here is the Friendfeed discussion that emerged around this post:

ASME Conference 2010

2010-07-24T10:18:00.000-07:00

The Association for the Study of Medical Education (ASME) had their conference in Cambridge, UK earlier this week. You can find out more about the conference here. I did tweet thoughout the conference and although I was a rather solitary voice I did have some good interaction with my followers as usual. A transcript of tweets can be found here.

I wish I could link to some of the very interesting presentations I attended but they are not online as far as I am aware. However, one of the keynote addresses was given by John Norcini, from FAIMER (Foundation for Advancement of International Medical Education and Research) using Prezi. I searched the website and found his presentation so can share it here with you.

Although ASME is an international organisation it does have strong UK roots so his presentation on the problems for medical education internationally was an interesting change. I should also point out that the UK does not yet have a national licensing exam. Licensing is carried out by medical schools who are accredited by the GMC (although I did hear some talk at the conference that a national exit exam may be back on the agenda).

One of his most interesting points was that often medical education followed fashion, which was then evaluated. He gave Problem-Based Learning (PBL) as an example of this. But there was evidence during the conference that other aspects such as the use of simulation are also being thought of more critically now. We don't have the evidence to justify widespread use.

I also talked to some other doctoral researchers about the need for a network to share our questions and learning. Watch this space for more about that!

What next for medical education? on Prezi

Social learning with Twitter

2010-07-14T12:09:00.000-07:00

Social Learning: an explanation using Twitter

View more presentations from Jane Hart.

I was looking at this presentation by Jane Hart when I thought I should share my own screencast about using Twitter for learning. I have been experiementing with using Screenr to record feedback to students who ask me questions through a discussion forum in Blackboard. I discovered that not all students know what a screencast is so that is something for me to consider in future years! And I have also experimented with downloading and sharing the short videos I've made on a Facebook page. Like all my screenrs this is quick and dirty but hopefully gets across quite a nice story.

Making it easier to share content

2010-06-23T13:07:00.000-07:00

My birthday was 10 days ago and I got a new camera. One of the first photos I took was of a bus at the end of my street.

A week later I joined the Guardian Cardiff Flickr pool. This pool supports the Guardian Cardiff local blog which has been doing great work in recent months. So today when Hannah, who runs the site, was looking for an image to put along side a story on the re-organisation of public transport in the city she used mine. Here is a link to the story.
So what if I took some photos that were relevant to education- lecture theatres, computers, an ipad(!), small groups etc. Which group would I put those in to make it easy for other educators to find and use in their materials? A quick search of Flickr shows that that a general education group- or a specific one for higher education- doesn't seem to exist yet.
So I propose that we start one. We would need to figure out some guidelines. It would seem sensible that images added to the pool should be under a Creative Commons license allowing re-use. What else do you think might be important to specify?
I am sure that there is lots of really useful content out there already. This pool would just make it a little easier to find out about. Martin Weller blogged about the Guardian local project recently and proposed developing something similar for education. I think this could be a first step. I think at this stage in social media we know that there is little point in trying to set up new sites and services. Get people to keep doing what they are doing already- just a little smarter!

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

2010-05-19T01:38:00.000-07:00

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.

How I made a Prezicast.

2010-03-31T16:26:00.000-07:00

If you are going to share your presentation online then you need audio. A presentation which is not text-heavy, and doesn't cause death by bullet-point, can be hard for others to follow if they can not hear what you are saying to make sense of the images. A few weeks ago I discovered how easy Slideshare makes adding audio to a powerpoint presentation to make a screencast. (And I had quite a lot of help from my twitter support team!)

Last week I gave my first presentation using Prezi and recorded the audio with my trusty Zoom Q3. I then set about trying to figure out how to put the two together. It causes quite a lot of consternation to users but Prezi does not host audio on their site. Allowing a sound file to be synced to the Prezi timeline would seem a very sensible thing for them to introduce so there must be a very good reason why it has not been introduced. I found some mention of possibly adding a sound file at the start of the presentation which would run throughout. This caused me to spend far too long- several hours- trying to figure out how to convert a .wav file (from ZoomQ3) to .swf (Prezi is flash-driven). I didn't manage it and was about to give up on the task entirely.

Instead I went back to one of the first solutions suggested to me : record a screencast with Camtasia. It's quite an expensive programme so I signed up for a trial. I then played my audio file outside of Camtasia and recorded the screen as I navigated through the Prezi in time. The end result is not perfect but it is good enough! If you are doing this make sure that you do not record sound within Camtasia when making the screencast.

I produced a video file... I think I chose mp4, which I then uploaded to Vimeo. Why did I choose Vimeo? Well, it was the first time to use this as well and I guess I like the clean interface when embedded.

So, that is how I made a Prezicast You can see the end result here. If you have managed to do this some other way please let me know. I did think about embedding the audio separately but I think that would have been more perplexing for my audience! Do you think any other screencast software would allow me to do this? Maybe even free?

Integrating Web 2.0 with Blackboard

2010-03-24T01:41:00.000-07:00

Untitled from Anne Marie Cunningham on Vimeo.

This is a presentation that I gave yesterday at a Cardiff University conference on Technology-Enhanced Education. You can see the Twitter stream here. It is about my experiences trying to use free social media tools with Blackboard. These are simple tools that any one could use and many of the people who read this blog will be very familiar with them. But I hope you might find it interesting.
The presentation uses Prezi. You can navigate your own way through it here on the Prezi website. I reused a template and you can reuse my presentation as well.
Near the start I mention that Web 2.0 is an old hat term. That refers to a tweet I saw in the last few days saying that social media is rising in popularity on google, as web 2.0 sinks. But I don't have a link to the source! (EDIT: The very helpful @sarahnicholas sent me this link which explains all)
Here are some of the services that I refer to:
Delicious (social bookmarking)
Diigo (social bookmarking)
Screenr (Quick and easy screencasts)
SNAPP (for analysis of networks in discusion forums)
Mindmeister (collaborative mindmapping)

Oh, and if you have any views on how we should model developing PLEs for students please leave a comment.

First Prezi Presentation!

2010-03-23T19:20:00.000-07:00

This was my presentation at #cu_tee today. Prezi is a lot of fun to work with and to present with. Ths presentation is based on a template available on the Prezi site which I reused. I recorded audio of my presentation and if I had used Powerpoint you would now be looking at a Slideshare with sound! But Slideshare doesn't support Prezi, and Prezi does not support hosting audio on their own site. This is a BIG drawback.

Integrating Web 2.0 with Blackboard on Prezi

Why Google Scholar has got a lot more useful for me!

2010-03-18T19:50:00.000-07:00

Everyone knows the pain of finding an interesting article and then realising that you don't have access to it. It's not fair. If you work for a university there is a good chance that your library does subscribe to the journal but figuring out how to access it will take a few steps. But now if you work in Cardiff University, at least, Google Scholar just got a lot more interesting. It is now easy to know which journals you really will have access to.

This made me think... wouldn't it be great if Google Reader knew which journals I have access to? And is there a search engine which accesses PubMed which knows these journals? If you know the answer to this, let me know!

CiteULike vs. Delicious

2010-03-18T19:33:00.000-07:00

On Twitter tonight I was asked how CiteULike was different to Delicious. I recorded this quick screencast to show why a tool like CiteULike is so much more useful for managing academic references.

How to set up a custom search in PubMed and get e-alerts.

2010-03-18T19:18:00.000-07:00

Yesterday a friend asked how he could get email alerts when new articles were published to Medical Education journals. I blogged about the query here. This is a solution using the journal search in PubMed. You will miss out if an article is published about medical education in the BMJ or the Lancet, but maybe soon publishers will let us subscribe to RSS feeds where we can specify the topics. Of course in the mean time you could have a pubmed custom search using MESH, and if any of my medical librarian colleagues wants to do a quick screenr about that I will be delighted! Here is how to do the most general search.

From Google Reader to CiteULike, Delicious and Twitter

2010-03-18T19:04:00.000-07:00

In my last post: Managing RSS feeds from journals/databases etc, I said I would record a screencast about how I am managing my Google Reader feeds today. It might be different tomorrow or next week! It would be great if you could tell me what you are doing too.

Managing RSS feeds from journals/databases etc

2010-03-18T06:50:00.000-07:00

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:)

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

2010-03-17T12:34:00.000-07:00

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?

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

2010-02-17T16:59:00.000-08:00

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

Information about the patient
Information about disease and management
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.

The ALISS project

View more presentations from picah.

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.

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

2010-01-31T18:33:00.000-08:00

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?

How do you feel about medical student shows?
Are medical student shows appropriate to share online?
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?
Would it affect your view of the individuals involved as professionals?
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

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

2010-01-30T10:14:00.000-08:00

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:

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

January Family Case Study Lecture

View more presentations from Anne Marie Cunningham.

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

How to sign up to Diigo from a group invitation.

2010-01-26T15:01:00.000-08:00

Diigo could make responding to a group invitation easier.

2010-01-26T11:52:00.000-08:00

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???

I'm a Diigo education pioneer!

2010-01-26T11:29:00.000-08:00

History
Last year I started an account on Delicious for the Family Case Study, my main responsibility in Cardiff's undergraduate medical course. I used it to save links which I shared with students through Blackboard, particularly in the dicsussion forums there. But I was also keen to have them join a network with me.

I was a little bit frustrated by Delicious because of

not knowing who students were... they tended to use their Cardiff Uni ids which I didn't know.
not knowing what students looked like... no avatars on delicious
not being able to send them a message, to say thanks or query how they might use a resource

There are a few posts on this blog discussing the relevant merits of delicious and diigo. Although I established a Diigo educator account last year, I hadn't got round to using it as I found Diigo quite clumsy to use. It seemed to be trying to do too much. So for my own personal social bookmarking I stayed with delicious too.

2010 rolls round, and the next set of students are about to start the project. I was going to record a screencast explaining delicious, but realised that I couldn't bring myself to ask them to sign up for a Yahoo ID. So I decided to look at the Diigo account again.

Diigo Educator Accounts
These allow educators to set up private areas for their students. I had the choice of generating accounts for all students or inviting them to join by email.

Generating accounts
Accounts can be generated by uploading a .csv file - infortunately the link which specified the format of the file Diigo would like was broken, so I uploaded just names. This generated 320 accounts and passwords, which I guess I could have put on Blackboard, but it didn't seem a great option. So I set about deleting those accounts to try a different way.

Inviting by email
220 of the 320 students told me their preferred email address when completing a google form last December. For some reason it wouldn't let me copy and paste that many email addresses in to the box. And there was not the option to upload email addresses from a .csv file. But it was possible to import contacts from an emai account. So, I set up a new gmail account. Imported the email addresses from a .csv to the gmail account and then imported the contacts in to Diigo. The complexity of this sequence makes me think that I must have been doing something wrong!

What happened next?
So far 6 (six) students have signed up in the first few hours. The very first student tweeted about the sign-up and I found her when searching twitter for diigo! Another of my students has sent me a message on twitter too which makes me wonder if it is worth trying out the twitter account I registered for the course.

Then... I wondered what the sign-up experience was like for the students. So, just as I had with google docs I invited myself. That's the next post......

Why I am starting an EdD

2010-01-24T08:37:00.000-08:00

On Thursday I started the first module of a Doctorate in Education in Cardiff University School of Social Sciences.

Why a higher degree?
I'm been working in Cardiff University since 2002. I completed a Masters in Public Health and considered pursuing a PhD in a clinical area. But.... it was not the right time in my personal life and instead I took on increasing teaching responsibilities and found myself enthused.
Having a higher degree is not necessary for or a guarantee of promotion on the basis of excellence in teaching, so this is not the reason I am committing myself to another 5-7 years of study. Some would argue that pursuing a PhD is unlikely to develop the skills and expertise necessary for an excellent teacher and I struggled with this myself.

Why an EdD?
I came across the professional doctorate programme last year. This seems to me to provide a better structure for personal development for someone who aspires to excellence in teaching. I will complete 8 taught modules over the next two years, on a range of topics related to education, and research design. The Cardiff course is unusual in that it is within Social Sciences rather than education. The first module 'Changing Modes of Professionalism" had students from the education, health and nursing streams which I found a considerable strength.
After 2 years I will have 3-5 years to complete a doctoral thesis of 40-60,000 words. I am not yet sure what the subject of the thesis will be and will use the next year to refine ideas. I have already had tentative supervisors allocated and will meet regularly with them throughout the course.

What do I expect to gain?

high quality learning opportunities
to join a local network of professionals engaged in doctoral study
the challenge of studying within a different discipline
a qualification

I hope to share much of my learning through social media so I hope you will join me on my journey.

.

Doctors should be advocating against patients' digital exclusion, not scare-mongering.

2009-12-16T10:21:00.000-08:00

This post in an edited version of my comment on KevinMD's post on "Patients using internet health information without physician guidance".
...........................
I’m a doctor. I’m a GP (family doctor) in Wales, UK and I teach medical students. I work in a deprived area and I wish that many more of my patients, rather than less, accessed information that could help them be more healthy. But many of my patients do not have easy access to the internet. This impacts on their health in many ways. One that is less often considered is that digital exclusion leads to reduced income.

Recently there was a post on StoryTellERdoc about “Grim Google”. This related the story of a young, healthy man who presented in ER with bright, red rectal bleeding convinced he had bowel carcinoma because he had googled his symptoms and saw that this was a possibility. The story itself and most of the comments are quite scathing. But is this the appropriate response to this episode?

In the UK we know that despite universal access to healthcare we still have differences in cancer survival rates between areas, with patients in well-off areas living longer. This may partly be due to delay in diagnosis.

With regards to late-stage diagnosis of colorectal cancer, research in 1996 in the US showed that patients living in areas of low socio-economic status (SES) were significantly more likely to be diagnosed at a late stage compared to those living in areas of high SES. You may think that times have changed, but more recent research in Denmark- covering 1996-2004- shows that older, wealthier patients, and younger more highly educated patients are less likely to be diagnosed with rectal cancer at a late stage.

So a simple story that seems to illustrate the fallacy of patients trying to diagnose themselves online, may instead represent the awareness and health behaviours which mean that those with the know-how feel empowered to seek care for what could be life-threatening symptoms.

We should be encouraging more of our patients to access health information, especially those who will find access harder. In fact we should be advocating against digital exclusion because its influence as a cause of health inequalities may increase in coming years.

When are Influential Blog Posts published? And what makes one anyway?

2009-12-10T12:29:00.000-08:00

I was really surprised when I noticed last month that Sarah Stewart had nominated me for an Edublog Award for Most Influential Blog Post. Actually, I was more than surprised I was shocked! The post in question was written a few weeks after I broke my wrist and was in response to an online BBC news article, with the title "Tech Addiction 'Harms Learning'". You can read the blog post here. It is about poor research and poor journalism. I'm not so sure how influential the article was, as none of the authors, the universities involved, or the publishers responded to my emails seeking clarification on the research.
I discovered later that the BBC were not the only people to publish the story. Most of the main UK newspapers had also picked up on it. So as google-sidewiki appeared at the same time I went around leaving links to my blog post anywhere that I could not leave a comment directly.
Paul Bradshaw did manage to get a response from the BBC after he picked the story up on his blog. Well done Paul! But not such a great response from the editor.

I am not so sure that the blog really was influential, or how anyone judges what an influential blog post is. But I am very happy that Sarah nominated me, and that the Edublog Awards team agreed it should be shortlisted.

Still, this post starts with a chart. There are 30 blog posts short listed in the Most Influential Blog Post category and I noticed that several of them, like mine seemed to be posted in the latter half of the year. So, why is September such a good month for blogs? Are we all well rested after the summer and keen to get back to blogging? Or are memories just short, and when nominating posts we tend to remember best what we have read most recently?

What do you think?

Edublog awards 2009

2009-12-08T17:08:00.000-08:00

My nominations for the Edublog awards 2009 are:

Best individual blog : Science of the Invisible
Best new blog : Dundee Chest
Best teacher blog : Dundee Chest
Best librarian / library blog: Laika's MedLibLog
Best educational use of a social networking service ELESIG Ning

I'm sorry that I am not writing why I am nominating these (because it is later!) but if you have a look, it will be self-evident! A special mention has to go to Dundee Chest which is an outstanding example of going beyond the walls of the VLE to connect with medical students and the world.

UPDATE: I checked yesterday to see if my nominations had made the final list. It looked like they hadn't. And then I realised that I hadn't followed correct procedure by emailing in the nomination as well as just linking. Sorry to the great people I nominated. Next year!

What happens when you invite students to collaborate on a google doc....

2009-12-08T10:31:00.001-08:00

Confused Sign
Originally uploaded by kudaker

..... and you use their university email address?

I've had a gmail account for years. I've used google documents with others for years. I've presumed that when I sent invites to universith colleagues to access a timetable in a google doc spreadsheet and fill in their availability etc, that this was quite an easy task to respond to. Although I had noticed that few people tended to actually add anything to the spreadsheet and emailed me back instead.

A few weeks ago, I invited the 7 students who I am working with on an audit project over the next year to collaborate on google documents. I used their university emails. Some of them could access the initial brainstorming document but they seemed to be denied access to to edit. Others couldn't even see the document. And a few 'asked permission' to edit, which I agreed to, although it seemed to be to the same email address which already had permission to edit! I was confused. They were confused.

So I decided to try it out for myself. I gave access to myself through my Cardiff Uni address to see how the process worked. This is what happened by way of my explanation to students:
"1. I received an email with a link which showed me the document and asked me to sign in with a google acount.
2. I didn't have a google account for Cardiff Uni address so I had to click to set one up.
3. I entered in Cardiff Uni email address and selected a password.
4. After a few minutes I received an email asking me to confirm that I had set up an account. When I clicked on this/logged in and clicked on docs, it looked as if the account was completely empty. There were no documents there.
5. I went back to the email with the link to the document. I clicked it and this time instead of being brought through to see the document I was told that I have been invited to share a document and I could click to accept or decline.
6. I accepted and was then able to go in and edit the document and invite others, and send all of you a mesage!
So if you are having trouble could you please follow these steps."

What have I learned? 1. If you invite someone to collaborate on a document and they don't already have a google account in that email address they might find the process more difficult that you think. It might be a good idea to instruct them to start by creating the google account.

2. I am so familiar with google accounts and documents that I assumed the process would be more striaghtforward to others than it was.

So, now for the question. What has been your experience of collaborating with students, or another group, who are unfamiliar with gdocs? What tips do you have?

Thanks!

Medical mistake

2009-11-29T15:30:00.001-08:00

Medical mistake
Originally uploaded by Lobke van Aar

What does this image mean to you?

Why I think I am a patient and not a consumer.

2009-10-29T17:05:00.000-07:00

In August I was having a great time at the Greenman festival in South Wales when I slipped and fell backwards when dancing. I broke my radius (and my ulnar styloid process). The fracture needed internal fixation with k wires and I had to spend two nights in hospital.

The next day after discharge my husband and I returned briefly to the festival... well, we had to pack up the tent! In the picture above I am sitting in a near empty comedy tent in between acts. This was my first few hours back in the real world. It was a Sunday evening and I had to let my doctor colleagues know that I would not be coming in to the practice. I was figuring out how I would cope with not being able to drive for several weeks. Soon after I went on holiday to Co. Kerry and watched on as the rest of my family set off for a day hike up Ireland's highest mountain.

My wrist got more painful and my next hospital check showed that the wires were pressing on my skin. Moving my thumb became very painful and I worried that I had ruptured my extensor pollicis longis tendon (a rare complication of Colles fracture) and was glad to be reassured that I hadn't. I googled to see if I could find an explanation for the pain in academic literature, or in the blogs and forums of others who had had a fracture like mine. But I didn't find anything. One night the pain in my arm woke me from sleep and I lay for a while half-crying before I remembered that the solution was to take more painkillers.

I wondered if I should return to the clinic early but I knew that I had been told that the wires couldn't really be removed before four weeks so I just had to wait it out. Two weeks after that the cast was removed and I could start exercising to conquer the stiffness that immobilisation had produced. I am still under the care of some excellent hand therapists. Tomorrow morning we will document how successful I have been in getting back to normal.

Whilst my arm was in the cast I did not see patients. I worked in the university but I felt too much of a patient myself to act as a doctor. But what do I mean by patient? I hadn't really thought about the term too much myself until I started seeing people use it in a way that I didn't recognise.

Last week the E-patients Connections 2009 (#epatcon) conference took place. Although it used the word e-patient in the title, the strapline made clear that this was about how to "reach, engage, educate today's digital health consumers". Consumers not patients. There were patients speaking there. ePatient Dave talked about how companies wanting to connect with patients should be authentic. Kerri Sparling (from Sixuntilme- a fantastic blog about her experiences of living with diabetes) wrote "It's a strange dance, watching people who are living with different health conditions in the same room as marketing teams and pharma companies and people who might view us as "consumers.""

The day after #epatcon I lamented that the only consideration of epatients at the conference had been as a consumers, and that perhaps there was no-one to fund a conference to look at the "real experience of patients". Jonathan Richman replied "I don't get it. What's the diff between 'consumers' & 'real patients'. They're the same ppl, just a diff word."

So is the word important? I have been recommending a book by a Dutch philosopher Annemarie Mol, " The Logic of Care: Health and the Problem of Patient Choice" in the past few months. Some of it is available here on Google books if you want to look before you buy (and you can read a great post by Ken Bottles on his thoughts about this book here). She describes how the response to the medical paternalism was an undue focus on patient choice as part of a consumerist model of healthcare. She is not opposed to patient choice and neither am I when it is appropriate but it is not sensible for it to be the focus of all interactions in health. It also implies that there may be a choice when there is not. Mol's study is of patients and professionals working with diabetes and some of her points resonate with another recent post by Kerri on Sixuntilme. Kerri talks about the guilt that is inflicted on those with Type 1 diabetes when they are made to feel that any deterioration in their illness is due to bad choices that they have made, and not to the disease itself. As the prologue of Mol's book states, she concludes that "good care is not a matter of making well-argued individual choices but is something that grows out of collaborative and continuing attempts to attune knowledge and technologies to diseased bodies and complex lives". Diseased bodies and complex lives.

So if consumer is not a good word to describe the experience of someone living and dealing day to day with a disease or disability, is patient any better? Patient as an adjective is defined as "bearing or enduring pain, difficulty, provocation or annoyance with calmness. It is only perhaps the "with calmness" part which is not appropriate. I often felt not very calm as a patient for a number of reasons. But this definition captures more of the root of the word "to endure" than does the most common definition of the noun "one who receives medical care, attention or treatment". When patients go online today to tell their story they don't just talk about their experiences of healthcare. That is just one part of dealing with an illness. There is another whole world outside of the hospital, doctor's clinic and medicine cabinet that must be negotiated. And that is what epatients tell us about. It is what I wanted to learn about when I searched for the stories of others who had endured a Colles fracture like me.

Some think that other terms such as survivor are more appropriate. I feel that I endured my wrist fracture rather than survived it, and I feel the same about other experiences of patienthood which I will not share here. Epatients tell us about how to endure and survive illness, how to collaborate with the professionals who care for us, and how to actively participate. The don't tell us about how to consume.

How do you feel about being a patient? Do the words matter at all?

Information Literacy Teaching- Sabotage!

2009-10-08T12:31:00.000-07:00

Today in a tutorial I met one of the students I spoke to last summer when doing the first year portfolio reviews. I mentioned that I had blogged about how he and other students used social media, including YouTube and Wikipedia.

He then told me a story about a teaching session they had on information literacy. They had been asked to compare an article on Wikipedia with a review paper on the same topic from an academic journal. The session aimed to show the inaccuracies of Wikipedia and how it could not be trusted. But this student sabotaged the exercise. He demonstrated that the essential quality of Wikipedia is that it can be edited. Before most students had got round to the piece of work, he went into the Wikipedia article and improved its quality by updating the content and referencing the article!

He says that the organisers were not too happy, but I'm sure they were. He had demonstrated:

Wikipedia is always changing
It can and often is a good source of information if we all contribute
Medical students CAN be Wikipedia editors.

Well done!

The BBC responds.

2009-09-24T10:12:00.000-07:00

A week had gone by and there was no response from BBC Education News to my email informing them of my blog post "Tech addiction 'harms learning' .....really??? $24.99 and I am no wiser". I probably would have left it at that.

The post was about an alarmingly titled BBC online news story on a study set in an English secondary school, that could only be accessed by spending $24.99. I did buy it and I used this blog to inform others who were interested but didn't purchase it. My finding was that this was a piece of poor research, done by people without backgrounds in education, and presented in a way that suggested that any peer-review process it had been near was 'light touch' in approach. In short, this Sigel Press "Special Report" didn't live up to the publisher's claim that it would contain "groundbreaking information", be "written by global experts", and be an "indispensible resource[s] to keep you up to speed in your field." For the record, my field is not secondary school education. I am a doctor and a university teacher and researcher. I maintain this blog as a way of connecting with others in the wider education community. Several of my past posts have criticised the methodology of peer-reviewed research on the use of new media in medicine; research which has been more or less reported in a positive way. I make it clear on this blog that I don't support the use of technology "for the sake of it", to the extent that I have on occasion gained the moniker "web 2.0 skeptic". And if there was evidence that the use of the internet or other tech really did harm learning, I would want to know about it. I'm not a push-over.

I emailed BBC Education News because I thought that anyone who had the report in their hands would have reached the same conclusions as me. I emailed Cranfield University PR department as well, and they thanked me and said they would pass my comments to the authors immediately. I didn't really expect to get any responses.

But Paul Bradshaw wasn't happy. He is a senior lecturer in journalism at Birmingham City University. He had emailed the BBC Education department as well and today he started chasing for a response. On the off chance I emailed the BBC again and 30 minutes later there was a reply to the email sent a week earlier. This is from Gary Eason, the BBC News website education editor:

"Hi Anne Marie
Thank you for your thoughts. The author of the article did have the whole report in front of her and interviewed one of the authors. I do not agree that our headline is "sensationalist".
best wishes
GE"

OK, we can agree to disagree I suppose. But then I saw Paul's blog post about the matter. His interaction with Mr. Eason was considerably longer and contains the following quote:

"It seems to me the results don’t fit her world view so she sets about rubbishing them. Is she seriously arguing that ‘cut-and-paste plagiarism’ is not a problem?”

Spot the logical fallacies. This study was not good science and should not have been reported by the BBC. My worldview has nothing to do with it and is simply a red herring. In any case as I have pointed out above, I am not dogmatic about the place of technology in education. I look for evidence to inform me about what we should be doing.

Next , we have the straw-man attempt to rubbish my blog post. I made no comment at all on whether plagiarism is a problem. All of us working in education know that this can be an issue if assessments are designed badly. But my argument was that this research told us nothing about the relationship between learning and 'addiction to technology'. It possibly could have done as the researchers had data which could have been analysed to tell us something about this. But they didn't. Yes, it was a small study with a dubious response rate but they failed to make the best of the data they had.

Tom Morris comments on Paul Bradshaw's blog that this is a "perfect example of a glaring editorial problem". I think I agree. What do you think?

Email to BBC News Education Re: Tech Addiction "Harms Learning"

2009-09-17T09:44:00.000-07:00

Dear BBC

I was disappointed when I read this article as I
could immediately see that the research was likely not to be of good quality.
But I was more concerned that you had managed to construct a sensationalist
title to go along with it. A cross-sectional study could never establish the
kind of causative relationship that your title infers.

I paid $24.99 to download the full report and my suspicions of poor
standards in research were supported. Did the author of this article actually
read the report or simply base their story on a press release from Cranfield
University?

Since this report is not freely available to the public, I think that the
BBC, a publicly funded body, has an even greater onus to ensue high
quality reporting of such 'research'.

Here is my blog
response.

Yours faithfully,

Anne Marie Cunningham
.......................................................
So how do we go about starting a campaign for decent science journalism on the BBC?

Tech addiction 'harms learning' .....really??? $24.99 and I am no wiser

2009-09-16T14:36:00.000-07:00

EDIT 11/12/09 This post has been nominated for an Edublog Award for "Most Influential Blog Post" You can vote here. Thank you to Sarah Stewart for her nomination.

Last night, I started noticing tweets about this BBC News Education story in my twitter stream. Researchers at Cranfield University had published a report "Techno Addicts: Young Person Addiction to Technology" about a study they had conducted where 267 secondary school pupils completed a written questionnaire about their mobile phone and internet use. Included in the BBC story is the statistic that 63% of respondents 'felt addicted' to the internet and 53% 'felt addicted' to their mobile phoneThe BBC headline ("Tech addiction 'harms learning'") suggests that the researchers have established a relationship between this feeling of addiction and poor learning. In fact, the headline suggests a causal relationship which a cross-sectional study could not establish, but the body of the text doesn't really support any relationship between addiction and learning.

I wanted to know more so I set out to find and read the report. Googling the full title pulled up a link to the Sigel Press site where the report could be purchased for $24.99. And a press release from Cranfield university confirmed that this was the only way to get my hands on it. It also was clear that none of the authors had an education background. The 2 main authors, Nadia and Andrew Kakabadse, have a blog showcasing their many interests but education doesn't feature amongst them. They descibe themselves as "experts in top team and board consulting, training and development". I bought the report.

I expected the report by university academics to follow a standard format but it doesn't. It is 24 pages long and contains no references and no appendices. The survey instrument is not included.

Mainly it consists of charts illustrating question responses. Unfortunately it contains some typos and poor grammar.

No response rate is given, although we are told that the single school contained 1277 students and that there were 267 respondents, so it may have been as low as 21%.

With regards to 'tech addiction' this seems to have been a self-assessment based on response to the question: How addicted are you to the internet or your mobile phone? The proportions given in the BBC report are those who stated they were 'quite' or 'very' addicted. Of course, we don't know what the students meant by 'addicted'.

With regards to this addiction harming learning, there is no analysis relating the perception of being addicted to outcomes in learning. In fact very few of the questions are related in any way to learning.

It is hard to understand several sections of the report because of lack of access to the questionnaire. For example, with regards to plagiarism the authors state that "A high proportion of students (84.3%) openly admitted that they inserted information from the Internet into their homework or projects on a number of occasions." The tone of this sentence reflects some of the bias which is found throughout the work. The authors don't seem to be aware that if referenced it is acceptable to insert information from the internet into work, so the students would have no reason to be ashamed and fear 'openly admitting' this. The finding that 59.2% of students have inserted information into work without reading it is more concerning. It is also reported that 28.5% of students "feel it acceptable to insert information from the Internet straight into schoolwork without editing or making adjustment, recognising that such behaviour is considered plagiarism." It would help a lot to see how that question was actually worded in the survey, as in the figure it is simply represented as "Ok to “insert” information from the Internet straight
into schoolwork- Yes/no". That's not quite the same!

But there is no analysis relating amount of time spent online (or perception of addiction) and likelihood to insert internet contents into work without reading it. It may be that those who spend less time online, have less skills in information literacy and are more likely to plagiarise.

In summary this report tells us very little about internet addiction or learning. Do you think that someone writing for the BBC website actually read the report? Many of those who tweeted about the BBC article thought there were no suprises in the findings, and that perhaps it suggested that teaching methods needed to change.

This evening Ben Goldacre and Lord Drayson were debating the state of science journalism in the UK. I wonder why do the BBC give space to research which is so poor? How did they manage to concoct such an alarming headline? And why do people believe it? Is it because as one person responded to me last night, there is the perception that "U may fault methodology, results true".

And the quotes from the authors are not even results, just their thoughts which may chime with readers. But it's definitely not science.

Image: "Playing with the new baby cell phone" http://www.flickr.com/photos/cwinters/2150107228/

EDIT: You can read the BBC response to this blog post here.

Apologies for quietness

2009-09-16T11:32:00.000-07:00

It's 2 months to the day since my last post. First there were holidays and then I broke my wrist. I was whirling round in a dance tent at the Green Man festival and then suddenly I wasn't. I was rushing backwards towards the ground and put my left hand out to save myself.

I think a broken wrist is a pretty good excuse for a blogging hiatus, though my story is not quite as dramatic as Stephen Fry's.

Supporting Scholarship in Medical Education: The Role of Social Media and Networks

2009-07-16T02:57:00.000-07:00

Supporting Scholarship in Medical Education: The Role of Social Media and Networks

This is the presentation I am shortly going to give at #asme09.
I will make more notes soon and update on feedback.

Web 2.0 tools and medical education - more sceptical comments

2009-07-12T17:54:00.000-07:00

Last week, @drves described me as a web2.0 skeptic. Those who know me in 'real-life' would certainly agree that I ask many questions, and may doubt received wisdom. Now it seems this facet of my personality is more apparent in the online world too!

Lemley, T., & Burnham, J. (2009). Web 2.0 tools in medical and nursing school curricula*EC Journal of the Medical Library Association : JMLA, 97 (1), 50-52 DOI: 10.3163/1536-5050.97.1.010

The above paper was published in January 2009. It has been talked about a lot on twitter today because it was mentioned in a student BMJ article, which was then picked up in a blog post by Dr Ves. The finding that '45% of medical schools use Web 2.0 tools in their curricula' is that most often cited in twitter and elsewhere. So what does this mean and how did the authors draw their conclusions?

Method
A survey was conducted using Survey Monkey. Participants were identified by emailing a link to the survey to 3 different email lists:
DR-ED (for those involved in medical education) 1383 subscribers
AACN (for those involved in nursing education) 150 subscribers
AAHSL (for academic health librarians- who were asked to forward the survey to those responsible for curricula in their institution) 146 subscribers

The questionnaire is given in an appendix.Although the title and background to the article talk about web 2.0, the first questions asks about use of the following 'web 2.o/social networking tools':

Blog
Del.icio.us or some type of social bookmarking resource
Flickr or some type of photo-sharing resource
Moodle
MySpace, Facebook, or some type of online community
Podcasts
Videocasts
Wiki
YouTube or some type of video-sharing resource

I don't know why Moodle, which is an open-source,and flexible learning management system (LMS) or virtual learning environment (VLE) is included as a web 2.0 or social networking tool. Moodle does support the use of web 2.0 tools, but so can other VLEs, so it is unclear why it is listed here.

Results

There was no way of tracking how those who responded to the survey found it, ie did they find it on a list themselves, or was it passed to them by a librarian? In any case there were responses from 36 individuals involved in medical school education, and 19 individuals involved in nursing school education.

The response rate from the medical school list is no higher than 36/1383 or 2.6%, amd possibly lower if some of the responses came via the librarians' list.

Several responses may have came from individuals in the same medical or nursing school as responses were anonymous.

Despite this the authors go on to report results as the percentage of medical schools which are engaging in the use of web 2.0 tools, rather than the percentage of medical educator respondents. The individuals who responded that they did not use these tools may work in institutions where many others do, and the individuals who responded positively may be the sole educators in the institution to use the tools out of several hundred or more.

The questionnaire did contain a question ("Please briefly describe how these tools are incorporated into your instruction.") which allowed free-text response and could have provided some information for a qualitative data analysis, but no results are given.

My conclusion

Does this paper tell us anything about the use of web 2.0 tools in medical and nursing schools in the US? No.

Is the author's justification of validity despite low response rate, because the study is "to gain insight into an issue", appropriate? No, because exclusively quantitative results are published.

This paper is short. It is open-access. I think that with a cursory look, most people would have reached similar conclusions to me. So why were so many people referring to this paper today without any criticism of the severe weaknesses in methodology?

Thanks to @drcolinmitchell for drawing my attention to this research.
He has also published a great post about this paper.