Sharing hashtags for upcoming medical/health conferences.

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!

Should the NHS be on Yahoo Answers?

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

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

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?

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

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

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.

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

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

"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?

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

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

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

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...

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.

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

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!

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!

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

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.

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

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

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?

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!

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

Early 2009: Phil Bauman's post on 140 Healthcare Uses for Twitter caused a lot of excitement. Then there was talk about surgeons twittering from operating theatres. It all left me a little bit cold. I couldn't see how I would use social media to support my work as a GP. But then I came across a review by Richard Smith from the BMJ in 1996, "What Clinical Information do Doctors Need" which helped me understand my resistance and the potential. To summarise there are three kinds of informations that doctors need

1. Information about the patient
2. Information about disease and management
3. Information about local services to help manage the patient's condition.

I could (and might) do a whole other blog post about how social media might be useful in direct interactions with patients. In medicine we are trained almost exclusively for synchronous communication with patients. When I am in the same room as a patient we can usually communicate so much better. Speaking on the telephone is the next best thing and has the added bonus that it is much more convenient for the patient.  But as I say this needs a lot more room to explore so I'm not going to focus on this now, but safe to say, I am unclear as to see social media could help me gain information about patients at the moment.

Next, there is information about diseases and management. I'm a generalist, and I work in the UK and in a practice with several other doctors. For many conditions such as diabetes or cardiovascular disease, my management is determined by national guidelines, which are then tailored to individual patients through shared decision making. I will often look for information about these more common and less common conditions, and I will use sites such as TripDatabase which will find me relevant research papers and guidelines quickly. But I don't bookmark the information I find there. Why would I? The next time I need some information about that condition, which may not be for a few months, I will search again because the evidence may have changed. Now, this is different to how I use social bookmarking for my work as an educator or as a student (I'm registered for an EdD). Social bookmarking is useful for infomation that I have come across through serendipity (perhaps through Twitter), or because I am specifically looking for information that I don't have time to completely study now but want to be able to find again. But my infomation needs in clinical medicine tend to be more just-in-time. I don't think that I am so alone in this and it probably explains why I have found it hard to find delicious doctors. 

(Should I be reading generalist journals to keep up to date? The RSS feeds of the BMJ, NEJM and the Lancet swamped my google reader and made me feel inadequate! But here is somewhere where social media is useful. If you have any interest in what is happening in the big medical journals sign up to the RSS feed from Richard Lehman's Journal Watch blog. He writes with wit, and cuts to the chase.)

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

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?

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


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


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


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


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


Questions
But what do you think?

1. How do you feel about medical student shows?
2. Are medical student shows appropriate to share online?
3. Would seeing photos or videos of doctors, nurses or pharmacists in a state of drunkenness on Facebook affect your view of the profession as a whole?
4. Would it affect your view of the individuals involved as professionals?
5. What determines your trust of the medical profession as a whole?

Feel free to answer these questions or leave any other comments.


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




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