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

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

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

Solutions suggested were

• Camtasia .... either as powerpoint plug-in or by exporting ppt as images and importing to Camtasia
• Slideshare
• Garageband (for a Mac and with benefit of possibility of publishing as a podcast from @nlafferty)

I was working on a PC so ruled out garageband. I had downloaded a trial version of Camtasia and spent a while trying to figure out if I could manage it. It seems to be a great product and I should spend longer with it, but I couldn't see how I would be able to do this without very carefully changing slides in time to the recorded audio. It's worth noting that Powerpoint itself doesn't seem to have an option to add existing audio to a presentation.

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

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

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

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

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

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


So in summary:

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

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.

Diigo could make responding to a group invitation easier.

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

I'm a Diigo education pioneer!

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

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.

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