I started this blog with the aim of recording my web 2.0 learning journey and also in the hope that I would find a community of people interested and participating in medical education. Today this bore some fruit as I participated at a distance in an online seminar about these topics.
The presentation by @ajcann, University of Leicester, reported on courses to help students develop skills in the use of web 2.0 and information literacy. The slides and document give a good summary of the findings. Students appeciated tools, like customised google searches and a Pageflakes page, that helped them find resources more quickly. But they did not use the social aspects of tools provided. There was not evidence of the formation of a community of practice.
There was no audio-visual streaming of the seminar, so I could only pick up on the talk in the room through the tweets of those present. You can find them here: #UOLTAN. I am sure that this means that I have missed out on a lot of valuable interaction and responses to the material presented. I commented that I was not surprised that medical students did not use social bookmarking because despite looking for the past few months I have only managed to find one doctor who uses social bookmarking to record sites that are cliically relevant. And if I was looking for information on how to manage stable COPD, see last night's post, my instinct would not be to start searching delicious to see what others in my network had saved.
So what does that tell me? Well, if clinicians are not yet using web 2.0 to help them with their day to day clinical work, is there any point in us worrying about whether or not sudents are interested in developing these skills? I don't mean that only 10% of GPs or hospital doctors are using social bookmarking and blogs to keep up to date. Or even that only 5% are. I doubt that even 1% are. Early adopters of web2.0 tools for clinical practice do not seem to exist yet.
One of the report conclusions reached was that "Students are reluctant to change their habits unless there is a clear tangible benefit to them. If we believe literacy skills are worth developing, we must make them a requirement not an added extra."
I think that before doing that we need to figure out if these tools actually deliver something that is useful to medical students and to doctors. What gap are they actually filling? Medical education can certainly be improved. But we need to describe the problems before we come up with the solutions.
Wednesday, January 14, 2009
Tuesday, January 13, 2009
Accessing Evidence-Based Medicine
There is discussion in blogs at the moment about the limits of Evidence-based medicine and how it may be impacted by web2.0 technologies. Laikas, a Dutch librarian, posted about this recently. Sarah Stewart, a midwife from NZ, replied by describing some of the difficulties faced by the public in accessing EBM and the resulting asymmetry of information between doctors and patients.
This reminded me of a You-Tube video I came across last year.
It is an interview Muir Gray, the NHS Chief Knowledge Officer (a post he first floated in 1998 in the BMJ), describes his view of the future of information in the NHS. Resources will be equally available to patients, (or to use his term, citizens) and to professionals. As a clinician and citizen I think this is an enlightened policy. I find much of the content on the NHS choices website very exciting, including Behind the Headlines. BtH gives an evidence-based critique of health stories in the press. I do not like Map of Medicine..... but more about that later:)
To illustrate some of the different sources of EBM available I am going to look at guidance on the management of stable COPD (chronic obstructive pulmonary disease).
First of all here is the page from the BMJ's Clinical Evidence site. I find this very unhelpful. If I wanted to know about one particular treatment and the evidence base, or lack of, for it's use in the management of the condition, this would be useful. But it is not at all useful for a brief synopsis of how to manage the condition.
Next, Clinical Knowledge summaries COPD page. This has many different levels of information and takes quite a lot of clicking around. But it is likely to be useful to a clinician in a surgery. And probably to patients/citizens as well.
GP Notebook is in my experience a favourite of UK GPs. Looking at it's info on the management of stable COPD it is clear that the guidance is related to the NICE guideline on the topic because it references the NICE guidance, and describes different steps for mild/moderate and severe levels of disease. This looks the easiest to access and most clinically relevant so far.
Lastly, we have the Map of Medicine stable COPD page. This annoys me on many levels. For one we are told under 'indications for referral' that this should be considered for severe COPD, but you have to go down to 'follow-up care in severe disease' to find out what the criteria for diagnosing severe COPD is.
What do you use to access EBM? Are different sites useful for different purposes? I'd love to hear your thoughts.
EDIT 11/8/10 I've reviewed the Map of Medicine page (previous link had died- new one is current) and it still does not make diagnosis criteria clear, unfortunately. Time to drop them a tweet!
This reminded me of a You-Tube video I came across last year.
It is an interview Muir Gray, the NHS Chief Knowledge Officer (a post he first floated in 1998 in the BMJ), describes his view of the future of information in the NHS. Resources will be equally available to patients, (or to use his term, citizens) and to professionals. As a clinician and citizen I think this is an enlightened policy. I find much of the content on the NHS choices website very exciting, including Behind the Headlines. BtH gives an evidence-based critique of health stories in the press. I do not like Map of Medicine..... but more about that later:)
To illustrate some of the different sources of EBM available I am going to look at guidance on the management of stable COPD (chronic obstructive pulmonary disease).
First of all here is the page from the BMJ's Clinical Evidence site. I find this very unhelpful. If I wanted to know about one particular treatment and the evidence base, or lack of, for it's use in the management of the condition, this would be useful. But it is not at all useful for a brief synopsis of how to manage the condition.
Next, Clinical Knowledge summaries COPD page. This has many different levels of information and takes quite a lot of clicking around. But it is likely to be useful to a clinician in a surgery. And probably to patients/citizens as well.
GP Notebook is in my experience a favourite of UK GPs. Looking at it's info on the management of stable COPD it is clear that the guidance is related to the NICE guideline on the topic because it references the NICE guidance, and describes different steps for mild/moderate and severe levels of disease. This looks the easiest to access and most clinically relevant so far.
Lastly, we have the Map of Medicine stable COPD page. This annoys me on many levels. For one we are told under 'indications for referral' that this should be considered for severe COPD, but you have to go down to 'follow-up care in severe disease' to find out what the criteria for diagnosing severe COPD is.
What do you use to access EBM? Are different sites useful for different purposes? I'd love to hear your thoughts.
EDIT 11/8/10 I've reviewed the Map of Medicine page (previous link had died- new one is current) and it still does not make diagnosis criteria clear, unfortunately. Time to drop them a tweet!
Power of social networking....
I started this blog a few months ago. Quite rapidly I started learning so much that it was hard to keep documenting my progress. So I find, like all reflective journals, that it is hard to keep it up. But sometimes something happens that really shows the progress you have made so I thought I would tell you a little story about some interactions in the last few hours.
Earlier I was looking at the Health Foundation's webpage. I saved it to my delicious and noticed that someone else had saved it too. The other person had lots of bookmarks interesting to me but no webpage or email address saved. I have been lamenting before about how it is hard to find people on delicious sometimes, but this person had actually twittered about their delicious account so their twitter ID showed up on this page when I googled their delicious ID. Yay! I had found @jranck!
Earlier I had noticed that jranck had bookmarked a blog about developing a communications network using old mobile phones, in a primary health care project in Malawi. The latest post describes analysis of the content of the text messages sent and also included the text of the messages. Somewhere in the last few months I also learned about wordle, and I thought this could do with one so I pasted the text and created a wordle:
So that is my snapshot of the power of social networking as I see it today:)
Earlier I was looking at the Health Foundation's webpage. I saved it to my delicious and noticed that someone else had saved it too. The other person had lots of bookmarks interesting to me but no webpage or email address saved. I have been lamenting before about how it is hard to find people on delicious sometimes, but this person had actually twittered about their delicious account so their twitter ID showed up on this page when I googled their delicious ID. Yay! I had found @jranck!
Earlier I had noticed that jranck had bookmarked a blog about developing a communications network using old mobile phones, in a primary health care project in Malawi. The latest post describes analysis of the content of the text messages sent and also included the text of the messages. Somewhere in the last few months I also learned about wordle, and I thought this could do with one so I pasted the text and created a wordle:
So that is my snapshot of the power of social networking as I see it today:)
Monday, January 5, 2009
Happy New Year....7 things you don't (need to) know about me
Let the frivolity not end yet. I have been tagged by Sarah so here goes:
1. I climbed the highest mountain in Northern Ireland for the first time last week. I grew up a few miles away from it.
2. My first trip outside the British Isles was to Croatia a few weeks after my 21st birthday. I spent the summer working as a volunteer in a refugee camp. I travelled from Belfast to Zagreb by bus.
3. I got a super crew tie-pin for selling 47 quarter pounder with cheese deluxes in one weekend. This was in Belfast's first McDonalds in 1991.
4. In 1998 I stood in the first elections to the Northern Ireland Assembly. I wasn't elected.
5. My mum made and embroidered my Irish dancing costume when I was 8.
6. My husband is great at roasting things.... intentionally, like chicken.
7. I go to bed too late.
Thanks Sarah:)
1. I climbed the highest mountain in Northern Ireland for the first time last week. I grew up a few miles away from it.
2. My first trip outside the British Isles was to Croatia a few weeks after my 21st birthday. I spent the summer working as a volunteer in a refugee camp. I travelled from Belfast to Zagreb by bus.
3. I got a super crew tie-pin for selling 47 quarter pounder with cheese deluxes in one weekend. This was in Belfast's first McDonalds in 1991.
4. In 1998 I stood in the first elections to the Northern Ireland Assembly. I wasn't elected.
5. My mum made and embroidered my Irish dancing costume when I was 8.
6. My husband is great at roasting things.... intentionally, like chicken.
7. I go to bed too late.
Thanks Sarah:)
Tuesday, December 23, 2008
Patient narrative- leading to transformation
Last week I came across two great papers by Arno Kumagai. He is an associate professor in the department of internal medicine in the University of Michigan. There they have a programme for first and second year medical students, the Family Centred Experience, which is similar to Cardiff''s Family Case Study.
The first paper " A Conceptual Framework for the Use of Illness Narratives in Medical Education" recognises that learning through patient narratives is often marginalised and considered 'soft' in medical school curricula. This was a point that I attempted to make recently.
He introduces a conceptual framenwork, whereby narratives are seen to help contribute to transformative learning. This is a wonderfully powerful idea where " The doctor-patient relationship changes from subject-to-object communication to intersubjective communication and action: the patient is no longer reified as an object to be worked on but an active subject to be worked with."
Unfortunately I read Arno's paper after my post on online narratives, so I emailed him to ask him his opinion.
"Dear Arno,
I just wanted to say how much I enjoyed this paper and the more recent one on patent narratives in diabetes. I wish I had read them before I wrote the following blog post! http://wishfulthinkinginmedicaleducation.blogspot.com/2008/12/patient-narratives-in-medical-education.html
I was wondering if you have any thoughts about how we could incorporate online patients voices into medical education. The world of health 2.0 is getting bigger and possibly better. It means that we can let students have access to many more experiences than in the past... particularly with regards to under-researched topics, or particularly stigmatising conditions.
I am sure you are very busy but if you have time to drop me a line I would be very grateful.
Happy Christmas,
Anne Marie"
He was very kind and replied at length:
"Hi Anne Marie:
Many thanks for your kind note and apologies for my delayed response. With the upcoming holidays, it has been a bit difficult to find time to quietly chew over your thoughtful insights and question. While I completely agree with you that the patient voice needs much more prominence in medical education, I often wonder whether there are limitations to use of on-line resources to introduce this perspective. I truly believe that there is something fundamental and powerful about going to someone's home, getting to know them and listening to their stories of loss and struggle (and triumph). There is something very old and very human about sitting in the physical presence of the storyteller and bearing witness, not only to their oral history, but also to them as individuals--their non-verbal queues, gestures, and emotions. While words are powerful tools (as a former student of comparative literature, I'm acutely aware of this), there is something in personal interaction which, I believe, may enhance perspective-taking and empathy. In addition, the fact that the students get to know a specific individual and his/her family over the course of 1-2 years makes the interactions--and consequences--highly personal, individual, and contextualized within a specific place and time. As a result, their understanding of chronic illness is different than, and complementary to, that they acquire through formal biomedical readings and lectures. I recently published a paper on this specifically in reference to diabetes (attached).
I fully realize, however, that to do this as a required activity is prohibitive for many institutions--I was just discussing this the other day with my associate dean. At Michigan, the program has 340 students (170 per class), 170 volunteer families, 30 small group instructors and 30 small groups. The amount of time and cost this requires is mind-boggling--as well as being a bit of a burn-out (I've been doing this for 6 years and hit a wall of exhaustion last year; fortunately, got a "second wind" and have been going strong since then.
I don't, by ANY means, want to discourage you from pursuing on-line approaches. In fact, one of the volunteers in the FCE with recently diagnosed type 1 diabetes has his own on-line blog, and I've referred many of my patients to it. The address is http://www.diabetesselfmanagement.com/blog/Eric_Lagergren/. Words ARE powerful tools and should be used in the service of the patients and of justice. One thought: since storytelling can take the form of movies/songs/videos, the use of video interviews or monologues may be a great way to give presence to the patients' voice. As a matter of fact, I'm working on a video project right now with a delightful young woman with sickle cell disease with this approach in mind.
Hope that's at least a little helpful. I'd be delighted to continue this conversation. Please feel free to post this to your blog if you wish."
I am very grateful to Arno for taking the time to respond and I agree with him that the level of interaction achieved by actually sitting with a patient in their own space can not be replicated in any other way. This is intrinsic to our Family Case Study and we would not want it to be removed or downgraded in anyway.
But I do think that it may be possible to supplement these very meaningful interactions. In other parts of the course, for example when studying surgery or gynaecology, we could make use of existing patient accounts on the internet to increase the insights of students. When patients talk to each other online they may speak with a candour which they find harder to use with health professionals. These authentic accounts may be a greater assistance to students developing empathy than fictional narratives, no matter how creative or well articulated.
I agree with Arno, that audio and visual accounts could be particularly rich. In the next few years patients more patients may start documenting their illness journeys on YouTube. Of course these patients may not reflect the entire patient population. The digital divide may mean that the stories of empowered patients get much more airplay from students than those of their disadvantaged neighbours. We need to think of ways of redressing the balance, so that our students will be equipped to move forward in partnership with all their patients.
The first paper " A Conceptual Framework for the Use of Illness Narratives in Medical Education" recognises that learning through patient narratives is often marginalised and considered 'soft' in medical school curricula. This was a point that I attempted to make recently.
He introduces a conceptual framenwork, whereby narratives are seen to help contribute to transformative learning. This is a wonderfully powerful idea where " The doctor-patient relationship changes from subject-to-object communication to intersubjective communication and action: the patient is no longer reified as an object to be worked on but an active subject to be worked with."
Unfortunately I read Arno's paper after my post on online narratives, so I emailed him to ask him his opinion.
"Dear Arno,
I just wanted to say how much I enjoyed this paper and the more recent one on patent narratives in diabetes. I wish I had read them before I wrote the following blog post! http://wishfulthinkinginmedicaleducation.blogspot.com/2008/12/patient-narratives-in-medical-education.html
I was wondering if you have any thoughts about how we could incorporate online patients voices into medical education. The world of health 2.0 is getting bigger and possibly better. It means that we can let students have access to many more experiences than in the past... particularly with regards to under-researched topics, or particularly stigmatising conditions.
I am sure you are very busy but if you have time to drop me a line I would be very grateful.
Happy Christmas,
Anne Marie"
He was very kind and replied at length:
"Hi Anne Marie:
Many thanks for your kind note and apologies for my delayed response. With the upcoming holidays, it has been a bit difficult to find time to quietly chew over your thoughtful insights and question. While I completely agree with you that the patient voice needs much more prominence in medical education, I often wonder whether there are limitations to use of on-line resources to introduce this perspective. I truly believe that there is something fundamental and powerful about going to someone's home, getting to know them and listening to their stories of loss and struggle (and triumph). There is something very old and very human about sitting in the physical presence of the storyteller and bearing witness, not only to their oral history, but also to them as individuals--their non-verbal queues, gestures, and emotions. While words are powerful tools (as a former student of comparative literature, I'm acutely aware of this), there is something in personal interaction which, I believe, may enhance perspective-taking and empathy. In addition, the fact that the students get to know a specific individual and his/her family over the course of 1-2 years makes the interactions--and consequences--highly personal, individual, and contextualized within a specific place and time. As a result, their understanding of chronic illness is different than, and complementary to, that they acquire through formal biomedical readings and lectures. I recently published a paper on this specifically in reference to diabetes (attached).
I fully realize, however, that to do this as a required activity is prohibitive for many institutions--I was just discussing this the other day with my associate dean. At Michigan, the program has 340 students (170 per class), 170 volunteer families, 30 small group instructors and 30 small groups. The amount of time and cost this requires is mind-boggling--as well as being a bit of a burn-out (I've been doing this for 6 years and hit a wall of exhaustion last year; fortunately, got a "second wind" and have been going strong since then.
I don't, by ANY means, want to discourage you from pursuing on-line approaches. In fact, one of the volunteers in the FCE with recently diagnosed type 1 diabetes has his own on-line blog, and I've referred many of my patients to it. The address is http://www.diabetesselfmanagement.com/blog/Eric_Lagergren/. Words ARE powerful tools and should be used in the service of the patients and of justice. One thought: since storytelling can take the form of movies/songs/videos, the use of video interviews or monologues may be a great way to give presence to the patients' voice. As a matter of fact, I'm working on a video project right now with a delightful young woman with sickle cell disease with this approach in mind.
Hope that's at least a little helpful. I'd be delighted to continue this conversation. Please feel free to post this to your blog if you wish."
I am very grateful to Arno for taking the time to respond and I agree with him that the level of interaction achieved by actually sitting with a patient in their own space can not be replicated in any other way. This is intrinsic to our Family Case Study and we would not want it to be removed or downgraded in anyway.
But I do think that it may be possible to supplement these very meaningful interactions. In other parts of the course, for example when studying surgery or gynaecology, we could make use of existing patient accounts on the internet to increase the insights of students. When patients talk to each other online they may speak with a candour which they find harder to use with health professionals. These authentic accounts may be a greater assistance to students developing empathy than fictional narratives, no matter how creative or well articulated.
I agree with Arno, that audio and visual accounts could be particularly rich. In the next few years patients more patients may start documenting their illness journeys on YouTube. Of course these patients may not reflect the entire patient population. The digital divide may mean that the stories of empowered patients get much more airplay from students than those of their disadvantaged neighbours. We need to think of ways of redressing the balance, so that our students will be equipped to move forward in partnership with all their patients.
Thursday, December 18, 2008
More networking options...
I am coming round to the idea that we need to leave as many traces as possible for people to find us. So to that end I want to mention a few of the places you can find the medical education community online at present. If you know more then please let me know:
First I found Deirdre Bonnycastle's Medical Education wiki.
And then the Medical Evolution NING.
By the end of October I was starting to use Twitter but I still had not made many medical educational contacts. Now there is a Twitter Medical Education Group which acts as a database.
In the meantime Natalie in Dundee started blogging too. We started discussing how we were using delicious and up came the diigo Medical Education group.
So where else might people be searching for a medical education community? Facebook was always a possibility so I have set up a group there too. And then I was reading about networking opportunities on AJ Cann's blog, and I thought that FriendFeed might be a good place to leave a trace as well. So I started a Medical Education room there too!
So that is a few bases covered. Where else do you think we should leave traces?
First I found Deirdre Bonnycastle's Medical Education wiki.
And then the Medical Evolution NING.
By the end of October I was starting to use Twitter but I still had not made many medical educational contacts. Now there is a Twitter Medical Education Group which acts as a database.
In the meantime Natalie in Dundee started blogging too. We started discussing how we were using delicious and up came the diigo Medical Education group.
So where else might people be searching for a medical education community? Facebook was always a possibility so I have set up a group there too. And then I was reading about networking opportunities on AJ Cann's blog, and I thought that FriendFeed might be a good place to leave a trace as well. So I started a Medical Education room there too!
So that is a few bases covered. Where else do you think we should leave traces?
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