Tweeting from a conference.

If you are following me on twitter you will have noticed many #comet09 tweets in the last two days. There will be more tomorrow as the conference finishes in the afternoon. So what was it about? COMET is an interdisciplinary conference in communication, medicine and ethics. It moves around the world and this year was on my doorstep in Cardiff so too good an opportunity to miss.

I decided to tweet because I thought the content would be interesting to quite a few of the people I know on Twitter. And it was. Some of the things that happened:

• @jrbtrip found out what an old colleague was up to
• @hadleybeeman and I had a discussion about whether patients had the right to not engage in partnership with their GP in their care
• @mrhyde found out about some research on how people who are obese access information on the internet.
• @vmontori who was a co-author of some work that my colleague presented was kept up to date although he was still on the other side of the Atlantic.
• @casesnetwork kept up to date with Brian Huritz's lecture.

And after seeing a presentation about using multiple modalities in drug patient information leaflets I remembered that I had seen a lightning talk about this last week at Health Camp but couldn't remember who. I tweeted and had the answer before the speaker had finished her presentation.

I do seem to have been the only person tweeting from COMET 09, but I predict that come COMET 10 in Boston there will be a few more. This was not about providing a backchannel to the conference, but simply about bringing the contents of interesting dialogues to a wider audience. So if you are listening to someone stimulating, think about tweeting. The chances are that someone you know will be glad that you have made the effort to share.

Where do first year medical students look things up?

In the last two days I have spoken to 31 first year medical students about their early clinical attachments in primary and seconday care. I asked them where they looked up unfamiliar clinical topics. These are some of the responses:

• Wikipedia
• Google
  
• Kumar and Clark
• Medical dictionary
  
• YouTube (especially to find out more about operations)
• NHS Direct/Choices
• Oxford Handbook of Clinical Medicine
• I didn't look anything up.

Wikipedia was definitely the most common choice. Many students said 'I know I shouldn't but....' and then qualified that they used Wikipedia first because it was easy to understand, they felt it was reasonably reliable, and accessible. One student used it to search directly from her phone when on placement.

I was intrigued by one student who was very keen to distinguish 'learning' which was what he did for exams... spotting questions on past papers and reviewing lecture notes... from 'experience', when he would access YouTube or Wikipedia to find out more about something that really interested him. His reluctance to call this learning reminded me of a third year student I spoke to earlier in the year. We were talking about how she would continue learning for the rest of her life. "That's so depressing", she said. In her mind learning was bound up with exams and assessment.

Should we worry about students turning to Wikipedia so often? Which other resources are just as user-friendly and comprehensive?

I think that NHS Choices is a good place to start.

EDIT: Just to make clear, the first year students I am referring to here are in an undergraduate 5 year course. The first few years of the course are pre-clinical but these early clinical attachements are to give them some initial insights into the world of clinical medicine. Some medical schools in the UK have no distinction between the pre-clinical and clinical parts of the course.

Facilitating a network

I am hoping to establish a network between those leading programmes in which medical students have the opportunity for contact early in the course with patients in their own homes or in the community. I think we will benefit from sharing motivations, materials and ideas on assessment. So I am wondering how I could support this. We could simply have an email list. Or a google group. Or a NING.

What would you use?

EDIT: This is to be a network with my peers- fellow medical educators- not with students.

Are you a digitially competent doctor? Do you need to be?

I was talking to a colleague in the last few days about digital competencies. He wondered if we should be exploring developing a set of competencies for medical students.

I started this blog more than 6 months ago as part of my learning journey on the use of web 2.0 (or whatever term you prefer) technologies and to meet other people who were on the same journey in medical education. I know that I could not yet say what the competencies needed for medicine are. I work with and know many good doctors providing good quality care and they do not blog, or use social networks, or collaborate online in wikis, or use rss feeds, or save or share links in social bookmarking tools. Would they be better doctors if they did?

And if I am not competent yet myself how could I decide that these, or others, are areas which students need to be competent in. How could I assess if they are competent?

Yesterday I was co-ordinating 3rd year exams assessing students skills in clinical examinations. Competency in clinical examination has been regarded as essential for doctors for many years. Maybe in the future it will be irrelevant. But for the moment we, as a profession, hold that it is important.

Will we ever have the same agreement about digital competency?

In praise of the walled garden (VLE)....

I have to start this by saying I am not a techy. I struggled a few nights ago to install MS Office on a netbook. But I am interested in how new technology can improve the way that we do things.

Back in 2004 I was invited to go on a Blackboard training session as there were plans that the medical school would use the VLE " increasingly to deliver course information and material". But when I went to the training session it wasn't this that got me excited but the discussion boards. I immediately thought that this would be a good way for me to communicate with and facilitate communication between 300 2nd year students undertaking a course I co-ordinated over 9 months. They were not even based in the same building as me. I've posted more about this here.

This year I used discussion boards, wikis and a course blog. Participation is voluntary. I don't assess contributions to the boards but students seem to find them a good way of accessing me and sharing with each other. The connections that they make through the discussion boards should help them to do better in the assessed written work.

So in my experience VLEs can work.

But many people do not like VLEs, or the way they are used or what they stand for (large, monollithic companies which I don't like either).

Martin Weller said the VLE is dead or dying back in 2007.Instead we will using "Loosely Coupled Teaching"... lots of different, freely available websites pulled together. Yes, that could mean lots of different log-ins and getting to grips with different websites but learning how to use wikis and discussion boards and blogs takes time no matter where they are, and tools such as openID, and facebook connect, might get past the log-in problems.

In 2009, Mike Bogle wrote about Distributed Online Learning Frameworks, now possibly including twitter, and was inspired by the experience of David M Silver.

But talk about moving away from VLEs is not just that they are big and cumbersome and slow, there is also a sense among many that it is the walled garden that is the problem. Access is restricted to those within the course within the institution. It is anti-edupunk and anti-connectivism. Mike Johnston thinks the VLE might be 'killing connections' for the institution's benefit.

But might there not be advantages to a walled garden? Can't students benefit from being able to talk and share in a private place where they can make a mistake and ask or say something stupid. We know the Cisco Fatty story. We're learning about digital identities. Is education in public really better? If institutions have any role in education might it not be the provision of a walled garden or safe space?

Emotional perspective taking

Last night my mum phoned to say that Traffic Cops was from Cardiff. Creepers break into houses and steal the keys of cars before stealing the cars. A car was found having rolled over on a road near where I used to work. The driver died. He couldn't be identified as his facial injuries were so severe, and a passenger abandined the car. A liaison office was called to break the news of the drivers death to the family. He called at the house of the owner of the car, to find that the house had been burgled and that the owner was alive and well.
I thought how awful it must be to find out that someone has died in your car, even if it not in any way your fault.
Next we were shown the owner of the car at the police station where he had gone with his father in the middle of the night to make a statement. He said that when he first heard that his car had been stolen and the driver had died in an accident he felt no sympathy. He thought to himself that it was what he deserved, after all he could have came up the stairs and clubbed him to death as these things happen.
I said out loud to my brother who was visiting that his response seemed to be the opposite of mine. My brother said 'maybe you empathise too much'.

So can we empathise too much? What does this mean? And in this case why were my feelings so different to the person who the event had actually happened to?

To read: Empathy Gaps in Emotional Perspective Taking

Empathy, caring, emotion, communication and learning

Oh, a long time since my last post again. Yet, again I have many things going round in my head and holding my attention for variable lengths of time. It is a chaotic narrative an one which may disturb you if I share it in its entirety:) So instead I will mention some parts.

Today, I got news that a colleague and myself have won an ASME small grant to explore how students might learn from the patient's online voice. We're starting with students- what do they think they learn from reading patient narratives in forums and blogs and what do they think of this process. I wonder if reading the way that people talk to each other about health and illness online will help students develop empathy for patients.

There are a lot of questions around empathy that I would like to be able to answer:

• What is empathy?
• How is empathy different to sympathy?
• How do we feel what another is experiencing?
• Is empathy necessary to be a good doctor?
• Is too much empathy bad?
• Can we help students develop empathy? And should we?
• How do others know we feel empathy with them?
• Can we fool others into thinking that we feel empathy for them when we don't?
  
• Can we understand an experience we have not been through?

I used to think I knew the answer to many of these questions but as is the nature of these things when you start reading and thinking more you start having more questions, and you realise that the questions you thought you had answered have not really been dealt with.

So in my next few blog posts I will endeavour to discuss some interesting papers that I have come across in the last few months and I hope that we can discuss them together.