Intimate examinations without consent- it's still happening.

Image: Exam Room by Maggie Osterburg

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

Press Release from University of Dundee.

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

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

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

What I have learnt about Twitter.

Image:  Greenfinch singing - Carduelis chloris by Rob Baldwin


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


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


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


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


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


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

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

Sharing hashtags for upcoming medical/health conferences.

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