What should be included in a #MedEdMOOC? Social Media in Continuing Professional Development

February 7, 2012 12 Comments


After previously considering what a MOOC for OT, and indeed for healthcare should look like, I am delighted to report that plans are underway to develop the first MOOC for Healthcare Professionals and other interested people, and the name chosen is MedEdMOOC (Medical Education MOOC).

One of the things to be considered, is what content we would wish to see included in the MOOC. I’m hoping to use some posts to record my hopes and fears for the MOOC, and I look forward to reading your comments about what I’ve written.

First, a quick reminder of what a MOOC is.

Social Media in CPD (Continuing Professional Development) for HCP (Healthcare Professionals)

One of my passions is the use of online technology and social media by HCPs to enhance and update their skills and experience, in order to offer the very best care to their patients. This can take many forms, and perhaps one of the nearest “real life” analogies I have is that of a peer supervision group.

Within peer supervision, a group of people without large differentials in status and seniority come together to share their thoughts, feelings, challenges and successes around their practice. Whilst patient confidentiality is observed during such sessions, challenges in particular cases may be shared with the group in order to get renewed insights and ideas about how to move the treament on. Additional insight may feed back into the case formulation, and therefore affect the future direction of treatment. Similarly, where a success has been hard won by our clients, the delight of the therapist involved might be shared with the group, who might be invited to help reflect on what the critical factors might have been.

Other ideas can be introduced, for example in a Journal Club, where people discuss and critically evaluate as a group recent research relevant to their treatment area(s). New assessments may be discussed, evaluated, or even tried out on each other. Audit tools, ways to collate evidence and interpret statistical information- anything at all that affects the way we can provide care is up for discussion.

Peer supervision is a time efficient way of supporting occupational therapists and HCPs in practice, using the benefits of group process in addition to the benefits of the individual reflective process. In some ways, it can be seen as the equivalent to a therapeutic group as used within OT practice- in that group process and support from peers is as important as the quality of the supervision received.

I see many parallels in the use of peer supervision offline and the use of communities of practice that form online through social media use, or by clustering around topics of mutual interest. One of the differences is that in the online space through the use of social media, this process often happens in a public space, rather than a private one. This changes the experience of membership of the group.

It contains opportunities as well as challenges:

Opportunities

  • By extending the membership beyond natural boundaries such as the employer or the physical location, groups may coalesce around mutual interest where before insufficient members were present in any single location.
  • Groups can be flexible, and a fluid membership can mean that new members can join the group at any time.
  • The non-heirarchical nature of the medium supports the formation of a group of “peers”, despite differences in status that might be apparent in “real life”. This can offer new opportunities to freely share with each other.
  • Groups can offer opportunities to develop confidence and skills in presenting information in an online format.
  • Group membership can lead to “real-life” relationships and support in an offline setting.
  • The public nature of the setting may serve as a reminder of acceptable public behaviour and mores related to professional role, embedding these behaviours in further online activity such as social networking; in line with professional guidance.
  • The public nature of the group means that insights from experts can be fed directly into the group, ensuring accuracy of the information and relevance of the opinions present.
  • The transparency of this approach may be attractive to HCPs who find it in line with their personal philosophy.
  • Patients and the public may be reassured to understand that this process is part of the “back end” of therapeutic work or medicine, ensuring the support they receive is evidence based, and the basis for clinical decision making may be better understood as a result.

Challenges

  • The public nature of the group can inhibit the most frank discussions of difficulties in practice.
  • Where social media guidance is lacking or insufficient, mistakes around information governance, or exposure of the individual practitioner to risk, may occur.
  • Rich information captured in body language and non-verbal cues in the “real-life” group setting may be lost in the online group.
  • Engagement in the activities may not be valued by the employer and traditional line-management structure, undermining the value of the process.
  • Participants could undervalue the process because of the fluidity and ease of membership, thus “drop out” before real benefits are gained.
  • Disruptive influences could “flood” the online space making positive progress of the group within the space difficult.

It is my hope that the MOOC will offer space not only to develop CPD for HCP, but also offer a structure around which HCP can reflect and discuss these challenges and opportunities presented by CPD in a community based in an online environment.

These are my initial thoughts about the value of looking at CPD within a healthcare MOOC, what are yours?

Filed under CPD, Evidence based practice, Reflection, Risk, Social Media Tagged with , , , , , ,

Censorship, or Duty of Care? “Little Feet”, Blogging on an Acute Mental Health Inpatients Ward.

January 4, 2012 24 Comments


This blog is inspired by a post I have read today by @Chaosandcontrol, who blogs as Little Feet. Please do read the original post and comments in their entirety, and excuse me for quoting from it in addition.

Here, Little Feet describes her actions in  password protecting her entire blog:

I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital.

She then posted about how because of this lack of privacy, she no longer felt safe to continue with her blog. She has currently stopped. I have so many things to say about this short statement. Im afraid they may come tumbling out helter skelter, so please bear with me.

Staff probably defend their actions by claiming they are acting to protect either the organisation (and staff), the patient, or the other patients. Each of these defences relies on slightly different clinical reasoning. Let me go through them.

First, let us consider Maslow’s famous hierarchy of needs.

An individual travels up this pyramid  from a baseline of meeting physiological needs, through safety, then social and emotional needs towards self expression and self actualization. By transferring the principles contained within this model, we can look at the organisation’s equivalent succession of needs within the social space, using a term coined by Jeremiah Owyang at the 2011 Leweb conference in Paris- the ‘Social Business Hierarchy of Needs’

If you haven’t got 20 minutes to watch the video, you could look at the Slideshare presentation.

climb-the-social-business-hierarchy-of-needs-leweb-keynote-2011?player=js

What we can learn from this is that the hospital in which Little Feet found herself was still concerned with the bottom layers of the pyramid- those regarding security and safety, whilst Little Feet had progressed past these layers in her digital interaction and was performing at a much higher level, concerned with self-exppression and self- actualisation.

We can see  that because of this disconnect in the digital literacy of the staff and organisation, and the population it is serving, the efforts by the staff to take control of the situation by using their power over their patients was (expectedly) experienced as oppressive by Little Feet, and also by the blogging community leaving comments on Twitter and on the blog itself. I am sure this was not the way they wished to be experienced, as I am sure they are good people who are just terrified by this new technology and way of communicating. But actively preventing someone from operating on the higher levels of Maslow’s pyramid is never going to be experienced as anything but oppressive, and services need to wake up to this fact and work out how to deal with their concerns about safety and move along in their own journey with social media.

Learning about patients from sources other than from within the clinical relationship and information from friends and family WITHOUT EXPRESS PERMISSION is not on. We are able to work that out from first principles, because one of the pre-eminent concerns of healthcare professionals is consent. Without consent, we must tread very carefully in what we do, using reflection, interdisciplinary learning, and close regard for the legal and policy framework for what we do (e.g. sectioning, deprivation of liberty). Little Feet did not consent for the staff to read her blog. They did not happen across it as a blog by an unknown individual, they had inside knowledge at the time of reading of Little Feet’s clinical presentation. That’s not cricket.

It’s unethical- In the same way that we would be justifiably angry if we found someone has read a secret diary, EVEN IF WE LEFT IT OPEN ON OUR INPATIENT BED we can have an expectation that clinical staff will form their clinical opinions based on presentation, symptoms, and medical history.

Discovering additional information about our clients is one of the cautionary tales warning clinical staff (and teachers for that matter) off from using SNS. The belief is that learning these insights will damage the therapeutic relationship, and cloud the (supposedly impartial) process of developing a diagnosis or formulation. That’s why your GP probably won’t friend you n Facebook.

It’s not that digital sources of information are irrelevant- but THIS SHOULD BE EXPRESSLY CONTRACTED WITH THE PATIENT.

What we present to the world is a series of faces, like the sides of a prism. None of them entirely explains our essential essence, each one is slightly different. How Little Feet appears in her blog is quite different from how she appears to her clinical team, I’m sure. After all, they are presented with a real life, flesh and blood version, perhaps with tears, anger, occasional incoherence, and frustration with the inherent power imbalance of mental health treatment- just like you or me in a mental health crisis.

The clinical team need to focus on the clinical presentation if they are to avoid bias, prejudice and all sorts of personal opinions from creeping unseen into the clinical situation. That’s why we have such developed conventions for clinical consultation. Contracting to source additional information pertinent to the clinical relationship could be appropriate, but it must be done with consent.

So, we can see that protecting the patient by removing her ability to express herself and self-actualize runs counter to the principles of recovery, which are about supporting progress up Maslow’s pyramid, not forcing someone down it. We have also seen how clinical treatments should not use information gleaned from  relationships outside the clinical arena without consent.

Protecting other patients is a little more difficult, in that we know that they will have a range of digital literacies and understanding of the consequences of being referred to within the blog. They will all occupy different levels of Maslow’s hierarchy. Confidentiality is a complicated issue, becase someone can be identified by a clinical picture (if unusual enough) just as easily as from a photograph. The difference here is that the staff hold the responsibility for protecting confidentiality, service users do not. That is why at the start of clinical group work, protecting confidentiality is generally introduced as a ground rule- to make sure it is in the mind of the participants.

However, what exactly are the patients here being protected from? In fact, there is no difference between Little Feet’s potential to discuss her descriptions and those of other patients. It is the medium of the descriptions that worries the staff.

Where conversations about services are confined to individuals, organisations feel happier because they are perceived as less threatening. What is frightening for the organisation about digital media is related to their lack of understanding of it, as discussed above. The old ‘command and control’ model of communications is so prevalent in health organisations dealing with digital media because they are operating in an unfamiliar medium and are just on the initial steps of Maslow’s pyramid.

There is excellent clinical practice out there, and there are both practitioners and organisations whoa re prepared for the journey they must take in understanding social media. But there are so many others who still haven’t framed the question, never mind worked out an answer.

Little Feet’s blog has served a critical purpose with the final post. It illustrates the difficulties that are facing health organisations who are treating individuals with much higher digital literacy than themselves. It’s time we woke up and started to play catch up in this arena.

What are your experiences of this?

If you would like to know how I can help your organisation or clinical staff move on in their understanding of digital and social media, get in touch at tech4health(at)gmail(dot)com.

Filed under Blogging, Inpatient Services, PTSD, Recovery, Reflection, Risk, Social Media, Society, Web 2.0 Tagged with , , , , , , , ,

Social Media Analytics (1) Klout and Algorithims

October 29, 2011 3 Comments


A short post today about analysing your social media impact.

Opinions vary about the usefulness of this, especially since the results are based on aalgorithims that we do not, as end users, have access to. Rumours abound on social media about how these algorithims work, so I would have to add this proviso when inspecting your own analysis:

  • algorithims do not take full account of your influence online
  • algorithims tend to downgrade your score according to the amount of contact you have with lower scored members- this can run counter to efforts to promote digital engagement, and to mentoring newer members of social networks.
  • there is no accepted final evaluation technique of network influence- all we have are the products available to us online, which are subject to the above provisos.
  • algorithims are, however quite fascinating. See this fantastic TED Talk by KevinSlavin:
You will be able to see industry leaders in your topics of interest are generally at the top of lists whichever product you use, what is harder is to correctly capture the influence of people who are not “power users” of social media.
This can mean that job role can have an impact on the eventual scores- if your job does not allow you to Tweet regularly, then you may have a lower score no matter howw reliable and trusted your links will be.
  1. Klout this free service recently tweaked it’s algorithim; some users were unaffected whilst others (including me!) saw their score reduce significantly. What does that mean? Watch this video to find out:

Klout allows us to offer +K to our “influencers”, people who have contributed to our understanding of a topic of mutual interest. It shows which topics we are supposed to be influential about, although this is a bit of a standing joke- most people hae experienced some confusion the first time they are announced to be influential about, for instance popcorn, skating, or entymology, if they have only ever Tweeted about their professional interests! Mashable have developed this guide to Klout.

That’s all for this post, next time I will be looking at other ways to measure online influence including:

  1. Peer Index
  2. Tweet Reach

Filed under Analytics, Digital Inclusion, Klout, Social Media, Social Media, Web 2.0 Tagged with , , ,

Blogs for Breakfast, #blogsforbreakfast at the #loveartsleeds Festival

October 12, 2011 1 Comment


I am very excited to say that I am a pannelist at Blogs for Breakfast, on Thursday 13th October in Leeds, an event which is part of the Love Arts Leeds Festival.

The purpose of this event is to

…debate how digital media is affecting how we communicate about mental health and wellbeing both personally and professionally:

• Blogging about personal experiences

• Campaigning on Facebook

• Personal and professional identities on Twitter

We hope to offer advice and information to anyone who would like to know a little more about how to use Social Media tools, in order to express themselves.

It’s exciting to me, because I have found blogging here to be an excellent tool for professional development. Using Social Media has allowed me to make contact with a “Community of Practice” online that would never be achievable off-line. I regularly collaborate with other OTs and healthcare professionals from all around the world. We use Facebook Groups and Pages, Google Groups, G+ Hangouts and Huddles, Skype, Twitter, and Blogs in order to discuss ideas, formulate projects, and disseminate research and best practice. The choice of tool is often dependent on the information which warrants a discussion, and flexible ability to deploy a range of tools means almost any situation can be accommodated.

Many of these goals can be achieved by more traditional means, but if we look at published academic journals, the time frame between submission and publication can be as long as 2 years. This allows for peer review, it is true, but it slows the progress of information through a profession, and subsequently there is not open access to the published research as most Journals require paid subscriptions. The process using blogging has less guarantee of academic peer review, but blog audiences are remarkably good at calling out errors in interpretation and analysis- the comments on blogs tend to show interesting discussions around the topic by other contributors whether professionals, service users, carers, or others. In addition, links can be made for professional networking opportunities with other people with similar interests, which would take attendance at a huge number of conferences at huge expense to replicate!

Mental Health Recovery means something different to everybody. Self expression is vital to wellbeing. For many people, writing may feel like a very difficult thing to start. But I believe that using a photoblogging site (e.g. FlickR) could offer opportunities for someone who wanted to document their story in other forms than words.

Video blogs can be used (e.g. YouTube channel) and can act as a diary, attracting people with similar life experiences, and sharing about different cultures. So blogging can be used even if you fear your writing skills are not up to scratch, or you would like to make your blog accessible to people who might have difficulty reading it.

I am frequently asked about the issue of personal and professional identities on Twitter and other Social Media platforms. My Twitter presence reflects my increasing comfort with open-ness about my shared personal and professional interests, but using Social Media is a process and for many people, there remains suspicion about having profiles which reflect both their personal and professional identities. To an extent, I share this feeling, hence I maintain separate personal and professional blogs. It will be interesting to debate this further in the context of the event.

If you would like to join us for this event, there are still tickets available. I hope to see you there.

Other Social Media reactions to this event:

Emachi Enje (@WellnessHQ) has used blogging in his personal Recovery story

I discuss this event at my personal blog which has helped me transition as a person with a disability.

Filed under Blogging, Conditions in Mental Health, Digital Inclusion, Google+, Physical disability, QR Codes, Second Life, Social Media, Stigma, Twitter, Uncategorized, Web 2.0 Tagged with , , , , , , , ,

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