Presentation charting the development of Web 2.0 technologies, and how to use them effectively as a medical professional, whilst avoiding the pitfalls. Draws on UK, ANZ and general professionalism guidelines.

1. Poking, Tweeting and Blogging
Training and Professionalism in the Digital Age
Date 15/04/11 Dr Chris Pell, Consultant Psychiatrist

3. OMG! LOL!

4. FOAF
OMG! LOL!
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ROFL
FTW!
LMAO @

5. FOAF
OMG! LOL!
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LMAO @
#meded

6. FOAF
OMG! LOL!
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ROFL
FTW!
LMAO @
#meded

7. Overview
✤ Internet is rapidly changing from Web 1.0 to 2.0 and beyond
✤ Read-only to read/write to mash-ups and the semantic web
✤ Digital identities
✤ New opportunities, but new challenges
✤ Ethical
✤ Social
✤ Technological

8. Overview

9. Overview

10. Overview
✤ The rise of the cyborgs
✤ Technologies in use
✤ Positive potential for medical practice
✤ Problem areas and cases
✤ How to be an effective digital professional

11. The Rise of the Cyborgs
✤ Internet developed out of networked computer systems (ARPAnet)
✤ Expanded gradually through the 1970’s when efforts made to link
separate such systems together
✤ Common languages developed – FTP, UNIX, HTML
✤ Internet (from inter-networking) coined 1974
✤ Further developments to infrastructure, language and the spread of
personal computers, increasingly decentralised and publicly driven
✤ Web 1.0 – read only – 1st Webpage 1991

12. The Rise of the Cyborgs
✤ Move to Web 2.0 began around the early 2000’s
✤ Functional change – interactive, collaborative and user drive
✤ By 2004 “social media” emerging as a phenomenon
✤ Early examples – Digg, MySpace, The Facebook, Bebo, Napster, VoiP
✤ Mobile technologies advancing, full web access became norm for
“smartphones” by late 2000’s
✤ iPhone launched by Apple in 2007, Google’s Android phones
followed soon after

13. The Rise of the Cyborgs
✤ "Cyborgs and Space” in Astronautics (September 1960), by Manfred E.
Clynes and Nathan S. Kline.
✤ Technological augmentation of the human body to allow new abilities
or adaptations
✤ Instant and pervasive internet access allows for offloading of factual
knowledge, and other skills

14. The Rise of the Cyborgs
✤ "Cyborgs and Space” in Astronautics (September 1960), by Manfred E.
Clynes and Nathan S. Kline.
✤ Technological augmentation of the human body to allow new abilities
or adaptations
✤ Instant and pervasive internet access allows for offloading of factual
knowledge, and other skills
✤ Do you know your spouse’s phone number?

15. The Rise of the Cyborgs
✤ "Cyborgs and Space” in Astronautics (September 1960), by Manfred E.
Clynes and Nathan S. Kline.
✤ Technological augmentation of the human body to allow new abilities
or adaptations
✤ Instant and pervasive internet access allows for offloading of factual
knowledge, and other skills
✤ Do you know your spouse’s phone number?
✤ What is your spouse’s phone number?

16. Technologies Used
✤ Blogs – Wordpress
✤ Wikis - Wikipedia
✤ Podcasts / Vidcasts - iTunes
✤ Video sharing sites – Vimeo, YouTube
✤ Social networks – Facebook, MySpace
✤ Twitter – microblogging and networking
✤ Location based services - 4square, Google Maps

17. Social Media Statistics
✤ Facebook:
✤ 6 years old
✤ ~640,000,000 users, half of whom log in on a daily basis
✤ Reported by 40% of teenage girls as being the most important thing
in their life
✤ Every 20mins: 15,870,000 wall posts, 2,716,000 photos uploaded
and 10,208,000 comments posted
✤ 30,000,000,000 pieces of content shared every month

18. Social Media Statistics
✤ Twitter:
✤ 5 years old
✤ 175,000,000 registered users
✤ 95,000,000 tweets per day (250% increase since last year)
✤ This despite 48% of users stating that they rarely or never check
Twitter

19. Social Media Statistics
✤ YouTube:
✤ Feb 2005
✤ 1st video entitled “Me at the Zoo” on April 23rd 2005
✤ Most viewed video “Charlie bit my finger” (300M views)
✤ 24 hours worth of video uploaded every minute
✤ 2 Billion views per 24 hours

20. Social Media Statistics
✤ Wikipedia:
✤ 17 million articles with 91,000 active contributors
✤ Flikr:
✤ 4 Billion images uploaded, 3,000 more every minute
✤ Wordpress:
✤ 18,753,000 blog pages, 500,000 posts per day, 112M words

21. Positive Uses
✤ E-portfolios
“Technology should be like oxygen:
✤ Networking Ubiquitous, Necessary, and Invisible.”
-Chris Lehmann
✤ Publicity
✤ Dissemination “If you don’t learn something new
each day on Twitter, then you are
✤ Education following the wrong people.”
-via @TweetSmarter
✤ Digital image

22. E-portfolios
Advantages:

23. E-portfolios
Advantages:

24. E-portfolios
Advantages:

25. E-portfolios
Advantages:

26. E-portfolios
Advantages:

27. E-portfolios
Disadvantages:

28. E-portfolios
Disadvantages:

29. E-portfolios
Disadvantages:

30. E-portfolios
Disadvantages:

31. E-portfolios
Disadvantages:

32. E-portfolios
Disadvantages:

33. E-portfolios
Disadvantages:

34. E-portfolios

35. E-portfolios

36. E-portfolios

37. E-portfolios
✤ Truly life-long tools
✤ Links with examination applications, eligibility criteria, results
✤ Links to application process for jobs
✤ E-CVs
✤ E-ARCPs
✤ Incorporation of more collaborative functions: social networking, blog
or wikis

38. Positive Uses
✤ Facebook ✤ Public health - track disease
outbreaks, emergencies
✤ Present a professional image
✤ Crowd sourcing platform - ask your
✤ Create a “fan page” for your followers
organisation - e.g. RCPsych
✤ Search engine
✤ Twitter
✤ Networking tool, particularly for
✤ Keep up to date: @scotgov, conferences - #AMEE2010
@bbcbreaking, @stvnews
✤ Inform patients
✤ Track jobs and other opportunities
✤ Novel uses - user groups, Qwitter,
✤ Find resources shared by etc
likeminded others #meded, #TwitJC

39. Positive Uses
✤ Blogs
✤ Informative, regularly updated, often critique other news items
and articles
✤ Interactive allowing discussion and clarification
✤ Podcasts
✤ Excellent sources of up to date information, often in niche areas
✤ Good examples: AmJPsych, RCPsych, Medical Educator, iTunesU

40. Positive Uses
✤ Mobile devices
✤ On-line anywhere
✤ Mobile apps
✤ Augmented reality
✤ Medical devices

41. Positive Uses
✤ Mobile devices
✤ On-line anywhere
✤ Mobile apps
✤ Augmented reality
✤ Medical devices

42. Negative Aspects
✤ Online anywhere ✤ Blocking of access to most
social media while at work
✤ Blurring of private and
professional lives ✤ Rapid and far-reaching societal
shifts still occurring
✤ Email accounts
✤ Ethical and social norms not
✤ Social networking profiles fully established
✤ Location based services
✤ Ownership of data

43. Digital Professionalism
✤ New technologies lead to reappraisal of doctors’ contract with society
✤ How do we incorporate digital spaces into our lives?
✤ Is there a disparity between what we practice and what we preach?
✤ How do these new media equate to traditional media?
✤ Rapid uptake and usage
✤ Current dearth of clear ethical guidance

44. It’s all about context
✤ #twitterjoketrial:
✤ Upshot as of Feb 2011 - all
tweets are considered
public domain material
✤ Material posted is
permanent and searchable

45. It’s all about context
✤ #twitterjoketrial:
✤ Upshot as of Feb 2011 - all
tweets are considered
public domain material
✤ Material posted is
permanent and searchable

46. It’s all about context
✤ #twitterjoketrial:
✤ Upshot as of Feb 2011 - all
tweets are considered
public domain material
✤ Material posted is
permanent and searchable

47. Problem Areas for Medics
✤ Confidentiality
✤ Personal views
✤ Professionalism
✤ Defamation
✤ Discrimination

48. Sharing of Information
✤ 2008 USA survey showed 2/3 medical students use Facebook
✤ Only 37.5% of these made their profiles private Guseh JS (2009)
✤ University of Otago NZ - class of 2006
✤ N=338 - 65% had Facebook accounts
✤ Only 63% had activated their privacy settings MacDonald J (2010)
✤ University of Rouen 2010
✤ N=202 - 73% had Facebook profiles, 61% changed privacy
Moubarak G (2011)

49. Sharing of Information
✤ What do they post?
✤ Survey by J. Chambers (2010) of Dundee medical students (N=487)
9%
14% Private Access
41% Closed Community
Public Access
Not Sure
36%

50. Sharing of Information
✤ What do they post?
✤ Survey by J. Chambers (2010) of Dundee medical students (N=487)
Full name 93.6%
Email address 48.6%
Home address 2.9%
Telephone no. 9.6%
Profile photo 80.2%
Relationship status 55.0%
Sexual preference 36.6%
Religious views 27.1%
Political views 12.2%
Uni attended 88.8%
Medical student 32.0%

51. Sharing of Information
✤ What do they post?
✤ Survey by J. Chambers (2010) of Dundee medical students (N=487)
Self 74% 16%
Alcohol
Other 78% 15%
Self 6% 11%
Smoking
Other 10% 14%
“Personal Self 18% 18%
content” Other 13% 11%

52. Sharing of Information
✤ What do they post?
✤ Survey by J. Chambers (2010) of Dundee medical students (N=487)
Course content 16.2%
Exam content 4.2%
Clinical practice 7.8%
Actions of other students or healthcare workers 12.3%

53. Pertinent Guidance
✤ GMC Good Practice Guidance:
✤ 33. You must not express to your patients your personal beliefs,
including political, religious or moral beliefs, in ways that exploit
their vulnerability or that are likely to cause them distress
✤ 37. Patients have a right to expect that information about them will
be held in confidence by their doctors. You must treat information
about patients as confidential, including after a patient has died.

54. The YouTube Generation
✤ Surgeons in Philippines struck off for posting videos of surgery on
YouTube in 2008
✤ Deemed clearly unprofessional, even though patient not identifiable
directly
✤ Recent programme Junior Doctors: Your Life in Their Hands (BBC3)
showed similar scene with less hilarity…

55. The YouTube Generation
✤ 1st Year University Medical Review show
✤ Parody of anatomy lab, set to choreographed dance routine and rap
✤ Posted on-line following permission of medical school office, and
with consent of all actors
✤ Senior student saw it and complained to Dean
✤ Video taken down pending faculty review
✤ 25,000 hits, 4.5 star rating

56. The YouTube Generation
✤ Recruitment video into psychiatry
✤ What advice would you give your trainee if they had posted this?

57. Pertinent Guidance
✤ GMC Good Practice Guidance:
✤ 57. You must make sure that your conduct at all times justifies your
patients' trust in you and the public's trust in the profession.

58. Sharing of Information
✤ Online posting of Unprofessional Content by Medical Students
✤ USA 2009 survey of Med School Deans
✤ N=78 of whom 60% reported incidents of medical students posting
unprofessional content on-line
✤ 30 had given informal warnings, 3 student had been dismissed
✤ Only 38% of Schools had specific policies...
Chretien K (2009)

59. Defamation
✤ “The act of making an unjustified statement (whether oral or written)
about a person or an organisation that is considered harmful to their
reputation, for example by damaging professional standing”
✤ Defamation is to a 3rd party and identifies the subject
✤ Defences - justification or “fair comment on a matter of public
opinion”
✤ Comments may also be considered in breach of discrimination laws if
deemed offensive to particular groups
BMA (2010)

60. Defamation
✤ “Dr Scot Junior”
✤ Surgical trainee in aftermath of MTAS posted a comment on the
closed forum Doctors.net
✤ “Excrematous and scatological language” used to describe Dame
Carol Black
✤ Comments viewed by Professor Paice who alerted Dr Junior’s Dean
✤ Immediate suspension from work for 6 weeks

61. Pertinent Guidance
✤ GMC Good Practice Guidance:
✤ 46. You must treat your colleagues fairly and with respect. You
must not bully or harass them, or unfairly discriminate against
them by allowing your personal views to affect adversely your
professional relationship with them. You should challenge
colleagues if their behaviour does not comply with this guidance.
✤ 47. You must not make malicious and unfounded criticisms of
colleagues that may undermine patients' trust in the care or
treatment they receive, or in the judgement of those treating them.

62. GMC
✤ No specific guidance on social media
✤ Comes down to probity, professionalism and confidentiality
✤ “In response to queries about this we have taken the view that doctors are allowed, like anyone else, to
have a private life and use of the internet and social networking sites are a part of this for many people. It
is clearly a matter of judgement, about what information doctors choose to share on such sites and with
whom, bearing in mind their professional obligations as a doctor and any contractual requirements. It is
not possible to state categorically what would and would not be acceptable in relation to these matters as
it is likely to depend on many factors, including the nature of the comments, who could access them, and
whether they were posted during or outside work hours.”
✤ “We would see the principles that apply to this as no different from those that apply in sharing
information in other areas, for example what information about their work doctors might share with
friends at the pub or in other social settings, although obviously the range of people who might have
access to their comments is likely to be wider.”

63. Personal vs Professional Personas
✤ Article 8 of the Human Rights Act states: “Everyone has the right to
respect for his private and family life, his home and his
correspondence.”
✤ Increasingly employers are seeking to implement policies relating to
social media
✤ Care needed to ensure does not infringe our rights to freedom of
speech, and to a private life
✤ Could policies be implemented that would monitor and limit what
we say in public? Are tweets and posts any different?

64. Avoiding the Pitfalls
✤ Understand the media
✤ Permanent, searchable, traceable
✤ Consider on-line content as public
✤ Maintain awareness of contextless view of the courts / media
✤ Consider your professional image now and for the future
✤ Use your on-line presence to your advantage
✤ Google yourself now and again

65. Avoiding the Pitfalls
✤ RCN Guidance - Clear don’ts:
✤ Disparage colleagues or the organisiation, or patients
✤ Identify your employer on your profile page
✤ Use social media from work or in work time
✤ Identify or photograph patients
✤ Post sexually explicit, racist, homophobic or other offensive content
✤ Breach any policies on internet use your employer has
✤ Respond in haste to emails
✤ Press respond to all, or spam large number of people

66. Avoiding the Pitfalls
✤ Joint AMA, NZMA, NZMSA, AMSA guidance:
✤ Have you ever...?
✤ Googled yourself?
✤ Posted info about a person from your workplace on Facebook?
✤ Added patients as friends?
✤ Added work colleagues as friends?
✤ Made an online comment that could be considered offensive?
✤ Put up photos that you would not want patients, colleagues to see?
✤ Checked your FB privacy settings?
✤ Let a friend know that they have posted unprofessional content?

67. Avoiding the Pitfalls
✤ Joint AMA, NZMA, NZMSA, AMSA guidance:
✤ Beware of cross-referencing with regards to confidentiality
✤ Avoid defamation
✤ Look after colleagues online, and speak to them about
unprofessional use of social media
✤ Protect your online image, examine your profile and ask if it truly
represents the values you uphold
✤ Manage friend requests and boundaries appropriately

68. Friending and Patients
✤ 76% of doctors in the Rouen survey felt that the doctor-patient
relationship would be altered if patients had viewed their FB profile
✤ Don’t accept requests if you are not absolutely certain who they are
✤ Ignore friend requests from patient
✤ Discuss the issue with them face to face if they persist
✤ Respect patients’ rights to on-line privacy and do not enter
information gathered from the internet into their case file without
their consent

69. Ellaway’s Principles
✤ Principle #1: establish and sustain an on online professional presence
that befits your responsibilities while representing your interests. Be
selective in which channels and places you establish a profile.
✤ Principle #2: use privacy controls to manage more personal parts of
your online profile and do not make public anything that you would
not be comfortable defending as professionally appropriate in a court
of law
✤ Principle #3: think carefully and critically about how what you say or
do will be perceived by others and act with appropriate restraint

70. Ellaway’s Principles
✤ Principle #4: think carefully and critically about how what you say or
do reflects on others, both individuals and organizations, and act with
appropriate restraint
✤ Principle #5: think carefully and critically about how what you say or
do will be perceived in years to come; consider every action online as
permanent
✤ Principle #6: be aware of the potential for attack or impersonation,
know how to protect your online reputation and what steps to take
when it is under attack
✤ Principle #7: an online community is still a community and you are
still a professional

71. The Future
✤ Contract with society being altered
✤ Professionalism being reshaped
✤ Digital competencies need to be taught, modelled and assessed
✤ Digital professionalism standards should be developed
✤ Don’t wait for guidance before examining your use of new technology
✤ Don’t be afraid!

73. OMG!
Its da endz!
FTW!

74. References
✤ GMC Good Practice Guidelines - accessed at www.gmc-uk.org on 14/4/11
✤ Farnan JM et al (2009) The relationship status of digital media and professionalism: it’s complicated. Academic
Medicine 84(11):1479-81.
✤ Farnan JM et al (2008) The YouTube generation: implications for medical professionalism. Perspectives in
Biology and Medicine. 51(4):517-24.
✤ Chretien KC et al (2009) Online posting of unprofessional content by medical students. JAMA 302(12): 1309-15.
✤ MacDonald J et al (2010) Privacy, professionalism and Facebook: a dilemma for young doctors. Medical
Education 2010; 44:805-813.
✤ Guseh JS et al (2009) Medical professionalism in the age of online social networking. Journal of Medical Ethics
2009;35:584-586.
✤ Social Media and the Medical Profession: A guide to online professionalism for medical practitioners and
medical students. AMA, NZMA, NZMSA, AMSA (2010)
✤ Moubarak G et al (2010) Facebook activity of residents and fellows and its impact on the doctor patient
relationship. Journal of Medical Ethics Online First DOI:10.1136/jme.2010.0362893