I was delighted (and a little surprised) to be invited to speak at this conference. Often when we talk about ‘digital identity’ we seem to discuss artefacts, bits of information that might allow others to make judgements about us. We talk about ‘digital footprints’- traces we leave for others. But how does being online make us understand ourselves better? And how might it inform us about what it means to be a ‘professional’?
I’ve already given you some information about what I might consider is important about me in that precious slide- my name, my institution and my Twitter ID! So who I am in digital spaces is of increasing importance.
Where people are from- the spaces they inhabit- and also tell us about them because we expect them to have relations with others we might know, or to have had common experiences. To use Dave White’s terminology- I am a resident in some of online spaces- for example, Twitter, but a visitor in others. http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/3171/3049
But this is where I grew up in a very beautiful part of the world. This is a mile up the road from my mum’s house – a lovely view of the Mourne mountains. There is a strong sense of community here and when I return I am not known just by my achievements but by my relationships.
The sheep! Yes, they are hardy and we could perhaps learn something about ‘thriving in a colder climate from them’. You might recognise this photo as I have had it as my twitter backdrop for a few years. More recently I added the ‘determined not to be one of the sheep’ line to my twitter bio. What did/do I mean by that? I suppose it is a reaction against the ‘herd mentality’ that we sometimes seem to see online. I wanted to assert that I pride myself on being critical, sceptical and reflexive.
Although I have seen many great presentations at the conference about innovations related to health professional education, I know that many of you will not be very familiar with the process of medical education so some quick fill-ins…
Since the GMC took over responsibility for assuring the quality of medical education we’ve had some recurring ‘complaints’. In fact these are not really unique to medical education and I am sure that others who work in higher education might feel that what might be aspired to is not achieved. In medicine the criticisms tended to be around the integration of basic science with clinical enducation. The curriculum was seen to be too full as new topics kept being added, and students ended up learning ‘facts’ rather than deeper principles.
We like our three-letter acronyms! In response to the criticisms described, McMaster developed problem-based learning which has spread to many other medical schools and sectors of education. That model is evolving too. CBL is case-based learning and we can be sure than many more innovative approaches are on the horizon.
So is medical education just about filling students with knowledge, or skills or concepts? I would like to suggest that it should also be about transforming our ways of knowing. More about this later.
I hold many professional roles – GP/family doctor, clinical researcher, educator, education researcher, “lead” for eLearning, doctoral student. They all intermingle so that at any one time I am influenced by what I learn from working in these other domains. Of course my personal identity is also important. The area that I have been most strongly socialised into- and have the clearest community of practice- is as a doctor. I started medical school in 1990 so that is 21 years of developing this identity. But some other areas are still more emergent…
In 2008 I went to two medical education conferences and realised that whilst research could help in some ways, what I really needed to know about was the ‘practice’ of other educators. What were hey trying to do? Why? What worked and what didn’t?
Although I had colleagues in the university I needed to know about what was happening further afield. I did feel isolated and at that time neither of the organisations which I was a member of were giving me the chance to network with others. So I decided..
--to start my own blog. This was my first post.
And through blogs and twitter I started forming a new network. These were some of the people I met. Sarah Stewart, http://sarah-stewart.blogspot.com/, DeirdreBonnycastlehttps://profiles.google.com/113013768145417216957/about, Natalie Lafferty http://mededelearning.wordpress.com/
At the start we seemed to talk a lot about social media itself…. What were the new tools and what could they be used for? How did social book marking work? Lots of this activity is described on my blog www.wishfulthinkinginmedicaleducation.blogspot.com
But I also realised that I needed to engage more people in medical education so I gave this presentation.. http://www.slideshare.net/amcunningham/supporting-scholarship-in-medical-education-the-role-of-social-media-and-networks
Strangely this did not lead to a paradigm shift in scholarly communication in #meded – by the way we have been using #meded as a Twitter tag.
And I was also wondering how these networks might be developed to support my practice as a doctor because…
… I hadn’t seen any evidence of them being used so far. When I discussed this with DrVes he called me the Web 2 sceptic. I still come top in google! But I still do believe that there is progress to be made. There is certainly a need because…
…althought we talk about ‘information overload’ – about all the papers that are published very week, even all the systematic reviews- these do not really lead to information overload. They can be reasonably easily searched and filtered- some good work is being done on this. But the problem is the LACK of local, practical knowledge. When that has been codified it is often poorly presented in PDFs that are hard to mention. It is published on intranets that google can’t find. And much of it has not been written at all. It is still tacit.
But the barriers to sharing this kind of local practical information are not only technical, they are more likely to be social. After all email has been around for years. If we were truly happy sharing about our practice then we would have been doing this already. Some of the reasons that we don’t share our practice are concerns about who we are talking to- who is in control? Who has power? What will be the implications of sharing for how we see ourselves and how others see us?
We’re balancing the risks of sharing and learning through openness against the safety and privacy (to maintain more fixed identities) of a closed environment.
Now I want to move on to a way of thinking about professional identity. Kegan’s model of constructive-development in transformative learning talks about the way we know the world. I came across Kegan’s work in his chapter in “Contemporary Theories of Learning”. You can read a lot more about his ideas here:http://terrypatten.typepad.com/iran/files/KeganEnglish.pdfAs far as I am aware, Kegan’s model has not been applied to professional identity but I am going to use it as a way of thinking around some of the issues that involvement in social media might bring.So the a socialized model of professional identity will be about meeting the expectations of others- that maybe peers informally, or more formally through regulatory frameworks, such as “Good Medical Practice” from the GMC. The next level is self-authoring professional identity. Here I have internalised values- I can fit together different parts of my own identity and make judgements based on them.The next level is self-transforming identity. I can step outside my own values and experiences and see how I have come to hold them and how others may see my profession/me as a professional differently.
This model is helpful because we can realise that social media gives us unbounded spaces where we have not been ‘socialised’- we don’t know what the rules are because there aren’t any. This research article was about patient communities on Facebook.
So when we are in new frontiers we have to have developed our own identities- have internalised our values to be able to operate at all. There are more and more guidelines coming out telling us what he could and, more often, should not do in social media. But to make any sense of it we have to know ourselves. But because we are in public we are also more likely to have experiences which need us to be reflexive about what it means to be a teacher or a doctor at all. The following slides will illustrate this.
I was asked this question by someone I don’t know on Twitter a few months ago. I thought about it an decided it was appropriate to respond.
This is what I said.
But the next tweet made it clear that this was about cancer- something much more serious that I had considered. I have written more about what happened in my blog here: http://wishfulthinkinginmedicaleducation.blogspot.com/2011/07/blurred-boundaries-for-health.html
So if we go back to thinking about this scenario how would different levels of professional identity have helped me to think about responding to this scenario:Socialised- what are the rules? One of the comments on my blog said: “I think it is an important point to consider what your local college of physicians (or regulatory authority) considers the establishment of a doctor patient relationship. Certainly there are jurisdictions that might consider that exchange to constitute the establishment of a relationship (and all that entails with regard to responsibility for care and confidentiality).” Incidentally I did try to make contact with the GMC to see if we do have rules about this. It’s not clear.Self-authoring- to me being a doctor is about service and relationship. I did not feel as if I was acting as a doctor here because of several questions that I didn’t ask that I normally would. I felt just a provider of information- and that is not a doctor.Self-transforming- but what does this encounter tell me about how we a profession function. We think that we are good at advising but still I am being asked this question on TWITTER! And how must it feel to be the person asking the question. If I had just shut down and refused to answer at all, how would that have made her feel at this difficult time?
I love this quote from a Norwegian medical student at the symposium on professionalism – it captures the reflexivity that I hope that all students will reach. Being a doctor or teacher is not just about following the rules or sticking to our own internal values. It is about questioning the systems that we work within. Being in public, participating in social media can mean that we have more of these ‘reflexive moments’ that disrupt our established way’s of thinking and cause us to see ourselves as others might do. We learn.
But how do others see our social media presence? I asked one of my students what my social media presence told her about me as a doctor/learner/teacher. This is what she told me. This answer is not about the links that I share- the information- even what I say. It is mainly about how I interact with others.
I think that to others are digital professional identity is not just the traces and ephemera that we leave behind. It is the processes and interactions and way that we ‘be’ in these spaces. Digital identity is relational- in many senses.
1. On being public…how social media reshapes professional identity.<br />Dr. Anne Marie Cunningham<br />@amcunningham<br />Primary Care and Public Health<br />Cardiff University<br />
2. Who am I?<br />
3. Where am I from?<br />
5. “determined not to be one of the sheep”<br />
6. A one minute summary of medical education<br />
7. 100+ years of criticism<br />
8. 40+ years of innovation?<br />
9. Is medical education a process of…?<br />Robert Kegan (2009). What "Form" Transforms? : A Constructive-Developmental Approach to Transformative Learning. In KnudIlleris (ed.),<br /> Contemporary Theories of Learning: Learning Theorists -- In Their Own Words. Routledge.<br />
10. My story<br />
11. My complex professional identity<br />
12. Medical education as ‘practice’<br />
13. isolation<br />
14. My first blog post<br />“I want to link up with other people in medical and health sciences education so that we can learn together”<br />
15. My new network<br />
16. Tools (and more tools)<br />
17. Supporting Scholarship in Medical Education: The role of social media and networks<br />Dr Anne Marie Cunningham<br />Cardiff University<br />ASME Summer 2009<br />
18. Paradigm shift in scholarly communication in medical education<br />
19. How will my skills and knowledge of the benefits of social media and networks influence my practice as a doctor?<br />
20. Techno-evangelist? Not me.<br />
21. The myth of information overload…<br />
23. Balancing<br />
24. Forms of professional identity?<br />Robert Kegan (2009). What "Form" Transforms? : A Constructive-Developmental Approach to Transformative Learning. In KnudIlleris (ed.),<br /> Contemporary Theories of Learning: Learning Theorists -- In Their Own Words. Routledge.<br />
25. Harvard health expert calls Facebook 'Wild West‘<br />http://news.cnet.com/8301-27083_3-20021519-247.html<br />
26. New Frontier<br />
27. A twitter exchange<br />“could @amcunningham answer me a quick question please? just need a definition of something medical”<br />
28. “go ahead... I can point you in right direction for good definitions:)”<br />
29. “@amcunningham thanks can you just tell me what is meant by distant metastases please the emphasis being on the' distant'”<br />
30. Forms of professional identity?<br />Robert Kegan (2009). What "Form" Transforms? : A Constructive-Developmental Approach to Transformative Learning. In KnudIlleris (ed.),<br /> Contemporary Theories of Learning: Learning Theorists -- In Their Own Words. Routledge.<br />
31. Norwegian medical student’s definition of professionalism:<br />“To be who the patient needs you to be” <br />AMEE, 2011<br />
32. “I think it shows your desire to embrace new ideas/technologies and learn from others regardless of whether they are students, doctors, patients or other health care professionals. (Multidisciplinary learning at its best). Also shows a willingness to adopt new teaching methods- which may involve use of trial and error, which in this case is very good.”<br />
33. “you are your information”<br />http://www.flickr.com/photos/verbeeldingskr8/4324902924/<br />