Welcome to the first ED grand round of 2012, and to my first ED grand round too! The title is (slide)
Jo and I had a discussion about the scope of this talk, and the title. His title was slightly more offensive, so I stuck with my own! There will be no RCT’s, no literature reviews, and no case presentation. I will present no data, no Forest plots and no evidence of any kind. It is primarily an opinion piece, and I confess to being massively biased, despite my Luddite beginnings – I am that most fanatical of zealots, the recent convert! So, here goes…
Anyone know who this is? It is the eponymous Ned Ludd, who from what I can gather, was essentially a thug, driven by opposition to the industrial revolution. He was an early version of a union heavy with a little anarchy thrown in. Not the cleverest by all accounts…he may have done OK in Tassie politics
This poem was written about Ned posthumously… (slide) I would like to put forward the motion that social media doubters are trying to “wreck and destroy” the greatest opportunity in modern medical education
Who am I, and who am I to talk about this? (slide) The point being, I am not a geek, or techy in any way. I have no idea about the hardware, and I fully expect that to let me down during this whole video conference thing!
So, what to expect from the next 45 minutes or so… I will outline how I believe that SM opens up a world of educational opportunity, and we are verging on negligent for not using it and contributing to it! I am pretty excited about the vista this stuff opens up, and I want to share it.
Before we launch into the talk proper, here is a little bit of scene-setting. Anyone know what this is? It is a page from the famous Book of Kells, an early Christian illuminated manuscript which now lives in my old alma mater in Dublin. It takes us way back in time, to a simpler age, when men were men, and either brandished swords and raped and pillaged, or cowered in stone towers painting books and trying to avoid being pillaged. The history of media is one of change, and resistance to change. I believe that all media are just tools, and none is “good” or “evil” in and of itself. Illuminated manuscripts were not “good.” They are certainly beautiful, but they were visible and accessible only to the educated and religious elite. They were shared with only a few.
The introduction of print led to similar debates as those raging today about social media, and the same discussion has revolved around almost every technological advance in communication. Now, we were sharing with a few more…but not everyone was happy with that…there was debate about the merits of enlightening the poor. I would argue that we debate the wrong thing. We shouldn’t be debating whether these technologies are a good or a bad thing, but rather embracing them as tools and learning to use them to DO good things rather than bad things. In many ways the history of communication is one that reflects democratic socialism, but that’s a whole ‘nother discussion.
We have covered religion and politics, which are of course never controversial, especially where I come from in Northern Ireland…I’d like to move on to the shadowy carpeted world of administration. Unfortunately not everyone agrees that increasing the accessibility of information is essentially of benefit. This is the RHH policy on the topic, which is not the worst, but definitely tends towards a staid view… Some progressive social media policies recognise the benefits, but many simply reflect the conservative establishment view that they are inherently a waste of time. For example, in our own department….internet is blocked on end of bed computers. This is meant to stop FB use, but it also stops use of educational resources for nursing staff, who feel the flight deck occupied by medical staff is not accessible to them. We may restrict abuse this way, but we also restrict constructive and instructive use of these tools.
In fact, you may leave yourself open to severe and unspecified punishment…
This a graphic “borrowed” (with permission) from Mike Cadogan, which illustrates the generational change in the primary sources used by doctors.
With this generational change in mind, I recently wrote a blog post on the imminent demise of the textbook for anything other than a doorstop or perhaps a bookshelf dressing proving how much you must know to non-medical dinner guests. This post led to an international Twitter discussion, until it was finally agreed that the textbook is on ECMO. As far as I can gather, this compromise was only reached because Mike Cadogan is smashing out another two textbooks this year (which he admittedly is publishing as iBooks) before giving up entirely on the genre…
So, what are “social media?” Most of you probably already use them to some degree either socially or professionally. If you know more than me about all this, feel free to contribute The Wikipedia definition is (slide) Whether Web 2.0 is qualitatively different from prior web technologies has been challenged by WWW inventor Tim Berners-Lee He called the term a &quot;piece of jargon“ because he intended his Web as &quot;a collaborative medium, a place where we [could] all meet and read and write&quot;. He originally called it the &quot;Read/Write Web“ and probably envisaged something like what exists today.
So, with that bit of background having killed a few minutes, this is the question I come to… (slide) As everyone who has sat or plans to sit the fellowship exam knows, discuss means pros and cons, so here goes! I have already alluded to the perceived con of time wasting etc. which is no doubt a real phenomenon, but is a function of human nature, not of the technology! Some other criticisms that have been levelled at social media by various commentators include…
Lets start off with some of the many genuine criticisms, as opposed to the knee jerk opposition of the rather conservative medical/administrative establishment Criticisms certainly exist… (slide) There is no right or wrong response to this position, except to say that one must bear it in mind when using these resources. Is it really any different to any other media that exist? The soapbox, parliamentary hustings, newspapers and television all could be criticised in the same way, I believe – the problem is not the TOOL, but HOW it is USED – I will keep coming back to this point until you are sick of it I am sure! So, my response to this criticism is to adulterate it slightly, thus…
(slide) However to those who question the motivation of the most influential voices in Emergency Medicine on Social Media, I would argue that ANYTHING shared, published or disseminated by ANY medium must be approached with healthy scepticism, and indeed the transparency of many of the voices in EM social media often exposes the opacity of the established peer-reviewed Journal and textbook leviathan.
(slide) Quite frankly I think these are just not true! The fluidity of various media is incredible. I can see an ECG at work, de-identify it (of course), share it on Twitter, automatically upload to my blog and have it be commented on by Steve Smith or Amal Mattu within minutes. I learn, I teach, and the lessons reverberate across the web. Innovation is celebrated and encouraged with dynamic enthusiasm in this community and Emergency Medicine, and especially Australian Emergency Medicine, is leading the way in this process.
In terms of ethical considerations: (slide) To this I say: Web 2.0 ethics breaches are no different to any other ethics and confidentiality breaches – you are just more public, and there is a record, so one is more likely to get caught! The response should not be to ban or restrict the medium, but embrace it and teach people to use it responsibly
And to anyone who disagrees with me, I am likely to be bigger and uglier than you, so…
The benefits are simple: Social media are tools which I believe are now as vital to good and current practice as stethoscope, or a pen, they are optics which can peer broadly and deep into the past, present and future of medical practice, and a community which is egalitarian, dynamic and vibrant. They offer open entry to what Mike Cadogan calls “the conversation” and the access to eminence and evidence is phenomenal. The aspect of this which I suspect some are uncomfortable with is that one cannot completely control one’s message in the social media world – it takes on an almost organic life of it’s own. To contribute to social media, you simply join the conversation, with the hope that you can achieve a degree of influence in it.
There are a number of components to the social media cycle, which are variously described by academics from the IT world, but this list is a summary of the aspects I believe are important in medicine
The integration of some of these aspects in the cycle is well illustrated here.
I will briefly summarise and give examples from the array of platforms available
Just another quick fellowship exam-style question… Clearly, you can’t use them all! Hell, I don’t even know what half of them are, but it makes a good picture round for a pub quiz!
Really simple syndication
There is no point in using a platform that people you want to connect with don’t use In Emergency Medicine and EM education, the most robust communities exist on Twitter, and on various different blogging platforms (such as Wordpress, Tumblr, Blogger etc.) Youtube, podcasts (as extensions of blogs) and various cloud sharing applications also are heavily used. Twitter is however, the major portal of entry to this world, and almost everything published or shared in the dynamic online community of EM is accessible through twitter. I recommend getting on Twitter, and getting an RSS aggregator and you can gather all you need from there… (If I have time) I’ll just demonstrate how easy this is using my own set-up. My only concern is that my grasp of the video-conferencing hardware may let me down here – fingers crossed!
If you haven’t seen her blog, it is worth checking out, especially for exam study – she e-publishes a comprehensive series of study cards entitled “Paucis Verbis” or “a few words” which are an invaluable quick reference. So I believe the future will hold increased recognition of the role of social media in medicine and education, and the increasingly dynamic democratisation of information, led by the pioneers Scott Weingart, Michelle Lin, Mike Cadogan, Cliff Reid, Rob Orman, and Mel Herbert.
We can’t afford to dismiss it, because if we do, we abandon our responsibility to guide the next generation through the ever more overwhelming content. We possess the real experience to guide them in using this stuff, but we must be familiar with the technology or we will lose them!
I think you should join the conversation and the revolution!!!
Social Media and Web 2.0 in Emergency Medicine* *the Luddiot’s guide domhnall brannigan 2012
“ Printing was considered vulgar and only for the poor…aristocratic bibliophiles refused to disgrace their collections with the presence of a non-manuscript text. It fell to the lower classes to recognize the importance of the printing press…by the end of the fifteenth century, more than 1000 printers had printed 10,000,000 copies of more than 40,000 books”
Andrew Keen criticizes social media in his book The Cult of the Amateur:
"Out of this anarchy, it suddenly became clear that what was governing the infinite monkeys now inputting away on the Internet was the law of digital Darwinism, the survival of the loudest and most opinionated. Under these rules, the only way to intellectually prevail is by infinite filibustering."
Andrew Keen criticizes social media in his book The Cult of the Amateur:
"Out of this anarchy, it suddenly became clear that what was governing the infinite monkeys now publishing in medical journals was the law of print Darwinism, the survival of the richest and most influential . Under these rules, the only way to intellectually prevail is by infinite filibustering."
“ There are clear things that doctors should not do, whether online or not—namely, break confidentiality or perform illegal acts…the trend for online discussion through blogs, discussion forums, or Twitter means that more people can view what doctors are saying to each other…”
Michelle Lin is the author of one of the original EM blogs “ Academic Life in Emergency Medicine ” and on January 13 th was elected to the Academic Chair of Emergency Education at UCSF in California, largely on the basis of her blog