Category Archives: FOAM

Networking: Twitter doesn’t build communities, stories do…

This blog posting is based on my talk to the #HSJRisingStars. It’s good to have the opportunity to expand on my thoughts as it’s clear from feedback that this didn’t quite touch the nerve I was expecting. Raising concerns about twitter, within twitter, is an interesting experience…

In the run up to NHS Change Day 2014 a number of constructive criticisms had been voiced on the type of pledges made. How can it be that health care professionals are pledging to “deliver safe care”, “create caring cultures”? Aren’t these pledges just paying lip service to the broader purpose? Are people just jumping on a bandwagon?

I wrote a blog in response to these concerns. It centred around my acknowledgement that on a busy shift I had forgotten to introduce myself to the parents/child I had just seen. I had essentially failed Kate Granger

I am not a prolific blog writer, I’m probably not even a good one, but Kate tweeted the blog post and in the space of 3 hours it had received 1300 views. This was dissemination on a pretty impressive scale and in fact far more powerful than any previous networking opportunity I had been engaged in. It made me really think about reach and how I had communicated in and out of networks.

Change Day has taught us a lot about the NHS. There seems to be a unmet need to publicly discuss and celebrate core values; reports by Francis and Berwick have removed the taboo of some of these issues. It has taught me personally a great deal about my role in change and the roles of other networks. The story of Change Day began with a discussion about junior doctors and at the very first Change Day meeting I told a story inspired by Helen Bevan, describing how it is the new generation who are most likely to bring about radical change. Interestingly, though, one of the groups least involved in Change Day (in terms of raw numbers) were junior doctors (probably second only to GPs).

How did that happen? Did my networks fail to understand to the message? Was I wrong in my belief that Change Day can – and will – be a powerful instrument for cultural change? I think the reasons are subtle but well worth exploring.

Change Day was in essence about individual people. The real narrative was the reasons behind the individual pledges; the event itself was more like a big scrap book recording and highlighting more than half a million stories. My biggest transformation of thought in the last couple of years has been about the power of narrative. It’s personal narrative which drives us. The networks you are part of, represent, lead or create, contain people who share parts of that narrative. But I wonder how often your (or your network’s) narrative is shared by others. Just because I know ‘x’ doesn’t necessarily mean that an e-mail to their “network” will spread to a wider “network” and will be effective at spreading the message.

I’m sure I am as guilty as anyone at pushing the ‘send all’ button. Similarly asking friends  “can you send to your networks?” is something I have realised may not really add value. In fact the use of networks in this way may, in fact, create silos due to the lack of proper dialogue between them. “Nobody talks anymore” is oft quoted but there is some danger that it really is a little too easy not talk. By all means use technology – Hangout, FaceTime and Skype have enabled conversations to take place that weren’t possible previously. They are conversations with animation of expression and vocal nuance. But the real essence of good narrative goes beyond the physical conversation to the nature of what is being spoken. My story of failing at #hellomynameis is much more powerful than telling people how important Change Day is. Similarly describing my personal pledge is a much better vehicle to create interest than a newsletter about the day itself.

None of us wish to create silos as I’m sure we share the same the values. The translation of those values into a vision is probably different between our networks though. So in this time of social media and electronic interfaces, maybe we all need to be a bit more personal. We need to reconnect with each other with personal stories and communications that unite networks – not just transfer information between them.

“In this age of omniconnectedness, words like ‘network,’ ‘community’ and even ‘friends’ no longer mean what they used to. Networks don’t exist on LinkedIn. A community is not something that happens on a blog or on Twitter. And a friend is more than someone whose online status you check.” – Simon Sinek

This (admittedly controversial) quote was really brought home to me when I attended #SMACCGold, a social media and critical care conference. I thoroughly recommend watching the talks when realeased as they are all very much personal stories. Undoubtedly it was twitter, google and blogs that brought people in the #FOAMed community together but the real benefit for me was meeting the people there and engaging directly with them. As I said after the #HSJRisingStars event:


(Thanks to Natalie May for pre-publication proof-reading and editing)

#SMACCGOLD – It hurts..

Too often we enjoy the comfort of opinion without the discomfort of thought

The 2nd SMACC (social media and critical care conference) has just finished. A packed 4 days (including pre-conference) with over 1000 delegates developed by a few brilliant individuals who have envisioned a different way of learning and collaborating.

This is no ordinary conference, with fantastic topics discussed and innovative events. See Salim Rezaie’s great blog for the detail. There are few conferences where professionally executed simulation debriefings occur in front of an entire auditorium, speakers’ cry in a context that feels appropriate and delegates give standing ovations in some of the break out sessions.

I sit writing this approaching Doha on the second stage of my journey home. I am a SMACC virgin, utterly humbled by the invitation to speak in Brisbane. I have met and listened to some extraordinary people but my over-riding emotion at the moment is one of sadness. I am truly sad it has finished. Don’t get me wrong, my youngest developed chicken pox during my journey away, I do want to go home. I am sad though that I know I will be attending other conferences (unfortunately SMACC Chicago is over a year away!) where I will sit and listen, I may learn some additional clinical information, I may meet a future research collaborator, if I am really lucky something may inspire me to change practice.

What is unlikely to happen is that there will be a tangible excitement when the first speaker takes to the stage, that over coffee break all the delegates will be smiling, that I will witness carefully constructed slide sets that support (not deliver) the stories the speakers are telling.

The attention to detail in the narratives delivered at SMACC was brilliant. It’s likely those reading this who weren’t at SMACC will probably be a little sceptical of this hyperbole. Please, please, watch the video casts when they are released. Watch how Cliff Reid and Iain Beardsell bring their emotional talks together full circle. Natalie May delivers to a packed crowd on “paediatric tips you won’t find in a book” using slides with no text and Tamara Hills received a standing ovation for her PK presentation.  Listen to Victoria Brazil deliver a 20 minute presentation in exactly 20 minutes with no timing aids (ok – I admit this is only probably considered really cool by geeks like me).

The hierarchical nature of academic events is not present at SMACC. It was brilliant to see a mix of professionals, grades, and specialities mucking in. Medical students and junior doctors delivering lectures and being part of the panel discussions. And so I could go on….

If there was one thing that encapsulated SMACC it was the patient centered approach to challenging dogma. I am struck that although the patient should be at the heart of everything we do – I often don’t see that at conferences. I hear people ‘talk’ about it but during lectures on new treatments or methods it’s about stats and facts. It’s about why the speaker thinks something is wrong. What SMACC did was deliver lectures where the speakers understood the challenges of normal practice. That patients are humans, that the things we do in critical and emergency care have an impact on them. That if we do what we always did, we will get where we are going – and is some cases that is simply not acceptable. Challenging Dogmalyis, championed by Prof. Simon Carley is uncomfortable. It hurts sometimes to be challenged.

SMACC hurt.

But until SMACC Chicago this type of hurt is so much better than the pain of any other conference you will go to….

Post Blog note:

Have already started getting messages saying but what about…..? Will start adding 🙂

“Text, Slides and Videotape”: #SMACCGold Workshop Pre-reading

The pre-conference workshops for #SMACCGOLD represent an opportunity for delegates to gain additional skills direct from some of the conference speakers

The Education Workshop contains a short session on “Text, Slides and Videotape” hosted by yours truly. The aim of this session is to aid delegates use of audio-visual tools to maximise the impact of their teaching. There will be lean towards the use of video as resources on other medium are easily found elsewhere (and its the area in which the greatest gains for least effort can be made IMHO)

I will also be offering an individual feedback session on videos/pictures used in teaching/assessment for attendees. Please send me your cases in advance (secure if needs be) and I’ll touch base at #SMACC. There might be a prize for the best use of audiovisual material for teaching….

It would be worthwhile for all participants to have a look at the following: (more will follow in the new year)


Education by Video 

P (cubed) A blog on Presentation Skills by Ross Fisher 

A literature review of Patient Video Cases (only for the seriously interested!)

ABC of learning and teaching in medicine

Tasks (these are not obligatory but will help inform the workshop)

1) Please register on (you’d don’t need to have any paediatric experience. This is to demonstrate videos in education. Orientate yourself to the site and then please go to

My waiting room > Patient Stories > Difficulty Breathing > Case 1

I’d like to start a discussion about this google + site.

2) I have added a test video to my vimeo site. It is password protected as the consent for this film means is only available to health care professionals. If you need a password please find it on the SMACC Education Google Discussion group or e-mail me on

Look forward to seeing you in 2014!

The #FOAMed universe – normal laws of evaluation don’t work here

I try and write blogs which can be accessed by anyone at anytime with minimal prior knowledge. However in this case you probably do need a understanding of what #FOAM is. It’s probably useful to also read @boringEM‘s thought provoking commentary on methods to evaluate #FOAMed sites. Essentially he proposes a number of metrics to evaluate, and potentially, rank #FOAMed resources. A number of tweets following this got me thinking of a potential conceptual challenge that may inhibit the debate:

I have spent the last three years looking at the evaluation of practice changing interventions, in particular educational ones, as part of my PhD (see summary here). Part of this involved an analysis of the term evaluation, which is different from assessment and effectiveness. One of the things that happens when medics start evaluating things is that they often apply the same measures to a variety of different environments. As soon as discussions started on judging #FOAMed content inevitable comparisons with the process of evaluating academic literature arose (some of my previous comments on this here). The problem with that is:

i) Not only are #FOAM sites, by definition, designed to share learning in an OPEN access fashion but

ii) The methodology of engagement with #FOAMed was always going to be different from that of an academic paper.

To set some context the naysayers and skeptics for #FOAMed have always stated there is no quality control of resources. How do you know if the content holds up to current evidence? What if the authors are not credible or has a conflict of interest? Well – think of the last journal you read? Did you go away and practice immediately what it told you? I am fairly sure you didn’t, probably for a variety of reasons, but ultimately because critical evaluation has been ingrained in most clinicians from early in their training. This criticism  is a particular bug-bear of mine and puts people off receiving information via Social Media (see here for previous thoughts). The lack of peer-review of #FOAM material makes it more vital that the reader is aware of potential error (if I was to change one think it would be a universal alert statement is placed on site highlighting this – this would also act as a very useful #FOAM brand) but the reader can still make their judgement. As an example this paper on Early Warning Scores in Emergency Departments has been a cited on a number of occasions but is neither peer reviewed or commissioned, ultimately it should have no more value than anything else or St.Emlyn’s have produced. Why does being in a journal make it have more value?

But I suppose I digress slightly, what is different about the evaluation? Well academic literature is spread by publication in journals, promoted by citations and only recently  encouraged by social media. #FOAM has always been essentially reliant on word-of-mouth. The route to #FOAM is rarely discussed. Think of the last #FOAMed site you went to – why did you go there? Did you just find it? I suspect (and please comment and say I have got this wrong) it’s because it is from a source you already follow or someone has directed you there. And who was that person? My guess it is someone  you trust,  follow or is a leader in #FOAM. Not really sure how you define a leader in #FOAM but I stake trust in the sites that key #FOAM supporters recommend. So if @sandnsurf@emmanchester, @_nmay, @predordialthump, @boringem, @jvrbntz or @tessardavis mention a site I take a look. Others may have a completely different list – but it probably doesn’t matter who they are. There is a different form of peer review in process here – that of trusted followership.

Could there be mistakes in the process – well yes there could. But the process of academia and publication has not been risk free . So when it comes to evaluation the metric is at stake is the spread of information. The more recommendations leading to website hits being a proxy measure of word of mouth assessment of the perceived quality of site. Problems still exist if you want to be pedantic- hits to sites can be manipulated (but this can be controlled for) and the “quality”, in terms of readability and evidence, if you are determined to measure this as well has still not formally been assessed. But if you are evaluating  the primary purpose of FOAM then it is metrics like hits which have value. How this reflects the sharing ability of some of the FOAM leaders is open to question? This also prompts the question about what is the ultimate aim of #FOAM and whether it wishes to be constrained by old paradigms of evaluation or maybe create new ones.