Category Archives: Social Media

Friday Follow #ff: Functional or Frivolous?

I have previously written about the notion of followership on twitter (distinct from the leadership concept which is equally as important!) and would like to ‘follow’ it up with a muse on #ff. A quick guide to what #ff actually means can be found here.

Those on Twitter will know as Friday morning comes around some people go to great lengths to include as many of their twitter colleagues in #ff lists. I always feel a little awkward about watching people list either:

i) the same people each and every week or

ii) fill as many people as possible behind or in front of the #ff as they can.

I feel awkward not because it really bothers me what they are doing but because I actually secretly enjoy getting a #ff but never really have the inclination to do #ff spamming myself. There is also something unsettling about what to do when you have received an #ff – do you have to #ff back? do you even have to acknowledge it at all?

I have #ff a number of people but I do try to choose people that I think others really should follow i.e not selecting close friends who have only tweeted 3 times in their entire life. But I often ponder if I am just being a miserly kill joy. There is something quite warming about a collection of people simply being nice to each other in a very public way. In fact there are few things, other than a ‘like’ on Facebook, which are as easy to publicly demonstrate your support, friendship or commoradie with others.

Currently healthcare is taking a bit of beating in the media, is under constant reform and moral is particularly low. Those who use social media to unwind or refresh from the constant pressure of clinical activity could easily be forgiven for celebrating a bit of shared good feeling. So maybe a random #ff , which actually may not be hugely beneficial for your followers, may actually be very beneficial for the recipient. Furthermore given the fact the art of simply smiling at work is clearly something health care professionals would like to see more of (NHS Change Day Interim report) a simple #ff is maybe what everyone needs.

Was Clare Balding right? (and was it relevant I was slightly wrong)

One of the great things about blogging is the permanency of your thoughts. Ideas and thoughts developed on a train journey are often lost forever but if you can encapsulate them in writing they are always available for ongoing reflection. Comments on your work are a functional way for this reflection to be forced upon you but I’d be interested to know how many other bloggers review their material, amend, maybe even comment their now changed views?

With this in mind a while back I posted on the Network site (@thenetwork001) a brief piece on an event that occurred during the Olympics “Was Clare Balding right? Adequacy versus Aspiration”. For those outside the UK Clare is a well respected BBC journalist and presenter. It’s short enough to share below:

During the Olympics Clare Balding apologised to the nation, “I am sorry we can only offer you a bronze.” her words after Rebecca Adlington’s performance. There was an instant twitter and email response with a prompt, and sincere, apology. In a different event, but with a similar theme, a number of commentators during the games made reference to counterfactual thinking on how actually getting a bronze maybe better than a silver.

The post-Darzi drive for Quality remains a powerful influence in commissioning, service delivery and outcome metrics. Appreciating quality has rarely been defined in terms of Gold, Silver, Bronze and ‘placed’ an exploration of delivery of healthcare find being ‘placed’ a common place event. Take, for example, Medical Education; those despairing at the acquisition of a host of work-place based assessments find the target to achieve a fixed number at a minimum standard. Achieving a gold standard performance is not really an option. How about a service delivery standard? The four hour wait is one part of the Emergency Medicine clinical quality indicators along with unplanned re-attendance and left without being seen amongst others. Trusts stagger towards achieving each of the minimum required standards but it would be more than possible to cluster performance across indicators to enable ‘medals’ to be awarded for going the extra mile. 

How do you rate your own performance? – are you happy that the patient was treated efficiently or effectively? Perhaps just treated? Do you check that your contribution to their care was as evidence based as possible? Do you hope that a percentage of patients thank you specifically for your role in their care. 

Ultimately, as unsustainable as it may feel, are you happy with your bronze performance…

Reading back now, not sure I would change much, but I did get an e-mail from my educational supervisor (a line manager in a medical training sense) saying it was important I got my facts right. My immediate reaction was concern that I had mis-quoted Clare Balding! However, this was not the case – I had used the term “wait” instead of ‘target”. This may not appear to be a significant error to the casual reader but it is an important principle. The NHS four hour target is well known throughout the world. It is not a ‘wait’ though, the “target” is that the patient spends no more than 4 hours in the department from the moment they register (which includes the consultation, investigations and decision to either discharge or move to a ward). For some in the Emergency Department world the distinction is really important both for public perception and the fact the target is dependant on a number of factors outside of the control of the Emergency Department.

Ultimately this is a really minor point. However lets say I had said something very  incorrect – does this really matter? I have never had a comment on a blog from a member of my own institution, and one involved in my training. What questions does this raise about blogging (and wider social media) as a means of assessment or professionalism. Obviously stripping naked on a night out isn’t an ideal thing for a line manager to see, but what degree of error is needed in a quasi-professional social media to attract the attention of an educational supervisor? As Social Media closes the boundaries between work and home-life these questions are likely to continue to be asked.

Peer Review – Pointless, Perfunctionary or Practical?

The twitter heaven gates opened today, although they have been building for some time, with postings around the following blog noted in the tweet below

There has been mixed response to this – some quite clear

Some more contemplative

and some amazingly not related in any way shape or form to the #FOAMed discussion but yet highly relevant!

The term scholarship has been used a lot. How do educators prove to institutions that they have been undertaking ‘scholarly’ activity by producing FOAM materials? What is scholarship? Well there are a few key papers

1. Fincher and Work (2006) Perspectives on the scholarship of teaching

2. Boyer (1990) Scholarship Reconsidered

3. McGaghie (2010) Scholarship, Publications and Career Advancement in Health Professions Education (AMEE Guide 43)

(1 and 2 don’t have a pay wall!) But I am struggling to find a definition I really like. Adrian Stanley at the University of Leicester has talked about

“Scholarship is the body of principles and practices used by scholars to make their claims about the world as valid and trustworthy as possible”

The key issue is the quoted need  (paper 1 above) to have peer review as a fail safe to ensure that standards are up held and maintained. Three issues arise for #FOAMed

i. Time

The beauty of anything #FOAMed is that it exists in the realtime of its creator. When it is ready it goes online. There is no delay. Peer review by the very nature of its objectivity requires a period of reflection which delays the product getting to the people who want to see it.

ii. Standards

Peer review is typically based on ‘peers’ judging your work against some implicit or explicit standards and then having those cross-referenced against a third party editor. These standards may vary between journals, grant reviewers or regulators but there is some criteria none-the-less. #FOAMed is  by definition what the user makes of it. If they like it they go back or spread the word and if they don’t, they don’t (and if they really don’t like it then they may tell people they don’t!). But the burden of ‘peer judgement’  is spread across many peers in what some might describe as crowd sourcing. However the open access nature of FOAMed allows anyone to have there say in a fashion that is easily counted via hits, tweets and likes.

iii. Relevance to a new age

When scholarship began the internet didn’t exist. Who would have thought 100 years ago that a musician may have more followers than an entire country (Lady Ga-Ga), who would have predicted that entire university courses may be taught without you physically being in a lecture (Distance Education at Harvard) and who would have believed that a academic conference in Australia may be accessible to anyone in the world (#SMACC2013)

So if I am an institutional director and I want to promote scholarship in my staff. Do I proceed with a system which takes time, may not be accessible to anyone outside my institution, the published beneficial outcomes only read by a small minority and in which there is no social media presence at all?  If educational resources are of poor quality – how do I know?

Or do I promote my staff producing resources which are instantly available to all, may have hits of 1000s and, if popular, are discussed across a spectrum of discussion sites. If they are of poor quality they will not get used.

Academics will continue to discuss peer-review into the next decade

IF #FOAMed is good enough it simply won’t matter

Hijacking Hierarchies: A potential and a peril of social media

Do you remember a time before facebook? There must have been an internet, and there were probably even blogs, but being popular meant a lot people would turn up for drinks at your birthday party. Since social media has taken off there has been an insidious introduction of more formal popularity measures. You have friends on facebook, hits on wordpress, followers on twitter – all potentially irrelevant information but a constant objective ‘measure’ non-the-less. I have mulled over this as on christmas eve a twitter posting (which frustratingly I forgot to favourite) stated the best leaders would concentrate on their families, not new followers, over the holiday period. I am not sure how many people actually look for followers on twitter (apart from the really annoying spam you receive) but the most popular tweeters (in terms of followers) are often clearly not concerned about ensuring wide appeal from their tweeting. However their does seem to be an increasing obsession with measuring popularity on social media. A number of social media ‘personality’ awards now exist. What purpose do these serve? Do those on twitter or facebook actually need reminding who they are all following? They certainly don’t affect those outside social media as they aren’t even on it. A ‘mercury music prize’ equivalent might be more reasonable with up and coming tweeters celebrated . Ultimately though however popular the Mercury might be if you don’t listen to music it probably doesn’t mean much to you! More formal measures of popularity exist (klout and others),  there is some science (seeking influence) and I have always liked [log(number of tweets)*(followers/following)]. So far major healthcare organisations have resisted this ceremony but might we one day see a British Medical Journal #SoMe award…

So is there any reason to continue supporting such narcissism? Can we see a day when gongs may be won on the basis of influence via social media. Well there might be one. If there is one great advantage to the explosion of SoME is the complete breakdown of hierarchy and flattening of communication channels. Who could have thought 5 years ago you could contact directly the chairs of the Royal College of General Practitioners (@clarercgp) , the president of the royal college of paediatrics and child health (@rcpch_president) or the chief executive of NHS Employers (@NHSE_dean) . Just follow their twitter lines to see examples of trainees and colleagues posing questions directly and getting responses. In the short term the promotion of individuals who use twitter (and other tools effectively) may draw attention to this brilliant engagement opportunity. In fact if objective measures of influence, rather than popularity, can be found it may promote greater involvement of organisations who have up to this point resisted dipping their toes in the water.

Ultimately popularity, whether relevant or not, will always be measured. It is now up to those on social media to decided on what the most constructive use of this is.

Remember the consciously incompetent: defining what Social Media is and isn’t

At #APEM2012 Dr. Natalie May (@_nmay) and I gave a talk entitled:

“This house believes Paediatric Emergency Medicine in the UK would benefit from more doctors being active on mainstream social media”

Natalie was “for” and I was (for the sake of the talk) against. Natalie did an excellent presentation (without bullet points and only pictures – @ffoliet would have been proud) and I responded with no audiovisual media (apart from the nativity social media you-tube video) to strengthen my argument (the transcript of the talk and the video can be found here).

A number of unexpected questions and responses came up which I think are useful to share as it is important that social media, #FOAMed and other potentially extremely helpful learning media are not tarred with the wrong brush!

1. Social Media is a concept not one thing (twitter is utterly different from facebook which in turn is not blogging).

2. Facebook ‘scares’ have done the reputation of Social Media significant harm. Health care professionals sticking naked pictures of themselves on their own personal sites does not mean that everyone must follow suit.

2. #FOAMed is a concept that may span many types social media, is certainly not contained by it, and can simply be information via a website…

3. There is great concern that not enough material is quality assured, “…but what if the information is wrong?” we were asked. I found this interesting as it is up to any clinician to decide themselves the quality of information they receive. Does reading one journal article mean you go out and change your practice completely? Do you not weigh up the information, discuss with colleagues and seek other sources of evidence? #FOAMed represents a methodology of the best content percolating upwards to the attention of  interested clinicians. Does everything need to come with a guaranteed evidence based seal of approval? Certainly not in my opinion – what better way to slow things down and stifle debate.

4. Consent and Patient confidentiality cause anxiety, “…but how do you talk about the most interesting, and therefore usually identifiable cases.” This is a very valid concern and has been debated previously (see the comments section). This is not an easy question to answer but in some ways is similar to [3]. In itself not a reason not to engage in the multitude of learning resources out there. Time, experience and legal testing will enable the public and regulators to determine what is appropriate or not but currently there is clear guidance on consent from the GMC (and other healthcare organisations around the world).

I am left with the feeling that the most engaged in developing education 2.0 need to remember they are unconsciously competent and that some work needs to be done to reach the consciously incompetent.

An alternative view of social media

The following is a transcript of the ‘against’ argument at #APEM2012 (

“Paediatric Emergency Medicine in the UK would benefit from more doctors on mainstream social media”

So let us be clear what we are talking about here. We are talking about social media – the facebook, the linkedIN , the twitter. All the things your children, nephews and nieces get involved with.

Who here has never used any of those things?

Excellent – well done. Clearly hasn’t done you any harm.

Those who support such things would have you believe that by being part of, what is it called  “ a global phenomenon”  that you are somehow missing out.  Missing out on what exactly  – arrogant, self-obessed individuals keen on knowing how many followers they have. We are paediatric emergency medicine specialists; we treat dying children. We don’t follow – we lead! Our knowledge if very valuable – why share it with a community of people you have never met. Much better if it stays within the four walls of the hospital you work; you have the best approach. You must do – no-one has challenged it for it years!

And lets say for the sake of argument I did want to dabble in the nonsense. Who has time for it? With all the google searching, trying to find the one paper you read 5 years ago in a dozen similarly labeled folders, putting together presentations from scratch how can you possibly have any PAs (that sessions for those of you in the US)  left.

And then clearly you will get sued! Remember that chap from Wales.  Posted something along the lines of “don’t like working in birth sheds, prefer the cabbage patch. The public were a little aggrieved when they found out he was talking about obstetric units and ICUs.

This shouldn’t really be a path we go down. A study from the US of 600 staff involved in the admission process for medical schools and residency programmes found that 2/3 were familiar with researching individuals on social networking sites. Furthermore, over half (53%) agreed that online professionalism should be a factor in the selection process and that “unprofessional behaviour” evinced from wall posts/comments, photos, and group memberships should compromise an applicant. Clearly the racous behaviour that the PEM community get up to on the evening of the APEM meal may well count against them in the future? I suppose it was re-assuring that only a small proportion (3-4%) said they used the information they found to reject a candidate.

Although this maybe only a US phenomenon. Jared Rhoads, senior research analyst with CSC’s Global Institute for Emerging Healthcare Practices, said feedback on therapies is one of the most valuable uses for social media — and possibly one of the easiest to facilitate (via amednews).

“If 10,000 people start talking about a side effect of a drug, it won’t be that hard to find that out,” he said. Really???

So basically if you are too busy, already know your stuff and what stay in the ‘real world’ social media is not for you

DISCLAIMER: Dr Damian Roland does not believe a word of the above 😉