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Archive for April, 2014

Is there any such thing as “IRL” ?

28 Apr, 14 | by Toby Hillman

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Social media is all pervasive – it is nigh on impossible to see an advertisement nowadays without a hastag, facebook, pinterest or twitter handle attached.  Social media has been credited with sparking revolutions, riots and bringing down criminals, and is even used by the Pope to spread his message to the world.

Perhaps it isn’t terribly surprising that medical students are enthusiastic users, with over 90% reporting regular use in some studies.  The varied subjects covered on social media make it perfect for sharing not only pictures of cats, but also valuable educational materials and lessons.  Indeed, there is a conference specifically aimed at those who work in critical care and use social media (SMACC) – it is well worth checking out #tags like #RespEd and #FOAMed on twitter for up to the minute reviews of new developments in medicine, and medical education.

There is, of course a double edge to this particular sword.

In a profession which is renowned for using dark humour as a coping strategy for the difficult situations which are it’s core business, it can be easy for users of social media to fall foul of the usual standards expected in day to day life.  Various organisations, including the GMC and RCGP have offered guidance on social media use in the medical profession – here and here

For younger members of our profession, who are growing up with social media as a normal part of life, concerns not for patients, but for themselves may be around the corner.

Residency programmes in the US have previously been surveyed about their willingness to use internet searches to find background information on applicants through their social media profiles (see here). 10% already use social media searches to inform their selection processes, and nearly 60% did not indicate that using these methods would constitute any violation of the applicants privacy.

When the potential recipients of such attention are asked, the responses are somewhat different.  Medical students in the US were surveyed for their attitudes towards the screening of their social media profile (Facebook specifically) in a study recently published in PMJ.  The question being reported was part of a larger survey into medical student use of Facebook.  The students were asked if a posting on Facebook with pictures showing the student intoxicated, wearing a lewd halloween costume should have any bearing on their application for a residency programme.

The respondents didn’t share the views of the residency programmes – with a third of respondents indicating that such pictures should have no influence on their application as they are irrelevant, and only 2.8% feeling that such pictures would be sufficient for an application to be rejected due to the pictures alone.

So we have 60% of residency programmes feeling that they have the right to screen social media for background on their applicants, and 33.7% of applicants thinking that photos of themselves displaying unprofessional conduct are irrelevant.

This gap in the perception of the importance of social media in revealing underlying attitudes, and even ethical viewpoints is important.

Medical students of old were famously badly behaved – Doctor in the House made great use of this reputation to win a BAFTA in 1955.  Those medical students are now grown up, and helping to administer training programmes.  The behaviours of todays medical students are probably not vastly different from those a few decades ago, but it is the exposure of them to the wider world which seems to be disagreeable.  The use and abuse of alcohol, dark humour, irreverent behaviour still goes on, but now that pictures of these activities can fly around the world in a split second and remain online in perpetuity, they take on a new significance.  What were once seen as rites of passage in medical school, are now seen as grounds for dismissal or rejection.

The advice given in the paper, is sound, to a point – students should be aware that there is little privacy on the internet, that future employers can find information easily, that online information is nigh on impossible to delete, and that their online activities can affect their professional reputation.

But one piece of advice which sits less comfortably with me is that students should ensure they know how to keep their activities behind privacy settings.  This is clearly a pragmatic approach, and sensible advice for individuals, but it does not address the heart of the issue.  It seems that if we put up screens around our activities, we might shroud them once again from the public, and save students from public embarrassment, but we won’t have made any progress in understanding why there is such a powerful hidden curriculum in medical education, and what effects it has on out trainees.

Just because social media exists in the ‘virtual’ online world, we should not forget that, actually there is no virtual, online, or alternative reality, there is only IRL

(IRL = in real life for those who aren’t up to speed…)


It’s all the little things.

13 Apr, 14 | by Toby Hillman

This week I have been privileged to be at “the Forum” or to give it it’s full title, the 19th International Forum on Quality and Safety in Healthcare.

The Forum is an impressive event – there were over 3000 delegates from 78 countries, and over the week the virtual presence of the event was significant. At one point delegates were asked to refrain from ‘pledging’ at the top of the Arc de Triomphe as the authorities were concerned that there was some sort of effort to start a revolution (which was sort of the intention, but not in the way they thought….)

The keynote speakers were impressive, global leaders in patient safety, healthcare improvement, and have led some of the revolutions in how we deliver healthcare, and how we think about healthcare in the last few decades. The delegates were impressive too – leaders of national, international and global efforts to improve care for patients.

The keynotes I attended often included a call for action – Maureen Bisognano  @maureenbis asked us to strive to reach escape velocity, not just 10% better but 10 times better than we are doing at the moment – to break the shackles that hold back improvement, and flip to a new way of “doing” healthcare. Indeed – she asked us to move beyond healthcare, and start to focus on health as the outcome we need to improve.

On Thursday was the turn of a giant in healthcare – Don Berwick [@donberwickforMA] to rally the troops. Don’s call to arms was a little different though, and, I felt, was a big risk. Instead of concentrating on the technical tasks of improvement, the challenge of balancing ever more demand with ever higher costs, and diminishing resource, he took us all to a different place.

Don spoke from the heart about his grandson, and the visceral joy it brings him to be with Caleb. And building on Maureen’s wish to see health as the goal, Don set out the case (medical and scientific) for flipping healthcare, and encouraged us to consider how we could wholeheartedly aim for health and wellbeing. He name checked gurus in what might be considered alternative thinking on healthcare, and used a word which was new to me, but got me excited – salutogenesis. (In later conversations with other delegates, it seems I am behind the curve on this one) the keythemes he wished to see included in the debate in the future are in there slide below:


But what about the hard thump of reality that is waiting for me when I get home? I don’t think I will be able to go to my medical director an say outright that we need to create a salutogenetic environment in our hospital and expect to be taken up on the scheme immediately. So for the non-superstar improvers, those who haven’t sparked revolutions yet? What did the conference hold for them?

Well, this was in fact the true message of this conference for me. The big, bold visions and calls to action were great, and my experience would have been less rich without them. BUT – taking a bit of time out to see the posters, and listening to the messages from many sessions on how to implement change, capture learning, use data effectively, I got a very different message.

It is all very well aiming for 10 times improvement in outcomes by flipping healthcare, and helping our patients achieving wellness, but the road to all of this is made up of tiny steps. Be that the simple, but massively influential #hellomynameis idea from Kate Granger @grangerkate or the rearrangement of clinical equipment stores to reduce time taken to get kit together from 2min41s to 26s) at St George’s Hospital, or learning how to tell your story to engage others – it is only through many thousands and millions of small changes, all anchored in the visions set out by the big players that we will achieve any of that vision.

The greatest moments for my own learning came through chatting about a problem I have to deal with at work with a few other delegates – very small, very personal, but it will start to introduce the changes my Hospital needs to make to reach a vision of enhancing health in the population it serves, not just delivering more and more health-care.

So – as one of the many quotes I noted at the conference says – we need to keep our feet on the ground, and our heads in the stars.

I hope that you will be able to make use of the conference resources or the ideas that delegates broadcast via the #quality2014 tag on twitter (even if you out don’t sign up its worth looking at twitter as a reference source for events like this) to start out on your own small change – however small that might seem.


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