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Author: Antony Willman

  • Salisbury Plain PBSGL

    I’ve added some of the posts from our PBSGL site just to get going!

  • PBSGL Oct 14 – Post Menopausal Symptoms

    An excellent discussion. Lots of areas where there was learning and confirmation of practice. There was also discussion about our role as patient advocate in 2 of the cases. Should we stop the HRT in the 74 yr old lady suddenly? What about if it was contra-indicated. Also the role of alternative medicine – if we advise it as an option & the patient is harmed, where do we stand?

    Unaswered questions were:

    1. Circulate a Menopause Rating Scale (ASW to do)
    2. Should we ask opportunistcally about peri-menopausal symptoms?
    3. When using topical E3 gel as a systemic therapy (as opposed to vaginal gel), what are the options for providing progesterone? The IUS was discussed as an excellent option but what about if it was contra-indicated or if the patient declined? Are progesterones actually required if use of E3 gel is intermittent and on a PRN basis? (JCS to find out).
    4. Which is the best primary care tool for memory/dementia screening (TW to find out).
    5. What are the absolute contra-indications for HRT and smoking? (ASW will investigate).

    Two new members (both young males) expressed concern about the limitations of their knowledge in this area. Whilst we all expressed this (we do not have many patients with peri-menopausal symptoms), it is something that needs to be raised on the PQO/PGMO course. The curriculum should cover common urogenital problems in middle aged women at least so GDMOs are confident in raising the subject. Women are known not to volunteer conditions such as loss of libido and stress incontinence.

    Areas of learning we discussed:

    1. The use of a topical E3 gel as a systemic therapy.
    2. Use of self help web sites – Amarant Menopause Trust.
    3. One of the scenarios involved a concern about dementia. We moved on to scoring systems in primary care – 6 question CIT, MMS.
    4. We all agreed the time constraints in a single consultation would rule out a comprehensive history, examination and investigation. Another option was to spread over 2-3 consults with the patient doing some research in the interim.

    There shouldn’t be too many barriers to change. ASW will raise the issue of the curriculum change with the GP Dean next week on the Tri-Service Trainers Course.

    Most of what we discussed had mutual agreement. Some guidelines were discussed and we agreed that a single sheet of pros/cons of the long term risks & benefits might be a useful tool in the surgery.

  • Online people tagging: SNS and work-based learning

    Online people tagging: SNS and work-based learning

    Cook, John, and Norbert Pachler. “Online people tagging: Social (mobile) network (ing) services and work‐based learning.” British Journal of Educational Technology 43.5 (2012): 711-725.

    After a break for a holiday, I am down to the last few articles I want to review before I submit my assignment. I am not going to get through them all but wanted to review this one first. This is another review article which looks at SNS in the context of informal learning in work place based assessment.

    Again this starts with a critical overview of the literature. The first part is spent linking workplace based assessment with informal learning. Often a GP registrar will learn a considerable amount from working in teams, from other healthcare professionals, being supervised, from significant events and complaints. The author cites another author, Michael Eraut, who has done quite a lot of research on workplace based learning. A synopsis of one of his studies is available here which is easy reading and from which I have taken the following table from.

    A typology of Early Career Learning (Source: Eraut, 2008)

    The table is also present in the article. The point being made is that a lot of learning at work is one to one, but this can be from peers, from the teacher, from colleagues and from patients.

    The article then discusses Social Network(ing). Eraut identifies the key enablers for confidence, learning and retention of information in workplace learning were support and feedback. This in turn leads to self-efficacy, the adult learner/reflective thinker. Whilst there is a dearth of research on SNS and how they can facilitate this, the author cites several papers which explore self-efficacy and the use of scaffolding to achieve this. Scaffolding is what we do as educators in GP training, by providing face to face feedback (e.g. Problem Case Analysis) and the ePortfolio as a SpR builds up a portfolio of experience. I do not foresee a major role for SNS in this but GP training is a one to one learning environment. Computer supported scaffolding is then explored briefly. The author mentioned some papers demonstrating promise in this area. I suppose with the ePortfolio we are already doing this.

    People Tagging

    The author describes people tagging next, using examples of social sites such as Linkedin. Two types of tagging are described – ontology’s and folksonomies. I had never heard of these terms. The former is a system classification (no examples are given but I would imagine rather like rank in the military), the latter is a user driven collective system. I would imagine this would be like Facebook likes, interests and hobbies. The two are linked but a folksonomy is disordered requiring ontological clarity. In a nutshell, sites such as Linkedin try to provide this. My own experience of Linkedin is that I keep on getting recommended for various skills by colleagues. If I agree, I get tagged for that skill eg medical education. The relevance of this is not clear. The author goes into some detail presents a typology of factors in social networking and work-based learning (it is probably worthwhile looking at this) and then describes a case study of a project called the MATURE project. This used a tagging system done by employees and/or superiors referring to expertise or interests. This can then complement self-assessment as well as competency assessment. The article is quite technical but in summary it is suggesting that this type of tagging (either ontological or folksonomy) can assist in work-place assessment.

    Summary

    I found this article quite hard going as it is very technical but there were some useful features. This review is my interpretation. I am not convinced of the value of SNS in work-place assessment. People tagging may be useful for networking and, in the case of Linkedin, potential employment, but not assessment. The work-place assessment we do for the MRCGP has prefined competencies as per the curriculum. It already has the ePortfolio which provides the ontological rigidity required for assuring competence. The authors conclude there is potential for social media in informal, professional, work-placed learning. I would argue whilst there is a role in informal learning, it is not thorough or discriminative enough for a formal work-place assessment delivered against set criteria.

  • Tweeting For Learning

    Tweeting for learning: A critical analysis of research on microblogging in education published in 2008–2011

    F Gao, T Luo, K Zhang – British Journal of Educational Technology 43.5 (2012): 783-801.

    I came across this article when searching for microblogging papers. It is a useful article in that it summarises the research done between 2008 and 2011 on microblogging, or more succinctly, microblogging in education (MIE). It is worth a read due to the design of the study. What the authors did was to try and look specifically at evidence for the benefit of MIE whilst excluding opinion pieces and review articles. During my various searches, I have come across a lot of opinion pieces which although relevant, do not always provide the evidence for benefit. This paper is essentially a systematic review. Due to the variety of the included studies, it isn’t a meta analysis but it does provide a nice summary. One can delve further into the individual studies if one wants to and I hope the title above links to a free text version of the paper.

    The article attempted to answer 4 research questions:

    1. What types of research were conducted on MIE?
    2. How was microblogging used for teaching and learning in these studies?
    3. What educational benefits did MIE have on teaching and learning as identified in these studies?
    4. What are the suggestions and implications for future MIE research?

    The method involved is one of the clearer descriptions I have read in a paper for a while and I would recommend reading this part of the paper. Four rounds of searches identified a total of 21 papers which met the criteria for inclusion. They were then analysed. Reassuringly some of the papers I have already reviewed plus ones which are pending were included in the datasets so I did feel a bit smug. It rated the paper by Ebner et Al as having greater validity (sample size, duration etc). Another rated highly is by Kop et Al available here which I haven’t read yet. The submission date in October is getting closer and every time I scratch the surface, another paper pops up.

    RESULTS

    The article described the papers included. These varied in several ways. For example a couple explored microblogging in the context of a conference and the positive effect of real time feedback and questions to the lecturer/presenter. Most were set in higher education. The sample size varied greatly. My own view is that this is less important as these tend not to be quantitative studies. The duration varied as well. A conference or lecture may only last a few hours yet some of the interventions extended to 2 semesters. Ebner’s study lasted 6 weeks yet was very labour intensive & meticulous. It also drew some very balanced conclusions.

    The areas further identified and explored by the authors are: Who is participating? When to learn? What to learn? How to learn? Participation and Engagement; Reflective thinking; Collaborative learning.

    The ‘who’ and ‘when’ are fairly straightforward. Examples of who given include delegates at conferences and the when is essentially at anytime. The concept of education when & where you want it. MIE has been used for informal communication outside of the classroom sustaining engagement by posting updates and relevant links.

    A lot of the positive benefits of MIE have already been described when looking at collaboration and these are all positive effects in the studies looked at. The remaining ‘how’ is a bit more interesting. ‘Fostering interactive activities’ and ‘encouraging informal learning’ are known strengths of MIE. The main educational effect from the review was the development of learning communities, promoting interaction between conversations between students as well as students and teachers. MIE is not meant to be a conversation tool but using the @ prefix achieved this. My own experience is that this is not the case but by flagging with a #, response and conversations are more likely. Apart from all these, there was no objective evidence on the educational impact of MIE. For example better scores in assessments. This is discussed in their future research suggestions. Only one of the studies was experimental, the rest being descriptive. This is what I am finding. Whilst these studies are important, it would be good to find an experimental study which perhaps compared marks with & without a Web 2.0 tool. This would be dependant on students being without their smartphones for a period or not using SNS, something which may prove more challenging.

  • Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education

    Maged N Kamel Boulos*, Inocencio Maramba and Steve Wheeler

    BMC Medical Education 2006, 6:41  doi:10.1186/1472-6920-6-41

    Free text here

    I found this article whilst doing a search trying to find evidence of the educational impact of SNS and Web 2.0 tools. Unfortunately it is a slightly older article so some of the concepts and ideas are a bit outdated but it is useful summary. It looks specifically at three types of Web 2.0 tools – Wikis, Blogs and Podcasts. It was written in 2006 and its age is shown slightly when it talks about the lack of evidence of the effect/impact of Web 2.0 tools in the context of medical education (although the research base is still expanding). However what I found most useful is it lists the advantages and disadvantages of the three tools. The article mentions the tools and resources to create a Blog or Wiki are freely available and easy to use. Since 2006 of course there has been an explosion of apps, programme & online resources which have made things even easier. I could not believe how easy it was to construct a blog from a freely accessible website. Since 2006 mobile platforms have expanded and become more powerful. I was still using a Palm 650 then. I compare this to my latest smart phone and the number of apps I can get for it, the expansion has been exponential. However, the article is not about this. It is about the impact on education.

    There are a couple of useful additional PowerPoint annexes to the article which I would recommend reading.

    Wikis

    I didn’t realise a Wiki is from the Hawaiian term wiki, to hurry, swift. I still don’t know why this term was used. Essentially it is an on-line resource which has open editing. Most people are aware of Wikipedia. This concept can also be used to make an educational or medical Wiki. It is clear for anyone who has used Wikipedia that this would be a useful too for increasing collaboration and indeed some examples are cited. Ganfyd is one which can be edited by any registered medical professional.

    A term I hadn’t heard before is Darwikinism. This refers to the evolution of Wiki pages as authors & collaborators edit and update the page. Indeed unlike evolution, this process is rapid. The authors mention a comparison with the Encyclopaedia Britannica and the fact both had similar numbers of errors. Unlike a printed publication, Wikipedia is corrected far more quickly. There is a downside to this, namely vandalism. A famous case was that of the American journalist John Seigenthaler. This downside is outweighed by the benefits of openness and the ability to restore a quality page using tools such as rolling back.

    Sharing a digital tool such as a Wiki (and to a lesser degree a Blog) enables participants to become a stakeholder in the outcome. This outcome could be part of a project or developing a reference resource. It also encourages a deeper understanding of the subject matter by encouraging online collaboration. This is a key concept underpinning the pedagogical impact of a Wiki and its main advantage.

    Ensuring accuracy is a concern but having a group of peer reviewers plus the ability to change an incorrect entry at the click of a mouse provides some assurance. Obviously for a large Wiki this may mean a large number of reviewers with subsequent time constraints but for smaller educational projects should be manageable.

    Blogs

    Of interest to me, blogs have obviously exploded in their popularity since 2006. It took me until June 2014 to start my first. As mentioned previously, it was a simple thing to set up and the tools are free. Unlike Wikis, it is the author (or co-author) that moderates the entries so this can make the moderation more consistent and refined. However this could skew the information posted given the lack of a group consensus. I would argue this is more advantageous as article meta-information is known. Wikis can lack this due to the anonymity of the contributors. I own my blog and have a sense of authorship.

    Both Blogs and Wikis run the risk of inadvertently posting copyright material as I found out. In my case it wasn’t malicious, just accidental (it was rectified easily by editing the post). As a single author this does protect me whereas the collaborative Wiki could be vulnerable. This lack of collaboration may reduce the educational impact of a blog – it could be perceived as an opinion piece which it essentially is. This article for example is my interpretation & critical evaluation of a journal article.

    Another downside of blogs as I have found out is that whilst people may like to read them, encouraging active participation is a different matter. What one does get is other bloggers following you so this is in itself, a Network of Practitioners. It is a diverse network however, not just medical. The educational impact is therefore about blogging (I have enjoyed reading followers own blogs), not about medical education. I am learning from an informal curriculum and its great fun.

    Podcasts

    Despite my best efforts I have never got into Podcasting and I worried that this might mean I never had anything interesting to say. I actually think the reason is it involves having either headphones on your head or listening in a car/at home and therefore requires more concentration. I started downloading BMJ & NEJM Podcasts but never actually got around to listening to them. The ones I listened to tended to be a background noise, rather like a nice piece of music, whilst I did something else. I did not learn from them. On this background of negativity, I was interested to see what the authors thought.

    Both audio & video Podcasts are used extensively. From recordings of lectures to audio recordings of text books, it is a tool which nicely encapsulates what m-learning is. One of the advantages described is the superior support for auditory learners (primary learning style in at least 30% of learners). The same applies to visual learners. On this basis, and not commented on by the authors, I would suggest this is their main disadvantage. I could not attend a Hot Topics course once so opted to do the ‘Webinar’ instead. This was essentially a video Podcast of the lectures with PowerPoint. I duly completed the exercise, answered a fairly straightforward quiz & was awarded my PGE credits. I reflected that I learnt very little but had a big thick textbook of Hot Topics & 6 hours accredited. It is clear that Podcasts do not work for me but I have always found Problem Based Learning & Small Group Work more effective. I like to be hands on. So whilst there is a pedagogical basis for some learners, it is not for everyone.

    To summarise, this is a nice review article which provides an interesting snapshot of Web 2.0 tools and their potential educational impact in 2006. It recognises the lack of an evidence base for this and encourages readers to get involved in research. And therein lies the rub. I am already out of date according to some teenagers I know (Facebook is sooo middle aged). I should be using WhatsApp and Instagram, until the next great thing comes along. Trying to research the educational impact of Social Networking tools when those tools are continuously changing is a challenge.

  • USING FACEBOOK FOR PROFESSIONAL NETWORKING: A MODERN DAY ESSENTIAL

    Bodell, Sarah, and Angela Hook. “Using Facebook for professional networking: a modern-day essential.” The British Journal of Occupational Therapy 74.12 (2011): 588-590.

    Abstract here

    This is another opinion piece by Sarah Bodell & Angela Hook on the merits of Facebook use for CPD and professional networking. The above link only links to an abstract which to be honest is not of much use. However I have asked permission from the author to publish a particularly useful table which I will add to this if the answer is in the affirmative. (Edit – see fig 1 at the end)

    This article again relates to how using SNS can promote professional networks and improve CPD. However there are two other important areas which the author comments on.

    Political Change in the NHS

    I am pretty protected from the massive changes in the NHS currently taking place. I work for the MOD which has its own particular pressures. However in any publicly funded service which is under pressure to save money in these times of ‘austerity’, justification of one’s job, role and work is not only vital but may well help preserve that job. A private provider can come in & produce a business plan which superficially states a like for like replacement at reduced costs but I think we all know in healthcare, the job is never like that. Indeed, private companies often underestimate the complexity of providing healthcare (an example). What is inevitable though is that public, private & volunteers will end up working together to provide the service. SNS and professional networking used as a low density and diverse network can play a vital role. The authors describe a low density network as being geographically dispersed and diversity as having a greater range eg OTs from several countries.

    The other important role of SNS in this theme is commissioning. Most healthcare professionals will have ‘to articulate the value and purpose of their role against nationally defined outcomes in order to ensure their services are commissioned’. Achieving this may well be helped by joining a professional network. This comes onto the second area the authors raise.

    Access to SNS

    I am particularly troubled by this. I live in rural Wiltshire where broadband speeds are slow, often at old dial up speeds. What makes things worse is poor 3G coverage. I went up to London for a gig recently and whilst sitting outside a pub enjoying a pint of remarkably good ale, could not believe the speed of 3G on my tablet. It was faster than our home broadband. I cannot access Twitter or Facebook at work. The desktop is not much better. Firewalls and security limitations restrict access to SNS sites in the NHS and in my organisation the MOD. I am not sure why this is. Individual accounts can be monitored so staff could be disciplined for overusing sites (although how anyone ever gets the time to…). Its use as a networking tool for academics has been proven. Unfortunately due to the prevalent belief that risks outweigh the benefits, employers will restrict access and employees will be forced to utilise SNS outside of their own workplace. This is likely to reduce uptake, one of the things I am finding with my blog.

    Another area of concern raised by the author is the reluctance of professionals to ‘advertise’ aspects of their professional working in a public domain. It is recognised however that healthcare professionals are very aware of confidentiality and are conservative in the nature of their posting. This is something I have been made acutely conscious of when thinking about what to write on my blog. I stick to generalisations and often will use a patient contact in the context of starting debate about a certain subject.

    All of this can be mitigated by an understanding of how to use social media. I have left my blog in the public domain but a Facebook group can be closed as can a Google group. It is disseminating this understanding alongside appropriate guidelines which will be the key enabler of low density, diverse professional networks.

    Fig 1

  • NEGATIVE FAECAL CALPROTECTIN RESULT USEFUL FOR RULING OUT IBD IN CHILDREN

    Henderson P, Anderson NH, Wilson DC. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol 2014;109(5):637-645.

    Abstract here

    Not just children but adults as well. I’m sure there is unwritten law that when something interesting happens in medicine, when an article appears in the media or a patient brings in an Internet printout, like buses several articles appear at once. It happened to me recently with a patient who was diagnosed with Postural Tachycardia Syndrome (POTS) when an article appeared in the Telegraph stating that up to a third of fibromyalgia sufferers may have POTS (I was seeing my patient that day). It also happened with a PBSGL we did on infant feeding problems when other guidance came out and again it was in the media. So when this POEM arrived after I had recently attended the excellent Essential Knowledge Update course run by the Wessex Faculty of the RCGP, it was unsurprising to find the subject of faecal calprotectin being raised. This was on the background on recent local guidance for our practice and one of my GP partners attending an educational event.

    This POEM is a summary of a meta-analysis looking at the use of the test in children when considering the diagnosis of Inflammatory Bowel Disease (IBD). The bottom line for me as a GP is to screen out the worried well & refer the suspected cases. I therefore need a test that correctly identifies those without disease – if I have a clinical concern, I will refer. The test measures the level of calprotectin and a cut off value is determined. Obviously the higher the cut off, the more accurate the test is at the cost of false negatives. The commonest cut off is 50ug per g of stool.

    Whilst writing this I reviewed the NICE guidance which was produced in Oct 13. The results are remarkably convergent and I suspect the studies in both meta-analyses are similar (although I could not confirm this). The test has a high sensitivity – a patient with IBD is highly likely to have a positive test – with a sensitivity approaching 100% with a cut off of 50ug. The specificity varied, the greatest variation noted by NICE occurring in the paediatric group (44 to 93%) which was exactly the same as this study.

    The likelihood ratios were quoted. The positive ratio was 3.1. This isn’t that high so it is saying that the test is moderately helpful as a test to identify IBD. This is because of it being raised in other conditions so whilst someone with IBD will have a positive test, if it is applied to a population, you will get IBD sufferers plus others. However the negative likelihood ratios was 0.03. This means the test is highly discriminatory in patients without IBD. If it is negative, it is very unlikely the patient has IBD.

    In summary, in children the test is very useful for reassuring a patient does not have IBD but if it is positive, it doesn’t necessarily mean the child has IBD. Ultimately I would be guided by clinical presentation and parental ideas, concerns & expectations. One thing I have noticed about paediatricians is they are very helpful reviewing children of worried well parents. As a parent myself, that reassures me.

  • MICROBLOGS IN HIGHER EDUCATION – A CHANCE TO FACILITATE INFORMAL AND PROCESS-ORIENTATED LEARNING?

    Ebner, Martin, et al. “Microblogs in Higher Education–A chance to facilitate informal and process-oriented learning?.” Computers & Education 55.1 (2010): 92-100.

    Free text available here if you register with Researchgate.net which I did.

    The study

    This is an interesting study if only as an attempt to provide objective evidence of the educational impact of microblogging in two areas of learning. It analysed the microblogging entries of a group of business students (full time & part time) at an Austrian University. The students undertook a ‘New Media and Multi-Channel Management’ module as part of the research. This was undertaken as an additional item of study at a busy time during a semester when the students were taking up to 5 parallel course subjects. Students had to use two type of new media – microblogging (MBlog) and Wiki (MediaWiki) – in order to collaborate, communicate and produce business plans. A bit like big brother, the entries on the blog & Wiki were analysed weekly over a 6 week period and categorised into 8 different subtypes (for example, including a hyperlink, content reflects a discussion about the topics of the course subject). In total, 11214 posts from 21 full time and 13 part time students were analysed. To support the extra workload of the students engaging with the module, more of the credit points for this module were awarded on the process, less on the actual business case presentations. The students were told of this.

    Theoretical Background

    I had come across informal learning before in my studies. One of the best examples I used with a previous student was the informal learning that takes place in the medical centre when a new doctor is posted in. The new doctor will be fresh with ideas, certainly up to date with medical knowledge and keen to make a mark. However, what they may not know certainly in a military context is how a job may affect a soldier’s medical condition and vice versa. Therefore time spent either with the medics or with the soldiers will allow them to learn about occupational aspects of their patients’ role through social interactions. The formal curriculum may teach them about PTSD; the informal curriculum may give insight into the horrific experiences of young soldiers especially in Afghanistan by talking and working with them.

    I knew roughly what process orientated learning was but sought clarification. From Wikipedia: Process Orientated learning is a pedagogical method in which students are encouraged to use process skills such as collaboration and written expression. Whilst reading this, I came across the term Positive Interdependence . This is where ‘members of a group who share common goals perceive that working together is individually and collectively beneficial, and success depends on the participation of all the members’. Negative interdependence is the opposite and reminded me of the McLaren Mercedes F1 ‘Team’ of Louis Hamilton and Nico Rosberg (‘individuals can only achieve their goal via the failure of a competitor’).

    Results

    By analysing the types of posts after they had been sub-divided, the authors attempted to assess what sort of learning had gone on. Positive outcomes were that students chatted a lot & communication levels went up through the 6 week observation period. This causally demonstrated informal learning and collaboration. The use of hyperlinks went down suggesting students were sharing factual information initially but less so as the period went on. Coursework discussion also increased suggesting positive interdependence. However, and it is a big however, the authors noted when they analysed the posts for evidence of process orientated learning, the students tended to use microblogging as an alternative medium for collaboration because they had to. With the number of posts being so high, the authors were suspicious the students were playing the game. There was no reflection on how the medium itself was changing the way they were working. I am really not surprised here as when a student is told the majority of the marks would be awarded for process, of course they will use the medium. The authors acknowledged this but possibly missed a trick but not blinding the marking system. However this in itself may have been on ethically dodgy ground.

    I also wonder what outcomes the students were told about. Were they asked to reflect on the use of the media itself or were they asked to use the media as method of collaboration. To be honest I have read the article several times and am still none the wiser. In their summary they quote McLuhan’s focus of ‘The Medium is the Message’ which I take to mean the research was about the medium of microblogging itself. They commented that the students did not reflect on the impact of microblogging on the way they were working. I have some sympathy with the students here. They are not educationalists interested in the deeper understanding of why microblogging might help. I tried reading McLuhan’s article but got to a bit about light bulbs having no message when my own light failed, late last night (or was it the red wine). I will try again this weekend & post any nuggets of educational wisdom as comments.

    What does this mean? The authors come up with valid conclusions that microblogging has potential to increase informal learning and that the collaboration which has taken place suggests it can be a catalyst for process-orientated learning. It does need more research however. It would have been interesting for example to have compared the outcomes (the business plans) from two groups, one using microblogging and one not then marked these with the assessors being blinded to which ones they were assessing. This would not have measured processes though, just outcomes. There is also an assumption made that lots of communicative posts indicated collaboration. It may just have been students gossiping although to their credit, the authors spent a large amount of time analysing the posts.

    This article made me think what am I try to achieve by blogging my critical appraisals and my article reviews? I am essentially making public the processes I am going through whilst writing my assignment (alongside the PBSGL). I reflected on this last night & came to the conclusion that I am really just throwing things into the mixer and seeing what comes out. This may all end with nothing (bar me being a bit wiser) but I suppose ultimately I am laying the foundation for my dissertation in 18 months time when I put SNS to the test in the context of peer review of teaching. Should I be looking at process orientated learning where a group of GP Trainers peer reviews the video of a tutorial? Or should I be looking at an outcome where the reviewee has a formative teaching plan based on the group feedback (as opposed to an individual reviewer). To be honest, I don’t know and I’m sure by the time I am writing my dissertation there may well be a new SNS which is the next best thing in education. Certainly exciting times in post graduate education and the thought makes the educationalist (or geek) in me tingle with excitement…

  • HOW BLOGGING CAN FACILITATE CPD AND LEARNING

    Bodell, S., et al. (2009). “Creating a learning community in today’s world: how blogging can facilitate continuing professional development and international learning.” The British Journal of Occupational Therapy 72(6): 279-281.

    Unfortunately I do not have the full text of this opinion piece to share which I had to get hold of via the Warwick University library. It is a shame as I have two by the same author both exploring how social media can assist with education. The other one I will eventually appraise (it is about professional Face booking) but I will start with this article from June 2009. One thing I have learnt in critically appraising a generic educational subject is that the first thing I look at – relevance – is less important. I am a primary care physician; the author of this article is an occupational therapist. Yet the principles of SNS and healthcare education are still the same.

    A blog (web log) is an example of a Web 2.0 use. I was always under the assumption Web 2.0 was a type of HTML or application. Actually Web 2.0 is a term used to describe second generation Internet capability. It is not specific. The benefits of Web 2.0 (and specifically blogging) in healthcare education are not widely known. Indeed one of the future considerations for research is to look at Web 2.0 and its educational impact in postgraduate education.

    The author describes 3 areas where a blog may be helpful.

    As a Tool for Reflection. Blogging is a useful way of reflecting both as an individual physician as well as in group reflection. The latter is my aim with writing a blog linked to the Salisbury Plain PBSGL.

    As a Tool for Peer Discussion. This follows on from using blogging as group reflection. Indeed these two are probably part of the same entity. Certainly receiving my POEMs or reading my journals, my intent is to write my own take on the articles (with a critical hat on) to try & promote discussion. Related to this is dissemination of guidelines and best practice amongst a Network of Practitioners. This sounds great in theory but with two cautions. Firstly it is time consuming. I am trying to work full time, trying to complete my assignment as well as have a home life. The limitations of a blog are it is author orientated so the onus is on me. This can be mitigated by engaging some of my fellow PBSGL members for which I will canvass support at the next meeting. The second area of concern is confidentiality. This I think will limit clinicians engaging and sharing experiences in a public forum.

    As a Tool for extending knowledge. The reverse chronological order of a blog is cited as a way of developing knowledge. I personally cannot see this as a decent search engine will find posts. It can however run alongside the traditional ways of acquiring knowledge to augment it and the author cites a couple of studies reinforcing this. Since starting my blog, and through microblogging (Twitter), I have viewed other blogs and sites and now have numerous tools at my disposal to answer questions that arise from my day to day practice. My most recent literature search involved registering with www.researchgate.net and I have also become reacquainted with CHAIN again ( http://chain.ulcc.ac.uk/chain/index.html ). Indeed if the term ‘tool for extending knowledge’ is defined loosely, through NoPs, informal learning, Web 2.0 applications etc, this is probably the most powerful effect of blogging.

    In summary, this opinion piece summarises nicely the potential of blogging in healthcare education. I am concurrently reading a research article which is attempting to put some meat on the bones; some objective evidence of improved outcomes using microblogging. However I have run out of time and have clinic so I will save that for another time…

  • Teachers & Social Networking part 2

    British Journal of Educational Technology Vol 43 No 5 2012 754-769

    This research in the article aimed to answer 3 research questions.

    Domain: how does the domain (and particularly the way it is approached) impact on group membership?

    Network: does it make sense to distinguish between different types of participatory attitudes and behaviours, involving different levels of engagement in the group?

    Practice: does engagement with a group of professionals sharing practices have an impact on ‘real life’ and professional development?

    It did this by testing several hypotheses. I will not go into details but suffice to say the statistical analyses seem sound although there are some confounders which I will address later. The analysis was based on several sub-groups of the 1107 respondents dividing the groups into generic & themed. An analogous example of the themed group would be a group of doctors interested in ADHD, the generic group our own PBSGL. Divisions were also made on whether the group was open or by application and how long individuals had been members for.

    Domain: There was a distinction here between themed and generic. For themed groups, FB provided emotional support and bonding social capital. Members were likely to have known one another before joining. For the generic group, FB provided a means for sharing information and ideas. It provided bridging social capital converting latent ties into weak ties.

     Network: Senior members demonstrated more active and confident behaviours compared to junior members, as would be expected. However the impact on professional life was similar regardless of length of time of membership. This impact was greater in the generic group reinforcing previous evidence that the motivation behind SNS was sharing ideas & projects.

     Practice: Thematic groups tended to use FB as a social support mechanism as there was already significant off-line co-operation and interaction. The members knew & worked with each other in real life with the SNS providing emotional support away from this. Interestingly the generic group was more likely to start projects in real life after on-line discussion and sharing. This is real evidence that SNS can have an impact in off-line activities.

     Applying the READER critical reading model:

     Relevance: Not primary care, not English. But it did look at a cohort of professionals looking to share information and develop educational ideas.

     Education: The authors make a good argument, it is well referenced and uses terms familiar to most readers. The theoretical background is explored in some detail. There is a logic to it, funnelling the arguments down to the three research questions (relevant to NOPs) being asked. Therefore there was an educational impact.

     Applicability: Highly applicable to the Salisbury Plain PBSGL, albeit with a lot smaller numbers. It is also very relevant to my assignment. The demographics could slightly bias it applicability though with more female members (87.2%).

     Discrimination: The research was amongst Italian teachers. However it could quite easily apply to Primary care. The themes that emerged from the questionnaires are relevant: ‘Feeling less isolated’, ‘sharing ideas and projects’, ‘keep me updated on group topics’.

     Evaluation: Interestingly, the Generic FB groups (sharing school experiences in general) generally had more positive outcomes than the Thematic FB groups (special interest eg ASD). The latter felt the group decreased isolation. The former felt it enabled sharing of ideas.

     Reaction: Once I had worked through the article and digested what they were saying, my reaction was very positive. Here is some evidence that SNS could improve the outcomes in our PBSGL group. Further research is required however, or in my case, more reading. It is a start though…