Sunday, 23 September 2012

Start of diabetes term!

The Diabetes Qualifications and Courses website has been taking up a lot of my time this last week. We've been working hard on it to ensure that it is ready for the launch of the new 'term' tomorrow.

There are three simultaneous modules running with over 300 students, and more than 20 tutors showing how quickly the course has grown since its launch in May 2011. The technical team have done wonders with the new Moodle cloud-based platform and the designers have reworked the new logo.

The course is a collaboration between BMJ Learning and University of Leicester and is a very rewarding, social learning environment looking at Masters level study in diabetes for healthcare professionals. Whilst the majority of students are currently doctors last year saw an entire intake of Diabetes Nurse Educators from the Middle East.

Being the digital steward for this course is really enjoyable and we are looking to bring in many new ideas for supporting the programme.

Saturday, 22 September 2012

Follow-up costs of bariatric surgery

There's an article in JAMA about the costs of care in those who have bariatric surgery. This Swedish cohort looked at 20 years' of follow-up after obesity surgery.

It seems that the costs for the first 6 years are higher in those that are surgically treated - more days spent in hospital, more outpatient visits - but after that the costs of care were in fact lower in the surgically treated group.

The authors conclude - "surgically treated patients used more inpatient and nonprimary outpatient care during the first 6-year period after undergoing bariatric surgery but not thereafter. Drug costs from years 7 through 20 were lower for surgery patients than for control patients."

Although the procedure used in these patients was different to that used now this data helps with the planning of ongoing care of people undergoing obesity surgery.

1. Neovius M, Narbro K, Keating C, Peltonen M, Sjöholm K, Agren G, Sjöström L, Carlsson L. Health care use during 20 years following bariatric surgery. JAMA 2012 Sep;308(11):1132–1141.

Friday, 7 September 2012

Medical Education & Social Media

New opportunities to connect people will improve learning

This is a short review I wrote for the IDEACON conference brochure souvenir that ran in India in July. I've included it here with some corrections. Comments and flames welcomed! :-)

Medical education could benefit from new forms of communication between health professionals made possible through social media - a collection of technologies that use the Internet to connect people. These technologies will be familiar to many and include Twitter, Facebook, LinkedIn and Google+. These social media create connections between individuals and form networks within which information is shared. In this short review I will outline some of the opportunities and challenges facing the use of social media and medical education. I will not focus on any particular form of medical education so the discussion includes undergraduate and postgraduate.

Although there have always been networks and communities of physicians it has not been on a scale and immediacy that is now possible with social media. In the past the size of communities was restricted by geography and slower modes of communication. This has broadened in recent decades. For example, the use of Twitter at conferences has increased and can be "successfully used by physicians ... to engage in clinical discussions" even if the author is not present at the event [1]. Scientists see social media as a critical form of communication [2], especially with the public, but also with colleagues and experts within and outside their disciplines. Some academics have called for the career recognition of the open, digital and networked exchange of information [3]. They argue that publishing should not be seen as a restricted, academic activity within journals but as part of a more open discourse and discovery.

The adoption of social media technologies has been rapid. The telephone took 100 years to be used by 50% of UK households. Facebook has taken just 5 years to reach 50% of the UK population and the most rapidly adopting group is now those aged over 50 [4]. However, social media can blur the distinction between professional and personal lives making professionalism and social media an uneasy mix [5]. There have been many reports of inadvertent disclosure of confidential information and public displays of unprofessional behaviour which have led many to look in horror at what social media could do to the profession. Doctors associations [6] have published - and regulators are drafting [7] - guidance on the use of social media.

However, I'd argue that social media and other new technologies are here to stay and we should become familiar with them. How can they be used in medical education? How should they be used to increase our knowledge and the reach of our profession?

Behaviourist, Cognitive and Social Theories of Learning have helped shape the design of medical education with lectures, small group and clinical attachments being familiar to most. Over the past decade the educational use of technology has become mainstream in medical education [8]. These various types of "e-learning [are] neither inherently superior nor inferior to traditional instruction; rather they are different and complementary" [9]. When tested against traditional teaching they often achieve the same levels of educational outcomes. What they do offer, by their very nature, is the opportunity for broader involvement, asynchronous communication, and more convenience for busy clinical schedules.

Recent theories of learning can be viewed as frameworks explaining how a particular type of learning takes place. Two of these learning theories I will describe further with reference to how social media can be successfully used in medical education.

Communities of Practice

Lave and Wenger's work on situated (workplace) learning has been extended to describe communities in the digital habitats [10] within which modern practitioners share the passion and expertise of their work. A Community of Practice has three dimensions of domain, practice and community. The domain is the area that participants have in common. The practice is the shared expertise that they have within that domain and the community consists of the social links between members of the Community of Practice.

The Facebook group "Key Opinion Leaders (KOL) blog on Diabetes and Endocrinology" [11] is an example of a Community of Practice of doctors, academics and the pharmaceutical industry based mainly in India. The domain is the scientific evidence in the field of diabetes and endocrinology. The practice is the critical appraisal skills and aggregation of information in the medical literature. The community is the social links between the members many of whom are based in India and discuss football and conferences alongside the discussions of new scientific findings. Facebook acts as the communication technology between members of the group allowing them to interact with each other at times that are convenient to each individual. The group has been set up and is monitored by some core individuals who perform the duties of digital stewardship - continually experimenting with and evaluating the usefulness of the technology to the needs of the group.

You are probably part of a community of practice already. Some communities have used the digital ecologies including social media but this is only useful if the community of practice finds it of value.


George Siemens has proposed a learning theory called Connectivism which at its core is the concept of amplification where "learning, knowledge and understanding [can be amplified] through the extension of a personal network" [12]. This is extension is, in part, through the digital, networked world. Learning takes place in a complex and changing environment where individuals have increasing levels of specialisation. By connecting these specialist 'nodes' to each other there is the ability to enact new domains of knowledge. For example, the SARS virus was discovered through a distributed research network which led to the collection and analysis of samples from researchers in seven countries [13]. Different experts and points of view, knowledge, understanding and skill were brought together to focus on a particular task. Whilst each of the countries could have solved the problem themselves - given time - a more efficient solution was developed through the connections they made with each other.

Connectivism describes the use of the technology available to learners today. Learners create blogs (weblogs - short public articles published on the web), post discussions on discussion boards, and stream thoughts through social media. They use tags to classify information such as #diabetes or #meded on Twitter and then others can use search engines to find postings from the network of learners interested in the same topic. The learner, in the world of connectivism, is not simply the student with inferior knowledge but everyone involved in the topic. Learners and the expertise is maintained in the network and not necessarily within the individuals.

An example of connectivism would be the use of the tag #CMEchat which involves an ongoing discussion of Continuing Medical Education (CME) by an international audience with varying levels of expertise. It ran, until recently, each week on a Wednesday at 11am EST, there is a Twitter chat where the community comes together for an hour to discuss an agenda on CME. In between the discussions individuals post to Twitter, on their own websites, in blogs, on YouTube and social bookmarking sites such as, items of interest and insights that they tag with #CMEchat for others to find. Individuals involved learn from each other and from the collected expertise of the group. Others can engage with the topic by searching and finding the resources identified by #CMEchat or through  the central hub of the group on its website ( Over time the expertise in CME is increased and artefacts are developed by the participants that are available to others.

An important aspect of connectivism is its openness and, in particular, the looseness of its definition of membership or engagement.

To many this technological world of medical education and social media can be seen as challenging. Adoption of these new tools may require a digital literacy that many do not possess and they may be perceived to involve a disruption to the boundaries of professional and private life. As Siemens says "When knowledge ... is needed, but not known, the ability to plug into sources to meet the requirements becomes a vital skill." [12]

How should a novice in this area get started? What simple steps can be suggested to 'plug in' to this new world of medical education? Some suggestions have been made by others [14,15] and I have summarised an approach below.
  • Start by 'lurking'. This means just listening and reading the social media that others produce. Join some social media sites, search for your areas of interest, and follow people to see what they are talking about. You don't need to post straight away so don't feel obliged to. It is generally good advice when joining any community to listen first to understand the culture and norms before talking yourself.
  • Listen to a few medical Twitter chats such as #TwitJC Twitter Journal Club ( and #phtwitjc Public Health Twitter Journal Club (
  • Rewrite your CV into a short biography of about 100 words and get a photograph of yourself so that you can use it as your profile in the social media sites that you join.
  • Talk to your colleagues at your institution and see what they feel about social media. Is it available on your computer network and what would be the implications if it were. Read your own specialist society's advice on social media.
  • When you are ready start posting - we look forward to hearing from you.

1. Chaudhry A, Glodé LM, Gillman M, Miller RS. Trends in Twitter Use by Physicians at the American Society of Clinical Oncology Annual Meeting, 2010 and 2011. JOP 2012 Apr; Available from:

2. Van Eperen L, Marincola FM. How scientists use social media to communicate their research. J Transl Med 2011;9:199. Available from:

3. Weller M. The Digital Scholar: How Technology Is Transforming Scholarly Practice. London: Bloomsbury Academic; 2011.

4. Cunningham A-M. Doctors’ use of social media. General Medical Council Review of Good Medical Practice 2012; Available from: Accessed 27th April 2012

5. McCartney M. How much of a social media profile can doctors have? BMJ 2012 Jan;344(jan23 1):e440-e440. Available from:

6. British Medial Association. Using social media: practical and ethical guidance for doctors and medical students. Available at Accessed 14th April 2012.

7. General Medical Council. GMC seeks views on doctors' use of social media. Available at Accessed 23rd April 2012.

8. Ellaway R, Masters K. AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment. Med Teach 2008 Jun;30(5):455–473. Available from:

9. Cook DA. The failure of e-learning research to inform educational practice, and what we can do about it. Med Teach 2009 Feb;31(2):158–162. Available from:

10. Wenger E, White N, Smith JD. Digital Habitats: stewarding technology for communities. Portland: CPsquare; 2009. Available from:

11. Key Opinion Leaders (KOL) blog on Diabetes and Endocrinology. Internet resource Available from Accessed 23rd April 2012.

12. Siemens G. (2004) Connectivism: A Learning Theory for the Digital Age. Available from

13. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, Rollin PE, Dowell SF, Ling A-E, Humphrey CD, Shieh W-J, Guarner J, Paddock CD, Rota P, Fields B, DeRisi J, Yang J-Y, Cox N, Hughes JM, LeDuc JW, Bellini WJ, Anderson LJ. A novel coronavirus associated with severe acute respiratory syndrome. N. Engl. J. Med. 2003 May;348(20):1953–1966. Available from

14. George DR. 'Friending Facebook?' A minicourse on the use of social media by health professionals. J Contin Educ Health Prof 2011;31(3):215-219. Available from:

15. Fisher WG. What Social Media Can Bring to the Physician Skeptic. Dr Wes Blog. Available from Accessed 17th April 2012