A Nursing student writes...

A Nursing student writes...

I recently received an email from a charming nursing student who read my blog, and wanted to know a little more about a presentation I'd uploaded to slideshare - on NICE and healthcare rationing. Primarily she wanted to reference it in an essay for her nursing degree on a similar topic. Now, of course I was very flattered, and yes, I do think my opinions are sensible and backed up by evidence, but I'm clearly not an expert on the ethics, law or economics of healthcare rationing. So I advised her to go to my references and look at the primary sources.

Because I'm a doctor I'm contractually obliged to unthinkingly underestimate nurses, and in fact she'd already done that. But she still thought it was appropriate to reference my presentation since she felt it had influenced her thinking:

"In some ways it's a grey area as I could solely reference primary sources and the Tutor would be unlikely to question it. But I am definitely borrowing the odd point from your presentation, so best to do the right thing"

TBH I don't think I would have been quite so honourable. I read a lot in articles, blogs, twitter feeds, on the TV, and from friends and colleagues. Sometimes I hear ideas or opinions I like or that persuade me to change my thinking. Some of it is conscious, much unconscious. So, when it comes to writing scholarly work, I tend to reference the primary sources that are at least published if not peer-reviewed too. Even if a blog article or online presentation influenced my thinking, I think I wouldn't reference it unless I was quoting it.

Is this reasonable, or am I being a snob about referencing sources that I don't think of as traditionally 'authoritative'? Would I feel better about referencing an article or book chapter by someone rather than the same person's blog? I think I probably would. And what about sites like wikipedia, which has the advantage of being 'peer reviewed' in some sense?

The debate about referencing wikipedia in scholarly work still has some distance to run, I think. For now, the rule seems to be that you can use wikipedia to learn but shouldn't rely on it as authoritative - and therefore shouldn't reference it directly. I think there's a lot to be said for wikipedia generally, especially if you understand how it works and how to look at the evolution of the article and its related discussions. But no matter how good wikipedia / my slideshare presentations / my blog waffling is, if I'm still sceptical about sticking them in the reference section of my essays, I think it'll be some time before these kinds of resources are widely accepted as reasonable reference points for academic work.

Perhaps this is a shame, but perhaps a conservative attitude to this new medium is wise until theres a widespread and deeper appreciation of how it works, how it can be used and what it adds.

Finally, my web-savvy nursing-student reader signed off with another interesting point. Having reviewed many of the primary sources I'd mentioned in my talk, she did pause for thought at the end of the assignment, reflecting...

"Oh well, I still can't give a patient a urinary catheter, but I read Aristotle today..."

What hath I wrought?

Bait for the MedWeb2Skeptic

Bait for the MedWeb2Skeptic

Gah, @amcunningham beat me to a proper look at this paper on web2 use in medical education. To be fair, I was on night shift at the time, so wasn't really in the right frame of mind to write anything longer than 140chars. Still, feeling quite chuffed that I got in there early with the critique, even if it was a little... concise.

Anyway, there isn't a massive amount to add to Anne-Marie's skewering of this survey-based paper on use of Web2 tools in medical/nursing education - she rightly critiques the low response rate, confusion & conflation of web2 / social media tools, and the authors' rather bold conclusions (subsequently echoed around the twittersphere).

The authors do acknowledge one of the paper's weaknesses when they state:

"...given the small sample size, it is difficult to predict whether the use of Web 2.0 tools portends a growing trend in education or merely represents a passing fad"

But although they note the small sample size, they still accept their findings as significant, albeit perhaps transient. To be honest, in this paper, the future of web2 use in medical education is not 'difficult to predict', it's completely outwith any of the conclusions that could possibly be drawn from the data.

But just a few more points...

1. A survey of web2 usage by medical/nursing institutions by a fairly open-access survey, with a very poor response rate means that any conclusions must be interpreted with a degree of caution. But it's not just the low response rate that sounds a note of caution. One also has to question why those particular people bothered to respond (selection bias). It's easy to hypothesize that survey recipients who'd never heard of Moodle etc would just delete the email, while those who were evangelical about using wikis and youtube would reply in their droves. So the sample biases itself.

2. I think there's two other ways to do this kind of research - either spend some time identifying IT/education leads at medical schools and send them a better-designed survey asking questions about overall web2 tool use in medical school, or survey a large number of medical students from several medical schools with a very short survey to ask what tools they actually use on a regular basis.

3. As Anne-Marie mentioned, the qualitative data isn't mentioned. My guess is that there wasn't very much of it. The question is too broad and vague "please briefly describe how these tools are used in your institution". This makes it difficult to answer (therefore most respondents probably don't bother) and unlikely to identify any common themes, as the responses given are likely to be highly heterogenous. If you've ever tried to get useful qualitative responses from questionnaires, you learn this lesson pretty quickly. I did, and I was doing an MSF in my spare time.

So, having kicked the corpse a bit, what's the real issue here? I think it's this - apart from generating headlines, what use is this kind of research anyway? So 45% of medical/nursing schools use web2 tools. Big woop. Who uses them? What for? How? How often? And most importantly, why? If a web2 tool can deliver a better educational outcome (or an equivalent one more cheaply / easily / quickly) than a conventional teaching method, that's a good thing. But just using web2 education tools isn't important - it's what you do with them that counts.

Teaching Feedback - 'The Intimidator'

Teaching Feedback - 'The Intimidator'

In 7 years as a doctor I think I've filled in a bazillion (approx) work-based assessments for junior doctors (most with contemporaneous structured feedback, some rather pointlessly a week or so later via email). I've handed in a few multi-source-feedback questionairres, and I've probably completed 0.3 bazillion post-lecture feedback forms. Feedback is everywhere in medicine now, and if it's done well it's incredibly useful. If it's done poorly, it's a total waste of time.

In terms of feedback I've received, most of it relates to my skills as a doctor, and very little has been comment on my skills as an educator. And if you don't count the aggregated scores from near-useless lecture feedback forms, I've received almost no feedback about my teaching. In fact, I really don't count those forms - the quantitative questions are so vague they're only useful for comparing yourself to the other speakers in a putative best-speaker competition. There is no specific information from this that can inform self-improvement.

Recently for the MSc in Geriatric Medicine (Teaching/Communication Module) I'm working towards, I completed an assigment on devising a multi-source feedback survey on one aspect of my teaching skills. The process, results and reflection was delivered by means of PowerPoint slides. This is it...

Appraising my Teaching Skills using MSF

View more documents from Colin Mitchell.

Notes:
1. Now, for those of you who don't know me, I'm not the kind of person that thinks of himself as intimidating. I'm a 5'7" geriatrics reg, ex-computer game reviewer, briefly a stand-up comedian. Not that these things define me or negate the possibility that I'm a scary, dastardly figure. But it's not something that's really come up very often, and frankly quite the opposite of my self-image, which is why I decided to explore the issue with my MSF. It seems I can be intimidating, to a few juniors. In fact this shouldn't be such a surprise, really. I've got just over 2 years until I'm a consultant, for many of them I'm 2-3 grades up in the professional hierarchy, I'm the teacher, I've (usually) got more knowledge than them... What do I do about it, though?

2. I don't actually think I'm Pete 'Maverick' Mitchell in Top Gun. But we do share a surname. And a nickname. Not really. But doing an MSF on yourself, about an aspect of your professional identity you're quite proud of is quite a challenge to self-image. That's what I was discussing with these slides.

3. Yes, the PPT slides are a bit wordy. But words mean points mean prizes (for the MSc markers).

4. HT to @nlafferty, who worked on the original DREEM, and pointed me towards the PHEEM (more relevant to F1s generally but less about teaching style, so I ended up using the DREEM as inspiration). The people you meet on Twitter...