 First of all, I'd like to introduce Anne-Marie Cunningham. Anne-Marie is a clinical lecturer in primary care and public health at Cardiff University. Anne-Marie is going to talk on being public, how social media reshaped professional identity. Anne-Marie. Hello, thank you very much for inviting me to come and speak to this conference. I have to say it really was, I was delighted to be invited and a little bit surprised. And I hope that what I'm going to talk about today is of interest to you. So professional identity, quite often when we start talking about professional identity and digital identity, we focus on all the things that go wrong. We have this notion, we talk a lot about medical students and other people, teachers putting things, photographs leaking out on Facebook that really shouldn't. And we imagine in some kind of way that this digital identity is just some bits of information that are kind of tracked and pulled together about people. But today I'm going to talk a little bit more about very positive, a positive way of actually thinking about being online in a social space of how we should be thinking about this. So if you were to sort of say, well, you know, who am I? I've already given you a few little clues about some of my identity in that previous slide. So there was my name and my institution where I, the department that I'm in, and so I had my Twitter ID. So increasingly the space of social media is somewhere where I am recognised as being a professional. And where I'm from, if you can hear my accent, actually where you're from also tells people about your identity. This is kind of the way it fits in with Dave White's idea of space and place and residence and visitors in a way I have moved to being a resident in some of these spaces. But actually, so where am I from? Well, it's about, if you don't know who can recognise this lovely part of the world. This is about a mile and a half, if that's up the road from where my mum lives and where I grew up in the Morns in Northern Ireland. And yes, there are sheep around there. For me, it's actually must have entered into my psyche and my identity more than I thought because I actually have this picture as my Twitter backdrop. And these are morn black-faced sheep who are very good at thriving in a colder climate. So maybe we can learn something from the sheep too. But I will also add it to my Twitter bio that I am determined not to be one of these sheep. I added that on by, I don't know, a year or so ago. And I don't know, I just had this feeling that actually quite often whenever you're online all are, there is a kind of herd at the end of the day. We all are sometimes feeling like we're looking in the same way. And I don't feel like that. I pride myself a little bit in maybe being more critical and thinking of different viewpoints and being reflexive. And I'm going to talk about how social media actually forces, if you're going to be a professional, you're nearly forced to be in that, to take on multiple viewpoints. So I know that you're maybe not so familiar with medical education, although there are great examples here. I've seen lots of very good examples about use of technology. But just so you can get an idea of where I'm coming from, there's been about 100 years of criticism from 1868 whenever the GMC took on responsibility for medical education. All the science has pretty integrated into the curriculum. It's too full. We've got too many facts. We're not really managing to do this job that well. And I've said that, so I've had that stopping in a way in about the middle of the 20th century, but it has actually continued. But there's also been a long time that we've had a lot of innovation. We do like the three-letter acronym, like other people. So there's PBL, Problem-Based Learning, which started in McMaster in Canada in the 70s and is being rolled out across into other sectors. CBL, Case-Based Learning. So lots of different approaches. In some ways, I would argue that we are a bit post-lecture in medicine. We have thought about different ways of approaching education. And one of the issues is that medical education. I mean, you're here using terminology of Robert Keegan, who has, from his constructive developmental approach to transformative learning. So there's this idea about information as against transformation. So we're filling up the students with all this content. And maybe that was the feeling for quite a long time that was going on. The other process, which is happening about transformation, becoming a doctor, developing that identity, becoming a sociocultural process, those are there as well. And traditionally, they've been through apprenticeship, encouraging students to be involved in reflective processes, mentoring. So that's how we go about transformation. And then a little bit on about me. So we've already have a litter there. I have this quite, like many people here, I'm sure, quite a complex professional identity. So I am a doctor. I'm a GP. I'm a practitioner. I work in the South Wales Valleys. I also am an educator. So I teach in some parts of the course and I've got a special interest in e-learning or the use of technology in the course. I am a researcher. I've done clinical research. I've done education research. And I'm also a student. I'm a doctor in education in the School of Social Sciences and Cardiff University. So all these bits and pieces are coming around. These are all communities that I'm part of and identities that I have. And I would say are actually represented in public in social media as well to more and greater extents. And if we think about an offline life, the one that which I've been longer socialised into is definitely being a doctor and a family doctor. That's probably always, unless something very radical changes, going to be an essential core part of who I see myself as. And being an educator, the community, and finding a community within that, well, within my own institution there are people. But how do I link up and connect to other people? And there is very clearly to me the idea that medical education, just as medicine itself is, is a practice. It's not a science. And even when you go to conferences, I went a few years ago to two medical education conferences, actually where this all started out from. And I realised that the kind of things I needed to know and wanted to be to make me a better educator was to be able to share a practice with other people, to get into this nitty gritty and be able to connect with others. But actually these organisations, which I was a member of, at that time were not really giving me a great deal of opportunity to do that. So after you came away from the conference, there was this kind of feeling a sense of isolation. How could you actually get contacting with other people and be developing this identity even more? And so I decided that I would just kind of take the bill by the horns and go out and try and find people myself. And I would start a blog. So I started a blog in October 2008, wishful thinking of medical education. I'd love you to go along and have a look and see there. And I also started popping up on Twitter. And I said that I wanted to find people to learn together with. That was my goal. And I quickly formed a network of other people. These were some of the first people I was in contact with. Sarah Stewart, midwife in New Zealand, Dodger Bonacastle, who is an educator in Saskatchewin in Canada. Natalie Lafferty, he's a very good colleague. He's got special interest in e-learning and is based in D&D in Scotland. Natalie and I had started getting very close in the way that we were. The difference is opinion, I'm sure, about the things that we do. We spent a long time communicating online and through Skype and different things. We actually met up for the first time at a workshop we organised together at a conference this year. So the other two, I still have to wait a bit longer to me. So this new network was there. And I suppose at the start, I read Dave White's paper and I thought, so much of what I was going to say in a way was related to this. At the start, I felt that we were spending a long time, talking about tools, social bookmarking, how different technologies actually would work within my practice and how they might make me a better educator. And I thought that they would probably meet some needs. I went off the next year to this conference, Medical Education Conference, as me, Association for Study of Medical Education. I said and I talked about how supporting scholarship, medical education could be done by social media and networks. But actually quite surprisingly, this did not lead to a paradigm shift in scholarly communication and medical education. But it's changing. Things are moving on. At AME last week in Vienna, nearly 3,000 delegates, there were people a lot of use of Twitter, people using blogs afterwards. We're getting on to having Google Plus starting to talk about, if we wanted to explore these areas, how would we do it? And also, we've started going out and sharing these spaces for medical education ourselves. We've started a Twitter chat with the hashtag hashmedad. And there are lots of very interesting things that are coming out, interacting with students across the world, particularly in the UK. We've got one at nine o'clock on a Thursday in the UK and then a nine o'clock eastern time in the US a few hours later. And so we're starting to explore these things. And the people, what I'm going to say is that I've also been thinking all along about how what I would learn and what's going on there would actually influence my practice as a doctor. And I'm not, I have to say, a techno evangelist. I don't think that I am. In fact, if you Google Webtooskeptic, the first thing that comes up is talking about me. I'm being referred to as a Webtooskeptic. I was talking to this chatting online with Dr Vezi. He's not a big medical blogger. As yet, I'm not sure how to learn about these new technologies and teach students about it because I'm not really using them in my practice yet. That's not because there really isn't a need. I would say that there is in a way this kind of myth of information overload in a sense. We talk about it as if doctors and people are swamped by all this different information. They cannot make their way through it. There are so many different journals and papers and you can never keep up to date. In fact, that is manageable. This generic scientific information is codified. It's searchable. You can filter it. What's actually missing, the information under load, I could say, is this local practical information. It's about practice. It's tacit. If it is codified, it's often poorly presented and not very easy to access. People putting out guidelines and PDF online. I can't really manage it very well. It's not easy to find. It often doesn't exist in forms that you can actually find it. That is true for medical education, for education practice and for medical practice. There is obviously a lot of way to go in this but we still haven't got there. That's partly because there are all these tensions about these things that we know about. You can talk more about how it is. What is my identity being online? Should we be anonymous or not? What are the risks? Who is in control? Who's got the power over these sort of spaces? Who do you trust? What are the issues over access? These are all points that must be part of why this is not happening more yet. It isn't just about not knowing the technology. If people could always work around and make it happen, it's because of these cultural issues. You end up with this balancing act. You talked about yesterday about this being open versus closed. If you're open there is more risk but you're sharing and learning against. You can be safe in your own network and be quite a private sort of space. I'm going then to kind of move on. This is just a modelling in a way to kind of help us to think about what we actually mean about identity. Again, I've used this idea of Robert Keegan's about a constructive developmental approach to transform learning. This is about the kind of ways that we know. What are our personal epistemologies and way of being? He talks about the socialised mind, the self-authoring mind and the self-transforming mind. I'm going to suggest that if we're talking about professional identity, I'm socialised into an identity about being a doctor. Whenever I'm being a doctor to a certain extent I'm meeting the guidelines, the institutions, the GMC, what other bodies, what my colleagues actually think so people, you can be socialised and be meeting the expectations of other external bodies or people to you. Then there's also self-authoring. You've taken in the values yourself. You've decided your own values and that's what actually influences your identity and how you practice and then this notion actually of being able to step outside that, be able to view it from the outside and see the different viewpoints, be reflexive and consider other people's point of view. In a way, I'll say this is in a way an EMI would say that we have in general the medicine. We expect doctors to be able to take on board the view of their patients and be reflexive and not come in just with these are the rules and this is what we do or these are my rules but actually I'm working with you. How is this then related to social media? Well it's also needed in the sense that there aren't rules out there. This is about the Facebook is a wide west from Harvard HealthX but was a study looking at patient communities online. There are no rules out there yet. This is a kind of new frontier. We can't rely on being socialised into these spaces to know how to be and how to behave because there aren't enough people to do that and we haven't figured it out yet and instead you're either depending on the own internalised that you have taken from other places and you're probably also being exposed to other ways of considering what your identity is and I'm going to tell you about this little story just as a way of illustrating this so although if you go and you look at my Twitter profile you'll see that I've made nearly up on 40,000 tweets over the last three years or so I don't think that it's not my mind that most of the time I'm projecting myself as a doctor even though I have GP as the first word or bio and I very rarely get approached I would say just as being a doctor or being asked sort of for advice but on this occasion a few months ago somebody said to me could they ask me a quick question about a definition of something medical and I didn't know this person it wasn't somebody I was following and I sort of thought well how do I respond to this it's about definition it's about information for medical students and they're involved in these stats or something I'd respond to it so of course I'll kind of respond to this so I said well you go ahead I'm pretty good by definitions I can cope with that and the response then was can you tell me what distant metastases mean now if you know anything this is about advanced cancer so we're moved away from just a simple kind of thing giving me the information towards this is a situation where obviously somebody has for some reason asking quite a emotional person sort of question so you can I asked the person's permission and I have blogged about this about this interaction and so you can see more about this story I don't have time to go into it all now but this made me kind of step back and think well why am I what does this tell me about my identity of being a professional in this space so going back to this idea I socialised, I blogged about it and the rest responded and they said you need to check with your licensing body was that entering into a doctor-patient relationship so there the idea about how to be there was from a socialised point of view what were the rules people sort of saying why are the GMC not told us yet about how to be in social media lots of people issuing guidelines about how medical students and doctors and people should present themselves and be within social media and these other public spaces that we have not we had a need for this before I was approaching it more from my self-authoring point of view my values to me being a doctor with a patient was about relationship and about relationship and service and I didn't feel I had that with that person for me this wasn't really about a doctor-patient relationship this was about me giving some information to somebody I met online but by blogging about it and advising that actually if you can step by why was that happening why was somebody coming and asking me who didn't know about what disability meant what conversations were not happening what what I tell myself about my profession and that we actually say we give people and we communicate and whatever social media forces you to realise that all the stories that we tell ourselves are not actually all true there is a different world out there and you see this whenever you start looking at our discussions about medical education we can be very cosy in our own spaces talking within these rooms and whatever with all the people who kind of more or less sometimes think the same way as us and are coming from the same perspectives but once you go out and you move into this you have to be able and prepared to be self-transforming to be engaged and take on other people's viewpoints and so I'm just going just to this nearly finished up with this idea this came from a Norwegian medical student and this was at this conference last week and she said to be a doctor to be a professional is to be who the patient needs you to be and it wasn't about what your organisation tells you it's not even about what you think but you must tie that in with who the patient needs you to be and as we move forwards we're going to have to take on board that our values may not be in step with some of the people that we're working with we have made the decisions about privacy and what people give away how are we going to do whenever people say I want to have a conversation with you in public what about my where do I actually come in and well do I want to be a practitioner practitioner in public I'm pretty clear at the moment that I don't feel comfortable with that but how will I take on board and actually deal with those situations and the other thing is as an educator I actually asked one of my own students asked privately on Twitter you know what do you think my presence my presence on Twitter tells you about me as an educator a learner as a doctor and this is what she said I hope oh sorry click on the wrong place she said this so my identity what she learned from about me and those things was not the links that I shared it wasn't a view point it wasn't information it wasn't even it was about what she saw was by interactions about how I conducted myself with other kind of viewpoints how I took on that's what I was modelling to her was about this giving her an idea about how to relate to other people online perhaps she didn't say she would actually follow it but I imagine that that in a way as an educator that's what I really was managing hopefully to do to be modelling other ways of being so just finish up with this idea again that we talk too often I think about digital identity and professionalism and professional digital identity as this bits of information that are actually coming together but it's not that people view me and make a mind of them and the important people the people who I actually am working with as an educator or possibly also if they come online my patients and people will it won't be about these little random bits of information but it will be about how I interact and how I am through my relationships my relational kind of identity so that's all I want to say so thank you thank you very much Henry that was great question time now can you raise your hands if you have some questions but then please wait until the microphone comes round before speaking so we can capture it for the online presentation thanks very much I really enjoyed your presentation and I think it's an important topic and I just I wonder if it reminds me of Irving Goffman's work in terms of performing yourself and I wonder if what I'd like to hear your comments on the sort of skillful use of different identities in these contexts I suspect that professionalism sometimes has to do with how how well you move between identities rather than the individual identities themselves as much and perhaps that this is even more relevant now that we've got these social media I think that that I suppose my view is that it nearly is moving on to being I I don't have a very, not a lot of I keep things like my Facebook sort of profile in everything quite close down my holiday pictures but actually it could be public really matter but I think what we're moving in a sense into and I haven't really talked a little that much about you what is it sometimes when we talk about being professional it's about us as being like a blank canvas for other people to project their kind of ideas onto that we don't want to give away sort of too much because we have this notion that it actually will distract from their experience people are considering you then who you are and how are you going to respond to me because of this rather than some of your values or whatever rather than what I need you to be so I can't project this on so well and I don't think that I kind of say that sometimes I'm spending, I'm too busy I've got so many things going on I don't actually really have that much time to be unprofessional actually I have, there is not that much but at the same time I don't share you know, don't tweet things all the time that are like really but I will say if I'm like sort of seeing some music and it's very good I don't mind, I don't worry that that's going to influence people too much about me, I don't think that my mind has moved on to thinking that that's not people will view me more important people in a kind of totality rather than these just isolated bits but maybe I'm over optimistic about that Thank you, there's a question just here but as the microphone moves round can we take one online one question Annemarie What are the implications of being a public general practitioner Oh this has actually came from that gentleman over there Oh well True my dear Do you want to add anything to it? Yes Thanks Annemarie and that was a refreshing presentation actually, it made us all think I believe about issues of identity and so on but the reason I ask that question is because I know a lot of other practitioners in other fields like in law for instance who are doing a very similar thing to this firstly the question is do you think there's going to be an increase in this kind of public performance of your profession and secondly if that's the case what do we do about things like authenticity you know somebody might masquerade as a doctor or a lawyer and not actually be one and they might be giving dangerous advice Yes Well I suppose I suppose that I was actually what I was trying to say is I am not I am not prepared to move into this space and practice as a professional as a GP That is not at all my kind of what I'm saying here What I'm saying is that you cannot having an absolute that you know anybody comes and asks me anything medical I will say sorry excuse me I cannot respond to that with me also being like an educator and being somebody who wants to share knowledge but I don't believe it just giving a simple piece of information like that very transactional thing to me that's not being a doctor that's not being a GP because if I was a GP in that situation or even if I met you somebody here and somebody said to me I said oh gosh what you know that sounds awful why is that or what's happening or whatever and we would have a very different conversation to me just saying oh yes I tried through the bladder and then they said well that's one friend and they don't know about this all I was trying to say about that sounds very distressing I didn't get into a big dialogue about I was not being a doctor in that situation and I don't think that we should I don't feel happy or comfortable going on being in that public way but as I'm saying we might be challenged about how do we if other people start coming forward you know how much then do we actually be reflexive and respond to other people decide how do we assess that actually you understand what you're doing and that you're confidential how do you understand that do I have a greater that even if you think that you want to share everything in public do I want to be seen as how I practice in public how do I have rights about this as well so I wouldn't advocate it by any sort of thing and I think I wanted to talk though more about how you actually can what are the issues of these things come up and you haven't you haven't set out for them to be there we've had a question over here and what are we going to do with another question hello yes one of the conundrums in medical education is that often the context of learning and the learning methods move ahead and the mirroring assessments that we apply to students don't change this will probably apply to medical practitioners in terms of the presence that you've been talking about what guidelines or what processes could be gone through for your college law builders in terms of what you might be suitable for or not or what will be acceptable practice how can we fast-track that process or update their concepts of what's acceptable and not well I think that this I mean I think that this isn't important although I'm sort of talking about getting out there and being reflexive and taking on that you know if you're there you will by necessity if you can keep conducting yourself just as being I kind of know what I'm doing first of all we don't have the rules it's not kind of clear so you have to before you even decide to go there need to be experienced you need to be you know because it is not a I am meeting students there and I'm supporting them and mentoring them if I come across them but I am not encouraging my students to go out and start having a public profile I am not sure that it is a safe place to you know to learn to be but this it also falls in like yesterday in the discussion about how students have within the VLA and within safe spaces we give they project maybe like an institutional socialised kind of identity you come across them in other spaces and they are in a way different so there are some people that are out there exploring what does it feel like to be talking in a public way about this and becoming more confident of their identity and we give you know I'm talking to some sometimes I take on this mentoring role for people across the UK medical student might say I'm thinking about writing a blog post something from Leicester or whatever I'm thinking about writing a blog post about this do you think this is okay as well have you thought would that person be able to recognise who you know you're from that maybe you should change this so in a way my role is being and it is no longer just even to people within my own institution but if I'm there as an educator in that public space I'm having a role that's you know sort of much more far reaching I think that we can there aren't to me simple sort of rules about this but and the things that have come out so far tend to be sort of saying you know it is what should I be careful which I think is right to a certain extent and maybe we could give people chances to come in and have these sort of discussions about sort of topics I'm trying to be quite careful about the things that we select for these chat sessions now we have approached some difficult things but some people is you know why don't can we talk about difficult difficult patients and I was like well I don't really feel that there are situations of difficult consultations maybe I'm a difficult doctor some days and I think that would be too complex a thing to talk about in 140 characters that would give people a chance to maybe appear on professional this is too too complicated for a discussion within this so you have to be careful about the things so it's much easier to talk about how to use technology in lecture theatre than something like that Can you wait for Mike so we can capture him So is there actually a proper definition for digital professionalism There's been some really good interesting work done by Rachel Ellaway on this about digital professionalism and actually this was published about a year ago a medical teacher and I had actually copied because that's a pay for journal I'd taken out her simple rules some of the rules and put them in a blog post so you actually want to see their kind of public there and I was saying this is although you come up with these rules easy and I think we're going to try and run a series and our kind of meta chat sessions with students and people and actually talk about what do these rules actually mean to us how do we develop amongst a group of people an idea about what these sort of ideas are what does it mean to say you should have a professional kind of presence you know what does that mean so we're going to try and hopefully tease that out so we'd love if people join in look at my blog and you'll find more about it hopefully thank you on that note Annemarie we're going to have to draw it to court so thank you for a great session