Rachel Ellaway, PhD—Assistant Dean Informatics, Northern Ontario School of Medicine, Canada
Janet Tworek—PhD Candidate and Manager of eLearning, Undergraduate Medical Education, University of Calgary, Canada
Is the Digital a Problem?
Digital technologies (whether for good or ill) now frame much of our day-to-day experiences. However, despite the ubiquity of the digital in both medical education and medical practice there is often great anxiety over what our learners, staff and faculty might do with it. Not only have mistakes and misdemeanors through sites like FaceBook or YouTube made the headlines there have probably been a great many more near misses (Ferdig et al, 2008; Chretien et al, 2009). Ill judged online actions have led to some learners failing to secure or retain employment or access to a program of study (Cain, Doneka & Smith, 2010).
Others have been disciplined because of their online activities, some of which may have been made years earlier. Because the use of the digital is increasingly being framed in terms of misdemeanors, it is hardly surprising that most institutions have respond in terms of discipline and punishment by beefing up codes of conduct and disciplinary procedures to deal with what is largely seen as a problem.
Despite this anxiety and negativity, digital technologies offer great opportunities to improve what we do and how we do it. Compare this with the teaching of communication skills. For a long time considered outside the realm of professional training, the criticality of being able to communicate appropriately and effectively means that this is now part of the medical education mainstream. Should it not also be the case for working with and within digital environments?
The thesis of this article is that we should move away from what has become a somewhat a punitive and largely negative stance to adopt a much more positive approach to professionalism in a digital age. In effect we should model good behaviors with and around digital media by folding what we call ‘digital professionalism’ into our curricula and programs.
Abdication of Responsibility
Commentators label the current generation of students as digital natives, based on the idea that young people are different because of their use of digital media. The rest of us are portrayed as second-class citizens fumbling to function effectively in the digital world (Prensky, 2001). This has led some teachers to defer on matters digital to their learners as being more expert. However, while our learners may well be confident, they often lack real competence in making sense and appropriate use of the digital in their education, as well as in developing professional lives (Beetham et al, 2009). It is not just our learners who need to practice good digital professionalism -- we all do.
Despite what we might think, our learners do still take a significant lead from their teachers and their environment and if we are uncertain or otherwise reluctant around modeling the use of the digital, they will of course take their lead from elsewhere. We therefore need to develop the principles and practice of digital professionalism and actively teach and model it for our learners. Although much of the literature focuses on social media, the framework has been developed to address the range of issues related to device management, network loads, data management, patient privacy, as well as the reputation of the individual and institution.
Principles of Digital Professionalism
Although professionalism in a digital context has been considered (Thompson et al, 2008; Rothman and Blumenthal, 2010) it has not led to particularly concrete changes. An ad hoc group of educators has come together to turn the negative reactions around the use of the digital in medical education into more affirmative approaches to teaching and learning. An earlier version of these professionalism principles (Ellaway, 2010) was reviewed and developed to create the following framework:
- establish and sustain an on online professional presence that befits your responsibilities while representing your interests … but be selective where you establish a profile
- your professional identity extends into all online communities you join, and you are still a professional there
- use privacy controls to manage more personal parts of your online profile and do not make public anything that you would not be comfortable defending as professionally appropriate in a court of law or in front of a disciplinary panel
- think carefully and critically about how what you say or do will be perceived by and reflect on others, including individuals and organizations. Act with appropriate restraint.
- almost everything online can be monitored, recorded or data mined by multiple groups. Consider every action online as permanent. Think carefully and critically how what you say or do online today will be perceived in years to come.
- pretence and deceit are inappropriate behaviors for health professionals. Do not impersonate or seek to hide your identity for malicious or unprofessional purposes.
- be aware of the potential for digital attack or impersonation. Know how to protect your reputation and what steps to take when it is under attack.
- theft and piracy are not acceptable for any professionals - work within the law.
- curation of information is a serious responsibility. Do not expose information to unnecessary risk and consider wisely the potential impact of any use or exchange of information you make
- behave professionally and respectfully in all venues and using all media and take responsibility for modeling positive digital professionalism to others.
The move from ‘knows’ to ‘ knows how to know’ in contemporary professional education implies (although rarely states) that participating in information environments is fundamental to a professional’s function and identity. Digital professionalism should therefore be seen not as just another esoteric (and largely optional) concern but an essential part of preparing tomorrow’s doctors. If we allow denial and punishment to continue to shape how the digital is represented in medical education then we are perpetuating a hidden curriculum that neglects our learners’ needs and thereby puts patients and the professions at risk. Surely expanding the models of professionalism we already have to accommodate the digital is not such a large task given the consequences of failing to do so?
Beetham, H, McGill, L and Littlejohn, A (2009). Thriving in the 21st century: Learning Literacies for the Digital Age. Glasgow, Glasgow Caledonian University/JISC. Online at https://www.jisc.ac.uk/media/documents/projects/llidareportjune2009.pdf
Cain, Jeff, Scott, Doneka R., & Smith, Kelly. (2010). Use of social media by residency program directors for resident selection. [Article]. American Journal of Health-System Pharmacy, 67(19), pp1635-1639
Chretien, K, Greysen, S, Chretien, J and Kind, T (2009). "Online Posting of Unprofessional Content by Medical Students." JAMA 302(12): pp1309-1315.
Ellaway, R. (2010). "eMedical Teacher: Digital Professionalism." Medical Teacher 32(8): pp705-707.
Ferdig, R, Dawson, K, Black, E, Black, N and Thompson, L (2008). "Medical students’ and residents’ use of online social networking tools: Implications for teaching professionalism in medical education." First Monday 13(9). Online at https://www.uic.edu/htbin/cgiwrap/bin/ojs/index.php/fm/article/viewArticle/2161/2026
Prensky, M. (2001). Digital Natives, Digital Immigrants. On the Horizon, 9(5).
Thompson, L, Dawson, K, Ferdig, R, Black, E, Boyer, J, Coutts, J and Black, N (2008). "The Intersection of Online Social Networking with Medical Professionalism." J Gen Intern Med 23(7): pp954-957.
Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press.