EDITORIAL

The emergence of Medicine 2.0 in medical education

La irrupción de la Medicina 2.0 en la educación médica

Jenaro A. Fernández-Valencia

Especialista en Cirugía Ortopédica y Traumatología. Tutor MIR, profesor clínico, Facultad de Medicina, Universitat de Barcelona. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Universitat de Barcelona. Vocal Sección eSalud, Colegio Oficial de Médicos de Barcelona.
E-mail: jenarofv@clinic.ub.es

The provisions of Chapter III of Act 16/2003, on the cohesion and quality of the National Health Service, define professional competency as 'the aptitude of healthcare professionals to integrate and apply the knowledge, skills and attitudes associated to the good practice of their profession in order to solve any problems that may arise'. A number of catalogues of competencies have been developed, such as the ACGME Project, CanMEDS, Scottish Doctor or the White Book of the Degree in Medicine, each of them defining the different domains of competency that can be assessed [1].

Our day-to-day professional practice has incorporated the use of technological elements based on the Internet, in which the social networks, collaboration, participation and free access to contents have marked a turning point in the way we, as healthcare professionals, deal with information, both among ourselves and with our patients. Professional practice within this new context has been labelled Medicine 2.0 [2] or eHealth, the two terms being considered synonyms [3]. The future updating of the catalogues of competencies will have to take these changes into account. In fact, for the new CanMEDS 2015 [4] a work group was set up to incorporate competencies into eHealth in each of the domains of competency [5].

What situations are we referring to when we talk about professional practice within the context of eHealth or Medicine 2.0? We are talking about many scenarios that we are already quite familiar with. The following are some examples. A resident physician sends the image of an open fracture to his attending physician via WhatsApp. A university lecturer updates her profile on Researchgate and links her account to her Twitter profile in order to promote her work and thus increase her chances of being indexed. A professional has developed a medical blog in which she gives advice on healthcare and promotes her professional activity or that of the centre where she works. A researcher receives an offer to work on a collaboration project via LinkedIn. A patient finds an app for his smartphone that allows him to monitor his weight control programme and improve his nutritional habits. The list of examples could go on forever. In 2009, only for the social network Twitter, 140 potential uses were described for application in the health sciences [6].

Indeed, the last MIR (Resident Intern) exam included a question reflecting these changes: 'Doctor, can I ask you to be my friend on Facebook?' [7]. It was asked by a 15-year-old patient recovering from an eating disorder. To answer this question, none of those sitting the exam had prepared the topic in their handbook. The correct answer was 'Tell her that it is important to keep certain limits between patients and professionals and that, unfortunately, if she makes such a request, you cannot accept it, and so it is better not to do it in the first place'. As a guide for healthcare professionals on how to deal with this and other matters on social networks, the Spanish Medical Association (OMC) had already drawn up a style guide on the good use of social networks, which is highly recommendable reading for both students and healthcare professionals [8].

The medical education literature is taking up these changes and studies that evaluate different situations are starting to appear. A doctor may have problems when it comes to preserving his or her privacy on social networks [9] or, for example, may have doubts about what can be made public on these media [10,11]. These different situations give rise to new challenges for the medical profession. The application of the classical principles of professionalism to the social networks environment has led to the concept of online professionalism [12], and new questions arise. If a patient reads what a doctor posts on social networks, can this generate feelings of mistrust or have a negative impact? Are there certain red lines that no professional should cross in their personal public profile simply because they are a physician?

As teachers and educators, we must prepare tomorrow's doctors in eHealth. The phenomenon of Medicine 2.0 is constantly changing, but it is undoubtedly here to stay.

References

1. Palés-Argullós J, Nolla-Domenjó M, Oriol-Bosch A, Gual A. Proceso de Bolonia (I): educación orientada a competencias. Educ Med 2010; 13: 127-35.         [ Links ]

2. Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res 2008; 10: e22.         [ Links ]

3. Hughes B, Joshi I, Wareham J. Health 2.0 and Medicine 2.0: tensions and controversies in the field. J Med Internet Res 2008; 10: e23.         [ Links ]

4. Frank JR, Snell L, Sherbino J, eds. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.         [ Links ]

5. Kendall HO. The CanMEDS 2015 eHealth Expert Working Group Report. Royal College of Physicians and Surgeons of Canada; 2015. URL: http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/ehealth_ewg_report_e.pdf. (02.04.2016).         [ Links ]

6. Forgie SE, Duff JP, Ross S. Twelve tips for using Twitter as a learning tool in medical education. Med Teach 2013; 35: 8-14.         [ Links ]

7. Una paciente de 15 años quiere agregarte a Facebook, ¿qué haces? La pregunta del MIR que nadie esperaba. URL: http://verne.elpais.com/verne/2016/02/10/articulo/1455102208_248714.html. (02.04.2016).         [ Links ]

8. Organización Médica Colegial de España. Manual de estilo sobre el buen uso de redes sociales. URL: http://www.cgcom.es/sites/default/files/u183/Manual%20Redes%20Sociales%20OMC.pdf.         [ Links ]

9. MacDonald J, Sohn S, Ellis P. Privacy, professionalism and Facebook: a dilemma for young doctors. Med Educ 2010; 44: 805-13.         [ Links ]

10. Jain A, Petty EM, Jaber RM, Tackett S, Purkiss J, Fitzgerald J, et al. What is appropriate to post on social media? Ratings from students, faculty members and the public. Med Educ 2014; 48: 157-69.         [ Links ]

11. Walton JM, White J, Ross S. What's on your Facebook profile? Evaluation of an educational intervention to promote appropriate use of privacy settings by medical students on social networking sites. Med Educ Online 2015; 20: 28708.         [ Links ]

12. Chretien KC, Tuck MG. Online professionalism: a synthetic review. Int Rev Psychiatry 2015; 27: 106-17.         [ Links ]