Online mutual mentorship for GPs - the where

Draft working document. Please suggest revisions in comments

There are many social media platforms available. What features would the ideal platform have?

Essential

Private groups
Accessible from commonly-used devices and networks
Easy to use
Secure
 - this needs to be balanced against accessibility
Trusted

Desirable

Threading of conversations
 - so that each case can have it's own discussion thread
Vehicle for anonymous posts
Free of charge
 - to allow for scalability
 - for ease of admininstration

It is difficult to find a platform which fulfils all of these criteria. One could host a system on one's own servers, either using existing forum-type software (such as phpBB) or bespoke software. A completely bespoke solution would be extremely expensive, and even existing software would need customising in a way few GPs have the skills for.

Any costs would have to be borne by group members or sponsors. A sponsor is unlikely to be interested in advertising on the group unless there was a substantial membership. This immediately presents a considerable hurdle: how can one fund the development and promotion of a new platform until then?

Of course, there are several social media platforms already available, funded by advertising (or will be), free of charge to the user.

Twitter

The 140 character limitation and lack of private groups really render Twitter unsuitable for this application.

Facebook

Facebook is attractive as it is the most widely used. I would argue, however, that there is a limit to how much it can be trusted.

Its funding model has apparently not yet been finalised, and so it is uncertain how it will use users' data for monetary gain.

Users have been suspended as a result of posts on private groups, implying a lack of respect for privacy from Facebook staff of content within these groups.

I can find no way of permitting anonymous posts. Users can post "as" Pages but not within groups.

Google Plus

For me, Google Plus seems to tick all the boxes. Its funding model is well established (serving advertisements to users based upon words they use or search for).

Its downsides are that fewer GPs in the UK are yet familiar with it. Also, many seem to be concerned about privacy in relation to sharing their data with Google. However, as far as I am aware, this data is only parsed by computers, not staff, to determine advertisements likely to be of interest. I have not heard of any instances of monitoring by Google staff of content within private groups.

Online mutual mentorship for GPs - the why

As a regular user of social media, I have been surprised by the degree of support I have derived from it. Public or large fora are a great place to learn and to interact with opinion leaders. Less expectedly, perhaps, one can form very real friendships.

However, there is a limit to how much one is willing to share in such fora. In particular, it is rare for someone willingly to expose a vulnerability in public, especially if it could damage their professional reputation. However, it is by reflecting on these very vulnerabilities that must be of highest importance for any professional in maintaining and improving their competence.

GPs face emotional and professional challenges every day. Most helping professions have well established systems for supporting each other. GPs now have a system of appraisal to support their professional development and applications for revalidation: these meetings occur only once a year and rarely provide much emotional support.

There have been many attempts at meeting this need in general practice. Local discussion groups of various kinds exist. Often, these comprise a factual educational component, sometimes with a guest speaker, in which case the group tends to be larger and more formal. One to one coaching or mentoring also takes place on a small scale.

Balint groups have been promoted as an explicit way of addressing the need of GPs for emotional support by encouraging in groups the exploration psychological aspects of consultations. Although there has recently been renewed interest in Balint groups, they never have achieved widespread adoption. John Launer suggests this may in part be due to the exclusive focus on psychological aspects. I suspect logistical obstacles such as spare time and local availability of like-minded trusted colleagues are also important.

Launer champions the concept of narrative-based clinical supervision (which he also calls "conversations inviting change"). Such conversations can take place informally in any setting, such as over the kettle when colleagues have just a few minutes to spare between patients. He opines: "the time has arrived for experimentation and pluralism in clinical supervision for GPs".

I would suggest that online social media could be a very useful setting for clinical supervision. Geographical separation may assist confidentiality and therefore openness. Even face to face and verbal communication is possible using video and telephone conferencing technology respectively. However, these benefits need to be set against the benefits of asynchronous text communication, which will allow participants to communicate whenever is individually convenient for them, in the now established manner of social media.

Reference
Launer J. Moving on from Balint: embracing clinical supervision. BJGP 2007; 57(536): 182–183.