디지털 프로페셔널리즘에 대하여 (Med Teach, 2015)

디지털 프로페셔널리즘에 대하여 (Med Teach, 2015)

Exploring digital professionalism

RACHEL H. ELLAWAY1, JANET CORAL2, DAVID TOPPS3 & MAUREEN TOPPS3

1The Northern Ontario School of Medicine, Canada, 2University of Colorado, Denver, USA, 3University of Calgary, Canada

'사회적 계약'이란 의학과 사회 사이의 관계를 정의하는 말로 사용되어 왔고, 의학 전문직업성의 토대이기도 하다. 의학과 의학교육은 그것이 위치하고 있는 더 포괄적인 사회적 맥락에 적응해가게 되며, 디지털 미디어의 흡수는 사회와 전문직 모두에게 큰 영향을 주었으며, 의학 전문직업성에까지 큰 도전이 되엇다.

The ‘social contract’ has been described as defining therelationship between medicine and society, and as such it isthe foundation for medical professionalism (Cruess & Cruess2008; Cruess et al. 2010). Medicine and medical educationadapt to the broader social contexts in which they are situated(Starr 1982), and the widespread uptake of digital media has had a major impact on society and the professions, which inturn presents a growing range of challenges to medicalprofessionalism (Ellaway 2010; Gagnon & Sabus 2015).

디지털 미디어의 활용은 우리가 서로 상호작용하는 기회를 크게 넓혔다. 전례없는 수준으로 활용도가 넓어져서 어떤 사회적 전통(예절과 공경의 형태)을 흐리게 하기도 했다. 동시에 소셜미디어의 활용으로 부적절한 행동과 상호작용을 낳기도 했다.

• The use of digital media has significantly expanded our range of opportunities to interact with each other. As much as this has been received with unprecedented uptake and enthusiasm, it has also tended to blur some social conventions (such as forms of politeness and deference), while providing new opportunities for ill- considered actions and interactions, particularly through the use of social media. 

디지털 미디어의 활용은 우리의 행동의 속도와 척도를 가속화했다. 전례없는 양의 w정보가 네트워크로 들어오고, 다른 사람들과의 의사소통과 협동은 시공간의 제약을 받지 않는다. 그러나 우리의 자료 접근과 상호작용이 많아질수록 우리는 스스로의 삶에 잠깐의 휴식을 가지고 성찰을 할 수 있는 시간을 잃게 되었으며, 프라이버시와 개인 시간도 크게 사라졌다.

• The use of digital media has accelerated the speed and scale of our actions. Unprecedented quantities of infor- mation can be retrieved instantly wherever a network connection can be accessed, allowing us to communicate and collaborate with others independent of space or time. However, as our access to resources and to each other has expanded, we have arguably lost many of the natural pauses for reflection in our lives, while privacy and personal time are being increasingly eroded.

인터넷의 파워는 이질적인 기술들의 대규모 상호연결성에 있다. 이것이 전례없는 기회를 만들어낼 수도 있지만, 이는 시스템간, 기기간, 유저간 상호의존성을 유발한다. 이는 시스템의 한 부분의 문제가 다른 부분 혹은 전체 시스템의 문제를 일으킬 수 있다는 것을 의미하며, 그 결과 기기의 분실 혹은 이메일과 같은 서비스의 심각한 문제는 우리의 주요한 능력이나 기능에 큰 영향을 준다.

• The power of the Internet is based on massiveinterconnectivity between heterogeneous technologies.Although this can create unprecedented opportunities(such as providing seamless interactions between devicesand services), it can also create increasing interdepen-dencies between systems, devices, and their users. Thismeans that failures in one part of a system cancompromise others, or the system as a whole. As aresult the loss of a device or of a critical online servicesuch as email can have a major impact on our ability (andon others’) to function professionally and domestically. 

인터넷은 아주 많은 수의 깊고 광범위하게 분포한 기억으로 우리가 그것을 사용하는 것이 추적되고, 이후 분석을 위하여 자료를 저장한다. 이는 우리의 용서하고 잊어버릴 집단적 능력을 저해시킬 뿐 아니라, 서로가 서로를 감시하는 상황을 강요한다. 

• The Internet has an increasingly deep and distributedmemory with a multitude of digital media tracking ouruse of them and storing that data for subsequentanalysis. Not only does this restrict our collective abilityto forgive and forget, it creates compelling panopticrelationships (a few individuals can anonymously scru-tinize a great many others) between Internet technolo-gies and those that use them (Land & Bayne 2005;Ellaway 2014). 

전통적으로 의료와 사회 사이의 사회적 계약은 약간의 단절이 있어서 역할과 책임이 서로와 서로에게 분명히 나뉘어질 수 있었다. 그러나 이러한 단절이 디지털 미디어와 함께 무너지고 전문직과 사회의 경계의 구멍이 뚫리며 정의내리기 힘들어졌다. 이는 사회적 계약이 그 타당성을 잃었음을 뜻하는 것은 아니다. 오히려 디지털미디어가 널리 퍼진 오늘날의 맥락에서 전문직이 전통적인 의미의 사회적 계약을 충실히 지키기 어려워졌음을 의미한다.

Traditionally, the social contract between medicine andsociety depended on a degree of separation between themso that their roles and responsibilities could be has clearlybeenarticulated with respect to one another. This somewhat collapsed in the presence of digital media, withthe result that the boundaries between profession and societyhave become increasingly porous and ill defined. This is notto say that the social contract has lost its validity; it is ratherthat it is increasingly difficult for professionals to adhere totraditional concepts of the social contract in a societal contextinformed by the widespread use of digital media. 

이러한 문제는 보건의료직 수련에서 더 증폭되었다. 네트워크 세대, 디지털 네이티브라는 개념에 의해 생겨난 어떤 가정, 즉 현시대의 학습자들이 디지털 미디어로부터 파생된 문제를 그들의 선생들보다 더 잘 다룰 것이라는 가정은 철저한 검토를 버텨내지 못했다. 학생들의 스스로의 skill에 대한 인식은 제한적이며, 심지어 무모하기까지 하다. 

These challenges are, if anything, amplified in the trainingof health professionals. Assumptions, encapsulated in con-cepts such as ‘netGen’ and ‘digital natives’ (Prensky 2001), thatcontemporary learners are better able to negotiate thechallenges of digital media than their teachers do notwithstand scrutiny. What differences there are seem to bemore about generational asymmetries in opportunity, confi-dence, and risk (Parasuraman 2000), than something that setsyouth apart, while students’ awareness of their skills can besomewhat limited (Beetham et al. 2009), and even, at times,reckless (Ferdig et al. 2008). 

디지털 악행(?)에 대한 기관의 대응은 규제와 처벌의 형태를 지닌다. 우리는 이러한 규제에 집중하는 것이, 그리고 특히 소셜미디어에 집중하는 것이 디지털 비-전문직업성이라는 잠재교육과정을 만들었다고 본다. 우리가 '디지털 프로페셔널리즘'이라 부르는 것에 대해서 더 건설적이고 종합적인 가이드를 줄 필요가 있다. 단순히 기존의 프로페셔널리즘이라는 개념을 가져다 붙이는 것이 아니라, 프로페셔널리즘의 원리와, 디지털 미디어의 역할과 기회, 그리고 그것들이 실현되는 사회적 맥락의 변화 간의 중요한 교차점으로서 교육해야 한다.

Institutional responses to of digital misdemeanours havetypically taken the form regulation and punishment(Farnan et al. 2009; Kind et al. 2010). We would argue thatthis focus on regulation, and the particular attention paid tosocial media (Gagnon & Sabus 2015) has created a hiddencurriculum of digital unprofessionalism. There is a needtherefore for more constructive and comprehensive guidanceon matters regarding what we call ‘digital professionalism’,not simply as an adjunct to existing concepts of profession-alism, but as a critical intersection between the principles ofprofessionalism, the roles and opportunities of digital media,and the shifting social contexts within which they are realized(Tworek 2012). 

디지털 프로페셔널리즘이라는 개념은 전통적인 의료 프로페셔널리즘에 기반하고 있으며, 특히 디지털 미디어를 활용하는 전문직이 맞닥뜨린 기회와 도전에 보다 관심을 기울이고 있다.

The concept of ‘digital professionalism’ isgrounded in traditional concepts of medical professionalismwhile drawing attention to the particular opportunities andchallenges afforded by professionals’ use of digital media andthe ways in which the profession is changed by this use(Ellaway & Tworek 2011; Topps & Powelson 2013). 

의료 전문직업성에는 다양한 모델이 있다. 소셜미디어의 활용에 대해서도 가이드의 형태든, 정책의 형태든 여러 프레임워크가 출판된 적 있었다. 비록 이러한 것들이 소셜미디어를 넘어서 보다 넓은 프로페셔널리즘 프레임워크에 대한 일반화가 있긴 했지만, 대부분으 소셜미디어에 집중하고 있었고, 그것이 비전문적 행위와 그것이 전문직에 미치는 위험에 대해 다루었을 뿐이다. 그 결과 프로페녀럴리즘이 디지털 시대에 어떤 비용을 지불해야 하는가에 대한 포괄적 고려는 거의 없다.

There are many models of medical professionalism thatset out physicians’ responsibilities to their patients, to society,to the profession, and to themselves (ABIM et al. 2002;Hafferty 2006; CPSO 2007a; Cruess et al. 2009; Mondoux 2010;Spandorfer et al. 2010; Frank et al. 2014). There have alsobeen a number of frameworks published regarding physicians’use of social media, both in the form of guidance (WMA 2011;Brasg 2013) and policies (CPSO 2007b; AMA 2011; APHRA2014). Although there has been some generalization beyondsocial media to broader professionalism frameworks(GMC 2013), the majority have focused on social media,reflecting its potential for affording unprofessional behaviourand the risks this presents to the profession (Gholami-Kordkheili et al. 2013). As a result, there has been littlebroader consideration of how professionalism fares in a digitalage. B

우리의 주장의 핵심은 디지털 기술과 우리의 관계가 변한다는 것이다.

Central have to this argument is the changing relationshipswe with our digital technologies. 

디지털 미디어의 활용이 학생과 의사들의 인지적 능력을 확장시켰을 뿐 아니라, 비판적 사고의 형태도 바꾸고 있다.

Not only can the useof these digital media extend student and practitioner cogni-tive abilities, they can even shape their clinical thinking(Percival et al. 2014). 

디지털 프로페셔널리즘에 대해서 다음과 같은 생각의 토대를 제안한다.

we propose the following foundational basis for digital professionalism: 

디지털 미디어는 의료 프로페셔널리즘의 내재적 위협이 아니다. 전문직은 디지털 미디어를 진료, 공감, 이타적 행동, 신뢰 등의 원칙에 따라 긍정적인 목적으로 활용해야 한다. 전문직은 디지털 미디어와의 관계를 만들어나가고 있음을 인식해야 하고, 신중하고, 윤리적이고, 책임있는 행동양식을 유지해야 한다.

Digital media are not an intrinsic threat to medical professionalism. Professionals should use digital media for positive purposes in ways that support principles of patient care, compassion, altruism, and trustworthiness. Professionals should be aware of the shaping nature of their relationships with digital media and they should maintain the capacity for deliberate, ethical, and accountable practice when using them.

이것에 기초해서 다음의 디지털 프로페셔널리즘 프레임워크를 제안한다.

Building on this foundation, we propose the following digital professionalism framework structured around concepts of proficiency, reputation, and responsibility: 

유창성 Proficiency: 

평판 Reputation: 

책임 Responsibility: 

전문직은 유창성/평판/책임과 관련하여 다음의 행동을 해야(하지 말아야) 한다.

이 프레임워크를 실제 현장으로 옮기는 것이 중요하다. 그러나 프로페셔널리즘의 다른 측면처럼 그 방법은 하나의 교육과정 인터벤션이 아니라 여러 개의 조직화된 행동이며, 그 중 일부는 개개인의 책임에 대한 것이고, 다른 것들은 교육 프로그램과 시스템의 책임이다. 다음의 네 영역으로 제안한다.

Translating this framework into practice is an essential part of realising its value. However, as with other aspects of professionalism, the answer is not a single curriculum inter- vention but rather multiple coordinated activities, some of which are about individual responsibility (as set out in the framework), while other aspects are broader and are the responsibility of educational programs and systems. We have grouped some suggested adoption strategies around the following four dimensions:

• Awareness: learners and teachers need to be aware of the dynamics and dimensions of digital professionalism. Rather than adding to curriculum content we suggest that this can be accomplished through iterative assess- ments of learners’ needs and uses of digital media at all stages of their medical careers. The likelihood of gener- ational differences in the perception and use of digital media affords constructive opportunities for discussion and debate, alongside the use of role-play and simulation to engage learners and their teachers in developing a strong and effective sense of digital professionalism.

• Alignment: digital professionalism should not be taught independent of other curriculum topics, nor as an independent skill. We suggest that it should instead be woven in to the fabric of the curriculum as a whole. For example, using digital devices at the bedside can help learners to develop technical competence, while their teachers can model appropriate professional use of hand held technology during patient consultations. There are intersections with many other topics, such as communication (learning how to use digital media in a consultation without losing important non-verbal cues)and advocacy (learning how to advise and teach patients about online health resources). Digital professionalism should also be folded in to the ongoing development of competencies, milestones, and entrustable professional activities (EPAs) to ensure appropriate levels of independent practice involving the use of digital media. 

• Assessment: as with other aspects of curriculum change,requiring that a competency be assessed can help to promote its legitimacy and value within a broader program context. The attainment and maintenance of skills in digital professionalism must therefore be woven into assessments in ways appropriate to, and aligned with,learners’ level of training and their appropriate use of digital media. However, as with broader concepts ofprofessionalism, this should involve the use of multiple methods including workplace-based assessments andpeer review. Moreover, remediation of learners may need to be approached differently when there are digital professionalism infractions that compromise patients’privacy or care, and/or colleagues’ or institutional reputations. 

• Accountability: responsibility and accountability provide connections between our personal and professional uses of digital media. Codes of conduct, by laws, guidelines and policies governing professional behaviour should be updated to encompass the use of digital media. Given the apparent asymmetrical attention paid to the risks and negatives of digital media in medicine, these changes should highlight constructive uses of digital media (such as the use of digital media to facilitate safe patient care delivery and management) as well as identifying boundaries, risks, and potentially negative outcomes. 

학습자가 디지털 미디어를 사용하는 것을 인지적 보조장치라고 언급했다. 의학교육에 있어서 교실에서, BST에서, 평가의 한 부분으로 디지털 미디어의 전문적 활용이라는 내용을 포함시켜야 한다. 보다 명확히 하자면 우리는 디지털 미디어가 모든 고셍 존재한다는 것에 가정한 의학교육 모델을 지지하는 것이 아니다. 학생과 의사들은 인지적 보조장치 없이 일할 수 있어야 한다. 따라서 우리는 어느 정도까지 학습자들이 인지적 보조장치를 활용하는 것이 괜찮은가 대한 역량을 정의해야 한다. 명백히 이것은 현재의 진료 모습에서 출발해야 하며, 인지적 보조장치의 적절한 활용에 대해서는 더 많은 연구가 필요하다. 

We have also noted learners’ use of digital media as cognitive prosthetics. This has a number of implications for medical education such as actively including the professional use of digital media in the classroom, at the bedside, and as apart of assessment. To be clear, we are not advocating for a model of medical education based on the ubiquitous presence of digital media. Physicians (and therefore our students) still need to be able to practice without their cognitive prosthetics(such as when their device is lost or there is no electricity or data service). We suggest therefore that we should define competence (along with its many other properties) in terms of how much our learners can or should employ cognitive prosthetics. Clearly this is a departure from current practice and, as such, the appropriate use of cognitive prosthetics needs further exploration. Furthermore, we have yet to explore the potential for digital media (in particular social media) to collaboratively enhance physicians’ resilience in practice. 

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Med Teach. 2015 Sep;37(9):844-9. doi: 10.3109/0142159X.2015.1044956. Epub 2015 Jun 1.

Exploring digital professionalism.

Ellaway RH1, Coral J2, Topps D3, Topps M3.

Author information

• 1a The Northern Ontario School of Medicine , Canada .
• 2b University of Colorado, Denver , USA .
• 3c University of Calgary , Canada.

Abstract

The widespread use of digital media (both computing devices and the services they access) has blurred the boundaries between our personal and professional lives. Contemporary students are the last to remember a time before the widespread use of the Internet and they will be the first to practice in a largely e-health environment. This article explores concepts of digital professionalism and their place in contemporary medical education, and proposes a series of principles of digital professionalism to guide teaching, learning and practice in the healthcare professions. Despite the many risks and fears surrounding their use, digital media are not an intrinsic threat to medical professionalism. Professionals should maintain the capacity for deliberate, ethical, and accountable practice when using digital media. The authors describe a digital professionalismframework structured around concepts of proficiency, reputation, and responsibility. Digital professionalism can be integrated into medical education using strategies based on awareness, alignment, assessment, and accountability. These principles of digital professionalism provide a way for medical students and medical practitioners to embrace the positive aspects of digital media use while being mindful and deliberate in its use to avoid or minimize any negative consequences.

PMID:

 

26030375

 

[PubMed - in process]