AMC Social Media Policy in relation to blog comments

Follow- up Statement on Recent Site Activity and Moderation

Unfortunately the gloves are off again. Content from this blog has caused (some) readers to be upset… As a background, we started this blog as a not-for-profit and not for personal gain platform for medical education. And overall it’s worked out really well. We have loved the experience but the last 6 months has seen the medical education foundation wavering.

This is based on recent experience of posts about the Australasian Emergency Fellowship Exam. Here is some (unsolicited) advice for those who post on this forum anonymously and have previously been ‘warned’ on my ‘open letter’. (Link)

We implore you, to refer to the AMC social medial policy when posting online. Be careful. You may think your anonymous, but your not necessarily. People can work it out and we are professionals and seen by the public as such. That means something.

For those who posted and have had comments moderated by us please note that you are medical professionals and breaching the AMC social media policy. Ironically, this exam, that we love to hate tests professionalism and our online posts actually reflect badly upon us with the senior doctors who actually want to help.

We may not agree with the ‘E.A.G.’ line by line, but we must acknowledge that the issue of ‘racism’ is in fact not clear cut. Not binary. Not simple. This is an evidence based comment that I have thoroughly explained in my replies and previous posts.

It may be cathartic to post openly and anonymously angry comments and opinions but actually it is circular if it is not a conversation. If you enter a conversation, not willing to be changed, it’s not really a conversation is it?

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AMC Social Medial Policy
Here is a summary of the issues to think about when posting:

Have you ever:
- Googled yourself?
- Search for your full name in Google, particularly ‘Australian Sites Only’ and ‘New Zealand Sites Only’.
- Do you feel comfortable with the results that are shown?
- Posted information about a patient or person from your workplace on Facebook?
- Have a look through your old online posts and blogs;
- Added patients as friends on Facebook or MySpace?
- Added people from your workplace as friends?
- Made a public comment online that could be considered offensive?
- Become a member or fan of any group that might be considered racist, sexist, or otherwise derogatory?
- Browse through all the groups that you have joined and consider whether these are an accurate reflection of the person you are, and the values that you hold.
- Put up photos or videos of yourself online that you would not want your patients, employers or people from your workplace to see?
- Checked your privacy settings on Facebook or MySpace?
- Felt that a friend has posted information online that may result in negative consequences for them? Did you let them know?

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Here is a link to the useful AMC guideline: Click Here

Dear Andrew, I appreciate your time and effort in creating and running the forum, thank you. Education includes robust discussion about training, assessment and overall checks and balances in the process of making specialists. It is the “managerial domain”. Quality assurance is an important principle especially in health care. I agree we have to be respectful in our interactions on the forum or elsewhere, there is no argument about, no two ways. And in the current context we have to work together to improve the quality of training and assessment to make the training program capable of delivering to the community a truly world standard specialist, dare I say in the current situation the product is not guaranteed .

Honesty, integrity, accountability, professionalism, leadership are extremely important attributes, for everyone more so for doctors, I am sure we all agree that the same applies to the people in roles of responsibility at the college. I am also certain that AMC expects this of all doctors and professional training bodies.

Lets not make this an “us versus them” eye for an eye will make us all blind. Lets get together and work. We owe it to the society and ourselves. We have a huge multinational talent pool with varied experience that we can draw into to create a fantastic world leading training process.

Treating the EAG report as just a document commenting only on discrimination and racism is like the labor and liberals talking just of the delivery part of NBN. I am certain no one is naive, It may be fair to conclude that this redirection of narrative from the broader issues with the training program and examinations to the a narrow discrimination binary, is deliberate, which in turn brings up the question of the core value system – Honesty.

Diversionary strategy I understand has helped, Mr. Trump become the most powerful man on the planet. But the issue here should not be a power struggle. Though as a spectator I cannot help but think that a power tussle in the college hierarchy is being played out. I personally see no reason why the leadership of the college will not hold to account those responsible for the poor design and roll of the training program, while displaying unifying leadership by accepting responsibility for a compromised training and assessment process.

ACEM Vision
‘Be the trusted authority for ensuring clinical, professional and training standards in the provision of quality, patient-focused emergency care.’

Our Mission:
“promote excellence in the delivery of quality emergency care to the community through our committed and expert members.’

It may be reasonable to conclude that as per the EAG report ACEM has confessed to failures in training, assessment, feedback and supervision process I.e. failed in its vision. And based on the findings of the report failed in its Mission.

I quote here from the EAG.

3.47.1 An apology from the College for the unintended systemic racial discrimination associated with introduction of the Fellowship OSCE in 2015 and for the inadequate feedback they received on their OSCE results.

Making racism a “multifactorial, complex issue, is like a fellowship candidate saying the 60 year old man has multifactorial etiology for his chest pain on the back ground of complex issues like fibromyalgia rheumatica, so I performed a CXR, Troponin, Lipase, D Dimer, CTPA and CTA, all of which are normal but I cant understand why he still has pain. The issue is pain, fix it. (sorry I just made up this example, but I can see the faces a number of Sr. Registrars and Jr. FACEMS say the exact words at handover.)

The issue of racism and discrimination is not complex at all, it is plain simple loss of opportunity due to lack of a robust system of assessment and accountability – FACEM fellowship examinations. It is suppression of expression by having mechanisms that are opaque and unquestionable – ITA’s. it is creating and sustaining a process that can flourish on intimidation and harassment by ensuring enormous power is wrested in individual discretion – WBA’s. In the case of ACEM this is further complicated by a poorly rolled out program with no quality assurance, checks or balances, I cannot describe this in any other terms other than incompetence coupled with being obstinately blind sighted. Lack of Honesty, honesty – AMC requirement.

The solution is simpler, acknowledge the issue improve transparency, set up controls. This cannot be tough.

However the issue in the EAG report was not just racism, we all know that. It would be insulting to everyone who is passionate about emergency medicine and patient care, to just make the document just an IMG specific, discrimination related work, it will frankly be unfair to the entire Australian community. The EAG report is also about quality assurance, accountability, checks and balances, competence and project management.

We all understand the report; it’s in black and white, the college confessed to poor quality training and supervision, questionable value of WBA’s and ITA’s. The EAG found fault with the roll out of the new training scheme, poor quality of fellowship examinations, lack of feedback and accountability and following the evidence from 2015.1 through to 2017.2 written examinations and OSCE’s, I don’t think anyone can argue about the lack of quality assurance in fellowship exams. The combination of confessions and findings in the report are a damming indictment of the poor quality training and assessment processes, broadly the working culture of the college. All of us are evidence to struggling junior FACEM’s, who going forward may perpetuate a culture of bullying to compensate for the lack of competence due to a poorly designed and badly executed training process, while effecting patient outcomes adversely. Lack of accountability, accountability – AMC requirement.

For the senior doctors who want to help and are offended by the comments, I would like to say, all of us are in well within our right to be offended. It should have never come to this. The demise of “senior” advocacy (DEMT, FACEM’s included), failure of role models, for the cause of emergency medicine and patient care by not standing up to a flawed, opaque system, is understandable, human nature demands subservience, otherwise the world would have been full of Gandhi’s, Mandella’s, Martin Luther Kings and Theresa’s. However the silence is disappointingly deafening. Everyone involved knew that the process was flawed, no one knew what was required of the examination process, there was no feedback, and yet remained mute spectators to the abuse of power, in my humble opinion this is lack integrity – AMC requirement.

Here I would like to state the example of the offshore detention policy and the fact that ACEM stood up to it, which is wonderful. However hypocrisy lies in failing to ensure checks, balances and accountability in ACEM’s own systems that are meant to guarantee quality specialist level care to the community. May I say this reflects lack of leadership – leadership AMC requirement. I am sure the honorable, world leading advocate of human rights who’s delivering a lecture at ACEM foundation this month may not be impressed with this and rightly so, like every concerned public figure or common citizen.

Respect is mutual and not just about language, clever verbiage is not a substitute for an honest confession. Putting our community at risk due to poor quality of training, assessment and supervision is possibly a bigger issue that people trying work out who wrote what on the blog. Denying a problem will definitely not solve it and will only make the problem worse. Professionalism – AMC requirement.

Lets work together to make our training program world class and restore the credibility of “FACEM”.

P.s.

“90% of trainees are really enjoyable and engaged individuals,” he said, “But 10% of trainees actually becomes 90% of the workload for DEMTs. This involves looking after the trainees that are having real difficulty and perhaps should not have been in the training process to begin with.”

The new process sorts applicants into three categories; suitable for training, those who might be suitable after another year or two of experience, and those who might be better off in another speciality.

“If we catch unsuitable candidates early, then they can move on to a career that is actually well suited for them early in their career rather than later on,” he said.

May I add, if “no one knows what’s going on” “there is no guidance or feedback” who are the DEMT’s helping and with what? And how can anyone know who’s suitable for training or not when, the training program is admittedly not standardized and compromised?

Should we really continue this hypocrisy? act as if nothing has happened, go on business as usual ? Or just stop, pause and go back to the drawing table and redesign, before it becomes the NBN equivalent for ACEM. Making policy on the go is never a good idea. I am sure well can agree.

I would like to call on all like-minded individuals who are passionate about patient care and emergency medicine to come together and help get out act in place, I am happy to contribute, time, effort and energy to host a forum for achieving the same.

I have a conflict of interest to declare, One day when I am the consumer of health care, I expect to be treated by the best trained.

One thought on “AMC Social Media Policy in relation to blog comments”

John Citizen says:

November 5, 2017 at 11:10 am

Dear Andrew, I appreciate your time and effort in creating and running the forum, thank you. Education includes robust discussion about training, assessment and overall checks and balances in the process of making specialists. It is the “managerial domain”. Quality assurance is an important principle especially in health care. I agree we have to be respectful in our interactions on the forum or elsewhere, there is no argument about, no two ways. And in the current context we have to work together to improve the quality of training and assessment to make the training program capable of delivering to the community a truly world standard specialist, dare I say in the current situation the product is not guaranteed .

Honesty, integrity, accountability, professionalism, leadership are extremely important attributes, for everyone more so for doctors, I am sure we all agree that the same applies to the people in roles of responsibility at the college. I am also certain that AMC expects this of all doctors and professional training bodies.

Lets not make this an “us versus them” eye for an eye will make us all blind. Lets get together and work. We owe it to the society and ourselves. We have a huge multinational talent pool with varied experience that we can draw into to create a fantastic world leading training process.

Treating the EAG report as just a document commenting only on discrimination and racism is like the labor and liberals talking just of the delivery part of NBN. I am certain no one is naive, It may be fair to conclude that this redirection of narrative from the broader issues with the training program and examinations to the a narrow discrimination binary, is deliberate, which in turn brings up the question of the core value system – Honesty.

Diversionary strategy I understand has helped, Mr. Trump become the most powerful man on the planet. But the issue here should not be a power struggle. Though as a spectator I cannot help but think that a power tussle in the college hierarchy is being played out. I personally see no reason why the leadership of the college will not hold to account those responsible for the poor design and roll of the training program, while displaying unifying leadership by accepting responsibility for a compromised training and assessment process.

ACEM Vision
‘Be the trusted authority for ensuring clinical, professional and training standards in the provision of quality, patient-focused emergency care.’

Our Mission:
“promote excellence in the delivery of quality emergency care to the community through our committed and expert members.’

It may be reasonable to conclude that as per the EAG report ACEM has confessed to failures in training, assessment, feedback and supervision process I.e. failed in its vision. And based on the findings of the report failed in its Mission.

I quote here from the EAG.

3.47.1 An apology from the College for the unintended systemic racial discrimination associated with introduction of the Fellowship OSCE in 2015 and for the inadequate feedback they received on their OSCE results.

Making racism a “multifactorial, complex issue, is like a fellowship candidate saying the 60 year old man has multifactorial etiology for his chest pain on the back ground of complex issues like fibromyalgia rheumatica, so I performed a CXR, Troponin, Lipase, D Dimer, CTPA and CTA, all of which are normal but I cant understand why he still has pain. The issue is pain, fix it. (sorry I just made up this example, but I can see the faces a number of Sr. Registrars and Jr. FACEMS say the exact words at handover.)

The issue of racism and discrimination is not complex at all, it is plain simple loss of opportunity due to lack of a robust system of assessment and accountability – FACEM fellowship examinations. It is suppression of expression by having mechanisms that are opaque and unquestionable – ITA’s. it is creating and sustaining a process that can flourish on intimidation and harassment by ensuring enormous power is wrested in individual discretion – WBA’s. In the case of ACEM this is further complicated by a poorly rolled out program with no quality assurance, checks or balances, I cannot describe this in any other terms other than incompetence coupled with being obstinately blind sighted. Lack of Honesty, honesty – AMC requirement.

The solution is simpler, acknowledge the issue improve transparency, set up controls. This cannot be tough.

However the issue in the EAG report was not just racism, we all know that. It would be insulting to everyone who is passionate about emergency medicine and patient care, to just make the document just an IMG specific, discrimination related work, it will frankly be unfair to the entire Australian community. The EAG report is also about quality assurance, accountability, checks and balances, competence and project management.

We all understand the report; it’s in black and white, the college confessed to poor quality training and supervision, questionable value of WBA’s and ITA’s. The EAG found fault with the roll out of the new training scheme, poor quality of fellowship examinations, lack of feedback and accountability and following the evidence from 2015.1 through to 2017.2 written examinations and OSCE’s, I don’t think anyone can argue about the lack of quality assurance in fellowship exams. The combination of confessions and findings in the report are a damming indictment of the poor quality training and assessment processes, broadly the working culture of the college. All of us are evidence to struggling junior FACEM’s, who going forward may perpetuate a culture of bullying to compensate for the lack of competence due to a poorly designed and badly executed training process, while effecting patient outcomes adversely. Lack of accountability, accountability – AMC requirement.

For the senior doctors who want to help and are offended by the comments, I would like to say, all of us are in well within our right to be offended. It should have never come to this. The demise of “senior” advocacy (DEMT, FACEM’s included), failure of role models, for the cause of emergency medicine and patient care by not standing up to a flawed, opaque system, is understandable, human nature demands subservience, otherwise the world would have been full of Gandhi’s, Mandella’s, Martin Luther Kings and Theresa’s. However the silence is disappointingly deafening. Everyone involved knew that the process was flawed, no one knew what was required of the examination process, there was no feedback, and yet remained mute spectators to the abuse of power, in my humble opinion this is lack integrity – AMC requirement.

Here I would like to state the example of the offshore detention policy and the fact that ACEM stood up to it, which is wonderful. However hypocrisy lies in failing to ensure checks, balances and accountability in ACEM’s own systems that are meant to guarantee quality specialist level care to the community. May I say this reflects lack of leadership – leadership AMC requirement. I am sure the honorable, world leading advocate of human rights who’s delivering a lecture at ACEM foundation this month may not be impressed with this and rightly so, like every concerned public figure or common citizen.

Respect is mutual and not just about language, clever verbiage is not a substitute for an honest confession. Putting our community at risk due to poor quality of training, assessment and supervision is possibly a bigger issue that people trying work out who wrote what on the blog. Denying a problem will definitely not solve it and will only make the problem worse. Professionalism – AMC requirement.

Lets work together to make our training program world class and restore the credibility of “FACEM”.

P.s.

“90% of trainees are really enjoyable and engaged individuals,” he said, “But 10% of trainees actually becomes 90% of the workload for DEMTs. This involves looking after the trainees that are having real difficulty and perhaps should not have been in the training process to begin with.”

The new process sorts applicants into three categories; suitable for training, those who might be suitable after another year or two of experience, and those who might be better off in another speciality.

“If we catch unsuitable candidates early, then they can move on to a career that is actually well suited for them early in their career rather than later on,” he said.

May I add, if “no one knows what’s going on” “there is no guidance or feedback” who are the DEMT’s helping and with what? And how can anyone know who’s suitable for training or not when, the training program is admittedly not standardized and compromised?

Should we really continue this hypocrisy? act as if nothing has happened, go on business as usual ? Or just stop, pause and go back to the drawing table and redesign, before it becomes the NBN equivalent for ACEM. Making policy on the go is never a good idea. I am sure well can agree.

I would like to call on all like-minded individuals who are passionate about patient care and emergency medicine to come together and help get out act in place, I am happy to contribute, time, effort and energy to host a forum for achieving the same.

I have a conflict of interest to declare, One day when I am the consumer of health care, I expect to be treated by the best trained.

Comments are closed.

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