Monday, 2 March 2015

Are speech and language therapists too "nice" for robust peer review on the internet?

This is a sensitive post that explores the issues around debates that take place on social media. Whereas with other blogs I have attempted to source third party information, due to the sensitive nature of the story told, parts of this blog will remain anonymous.  Some readers will be aware of specific events I have referred to from Twitter, but as the role of this blog is to explore the themes and principles necessary to learn about professional development through social media, individual names and tweets will not be repeated here.

Social media has burst into the professional arena over the past few years and is increasingly being used to network with colleagues, share information and reflect on practice.  In my last blog "Healthy skepticism in clinical practice" I recommended Twitter as a forum to share critical thinking in order to develop robust practice.   The past few days, however, have been rather heated in the Twittersphere with allegations of cyberbullying and individuals being requested not to use certain professional networking hashtags as a result of their previous tweets.

The twitterstorm originated from one user challenging a speech and language therapist who had hosted a guest post about psychological astrology on a professional blog.  Requests were made to remove this post with the argument that it did not adhere to the principles of evidence based practice.  A lively discussion followed on twitter which extended to discussion around evidence based practice and blogging in general.  Shortly after this, however, the originator found themselves the subject of allegations of cyberbullying from several users of the professional hashtag.  Allegations included using an inappropriate tone in tweets, "obsession with EBP", and fostering negativity on the hashtag.  The originator was asked by these users to stop requesting that fad therapy posts be removed, stop asking for evidence for interventions and to stop using the professional hashtag.  Whilst there may be differences in opinion over the hows and whys of the discussion that had taken place, was it necessary to jump to public allegations of cyberbullying?  And was it appropriate to request another user to stop tweeting and to veto them from a professional network hashtag?

This incident has raised a few issues that as a profession we need to explore. Discussed in more detail below they are: a; the nature of pre peer review publication, b; conduct on social media concerning peer review and c; professional standards in the world of social media.

The nature of pre peer review publication
Before the emergence of social media most professionals communicated through peer reviewed journals or edited professional magazines.  These media give should give the reader confidence that the reports and views of the author have been reviewed and given approval for publication by other professionals in the field. (That assumption has recently been in dispute in one case, as described by Bishop, but largely holds true).  Whilst professional magazines (such as the RCSLT's Bulletin) are not peer reviewed, the editorial process provides some protection to the reader against outlandish or rogue opinions.  Magazines also often give an opportunity for readers to respond to articles through a letters page.

Things on the internet are different.  Individuals may freely publish articles on blogs without any peer review.  Opinions can also be tweeted without checks and balances on twitter and can reach thousands of people very quickly.  This has benefits and disadvantages.  One of the benefits of these forms of media is the democratisation of opinions.  You don't have to be an established figure or authority to have a voice, and anyone can comment on information.  Another benefit is the speed and degree to which information can be shared amongst professionals.  Through tweets and blogs news gets out very quickly and can be disseminated widely.  I believe I am better informed in my area of practice (early language development) than I would be if I were not on Twitter and did not read other professionals' blogs.   Social media also gives an international perspective for things, so as a UK speech and language therapist I am learning from professionals in different countries and different health economies. In her keynote speech to the RCSLT 2014 conference, Caroline Bowen proposed that Twitter was useful for generation and dissemination of news, engaging in discussion, asking and answering questions, inspiring, encouraging and supporting others, participating in professional learning networks, and connecting and collaborating with groups. Disadvantages of social media, however, include the ease in which cod science and quackery can be distributed and the unpleasant interactions that can result from this unregulated environment (both of which I have alluded to above).

Two blogposts with guidance for academics on Twitter and Blogging have been written by Dorothy Bishop.  This guidance may be equally applied to clinical professions, such as speech and language therapy.  Bishop also discusses the role of blogging in post publication peer review here. The value of peer critique on social media extends beyond post publication review of peer reviewed journal articles. I would argue it is not only of huge benefit to our profession but is essential in the presence of pre-peer reviewed publications, such as professional blogs and websites.  It is the post publication review (via comments on a blog, tweets and shares) that takes place within social media that helps the wider community interpret and understand the validity of what is published.  Put simply, if you blog or tweet, you need to be open to critique of what you are saying.  If we seek to stifle or subdue opinion, that is to the detriment of our profession.

Conduct on social media concerning peer review:
Given the unregulated environment of social media, and its relative youth in terms of a medium for human communication it is not surprising that things go wrong.  There are many examples in Twitter of where things have got nasty and personal.  Trolling on Twitter happens and we need to be aware of it. There are steps you can take to protect yourself from this, including blocking and reporting offensive tweeters.  The extreme reaction to this is not to be on Twitter, or not to tweet what you really think.  Whilst I always advocate 'thinking before tweeting' and not being offensive or personal, it would be such a shame if our desire to always be 'nice' or 'positive' resulted in a muting of the debate.   Our profession could consider a code of conduct when communicating with others on Twitter.  There are several questions that such a code might address.  First, what is the right way to critically appraise someone else's work?  How might someone whistle blow if professional misconduct is observed on social media?  How should we decide what is the appropriate use of a hashtag?  I would argue that it would not be appropriate to dictate who can or cannot use hashtags as that goes against the democratic nature of social media.  It seems reasonable, however, to have explicit agreed rules over how a hashtag may be used.  #WeSpeechies, for example has a rule that the hashtag is not used for promotion or advertising of commercial goods and services.

Professional standards in the world of social media:
Another issue that this incident raised is the extent to which we are free to publish or post what we like on a professional blog or website.  A clinical standard which all speech and language therapy professional bodies now expect, for example, is adherence to the principles of evidence based practice.  Our clinical practice falls along a continuum regarding levels of underpinning evidence and I would doubt anyone would advocate too strict a policy regarding what level of evidence is required for services.  It could be argued, however, that it is not appropriate for our profession to promote services that would be considered 'rogue' or 'outlandish', however, or services where there has been clear evidence of non-effectiveness.  Given that many speech and language therapy professionals now use the internet to promote services, I suggest that our profession would benefit from professional standards on blogging and other publication on the internet.

Update 6th March:
Thank you to those of you who responded to a request for information regarding current guidelines. In the UK the RCSLT does not have its own standards, but refers all enquiries to the HCPC which has guidelines on social media here. Speech Pathology Australia have guidelines here and please see Caroline Bowen's comment below for guidance on use of the #WeSpeechies hashtag. If you are aware of any other professional bodies across the world with guidelines or standards for publishing on the internet, please do get in touch with me and I'll update this blogpost.

Conclusion - are we too nice?
The internet is the 'wild west' of our professional practice.  Currently unregulated and with no code of conduct it appears that anything goes.  This can be refreshing and liberating but it also has its consequences.  While we do develop our practice in this arena, however, I challenge the reader to consider the priorities. When working towards a better, more clinically robust service for the benefit of our clients (who I would hope should always be the priority), let's not close down discussions for fear of not being 'nice' enough.  We need to be robust and stand up to critique, especially those of us who publish on the internet.  Try to be nice on the internet, but not too nice not to keep the debate open for the benefit of everyone.

3rd March 2015 PS: Further to my request for information on guidelines from different professional bodies I have received comments from readers with information.  I am waiting to hear from others, after which I will update this blogpost.  In the meantime please do read the comments below where you will find more information on professional guidelines for social media and internet use.