Medical students’ sharing of patients’ images raises concerns over consent

Authors: Matthew Limb 

Publication date:  27 Apr 2015

UK medical students have taken rapidly to sharing medical images by smartphone to aid their learning, raising concerns as to whether appropriate patient consent safeguards are in place.

Around 15% of the UK’s 41 000 students have now signed up to use Figure1, a free image sharing app that launched in Europe last year and was dubbed the “Instagram for doctors.” Its creator, Joshua Landy, who is an intensive care doctor working in Toronto, revealed the figure when he spoke at the Royal Society of Medicine’s medical innovations summit on 18 April.

Landy said that UK students were seizing the opportunity to collaborate with colleagues, uploading and discussing contributions that made up an “almanac” of millions of medical images. “Seeing more cases just brings you more opportunity to gain knowledge,” he said.

The Figure1 app is free for anyone to download, although only “verified” healthcare professionals can upload photos or comment on them.

Vikas Shah, a consultant radiologist at University Hospitals of Leicester NHS Trust, told BMJ Careers that he had recently begun uploading x ray images and series of scans on his smartphone and tablet computer for teaching purposes and to learn from others’ postings. “We’ve got a generation of medical students right now who have grown up on social media and apps and digital learning, and I think this fits neatly into how they approach their learning and how they approach education,” he said.

Shah said that such apps allowed teaching to cross geographical and professional boundaries. “You can teach anyone from a medical student to a junior doctor to a doctor in another specialty, a radiographer, nurse or physiotherapist, so the audience you can reach is much greater,” he said.

Jaime Bolzern, a second year undergraduate medical student at the Hull York Medical School, said that she had searched for specific images of electrocardiograms (ECGs), chest x ray pictures, and shingles rashes. “Seeing those images helps me to put classroom based learning into more of a clinical context, and being able to ask questions of the people who upload and view the images and receive almost instant replies is really helpful,” she said.

Bolzern said that whereas images that appeared in traditional textbooks and lectures were often chosen because they were “classical presentations” of a pathology, those she had seen uploaded were more likely to be non-classical “but still true to life.”

“It definitely can be good for medical education, but there are some limitations,” she said. “Often, the pictures are posted because they are extreme or unusual examples of disease and trauma, which [to students] can paint a misleading picture of what clinical practice is like, even if it is interesting, and might not be the most helpful thing for learning.”

Questions have been raised about whether the app’s features and terms of use were adequate to protect patients from being identified, ensure that consent had been obtained, and verify users’ credentials.

Bolzern said, “In terms of ethics, I do sometimes wonder if the images have been shared with informed consent of how they will be used.” She said that she had seen an article on one website that had collected photos from Figure1 and seemed to be aimed at “generating viral content by provoking a reaction of disgust.”

Landy told BMJ Careers, “We moderate the images to make sure the content is educational. We don’t want people posting things that are simply striking and sensationalistic.” He said that safeguards were robust and that his company took privacy and consent concerns seriously.

Bolzern said, “Apps have been part of medical education for longer than I have been. I’ve seen my peers use apps which create layered anatomical models for learning, apps with user generated flashcards for revision, and apps from NICE [the National Institute for Health and Care Excellence]. I’ve never known any different.”

Matthew Limb BMJ Careers

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