Ethical implications of digital images for teaching and learning purposes: an integrative review

Figures & data

Figure 1 Flow diagram: literature review.

Table 1 Summary of included studies for the integrative review

Author/s, year (country)	Purpose	Data collection	Methods of analysis	Sample and study population	Reported outcomes
Bhangoo, Maconochie, Batrick, and Henry, 2005 (UK)^Citation20	To identify if EDs have a written policy for the use of clinical photography	Questionnaire	Statistical analysis not reported	N=117 (78% response rate); consultants, specialist registrars, and senior nursing staff	36% of EDs reported having a policy. Of those with a policy, four EDs used images for teaching purposes, and of these four, only two had written policies addressing digital images for teaching and learning; 17 had a specific consent form and three had a written consent in the notes 63% of EDs reported not having a policy with 53 EDs using images for teaching purposes; only 10/53 EDs had written consent documented in the notes and 43/53 had verbal consent
Burns and Belton, 2013 (Australia)^Citation10	To explore the widespread use of medical photography in a tertiary hospital and its ethical and legal implications	Validated questionnaire (two) and interviews containing 13 open-ended questions	Descriptive statistics and literature-generated topics (thematic analysis)	N=167 (22.6% response rate); interviews N=8; doctors and nurses	Education was the main reason for taking photographs; 51.2% took photos for teaching/education; verbal consent was the most frequent mode of consent; and 38.2% disclosed not obtaining consent. 81.2% used hospital cameras, 7.5% personal cameras, and the remainder of participants personal smartphones
Hubbard, Goddard, and Walker, 2009 (UK)^Citation1	To determine the use of digital cameras by the members of the British Association of Dermatologists	Anonymous online survey via direct link	Descriptive statistics	N=339 members of the British Association of Dermatologists (37.6% response rate); 239 consultants, 71 registrars, eight general practitioners, 16 non-consultant career grades, one hospital practitioner, and four research/clinical fellows	63% respondents used a digital camera of which 7.4% did not obtain consent; 34.9% obtained verbal consent and documented in patient’s notes; and 42.3% used a medical illustrator consent form and 15.3% used an alternative consent form. The most common use of a digital image for which consent was obtained was for teaching purposes
Kunde, McMeniman, and Parker, 2013 (Australia)^Citation9	To determine how dermatology trainees are utilizing digital photography in their clinical practice and the procedures followed	Online survey platform SurveyMonkey	Descriptive statistics	N=13 (65% response rate) dermatological registrars	All the respondents reported using their own personal smartphone for taking digital images; seven respondents use digital photography for teaching purposes; 62% of respondents used their digital camera in consultation; only seven respondents routinely disclosed to their patients the identity of the third party with whom their image was to be shared; six respondents inconsistently informed their patient; and verbal consent for photography was common in 92% of cases, with only two respondents claiming that they routinely documented having obtained consent verbally
Taylor, Foster, Dunkin, and Fitzgerald, 2008 (UK)^Citation2	To investigate the prevalence of digital photography among plastic surgeons	Questionnaire was designed using the guidelines set out by the UK Institute of Medical Illustrators; to heighten cohesion, questions were themed grouped and closed ended	Using descriptive statistics; responses were on adjectival scale with an even number of possibilities; and survey mapped to prevent participants responding to unnecessary questions	N=42 plastic surgeons residing at three plastic surgical units in the UK (70% response rate)	25 out of 30 surgeons took photographs for teaching purposes of which 10 always gained consent for the purpose of teaching, 12 usually did, two rarely did, and one never did. Seventeen surgeons stated that the consent was usually obtained verbally; eight usually documented consent in patient’s notes; nine of the 30 usually informed the patient of hiss/her right to withdraw consent; and 30 surgeons out of 42 took photographs using their own cameras

Abbreviation: ED, emergency department.

BhangooPMaconochieIKBatrickNHenryEClinicians taking pictures – a survey of current practice in emergency departments and proposed recommendations of best practiceEmerg Med J2005221176176516244330

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BurnsKBeltonSClinicians and their cameras: policy, ethics and practice in an Australian tertiary hospitalAust Health Rev201337443744123777890

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HubbardVGGoddardDJWalkerSLAn online survey of the use of digital cameras by members of the British Association of DermatologistsClin Exp Dermatol200934449249419175618

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KundeLMcMenimanEParkerMClinical photography in dermatology: ethical and medico-legal considerations in the age of digital and smartphone technologyAustralas J Dermatol201354319219723713892

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TaylorDFosterEDunkinCSFitzgeraldAMA study of the personal use of digital photography within plastic surgeryJ Plast Reconstr Aesthet Surg2008611374017766207

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