2014, 36: 547–549
eMEDICAL TEACHER
Panoptic, synoptic, and omnoptic surveillance
RACHEL H. ELLAWAY
Northern Ontario School of Medicine, Canada
Introduction
We are generating more and more data through our digital
devices and services, both educational and otherwise. These
data are automatically logged in our device and service
providers’ databases and they are increasingly being analyzed
and mined to yield information on what we have done, are
doing, and are likely to do. When drawn from a single system
(or from sources intended for this purpose), this parsing of
user datasets is called ‘analytics’, and (although still a form of
analytics) when extracted from multiple large sources that
were not necessarily intended for this purpose this has come to
be known as ‘big data’ (Ellaway et al. 2014). Access to these
analytical tools and databases can confer significant power
over the individuals whose data are stored in them.
The disclosures from Edward Snowden and others over the
extent of government surveillance of our digital lives have,
along with the inexorable rise in identity theft and cybercrime,
thrown light on the ways we are or can be tracked, profiled,
and targeted based on our digital lives. Although the
possibilities and perils of educational technologies used for
panoptic purposes have previously been considered else-
where (Land & Bayne 2005), more recent disclosures around
surveillance using erstwhile private digital data warrant
another review of this topic in medical education. This essay
explores emerging issues in medical education at a time when
everything we do online has the potential of being observed
and used by others.
Capturing data
We can start with a simple truism: only those activities that
involve interactions with digital tools generate data. The
corollary of this is that all digital acts are mediated and most
are logged or tracked. Where once we had maybe just a single
computer, it is now common to have a work computer, one or
more home computers, a smart phone, a tablet, and so on. All
these can capture data about what we do with them.
Although mostly unavailable to the average medical
teacher, device metadata (such as wifi pings, websites
accessed, and telephone numbers called) are nevertheless
being logged by network providers. Logs of our use of
software on our devices tend to be more accessible to
teachers, particularly if it is software connected to a medical
Correspondence: Dr Rachel Ellaway, Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, ON P3E 2C6, Canada. Tel: +1 705 662
7196. E-mail: rellaway@nosm.ca
ISSN 0142-159X print/ISSN 1466-187X online/14/60547–3 ß 2014 Informa UK Ltd.
DOI: 10.3109/0142159X.2014.914680
school system, such as a portfolio, evaluation, or clinical
logging system. Some social media data can also be tracked,
such as an individual’s activity on Twitter, and clinicians’ use of
electronic health records and order entry systems can also be
tracked and logged.
The environments that you move through can also track us.
For instance, we have seen a proliferation of room cameras
and closed-circuit television (CCTV), web cams, store loyalty
cards, swipe entry keys, all of which can record or log aspects
of our behavior. The development of Google Glass and other
wearable tracking technologies presents new challenges
regarding surveillance and privacy, as do the camera carrying
radio controlled drone helicopters that you can now buy at a
hobby store for a few hundred dollars.
Accessing data
Who, if anyone, is making use of these data? The recent
disclosures that governments regularly access and analyze our
device metadata, principally it would seem for security
purposes, has been a revelation for many. Rather less
controversially, teachers can usually access the analytic data
from the school systems their students use, and software
manufacturers receive all sorts of data about how their
products are used. Setting aside digital paranoia, it would be
unethical to collect data without using it, a constant challenge
with evaluation data and quality assurance cycles. How much
of our logged data are subsequently used remains unclear. We
can, however, explore three key questions: who has access to
the data, what uses are made of them, and how aware are the
individuals concerned of this surveillance?
In exploring these questions, let us consider a relatively
benign situation; an elective on research methods. Students
post materials and thoughts on a learning management system
(LMS), contribute to a knowledgebase wiki, and submit and
view online course evaluations. The wiki allows any user to
contribute, to see who has done what, and to roll back edits.
The wiki has only the one role; ‘contributor’. The LMS, in
contrast, assigns different roles. The teacher’s role allows them
to track every interaction their learners have with the system,
the learners’ role allows them to see relatively little other than
when their peers have made a contribution. The teacher’s line
manager can also use the LMS to see how often she has
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interacted with her learners. The course evaluation tool allows
the learners to anonymously post their evaluations of their
experiences and to see all the other student evaluations of the
course and its teachers over time.
These three tools illustrate three kinds of surveillance:
panoptic, synoptic, and omnoptic:
 Panopticism, a concept developed by utilitarian philoso-
pher Jeremy Bentham (whose preserved body still sits in a
box at University College London) and extended by
Foucault (1975), refers to a model of surveillance where
the few observe the many without themselves being
observed. The LMS in the scenario is panoptic in that the
teacher can observe her learners without them being
aware of being observed, and the teacher’s manager
can in turn observe the teacher’s work without her being
aware of this scrutiny.
 Synopticism in contrast refers to the many observing
the few (Mathieson 1997), reflected for instance in the
way popular media follow celebrities and publish the
details of their lives for mass consumption. The evaluation
tool in the elective scenario is synoptic as it allows the
learners to observe how their teacher is and has been
rated without the teacher being aware of any specific
scrutiny or their specific evaluators’ identities.
 Omnopticism refers to the many observing the many
(Jensen 2007). The wiki is omnoptic in that all contribu-
tors can see what all other contributors have done without
the privilege of scrutiny given to some participants over
others.
Using data
Tracking data are often used for formative and summative
assessment purposes. For instance, the LMS in our example
may help a teacher to spot a potentially failing student and
help them to stay ‘on course’. The LMS may also provide data
on students’ performance and completion of summative
measures such as scores on quizzes, whether assignments
were submitted on time, and so on. But what is to stop tracking
and surveillance data from being used for less positive
purposes?
Medical education has a significant dimension of socializa-
tion to the profession of medicine and as such it arguably
seeks to normalize students to a greater extent than other
disciplines. Is there a boundary in medical education between
surveillance for formative and summative assessment purposes
and surveillance for the sake of professional or social
conformity? Clearly the panoptic overtones of the LMS raise
complex questions regarding the ethical basis for their
surveilling capabilities and there is little in these technologies
to help us to address them. What about other kinds of
surveillance architectures?
The synoptic evaluation system should, at least in principle,
lead to greater accountability and transparency of the teaching
practices the learners are exposed to, but to what extent this is
educationally useful is unclear. Although one might hope that
this would encourage learners to be more reflective and
deliberate in their learning, it should be noted that this kind of
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synopticism is rare in medical education as the confidentiality
of evaluations about individual teachers is typically our
primary concern. There is perhaps a ‘medium as message’
aspect to this as physician and lecturer rating sites (such as
www.ratemymd.ca or www.ratemyprofessors.com) are clearly
synoptic in nature.
The omnoptic wiki tracking data could be used for
assessment purposes as well as supporting a high level of
transparency regarding who did what. Despite there being
little or nothing in the software that creates asymmetries of
power or authority, its tracking data may also have rather less
utility than the panoptic tools in the LMS.
Consent
Although the students in the scenario may not be aware of
specific acts of surveillance, they should be aware at some
level that their online activities can be observed by others.
However, quite what can be observed and how those
observations will be used may be less clear. Learners’ consent
to be surveilled and to have data about them used for
formative and summative purposes is implied by their willing
participation in programs of medical education. It is rare it
would seem for the extent of this surveillance to be declared
by teachers or explicitly consented to by learners, although it
may be covered at matriculation or in student codes of
conduct.
Adult learners should ideally be partners in learning rather
than adversaries, suggesting that all forms of surveillance
should be openly declared and discussed. However, there is
also an argument to be made that too much detail in the hands
of learners about the way that they are surveilled and judged
will lead them to game their learning – to deliberately behave
in ways that makes their data look good without necessarily
having fully engaged with the task in hand. Yet again we are
faced with a complex question; how much surveillance is or
should be disclosed to the learner and is their consent sought
or even required?
Discussion
I have considered three kinds of surveillance for educational
purposes: panoptic, synoptic, and omnoptic. Panoptic tech-
nologies in medical education reflect the broader power
asymmetries in teacher–student roles, at least as they are
currently configured. Certainly the tools and systems selected
by educational institutions tend to be somewhat panoptic in
nature. Synoptic systems are by comparison relatively rare in
medical education and do not currently play a significant role
in the practice of teaching and learning. As an aside, it is
notable that the system of publishing academic papers is
synoptic in that the work of a few may be anonymously seen
and judged by the many. This would seem to suggest that
medical education research is rather more synoptic than
its practice.
Omnoptic systems would seem to be the most symmetrical
in terms of power and scrutiny, but this does not necessarily
make them more useful, at least when used in medical

education settings with a significant political dimension (which
is of course all of them). Omnoptic technologies might be
better aligned with more open and collegial educational
philosophies but we may need to change our medical
education practices and cultures to realize the full benefits of
using such systems. For now, the dominant model of surveil-
lance in medical education (panoptic) would seem to follow
the sociopolitical norms of the institutions that use them.
Conclusion
It was not very long ago that most of our actions were
ephemeral, rarely recorded, sometimes observed by others or
tracked in paperwork, but mostly not. Being largely free of
observation, we were able to do whatever it is we did with
little consequence as to how we did it. Of course, this also
meant that we knew relatively little about what everyone else
was doing. In this surveillance age, much more is known about
what we do and we have the ability to know much more about
what others do. Whether or not we seek it out, the tools we
use lead us to engage in acts of surveillance, as observer or
observed, or both.
Although we often consider the explicit and deliberate use
of technology in assessment (Amin et al. 2011), the implicit use
of technologies for surveillance-enabled assessment is rather
less well articulated or addressed in current assessment
practices. We should, therefore, be more aware and critical
of the forms of surveillance that we encounter as teachers and
learners. We should also seek to select tools and technologies
that align with and support our ethical stance on surveillance
in medical education.
We need to be more critical of the societal trends that
rationalize the use of surveillance technologies in medical
education. Onora O’Neill (2013), writing about the UK school
system observed that: ‘‘during the last 25 years accountability
has been widely seen as a successor to trust, and is now
deeply entrenched in nearly all aspects of educational and
professional life’’. This raises a number of questions. To what
extent is our use of panoptic, synoptic, and omnoptic
Educational surveillance
surveillance and tracking tools a reflection of this wider drive
for increased accountability in medical education? To what
extent does this growing use of surveillance mark a commen-
surate decline in trust across medical education? Is the
optimum endpoint an omnoptic model of medical education
surveillance where everyone can observe everyone else?
I hope the medical education community’s response to these
issues will be well considered. After all, you never know who
will be watching.
Note on contributor
RACHEL H. ELLAWAY, Ph.D., is Assistant Dean Curriculum and Planning
and an Associate Professor at the Northern Ontario School of Medicine,
Canada.
Declaration of interest: The author reports no conflicts of
interest. The author alone is responsible for the content and
writing of the article.
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