Monday, January 23, 2012

Social Media and Stages of Change

I am a physician educator, and have been for over 10 years.  I have been involved in teaching residents (GME, or Graduate Medical Education) for 10 years now, and have recently added to that the opportunity to work and learn in the CME (Continuing Medical Education) world.  Both of these areas carefully study ways to best teach medicine and medical concepts to learners.
One concept important for any physician to learn is something called “Stages of Change”.  One key tenet of this model is that people progress through different stages in the journey to change.  Sometimes, it takes a long time to complete this progression. 
The first stage is Precontemplation, in which one has not yet fully acknowledged that a change for a problem behavior is necessary.  In Contemplation, the second stage, acknowledgement has occurred, but the person is not yet ready for the behavior change.  In the next stage, Preparation, the person is ready for the change.  The next stage, Action, involves changing the behavior.  The Maintenance stage is one in which the behavior remains changed.  Sometimes another stage is Relapse, in which the person reverts back to the undesired behavior.
Two classic examples used to teach this in medical school are quitting smoking, or starting an exercise regimen.  However, one can apply the principles of the Stages of Change Model to other areas. 
Obviously, one very hot topic nowadays is physician involvement in social media.  Many physicians are jumping on the bandwagon.  Others, however, are “holding out” for various reasons (many of which include some reference to lack of time).  Personally, I was actually in this second category until May, 2011. 
In May of 2011, my wife mentioned that I should join Twitter.  That turned out to be the beginning of a new era in how I do what I do.  I joined one weekend, and have never looked back.  Now, I have actually been a heavy user of Twitter during medical conference meetings (apparently, I was the highest volume tweeter at the AAMC meeting in November, 2011, and also came back from the ACEHP meeting this past weekend as a high volume tweeter as well.  I’ve joined a few others (LinkedIn, Google+, Doximity, and others), and have learned so much in the process.
One of my plans is to become involved in the scholarly work around the use of social media by physicians, to ultimately help patients.  I had a great opportunity to meet with others at the ACEHP meeting in Orlando about this topic, and think that it will definitely be lots of fun to study this area.
So what does that mean for me?  I went from the Precontemplative stage to the Action stage relatively quickly, regarding my own personal use of social media.  I use it to learn, to teach, and to advocate (Reference 1).  I personally feel it has made me more efficient, not less.  Plus, it has been a lot of fun, and I have met (virtually, and a few in real life) many new people I would otherwise not have had the opportunity to meet.
So where do you fit in to the Stages of Change Model with regards to using Social Media?  Are you still dead set on not joining Social Media (Precontemplative)?  Have you considered joining social media (Contemplative)?  Are you planning on taking the plunge (Preparation)?  Have you joined (Action), but then gave it up (Relapse)? 

Reference 1.  McGowan B. Technology and Medical Education.  Presented at ACEHP PreConference Workshop on January 21, 2012.  Found at: 
Reference 2. Sherman L. Sitting next to me during Reference 1, saying “Do you realize that you bypassed some stages of change?” on January 21, 2012.


  1. The one thing I would add is that it should NOT be a stigma on someone (doctors included) if they are precontemplative and stay precontemplative. The beauty and power of social media is that it allows people to interface with it in whatever ways they do (or do not) desire. I think everyone should at least take a step into the "Contemplative" zone for a period of time, but if you decide to go back to precontemplative, more power to you.

  2. Couldn't agree more. Just like it takes some patients time to stop smoking, one would theorize that it will take time for some doctors to join the social media "movement".