Demonstration of "Tweeting the Meeting"

I had the privilege of writing a paper recently with Dr. Janine Zee-Cheng on Live Tweeting in Medicine: 'Tweeting the Meeting', which came out a few months ago (and allows free open access to all articles through the end of June, 2015).  In it, we highlighted the importance of lifelong learning through the use of Twitter at conferences.  I also encourage a quick read of this other great piece giving suggestions on how to live tweet in conferences.

Dr. Zee-Cheng, a pediatric critical care physician from my institution, is giving a presentation on a social media-related project she did as part of her fellowship, at a conference currently going on this week in Chicago.  The hashtag is #smaccUS (to reflect social media and critical care).  I highly encourage those who are reading this blog now to check out the tweets from this conference.  The discussions, on a variety of topics, are truly epic, and range from general content in the management of critically ill patients, to the emotional side of medicine, to introspective reflection about one’s practice, to frank humor.

While I am not at the conference (we are orienting new incoming interns to begin their clinical duties), I have learned so much from reading tweets from participants.  I encourage all interested in this topic, and literally, medicine in general, to check out the #smaccUS hashtag—you will not regret it!

Social Media in Medicine: Lifelong Learning for All Through Free Open Access

I recently posted about online resources for lifelong learning.  This is a very important topic as emerging technology continues to be a part of medicine.  Just last month, I was privileged to be an author for one article on Live Tweeting in Medicine, within an entire issue of a medical journal focusing on social media.  The guest editor, Dr. Meg Chisolm, has worked with the journal, International Review of Psychiatry, to make the entire issue free open access from now until the end of June 2015.  This is extremely exciting as it makes available to all some wonderful reviews of social media within medicine in a variety of contexts.  I encourage you to take advantage of reviewing these articles, and saving them as resources.  The link to the entire issue of the journal (with free access to all articles full-text through June 2015) is here. 

In addition, a Twitter chat discussing pertinent issues of social media in medicine, under the hashtag #nephJC will take place on June 16, 2015 at 9 pm EST, and again at 8 pm GMT on June 17, 2015 (as a time more conducive for our colleagues in Europe/Africa).  Many of the authors from this issue will be tweeting in during that discussion.

This is a leading example of sharing materials for lifelong learning for all.  Please share via social media to demonstrate the impact that social media can have!

Using Technology for Lifelong Learning in Medicine

I think that in the current age of “everything at one’s fingertips”, in the form of mobile devices like smartphones and tablets, the concept of lifelong learning has never been more important.  How does a physician “keep up”?  What are the skills that are important for physicians to have?  Dr. Vartabedian has written extensively on the subject of the digital literacy that is needed for today’s physicians.  Curating, collating, and how to find what one needs are skills that need to be taught, not only to students and residents, but also to practicing clinicians.

Given the plethora of sources available, I am seeing trainees more and more asking “what should I read/study?”  This is interesting, since there never have been more resources available than in today’s age.  I’d like to give just a few examples of tools that I find incredibly helpful.

[Full disclosure, I have no financial conflicts with any of these tools mentioned.  My spouse is an emergency physician in community practice.]

Browzine.  I use this resource on a mobile tablet through my institutional library subscription.  It allows opportunity to get full text articles from most of the journals with which our library has a subscription.  It is also great to review table of contents quickly, with fast linking to the full text if I want to read more.

NEJM Knowledge+. This resource is a way to review content for internal medicine (and family medicine) through adaptive learning, which is very unique.  I think of it as “smart testing”, whereby one inputs both answers to multiple choice questions, as well as her/his confidence in the answer provided.  Here is a link to an explanation on this type of learning.  I have used my own account to choose questions for residents during education conferences, and the engagement from the residents has been quite impressive.  There is also an opportunity to purchase an account for an entire residency program.

ALiEM: this is a compendium by emergency medicine specialists which is an incredible resource for those interested in this field.  It includes posts on staying healthy, links to apps pertinent to caring for patients in an emergency setting, resources for teaching in emergency medicine, as well as learning emergency medicine.    I especially like the videos describing procedures in the ED setting.  For those interested in improving their educator skills, the MEdiC links are incredibly helpful.

Twitter: there is an incredible community of practice related to medical educators on Twitter.  I learn so much from folks I have met, and also many I have yet to meet in real life.  A Thursday evening, 9 pm EDT Twitter chat on medical education topics is a great opportunity to start learning from others.  For literature on this topic, see these two articles: one on using Twitter as a learning tool, and one on social media for lifelong learning. 

I am curious what other online resources and technology that others are using for their own lifelong learning.  

Enhancing Social Media within Medicine

So Twitter recently announced that it now has a video feature (up to 30 seconds).  See this post.

I wonder how we can use such an opportunity in medicine and medical education,  Will short snippets or "nuggets" of information now be sent via Twitter from one doctor to another?  Interesting to see what will come of this.  The hope would be that health care professionals would use it for dissemination of information that IS allowed in the public space, and not to violate privacy laws.

For those interested in learning more about social media within medicine, here is a nice review from JMIR on the topic, published within the last year.  The enhancement of such services is a great example of how innovation in technology has the potential to improve communication and education.

Randomized Controlled Trials, Social Media and "Intention to Tweet"

I have to hand it to cardiologists: for years they have created the most innovative and fun names for trials that are conducted.  As a generalist, I still remember the DIG trial from way back when, or the RALES trial, sometimes referencing names of trials when discussed medications for common conditions such as heart failure.  As therapy evolves, we get a PARADIGM-HF shift, some might say!

Today, I was sent a tweet about a fascinating trial, the “Intention to Tweet” trial (hats off again to our cardiology colleagues: TNOTY (Trial Name of the Year).  This trial was a randomized trial of social media to see the impact of social media on views of articles within one journal, Circulation.  In the intervention group, they tweeted out links to half of the articles, and a link to the Facebook page.  In the control group, no tweets were sent.  Kudos to Lee Aase for a wonderful review of what was done in the study, and what it might mean for the future. 

Essentially, what the authors found was that there was no difference in clicks between the articles which had tweets sent/Facebook page links, and those which did not.  Some might refer to this as a “negative trial”.  I think that, in medicine, we need to see results of “negative trials” that show something was ineffective or not better than “usual care”, just like we need to see results that demonstrate a positive effect of an intervention.

But here is the clincher for this: I have seen several tweets from physicians and other scientists who are meaningful users of social media who are questioning the results or the design of the trial.  Some might interpret this as a “defeat” for social media.  

Looking on the Altmetrics page for this particular article, however, paints a different picture.  Recall that this article was announced and sent out TODAY (11/19/14) as an early release article.  The Altmetrics description for this article puts it at the 92^nd percentile of all articles within this Circulation journal.  It is in the 94^th percentile for all articles of a similar age.  94^th percentile!  That is pretty awesome!  Compared with other articles of a similar age in this journal Circulation, it ranks 2^nd, in the 85^th percentile.  Again, this article came out TODAY.

So here is the kicker.  This article on social media, based on these Altmetrics data, has “gone viral” on social media (at least compared with other articles from this same journal), and is ranked quite favorably in one metric used to gauge social media impact (that metric being “Altmetrics”).  I think that suggests exactly the opposite of what the conclusion did (meaning that dissemination of THIS ARTICLE via social media made it quite a favorable article), which could be interpreted as "social media does have an impact on readership of journal articles.  See this screenshot from Altmetrics from 10:30 pm EST on 11/19/14.

I applaud the authors for developing such a trial and Circulation for having social media editors in the first place.  Those of us who “believe” in the power of social media to teach, to learn and to advocate appreciate the scientific principles which went into creating this trial.  I do agree with one sentence in the conclusion that “further research is necessary to understand and quantify the ways in which social media can increase the impact of research”.  

This article is a wonderful first step towards understanding these concepts, and provides a meaningful way to understand how to consider the impact.  As a social media editor for a journal myself (JCEHP), I plan to reference this article and use it in descriptions of how social media can impact journals, and ultimately, patient health and outcomes.

Tweeting the (Medical) Meeting

I am currently in the airport on the last leg of a brief trip to present to the Institute of Medicine about using emerging technology in medical education. I am very pleased that the IOM has agreed to use a second screen to showcase a live Twitter feed during the meeting.  I have used this “second screen” option for several presentations over the past few years; it is done as an attempt to demonstrate live the content that is being highlighted: an opportunity for communication and discussion within medical education in a unique format.

I have written about this in the past.  However, this piece from a few days ago cautioned folks who do tweet the meetings.  Dr. Bryan Vartabedian wrote this phenomenal piece on “tweeting the meeting” earlier today.  I concur 100% with his eloquent, succinct statements that really get into “what it is all about” at such meetings.

I hope the demonstration tomorrow goes well.  If interested, please follow the hashtag highlighting this meeting: #IOMgenomics.  My part is “Innovative Models of Education: Using Technology Appropriately in Medical Education” and starts around 9:45 am EST on 8/18/14.  As always, feel free to follow the #meded chat as well.

Scholarship, Emerging Technology and Medical Education

Those who know me know my interest in emerging technology in medicine and medical education continues to flourish.  I am always looking for ways that technology can help drive medical education.  Specifically, social media has the capability of disseminating information to a much greater number of learners than in the past via traditional formats.  One such example is this great video by the AAMC on using wearable technologies in medical education, featuring Dr. Warren Wiechmann.

In discussing this within my academic environment, conversations almost always come back to scholarship, specifically, publishing in peer-reviewed journals.  Articles on the use of social media in medicine are sparse, but are beginning to crop up in mainstream medical journals.  Leaders such as Dr. Terry Kind are really demonstrating the impact via a scholarly approach.

It is with excitement that I read some recent articles (this and this) by some innovators in emergency medicine that can get physicians started using online resources and thinking about peer review with respect to blogs.  Simply put, these articles are phenomenal!  It is exciting to see that journal editors are beginning to see the impact of technology and social media for their readers.  

With this blog, I am excited to announce a new opportunity for me: as social media editor for the Journal of Continuing Education in the Health Professions (@JCEHP).  I thank JCEHP's senior editor, Curt Olson, for his vision to allow me to become involved in growing the journal's reach by utilizing social media, specifically twitter.  In the coming year, we will work on creating and disseminating information via a blog for readers to provide comments on articles of interest, and will push content out to those interested via online social networks.

There are great ways of using social media for the betterment of medicine and medical education.  One such way we have been utilizing at the Indiana University School of Medicine is to tweet our Pediatrics Grand Rounds (follow on Wednesday mornings, 8 am EST, at #iupedsgrrounds), which we've been doing for several years now.  But how do we show (in a peer-reviewed journal) the impact of this activity?  Many specialties have written about tweeting national conferences (including Oncology, Surgery, Nephrology and Urology, to name a few).  

So how can we demonstrate this impact in the JCEHP journal?  By including a presence within social media, we hope to start a conversation on how social media can provide an impact within medical education.  It's a start, but we have to start somewhere.  I'm excited to be a small part of this journey, both at my institution and at JCEHP.

Reflections on #AIMW13 and the APDIM Fall Meeting

I just finished a wonderful two days at the Academic Internal Medicine Week meeting in New Orleans.  This is a meeting bringing together organizations involved in internal medicine education and leadership, including, among others, the Clerkship Directors in Internal Medicine, and the Association of Program Directors in Internal Medicine.  It is this latter group to which I belong, and, as usual, this meeting did not disappoint.  I was not able to attend the entire meeting, but was present for the last two days.  Here are my brief thoughts on this meeting from those sessions I attended.

Direct observation has definitely come front and center as an important component of training.  Not just an an assessment tool OF learning, but rather as assessment FOR learning.  It needs to be the culture that we regularly observe trainees in their direct interaction with patients (akin to playing the piano: my teacher was there right next to me the entire time, giving constant feedback when I was doing something wrong or had held my fingers in the incorrect position!).

I attended a session on a writer’s club to improve scholarly output.  This session really was riveting for those who attended.  Probably the best discussion was on the fact that scholarly output does NOT have to be ONLY the peer-reviewed publication (although that certainly is excellent!).  Rather, we should consider other products which still demonstrate a scholarly approach.  Those products might include writing a policy, disseminating a curriculum, or creating a tool that others can use for evaluation purposes.  A phenomenal example of how to consider this (focusing on the scholarship of education) is this toolbox from the AAMC MedEdPortal on evaluating educators.

I also attended a great session by colleagues from the U of Cincinnati and Nebraska on considering tools that we ALREADY use to report the Next Accreditation System Milestones.  This session created my “A-HA” moment for how educators might look at Milestones and Entrustable Professional Activities.

The next day, I was on the docket with others focusing on innovation in resident ambulatory experiences.  I had the privilege of discussing our residency experience with teaching quality improvement to trainees.  Other leaders discussed “X+Y scheduling”, to help improve resident interest in doing primary care, ways to teach Evidence-Based Medicine in the ambulatory arena, and experiences in residents having a second continuity clinic with primary care physicians (known in their program as “Second Site”).

In the final plenary, on one of my favorite topics, utilizing emerging technology in medical education, four different programs discussed their experiences with what they were able to accomplish.  One was a current fellow who himself created a smartphone app focusing on evidence-based management of patients admitted/observed for chest pain.  The app link is found here (only available on iOS devices).  Another speaker taught us basics of using Podcasting for medical education, and two others demonstrated the use of iPads in medical education and how others might consider using tablets for that purpose.

For anyone interested, the presentations mentioned above, as well as all of the presentations that were loaded up, can be found here.

All in all, it was a phenomenal conference for me to attend.  Lots of great tweeting was done, as the conference encouraged the Twitter hashtag #AIMW13 for connections via this microblogging social network.  If you are interested, please see my tweets from 10/5/13 and 10/6/13, which were mostly dedicated to the content of this conference.

As a last note, I want to thank the incredibly professional staff of AAIM for hosting a phenomenal meeting, and especially the security staff of the Hilton Riverside in New Orleans Hotel for finding my misplaced keys!

Technology in Medical Education

I was given the privilege of presenting the keynote talk at a faculty development session for the Indiana University School of Medicine Department of Emergency Medicine earlier this week.  The theme of the entire day was using technology in education.  The opening speaker, Dr. Bart Besinger, gave a phenomenal talk on “How to give a lecture with or without technology”.  It was one of the most engaging talks I have ever heard, and included practical information and tips for making one’s didactics top notch!  Later in the day, the topic I spoke about was the use of social media to communicate and teach in medicine.  It was a wonderful opportunity to network with colleagues from outside of my own departments, and I found the faculty completely engaged and willing to try something new.

We discussed some of the literature on the use of social media in medicine and medical education, and how educators can leverage social media as a tool to disseminate medical information.  The highlight came at the end, when we taught the faculty how to use Twitter.  The goal was to have 5 new faculty join Twitter.  Many more joined, and the discussion was nothing short of fabulous.  It was clear that the faculty were wholly accepting of taking the plunge to use Twitter in medical education (the hashtag used was #IUEMFacDev).

Today, the learning that took place just two days ago was put into action.  The faculty used a hashtag (#IUEMTalks) for their own lecture series.  Kudos to Dr. Dan Rusyniak, for putting on this great workshop.  I appreciate so much the invitation to share and learn from emergency medicine faculty colleagues, as well as the  willingness of so many to put into practice this new learning tool. 

Here is a link to the workshop handouts.

In an upcoming venue, our institution is privileged to host the 1^st inaugural Mobile Computing in Medical Education conference on May 31, 2013, in Indianapolis.  In this conference, we will showcase several different ways in which medical students, residents, fellows and faculty utilize mobile tablets in medical education.  We look forward to sharing the learning opportunities in this one-of-a-kind conference.

So how are you using emerging technology to further medical education?

Mobile Tablets in Clinical Medicine

I read this piece on perception of professionalism around use of mobile tablets in medicine this morning, and it struck a chord with me.  I am the first to admit that I have had both formal and informal discussions with medical students and residents about looking on smart phones or tablet in the middle of rounds.  I have discussed it in a variety of terms likely related to “this is not professional, and it appears to me as if you are disinterested.”  The traditional thinking is that the learner is bored and/or distracted, and either surfing the internet, checking email, playing a video game or doing some other activity besides listening intently on rounds.

However, this survey article on the use of mobile computing by trainees is quite intriguing.  40% of academic physicians and trainees said they owned a mobile tablet, and 50% of those, or 20% total, use them for clinical medicine at the point of care.  That is a lot, and I bet the number is growing daily.  Many residency programs have begun purchasing mobile tablets for their trainees specifically for the use in the clinical arena, either for the purposes of medical education, or direct patient care activities.  The University of Chicago Department of Medicine residency program even published outcomes on the impact of providing trainees with tablets.

So what should we do about the professionalism issue?  One thing I would suggest is calling out the “elephant in the room”.  Trainees could actually state up front to their faculty instructors that they use their tablets to look up information.  Second, faculty could embrace it, and have, for example, “tablet breaks”, where in the middle of rounds, for 5-10 minutes, everyone could stop, take a break, and look at their tablets for whatever they wanted (be it looking up information, checking email, or whatever they feel is important for themselves personally). [credit for this idea goes to my Executive Associate Dean for Education, Dr. Maryellen Gusic, who suggested it to me].  Third, faculty can lead by example.  Specifically, they could show trainees how to use tablets and collect and disseminate information from the use of mobile tablets at the point of care, without appearing completely engrossed in the tablet itself (provided they know how to do so themselves).  Literally, this would be done as a teaching point just like any other golden nugget of teaching.  We highlighted this example as a workshop at the APDIM Spring conference in April of 2012.

One example from my own personal learning is what I do every week.  When in attendance, I tweet Pediatrics Grand Rounds every Wednesday at 8 am EST, at the hashtag #IUPedsGrRounds.  I wonder what I look like to others in the room as I am typing furiously on the tablet keyboard to keep up with the speaker.  I can honestly say that I am totally listening to the speaker, trying to learn as much as possible, and also trying to get the information out there onto Twitter.  I could probably argue that I am more engaged in learning from the one-hour session than others in the room—but I see how it could appear to others that I am distracted, and doing something less than "scholarly-appearing".

Have you seen instances where trainees appear to have their faces buried in their tablets or smartphones, and how have you handled it?  What can we say to trainees to help them avoid the appearance of being unprofessional, especially when they may be doing the exact opposite: helping the team find information to optimize patient care?

As a way of highlighting the importance of this and other ways to integrate mobile tablets into the medical education arena, we are excited to host the inaugural Mobile Computing in Medical Education conference on Friday May 31, 2013, on the campus of the Indiana University School of Medicine.  Topics like this would be definitely welcome.  The call for proposals is still open—please submit if you are interested in attending, and disseminating your work to others!