Learning Theory and Social Media

I read this really interesting piece on learning theory for medical educators interested in the use of social media.  The authors hint that it is really important for educators to consider an understanding of learning theory when integrating social media into the learning process.  I agree wholeheartedly for many reasons.  

First, after having given a recent grand rounds (to two separate audiences) on the topic of learning theory in medical education and how technology can help, I feel that it is very important to reflect on these theories for a better understanding of why learners use (or don't use) social media and other emerging technology.  Communities of practice (CoPs) are a great way to bring groups of people together around a common theme, and virtual/electronic CoPs are catching on in medicine and medical education.

Second, it is important, as the authors mention, to consider connectivism and constructivism as key theories behind why some learn with social media (and may prefer to learn via such tools).  Using constructivism, learners should be reflective, and the teacher needs to adopt a facilitative approach (instead of being an "expert").

For the educators out there who are integrating social media into your learning methods, which theory or theories reflect why you use social media or how your learners use social media?

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!

Lifelong Learning in Medicine

Physicians and other health care providers are incredibly busy.  The administrative burdens have never been greater, they must learn to “keep up” in their respective area of practice, and caring for patients is a complex set of skills that takes time to achieve proficiency.  Recently, there has been a flurry of conversation in medical education about lifelong learning, including this piece on the interplay of social media and lifelong learning.  Most would agree that lifelong learning (whether self-directed or otherwise) is an important skill.  In fact, we teach this early on in medical school, and continue to stress the importance of lifelong learning during residency training and again in practice.

This post by Dr. John Mandrola on the NEJM Knowledge+ blog really hits home with respect to lifelong learning for practicing clinicians.  I really appreciate the last point about finding one’s own strategy for lifelong learning.  I struggle with optimal formats for “teaching” people to have a strategy.  Some excel at this skill, and others really need to work at it.  I think that maybe modeling it to trainees could have an effect (“Someday, I want to be like Dr. X; she is always striving to learn, even after 20 years in practice”). 

I do believe that given the rate of change in medicine, it is paramount that physicians consider the important of lifelong learning.  After all, our patients will ultimately benefit from our efforts to be lifelong learners and to stay current in our practice of medicine.

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.

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.

Burnout and Resiliency in Medicine

I have not blogged in a while; there are many reasons for this, including many things going on in my life as well as with my work as a medical educator and administrator.  The weather here in the Midwest has also been challenging this winter (and another storm headed this way over the next 24 hours) which likely has contributed to my lack of blogging.

Nevertheless, I really enjoy what I do and find meaning in my work.  In fact, a timely discussion with residents during a teaching clinic highlighting this really hit home.  We were talking about burnout and ways to combat it.  The practice of medicine is hard: helping improve the health of our patients is a privilege which brings great responsibility.  This can, however, impact physicians’ own lives in various ways.

Social media itself (in the form of blogging) can be a great tool to ease burnout in medicine.  See this recent blog on this very topic. 

Can burnout be prevented?  What about resiliency in medicine?  Does one's resiliency lessen the potential impact of burnout?  Our institution is proud to host the FIRM (Finding Inspiration and Resilience in Medicine) conference on April 25, 2014.  This conference is being organized by medical students, which really demonstrates how our future generation is paving the way for the necessary changes to the way medicine can and will be practiced.  At that conference, one of our own faculty who wrote a recent post on this topic will be featured. 

So what steps do you take to prevent burnout?  How can you develop the resilience necessary to stay on top of your game and be the best you can be for patients and for yourself/your family?  Some have described interventions during training that impact burnout.  These curricular efforts should be applauded, and are one step towards an improved culture in medicine that helps everyone: patients and health care professionals alike. 

Advocacy in Academic Medicine

Today’s blog covers advocacy from a variety of angles, and reflects my thoughts over what I learned from the #AAMC13 meeting over the last 24 hours.

Advocacy within Social Media

The University of Utah is taking a huge presence at this meeting with its Innovations theme.  At a booth set up in the exhibit hall, they were interviewing folks coming through to provide brief reflections.  I was able to spend a few moments reflecting on what the impact that social media can have on medicine and medical education.  What a timely opportunity to focus on what so many great folks have done parlaying the importance of vaccines for communities, as well as providing truthful, succinct messages to society.  See the audio interview here.

Advocacy within Education

Daphne Koller, who started Coursera, spoke to the participants on the power of what MOOCs (Massive Online Open Courses) can do, not just for the schools or professors who host them, but for society as well.  I was moved by the stories from student learners from sub-saharan Africa and others who became more educated from their use of Coursera.  The potential ramifications of the betterment of the entire planet: wow!

Advocacy within Continuing Education

I attended a workshop on CME in which Don Moore described a tool that integrates the IHI Model for Improvement with PI CME (Performance Improvement CME) to help clinicians better understand the pieces needed to make improvement science and lifelong learning relevant to their day-to-day practice.  Some in the community have questioned how Maintenance of Certification actually “helps” them provide better care for their patients.  This session helped clarify the potential benefits of the Maintenance of Certification program.  We also heard from Mary Turco and George Blike about a concept at Dartmouth called “Value Grand Rounds”, which itself showcases improvements in the health system, but also itself has the opportunity for members of a team to see the fruits of their labor, and also drives them to want to get better.

Advocacy for Research

At the Town Hall meeting, Dr. Darrell Kirch answered questions from the audience about a variety of topics.  One comment hit home: the public is “scientifically illiterate”.  A new initiative by the AAMC entitled “Research Means Hope” focuses on how the public can better understand why research funding is so desparately needed, because the end product of research should be improved patient livelihood. 

Advocacy for Graduate Medical Education

Also at the Town Hall meeting, a question was raised about the “rate limiting step” in producing new physicians in the United States—namely, the shortage of residency positions for graduates of medical schools, who themselves have increased enrollment by 25-30% over the past few years.  Atul Grover discussed bills in Congress that aim to address the “GME crisis”: HR 1180, HR 1201, and Senate 577.  We hope that these campaigns can be successful in providing the resources for the physicians of the future, hoping to achieve the ultimate goal of improved patient outcomes in our communities.

Advocacy for Me

I was honored to have met Dr. Lewis First as well, the editor of the journal Pediatrics, and a giant in the world of pediatrics.  His own career embodies the best of academic medicine, and the best of how physicians can make a difference.

A hearty thanks go out to the AAMC on a fantastic meeting, with so many opportunities for reflection, for networking, and for the opportunity to improve the education of future physicians and leaders in health care.

Advocacy and Education in Social Media for Medical Students

I had a great discussion today as part of a social media faculty learning community (FLC) at my institution and thought it should be shared.  

As a group, we decided that what we would create is an elective for 4^th year medical students on using social media in medicine and medical education.  We are still finalizing the learning objectives, content and other components of what we want the students to learn.  We are aware that students are very savvy when it comes to social media, but know that there is more for them (and others, including us) to learn.  Including a section on professionalism is an obvious must.  In addition, we plan to have a reflection component where students must contribute their reflections in writing.

We had a phenomenal discussion today about including a section on advocacy.  We came to the conclusion that medical students should learn advocacy within the realm of social media.  An absolutely phenomenal example is what Dr.Bryan Vartabadian has accomplished with his blog and Twitter feed, which ultimately made its way to a post on the Forbes website.  This clearly demonstrates the impact that implementing one’s voice through social media channels can have.

What are your thoughts on medical education focusing on advocacy within social media?  In addition, we would love your opinions on what else we should include in this elective for students.  I look forward to any ideas.  Crowdsourcing at its best!

Promotion and Tenure: Peer Review

In the world of academic medicine, Promotion and Tenure (P&T) refers to the process where someone “applies” to rise up the ranks from Lecturer, to Assistant, to Associate, and ultimately, to “Full” Professor.  There are set criteria for this process set forth by academic institutions.  I am impressed at how the P&T process at my institution is disseminated out to faculty: complete transparency in what the expectations are.

I recently attended a session for faculty to teach us about this process.  I have been to these before, but I learn something new every time I attend these.  It allows me to understand what I need to be doing within a timeline, what data I need to collect, and how I should go about crafting my “personal statement” (akin to the same personal statement one writes for residency applications).

While hearing about the criteria at a faculty development session on P&T, I learned about different ways to apply scholarship.  I am pleased that my institution uses the word “scholarship” instead of “research”, because scholarship is more broadly defined and does not restrict it to only publishing papers in traditional medical or scientific journals (although those are still the “holy grail” of scholarship).

Given my interest in social media, and blogging, I asked a simple question: “Would describing my blog and my foray into social media through Twitter be considered scholarship?”  After all, my blog is really about Medical Education in general (it is even in the title!).  It was a simple question, as at the time, other examples of scholarship besides publications in mainstream journals were being described.  The answer came in the form of a question: “Is your blog peer reviewed?”

Apparently, having something be “peer reviewed” is a critical step to making it “count” as scholarship (in the eyes of P&T, at least).  Another step is “retrievable”.  Whew!  That one is easily attainable—but the peer reviewed part—I’m not so sure.

It got me thinking.  How can we “peer review” content disseminated via social media, with respect to medicine or medical education?  A great blog here (from earlier today!) describes a future direction of medical education, called “FOAM”.  In it, the author describes the lack of peer review, but also calls into question the “traditional peer review process”.  What I love is a reference to an article titled “Peer review: a flawed process at the heart of science and journals”, which, undoubtedly and ironically, required peer review, to get into the journal in the first place.  Another article describing a survey to chairs related to E-learning as educational scholarship concludes that chairs feel that e-learning is valuable as scholarship. 

So here is the question to ponder: how can those who blog or use other social media tools within medicine or medical education achieve the “peer review” criterion for P&T?  Or should we call into question that criterion, as demonstrated in the article?  Given the explosion of social media (including blogging) in today’s society, should we push to abandon or adapt the “it needs to be peer reviewed” component necessary for scholarship within academic P&T committees?

At this time, I am still crafting my own opinion on this, but figured “Why not crowd source the question and see what others think?”  In reality, that is a version of a “peer review process” in and of itself.  Please feel free to weigh in on this topic; I would love to know your opinion.

Faculty Learning in Social Media

It has been a great last week for me.  I have successfully returned from vacation and have come out of “email jail” relatively unscathed.  I begin a short two-week stint on the inpatient medicine service in a few weeks, and am using this week to get caught up on some important activities soon to come.

First, I am excited to be giving a Grand Rounds presentation at Columbus Regional Hospital in Columbus, IN, in a few days on social media in medicine and medical education.  It has provided me with an opportunity to reflect on all of the information I have collected on the topic over the past year or so.  We will be live tweeting the event at the hashtag #CRHGrandRounds, at 12 noon EST on 8/22/12, and I look forward to the discussions both in person and online from that.

Second, I am pleased to report that we are rolling out a Faculty Learning Community (FLC) in Social Media for IUSM faculty members.  I had the privilege of belonging to a similar FLC in the use of iPads in medical education for the past two years, and it was widely successful.  With this new project in Social Media just starting, the hope is to learn from others, and move forward scholarship with regards to using social media within medicine and medical education.  We are starting it off with a presentation on how to use Twitter in medicine, followed by applications from faculty members who want to join this FLC, starting the actual group out in October.  I am extremely honored to be leading this FLC, and hope that we can determine some real areas for research around social media and follow through on that research in the coming year.  For example, how do we best teach students and trainees about using social media without compromising professionalism?  How can physician use of social media impact direct patient care in a positive manner?

For my fellow faculty at the IUSM: please send in an application if you are interested in how social media impacts your teaching and learning!  I am curious for those faculty out there at other institutions: have you done a similar thing to these learning communities, and what were your successes and failures?  What worked well and what didn’t work so well?  Please comment so others may learn from what you have accomplished.

A Medical Educator Joins Social Media: One Year Later

I just realized that yesterday was my one-year “anniversary” for joining Twitter.  Wow, what a ride it has been.  I have learned so much in this short year.  Here are a few take-home points:

1.      If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are.

2.      Despite #1, there are late adopters who feel that social media is a “waste of time” for physicians.  That is ok.  Forcing them to “do social networking” will not be fruitful.

3.      Social media is a fantastic way to meet other like-minded individuals who have similar interests.  I never would have met a great group of people (some in real life) had I not joined social media.

4.      Patients crave information about their health.  If they want it via social networking routes, we should offer it to them.

5.      There is a lot of mis-information floating around on the internet.  It is a duty of physicians to combat this and provide correct information.  I fail to understand why physicians don’t embrace this more: it is advocacy in the truest sense!

6.      If you decide to join social media, start slow, but start.  It will take a while, like riding a bike is not learned in 15 minutes.

7.      Do not let social media take over your life.  The important things (family, friends, etc.) are still the important things, so don’t lose the priorities.

8.      Push the envelope.  It is time for curricula in social media within medical education to be formally written, and also to be disseminated.  Policies or guidelines are one thing, but curricula are another.

9.      There are many “tools” to make it easier to integrate social media into “what you do”.  Pick one or two, and use them.  It will make the process less overwhelming.

10.   Have fun!  There is some great learning, and in addition there are some fun people out there, and I am a better person for having met them virtually.

Disseminating the Message

I have had a blast the past few weeks.  I enjoyed a great vacation with my family.  I was privileged to give a Grand Rounds presentation on how doctors can use social media responsibly to improve education and health in general.  What a great opportunity, capped off by several across the country watching the live stream and others live tweeting specific points from the presentation.

Today, a segment on physicians using social media is airing on the radio show Sound Medicine.  I have to say that doing this segment was simply a phenomenal time, and an honor to work with the incredible people from Sound Medicine.  Nora Hiatt, Barbara Lewis, and of course, Dr. Kathy Miller, are complete professionals, who left me wanting to come back as soon as possible to do another show.  The radio show that is Sound Medicine is an example of what is good in medicine, and how we can educate not only other health care professionals but also patients and families.  Click here for more information about Sound Medicine.

So what’s the point of this post?  Disseminate the message.  Make it simple.  Social media can really help medicine and ultimately, patient care.  Doctors should not blindly jump in without a plan, but should definitely consider joining in social media to deliver information, ideally for the betterment of patients.  It is an opportunity to provide factual content to a place where many of the patients currently exist: on the internet, looking up health information.  We have an obligation to our patients to educate them how they want to be educated: let’s make good on that obligation.