Best Practices for Social Media Use in Medical Education

This is a video presentation and summary by one of the best medical bloggers, Mike Cadogan of Life in the Fast Lane:



The Cycle Of Social Media In Medical Education he mentions is based in part on my concept of TIC, Two Interlocking Cycles for Physician and Patient Education.

Dr. Cadogan asked me for feedback on a few questions that he used to prepare the presentations a few weeks ago. The answers are listed below:

1) What are your TOP 3 TIPS for the intrepid doctors starting out on their social media crusade?

1. Post 3 times a week. Schedule posts in advance. In reality, 95% of medical bloggers probably quit within one year.

2. Use your blog to collect interesting ideas and share/comment on health news.

3. Write some original content, if you can, but if you don't have time, that's OK. You have a more important job as a physician in real world.

2) What are your TOP 3 TIPS for WHAT NOT TO DO on this crusade?

1. Don't disclose patient information.

2. Don't offend people.

3. Don't be unprofessional. If you use your real name, it's better to let your employer know about your social media activities. It's OK to start an anonymous blog/Twitter account to test the waters.

3) What are the top 3 benefits YOU see for the role of social media in medicine?

1. Provide expert info on health news and diseases. You, as a doctor, are the one who actually knows what he is talking about - if you stick to your area of expertise.

2. Collaborate with like-minded people.

3. Gather feedback (including critical feedback) for your ideas.

4. Grow your practice by providing high-quality actionable info to patients.

4) What (in your opinion) are the MOST USEFUL 'platforms/apps' in the social media revolution (e.g. Twitter, G+, Slideshare, Facebook, etc.)?

1. Start a blog.

2. Get useful feeds in Google Reader.

3. Share ideas and communicate on Twitter and Facebook.

Speaking from personal experience, I've started more than 30 blogs and still keep around about 7. It's important to find a purpose for your blog and other social media activities. If you don't enjoy it, you will stop eventually. Set limits and respect other priorities. Your family and your patients come first, blogs and social media are a distant second - if you spend most of your time in clinical medicine, of course. Stay away from trolls and online personas looking to start a fight. Ask for help when you need it.

References:

The Social Media Conversation
Social Media In Medical Education

Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
Social media in medical education - Grand Rounds presentation by IUH Med/Peds residency program director http://goo.gl/Zw3lK

Scabies - NHS patient education video

From the NHS Choices YouTube channel: Scabies is a contagious skin infection which itches intensely. A GP talks about the causes, symptoms and treatment.

From the memorable medical textbooks of the past: Medical textbooks were not always as dreary and as bland as they are now, according to BMJ.

Some examples of lively, first person didactic tone come from J L Burton’s Essentials of Dermatology: "The simultaneous occurrence of scabies in a doctor and a nurse may mean that they have shared nothing more exciting than a patient with Norwegian scabies."

References:

Memorable medical textbooks of the past

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Solving the puzzle of the periodic table - TED Education video

Solving the puzzle of the periodic table - TED Education video. View the full lesson here: http://ed.ted.com/lessons/solving-the-puzzle-of-the-periodic-table-eric-rosado

What is HDL? Videos for patient education by Cleveland Clinic

Watch and learn how high-density lipoprotein (HDL) cholesterol can protect the body from heart disease in this whiteboard session lead by Cleveland Clinic Cardiologist Michael Rocco, MD.



Here are more videos from the same series:

What is LDL? - YouTube http://bit.ly/18cuEay

What is a lipid profile? - YouTube http://bit.ly/18cuFLE

What is cholesterol? - YouTube http://bit.ly/18cuHmX

What are the types of cholesterol? - YouTube http://bit.ly/18cuKPA

Time to treat your cholesterol numbers - YouTube http://bit.ly/18cuLmD

Know your cholesterol numbers - YouTube http://bit.ly/18cuMa7

COPD - NHS patient education video

Chronic obstructive pulmonary disease (COPD) is a chronic disorder with high mortality rates (one of the top 5 causes of death). 10% of people worldwide over the age of 40 are affected by COPD.

COPD is expected to rise to the third leading cause of death worldwide by 2030. More than 25% of COPD patients have never been smokers.



From NHS Choices YouTube channel: COPD (bronchitis and emphysema) affects an estimated three million people in the UK, and smoking is a major cause. There is a lot that can be done to relieve the symptoms and improve your quality of life.

Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).



Related reading:

Controversies in COPD treatment http://bit.ly/1chf02V
Replacing the terms asthma and COPD with "A to E" of airway disease? http://bit.ly/1chf1E8
2 in 3 people with known risk factors for COPD don't know they have the disease http://bit.ly/1chf4zL
Diagnosis and Management of COPD - Current Guidelines http://bit.ly/1chf56T

Anesthesia 2.0: Web 2.0 in anesthesia education

Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education.

Web 2.0 technologies include:

- microblogging
- blogs
- really simple syndication (RSS) feeds
- podcasts
- wikis
- social bookmarking and networking

Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed.

Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

References:
Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education. Chu LF, Young C, Zamora A, Kurup V, Macario A. Curr Opin Anaesthesiol. 2010 Jan 19. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20090518

Image source: Wikipedia.

The #FOAMed revolution (Free Open Access Medical education)

From Mike Cadogan:

"The net effect of #FOAM has taken me quite by surprise (editor's note: #FOAMed is Free Open Access Medical education). Despite a complete lack of evidence, peer review, mission statements OR Big Pharma backing – the FOAMed revolution continues to infiltrate the psyche of the everyday healthcare professional. The ability to intelligently review, discuss and develop hypotheses, guidelines and issues; the sense of community; the sense of rebellious augmented learning and the joy of independence is rife…and contagious.

There are now an amazing 180 emergency medicine and critical care blogs. Bloggers write from 21 different countries. GMEP – ‘the Facebook of Medicine’ has just welcomed it’s 800th new member, 2 weeks after launch." http://buff.ly/12lzWzs

Here is my comment: Congratulations, Mike! These are amazing stats that illustrate an inspiring success! "Facebook of medicine", indeed. Let's keep it growing.

Free Medical Education Resources by the Association of American Medical Colleges (AAMC)

Head, Neck and Oral Cancer Examination

This 40-minute video is intended for practitioners of dentistry, medicine, nursing and public health who are responsible for diagnosing and referring patients with head and neck and oral cancer.

Emergency Medicine Ultrasound Simulation (U/SS) Case Scenario Package

This resource consisit of a modular package containing 5 high-fidelity full-body simulation case scenarios with supplemental bedside Emergency Department Ultrasound videos (de-identified) to assist in EM decision-making training.

Disclosing Medical Errors To Patients

This is a standardized patient case, which has been used to assess the communication skills of radiology residents when disclosing a medical error to a patient. The case content can be modified for use in other specialties. The checklist for the standardized patient and the self-evaluation checklist for the resident can be used without modification by all residencies.

Introduction to Effective Communication Skills

This PowerPoint with audio program covers the relevance and basic concepts of communication and interpersonal skills as they apply to general dentistry.

The Study Skills Workshop

The Study Skills Workshop was introduced to guide and promote 1st year Medical Students towards effective ways of learning in medicine. It is hoped that through the workshop the students are able to identify their individual learning styles and approaches. Thus they can find out self-improvement strategies to enhance their learning in medicine.

Image source: OpenClipArt.org, public domain.

Are doctors required to get patient permission to use non-identifiable X-rays, CTs, EKGs for medical education online?

Sam Ko, MD, MBA asked this pertinent question on Twitter. My answer is below. Feel free to correct me and please provide references for your opinion.

Question: "Are Drs required to get Pt permission to use non-identifiable images for medical education?"

Answer: According to most journals, no.

The NEJM policy is here:

"If a photograph of an identifiable patient is used, the patient should complete and sign our Release Form for Photographs of Identifiable Patients. Any information that might identify the patient or hospital, including the date, should be removed from the image."

This is the BMJ policy:

Images – such as x rays, laparoscopic images, ultrasound images, pathology slides, or images of undistinctive parts of the body – may be used without consent so long as they are anonymised by the removal of any identifying marks and are not accompanied by text that could reveal the patient’s identity through clinical or personal detail.

Case Reports and HIPAA

Physicians must assure that the case report does not contain any of the 18 health information identifiers noted in the HIPAA regulations, unless authorization from the individual (s) has been obtained. The authorization is not required if neither of the 18 identifiers below are used in the case report.

List of 18 Identifiers:

1. Names;

2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.

3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

4. Phone numbers;

5. Fax numbers;

6. Electronic mail addresses;

7. Social Security numbers;

8. Medical record numbers;

9. Health plan beneficiary numbers;

10. Account numbers;

11. Certificate/license numbers;

12. Vehicle identifiers and serial numbers, including license plate numbers;

13. Device identifiers and serial numbers;

14. Web Universal Resource Locators (URLs);

15. Internet Protocol (IP) address numbers;

16. Biometric identifiers, including finger and voice prints;

17. Full face photographic images and any comparable images; and

18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

References:

Author Center - NEJM Images in Clinical Medicine.

Patient confidentiality. BMJ.

Case Reports and HIPAA Rules

The Human Research Protection Program - UCSF.edu.
HIPAA Resources - The Privacy Rule - NIH.gov.
Single Case Report Policy - Johns Hopkins Medicine.
Medical Case Report Policy - Louisville.edu.
Privacy of Individually Identifiable Health Information. Code of Federal Regulations.

Image source: Bone fracture, from Wikipedia, the free encyclopedia (public domain).

12 tips for using Twitter as a learning tool in medical education - PubMed article

The suggested tips are organized into the following categories:

- mechanics of using Twitter
- suggestions and evidence for incorporating Twitter into many medical education contexts
- promoting research into the use of Twitter in medical education

However, you will need paid (or institutional) access to read the actual 12 tips for using Twitter as a learning tool in medical education, published at the Informa website:

http://informahealthcare.com/doi/abs/10.3109/0142159X.2012.746448

References:

Twelve tips for using Twitter as a learning tool in medical education. Forgie SE, Duff JP, Ross S. Med Teach. 2012 Dec 21.
http://www.ncbi.nlm.nih.gov/pubmed/23259608

Social Media in Medical Education: What are the Burning Questions?

The 2011 Association for the Study of Medical Education (ASME) conference will take place in Edinburgh in July.

The conference organizers are asking all the right questions:

- Is a WordPress blog more useful than a Blackboard module?

- How social is social bookmarking?

- How can social media help medical education researchers?

- How can we manage and develop our own digital identity?


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:

Social Media and Networks in Medical Education: Workshop at ASME
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Protecting the brain from concussion: $20-helmet is a good way to protect $100,000 education

Neuropsychologist Kim Gorgens makes the case for better protecting our brains against the risk of concussion -- with a compelling pitch for putting helmets on kids: A $20-helmet is a good way to protect $100,000 education. "Mind your (brain) matter."

Just consider the following tragic story:

Former NFL payer shot himself in chest so that his brain could remain intact for examination for encephalopathy

Before he shot himself fatally in the chest Thursday, the former Chicago Bears defensive back Dave Duerson sent family members text messages requesting that his brain tissue be examined for the same damage recently found in other retired players.

As a longtime force in the N.F.L. players union, Duerson, 50, was keenly aware of chronic traumatic encephalopathy, the degenerative brain disease linked to depression, dementia and occasionally suicide among more than a dozen deceased players. He had expressed concern in recent months that he might have had the condition.

“This thing has the whole union community pretty shaken up.”

Related reading:

The protective effects of helmets in skiers and snowboarders - why 15% of neurosurgeons bought helmets right away. BMJ, 2011.

Before Shooting Himself, Duerson Asked That His Brain Be Studied, NYTimes, 2011.

Former NFL payer shot himself in chest so that his brain could remain intact for examination for encephalopathy, NYTimes, 2011.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

25% of medical students use Facebook for education - with mixed success

This Australian study aimed to evaluate how effectively medical students may be using Facebook for education.

Researchers surveyed 759 medical students at one Melbourne university, and explored the design and conduct of 4 Facebook study groups.

25.5% of students reported using Facebook for education-related reasons and another 50.0% said they were open to doing so.

The case studies showed conservative approaches in students' efforts to support their development of medical knowledge and mixed successes.

The study authors concluded that Facebook as part of learning and teaching is as much of a challenge for many students as it may be for most educators.

References:

Medical students' use of Facebook to support learning: Insights from four case studies. Gray K, Annabell L, Kennedy G. Med Teach. 2010;32(12):971-6.

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

Effect of 16-Hour Duty Periods on Patient Care and Resident Education

Dr. Amy Oxentenko details a study appearing in the March 2011 issue of Mayo Clinic Proceedings (available at: http://www.mayoclinicproceedings.com) that looked at the effects of 16-hour duty periods for residents, and the impact of reduced shift length on:

- patient care metrics

- education

- transitions of care

- work hours

- resident satisfaction

How to Use Social Media for Medical Education

Here are a few suggested approaches for social media use in medical education:

- Peer student groups can utilize a private blog to share clinical experiences

- Course/program directors and staff can use a wiki to manage course/program materials and centralize frequently used documents

- Longitudinal preceptors can use a microblog (e.g., Twitter) to share links to journal articles, medical news, and reminders

- Admissions personnel can use social networks during the application, interview, and acceptance processes to build a community before students ever set foot on campus

- A public affairs office could generate podcasts to share graduate news, campus information, celebrations, and research success stories


The Networked Teacher - Diagram, Flickr http://goo.gl/CVddi

References:

Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 9(1):12-13, 19. Read the full-text PDF here.

What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging