Education Becomes Social: The Intersection of Social Media and Medical Education
2015; Elsevier BV; Volume: 149; Issue: 4 Linguagem: Inglês
10.1053/j.gastro.2015.08.037
ISSN1528-0012
Autores Tópico(s)Web and Library Services
ResumoSocial media has become an integral method of communication for a vast majority of our digitally connected society. Although our patients have raced to join the throngs flooding social media sites and networks, the medical profession as a whole has lagged behind in joining those we serve in social media. This reluctance is slowly changing as physicians begin to see the increasing utility of social media in medicine. In 2015, the vast majority of academic physicians are predominantly “digital immigrants” who were born before the dramatic rise in digital technology. On the other hand, postgraduate trainees, the most junior members of the medical profession, and medical students, the soon-to-be members of the profession, are “digital natives,” who have grown up using social media as an integral part of their lives. Although most current gastroenterology fellows and junior faculty were already in medical school or residency by the time Facebook and Twitter icons became ubiquitous, even this cohort will soon be composed of digital natives who have used social media through their early adulthood or even teenage years. As the demographics of the profession change and more physicians become facile with the tools offered currently on the Internet (“Web 2.0”), social media is poised to evolve from being seen as interruptive to workflow or corruptive to its users into a primary disruptive technology of medical education. This article is not meant to be a comprehensive review of how social media platforms have been used in medical education and training. Instead, the goal is to provide a broad overview of the intersection of social media with medical education, reinforce the work of those who are already using novel educational methods, and hopefully stimulate educators in gastroenterology who might be interested in using social media to consider innovations in this rapidly expanding arena (Table 1).Table 1Selected examples of social media tools available for use in medical educationSocial Media ToolExample/SiteBlogWordPressMicro-blogTwitterSocial network GeneralFacebook Professional (general)LinkedIn MedicalDoximity Research/academiaResearchGateVideo/video sharingYouTubeCollaboration (Wiki)WikipediaSocial bookmarkingMendeleyPodcastingiTunesUCommentingPubMed Commons Open table in a new tab A blog (short for “web log”) is an online page or website containing writings and/or other media, often reflections or commentaries, published in reverse chronological order. Among types of social media used in medical education, blogging is the most common tool studied for its outcomes. Blogs have been used to improve learner engagement, stimulate interaction with faculty, maintain students’ humanism and empathy, and enhance collaboration.1Cheston C.C. Flickinger T.E. Chisolm M.S. Social media use in medical education: a systematic review.Acad Med. 2013; 88: 893-901Crossref PubMed Scopus (408) Google Scholar In 1 study, active participation in a blog-based discussion forum correlated with higher final course grades.2Carvas M. Imamura M. Hsing W. et al.An innovative method of global clinical research training using collaborative learning with Web 2.0 tools.Med Teach. 2010; 32: 270Crossref PubMed Scopus (4) Google Scholar Required reflective student blogs during a medicine clerkship heavily focused on professional behaviors and attitudes while simultaneously uncovered aspects of the hidden curriculum.3Chretien K. Goldman E. Faselis C. The reflective writing class blog: using technology to promote reflection and professional development.J Gen Intern Med. 2008; 23: 2066-2070Crossref PubMed Scopus (88) Google Scholar Major journals and professional societies are increasingly using blogs to span the spectrum of education by enhancing practicing physicians’ ongoing professional development. Blogs such as the American Gastroenterological Association Journals Blog (http://journalsblog.gastro.org) enrich journal content and provide a more interactive opportunity for physicians to personalize their continuing education in a manner that was previously unavailable by publicly discussing the content of the articles. Twitter is the most well-known platform for “micro-blogging” in which posts (tweets) are limited to 140 characters. Twitter has a relatively specific lingo that can seem confusing and off-putting to many digital immigrants. Although a specific discussion of the Twitter format and lingo is beyond the scope of this paper, more detailed explanations about the use of Twitter can be found on the author’s Gut Check Blog (http://gutcheckblog.com).4Madanick R. OK I’m on Twitter…Now what? A primer for physicians (aka Twitter 101 for docs). available FROM: http://gutcheckblog.com. Updated April 30, 2012. Accessed July 17, 2015.Google Scholar, 5Madanick R. Twitter 101 for docs: Twitter lingo. Available from: http://gutcheckblog.com. Updated May 28, 2012. Accessed July 17, 2015.Google Scholar Twitter has been used within medical education in a number of ways, the most prominent of which may be “live-tweeting” at medical conferences, in which tweets are sent out by conference attendees with a specific hashtag (eg, #DDW15 for Digestive Disease Week 2015). Live tweeting at medical conferences creates a “backchannel” in which participants can disseminate information to a much broader audience and create virtual networks of learners.6Djuricich A.M. Zee-Cheng J.E. Live tweeting in medicine: “Tweeting the meeting.”.Int Rev Psychiatry. 2015; 27: 133-139Crossref PubMed Scopus (35) Google Scholar Within the last 5 years, Twitter has gone from a mere sidenote at medical conferences to being actively promoted by most major medical conference organizers. During a 5-day time period around DDW in 2015, 1839 discrete Twitter users composed 9984 tweets, compared with only 224 discrete Twitter users creating 1492 tweets during the same 5-day period around DDW in 2011.7Symplur. Homepage on the Internet. Available from: www.symplur.com. Accessed July 17, 2015.Google Scholar Twitter chats have also found their way into medical education. A Twitter chat is a moderated discussed focused on a single topic. Twitter users may participate by following the stream of tweets that include the hashtag or actively engage in the chat by including the appropriate Twitter hashtag in a tweet. The #meded (the hashtag for “medical education”) chat was launched in June 2011 and occurs on Thursday nights at 9 pm Eastern time. This ongoing weekly chat is dedicated to topics in medical education and academic medicine and has stimulated the development of a network of medical educators in the United States and Canada. With the success of the #meded chat, an offshoot chat, #mededfr (the French version of #meded), has also been launched to help create a network of French medical educators. Several groups have also used Twitter chats to conduct virtual journal clubs and discuss articles with a broader, sometimes even international, audience. Social networks such as Facebook are among the most widely used social media sites worldwide. Social networks allow users to create a profile, connect and communicate with other users, and navigate their connections’ profiles to extend their own personal and professional networks. As of March 2015, Facebook and LinkedIn, a professional social network, had 1.4 billion and 347 million monthly active users, respectively.8Statista: the statistics portal. Available from: www.statista.com. Accessed July 20, 2015.Google Scholar Doximity is a social network designed exclusively for medical professionals. Doximity now claims to have more one-than half of all US physicians among its membership.9Sullivan M. Doximity—the ‘LinkedIn for doctors’—has signed up more than half of U.S. physicians. VentureBeat. Available from: http://venturebeat.com/2014/12/09/doximity-the-linkedin-for-doctors-has-signed-up-more-than-half-of-u-s-physicians/. Updated December 7, 2014. Accessed July 20, 2015.Google Scholar Despite their large user bases, most social networks have not seen the same enthusiasm for delivering innovative models within the medical education community as other social media tools. Social networks may find their ultimate utility in medical education through their capability for users with similar interests to share ideas through written posts and other media by creating virtual learning communities. These virtual learning communities can develop organically through active user networking within the social networks, or can be created by a group that exists outside of the social network itself. Either type of group can be open or restricted by the moderators/creators by requiring a password or invitation to participate. Groups created within social networks can be used as a forum for specific medical school classes,10Ravindran R. Kashyap M. Lilis L. et al.Evaluation of an online medical teaching forum.Clin Teach. 2014; 11: 274-278Crossref PubMed Scopus (13) Google Scholar clinical rotations, residency and fellowship programs, and faculty development programs.11Klein M. Nieburh V. D’Alessandro D. Innovative online faculty development utilizing the power of social media.Acad Pediatric. 2013; 13: 564-569Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The major concern about using social networks is the potential for breaches in professionalism and patient privacy. Because most social network sites are not compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), sharing patient data or images infringes on patients’ rights to privacy, even in restricted groups. Some social networks, especially those with a focus toward healthcare, are beginning to offer HIPAA compliant security that could help to advance their use as a means for discussing actual clinic scenarios. Videos can serve numerous purposes to advance medical education. Videos can address virtually any topic of concern at any level of medical education, from premedical to postgraduate. Video modules are becoming popular as one method for delivering portions of the core knowledge with undergraduate medical curricula moving toward a flipped classroom model. The flipped classroom is an educational construct in which the settings for the traditional elements, ie, the lecture and the homework, are reversed (flipped). The didactic material is provided at home, for students to use to prepare in advance of the class, and the in-class time is instead used to engage the learners in more active learning exercises.12Prober C.G. Khan S. Medical education reimagined: a call to action.Acad Med. 2013; 88: 1407-1410Crossref PubMed Scopus (288) Google Scholar, 13Moffett J. Twelve tips for “flipping” the classroom.Med Teach. 2015; 37: 331-336Crossref PubMed Scopus (165) Google Scholar Online video publishing in academic medicine has been growing rapidly through sites such as YouTube. These sites allow educators to not only publish their videos, but also to disseminate their work to a larger group of learners. Teachers and learners can then engage each other in discussion about the content, and faculty can subsequently improve their material through this engagement. Many journals now also routinely publish videos that are featured on their websites (eg, an interview with authors of a manuscript, meet the editors videos) or are part of the manuscript data (eg, live cell imaging, video of a procedure, etc), and there is even a Journal of Visualized Experiments (http://www.jove.com/). In considering the options for video publishing, educators should consider the advantages and drawbacks to various types of sites. YouTube and similar platforms offer a capability to publish nearly instantaneously, a massive user-base of potential learners, an intuitive user interface, extensive mechanisms for user feedback, and easy search features.14Topps D. Helmer J. Ellaway R. YouTube as a platform for publishing clinical skills training videos.Acad Med. 2013; 88: 192-197Crossref PubMed Scopus (103) Google Scholar One series of 15 videos of basic procedures (eg, central line placement, shave biopsy) garnered >1.74 million views over its first 33 months after publication, with sustained viewership over subsequent months. By reviewing the analytic data provided by the sites, faculty discovered that viewers often watched until the end of the clips and discovered some segments that viewers seemed to replay frequently. These data influenced faculty to refine the clips and annotate their original content for clarification.14Topps D. Helmer J. Ellaway R. YouTube as a platform for publishing clinical skills training videos.Acad Med. 2013; 88: 192-197Crossref PubMed Scopus (103) Google Scholar Nonetheless, some faculty who create educational videos for their learners maintain concerns about sharing their content publicly on social media as well as the potential forsaking of traditional academic advantages of education- or specialty-focused platforms (eg, MedEdPortal), such as a peer-review process. A Wiki is a collaborative website in which the content can be edited by anyone with access to it.15Kamel Boulos M.N. Maramba I. Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education.BMC Med Educ. 2006; 15: 41Crossref Scopus (775) Google Scholar The most well-known Wiki, Wikipedia, has nearly 36.7 million pages with 781 million page edits since its inception.16Wikipedia. Available from: wikipedia.org. Accessed July 21, 2015.Google Scholar As a tool for medical education, Wikis can allow learners to collaborate and create a shared resource of information, structure the content in a fashion that mirrors their own internal construction of knowledge, and provide feedback to other users through edits and comments.17Rasmussen A. Lewis M. White J. The application of wiki technology in medical education.Med Teach. 2013; 35: 109-114Crossref PubMed Scopus (18) Google Scholar Numerous tools are available to allow educators to create Wikis on institutional or program websites as well as on Wiki-hosting sites (eg, Wikispaces, Wikia). Wiki use in medical education has had mixed success. A first-year medical student audience infrequently accessed or edited a Wiki aimed at their level of training, whereas fourth-year medical students were very satisfied with the use of a Wiki in a dermatology elective rotation.18Jalali A. Mioduszewski M. Gauthier M. et al.Wiki use and challenges in undergraduate medical education.Med Educ. 2009; 43: 1117Crossref PubMed Scopus (14) Google Scholar, 19Karimkhani C. Boyers L.N. Ellis L.Z. et al.Impact of a dermatology wiki website on dermatology education.Dermal Online J. 2015; 21: 10Google Scholar Residency programs have used Wikis to share and edit not only educational content but also administrative content (institutional policies, phone numbers, etc) for completing day-to-day tasks.20Kohli M.D. Bradshaw J.K. What is a wiki, and how can it be used in resident education?.J Dig Imaging. 2011; 24: 170-175Crossref PubMed Scopus (22) Google Scholar, 21Crotty B.H. Mostaghimi A. Reynolds E.E. Adoption of a wiki within a large internal medicine residency program: a 3-year experience.J Am Med Inform Assoc. 2012; 19: 621-625Crossref PubMed Scopus (15) Google Scholar In 1 large internal medicine residency program, almost all residents found the Wiki useful for guiding their education, although only 57% of residents reported that the Wiki improved their education.21Crotty B.H. Mostaghimi A. Reynolds E.E. Adoption of a wiki within a large internal medicine residency program: a 3-year experience.J Am Med Inform Assoc. 2012; 19: 621-625Crossref PubMed Scopus (15) Google Scholar For a Wiki to be successful in a training program, the intended audience needs to feel invested in the project. Investment may need to be stimulated by the Wiki administrators to engage an adequate user base at its inception. Providing credit for contributing to the Wiki may help to facilitate greater participation.15Kamel Boulos M.N. Maramba I. Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education.BMC Med Educ. 2006; 15: 41Crossref Scopus (775) Google Scholar Designating residents as section or topic editors with faculty oversight can also help to maintain the accuracy of the educational content posted within the Wiki.21Crotty B.H. Mostaghimi A. Reynolds E.E. Adoption of a wiki within a large internal medicine residency program: a 3-year experience.J Am Med Inform Assoc. 2012; 19: 621-625Crossref PubMed Scopus (15) Google Scholar Although this article discussed many of the most common social media tools already being used in medical education, it would be nearly impossible to discuss every tool or category of tools, because new sites, tools, and formats are being created daily. Already social media tools have intersected with medical education for a number of innovative educational constructs, such as massive open online courses (MOOCs)22Chan T.M. Thoma B. Lin M. Creating, curating, and sharing online faculty development resources: the Medical Education In Cases Series experience.Acad Med. 2015; 90: 785-790Crossref PubMed Scopus (28) Google Scholar and free open access meducation (FOAM or FOAMed).23Cadogan M. Thoma B. Chan T.M. et al.Free open access meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002–2013).Emerg Med J. 2014; 31: e76-e77Crossref PubMed Scopus (175) Google Scholar The scientific community is also dipping its toes into social media. Social networks such as ResearchGate and Mendeley focus on academics and allow scientists, medical researchers, and students to collaborate on research, share their papers, and track views and downloads.24van Noorden R. Scientists and the social network.Nature. 2014; 512: 126-129Crossref PubMed Scopus (432) Google Scholar The new field of altmetrics is trying to assess the impact of scholarly work within social media, even works published originally in these traditionally “nonacademic” venues. This measure can be particularly important for educators who are compelled to demonstrate the impact of their scholarly activity for their careers.25Priem J. Groth P. Taraborelli D. The altmetrics collection.PLOS One. 2012; 7: e48753Crossref PubMed Scopus (181) Google Scholar Even PubMed has opened its own commenting platform, PubMed Commons, to allow authors to share their opinions about individual citations within the large PubMed database.
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