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Experience in the Use of Social Media in Medical and Health Education

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Education Becomes Social: The Intersection of Social Media and Medical Education

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The Use of Social Media in Medical Education: A Literature Review

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The Use of Social Media in Medical Education: A Literature Review

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Social networks are frequently used by university students, as well as by the rest of the population worldwide to communicate, collect information, and share information and images. The aim of this report was to determine if there was substantial evidence in the literature that demonstrated the benefits of using social networks to enhance the learning process, as measured by students' performance on examinations.

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Social media use by physicians: a qualitative study of the new frontier of medicine

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BMC Medical Informatics and Decision Making

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Abstract

Background

A growing number of physicians are using social media as a professional platform for health communication. The purpose of this study was to understand perspectives and experiences of these "early adopter" physician bloggers and social media users.

Methods

This was an exploratory qualitative study involving in-depth semi-structured telephone interviews of physicians who were early adopters, defined as physicians who used social media to distribute health information. Participants were recruited through snowball sampling. Interview transcripts were manually analyzed for common themes by three separate investigators who came to common conclusions via the constant comparative method.

Results

Seventeen physicians participated in this study, including 35 % females, 76 % pediatricians and 76 % bloggers. Participants identified multiple perceived benefits and barriers to social media use by physicians; further, four major themes were identified. First, participants often saw themselves as rugged individualists who set their own rules for social media health communications. Second, participants expressed uncertainty about boundaries or strategies for social media use. Third, participants described using social media much like traditional media, as a one-way communication platform, rather than as an interactive forum. Finally, participants expressed disparate views regarding the time involved in participating in social media; some felt that time spent on social media was unproblematic to fit into their day while others felt that it was an impediment to patient care.

Conclusions

Uncertainty remains regarding roles and responsibilities of physicians providing medical content within social media forums and few providers appeared to be using the platform to its full potential. Future studies may inform best practices to optimize social media health communication to benefit patients.

Keywords

Health Information Social Medium Social Networking Site Early Adopter Traditional Medium

Background

The internet now provides access to health information ranging from factsheets on how to sooth a colicky baby to videos on how to perform a heart transplant [, ]. As of 2014, 87 % of U.S. adults reported using the internet and 72 % of internet users reported looking for health information online [, ]. Furthermore, a significant number of people accessing health information online reported that the information they found would "likely" or "very likely" influence their future health care decisions []. A 2011 study found that both patients and healthcare professionals are increasingly turning to these online resources, including websites, social media and personal research tools for health information [].

The use of social media sites has grown exponentially over the last few years, with participation in social media increasing from 8 % of internet users in 2005, to 74 % in 2014 [, ]. The Oxford Dictionary defines social media as "websites and applications that enable users to create and share content or to participate in social networking" []. Social media provides users the opportunity to generate, share, comment on and receive multimedia content distributed amongst multiple users []. Social media platforms include collaborative projects (eg. Wikipedia), social networking sites (eg. Facebook) and web logs (blogs) [].

As social media use has grown, so has peoples' interest in using it to find or exchange health information. A 2012 survey found that 26 % of health care consumers use a social networking site for health-related purposes, including 11 % who actively participated by posting comments, queries or information about health or medical issues [, ]. A 2013 systematic review identified seven key uses of social media for health communication: 1) provide health information on a range of conditions, 2) provide answers to medical questions, 3) facilitate dialogue patient-to-patient and patient-to-health professional, 4) collect data on patient experiences and opinions, 5) health intervention, health promotion and health education, 6) reduce illness stigma and 7) provide online consultations []. Social media is unique in that it allows for two-way communication online between creators and consumers of information. Thus, social media may be an ideal platform for mass health communication as well as the potential for addressing specific queries by individuals [].

Research to date on social media and health has largely focused on the patient experience. A 2014 study illustrated that patients use social media to locate health information, participate in discussion groups and seek support for struggles with illness []. This type of information seeking and sharing happens in a variety of ways including discussion forums, chat rooms, instant messaging and even via online consultations with clinicians [-]. In some cases, specific social media platforms facilitate health-related dialogue, such as blogs devoted to specific health conditions such as diabetes, or patient portals dedicated to sharing stories such as PatientsLikeMe [, , ].

Fewer studies have focused on the physician's role on social media, though physician-generated health information is growing. In a 2010 study of 921 health-related blogs, 43 % of bloggers were physicians []. Physician-bloggers have used social media to share health information, network with colleagues, disseminate research, market their practice and engage in health advocacy []. However, few healthcare providers have engaged with their patients online [] and some are hesitant about the acceptability of interacting with patients in this new venue with unclear boundaries []. In one 2008 study which analyzed the content of 271 weblogs written by health professionals, researchers found that weblogs offered the opportunity to share narratives, but also risked revealing confidential patient information or reflecting poorly on the author or profession [].

While some national medical organizations have published social media guidelines, these guidelines often lack specific behavioral guidance or definitions of professionalism [-]. More information is needed to understand best practices to optimize social media's potential for health communication []. Guidelines may be informed by understanding the perspectives and strategies employed by "early adopter" [] physicians who were pioneers in being among the first wave of physicians to use social media professionally to disseminate health information. The purpose of this study was to explore why and how physicians on social media use these new technology tools. Our study aims were to understand perceived benefits and risks of using social media as a health professional, as well as to understand physician's experiences, perceptions and views on current and future use of social media in healthcare.

Methods

Study design

This was an exploratory qualitative research study designed to gain an understanding of physician views on using social media for communication about health. For the purpose of this study, social media was defined as any website that enables users to create and share content or to participate in social networking. Qualitative methods were used for this study because they are the optimum method to provide data on the needs, beliefs, attitudes and values of key populations []. Consistent with qualitative research methods, we did not enter into this study with specific hypotheses. Interviews were selected as the primary method of data collection because this approach encourages open information exchange and targeted follow-up questions. One-on-one telephone interviews between a physician and a researcher were recorded verbatim by the researcher via hand-typed notes. This study was conducted between January 2014 and November 2015.

Participants

The participants in this study were physicians who had at least one year cumulative experience using social media to distribute health information. As social media use for health promotion by physicians is still a relatively new practice, the participants were considered to be early adopters in this field.

Data collection

Our study aims were to understand perceived benefits and risks of using social media as a health professional, as well as to understand physician's experiences, perceptions and views on current and future use of social media in healthcare. Interview questions to meet these objectives were developed by study staff and reviewed by several experts in qualitative research. Questions were further revised on the basis of feedback from participants. Given that the phenomenon of social media use by healthcare providers is relatively new, open-ended questions were used to obtain insights from participants. We asked physicians to describe their experiences with using social media for health information, including benefits and challenges, institution support, and perceptions and experiences of their online audiences. Demographic information included gender, race, years in practice, type of practice, and social media tools used.

Recruitment

Recruitment took place through snowball sampling: a recruitment technique involving identifying an initial purposeful sample, then asking those participants for further suggestions of potential participants who meet inclusion criteria [-]. This technique is particularly effective in studies of early adopters since there are usually few individuals involved: they are usually the best resource for determining who else is involved in the field. While recruitment began with pediatricians, we asked that participants recommend physicians from a variety of specialties in a variety of practices for future interviews, including prominent physician bloggers. Providers were sent a standardized email, blog or Facebook message informing them of the purpose and purview of the study and consent information. Upon receiving a positive reply, a telephone call was scheduled to provide additional information, discuss informed consent and conduct the interview.

Procedure

Prior to the interview, the researcher and participant discussed the study goals and followed informed consent procedures. Interviews were transcribed verbatim by the interviewer via hand-typed notes. Participants were not provided with incentives for their participation. Interviews generally lasted twenty to forty minutes.

Availability of data and materials

Data is available in the University of Washington Thesis Library database or upon request of the primary investigator.

Analysis

Analyses were conducted in two stages. First, a preliminary evaluation of transcripts was completed after ten interviews. In these analyses, preliminary coding and discussion was conducted by two investigators to inform early ideas about themes, to assess repetition of benefits and risks, and to consider thematic saturation. After 17 interviews were completed, investigators reviewed transcripts and noted repetition of benefits and risks and saturation of themes. Thus, a formal coding was conducted at that time using an iterative process [], transcripts were first read individually by three investigators to identify key codes and themes. A discussion was then held between investigators to discuss codes and themes towards a consensus on coding approaches. Transcripts were then re-assessed and the investigators deliberated until consensus was reached on the common themes and concepts expressed by participants using the constant comparative method [].

Results

Participants

Seventeen physicians participated in this study, only one blogger responded and declined participation. Of the seventeen participants, the majority were male (65 %) and Caucasian (82 %) (Table ). Only one of the participants had practiced medicine for less than five years, with the majority (41 %) having been in practice for eleven to twenty years (Table ). In terms of specialty, most of the participants were pediatricians (76 %) (Table ). Almost all of the participants engaged with multiple social media platforms, including Twitter (10), Facebook (7), Pinterest (3), YouTube (2) and Tumblr (2) as well as freestanding Blogs (13) (Fig. ). Five of the participants also engaged in traditional media such as radio, newspaper columns and magazines (Fig. ). Although the majority of participants spent three to six hours per week working on social media platforms, a few spent less than two or greater than ten hours per week on social media (Fig. ). Around one third of participants were compensated for at least some of their work on social media (Table ).

Benefits and barriers

Findings included a striking variety of perceived benefits and barriers to social media use by physicians. Most physicians voiced the opinion that the benefits of their participation in social media far outweighed any barriers they faced. The perceived benefits of their social media use included forwarding their career or research endeavors, self-improvement through reading others' tweets and keeping up with the literature, increasing their reach, i.e., their audience, and providing a space for them to openly express their opinions. However, participants also identified several categories of barriers hindering their participation in social media. Examples of these included the time/work requirements, skill requirements, lack of institutional support, fear of saying the wrong thing online and lack of models/guidelines in how to conduct themselves online in their role as physicians.

Physician participants also discussed several benefits and barriers for patients using social media for health information. They perceived that patient benefits may include having increased access to an accurate, trusted and understandable source of health information, that social media is accessible in general and that it provides a way for patients to engage with providers outside the office. Participants also perceived several barriers to patient engagement in social media, including language barriers, poor literacy/education, lack of internet access and worries about the lack of online privacy. In addition, participants identified several mutual benefits for patients and providers. These included increasing communication options and the speed of communication as well as breaking down traditional professional barriers. Finally, social media know-how was described by participants as a mutual barrier to uptake for both physicians and patients. See Table below for a full list of benefits and barriers to social media use by physicians as perceived by participants.

For Providers/ Institutions

Forward Career/Research

It "doesn't cost much in terms of money... and it can lead to other opportunities (for the provider). It can lead to more media outreach, speaking engagements, opportunities to teach, promotion for your practice, i.e., 'free' publicity."

"Time is a biggie. And training to some extent, although I think that most people these days get how to use social media. Using it well to communicate health information and thoughtfully so you're not misunderstood and get in medical or legal trouble, that's different."

Marketing, Publicity, Branding

Networking/ Sharing ideas

New Research/Career Opportunities

Low Cost

Repository for Information

Improvement in Clinic Efficiency

Self-improvement

"As soon as the new blood pressure guidelines came out, people started tweeting about them. I know about it 'cause I'm following people who pay attention to that on twitter. It's a good way to keep up with what thought leaders are talking about."

Skill requirements

"When I started, I literally had never heard of a blog before... and so the stumbling block was going from never even using it to being it (social media)." "Number two is that it's an evolving field." "Another barrier is knowing how to write. People go to college to learn how to do this. Most doctors don't know how to do this."

Social media know-how

Unfamiliarity with tools

Unfamiliarity with etiquette/rules

Constantly evolving environment

Communication skills

Media skills

Learning (staying current)

Listening to patient views/ understanding patient needs

Teaching (medical education)

"We realized that each of us could see maybe 20 to 25 patients a day, but on social media, we could reach hundreds or thousands of patients a day."

"People are old in the healthcare system. They're scared and don't know how to use the medium...There is a 19 th century mentality at the level of academic medicine. I think it's an old world-new world mentality. Healthcare's been stuck in this 19 th century rut."

"It seems that everyone turns to social media for information. When I go to google something, I almost always end up on a social media site."

Independent/Unregulated Venue

"I found that I really enjoy twitter for learning and connecting with people and building relationships. There aren't many of us, the physicians in this space. This is the best and easiest place to find them (other physicians)."

Fear of saying the wrong thing

"Barriers like if you post something that you shouldn't have. You can take back something you've said, but to have something out there that can be re-tweeted or re-purposed."

Saying something unprofessional

Breaching patient privacy (HIPPA)

Negative response

Providing misinformation

Place to express opinions

It's FUN

Camaraderie

Lack of models/guidelines

For Patients/ Communities

Source of health information

"It can provide accurate information from evidence-based research. I can provide a summary of an article in terms that parents can understand instead of them just reading information from the latest celebrity."

"The main reason I don't use it in my own patient care is because the patients I care for have problems with access. For the most empowered, educated patients, it might be useful. That's not the kind of people I take care of in an urban underserved hospital."

Source of 'accurate' health information

Source of 'trusted' health information

Source of 'understandable' health information

Source of 'current' health information

Source of 'targeted' health information

Source of information outside the clinic visit

Low cost for patients

The benefit "to the patient is that it's free healthcare."

Lack of physicians with similar backgrounds

Community Outreach/ Input/ Engagement

"It increases the reach of the message and allows me to interact better. It's not about broadcasting, it's about being there and being more accessible for people"

Distinguishing credible information

"the general public not being able to distinguish what's credible on the internet"

Accessible

"Just today, I've gotten emails, pings, hits, likes from 8 different countries. It runs the gamut. I have people from India or Malaysia who probably make dollars per day to presidents of companies who ask for second opinions. It helps to level the playing field."

Health Behavior Change

"We're trying to educate people who are misinformed. For good or for bad, social media is very good at changing opinions."

It's fast (quick exchange of information)

"When you email them, you don't get a response. When you tweet them, it's literally a one min response."

Lack of social media know-how

"Honestly, I am my own barrier. I'd never heard the word blog until 5 years ago. I'm still learning. My 14 year-old to tells me how."

Improved doctor-patient relationship

"It also allows you to maintain a relationship with your patient population on an ongoing basis. About half your patient population is only going to come in once a year or twice a year. How do you stay in touch with that population, make sure they come back, make sure you can provide them information? It helps them and helps them appreciate you as a physician."

Lack of privacy

"You can almost trace everybody back. What's that they say? 'On social media, it's written in pen not pencil."

Breaks down professional barriers

Increases communication

Themes

In addition to the benefits and barriers, four major themes were identified: (a) Rugged individualism, (b) Uncertainty, (c) Social media as media and (d) Time constraints. These themes were present across interviews and emerged in response to varied questions and discussions.

Theme 1: Rugged individualism

A common sentiment that arose during interviews was that physicians participating in social media perceived themselves as pioneers in the field who would like to make their mark on a new frontier of medicine. Thus, participants stated that they often felt alone or independent in this effort. In the words of one participant, "I think most of us who are doing it (social media) feel a little bit like lone rangers." Physicians expressed several motivations for their participation. For most, the appeal of social media was described as its ability to serve as an independent platform where they could express their own opinions freely, without administrative interference or oversight. Most participants stated that their participation in social media hinged on the premise that they "have all editorial control" on what is published. Only six of the seventeen physicians interviewed reported any peer review of their publications, where the oversight came from a co-blogger or their own practice. None of the seventeen participants mentioned a formal peer review process. One participant described their experience of clinic-based oversight as follows: "They can choose a question, but the answers are always mine."

While participants were conscious of their role as physicians online and the responsibility of the information that they promulgated, the majority still described their social media page as a personal platform. One example quote was:

"There's things I can do personally that I couldn't as part of my practice or the hospital. I can say what I think is important or not, and laugh and joke. It's just a nice outlet. I've definitely gotten connected with people because of my activities on the canvas. I like the idea that as an individual you can be a thought leader without working with these huge multilevel institutions. The ability to do this as an individual, as a physician, is very cool."

Even though the study was preferentially targeted towards physicians using social media as a tool to reach patients/communities, participants more often touted its utility for personal branding, marketing and networking than for interacting with patients. One participant described, "if you write your own stuff and other people see it, it's a good way to self-promote." Furthermore, several participants highlighted that this drive towards personal promotion resulted in having been granted new research or career opportunities as a result of their engagement with social media, even if this was not their original motivation for joining these platforms.

Finally, most participants described using social media as fun and enjoyable. One participant stated: "It's actually an incredibly empowering medium as a form of self-expression. If you understand how to use it and communicate with it, then it's really exciting." The majority of participants had been involved in traditional media or communications prior to engaging with social media and enjoyed interacting in this new sphere personally as well as professionally.

Theme 2: Uncertainty

Participants expressed many levels of uncertainty about their preparedness, their impact, the potential for repercussions and the future of physicians' presence on social media. Participants described feeling unprepared when they started using social media. Many participants described concerns such as lacking knowledge about how to use certain social media platforms versus others. Others described confusion about the rules or etiquette for use, and how to integrate social media with traditional media. Several participants felt that they were "digital immigrants," including one physician who had "literally never heard of a blog before starting to write one a year ago." While all participants articulated that they felt capable of learning through experience, uncertainty remained around practical aspects of social media use; for example, when and how often they should be posting content and responding to comments. In addition, participants struggled to define the line between personal and professional use. While most participants chose to share personal stories of health and family, some wrote solely about medical issues and updates. For example, one participant expressed how they "wanted to story-tell and share information organically, to talk about my experience of raising my children at the same time as giving information on pediatrics and prevention." While another participant explained how she is "very much being a doctor on social media. I'm not doing it much for personal things."

Secondly, participants were uncertain about who they reached and the impact they had on their audience. Although most physicians were able to track how many hits they had on their site and where the hits were from geographically, where a "hit" is a click on a page, they could only guess at the demographics of their followers and responders. As one participant responded, "I don't really know. I assume that I'm reaching a representative sample from our patient population at [our health system], but I don't know." It is interesting to note that most participants stated that they guessed they were reaching "white middle-to-upper class English speakers with a high reading level." In response to a question about who they were reaching through social media, one participant responded that she perceived that her readers were "mostly college educated, higher literacy level because I wasn't writing it as the third grade reading level. I was writing it in the way I would in college. And the questions I'd get back were written in a similar tone."

In addition, participants did not have information on the outcomes of their social media content in terms of knowledge, skills or behavior change for their audience. A few physicians noted anecdotally that patients would mention topics that they had posted about online; however, they had no data on behavior change, as described by one participant:

"Right now, our data metrics are flawed. We have [information on] how many hits. We have how many people are following you, etcetera. But we don't have what happened after they access the information. The only thing we can do is if they actually answer us, 'These three things I'm gonna change....' People say I'm gonna change this and change that but we don't really know."

One participant pointed out that she perceived a change in the vaccination rate of her clinic population of patients since starting her blog. However, she also speculated that this was more likely to be confounding from new patients coming to her clinic or old patients leaving her clinic based on whether or not they agreed with her views on vaccination posted online than on patients changing their minds.

Thirdly, uncertainty was expressed regarding potential negative repercussions as a result of social media use. Some physicians expressed concern about backlash from the media or an employer based on something another physician had posted, though few felt like they were at risk themselves of making such an egregious error. One participant went as far as to insist this concern was irrational:

"The number one problem is the irrational fear of litigation. I have many different physicians writing for me on different topics. I wanted to get some obstetricians to write about prenatal care and they all said, 'no.' Malpractice doesn't include verbiage about this but they should so people can feel free to write... There's no precedent for docs being sued for general medical writing."

Finally, participants expressed uncertainty around the issue of whether or not it is the duty/ obligation of all physicians to provide health information on this new accessible medium. While some participants were insistent that more physicians should be involved, most were equivocal, stating that physicians should only participate if they feel they would enjoy it and are equipped to do so. Physicians in private practice were more likely to view social media as an increasingly important aspect of their practice, as one participant described:

"I think everyone should be using social media in their practices. This is how communication is happening right now. As a pediatric provider, you're not just communicating in the exam room, but ideally you're being involved in your community, making your community a better place for children. It really becomes global with the internet."

Two physicians who reported primarily working in low-resource settings, such as with Medicaid patients, were both less enamored with its prospects of reaching their patient populations, or the idea that every physician should be involved in social media. As one physician expressed, "not every platform is for every person. If you're interested, there's a lot of benefit, but if you're not interested, there's already a lot of people out there."

Theme 3: Social media as media

A third theme was that physicians tended to describe their use of social media similar to what would be expected in traditional media rather than as an interactive "social" platform. Unlike traditional media in which messages are distributed in a one directional manner, social media allows participants to listen as well as communicate back. However, most physicians in this study described treating this platform as a personal space where they could advertise their ideas or brand their niche in medicine instead of as a bidirectional patient-provider network. As one participant phrased it, "I think it's a megaphone, like any media. It amplifies. Your voice gets to more people." Many participants described using social media like a loudspeaker where they could project opinions and post evidence based medicine rather an as a conversational tool, such as this participant's comment:

"I'm an educator and I use social media to educate and to opine. I like just ranting and raving and telling people what I think about something and causing a raucous. It is the twenty first century Hyde park... you can stand on your soap box and yell and they'll yell back."

Another related and important aspect of social media discussed by physicians was the amplification effect. According to participants, the amplification effect is "the ability to broadcast or narrow-cast content. Using different tools, you can amplify a message to a certain population or the population at large." Several physicians discussed how this amplifying effect was exactly the reason why more physicians need to add their voice to social media, especially in terms of countering vaccine misinformation. Participants viewed it as a powerful tool for reaching patients with important medical information, especially messages concerning public health.

Theme 4: Time constraints

Time was a thematic element which seemed to diffuse itself through every part of every interview. Participants adamantly defended their views on whether or not time spent working on social media was a serious impediment versus an easy to fit into their day. For some physicians, the time spent listening to others' twitter streams and blogs, prepping and composing their posts and responding to comments required that they decrease their patient load or add additional work-time to their already busy week. One participant noted that,

"right now, most of the doctors I know with very successful blogs have quit practicing medicine. They're now bloggers and not doctors. I see that occurring pretty regularly... I have 12 hour days in the office. It's very difficult for me to go home and do a lot of blogging."

Conversely, other participants felt that their time spent on social media could easily fit into downtime at meetings or 15 min before bed and expressed the sentiment that physicians who felt otherwise were mistaken. One participant described:

"I would say, the nice thing about social media is that you can do it in between things. I dedicate thirty minutes a day on average. I bundle all of it so I can reach multiple platforms at once. It's not a lot of time. That is one of the biggest misconceptions."

Participants also debated whether using social media for health promotion improved or decreased efficiency in the office. While some physicians postulated that their posts on social media may increase clinic efficiency by decreasing unnecessary patient calls and visits, others believed that it decreased efficiency by distracting providers from direct patient care.

Time also served as a barrier to establishing institutional support for participants' use of social media. Participants expressed how "institutional backing is lukewarm at best" and how, "apparently, according to our organization, we have other priorities." Several physicians expressed their frustration with trying to "jump through multiple hoops" in order to partner with their institution or practice. Many of these physicians concluded that the time and effort required establishing a partnership was too great of a barrier and that they would rather continue alone. One participant argued, "I've been reluctant and too lazy to deal with the formalities of it. Last thing I want to do is spearhead the activities for my colleagues behind the times." Time was also discussed in terms of the "21 st century conception of time," where clinical conversations, questions and updates happen immediately, not only in a 15 min office visit. Several participants felt that this was one of the most pressing reasons for physicians to expand into the realm of social media, as described in this quote:

"We have the 15 minutes problem. The amount of time I have to speak with people. I cannot cover everything. Some of my patients I may only see once or twice a year. And in the meantime, I'm learning about things that could benefit them. If they're following me, they can learn about the things I'm learning about... I think that it expands the visit and the relationship in ways that are really great and really easy."

However, it also represented a barrier to use, since physicians rarely had the flexibility to respond instantaneously or engage in present-time twitter conversations, as described in this quote:

"Most docs are just so pressed for time as it is, trying to already balance work and life. Finding the time to do something you need to update quite frequently. When there were blogs, to post, you could put out content on your own time. Now that it's constant with Facebook and Twitter, you really need to update on a more timely bases. It's almost a living thing that keeps going even while you're in clinic or at home."

Overall, time held a conflicted position in the eyes of participants.

Discussion

In this study of social media use by physicians, we identified multiple perceived benefits and barriers for both physicians who create content and readers who consume this content, as well as several themes. First, participants who engaged in social media often saw themselves as rugged individualists who preferred to set their own rules for social media use. Second, participants expressed significant uncertainty concerning when, how and to what extent they should use social media, and the impact of their use of social media on their followers. Third, participants often reported using social media like traditional media, as a one-way communication platform, rather than as a "social" forum. Finally, participants expressed disparate views regarding the concept of time; some felt that time spent on social media was insignificant and easy to fit into their day while others felt that it was an impediment.

Our first theme was that physicians using social media viewed themselves as "rugged individualists." This viewpoint is consistent with characteristics of early adopters described in previous literature []. Previous studies have found that physicians may be early adopters of other ideas and products, such as pharmaceuticals []. As the first generation of physicians using social media, it may not be surprising that these participants value their independence, ability to make autonomous decisions and importance in the field. However, as the next wave of physicians begins to engage in social media, it will be important to temper this independence and enthusiasm with the responsibilities of providing published medical counsel on the internet. This may include instituting peer oversight of published content, demonstrating credibility online in terms of professional licensure, institutional support (from American Academy of Pediatrics (AAP), American Medical Association (AMA), American Academy of Family Physicians (AAFP), etc.), or other certification of informational accuracy and providing more training/mentoring for physicians who choose to engage in social media.

Our second theme described how participants noted uncertainty in their responsibilities around providing a new type of information in a new venue. Key contributing factors included a lack of communication or agreement between the needs of the physicians using social media, the needs of the medical community and the needs of patients. While several medical associations have produced guidelines for social media use among physicians, few have taken into account the goals and needs of physicians who are engaged in social media. Guidelines from the AMA and AAP are narrowly focused on professionalism [, ]. The AAFP has developed a more comprehensive guide, with topics ranging from patient privacy to medical board concerns to setting social media policies within a practice []. While these guidelines may be helpful for physicians on social media, especially concerning liability, few address physicians' motivations for using social media and their perceived benefits and barriers to use. These uncertainties represent areas in which physician-social media users could collaborate to develop best practices, similar to the process employed when best practices were developed for email use by physicians [].

Finally, our third theme illustrated that while our participants were recognized as forerunners in the field, many of them still underutilized the full power of social media tools. Many of our participants described using social media as a "megaphone" or mouthpiece, suggesting they were using it to broadcast their own views. The idea of the loudspeaker may be an artifact of the fact that many of our participants had previous experience in traditional broadcast media, marketing or communications. However, participant responses suggested that they felt unaware of who was listening or what their audience was saying. This key element of social media, the capacity for interactive and two-way communication, appeared to be underutilized. Furthermore, several participants' comments suggested pessimism about reaching their low income, non-English speaking, low literacy and older patients using social media. Participants voiced that they generally felt that their audiences were most likely middle-upper class Caucasian readers. However, studies on social media have found that African American internet-users are more likely to use social networking sites than their non-Hispanic Caucasian counterparts and that seven of ten households earning less than ten thousand dollars a year are using the internet [, ]. Thus, there seems to be a disconnect between who physicians are targeting on social media and who is using social media. As a profession, this is an opportunity to provide greater access to health information for all patients and transmit new knowledge to physicians.

Limitations of this study include the small and purposeful study sample, and the predominance of pediatricians in our sample. We specifically recruited physician-bloggers who were nominated by their peers because of their success, influence and recognition. It was the views of these early adopters that we wanted to capture in this study. However, given that this is a nonrandom sample, our findings cannot be generalized to other populations or the full network of physicians on social media. This study was conducted and analyzed over two years, and social media systems are consistently changing. We did not include longitudinal assessments in this study thus we did not assess whether participants' usage or attitudes changed over the study period. Furthermore, since our study design was qualitative in nature, causal inference was not the goal. Rather, we wanted to explore major themes and areas of importance for the field in order to guide future research and recommendations.

Conclusions

Our study is the first to evaluate physicians' perceptions, goals and challenges in using social media. Our participants described numerous benefits and downsides of using social media, viewed themselves as pioneers in the field facing much uncertainty, and debated whether time spent on social media was feasible. According to our participants and general trends, social media is only going to continue to grow its presence within medical care. Therefore, it will be important to consider how to develop best practices. Study findings may be used by physicians who are considering blogging to understand early adopter perspectives on benefits and risks. A peer review process may benefit physician bloggers by reducing uncertainty and helping physician bloggers connect to others in their field. Further, organizations may wish to develop standards for best practices for physicians on social media. These best practices will benefit from input from physicians, medical organizations and patients. In addition, it will be important for current and future physician-social media users to continue improving their integration of the "social" tools of social media to better connect with their patient- and colleague-followers.

Declarations

Acknowledgements

The authors would like to thank Kimberly Cowan for her assistance with this manuscript preparation.

Funding

No funding was obtained for this study.

Availability of data and materials

Data, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes, without breaching participant confidentiality. Data can be requested of the authors and will be de-identified prior to submission.

Authors' contributions

LC was involved in all stages of this project. LC designed and conceptualized the study, conducted data collection, participated in analysis, drafted and revised the manuscript, and approved the final version of this manuscript. MP was involved in conceptualizing the study, participated in analysis, drafted and revised the manuscript, participated in key editing and approved the final version of this manuscript. YE was involved in interpretation of analysis findings, drafted and revised the manuscript, participated in key editing and approved the final version of this manuscript. MM was involved in all stages of this project. LC and MM designed and conceptualized the study, participated in analysis, drafted and revised the manuscript, participated in key editing and approved the final version of this manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

All participants provided consent to publish quotes from their interview in this publication.

Ethics approval and consent to participate

This project was considered exempt by the University of Washington Human Subjects Review Committee (#46467). We obtained verbal consent of each healthcare provider who participated.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

References

1. Hawn C. Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. Health Aff (Millwood). 2009;28(2):361-8.

2. Colineau N, Paris C. Talking about your health to strangers: understanding the use of online social networks by patients. New Rev Hypermedia Multimedia. 2010;16(1-2):141-60.

3. Govindarajan V, Kopalle PK. Disruptiveness of innovations: measurement and an assessment of reliability and validity. Strateg Manag J. 2005;27(2):189-99.

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Social media use by physicians: a qualitative study of the new frontier of medicine

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A growing number of physicians are using social media as a professional platform for health communication. The purpose of this study was to understand perspectives and experiences of these "early adopter" physician bloggers and social media users.

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Social media as an open-learning resource in medical education: current perspectives

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Abstract

Purpose

Numerous studies evaluate the use of social media as an open-learning resource in education, but there is a little published knowledge of empirical evidence that such open-learning resources produce educative outcomes, particularly with regard to student performance. This study undertook a systematic review of the published literature in medical education to determine the state of the evidence as to empirical studies that conduct an evaluation or research regarding social media and open-learning resources.

Methods

The authors searched MEDLINE, ERIC, Embase, PubMed, Scopus, and Google Scholar from 2012 to 2017. This search included using keywords related to social media, medical education, research, and evaluation, while restricting the search to peer reviewed, English language articles only. To meet inclusion criteria, manuscripts had to employ evaluative methods and undertake empirical research.

Results

Empirical work designed to evaluate the impact of social media as an open-learning resource in medical education is limited as only 13 studies met inclusion criteria. The majority of these studies used undergraduate medical education as the backdrop to investigate open-learning resources, such as Facebook, Twitter, and YouTube. YouTube appears to have little educational value due to the unsupervised nature of content added on a daily basis. Overall, extant reviews have demonstrated that we know a considerable amount about social media use, although to date, its impacts remain unclear.

Conclusion

There is a paucity of outcome-based, empirical studies assessing the impact of social media in medical education. The few empirical studies identified tend to focus on evaluating the affective outcomes of social media and medical education as opposed to understanding any linkages between social media and performance outcomes. Given the potential for social media use in medical education, more empirical evaluative studies are required to determine educational value.

Keywords: social media, Facebook, YouTube, medical education, evaluation

Introduction

Social media has become an integral tool for medical societies, hospitals, and advocacy groups. These groups are using social media to engage, teach, and connect, and they play an important role in providing accurate, vetted health information. In addition, organizations have realized that encouraging live-tweeting or blogging of conferences provides opportunities for wide dissemination of content. 1- 3 Medicine and health care professions have widely embraced the use of social media in medical education, and there is a growing culture of sharing open resources in medicine with internationally well-established repositories. Research activity is investigating growing numbers of open data sets on health but there seems to be little discussion around how these might effectively be used in medical education. That is, the quality of the content on social media and the Internet is solely dependent on the members of the online community. Although there may be real-time peer-review to critique misleading and/or incorrect information, the quality of that content may be variable. Perhaps most importantly, recent research has demonstrated a lack in high-quality evidence, infrequent assessment of skill or behavior-based outcomes, and no assessment of patient-based outcomes. 4- 6 What we need is to employ structured processes to better understand the impact(s) social media is having on medical education. Free and unregulated information available on the Internet carries the potential hazard of misinformation. 7

In becoming more "evidence-based," North American medical schools have embraced the necessity and utility of evaluation. Learning from and about evaluation often requires us to change our mental models - to rethink our assumptions and beliefs to develop new understandings about our programs and evaluation processes. Evaluation purposes range from hard-nosed judgement-oriented summative exercises to formative, improvement-oriented ones that tend solely to provide support for decision-making. These evaluations can be conducted by members or groups external to the program and/or organization, by those internal to it, or by a blend of the two. 8 Multiple methods can be employed in evaluation, ranging from quantitative to qualitative and often involving a mix of the two.

Ultimately, evaluation leads to knowledge production, the validity, credibility, sophistication, timeliness, and relevance of which depend on the evaluation processes in place. It also leads to forms of the use of the knowledge produced. Empirical research and evaluation is based on an observed and measured phenomenon and derives knowledge from actual experience rather than from theory or simply beliefs. 9 Characteristics of empirical studies include specific research/evaluation questions to be answered, a definition of the population, behavior, or phenomena being studied, description of the processes used to study this population including selection criteria, and testing instruments (i.e., surveys and interview protocols). This study undertook a systematic review of the published literature in medical education to determine the state of the evidence as to empirical studies that conduct an evaluation or research regarding social media and open-learning resources.

Methods

Review of current empirical evaluative literature

In essence, this article represents a form of meta-analysis of empirical research and evaluation in the area. Described below are the sampling criteria, characteristics of the sample, and the method used to analyze findings across studies.

Sampling criteria

With the abundance of interest in the domain of social media in medical education, the search terms "social media and medical education" generated a plethora of peer-reviewed articles. However, our purpose here is to determine what work has been done in terms of actual empirical research and evaluation of the use of social media in medical education. For this reason, we restricted our sample to the past 5 years (2012-2017). We searched the literature in six popular databases (MEDLINE, ERIC, Embase, PubMed, Scopus, and Google Scholar) for English-language studies on social media use in medical education published in peer-reviewed journals. We followed a similar definitional strategy as used by Cheston et al and defined social media as Web-based technologies that facilitate multi-user interaction that goes beyond fact sharing. 4, 10, 11 We defined medical education as all levels of physician training (medical school, residency, fellowship, and continuing medical education). We subsumed any potential patient outcomes within our general search terms of "social media", "medial education", and "evaluation". From the initial sample, we deleted all duplicates as well as clearly irrelevant work. From the initial sample, we tracked down other peer-reviewed studies through bibliographic follow-up. illustrates the steps we took in conducting the systematic literature review.

Table 1

Identified and downloaded documents

Searched the literature for the period of January 1 2012 to January 1, 2017 in the following databases: MEDLINE, ERIC, Embase, PubMed, Scopus, and Google Scholar. Keywords used in the empirical review included: "social media", "medical education", and "evaluation". Found 406 entries; SS reviewed all entries and identified 128 for further consideration.

Inclusion criteria and selected documents that met the criteria

Developed and applied inclusion criteria that the studies had to 1) be reported in peer-reviewed journals, 2) be published within the five-year time period (2012-2017), 3) report on empirical data with descriptions of study methods, and 4) authors must be conducting an evaluation or research regarding social media and open-learning resources. Identified 13 articles that met inclusion criteria.

Identified and coded appropriate information; analyzed the information

Studies were coded for 1) research design and data collection methods, 2) medical speciality, 3) target population, and 4) study outcomes.

Results

All of the studies meeting inclusion are listed in . Each of the studies analyzed their various elements, including research design/data collection methods, study population, medical speciality, open-learning resource tool(s) under evaluation, and study outcomes. Each will be discussed in turn.

Table 2

Research/evaluation design

Six studies employed a qualitative design, whereby data were extracted from either Facebook or YouTube then qualitatively analyzed for themes. 7, 12- 16 Four of these studies employed almost the exact same design to investigate the quality and accuracy of material on YouTube. 7, 13- 15 Specifically, a given number of terms were searched on YouTube, videos were downloaded and analyzed for specific domain-specific content. The Camm et al paper employed a "purpose-built tool" to rate the videos. 14 Alotaibi et al employed a similar design as the studies listed above; however, they widened their search not only to YouTube but also to include Facebook and Twitter. 12 Only one paper employed a rigorous qualitative design including conducting 10 focus groups with participants. 17

Four studies used a quantitative design whereby they utilized a survey instrument to obtain perceptual data on social media uses. 18- 21 Of the remaining two studies, one employed a mixed-method design whereby they distributed questionnaires to Twitter users, and then conducted focus groups. ²¹ The other study utilized a pre- and post-design. ² ² For example, the authors examined Facebook profiles for the presence of security settings, gave an intervention in the form of a workshop focused on professionalism and social media, and finally re-examined the same Facebook profiles for any evidence of impact from the intervention.

Study population

Overwhelmingly, the majority of studies (N=10) were directed to examine open-learning resources for undergraduate medical student use focus on undergraduate medical students' pedagogical preferences, practices, and utilization patterns. One study 18 focused its inquiry on differences in social media use between medical residents and faculty, whereas another study investigated faculty uses of social media. The final study was interested in a specific segment of a given population, specifically, low socioeconomic status, African Americans in upstate New York. 23

Medical specialty

Ultimately, we identified a total sample of 13 studies (). The most frequently cited speciality was anatomy with three studies. 13, 15, 22 Two studies were found within the domain of cardiology. 7, 14 The remaining studies were spread across a variety of medical specialities including pathology, 20 emergency medicine, 18 neurosurgery, 12 and another study focused on continuing medical education. 21 Of the remaining four studies that met inclusion criteria, three applied to the broad domain of undergraduate medical education. 16, 19, 23 The final study was focused on a community health intervention with the authors representing a cancer center. 17

Open-learning resource tools

YouTube and Facebook were the most commonly evaluated social media tools. Four studies focused their assessments on the credibility and educational utility of material on YouTube. 7, 13- 15 Three studies focused on utilization frequencies and patterns assessed both Facebook and YouTube. 12, 19, 21 Facebook was the primary social media tool used in three studies. 16, 20, 23 Only one study meeting inclusion criteria examined Twitter as an open-learning educational resource. 22 The final two studies 17, 18 examined social media in a more general way. Pearson et al study was most interested in frequency of social media use between residents and faculty, whereas the Mahoney et al paper focused on social media use in terms of the most effective distribution mechanism. 17, 18

Study outcomes

Facebook was viewed to have positive effects on the more affective dimensions of learning. That is, studies found Facebook to be useful in promoting collaborative online communities of learners 16, 20 as well as an effective means to distribute content-specific information to key subgroups (i.e., brain aneurysm patients). 12 Study outcomes were weak as they relied primarily on self-reporting and may not be transferrable to other populations or contexts. The four studies focusing solely on assessing YouTube content were consistent in their consensus that YouTube is often an inadequate source of information for learning medical content. 7, 13- 15

Studies that investigated open resources more broadly, that is, not focusing on a single tool but rather sought to determine the preferred tool among users generally found age and/or technical savviness to be a key component in social media use. Pearson et al found that residents were far more likely to utilize social media than were faculty. 18 Similarly, Wang et al found younger faculty (and those technologically inclined) more likely to use social media with regard to continuing medical education. 21 Perhaps, the most rigorous of all the studies that met inclusion criteria 22 demonstrated a negligible correlation between medical students, Twitter engagement and exam performance suggesting that the use of Twitter in this context is limited to enhancing the student experience rather than improving knowledge.

Discussion

The growing integration of social media into medical education has led some to believe that social media constitutes the cornerstone platform for the future of medical education. Perhaps for this reason and despite a decade of social media presence, scores of studies are still probing the utilization question. That is, many peer-reviewed papers are commentary in nature seeking to describe potential uses of social media in medical education. This study has demonstrated the paucity of research and evaluative work that is employing methods for deeper understanding as to the potential impacts of social media in medical education. The limited number of empirical studies should not be taken to mean that social media as open-source learning has not received much attention in the literature. On the contrary, there are numerous studies on the topic; however, most are commentaries and/or reflective narratives that were not included in this study.

Open-learning resources (integrate Facebook, YouTube, and Twitter) have no correlation with student performance, rather there was only a correlation with student affect. Facebook appeared to have an impact in terms of creating online-learning communities and fostering-increased learner engagement in educational content. True value may be to enhance the student experience rather than with the explicit aim of improving exam performance. YouTube was found to be an inadequate resource for educational purposes due to the highly variable content. The modern world has censorship-free access to the internet that requires a high degree of responsibility for those making educational material available to the public. 15 A novel service named YouTube EDU has been introduced recently giving access to a broad set of academic lectures and inspirational speeches endorsed by institutions and universities and has replaced the previous education category. 24 Some studies located called for YouTube to institute a moderating service so as to assess the quality of educational videos, though many authors noted that this was likely not a practical suggestion given the volume of new content that is added to YouTube on a daily basis. 7, 14

Perhaps, social media as an open-learning resource in medical education is geared for the young and the young at heart. The majority of studies included in this study served to better understand learning at the undergraduate medical student level. Furthermore, some study outcomes explicitly found social media use more prevalent in younger students, and those labeled "youthful" and "technologically savvy." 18 More empirical evaluative work needs to be directed to better understand the linkage between social media use and generational differences. We know a considerable amount about social media use, although to date, its impacts remain unclear. Despite the existence of social media platforms for more than a decade, the vast majority of peer-reviewed studies in the literature do not engage in rigorous programmatic evaluation.

Limitations

This study has several limitations. Despite making every attempt to capture all relevant empirical studies, this field is expanding exponentially making it difficult to be completely inclusive. Our bias favoring only empirically based studies demonstrating clear outcomes may have inadvertently excluded some articles for inclusion. Finally, two additional empirical evaluations with adequate outcomes were located yet they were not published in peer-reviewed journals. This is noteworthy as there may be some additional work underway and not captured here. Despite these limitations, this review offers guidance for future research and evaluation. In particular, we have demonstrated a lack of outcome-based work in this area and call for evaluation in this domain to begin to further our understanding.

Conclusion

Despite the exponential growth in published research in the domain of open-learning resources, the empirical, evaluative body of work is thin. Perhaps, this is due to the limits in funding and/or expertise in evaluation. Indeed, there is huge potential for medical and health care professions educators to capitalize on these rich open data sets in a variety of contexts to support a range of outcomes expected to be achieved by medical graduates. The use of open data from social media channels in health care research and medical education is still in its infancy. 25 For practice, we hope that this study will serve to stimulate and subsequently generate research and evaluation in the area of social media use in medical education.

Social media and the term web 2.0 technologies have opened up opportunities for Medicine and, in particular, the emergence of the construct Medicine 2.0 or a computerization of medical services. Medicine 2.0 is related primarily to patients and their interaction with health care professionals (e.g., physicians, specialists, and other clinicians). In practical terms, Medicine 2.0 is redefining the doctor-patient relationship. This is an innovative shift in medicine and worthy of rigorous research and evaluation to better understand functionality and evaluate patient outcomes.

Footnotes
Disclosure
The authors report no conflicts of interest in this work.

References

6. Sterling MR, Leung P, Wright D, Bishop TF. The use of social media in graduate medical education (GME): a systematic review. Acad Med. 2017 Feb 21; Epub. [ PMC free article]

8. Cousins JB, Goh SC, Clark S, Lee LE. Integrating evaluative inquiry into the organizational culture: a review and synthesis of the knowledge base. Can J Program Eval. 2004;19(2):99-141.

9. Punch KF. Introduction to research methods in education. Thousand Oaks: Sage; 2009.

16. Whittaker AL, Howarth GS, Lymn KA. Evaluation of Facebook© to create an online learning community in an undergraduate animal science class. Educ Media Int. 2014;51(2):135-145.

20. Thalluri J, Penman J. Social media for learning and teaching undergraduate sciences: good practice guidelines from intervention. Electron J e-Learn. 2015;13(6):455-465.

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Social media as an open-learning resource in medical education: current perspectives

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Numerous studies evaluate the use of social media as an open-learning resource in education, but there is a little published knowledge of empirical evidence that such open-learning resources produce educative outcomes, particularly with regard to student performance.

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Social Media in Medical Education

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According to a 2011 survey, 94% of medical students and 79.4% of residents in the United States are active on-line social media users. Social media represent a relatively simple technique to provide educational material in a format that is adapted to the learning styles preferred by the "millennial" generation. Evidence suggests that most incoming medical students are receptive to on-line learning tools even in the absence of prior exposure to such methods for educational purposes. However, despite all of the attention social media have received in medical education circles, it remains unclear how social media use can be optimized to educate communities of learners through information sharing and knowledge dissemination.

Those of us engaged in the education of medical students, residents, and fellows have witnessed a transition in recent years from print textbooks, journals, and syllabi to predominantly electronic media. At many medical schools across the country, learning experience has in part shifted from classrooms into on-line platforms, commonly accessed through mobile devices. For instance, Stanford Medical School saw an increase in class attendance from 30% to 80% after transitioning much of the traditionally didactic classroom lessons into concise on-line sessions, and reserving classroom time for interactive discussions and problem solving. Similarly, many radiology programs, such as the program at the University of Arkansas for Medical Sciences, now use Web-based educational activities as an adjuvant to traditional didactic lectures. Advantages of electronic educational resources, or e-learning, include ease of access and physical transport, search-ability, and the potential for interaction among trainees as well as between trainees and educators. Dissemination of electronic educational resources via social media leverages one of this format's strengths: information flow is based largely on relative value as judged by users. For example, popular or particularly valuable resources will be posted, "liked," retweeted, and "favorited" more often, thus gaining a wider audience than resources that are deemed less valuable.

As of 2011, most health professional students prefer to receive educational material on-line. Even beyond formal training, practicing physicians now have access to an increasing array of on-line sources for continuing medical education (CME) such as the American Society of Neuroradiology's eCME course catalog ( http://members.asnr.org/ecme/) and American Academy of Neurology's on-line CME site ( https://cme.neurology.org/s/catalog). Social media represent an ideal way for professional organizations to disseminate new or updated on-line CME material to their members. Furthermore, social media also allow professional organizations to meaningfully interact with their members, collect feedback, and respond purposefully in a way that was not possible with traditional methods of member-organization communication.

In their review of social media use in medical education, Cheston et al report that the introduction of social media-based content favorably impacts learner satisfaction and knowledge. Social media succeed in accomplishing this in a number of ways. For educators, links to reading assignments or "case of the week" installments can be efficiently distributed to a group of followers using platforms such as Twitter. Hashtags can serve to archive current and past assignments, and to manage on-line group discussions on a particular topic. Tweet chats during and after lectures and journal clubs offer trainees the opportunity to ask questions and have discussions, or provide the group with links to related material in real time. Through such interactivity, social media channels promote knowledge sharing, rather than consumption of the material that is "pushed" to target audiences. In addition, participants in social media forums often have a variety of experiences and abilities, thus diversifying and enriching conversations.

The potentials of social media for medical education are only recently being realized, and robust evidenced-based data on this subject are lacking. In the coming years with the anticipated continuing shift of student preferences toward on-line content, increased interconnectivity, and peer-to-peer knowledge sharing, social media have the potential to substantially impact and disrupt medical education. The radiology community would be well served by leading this charge.

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According to a 2011 survey, 94% of medical students and 79.4% of residents in the United States are active on-line social media users.[1][1] Social media represent a relatively simple technique to provide educational material in a format that is adapted to the learning styles preferred by the "

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Social media and medical education: Exploring the potential of Twitter as a learning tool

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Social media in undergraduate medical education

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Are you interested in contributing to HLWIKI International? : dean.giustini@ubc.ca

To browse other articles on a range of HSL topics, see the A-Z index.

This entry is out of date, and will not be updated, May 2017

Introduction

Social media has been defined as:

"...a category of online media where people are talking, participating, sharing, networking, and bookmarking online. Most social media services encourage discussion, feedback, voting, comments, and sharing of information from all interested parties. It's more of a two-way conversation, rather than a one-way broadcast like traditional media. (Jones, 2009)..."

Major reasons why social media may be important in biomedicine

health professionals are required to know about and navigate the web's communication and collaboration ecosystems

social media such as blogs, wikis, RSS and Twitter are beginning to change medical education, clinical practice and research

may broaden the modes of education including expanding the curriculum around the science of teamwork, quality improvement, culture of innovation, and safety; use of social media and other technologies to expand learning opportunities

web 2.0 may be an effective platform to bring patients, physicians and information together

wikis and blogs help people collaborate and work together across distances

social media help health professionals to network, communicate and form communities of practice

social media is one part of a larger curriculum in social medicine, an emerging field with big potential in medical schools as they integrate new ways of teaching into the medical school curriculum

"...as the internet is becoming more and more important in medicine, we must include digital literacy in medical education as young doctors must learn about internet-related issues..." (Bertalan Mesko, 2012)

According to Hommes et al "...social networks have been shown to increase student learning. In addition, academic motivation, social integration and prior performance have been shown increase student learning as well. In addition, motivation and social integration have shown to be socially constructed, which might cause indirect effects of social networks on student learning..."

According to Jaffer "The use of online social networks in medical education can remodel and enhance anatomy teaching and learning; one such network is the video-sharing site YouTube."

Professionalism issues

According to Cheston's 2012 systematic review, "...three themes emerged from the literature re: challenges presented by social media in medical education 1) breaches of professionalism (49% of articles), 2) user privacy (32%), and 3) information quality (27%)

other concerns are physicians' lack of time; tools create distractions; respecting professional boundaries and confidentiality

characteristics of social networking sites, blogs, and search engines have potential to pose problems of professional boundaries

professional boundaries in online communication can be subdivided into ethical concerns, professionalism and clinical dilemmas

the web redefines privacy and anonymity for clinicians; any activities must be managed

alteration of professional boundaries, professionalism and clinical work, arise due to complexities of cyberspace

preparing for practicing medicine in the digital age means learning how to manage digital information but also digital relationships and boundaries; includes e-patients, physician rating sites, clinical practices using social media, social media medicine competencies

what is gained by using social media (i.e., scholarship, professional development, advocacy, patient education, medical education) followed by what is at stake if physicians don't use social media (ethical and legal problems, licensing issues, public trust in profession)

issues include how to prepare doctors for digital doctoring, professionalism, generational differences in what is appropriate, formal guidelines/policies, issue of who social media "experts" are

education about social media for trainees needs to be framed in the positive: the opportunities

physicians should avoid making or accepting "friend" requests through social networking with patients http://bit.ly/10QVUZs

Social media competencies in medicine

social media literacies; familiarity with social media and its purpose

provide definitions of major terms and tools tool

recognize principles of using social media professionally

identify preferred social media tools for medical education

understand generational differences in technology/social media use and views on professionalism

understand privacy and security issues pertaining to social media

develop social media policies

online content may affect physician reputations and medical careers; may undermine public trust in medical profession

Social media best practices in medicine

Facebook and Twitter are increasingly being used to disseminate information among health professionals and patients but, more recently, are being seen as a source of data for surveillance and research

Twitter hashtags are effective in building up a filter for information about new concepts in medicine

Twitter is also used more at conferences, enabling people on the other side of the world to follow the events live using a hashtag. You stick a label like #meded onto a Twitter post, and it enables others to connect to that conversation

"medical educators...felt that writing a deidentified patient narrative using a respectful tone was never or rarely acceptable (61%)" Chretien and Kind, 2013

Due to ease of use and widespread applicability, Twitter and Facebook are excellent applications of "push technology" as a means to deliver educational content. This pilot project demonstrates the potential of social media to both supplement and enhance traditional educational methods (Bahner, 2012)

ongoing need for continuing social media education, knowledge sharing, professional sharing (e.g. dialogue with colleagues about professional issues in online communities)

social media can help to build communities of learning and practice (for e.g. building Facebook pages for medical school courses, Twitter posts for medical school admissions) or patient support, especially in chronic conditions

through Twitter accounts, can be used for advising medical students, getting feedback from tutors, sharing ideas, curating flow of information, tweeting medical meetings, tweeting from the surgery, disaster management and response, etc.

Medical educators have both opportunities and responsibilities (Madanick, 2011): for themselves (supporting their continuing professional development, collaborative research, academic / scholarly communication, publishing and peer review), for their patients (improve their care and empowers them to have more control over their own data about their health), for their learners and for the public (gain media coverage, fundraising etc.). Although there are many opportunities offered by web 2.0 technologies, there is an increased need for training in how to use these technologies to enhance teaching and learning to support undergraduate and postgraduate medical education.

Key websites

Khan Academy, in collaboration with the Robert Wood Johnson Foundation and the Association of American Medical Colleges, is looking for the next generation of medical educators. We are launching a competition to produce the best medical and pre-health video lessons and accompanying questions.

"...The school I envision would embrace technology not for its own sake, but as a means to improve deep conceptual understanding, to make quality, relevant education far more portable and - somewhat counterintuitively - to humanize the classroom. It would raise both the status and the morale of teachers by freeing them from the drudgery and allowing them more time to teach, to help. It would give students more independence and control, allowing they to claim true ownership of their education..."

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Issa N, Mayer RE, Schuller M, Wang E, Shapiro MB, Darosa DA. Teaching for understanding in medical classrooms using multimedia design principles. Med Educ. 2013 Apr;47(4):388-96.

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Madanick RD. Social media in medical education: embracing a new medium. University of North Carolina School of Medicine on October 27, 2011, as part of the UNC Academy of Educators Lecture Series.

McGee JB, Begg M. What medical educators need to know about "Web 2.0". Med Teach. 2008;30:164-169.

Mostaghimi A. Professionalism in the digital age. Ann Intern Med. 2011;154(8):560-2.

Oakley M, Spallek H. Social media in dental education: a call for research and action. J Dent Ed. 2012;76(3):279-287.

Patel PD, et al. The responsible use of online social networking: who should mentor medical students. Teach Learn Med. 2012;24(4):348-354.

Ross S, Forgie S. Distracted doctoring: smartphones before patients? CMAJ. 2012;184(12):1440.

Saarinen C, Arora V, Fergusen B, Chretien K. Incorporating social media into medical education. Academic Internal Medicine Insight. 2011;9(1):12-13, 19.

Sandars J, Schroter S. Web 2.0 technologies for undergraduate and postgraduate medical education: an online survey. Postgrad Med J. 2007;83(986):759-62.

Thompson LA, Black EW. Nonclinical use of online social networking sites: new and old challenges to medical professionalism. J Clin Ethics. 2011 Summer;22(2):179-82.

Thompson A. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008;23:954-957.

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Are you interested in contributing to HLWIKI International? : dean.giustini@ubc.ca To browse other articles on a range of HSL topics, see the A-Z index . This entry is out of date, and will not be updated, May 2017 Social media has been defined as: "...a category of online media where people are talking, participating, sharing, networking, and bookmarking online.

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Social Media and Free Open Access Medical Education: The Future of Medical and Nursing Education?

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Christopher L. Carroll, is a pediatric critical care physician at Connecticut Children's Medical Center, Hartford, CT. Kristi Bruno is pursuing a master's degree in New Media Studies, DePaul University, Chicago, IL, and Michael vonTschudi is a nurse intensivist, at the Central Florida Critical Care Group, Orlando, FL.

Corresponding author: Christopher L. Carroll, md, ms, Division of Pediatric Critical Care, Connecticut Children's Medical Center, 282 Washington Street Hartford, CT 06106 (email: ccarrol{at}connecticutchildrens.org ).

It has become cliché to say that the Internet has changed everything, but it did, fundamentally transforming how we communicate and interact. All the world's knowledge and experiences are available at any time with just a click of the mouse. Information is easily accessible and free to anyone with a computer, and communication across continents is as easy as e-mailing someone next door. In 1995, just 14% of American adults used the Internet, but by 2014, 87% were regular Internet users. Today, organizations and private citizens in all areas have taken to the Internet to entertain, to inform, and to advocate.

As the Internet expanded into our homes, there was a growing expectation of free and open access to information. Because information was so easily accessible on so many sites, there developed an expectation that all information should be free. In the 1990s, there was an expectation of free music downloads. In the 2000s and 2010s, there was an expectation of free videos, movies, and television shows. And in higher education, universities began offering free online courses in an effort to grow their online presence and expand reach and goodwill. Now, massive groups of online students watch the same lectures and (and in some cases take the same tests) as paying in-person students.

From this openness, people found new ways to interact online. At first this interaction was through communication in chat rooms, online message boards, and e-mail. In the beginning, these communications were relatively uncommon. Although it is hard to imagine now, in the early 2000s many people did not have computers in their homes. However, with cheaper and faster computers, and with the development of the smartphone, these interactions were easier and more convenient than ever. Currently, 64% of American adults have a smartphone equipped with Internet access, up from just 35% in spring of 2011. Users have the tools to communicate and interact with anyone at any time literally in the palm of their hands. With these advances in technology, digital interactions became more commonplace and more mainstream, and the social use of these tools began to explode in popularity.

What Are Social Media?

Social media are broadly defined as the use of platforms of electronic communication through which users create online communities. Social media use is common; 74% of Internet users spend time on social networking sites, with 71% of online adults using Facebook and 23% using Twitter. Women currently outpace men in social media use, with a recent survey finding 74% of women were users of social media compared with 62% of men.

These online communities are used to share information, ideas, personal messages, and other content. A variety of social media platforms comprise these communities, including Twitter, Facebook, YouTube, and blogs. Each social media platform has slightly different characteristics that depend on the nature of that platform, which result in different user bases and functions. For example, Twitter is a brief, fast-paced microblogging platform that allows just 140 characters per post and requires extreme brevity and a flair for great writing. Facebook is slower paced and visually oriented, and the communities feel more insular to the end user. Blogs are generally static forums, but allow for longer-form content. And YouTube provides a forum for videos that can entertain as well as inform. Each platform offers different services and methods for connecting, and multidisciplinary communities of providers and patients form organically within each of these spaces.

On some platforms including Twitter, Instagram, and Facebook, users connect through the use of "hashtags." These searchable keywords, indicated by the # sign, allow for users of similar interests to aggregate and connect. Some examples of online communities include #hcsm for health care social media, #pulmCC for pulmonary and critical-care medicine, and #FOAMed for free open access medical education. Symplur's Healthcare Hashtag Project has collected and organized more than 8000 health care hashtags, each representing a disease state, medical conference, or group of people interested in the topic.

Social media have also become an integral tool for medical societies, hospitals, and advocacy groups. These groups are using social media to engage, teach, and connect, and they play an important role in providing accurate, vetted health information. Additionally, organizations have realized that encouraging live-tweeting or blogging of conferences provides opportunities for wide dissemination of content that far surpasses in-person attendance.

State of Medical/Nursing Education Today

It has been said that we are drowning in data, but starving for knowledge. The amount of knowledge and information required for health care providers today is staggering. The need for continuing education is more important than ever before. Social media platforms can help supplement traditional knowledge. Students and learners of all levels routinely check the Internet for facts about disease states, therapies, and physiology. Although these platforms can supplement and enhance learning, it is important to realize that they cannot replace fundamental education and experience.

What is FOAM?

The Free Open Access Medical Education (FOAM) movement is an online community that provides medical education through a variety of social media platforms. The FOAM community is organized primarily around the #FOAMed hashtag but includes several other related hashtags including #FOAMcc (FOAM critical care), #FOANed (free open access nursing education) and #FOAMrn (FOAM nursing). Content is posted on blogs, YouTube videos, podcasts, Twitter feeds, and Facebook groups. Like many social media communities, FOAM has no official leader. Content is created organically by individuals in a variety of disciplines and subspecialties and from all over the world. The quality of the content is vetted in real time by the users.

The story goes that the term FOAM was coined in a bar over a pint of Guinness by Mike Cadgoan in 2012. But the movement that was later to be called FOAM can also be traced to informal groups of multiprofessionals who joined together in e-mail listservs and chat rooms to discuss difficult cases, to learn, and to generally commiserate. Among the earliest of these was David Crippen's CCM-L, the International Internet Critical Care Medicine Group. Spurred on by an increased connectivity and ease of participation through improvements in computing technology, coupled with a growing cultural expectation of free and open access in the digital age, the open access medical education movement was born.

How Do People Use FOAM?

FOAM is used to communicate and educate. Users can search Twitter for articles, listen to podcasts for the latest in evidence-based medicine, read blogs for summaries and commentaries, and watch YouTube for video instruction. These pieces are typically more dynamic, less formal, and more conversational than traditional educational materials. All can be done at the user's own time, or asynchronously from the author.

One of the central benefits of FOAM is the low barrier to entry. Twitter accounts are free to set up and use, and by attaching an appropriate hashtag, users can join in and begin to build a community. When we consider geographic and economic barriers that currently exist in medical education, FOAM becomes even more attractive. Users share interesting content, often free of charge, seek out free content from publishers, and debate topics. Location is of little importance-in Los Angeles, London, or Laos, users are able to learn, share and contribute.

Social media users follow a spectrum of involvement in social media that ranges from low to high involvement. Will Hill of AT&T Laboratories first outlined the idea of participation inequalities in the 1990s when reviewing early forms of social media such as Usenet newsgroups and CompuServe message boards. The 90-9-1 Rule for Participation outlines the inequality in social media and online communities and states that 90% of members of an online community exclusively lurk and never contribute; 9% contribute a little, and 1% of users account for almost all the action. In a Nielsen Norman blog post by Jakob Nielsen, it is noted that blogs have an even more drastic participation inequality. Nielsen estimates the rule shifts to 95-5-0.1 when applied to blogs, a major outlet for FOAM content creators.

What is the Future of FOAM and Medical/ Nursing Education?

The danger in all social media is that well-informed participants with important ideas must be strong self-promoters or risk their voices going unheard, whereas the voices of those with popular views or sponsors (or in the market for sponsorship) rise above all the others simply because of their skill at self-promotion. The problem is that sometimes ego outweighs talent, unbeknownst to the reader or listener. Thousands of followers or "likes" are not necessarily indicative of an individual who seeks to contribute to the knowledge base or refine the practice.

Content producers cannot assume that their followers are erudite; they may simply be inexperienced and searching for a mentor. All who seek knowledge, regardless of the medium, must attempt to curate high-quality information and accurate content amid the din of popular content. Therein lies the conundrum. The content will only be as good as the audience demands. In much the same way that social media can claim small victories in correcting statistical errors in published studies, the same attention to detail becomes paramount when the evidence outweighs the enthusiasm for practice changes supported by the most ubiquitous voices in social media.

Regarding the quality of online nursing content, we see that often, instead of talking about issues that affect the collective and the patients, the conversation revolves around products. Presumably this is because these posts trend well. However, there is a new generation of nurses who may be insecure in their practice and want access to information and knowledge beyond the very general education provided in nursing school.

Whereas physicians fresh out of medical school have 3 years (at a minimum) to augment their knowledge and hone their skills, with oversight and guidance from a more experienced physician, before the full burden of patient care is theirs alone to bear, a new registered nurse (RN) will be given 12 weeks, often less, of orientation with another RN, who may also be quite inexperienced. Further, many smaller hospitals lack the resources to provide the cutting-edge education modern nurses require to adequately provide care to the patient populations they serve. Quality educational offerings, and those who curate them, are available online from many sources, only a click or a follow away, at no cost to the learner other than the time it takes to filter and process them. This is the true potential benefit of social media.

Unfortunately, many nurse leaders, with years of experience in this multifaceted profession, have yet to join the conversation on social media. Therefore, the conversation is often led by novices in the field, simply because leaders are absent. As bedside nurses, we must attempt to convince nurse leaders that the conversations begun in nursing school are ongoing; they have simply relocated from the physical classroom to the burgeoning virtual classroom.

Limitations of FOAM

But there is a potential downside to this open access. The quality of the content on social media and the Internet is dependent solely on the members of the online community. Although there may be real-time peer review to critique misleading or incorrect information, the quality of that content may be variable. Additionally, social media forums necessitate brevity. Forcing brevity is a excellent way to facilitate understanding by the author and reader. But the downside is that some things are not simple and deserve further explanation. Nuance and complexity can be lost behind pithy statements.

Also, since FOAM does not follow a curriculum, there is a risk of failing to cover potentially important topics. In social media, there is a heavy focus on areas of emerging treatments such as point-of-care ultrasound, bronchoscopy, and the use of technology and data in patient care. Other less glamorous but still important basic topics may get missed by beginning learners who rely solely on social media for their educational content.

Conclusions

Social media are here to stay. Social media platforms, and in particular the FOAM movement, have the potential to be a novel way to augment your education and to connect with other leaders in health care. But social media cannot fully take the place of traditional education methods. Health care providers have an obligation to participate in the active discussions taking place on these social media platforms. As stewards of health care, it is our responsibility to help educate the next generation of providers.

Footnotes

A regular feature of the American Journal of Critical Care, Current Controversies in Critical Care addresses the ethical and administrative issues faced by health care professionals working in today's critical care environment. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click "Respond to This Article" on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of scenarios for future discussion.

FINANCIAL DISCLOSURES

None reported.

eLetters
Now that you've read the article, create or contribute to an online discussion on this topic. Visit www.ajcconline.org and click "Submit a response" in either the full-text or PDF view of the article.

To purchase electronic or print reprints, contact American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org .

# data[].attributes.attachment_link.title
Social Media and Free Open Access Medical Education: The Future of Medical and Nursing Education?

# data[].attributes.attachment_link.description
Christopher L. Carroll, is a pediatric critical care physician at Connecticut Children's Medical Center, Hartford, CT. Kristi Bruno is pursuing a master's degree in New Media Studies, DePaul University, Chicago, IL, and Michael vonTschudi is a nurse intensivist, at the Central Florida Critical Care Group, Orlando, FL. Corresponding author: Christopher L.

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Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective

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Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective

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Social media, through the Internet and other web-based technologies, have become a means of communication and knowledge-sharing. In this article, we p...

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The Use of Social Media in Graduate Medical Education: A Systematic Review

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What do We Know about the Use of Social Media in Medical Education?

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What do We Know about the Use of Social Media in Medical Education?

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In the last years there has been a growing interest in using social media in every area of higher education (from political and social sciences toward...

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Social media in medical education: a new pedagogical paradigm?

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Social media is now a part of modern life. 1 Internet based tools allow millions to keep in touch with each other and anyone to create, and publish content instantly. Individuals enjoy the fun, and rely on the functionality of social media in their daily lives. But the real power of social media is the impact of bringing together clusters of like-minded people to engage in real-time, on-line dialogue on topics that merely interest them-or about which they feel passionately: 'community' is no longer a function of geography.

Crowd-sourced funding initiatives for start-up companies, and attempts to influence government or corporate policy through petitions 'signed' by thousands in a matter of days, are normal aspects of enterprise today. The Arab Spring is perhaps the most notable example of the potential impact of social media and shows how connecting thousands of people, in real time, can raise activism from a local concern to a worldwide movement. 2 Such developments are way beyond the expectations of the small group of academics who, in 1989, invented the internet to improve communication between scientists. 3 Their altruism, and insistence that the World Wide Web should be available 'free' to anyone on the planet, laid the foundation of today's developments.

Social media has yet to have the same impact on medical practice as they are having on daily life. However, the internet is making a difference. Knowledge, once the monopoly of the professions is now available 24/7 to anyone with a search engine. Healthcare professionals must get used to losing this monopoly or they won't be able to function in today's world. Inexorably, the tenor of consultations is changing: doctors-once suppliers of information are increasingly guides and interpreters, helping patients to make their decisions. And social media allows communities of people with similar conditions to come together and share experiences and information. So, the knowledge and experiences that patients bring to consultations may be of a completely different calibre to that found in text books and papers, something that doctors need to know how to respond to.

In tandem with the rest of society, the lives of doctors have been changed by social media. Professional and personal lives are not as distinct as they once were; the values, behaviours and relationships that underpin medical professionalism are the same. However, whereas professional behaviours were once mostly of concern during working hours, the actions and opinions of doctors can now be shared instantly with thousands on-line, 24 h a day. Maintaining trust can be a different challenge for doctors active in social media. Already, important guidance about professionalism and social media has been published to help doctors keep within professional boundaries when using social media for work and leisure. 4

Education on the other hand, has already been more clearly changed by social media. Through organisations such as the Khan Academy, education is available online to many; 5 seminars have become webinars; traditional categories of teacher and learner are changing. 'Flipping the classroom' (see box 1) is now an accepted approach to learning in which learners play a much more active role and teachers are more supportive than didactic. 6 , 7 But traditionally, medical education has evolved slowly and, despite enormous changes in medical practice, William Osler would still recognise many styles of medical education in clinics and hospitals worldwide.

Flipping the classroom

The concept of the 'flipped classroom' emerged throughout the 1990s. The intention is to use contact time with faculty for knowledge assimilation and exploration, with the process of knowledge transfer taking place elsewhere. Instead of the traditional didactic lecture being the mainstay of lesson time, it is replaced with coaching or discussion, with lectures and other materials often made available on-line. This model has been applied successfully in healthcare settings, as well as in mainstream high school and college education. 7

Today's younger generations are 'growing up' using social media, and many can be considered 'digital natives'. Medical students and postgraduate trainees may have already experienced the power of on-line learning in addition to traditional forms of knowledge transfer. 8 The internet rather than the library is now the usual source of knowledge and the learning environment is changing. Now, the 'apprentice' does not have to rely on a discrete source of knowledge but can seek information from many 'masters' unbounded by geography or even qualification. The free and open access medical education movement has democratised medical education materials 9 and has empowered learners.

Steadily the social media movement is having an impact on learning. Conferences and conventions have #tags, @conference twitter accounts and some have more on-line distant participants than those at the convention centre. But more radical changes are happening. Existing projects leveraging social media in medical education include online journal clubs where authors defend their work during a global meeting of minds and 'tweet chats' that flatten the hierarchy and allow the wider multidisciplinary team (including patients) to contribute to learning about a subject area in a public forum. 10 , 11 None of this would be recognised by William Osler.

So, while much of medical education continues as it always has, a true 'disruption' is also happening. It is important that the impact of making potentially radical changes to how we teach and how we learn are properly assessed and evaluated. Some of these were discussed at the Social Media Summit at the 2014 International Conference on Residency Education.

The Summit, marking the importance and influence of social media on medical education, was an international open access meeting promoted using multiple media streams. 12 Through four major themes the conference explored some of the major questions about social media in medical education. For example, instant publication can lead to unformed ideas making it onto the world stage without having to break through the traditional cocoon of peer review, sense-checking and revision-so how can true scholarship flourish in this environment? Concerns about the genuine value of an innovation; how to navigate the plethora of blogs, websites and chats are addressed; how to reassure that social media education can be located within the traditional classification of pedagogy, and participants' hopes for the future of social media in medical education were all reflected in the work of the summit. 13-16 Recognising the importance of such questions and responding to them is crucial if we are to realise the possibilities of social-media based education.

We need to understand what works when, and be able to compare social-media based approaches to medical education with traditional methods. To do otherwise would perhaps be seen to be no better than continuing as we always have. But here is the difficulty. Social media platforms are not simply a tool to be applied in certain situations; they are now fundamental to how we relate to, and with, society. We simply cannot explore education innovations without recognising the impact of social media on our enterprise. Moreover, as social creatures, working in the socially situated science of medicine, we must resist simply codifying and classifying social media according to current ideas about how we practice medicine or medical education. It is likely that we are experiencing or are about to experience a significant 'disruption' to medical practice and medical education. Time is not on our side, and the nature of our discourse is already in the process of changing.

Clinical educators have always had the task of preparing today's students for tomorrow's practice, but never before have they had to balance such a range of approaches to learning and training. Confining or restricting the influence of social media on medical education so we can study its impact would be a hopeless task. So perhaps, rather than using a rigorous traditional framework of appraisal and scholarship, clinician educators should facilitate the transition of social media in healthcare into a valid, recognised element of professional practice, working with learners to ensure that we realise the potential to facilitate learning. And in doing so, the tricky task of today's clinical educators may be helped by coproduction and colearning with their generation of students: a real change from traditional pedagogy

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Social media in medical education: a new pedagogical paradigm?

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Social media is now a part of modern life.1 Internet based tools allow millions to keep in touch with each other and anyone to create, and publish content instantly. Individuals enjoy the fun, and rely on the functionality of social media in their daily lives.

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Social Media use within medical education: A systematic review to develop a pilot questionnaire on how social media can be best used at BSMS

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MedEdPublish Article: Social Media use within medical education: A systematic review to develop a pilot questionnaire on how social media can be best used at BSMS

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MedEdPublish (ISSN 2312-7996) is a highly visible, open access, specialist practitioner e-journal that enables academics, teachers, clinicians, researchers and students to publish their experiences, views and research findings relating to teaching, learning and assessment in medical and health professions education. An innovative and key feature of MedEdPublish is that the peer review process begins following publication.

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Advancing social media in medical education

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With rapid, grassroots adoption of social media in medical education, concerns are emerging about potential risks, while benefits may be unclear. Social media holds great value as a teaching and learning tool. Canadian medical schools need to proactively adapt their curricula to this dynamic learning landscape by incorporating social media within their teaching environments in ways that are innovative, timely and evidence-based. We discuss the value of social media as a teaching and learning tool and examine some known risks and mitigating strategies.

Within the broad category of Web-based learning, educational platforms typically exist along a spectrum, varying in the degree to which users connect and collectively create content. Although many e-learning, mobile and Web-based educational tools adhere to conventional, didactic models for knowledge transmission and dissemination, social media is user-generated and collaborative, introducing a new dimension of participatory learning. The penetration of these media into educational realms provides the opportunity to shift learning paradigms from an individual, constructivist model, where knowledge is constructed by the learner, to a connectivist model, where knowledge is generated by information exchange and distributed across connections between learners. Web-based tools such as social media support the latter model in learning within, and between, communities of practice. This evolution to connectivism, dubbed "a learning theory for the digital age," can be seen in parallels between more traditional learning materials (e.g., paper-based textbooks) and their newer, sociotechnical counterparts (e.g., collaboratively created "wikis").

Although social media may be a relatively novel or unfamiliar tool for some educators, today's medical students have used it extensively as a communication tool throughout their teen and early adult personal, professional and educational lives. Social media enhances medical education by including students in the explicit creation of their own knowledge and by facilitating engagement, self-reflection and active learning. For example, medical trainees may use Facebook or Google+ for online group collaboration, sharing of resources and virtual moral support from student peers. Educators may incorporate YouTube videos covering medical topics in classroom lectures to enhance concept delivery with animations or video demonstrations, and students may stream videos to review difficult concepts outside of class hours. Students may be encouraged to tweet questions during lectures or conferences, using hashtags to link related Twitter conversations. Some students may be asked to reflect on their training experiences by writing blog posts that can then be made available to their peers for comment or feedback. Students may collaborate in the creation of wikis related to medical topics, synthesizing information and sharing knowledge. Podcasts, photo-sharing (e.g., through Flickr or the Figure 1 app) and file collaboration (e.g., through Google Drive or Dropbox) can also be used. In addition, this online milieu can stimulate peer and faculty review of posted social media content (e.g., through a comments feature) on a global platform to ensure accuracy of information, and it facilitates rapid feedback to learners from within and outside of formal learning circles., Knowledge translation and continuing professional development can be enhanced through the formation of collaborative, international online journal clubs.

A lack of established metrics within the field, compounded by logistical difficulties in collecting certain data (e.g., who is using what tools, and how), presents challenges to research. As such, there are limited data from rigorous program evaluations supporting the theoretical, and anecdotal, advantages of social media in medical education.

Although most medical trainees and many faculty already use some form of social media in education, institutions and licensing bodies have been more conservative in their adoption of official policies and programming to endorse and support its use. This caution may be due in part to the numerous anticipated risks and challenges commonly associated with the use of social media in medicine and medical education. Social media use during lectures may be a substantial source of distraction, leading some instructors to limit its use during class time. Professionalism is also a major concern as teachers and learners manage and negotiate the boundaries between their personal and professional online identities. For example, private photos, perhaps inappropriate in a professional context, may be seen by others when a personal social media account is used for educational purposes. Moreover, in this connected, digital age, previously distinct personal-professional boundaries may now be more blurred because identities are represented holistically. Health professionals and trainees will thus need to navigate virtual interactions authentically yet cautiously. Preserving patient confidentiality is also of great concern, since identifiable images or patient information might be shared online without appropriate consent. Further challenges of integrating social media into mainstream medical education include the legality of sharing copyrighted educational material and other intellectual property (e.g., lecture slides and images);, the global nature of social media in culling content of highly uneven quality (sometimes produced by non-experts) and potentially exposing students to wrong or misleading information;, and the significant variability in the degree to which students and faculty embrace electronic and social media.

A one-size-fits-all approach will not be suitable for every learning context. Guidelines on the appropriate use of social media were developed by the Canadian Medical Association (CMA) and the Canadian Federation of Medical Students., The latter are targeted toward medical students and are both recent and pertinent to medical education, whereas the CMA guidelines offer limited guidance for medical educators and will need to be updated to remain current given the rapid evolution of social media.

By developing evidence-based policies related to social media use, medical schools can effectively mitigate risks to the legal, professional and ethical integrity of medical trainees and teachers. By providing training around social media and online professionalism, schools can effectively educate students and prevent or reduce lapses in professionalism and breaches of confidentiality. Some Canadian medical schools have already begun to incorporate this within their curricula. In addition, the provision of ongoing technical guidance will support users at all levels. Where concerns about the potential for distraction may lead some teachers to want to limit the use of social media during class time, education programs could instead seek to harness the power of the technology and aim to control social media as part of the learning process, with well thought-out strategies for engagement.

Institutions and faculty should proactively identify and highlight high-quality resources to ensure learning materials used in social media are accurate and relevant. Further research needs to substantiate and characterize best educational practices in social media and to identify optimal ways to assist institutions in integrating and implementing these approaches in their curricula. Through these policies, institutions will foster an environment that enables appropriate social media-enhanced teaching and learning, and the co-creation of a dynamic and active learning milieu by teachers and students together.

Key points

With the rapid, grassroots adoption of social media by medical trainees and teachers, medical schools need to account for and incorporate social media within their curricula.

The use of social media holds great value as a teaching and learning tool in medical education, by including students in the creation of their own knowledge and by facilitating engagement, self-reflection and active learning.

Proactive policies and training can effectively mitigate risks and challenges associated with the use of social media in medical education (e.g., confidentiality breaches and professionalism concerns).

# data[].attributes.attachment_link.title
Advancing social media in medical education

# data[].attributes.attachment_link.description
With rapid, grassroots adoption of social media in medical education, concerns are emerging about potential risks, while benefits may be unclear. Social media holds great value as a teaching and learning tool. Canadian medical schools need to proactively adapt their curricula to this dynamic learning landscape by incorporating social media within their teaching environments in ways that are innovative, timely and evidence-based.