The Power of Social Media in Medicine and Medical Education: Opportunities, Risks, and Rewards

Abstract

Tweets. Hashtags. Blogs. Hangouts. Podcasts. Wikis. What do these social media platforms and verbiage have to do with education, and why should you care? Social media is used on a daily and even hourly basis as a modality to rapidly and effectively communicate, educate, and learn. Some medical specialties have quickly adopted and embraced social media, particularly in the fields of emergency medicine, family medicine, and pediatrics. Other fields, including laboratory medicine and pathology, have had a much slower uptake that may directly correlate with the amount of patient–physician interaction. The specialties that have a high rate of use have also catalyzed implementation of social media into medical education and residency program curriculum, and used it as a modality to recruit physicians and staff at all levels. In addition, the free open-access movement (FOAM)9 has altered how medical education resources and content are accessed by physicians and patients, ultimately shifting and removing geographical and income barriers across the globe. Laboratorians and pathologists have a unique opportunity to move outside the 4 walls of the laboratory and engage other physicians, residents, and even patients in a way that has never been done before. Perhaps it is time we communicate beyond the results reported in the electronic medical record, and instead discuss the value and contributions that our laboratories provide every day. Here, 6 experts in the social media field share their thoughts on social media use, challenges, and opportunities. What are the primary forms of social media you use from a professional and educational standpoint, and how long have you been using them? How has your profession and/or colleagues responded (i.e., fast or slow adopters) to using social media? What do you believe are the primary contributing factors to this response? Shannon Haymond: My primary format for this purpose is Twitter. I have been using Twitter as a news source and way to collate information since 2010. However, it was only after I saw a lecture by Dr. Seth Trueger (@MDAware) called “Number Needed to Tweet: How Social Media Is Changing Medical Education” that I became brave enough to use it to share my own thoughts and disseminate information. The professional response in our field has been slow, but I am seeing more and more laboratorians engaging, which is fantastic. I think a barrier to faster adoption is that people are not sure of the value or level of professionalism (i.e., they assume it is all about pop culture and celebrity feuds) and may be apprehensive to put their opinions out into the public conversation. Social media users experience a bit of a learning curve, requiring time and dedication to hone this new skill. Without recognizing the benefit, it is difficult to justify the time needed to add to and keep up with one more thing in an already packed life. Social media platforms are also constantly evolving: Several options exist with more being added all the time; their functionality changes; and trends in popularity among specific groups of users shift relatively quickly. Stephen Smith: The primary forms of social media that I use are Facebook and Twitter. I find Facebook by far the most useful. I frequently look at electrocardiograms (ECGs) on the Facebook ECG club, where I learn from and teach others. Every time I post on my own ECG blog, I share it on multiple Facebook pages, aside from my own, including other ECG, cardiology, paramedic, and internal medicine pages. Another useful way to share information is through blogs. Because I use Google Blogger, I am automatically part of Google+, which has given me great exposure. Until a year ago when they stopped tabulating Google+ pages, I was getting 40000 page views a day and had 37 million page views. I believe many of my colleagues do not use social media nearly as much as I do, and I think the major factor is lack of time. Those who want to disseminate information are much more likely to use social media. I use it primarily because I have a lot of content to distribute. If you are using social media only to be updated, I think it is inefficient, especially if you subscribe to many different feeds. You can spend an enormous amount of time following all your Twitter feeds without a whole lot of direct benefit. Simon Carley: I started using social media seriously in 2012 with Twitter, developing a personal presence and leading the online virtual hospital St. Emlyn's. Now we cover most mainstream platforms, WordPress blogs, podcasts, Facebook, Tumblr, and, more recently, Instagram. Emergency and critical care medicine have embraced social media under the free open-access medical education (#FOAMEd) movement that seeks to share knowledge as widely as possible and for free. Initially there was a lot of skepticism, but I think that has largely passed. In the UK, many emergency medicine physicians find it a useful resource for learning, although there is a big gap between awareness and involvement, and many physicians are not engaged at all. Emergency medicine has adopted social media at a much faster pace than most specialties owing to the ability of social media to engage individuals across the breadth of our specialty, despite the chronological and geographical challenges that typify our practice. Michael Berkwits: The JAMA Network, a family of 13 clinical journals, has been using social media since the end of 2011. Our efforts focus on Facebook, Twitter, and Google+, with selective posting on Pinterest and LinkedIn. Growth in followers has been steady because we have committed to posting everything we publish on these platforms regularly. User engagement on the platforms sends a clear signal that we are appealing to clinicians, allied health professionals, students and trainees, and the lay public who are already using the platforms for personal and informational purposes. Jonathan Sherbino: I use 3 social media platforms regularly in my role as a medical educator. I edit a blog (International Clinician Educator, ICEnet.royalcollege.ca) that connects a global community of health professions educators. The blog has 8 contributing authors and 4500 subscribers representing 125 countries—and started just 4 years ago. Posts are published twice weekly and include reviews of emerging literature and commentaries on issues of importance to the health professions education community. The tone is informal and conversational, and the pieces are brief (i.e., digestible in <5 min) with links to additional resources for the interested reader. I also cohost a biweekly 20-min podcast called Key Literature in Medical Education (keylimepodcast.royalcollege.ca). A single article from the recent health professions education literature is discussed with attention to the methodological rigor and the educational impact of the article. The KeyLIME podcast was started 5 years ago. Finally, I have a professional (i.e., associated with my interest in health professions education) Twitter account that I began using 5 years ago and utilize in 3 ways. I use Twitter as an aggregator to condense numerous online conversations relevant to health professions education into a single stream. By monitoring the stream, I can identify emerging issues to investigate more fully. I also use Twitter to disseminate and share resources that I have discovered or assisted in developing. This platform allows rapid exponential dissemination of a resource that may benefit the broader health professions education community. Finally, I use Twitter as a “help desk,” submitting inquiries to my social network, where solutions or next steps are regularly provided. Within health professions education, I think we are now at a tipping point from the early adopters to the early majority, largely a function of a generational shift with early career educators promoting and modeling the professional use of social media. I cochair the International Conference on Residency Education, and even 5 years ago we did not have a hashtag. Now we have Twitter monitors for every session to curate virtual and physical audience interactions with the speaker. We livestream plenary sessions with remote viewing parties and online discussion from around the world. Finally, we have introduced virtual posters, where video presentations of research abstracts are hosted on a blog platform with questions and answers posed via the comments section, allowing a researcher to access an audience beyond onsite conference attendees. However, my suspicion is that these social media platforms are more widely embraced by younger generations. My opinion may be influenced by a medical education fellowship that I codirect. We use a social media platform (Slack.com) to enable asynchronous dialog among cohorts of trainees. Uptake and ease of use are routinely stratified by year of birth. One of many factors that has influenced the adoption of social media among early career educators is access to virtual communities of practice. The health professions education community is small compared with other clinical disciplines. Access to individuals with shared interests and, of particular importance, access to specialized mentorship in education can be challenging if limited by geographical boundaries. Social media removes these physical barriers, allowing an individual to participate in a richer community. Familiarity with the technological platforms for personal use (e.g., Facebook to keep up with friends) allows easy cross-purposing of the platform for professional networking. Marie Ennis-O'Connor: Although I use a variety of social media, Twitter is my go-to platform for keeping up to date with research, networking with peers, and taking the pulse of what is topical in healthcare. I started a healthcare blog in 2009 and joined Twitter, LinkedIn, and Facebook in a personal capacity. In the past 5 years I have turned my focus increasingly toward using social media to enhance my professional goals. I was an early adopter in some respects in the healthcare field, but my profession and my peers are catching up. I believe adoption of social media in healthcare has been largely driven in response to the increase of more engaged healthcare consumers. What are the advantages to being active in social media, from either an educational or professional standpoint? How has it altered your career and/or redefined how you work daily? Michael Berkwits: Social media allows publishers to distribute information to readers in the work flow and spaces they are already using. With innumerable options, most people direct-access only a handful of website homepages (usually for sports scores or news) and instead use social media platforms as way to curate “tables of contents” of people, interests, and sources they want to keep up with. From a publisher's perspective, the platforms have multiple advantages over core websites: They facilitate amplification through social sharing; they permit user targeting by interest; and they can help ranking in search, a less social but critical way users find and access information. Social media opportunities have not redefined the work of journal publishing, but the JAMA Network has evolved a system to publish articles to social media platforms, just as it publishes to print and online platforms. Jonathan Sherbino: For early adopters of social media, there was an obvious scholarship opportunity as educators investigated the adoption of social media to promote learning. I was fortunate to collaborate with other education researchers to investigate the use of social media in health professions education, making this a minor theme in my program of scholarship. However, this space is increasingly occupied with the novelty of social media as an emerging phenomenon being replaced with lines of inquiry that take advantage of the principles of social media: open access, interconnectivity, asynchronous dialog, and crowdsourcing. Currently, social media has increased my professional connectivity. I have made virtual introductions and collaborated on research projects with individuals I have yet to meet in person. I am cosupervising a cohort of medical education fellows from across North America over an academic year without ever meeting any of them in person. Simon Carley: I am more up to date than my peers who do not engage. I am a better physician as a result, and I truly believe that my patients receive better care because of this. Professionally I find it intellectually satisfying, as I am forced to constantly learn and reflect on my current practice. It has created opportunities to join research and educational groups across the globe with interactions through leading to journal and numerous to at and My personal learning of experts is limited to in my or and I regularly learn from in other and health Marie Ennis-O'Connor: Social media has my life. may a but I have the of my career as a direct of social media. My interest in using social media in healthcare was from my experience as a I discovered how social media me access to information and I was I now work as a social media in to the healthcare Social media a whole new of that has driven my work in and healthcare Shannon Haymond: It is a way to up to date on rapidly fields and to with a of people who share your This is particularly for interested in your of but from a different I use social media to find and for the content and of my and educational I have also that it is a great way to that we teach to and to who are experts in a given Social media is an for about with the to from the of use social media is among younger the including free access and of the of online information is Social media is a great way for laboratory medicine to and to the content relevant to our of This your own personal work and opinions in to on that of for the broader role of our Stephen Smith: the benefit that I have from social media is in of my own work and with Facebook being by far the most social media for I put up a new post and share it on Facebook, I receive between and views on Facebook, and Facebook a amount of directly to my blog I began using Facebook more this it has to my to The amount of information in different social media can be What are for of Simon Carley: is a of We all to the flow of information and to the high value I use personal learning and to help me and collate useful I have a personal learning of individuals who collate and curate interest are individuals who have a interest in an (e.g., and who share the most in that I use them as in relevant to my and I in the in for which I have You find and the high high individuals or that content for I also that as for social media which a weekly and it to your I also use and that collate different (e.g., to content on any in an a as and to and automatically content for I to information Marie Ennis-O'Connor: It is information the is taking a from a I up Google for specific and use aggregator and to keep up to I also on to and links for easy and use as a Jonathan Sherbino: Social media is a in research, a of information that to identify information. has this of to relevant the needed to are that I to the of social media the to all social media platforms allows the of a on a specific the amount of information to be to by a I more attention to or with a of high than any my provide and A of social media can identify these Shannon Haymond: this is a are the social media that can With Twitter, for on the of the one using or are to by or I for and links or articles that I either want to have to in more or that I I want to in the I use and help to the amount of find relevant content from other and to What do you believe are some of the major and when using social media? Stephen Smith: this is my but I think social media is used much for I think you should be about what you post on social media. It should be high Although it not be it should be as as This you to be an in what you are are many people who are information that is not This to information Because there is much we should to what we post to only that are and to the of our We should not be posting for our own to be to how many followers one or how many one has put up. Marie Ennis-O'Connor: add to the you share a to an beyond the to add your useful content and provide links to information that be of value to others. twice as much as you media is a conversation. into public on social media. If to with you on Twitter, either them they have a it and with it in the be If you an or opinion that with the source Michael Berkwits: (i.e., or (e.g., an online and engage users to with you or your through the to current and find opportunities to that may be If your audience is or physicians, recruit a to of social media to or publish of patients, how Shannon Haymond: a with a your in a professional and their new and outside of your direct of and use to better content and only post your own that this is a public and as with may be Simon Carley: For the I be and never the opportunity to share what you and help you and are of people on the but there are never any to join The for is what of me in (i.e., be about what you post online in any What are the with using social media from a professional standpoint? Jonathan Sherbino: One that I attention to is This phenomenon has been from the use of social media. Although the use of on social media platforms in medical education is the audience for online for some of by users a community of practice. This a of users to using to comments and can be challenging in social media, particularly if a be limited to Michael Berkwits: From a publisher's perspective, there are to Social media can be out of but are or if is attention to user Simon Carley: I think are Social media your research, and ability to a audience and that can to difficult but they are not different from that take through The only is that social media your views with a If you and in more people if you are a and more people find Stephen Smith: I think the is up information that is It is easy to believe to be without social media, you can put up that is through your you can publish your own of one be Shannon Haymond: The are to the public of the platform and around This may include to information or in and of boundaries. on the of a professional may be help with most and some professional have for professional use of social media. are social media for educational and these include (e.g., ECG, What are the issues with posting specific information about a Michael Berkwits: The JAMA Network to publish any and in our issues with posting information. Marie Ennis-O'Connor: Although individual pieces of information may not the of published information online be to identify a or to if their have been there is the of It is my that content on social networking should ever patients or their specific Stephen Smith: You to be that what you are be to a by healthcare who that In other if who already has access to the information that it is one should the for it is to by an ECG you already the medical I what hospital a and I an I and other information and provide the most but Jonathan Sherbino: is never by a technological platform or the principles to social media, including educational and and with and be is a social media platform that has these issues to provide to the global medical community for promoting learning. Social media has already had a major impact in medicine, and How do you the role of social media in the Marie Ennis-O'Connor: Social media is the that patients with healthcare and the healthcare It is increasingly for patients to use information to access to information and their own healthcare. and are of what it to be a We are a new of out of clinical and now in a online access to the and public health information to many more people, more quickly and directly than at any time in Social media access to who may not

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