Using Social Ledia in Medical Education

Recently I gave a medical informatics grand rounds on the topic of Social Media in Medical Education.  The overarching goal of the presentation was:

• to expose the audience to various examples of use of SoMe in education and
• to let them draw connections between some of the theories of learning (and knowledge) and these examples

The outline of the presentation:

• Get beyond the issues of Professionalism.  While a very important issue it should not scare students and physicians away for a potentially very useful and powerful medium for learning
• Brief overview of some theories of learning and knowledge.  To make the point, I somewhat oversimplified these - took some editorial liberties with the descriptions.  This was done keeping in mind the needs of the audience.  Also this was not the focus of the topic.  I was making the point that some of these create a good framework to help understand the role of social media in education. 
• Differentiate Social Media and Web 2.0 from static one-way media like print media.
• Types of Social Media - Publishing, Sharing, Discussing, Networking, Location, Commerce etc.
• Reference to recent Talk of the Nation on NPR re' the education of Net Generation.
• Examples of use of Social Media for education
• Blogs - opportunities for conversations with thought leaders (George Siemens), place for personal reflection, and sharing those with society.
• Watching a Khan Academy video and summarizing it in a blog post.
• Google+ example of deep and rich conversations with experts whom you would not normally be able to communicate with.
• Twitter example of #meded chats and #twitjc journals clubs (reference to one on surgical checklists that had Atul Gawande participating, case discussions (Nick Bennett's #micro140)
• Hangout - examples of use - can we use this as a model of office hours for professors (Stephen Downes)
• The web 2.0 learning cycle from Google Reader to Blogs and Social Learning Networks with examples of how interacting with people in these networks has generated rich discussions and new ideas. 
Using social media in medical education (link to Slideshare - view with speaker notes) (These slides were edited from a presentation at medical informatics grand rounds.  The slide notes were added to substitute for the lack of an audio recording).

Conclusions:

• Our trainees grew up with online social media, this is how they collaborate, interact.
• When they enter the medical profession, they can leverage these skills to enhance their learning. 
• While they need to be aware of how to be professional in this space, let us not scare them away from this potentially useful tool. 
• Our educators need to keep an open mind and personally experience this medium before passing judgment.

A Practical Medical Informatics Curriculum for Medical Students

How can best prepare our medical students to practice medicine in world of technology?  A number of efforts have been made to create curricula for medical schools and also for special fellowships in medical informatics.  This is a very rapidly moving target and the products of these efforts need constant updating. 
The American Medical Informatics Association website states that "biomedical and health informatics applies principles of computer and information science to the advancement of life sciences research, health professions education, public health, and patient care"


If we had to develop a list of concepts that we need our graduating medical students to be familiar with; what would it include today?  Maybe, if our students were all self motivated, reflective, life long learners, all we would have to do it ensure that they know how to find answers to their problems and questions, share this list of concepts with them and we would be set; we would not even have to develop a course for this curriculum!

This list of Core topics for all medical students would look something like this: (clearly a work in progress):

1. Computers (desktops, laptops), mobile devices, smartphones, portable data storage devices
2. Networking and connectivity – Intranet, Internet, WWW, VPN, Wireless, Bluetooth, 4G etc
3. Software – Office (word processing, presentation, spreadsheet etc), Statistical software, Bibliography tools, Cloud computing, Browsers and add-ons, mind mapping etc.
4. EBM concepts – Information resources, information retrieval, Appraisal of literature, Application to clinical practice, guidelines etc, also related to this are the concepts of public health informatics
5. Communications – e-mail, list serv, text messaging, discussion groups, social media, professional and patient communication, presentations (live and online),  Web 2.0, blogs and Wikis, social networking
6. Data – data collection, organization, storage and representation, data standards (including HL7), data interchange,
7. Personal knowledge management, project management, organization tools
8. EHRs/EMRs, Personal (patient) health records, meaningful use, physician report cards, Quality metrics etc. ePrescribing, RxHub, etc.  (Some topics like PACS might be more relevant to those going to radiology)
9. Decision science (decision analysis, probability, test characteristics, likelihood ratios etc) , online and point of care decision support tools,  Clinical decision support (Alerts, reminders),
10. Ethics, professionalism, legal and regulatory issues, privacy, security, authenticity and encryption
11. Ontology, terminology (Thanks to comment from Anonymous)

There are areas that might be optional for some students and be offered as electives.

1. Education informatics – Learning management systems, virtual learning environments, personal and social learning environments 
2. Bioinformatics (genomics etc)
3. Research informatics 

What do you think?  What are some other concepts that every graduating medical student should have that are not included here or could be better defined/organized?  


For reference, here is a recent JAMIA article with a detailed curriculum for clinical informatics specialists.
J Am Med Inform Assoc. 2009;16:153–157. DOI 10.1197/jamia.M3045.
And
Here is the AAMC Medical School Objectives Project (MSOP) Phase II report that covers medical informatics and Public Health.  https://services.aamc.org/publications/showfile.cfm?file=version88.pdf&prd_id=199&prv_id=240&pdf_id=88

The Logical Flow of a Physical Exam

The other day I was observing a 2nd year medical student examining a patient in my outpatient clinic. The student did a very good job- doing a very thorough examination of each organ system.

The only problem was the flow of the exam or the lack of one. He would start at the head and examine the mouth and then move down to the neck. Later he would come back to the mouth to check for the midline tongue and the gag reflex.

The patient would have to lie down for the abdominal exam, and then sit up to have the lumbar spine examined; lie down for the Straight Leg Raise test and sit up for the knee and ankle jerk; you get the idea.

It seemed an example of a logical flow of a physical exam that combined the elements of:

1. Going down from head to toe
2. Patient comfort and convenience
3. Efficiency

might be helpful. Of course everyone will have a slightly different protocol for doing this.

As I was wondering how to present this information, I came across Bubbl.us a cool mindmapping tool. So I created the following schema of the Logical Flow of a Physical Exam using Bubbl.us

The problem is that the site is transitioning to beta and is very very slow! Also if you use the beta it does not let you share the mind map or embed the code. So here it is in its slow but still glorious 1.0 form (Click the - sign in upper left to zoom out. Click and drag to see different elements, to see the full size, click the read only link at the bottom):

If you want to check it out on Bubbl.us, here is the read only link

Collaborative learning in Medical Education - Where is the Patient?

For a while now I have been muddling over a few thoughts in my head. These were prompted by

1. Medicine's incredible success at treating acute problems and thus bringing chronic problems to the forefront e.g. patient survives a stroke but is left with bed sores, incontinence OR survives an acute heart attack and is left with congestive heart failure. A William Schwab put it at a recent grand rounds, "Success brings failure" and thus our success in treating acute problems has brought us an excess of chronic problems.
   
2. Increasing popularity of social media tools like Facebook, Twitter and Second Life. A recent study that I discussed earlier showing students were more likely to use Facebook for a course discussion than the University's learning management system.
   
3. Medical education moving from a traditional "talking to the boards" model to a small group collaborative problem solving model - can we use this momentum for including patients into the learning "group"? This thought was resurrected by a post I read by Anne Marie Cunningham.
   

It seems that learning how to treat an acute problem is something we can do well in our current model of education which has minimal involvement of the patient (in most schools). As our population ages, has more chronic problems, a model that does not involve the patient in the learning process is not going to succeed.

Thus we know what an obese patient with poorly controlled diabetes needs to do to bring his/her condition under control and maintain it there. Patient also often knows this. Still optimal outcome occurs only rarely and if it does, it is not sustained.

In managing chronic conditions, the patient has to learn to take control of his/her condition and the physician is only a part of the solution to make this happen. Our medical students learning is designed to occur either in classrooms or in hospitals - both of which are perfect for acute condition management. The exposure to outpatient chronic condition management where they can interact with the same few patients longitudinally does not occur in most schools.

The reasons for this are mostly logistic. Scheduling students to be in the clinic the same time as specific patients is a logistic nightmare. How about a model using social media?

Can we have students create limited, private accounts in a social media site like Facebook or create a specific site using Ning and invite consenting patients to be their "friends". We could have a list of patients with different conditions and abilities to use these social media tools. The sites would not be accessible except to invitees. The students would collaborate with a set of patients over their entire medical school experience. The patients would post/tweet about their symptoms, office visits, hospitalizations, test results and the students would learn/read up about these and explain these to the patients. In addition, they would work on skills like motivational interviewing, negotiated goal setting to help the patients take better control of their conditions.

This model will allow students to learn the role they have to play in management of chronic conditions and prepare them for the future!