Shelley Ross

Twelve tips for using Twitter as a learning tool in medical education

Background: Twitter is an online social networking service, accessible from any Internet-capable device. While other social networking sites are online confessionals or portfolios of personal current events, Twitter is designed and used as a vehicle to converse and share ideas. For this reason, we believe that Twitter may be the most likely candidate for integrating social networking with medical education. Aims: Using current research in medical education, motivation and the use of social media in higher education, we aim to show the ways Twitter may be used as a learning tool in medical education. Method: A literature search of several databases, online sources and blogs was carried out examining the use of Twitter in higher education. Results: We created 12 tips for using Twitter as a learning tool and organized them into: the mechanics of using Twitter, suggestions and evidence for incorporating Twitter into many medical education contexts, and promoting research into the use of Twitter in medical education. Conclusion: Twitter is a relatively new social medium, and its use in higher education is in its infancy. With further research and thoughtful application of media literacy, Twitter is likely to become a useful adjunct for more personalized teaching and learning in medical education.

'Have you seen what is on Facebook?' The use of social networking software by healthcare professions students.

Objective The use of social networking software has become ubiquitous in our society. The aim of this study was to explore the attitudes and experiences of healthcare professional students using Facebook at our school, to determine if there is a need for development of policy to assist students in this area. Design A mixed-methods approach was employed, using semistructured interviews to identify themes which were explored using an online survey. A combination of descriptive statistics and thematic analysis was used for analysis. Setting Healthcare professions education programmes at a large Canadian university. Participants Students of medicine, nursing, pharmacy, speech and language pathology, occupational therapy, physical therapy, dentistry, dental hygiene and medical laboratory Science were invited to participate. 14 participants were interviewed, and 682 participants responded to an online survey; the female:male balance was 3 : 1. Results 14 interviews were analysed in-depth, and 682 students responded to the survey (17% response rate). 93% reported current Facebook use. Themes identified included patterns of use and attitudes to friendship, attitudes to online privacy, breaches of professional behaviour on Facebook and attitudes to guidelines relating to Facebook use. A majority considered posting of the following material unprofessional: use of alcohol/drugs, crime, obscenity/nudity/sexual content, patient/client information, criticism of others. 44% reported seeing such material posted by a colleague, and 27% reported posting such material themselves. A majority of participants agreed that guidelines for Facebook use would be beneficial. Conclusions Social networking software use, specifically Facebook use, was widespread among healthcare students at our school who responded to our survey. Our results highlight some of the challenges which can accompany the use of this new technology and offer potential insights to help understand the pedagogy and practices of Facebook use in this population, and to help students navigate the dilemmas associated with becoming 21st century healthcare professionals.

Distracted doctoring: smartphones before patients?

I stood in front of the darkened classroom, noting that many of the medical students’ faces were bathed in the eerie blue glow from laptop screens. My heart sank. When we moved into this wired classroom, I complained to colleagues that students no longer seemed to listen — they were distracted

''I have the right to a private life'': Medical students' views about professionalism in a digital world

Background: Social media site use is ubiquitous, particularly Facebook. Postings on social media can have an impact on the perceived professionalism of students and practitioners. Aims: In this study, we explored the attitudes and understanding of undergraduate medical students towards professionalism, with a specific focus on online behaviour. Methods: A volunteer sample of students (n = 236) responded to an online survey about understanding of professionalism and perceptions of professionalism in online environments. Respondents were encouraged to provide free text examples and to elaborate on their responses through free text comments. Descriptive analyzes and emergent themes analysis were carried out. Results: Respondents were nearly unanimous on most questions of professionalism in the workplace, while 43% felt that students should act professionally at all times (including free time). Sixty-four free text comments revealed three themes: “free time is private time”;” professionalism is unrealistic as a way of life”; and “professionalism should be a way of life”. Conclusions: Our findings indicate a disconnect between what students report of what they understand of professionalism, and what students feel is appropriate and inappropriate in both online and real life behaviour. Curriculum needs to target understanding of professionalism in online and real environments and communicate realistic expectations for students.

Toward a shared language for competency-based medical education

Abstract The paradigm shift brought about by the advent of competency-based medical education (CBME) can be characterized as an adaptive change. Currently, its development and implementation suffer from the lack of a lingua franca. A shared language is needed to support collaboration and dissemination across the world community of medical educators. The International CBME Collaborators held a second summit in 2013 to explore this and other contemporary CBME issues. We present the resulting International CBME Collaborator’s glossary of CBME terms. Particular attention is given to the terms competency, entrustable professional activity (EPA), and milestone and their interrelationships. Medical education scholars and enthusiasts of the competency-based approach are encouraged to adopt these terms and definitions, although no doubt the vocabulary of CBME will continue to evolve.

Death is not always a failure: outcomes from implementing an online virtual patient clinical case in palliative care for family medicine clerkship

Background The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care. Aims To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010–2011 Year Three Family Medicine Clerkship rotation curriculum. Methods A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students’ educational experience of using this case. Results Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students’ self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as ‘Good to Excellent’, 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate. Conclusions The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs.

What's on YOUR Facebook profile? Evaluation of an educational intervention to promote appropriate use of privacy settings by medical students on social networking sites.

Background The rise of social media has led to growing concerns about the potential implications of ‘unprofessional’ postings by physicians and medical students on individuals, institutions, and the medical profession. Relevant and effective guidelines have been difficult to develop and enforce, and there is a need for students and physicians to consider how their online activities may be perceived in the context of their professional roles. The purpose of this project was to examine the Internet presence of a graduating Canadian medical school class by scanning students’ public profiles on the social media site Facebook, incorporate this information into an educational activity addressing professionalism and social media, and evaluate the impact of this activity on student behavior. Methods A systematic search for public Facebook profiles of each member of the class was conducted, and data were collected on the types of publicly visible material. These were presented as part of an educational session on social media and professionalism. One month later, the Facebook search was repeated. Results Of 152 students in the class, profiles were found for 121 (79.8%). The majority of students used appropriately restrictive privacy settings; however, a significant minority had publicly visible information, including comments, photographs, location, and status as a medical student. The educational innovation was well received with more than 90% of students agreeing that this topic was important and well addressed. A follow-up search found that many students had altered their privacy settings to make less information publicly available. Conclusions A small but significant proportion of students share potentially unprofessional content on social media. An interactive educational intervention, which includes specific disclosure of how participants appear to others on social media, resulted in a significant change in student behavior.

Toward a research agenda for competency-based medical education.

Abstract Competency-based medical education (CBME) is both an educational philosophy and an approach to educational design. CBME has already had a broad impact on medical schools, residency programs, and continuing professional development in health professions around the world. As the CBME movement evolves and CBME programs are implemented, a wide range of emerging research questions will warrant scholarly examination. In this paper, we describe a proposed CBME research agenda developed by the International CBME Collaborators. The resulting framework includes questions about the meaning of key concepts of CBME and their implications for learners, faculty members, and institutional structures. Other research questions relate to the learning process, the meaning of entrustment decisions, fundamental measurement issues, and the nature and definition of standards. The exploration of these questions will help to solidify the theoretical foundation of CBME, but many issues related to implementation also need to be addressed. These pertain to, among other things, nurturing independent learning, assembling and using assessment results to make decisions about competence, structuring feedback, supporting remediation, and how best to evaluate the longer-term outcomes of CBME. High-quality research on these questions will require rigorous outcome measures with strong validity evidence. The complexity of CBME necessitates theoretical and methodological diversity. It also requires multi-institutional studies that examine effects at multiple levels, from the learner to the team, the institution, and the health care system. Such a framework of research questions can guide and facilitate scholarly discourse on the theoretical and practical body of knowledge related to competency-based health professions education.

Evolving concepts of assessment in a competency-based world

Abstract Competency-based medical education (CBME) is an approach to the design of educational systems or curricula that focuses on graduate abilities or competencies. It has been adopted in many jurisdictions, and in recent years an explosion of publications has examined its implementation and provided a critique of the approach. Assessment in a CBME context is often based on observations or judgments about an individual’s level of expertise; it emphasizes frequent, direct observation of performance along with constructive and timely feedback to ensure that learners, including clinicians, have the expertise they need to perform entrusted tasks. This paper explores recent developments since the publication in 2010 of Holmboe and colleagues’ description of CBME assessment. Seven themes regarding assessment that arose at the second invitational summit on CBME, held in 2013, are described: competency frameworks, the reconceptualization of validity, qualitative methods, milestones, feedback, assessment processes, and assessment across the medical education continuum. Medical educators interested in CBME, or assessment more generally, should consider the implications for their practice of the review of these emerging concepts.

Overarching challenges to the implementation of competency-based medical education

Abstract Medical education is under increasing pressure to more effectively prepare physicians to meet the needs of patients and populations. With its emphasis on individual, programmatic, and institutional outcomes, competency-based medical education (CBME) has the potential to realign medical education with this societal expectation. Implementing CBME, however, comes with significant challenges. This manuscript describes four overarching challenges that must be confronted by medical educators worldwide in the implementation of CBME: (1) the need to align all regulatory stakeholders in order to facilitate the optimization of training programs and learning environments so that they support competency-based progression; (2) the purposeful integration of efforts to redesign both medical education and the delivery of clinical care; (3) the need to establish expected outcomes for individuals, programs, training institutions, and health care systems so that performance can be measured; and (4) the need to establish a culture of mutual accountability for the achievement of these defined outcomes. In overcoming these challenges, medical educators, leaders, and policy-makers will need to seek collaborative approaches to common problems and to learn from innovators who have already successfully made the transition to CBME.