Tabor E. Flickinger

Social Media Use in Medical Education: A Systematic Review

Purpose The authors conducted a systematic review of the published literature on social media use in medical education to answer two questions: (1) How have interventions using social media tools affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-training? and (2) What challenges and opportunities specific to social media have educators encountered in implementing these interventions? Method The authors searched the MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus databases (from the start of each through September 12, 2011) using keywords related to social media and medical education. Two authors independently reviewed the search results to select peer-reviewed, English-language articles discussing social media use in educational interventions at any level of physician training. They assessed study quality using the Medical Education Research Study Quality Instrument. Results Fourteen studies met inclusion criteria. Interventions using social media tools were associated with improved knowledge (e.g., exam scores), attitudes (e.g., empathy), and skills (e.g., reflective writing). The most commonly reported opportunities related to incorporating social media tools were promoting learner engagement (71% of studies), feedback (57%), and collaboration and professional development (both 36%). The most commonly cited challenges were technical issues (43%), variable learner participation (43%), and privacy/security concerns (29%). Studies were generally of low to moderate quality; there was only one randomized controlled trial. Conclusions Social media use in medical education is an emerging field of scholarship that merits further investigation. Educators face challenges in adapting new technologies, but they also have opportunities for innovation.

Teaching empathy to medical students: an updated, systematic review.

Purpose Some research shows that empathy declines during medical school. The authors conducted an updated, systematic review of the literature on empathy-enhancing educational interventions in undergraduate medical education. Method The authors searched PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science (January 1, 2004 through March 19, 2012) using key words related to undergraduate medical education and empathy. They independently selected and reviewed all English-language articles that described an educational intervention designed to promote empathy in medical students, assessing the quality of the quantitative studies using the Medical Education Research Study Quality Instrument (MERSQI). Results The authors identified and reviewed the full texts of 18 articles (15 quantitative and 3 qualitative studies). Included interventions used one or more of the following—patient narrative and creative arts (n = 7), writing (n = 3), drama (n=1), communication skills training (n = 4), problem-based learning (n = 1), interprofessional skills training (n = 1), patient interviews (n = 4), experiential learning (n = 2), and empathy-focused training (n = 1). Fifteen articles reported significant increases in empathy. Mean effect size was 0.23. Mean MERSQI scorewas 10.13 (range 6.5–14). Conclusions These findings suggest that educational interventions can be effective in maintaining and enhancing empathy in undergraduate medical students. In addition, they highlight the need for multicenter, randomized controlled trials, reporting long-term data to evaluate the longevity of intervention effects. Defining empathy remains problematic, and the authors call for conceptual clarity to aid future research.

Promoting engagement by patients and families to reduce adverse events in acute care settings: a systematic review

Introduction Patient-centeredness is central to healthcare. Hospitals should address patients’ unique needs to improve safety and quality. Patient engagement in healthcare, which may help prevent adverse events, can be approached as an independent patient safety practice (PSP) or as part of a multifactorial PSP. Objectives This review examines how interventions encouraging this engagement have been implemented in controlled trials. Methods We searched Medline, CINAHL, Embase and Cochrane from 2000 to 2012 for English language studies in hospital settings with prospective controlled designs, addressing the effectiveness or implementation of patient/family engagement in PSPs. We separately reviewed interventions implemented as part of selected broader PSPs by way of example: hand hygiene, ventilator-associated pneumonia, rapid response systems and care transitions. Results Six articles met the inclusion criteria for effectiveness with a primary focus on patient engagement. We identified 12 studies implementing patient engagement as an aspect of selected broader PSPs. A number of studies relied on patients’ possible function as a reporter of error to healthcare workers and patients as a source of reminders regarding safety behaviours, while others relied on direct activation of patients or families. Definitions of patient and family engagement were lacking, as well as evidence regarding the types of patients who might feel comfortable engaging with providers, and in what contexts. Conclusions While patient engagement in safety is appealing, there is insufficient high-quality evidence informing real-world implementation. Further work should evaluate the effectiveness of interventions on patient and family engagement and clarify the added benefit of incorporating engagement in multifaceted approaches to improve patient safety endpoints. In addition, strategies to assess and overcome barriers to patients’ willingness to actively engage in their care should be investigated.

The Times They Are A-Changin’: Academia, Social Media and the JGIM Twitter Journal Club

J ournal clubs have long been a core component of medical education. Initially the purpose of the journal club was to update participants about key medical advances. As the medical literature expanded, journal clubs evolved into forums for discussion of advances in focused medical topics and activities to teach critical appraisal and evidence-based medicine. Low attendance and poor participation at face-to-face journal clubs led to experimentation with online synchronous or asynchronous journal clubs to overcome geographic and temporal barriers. We are now in the era of Web 2.0 where social media and smart mobile devices have introduced physicians to the usefulness and usability of social networking sites like Facebook. These sites are attractive to academia as they enable easy sharing of ideas, opinions, multimedia resources and references. They allow users to find and connect with other likeminded users and thus build professional learning networks. This exposure has stimulated medical academicians to experiment with social media, e.g., using Twitter at medical conferences, holding Google Hangout panel discussions for continuing medical education, and building professional online communities like GIM Connect for the Society of General Internal Medicine (SGIM). Twitter is a popular online social network that is based on microblogging or “Tweets” to share news, resources and opinions. The use of hashtags and lists allows users to filter content and find others with common interests. Drawn by these features, several medical groups and societies are utilizing Twitter to conduct journal clubs. Twitter makes it possible to directly connect journal readers at various stages of training with authors and editors; the medium can also involve patients and experts from multiple disciplines. JGIM has begun to explore this medium by launching a new Twitter journal club, bringing readers, editors, and authors together in a real-time online discussion of a recently published JGIM paper. The first JGIM Twitter journal club took place on 5 June 2014 with discussion of a recent paper on the impact of displaying the cost of laboratory tests on primary care physicians’ test ordering behavior. It was organized as a Twitter chat session using the #meded hashtag to bring together a worldwide community of Twitter users interested in medication education. Tabor Flickinger, MD (@TaborF) served as moderator. The event was promoted through announcements on Twitter, jgim.org, GIM Connect and SGIM eNews. These announcements linked to the article abstract and included guiding questions that were used by the moderator to frame the journal club discussion. The June 5 journal club was lively, with 367 tweets from 78 participants, with an average of 4.7 tweets per/participant (range 1–37) during the hour. Participants included medical educators, clerkship and residency program directors, clinicians, and medical trainees. With the article’s findings as a starting point, the discussion expanded to explore issues of healthcare costs in medical education. It culminated with the sharing of informal teaching and learning experiences and formal curricula at a variety of institutions regarding cost and high-value care. Contributions from the JGIM editors and article authors added an expert perspective to the discussion and stimulated thoughtful debate. In reflecting on the experience, one of the authors, Dr. Horn commented: “It was great to see physicians from across the country converge to passionately discuss cost transparency in healthcare. Holding the journal club via Twitter allowed for a low barrier to entry for potential participants to join in the conversation.” Twitter offers several advantages over traditional in-person journal clubs by bringing together participants with diverse experiences and perspectives, bridging geographic barriers, and promoting the dissemination of timely research and innovations in teaching and practice. Twitter journal clubs can allow researchers to directly connect with not just their readers, but also patients. An interesting feature of Twitter is the use of various metrics like the number of times a post gets shared (retweeted) or marked as favorite, and which topics (hashtags) become popular at a particular time. These features allow not only for crowd-sourcing the identification of popular information, but can also be a key factor determining popularity. There are several challenges to conducting Twitter journal clubs. The diversity of the audience and the 140 character limits for posts make it more conducive to informal exchange of ideas and opinions than in-depth discussion of study methods or statistical analysis. It is important to choose an Published online August 5, 2014 JGIM

The role of social media in clinical excellence.

The provision of excellent patient care is a goal shared by all doctors. The role of social media (SM) in helping medical students and doctors achieve clinical excellence is unknown.

Counseling to Reduce High-Risk Sexual Behavior in HIV Care: A Multi-Center, Direct Observation Study

A key opportunity to reduce HIV transmission lies with healthcare providers counseling HIV-infected patients about safer sex. We audio-recorded and transcribed clinical encounters between 45 healthcare providers and 417 of their HIV-infected patients at four outpatient sites in the United States. We used logistic regressions to evaluate associations between patient and provider characteristics, and the occurrence of discussion (any talk about sex) and counseling (advice about safer sex). Of the 417 encounters, discussion of sex occurred in 187 (45% of encounters, 95% CI: 40-50%). Counseling occurred for 49% (95% CI: 35-63%) of patients reporting unsafe sex. Discussion of sex was more likely with younger or less-educated patients and with less cultural difference between patient and provider, while counseling was associated with greater provider mindfulness and lower provider empathy. These findings suggest targets to improve communication regarding sexual risk reduction in HIV care.

Career development for early career academics: benefits of networking and the role of professional societies.

Whilst effective networking is vitally important for early career academics, understanding and establishing useful networks is challenging. This paper provides an overview of the benefits and challenges of networking in the academic field, particularly for early career academics, and reflects on the role of professional societies in facilitating networking.

Content Analysis and User Characteristics of a Smartphone-Based Online Support Group for People Living with HIV.

BACKGROUND Although there is growing interest in mobile applications and online support groups to enhance chronic disease self-management, little is known about their potential impact for people living with HIV (PLWH). INTRODUCTION We developed an innovative online support group delivered through a community message board (CMB) within a clinic-affiliated smartphone application Positive Links (PL). We analyzed characteristics of posters and nonposters to the CMB and evaluated content posted to the CMB. MATERIALS AND METHODS For this study, 38 HIV-infected patients received cell phones with the PL application that included the opportunity to interact with other users on a CMB. Logistic regressions investigated associations between participant characteristics and posting. CMB messages were downloaded and analyzed qualitatively. RESULTS 24 participants posted to the CMB; 14 did not. Participants had lower odds of posting if they were white (p = 0.028) and had private insurance (p = 0.003). Participants had higher odds of posting if they had unsuppressed viral loads (p = 0.034). Of the 840 CMB messages over 8 months, 62% had psychosocial content, followed by community chat (29%), and biomedical content (10%). DISCUSSION Psychosocial content was most prevalent on this CMB, in contrast to other online forums dominated by informational content. Participants who posted expressed support for each other, appreciation for the community, and a perception that the app played a positive role in their HIV self-management. CONCLUSIONS This CMB on a clinic-affiliated mobile application may reach vulnerable populations, including racial/ethnic minorities and those of lower socioeconomic status, and provide psychosocial support to PLWH.