Disruption in medical education — Teaching the teachers via social media?

Everyone agrees that doctors should be informed and up-to-date. Perpetual medical education has always been a vital component of doctoring. But now, as the rapid pace of healthcare innovation pushes against the limits of biology, and really, our humanity, medical education gains even more importance. Doctors (and patients) must know what can and cannot be accomplished. We must know the evidence. And these days, evidence pours in.

Doctors are essentially teachers, and thus, a central question in medical education parallels that in regular education: What is the best means for teaching the teachers?

I’ve written before that disruption in med-ed is coming soon, via social media. It seems like a bold statement, but then there is Sal Kahn and Dr. Mike Evans.

I recently came across a blog post in the British Medical Journal that validates my thesis: Social media is indeed a new brand of medical education.

Background:

Currently, there are two legacy models of medical education, and both have come under intense, and in my opinion, deserved, criticism. The CME (or continuing medical education) model has taken criticism for its conflicts of interest with industry. These are legitimate concerns, and examples of folly abound. Look no further than dronedarone. An argument can be made that a major deficit in today’s model of medical information transfer comes in the form of irrational exuberance from conflicted sources–e.g. marketing hype. The good news is that industry influence of CME is decreasing. The bad news is not all industry-supported CME was bad.

The second major model of medical education is the board certification process. Here, we have a case study in monopoly. The American Board of Internal Medicine (ABIM), in alliance with major professional organizations, has long controlled the lucrative market of certifying doctors. Being “board-certified” used to entail passing a multiple choice test every ten years. It was a rigorous test that required significant prep work and oodles of memorization–the latter being a dubious exercise in the smartphone era. That said, it was hard to fuss too much about a once-decade review. Recently, the ABIM has upped the ante, and front-line doctors must now comply with onerous, untested and expensive two-year “Maintenance of Certification” intrusions. The overreach is breathtaking, and criticism from doctors has been robust. Even I, a test proponent and Choosing Wisely disciple, called the foul.

The disruption:

Dr.Ryan Radecki is an assistant professor in Emergency Medicine and a “clinical Informatician.” He writes in the BMJ about the revolution in the transfer of medical knowledge. His example centers on the FOAM movement. FOAM stands for Free Open Access Meducation – Medical education for anyone, anywhere, anytime.

This from the Life in the Fast Lane Blog:

FOAM is the movement that has spontaneously emerged from the exploding collection of constantly evolving, collaborative and interactive open access medical education resources being distributed on the web with one objective — to make the world a better place. FOAM is independent of platform or media — it includes blogs, podcasts, tweets, Google hangouts, online videos, text documents, photographs, Facebook groups, and a whole lot more.

FOAM should not be seen as a teaching philosophy or strategy, but rather as a globally accessible crowd-sourced educational adjunct providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles.

Ok. I know what you may be thinking: that all sounds nice but how does it educate doctors?

Here’s the example. Radecki uses recent data on cooling (therapeutic hypothermia–in medical-speak) patients after cardiac arrest. He describes a Global Journal Club series featuring an online FOAM discussion of recent publications regarding therapeutic hypothermia.

He writes, “within a handful of days of publication, no fewer than 18 experts in emergency medicine and resuscitation had provided commentary, whether through blog posts or podcasts.”

I’ve looked at these free posts. I read a few on my laptop, others on my smartphone. I saved two of the better ones on Evernote. Yes, it’s true that not all of the 18 posts are perfect. But the bottom line is that I now have a great handle on the issue. I’m informed and educated. I also can’t emphasize enough how nice it was to read real language rather than journal-speak.

Perhaps the most notable facet of this new brand of knowledge transfer is its democracy. There are no paywalls; patients get access too. Let’s emphasize the value of patients learning alongside caregivers. This democracy of knowledge is vital. For instance, do you think we would have the current humanitarian crisis in futile end-of-life care if patients were aptly informed? Would there be droves of kids on brain stimulants if all parties were educated on the actual data–and long-term risks? You can fill in many more examples.

Challenges remain:

I’m not suggesting doctors take to Twitter and Facebook for all their medical information. But…A global journal club? Reflect on that for a moment. And this: 18 posts from motivated learners on one medical topic. That’s a lot of (free) transfer of knowledge.

An often cited challenge comes in the vetting of information. Skeptics of social media and the Internet have asked me how one knows the truth. Their bias, of course, is that prose written in peer-reviewed journals is accurate and free of conflict. That’s a laughable bias these days.

Make no mistake, I don’t aim to bash medical journals or journal editors. Peer-reviewed science is the engine of medical progress. That’s the point.

Done well, social media, and the conversation it induces, the learners it inspires, the skepticism it allows, can be the megaphone that broadcasts the results of the scientific method. This is key. For it is in knowing the absolute benefits and risks and expectations of treatments that lead to the best medical decisions.

Times are changing. It’s a fun time to be a learner.

JMM

9 comments

  1. I hope this trend will continue and expand. The high cost of learning after residency strikes me as a major barrier to continuing education, with patients bearing the brunt of the consequences.

    As a resident affiliated with an academic institution, I have “free” access to most of the medical literature I want/need. But when I graduate this summer, suddenly my free access will be markedly limited to things like Medscape, QuantiaMD, and social media.

    I do subscribe to NEJM Journal Watch and a few professional journals, but I need to stay abreast of my specialty AND the broad fields of Medicine, neurology, neurosurgery, orthopedics, anatomy, and [peripheral] electrophysiology. I’m planning to practice in the rural Midwest so won’t be affiliated with an academic institution yet cannot afford to subscribe to all the journals in I feel I need to be the best doctor I can be. I attend expensive conferences but learn the most through reading.

    I realize it costs piles upon piles of money to produce high quality (and even not-so-high quality) medical literature, but it’s also in the best interest of everyone to facilitate physician lifelong learning. Maybe if the education is free or low-cost and interactive more docs will take advantage of the opportunity.

  2. I’m a huge fan of open online access to information, complicated information, information that might make you think “Who in the world is going to be interested in this stuff?”

    Why? Consider people like this: http://www.csmonitor.com/USA/Society/2014/0223/How-colleges-are-finding-tomorrow-s-prodigies

    People like this are uncommon, for sure, but consider the untapped human potential hiding somewhere among the almost 3 billion people with online access.

    The next 100 years are going to blow our collective minds. I’m sure of it.

  3. FOAM sounds really interesting and refreshing if it will make getting information on conditions and medications extremely easier. More and more of my doctors and suggesting medications and asking me to look them up to see if they are safe. Often times all I can determine from prescribing pamphlets and packaging inserts is whether or not a drug is expected to cause arrhythmias. I’m sure that the information is there to determine if the medication changes the EP intervals or causes tachycardia through it’s ability to cause hypotension, but I don’t speak the language. Still I appreciate being included in the decision making process. Ultimately I am the one who suffers if the decision is wrong. As a disclaimer to my doctors, the ones who include me in the decision process follow up closely in order to stem off any ill affects before they happen.

  4. There IS quality work “out there” as FOAM. That said – there is need for careful selection of what one reads and believes. With practice and experience – it becomes easier to determine what information from the internet is truly worthwhile (and “door-opening” in providing insight on a given topic) – vs that which is highly questionable, if not frankly inaccurate. One example is THIS BLOG – in which Dr. John ALWAYS backs up whatever he says with reference to the most current literature – with extra advantage of his extensive clinical experience that provides clinical wisdom rarely extractable from “publish or perish” literature (that all too often is from a study sponsored by someone = Big Pharma, with large potential for secondary gain). It IS a new world out there. Even without the ready access I used to have to PubMed that I enjoyed when I was teaching in academia – I find that I’m able to find out what I need to know about virtually any medical topic within minutes by simple internet search on iphone. FOAM is here to stay – so interest is served by learning to optimally access it.

    1. That’s the problem isn’t it? Picking out what is useful and what is not. Yes, Dr. John does back up his claims, but many time it takes a subscription to open the documentation or I don’t understand what I’m reading. And then you do have a world full of misguided people out there proselytizing the latest unproven fad. You do have to choose carefully. It’s usually pretty easy to tell the difference between something you read on rxlist.com and something spouted by Dr. Andrew Weil or Dr. Oz. It isn’t always that easy to understand what you are reading on nih.gov, or even keeping what you do understand in perspective. But if you have a complicated medical history you are usually the only one who will understand the ins and out of it, as in that drug will help with this condition, but has side effects that can aggrevate another condition. Truthfully, I’ve had doctors who just don’t care that certain medications can cause great harm to me. Other people can take them without consequence so I am just being difficult. At the end of the day, I am responsible for my decision to accept a treatment or deny it. It is better to go into that process armed with reliable information.

      1. @ Lisa – You are absolutely correct that it is at times challenging trying to pick out what is accurate vs what is better not read. And it is obviously easier for me to do this because I am a physician. But in my experience – I’ve been able to find what I need on virtually any topic (medical or non-medical) by usually no more than quick internet search on whatever topic I am looking up. When researching a topic that is new to me on the internet (a topic in which I do not have any expertise) – there is initially more trial and error – but usually within no more than a little while, I am able to “sniff out” what is useful and at least fairly reliable information vs what is worthless. Researching almost anything in 2014 is easier for me than it ever was in years gone by.

  5. FOAM and access to growing med databases is so heartening. Our doctors need the help,patients need a chance at more correct diagnoses. Currently there isn’t even a stipulation that diagnoses be correct. The average 7-11 minute exam visit completely overrides any chance for much real information exchange and precludes the chance for patients to trust doctors. 7 minutes is absurd. FOAM and others are on the way towards protecting patients. We don’t have time to wait for CME catch ups attended by resistant, resentful medical staff. Too much coming out fast and furiously for any one doctor to know….I want my docs to have access to instant assists. Don’t want my docs to be so exhausted, beleaguered by insurer/certification tyranny either but that isn’t going away.
    So FOAM et. al. it is….and that 7-11 minutes. I cannot trust doctors who aren’t tech/media savvy. For $50,annul fee, I can get civilian access to the entire medical teaching university library nearby. It’s going to be ok. It’s morphing forever now and not too far away from realtime patient assays, scans, etc.

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