We're going to be talking about the changing landscape of medical education and the powers and pitfalls of using social media. Ignore the titles that are on the little session thing, because ours are better. So it's going to be awesome today. I'm going to get us started. I'm Gretchen Winter from everywhere, living the locum's life. And I'm going to be talking about social media for the use of medical education. And my Twitter is there, because this is a social media talk. So my first slide, everyone's favorite slide, is that I have no financial disclosures, professional disclosures, but I do have more pets that are socially acceptable, and they may or may not be making appearances. OK, I'll be honest. This is the only slide they're on, so soak up all that cuteness and remember it when you're doing your evaluations. All right, so our learning objectives today. By the end of this session, the learner will be able to discuss learning theories that support the use of social media for education, to list five advantages of social media use in medical education, and to summarize the use of different social media technologies in medical education. So a little bit of a session outline. We're going to discuss a few learning theories that are applicable to social media, followed by discussing some potential benefits of the use of social media and some strategies for its use. We'll do a brief overview of some of the social media tools, and we'll end with a very brief discussion of potential challenges and cautions so as not to steal Dr. Shulman's thunder. So over the last decade, there has been a significant increase in the number of professionals that are using social media. There was a study done in 2017 that found that 97% of health care professionals owned electronic devices, and 88% of those used social media. And as might be expected, health care workers under the age of 40 were more involved in social media use than those over the age of 40, which I now fit into that group, and it's painful to admit. A study that was published in 2012 found that 24% of physicians use social media at least daily, and 14% of those contributed new information to social media on a daily basis. 57% of physicians felt that social media was a good way that they found it to be beneficial, engaging, and a good way to get current, high-quality information. Also, 58% of respondents in that same survey said that they felt that social media actually helped them to care for their patients more effectively, and 60% said that they thought it improved the quality of the patient care that they delivered. Now, according to a 2019 review of the literature, publications featuring social media for medical education have increased over the last decade. And while many academic physicians are what we might call digital immigrants coming into it, most of our trainees are going to be digital natives, meaning that they were raised around social media and these internet technologies, and they have an expectation coming in that these technologies are going to be part of their medical education. So what about the learning theories that are applicable to this? So one study assessed the learning theories of medical educators who use social media for the education, and they found that they were aligned with several different learning theories, including the theories of connectivism, social development, and communities of practice learning theory. So connectivism is a learning theory that explores how internet technologies created opportunities for learning across these online peer networks. So these teachers guide their students to the information and to key answers in order to support the students' learning and sharing. The social development learning theory asserts that social interaction is fundamental to learning. So learning occurs in this area of proximal development, and that proximal development area is the zone between which someone is able to do things independently and when they need guidance from a teacher or their peers. And in that zone, you can actually access that zone through social media. And the communities of practice learning theory states that there is a process of social learning that occurs when people who have a common interest collaborate, when they share ideas and strategies, when they help to determine solutions, and when they create innovations. So with the concepts that are common to these different learning theories are the belief that knowledge is subjectively constructed primarily within a social construct. So learners learn from those who have more expertise than themselves, and that may be an instructor, but it may also just be a peer who has more knowledge on a certain subject. And learning is a social process in which students best learn when they actively construct their own knowledge, understanding, and meaning through peer interaction. So those learning theories that we just gave an overview of help explain the potential benefits from the use of social media in medical education. So moving on to those benefits, there are a number of potential benefits of social media for med ed. It can be used to encourage conversation about specific disorders and their treatment. It may help to promote active learning because it can stimulate interaction and learner-generated content. It can provide opportunities for more feedback than some traditional teaching methods can. And it can be accessed asynchronously, both geographically and temporarily. Additionally, the flexibility of online tools allows for learning to really be customized to fit the learner's needs. It allows for easily searchable and stored content. I actually had to search and look back at stored content for some examples for this presentation, and it was all right there. It can promote collaboration and professional development, career advancement with networking and supportive learning opportunities. The free and open access medical education idea movement, also known as F.O.A.M., has also democratized medical education materials and thus has empowered learners a lot. So when it comes to social media for medical education, there are a variety of different strategies that can be employed. There are push strategies, engagement strategies, and combined strategies. So push strategies are when the educator puts forth content or material with occasional engagement opportunities. So that's just things like blogs, infographics, podcasts, video sharing. Then there are engagement strategies, and those focus more on interaction between individuals. Those are things like online case-based learning, Twitter journal clubs, things like that. And then the blended strategies focus both on disseminating information and engaging learners. And those are things like live tweeting at conferences and virtual networking. So there are a variety of different tools for social media that can be used in medical education. Those include things like blogging, micro-blogging, podcasts, video sharing, social networks. I'm gonna give a brief overview of some of the pros of each of these. So a blog is an online page or website that contains writings or other media that are often reflections or commentaries. Blogging is the most studied type of social media used in medical education. It's often used to complement case-based teaching or to support online journal clubs. And of note, some major journals and professional societies, including CHEST itself, are using blogs to help enrich their journal content and to provide interactive opportunities for physicians to more personalize their continuing education. And now micro-blogging is my favorite. Oh, sorry, going back to blogging. There are many positive effects. I mentioned that it was the most studied type of social media used in medical education. So we do have studies demonstrating that it leads to improved learner engagement, it can help stimulate interaction with the faculty, it helps to maintain students' humanism and empathy, it helps to enhance collaboration. And one study even found that active participation in a blog-based discussion actually correlated with higher grades. So that's cool. Now micro-blogging is my particular specialty. So Twitter is known as micro-blogging. And that's where posts are limited to a smaller number of characters. So Twitter has been used, and yes, I know it's called X now, but I refuse to acknowledge that, so we're just gonna move right past that. It has been used in a number of different ways, including live tweeting at medical conferences in which tweets are sent out by conference participants with an associated specific hashtag, which for this one would be CHEST2023, baby. This creates a forum for participants to disseminate information to a larger audience, people who may be at this conference, but attending other sessions, people who couldn't make it to this conference, and to create a virtual network of learners. Most major medical conferences now do engage and promote active Twitter use. One institution actually launched a organizational Twitter page, and they found a significant increase in the use and frequency of Twitter for medical residents for their education over the ensuing next six months. They also found that 95% of their residents felt that social media could be useful as a medical education tool. Another study looked at internal medicine residents' attitudes towards a one-year chief-run Twitter feed, and the residents generally found that the chief residents' tweets were informative, and 69% agreed that Twitter had enhanced the overall education during their residency. Now, Twitter can also be used for Twitter chats. These are a moderated online discussion on a single topic normally chosen in advance. Sometimes we invite experts to participate in these, and sometimes anyone who wants to can participate. People participate in the chat by tweeting using specific hashtags and under specific questions, and Twitter chats are regularly used by medical organizations to discuss certain topics, as well as by other interest groups to help to discuss topics like medical education, women in medicine, medical humanities, and things like that. Now, here are a few examples from microblogs that I've recently saved. You've got ones teaching us about, showing us EKGs that are irregular, and asking us, like, what's going on here, and then follow up in the responses a week later or 24 hours later with explanations of pre-excitability and Wolff-Parkinson-White's, why magnesium is used to treat torsades, and then this is actually an infographic that was posted with a ATS, What Educators Are Reading blog that I actually just did recently, that they came up and then they posted a link to the blog as well as this infographic on Twitter. So, podcasts, also kind of one of my babies. Podcasts are digital audio that is made available for downloading or streaming. They're typically part of a series that addresses a certain topic. So, there are many medical journals that have podcasts to assist with disseminating information about their publications, including chest, and then there are also a number of podcasts that focus specifically on medical education. So, the APCC and PD Scholars podcast, of which I am a host, discuss a number of topics relevant to medical educators of pulmonary and critical care. The Academic Medicine podcast discusses a variety of topics in medical education, and the Keyline podcast reviews medical education literature. Of note, podcasts maybe offer really superior support for auditory learners, and primary learning style is auditory in up to 30% of learners. So, this actually may be superior learning for that rather large chunk. So, what about video sharing? Video sharing allows for people to create videos and then distribute them to others on platforms like YouTube and TikTok. Video sharing can serve a number of different purposes in medical education. They can address just about any topic, from how to perform procedures, how to interpret EKGs, to how to have an end-of-life conversation. It can also be an effective method of delivering part of the curricula in a flipped classroom model, where the didactic portion is provided at home to learners to review in advance, and then the actual classroom time is used for more interactive learning exercises and discussions. So, there are examples here of different videos that you can find on YouTube and on TikTok, where they're discussing all kinds of different topics. And this one here is not specifically, is not specifically medical education, but it does promote laughter, which is key to our wellness, which I think counts as part of medical education. There we go. All my notes are done. Oh. All your phone calls are done too. Yeah, I'm just gonna get out of this. It's pretty funny, guys. So, go watch Glockenflecken on TikTok, and it will make your day and make your trainees very happy. I regularly insert his videos to our rounds conversations, and the residents always get a laugh out of that. So, moving on, social networks. So, social networks like Facebook, LinkedIn, Doximity, these can allow users to create profiles, connect, and then to communicate with others. These may help facilitate these social networks that can help users who have similar interests to connect, to share ideas through written posts and other medias. And these virtual communities that are online can actually help to create a group that exists outside the social network itself, like a training program can be used. And then either type, when you use these, like a training program can use a group within Facebook, for instance, or you can have a women in medicine interest group within Facebook. And when you have those groups within these social networks, you can actually create those to be open access where anyone can join and can see that information versus closed where everything is private only to people who have been admitted to the group. And you can use those for specific programs, but also specific classes, clinical rotations, training programs, et cetera. So, what about some challenges? There are, of course, going to be challenges to the use of social media for medical education and everything else. So, studies have reported challenges, including technical difficulties, variable levels of learner participation, and demands on time. But I do think it's important to note that the latter two of those are applicable to all forms of medical education. And then, of course, we have the incomparable Dr. Solman up next to rip this apart and tell us all why social media is really, really bad. But a couple of cautions when you are using social media for med ed. Educators and learners need to use caution when they're engaging in it to remain professional. Patient confidentiality needs to be maintained at all times. The accuracy of the information that's disseminated really needs to be verified because if you're using your voice and your platform as a healthcare professional, there's gonna be automatic trust that goes into your post, so you really need to make sure what you're posting is accurate. And then, healthcare professionals who do engage in social media need to be mindful that their online activity is available for the public to see, and there is a digital footprint of anything that you put online, so assume that it is seen by everyone and permanent. So, some take-home points. Social media use is increasing among healthcare professionals, especially our trainees, and it has an expanding role in medical education. Social media has many potential benefits in medical education, including flexibility, the ability for asynchronous learning, and encouraging interaction. Different forms of social media used for medical education include things like blogging, micro-blogging, podcasts, video, social networks. Challenges in the use of social media include technical difficulties, and then variable levels of learner participation and demands on time, and then always make sure to ensure patient confidentiality, the accuracy of your information, and to maintain professionalism. So, there are some references here for your perusal, and next up, we have Dr. Shulman to tell us why I'm wrong. I didn't say you were wrong, I just said I wanna make sure that it was, so I'm gonna try to grab us back on time. We started a couple minutes late, we're at 3.20, so I'm gonna try to shorten a little bit to make sure our latter two speakers have a chance to present, since they are far more learned and adverse. But, I also wanna put into everybody's head, like, hey, this is not necessarily the perfect thing. So, my topic, I was asked by incoming President Jack Buckley to speak a little bit about the potential downsides to social media, because it is a little bit of a wild west out there. So, I would argue that my primary learning objective is to temper Dr. Winter's enthusiasm for the greatness of social media, and it is great, but it's a downside. I'm gonna skip the educational theory stuff in the interest of getting to the negatives, but I concede that there are some benefits, including connecting to other individuals, creating communities of practice, which let the learners also feel like they're teaching, which makes them feel more involved and potentially benefiting. There are a lot of different modalities that you can use. Gretchen, I'm gonna go too fast over these benefits, so you won't be able to get pictures of all of them. But, I wanna make sure we get to the negatives. And then, the other, I think, important thing that's worth mentioning is that there's this concept of decolonizing medicine, that folks who are from traditionally enriched backgrounds have more access to a lot of resources, and the idea is those who represent traditionally underrepresented groups may get more access in the context of a freely available community in which to speak. And so, I think there's a lot of benefit to that. Now, that said, there are some downsides. So, the first argument I would make is that live tweeting, as Dr. Winter is doing right now, doesn't necessarily capture the richness and sophistication of content covered herein, right? She's getting 140 characters or 280 at a time, but I'm from Jersey, I speak way quicker than she can type, even though she can type really fast. And just giving facts doesn't necessarily help retention, right, you don't memorize from the list of facts, right? As our keynote speaker said yesterday, you wanna connect the dots, not just collect the dots, and I think tweeting is a great way of just collecting the dots. That's not necessarily conducive. The other thing is that interaction is great, and it's not, yes, you can interact with people, but if you're not on Twitter 24-7, which most of us don't live, you're not interacting in real time, and so your ability to retain stuff may be a little bit more limited. The other thing is you don't know who's out there. Yes, you presented Avi Cooper, and Avi Cooper is brilliant, and everyone can learn from Avi Cooper, but there are a lot more people who are junior to Avi Cooper out there tweeting. Social media is dominated by the internet literate, and medical students outnumber residents, residents outnumber faculty, and while there are really brilliant medical students and residents out there, you have to take a little bit of what you see for the grain of salt, right? Not everybody is as proficient at tutoring as the person who put this sign up, and you wanna have a sense of who the speaker is when you decide how well you wanna incorporate their content. At best, their status may be unavailable. At worst, it may be misrepresented. There's a ton of information out there. It's water hose time, folks, and finding the good stuff can be challenging. Figuring out how to weight different things can be challenging. There was a time when the blue check mark meant something. Now you can buy it, and just because somebody has a million social media followers doesn't necessarily correlate with accuracy, but correlates with popularity, and is there an R value? Probably. Is it positive? Maybe. Is it very positive? Probably not. So that, it's hard to, unless you find one or two channels you really like, it's hard. Intellectual property infringement is also a thing, and this is one of the things that Gretchen really wanted me to focus on. It's weird, and theoretically, when something is published, you shouldn't even be clipping a picture from the website of the title of that and tweeting it. You can use the words, but you shouldn't use a picture of it. This is a relatively new term. I don't think anybody's been aggressively sued for distributing figures from manuscripts online, but it's theoretically possible. It's a weird time for publishing, and these companies tend to be a little litigious, so I think if you are gonna use materials, you wanna make sure that you include pictures. You wanna make sure you get permission to do that, particularly for manuscript excerpts. I do have a couple of sound excerpts I really like. Anyone familiar with Figure 1? Anyone remember Figure 1? I'm gonna play, this is a short sound clip, but I think it's worth playing. Let's see if it works. ♪♪ Hello, I'm PJ Vogt, and from Gimlet Media, this is Reply All, a show about the internet. And this week's episode is super gross and disturbing. I have 98 apps on my phone, and this week we are talking about the only one that I'm terrified of. That app is called Figure 1, and it's billed as Instagram, but for doctors. That means that it's a place where if you're a doctor at work, and you see something that is really disturbing, like a particularly unusual kind of gunshot wound, Figure 1 will let you take a picture of it, post it online, and have other doctors comment and favorite it. Your first question about this app is probably how can this be legal? And actually, it's entirely legal. The app forces the doctor to actually get consent from the patient that they're photographing. There's a built-in screen where the patient has to have the entire app explained to them, and then sign their approval with their finger. And the app includes a bunch of rules about how the pictures have to be taken in a way that preserves the patient's anonymity. One of those rules is that you can't show someone's face, really, which means that as you scroll through the app, which actually does look remarkably like Instagram, you just get close-ups of the broken parts of people's bodies. So here's one particular piece from Figure 1, and here's the description that accompanies. So I'm not a surgeon, most of you, to my knowledge, and the audience that aren't surgeons, you probably look at this with the same sort of revulsion that I do, but potentially there is. So the question is, right, patient involved in a head-on collision, alert and oriented times four, Glasgow, school L15, two dead in arrival in the other vehicle. Only injury on this patient is as shown. Manually reduced back into place, resulting in faint pulses. Was it a dislocation or fracture or both? No X-rays on site, just curious if it's possible to tell. So this is somebody who's looking for education. It's kind of nasty, but the intent is presumably good. Like, is there a way to figure this out? And the responses are actually generally pretty constructive, right? Without putting my own hands on the patient, I would suspect both, given the history of mechanism of injury, need imaging to confirm. I guess the main reason I asked was because it seemed to fall back into a place pretty easy, or what seemed to be its place, ha ha. Needed an exam to tell for certain, but looks to be a tailor extrusion. I'm gonna play one more brief excerpt from the podcast on this. John said that the part of Figure 1 that really gets to him isn't the pictures, it's the comments beneath them, left by other doctors. When you see a doctor talking about, like, a finger that's been punctured by a nail, and making a joke about how the patient nailed it, and then punctuating that joke with LOL, it's just, I mean, it's, I wouldn't say it's wrong, it's just so strange to see it. Right. I caught myself feeling strange about this, and then immediately thought, like, of course this is how doctors talk, this is how I would talk, this is how anyone who faces anything like this would talk. There will be LOLs, and LMAOs, and ruffles, and things like that, and it's like, there's, these are like the conversations that doctors would be having in a break room when they assume no one else was there. The combination of tone and subject matter is something that I've never quite seen anywhere else, as a civilian, I guess. What do you most wish you could unsee of the things you've seen on it? Uh, for some reason, it's the late-stage skin cancers. Those are pretty common, I guess you would say trope on here because it'll be someone who came in with an undiagnosed melanoma, and clearly this person does not have long left. You're just seeing a cropped image of, like, a lower back with this fatal growth on it, and then there's no sense that you're watching someone, or that you're eavesdropping on this conversation about someone who has any sort of chance. So we don't often think of the patient perspective, but let's concede that, by and large, the social media, unless it's using, like, a locked Facebook group or something, I don't even think that's a thing anymore, it is available for public consumption, and I pulled some quotes from this because I think that they really hit close to home because we do have a language as care providers that we use amongst ourselves that the public doesn't often get to see, and when they see it, it can be really disturbing for them, right? Of course, this is how doctors talk, it's how I would talk, it's like how they would talk in the break room when they assume no one else is there. The combination of tone and subject matter is something I've not quite seen somewhere else. For us, it is normal. For them, it's not, and we just need to be cognizant of that. One last piece, and that is that privacy remains an issue, right, so follow-up on that injury is that you guys reduce in the field, EMT just wondering what region you're in and what protocol for field reduction if you have one. Yes, so we're out in Canyon Lake, Texas, 70 minutes from a level one trauma center, 25 minutes from a level four. Okay, so again, if you do a little Google, Canyon Lake, Texas, we know the date this was posted, we know there were two DOA, and it doesn't become particularly hard to figure out who that is because the internet's a pretty big place with lots of interesting information, so it's not hard to find things if you look for them. As a humor person, I point out that humor doesn't always translate well. Poe's Law says that without a clear indicator of author's intent, any parody can be mistaken by some readers for an extreme, for an insincere expression of those views. Last year, I put together Dr. Didactic, which was like a goof, like enemy of chest. I made this guy up, and he was gonna taunt chest, and he ended up giving out a prize. I see Dr. Sharp in the back of the room who won the prize, congratulations again. But I would have him tweet at people, right, and I told the people, like, hey, this is fake, and don't believe it. People saw this guy and would reach out to Chris Carroll or Anissa and be like, hey, careful, this troll's out there, right? It was completely parody, but they didn't realize that it was parody. And then Courtney Gallo's humor, for reasons we talked about, while it has a good therapeutic role, it doesn't necessarily work when people outside medicine see it. They don't know that it doesn't come from a good place. So here's an example of one of our membership. I left their name out. In medical school, they never teach you that when a pizza delivery man arrives in the ER waiting room with $200 of pizza ordered by a patient for an ER waiting for a pizza party, this person wrote, do you move them lower on the triage list? They're clearly not that sick. And the response from somebody was, appreciate your contributions to medicine, but I don't think this comment is in good taste. So they ended up apologizing, you know, for those who, but of course, the internet doesn't, that's not gonna be enough for the internet. So the internet then went, you made a comment that represents your professional person. I know this person. Many of you do know this person. I will not disclose their identity. But this is a wonderful person. You're only apologizing because you've been called out for it. I would have an extremely hard time trusting you. And of course, then the internet further indicating where this person saw patients. The internet folks is a scary place. I don't care what the next speakers say. It is a bit of a wild west. It is hostile. People have strong opinions. They're not always evidence-based. Our friend and colleague Gabe Bosslet wrote a long Twitter feed a couple months ago. People wanna look back and litigate the specific details the ICU care for COVID patients should be ignored. Full stop, don't quote them, don't screenshot them. They want your outrage. Don't give it to them. He then got their outrage and closed his DMs because that's what the world is. I don't know what the right answer is. I'll close with one last story. It's about institutional concerns. Most universities in some practices have social media policies. Many of you probably work at places where they do. And even though your profile can say, I only speak for myself, your employer will take notice. And so one of my fellows, who many of you may know, Nicole Herbst, who's now a junior, was a former fellow. Now she's a junior faculty member, wrote about an experience she had in clinic where she saw three patients in clinic for an abnormal chest CTs that they bought on Groupon. And you can see her panoply of thoughts. US healthcare is bonkers. Nicole had probably 100 to 200 followers at the time. This was picked up by national media. And she now has five digits in the followers, but she did not want the attention. She'd be like, people were reaching out to her, asking for her to quote an opinion and Emory Healthcare took notice. And like, this is a relatively, it doesn't mention the patient. Now, could a patient look this up and say, yes, I saw a Dr. Herbst in clinic and I had a CT, so they're referring to me. Now, it's not derogatory about the patient, but social media is complicated. And so that's, I will leave with that. It's my final slide. There is no right answer. But my point is, despite the wonderful enthusiasm the other speakers today will have, and I think you should be, because I think it's a wonderful tool, it's not the be all, end all. And there are opportunities to get it wrong, even if you have the best of intentions as these folks did. So with that, I would ask that you be careful out there. I believe, is Dr. Mark next? Who's next? All right. With that, then hand off to my friend, my new friend, but my colleague, Nicholas Mark, who will speak a little bit more concretely about some more advantages of social media. Floor is yours, sir. Very well done. Hard act to follow. All right, well, thank you, folks. My name is Nick Mark. I'm an ICU doctor at Swedish in Seattle, Washington. And I'm gonna be sort of arguing the pro side of this and maybe trying to get in a little more into the weeds about how we can use social media in ways that are productive. So maybe not trying to refute those points because I agree with those points, but sort of giving some strategies to do it well. So a quick roadmap of this. Why use social media in med ed? I'll double-click on microblogging platforms, so Twitter slash X and its alternatives. And then I'll conclude by giving you some tips for how to do this more effectively should you choose to do so. So I always like to imagine, in order to understand medical education, it's kind of important to think about how we got here. And I always like to imagine like the time traveler who comes, you know, 100 years to the present and like how strange the world would be. You know, how we communicate, how we get around, how we access information have all changed dramatically in the last century. But one thing is actually quite similar which is medical education. In some cases, we have the very same lecture hall being used by the same titled professor to give the same talk. And, you know, the format of this is very important. The format is the lecture which comes from the Latin lectura meaning a reading. This was developed in the medieval university at a time when literacy rates were really low and books were really scarce. So one person reading to a room made a lot of sense pragmatically. But it's not necessarily the best way to convey information. It solved problems that we've long since solved with the printing press and reading. And to give you an example of how the lecture is applied in medicine, this is a very famous painting by Thomas Ekins of Dr. David Agnew's clinic. And you can see he's an amazing surgeon but he may not be the most engaging lecturer. Just to highlight some things, there's a guy checking his watch, there's two people cuddling, and there's a third person up there who's basically full horizontal asleep. So great surgeon, not an engaging lecturer. How can we do better? Well, it turns out the answer is we can go back a little further. So this is the Socratic method. That's Socrates there. And this is seen as an argumentative dialogue between individuals. This is where it's not a passive recitation of information but a discussion about a topic. And you can see that in contrast to the last painting his audience is engaged. They're leaning forward. They're amplifying his gestures. They're, I assume that guy is disagreeing with him. But they're sharing strong opinions, either agreement or disagreement. And this to me sounds a lot like contemporary medical education. I think there are, and you've heard much of this already so I won't belabor this point, but I think there are five really key advantages to keep in mind when we think about the strengths of using social media. First and foremost, scale, right? We have perhaps 30 people in this room. I could give a talk of this size every day for 10 years and not reach as many people as a tweet could. So as far as reaching your audience, scale is an undeniable advantage. Second, interactivity, right? People can reply. It can be a conversation. We can make it more Socratic. Third, we planned this session like nine months ago, right? And we've changed stuff since then, right? There's a long latency when you talk about traditional modes of medical education. And the joke is like if you buy a medical textbook, you've just learned what the state of the art was five years ago, right? So in order to keep up with a rapidly changing world, having a media that lets you disseminate up to the minute information is really valuable. Fourth is availability, and Gretchen mentioned this as well, the value of asynchronously available information. People, we don't have to be in the same room. We don't have to be in the same time zone. It can be a year hence, and you can access this information. That's very valuable. That's part of why scale is so great, but it also accommodates different styles of learners. And then finally, and I think maybe one of the most significant features is cost. You can provide content for free where traditional modes of medical education often are costly, and therefore, people who traditionally didn't have access may be able to access this. So I would propose that using those five advantages properly, we can have less of this and more of this, more of an argumentative dialogue and less of a dry, passive lecture. So now let's double click on microblogging, Twitter and its alternatives, and talk about this. So before we talk about the message, we should talk about the media, and this is it. So there are many more than just four, but these are the four leading platforms that are used for sharing information in the form of microblogs. And just to highlight a few points on this somewhat busy slide, each of the platforms, the posts have a different name. There are small differences in the number of characters per post. Some of the newer ones allow you to put a little bit more, so it's less micro. Conspicuously, Blue Sky does not support videos as yet. Some support more or fewer images. And I think one of the most important differences, though, is scale. So there's lots of talk about Twitter being in decline, but in terms of the audience, Twitter has over half a billion monthly active users, and by some estimates, 70% of practicing MDs are on the platform. So this is, unfortunately or fortunately, where the people are. In contrast, you can see that despite a strong start, Threads has declined substantially in users. Blue Sky and Nacidon also remain quite small. Part of this, of course, is because this is invite-only, you know, it's not widely available. And then as kind of a last point, the architecture of these platforms, even though the user experience is very similar, what you see might be the same, what's going on behind the scenes has some differences. For example, Mastodon, and to some degree, maybe in a future instance, Blue Sky, are decentralized. So there may be separate instances that have separate moderation that may reflect the view of clinicians better or worse. Though I would point out that three of the four are owned by essentially Bond villains. So, you know, hoping for these platforms to reflect our values may be kind of a hope, dream. So now that we've talked about what those are, let's talk about why do people tweet, skeet, Thread, or toot. And this is from a survey that Nature did of their readers about 10 years ago now, so a ways, where they asked them, why do you use these different platforms? And importantly, the people who use Twitter used it for very different reasons than the other platforms. First and foremost, they used it to find peers, to read their work, and then to share their own content. But importantly, they also used it to comment and discuss other people's work and to follow those discussions. And so it was not just an opportunity to see what others are doing, but also to engage in a commentary with them, and also for people to role model how to have professional conversations, which I think is very germane to a point that Gretchen made as well, that with a disproportionate number of junior people on these platforms, there's a lot of value in showing how to have a professional exchange. I would also point out that not only does, not only is Twitter a good way to reach more audience, but it's a good way to make traditional content reach more audience. So this was a study done by the Thoracic Surgery Social Media Network, which is an association of thoracic journals, where they randomized 114 articles over six months to either be tweeted or not. And they found that the articles that were tweeted had higher altimetric scores, so more people looked at them and shared them, but also more citations. And I think that's really crucial because not only does this impact people looking at it, but presumably that means more people are building on your work, which is the very purpose of academic dissemination of content. Now, let's go a little bit deeper into how we can use this. And I think of this as a pyramid, right? There's kind of three ways that we as clinicians can engage in social media. At the bottom, we have passive engagement, so we can use it to follow others and their content. You can basically not post anything yourself, but just see what others have to say. Moving above that, semi-actively, you can use this to amplify and comment on other people's work. Maybe you don't feel comfortable sharing your own feelings, but you can react, and your reactions are valuable. And then building on top of that at the apex, you can share your own content. And this is a pyramid for a reason, because the goal is to listen more than you talk, I should say, that we can absorb others' content a lot, we can amplify and comment on it somewhat, and we can share our own a little. And depending on what you're comfortable with, the pyramid can stop at its base. Obviously, a pyramid needs a base, right? And you need more people there. So I think this is a good framework for sort of orienting yourself. Where do you feel comfortable? How do you want to engage? So now let's conclude by talking about a couple different ways that I think we can use Twitter productively. And so I think of this as kind of four big categories. First and foremost, you can share or comment on new publications, including your own. And you can think about this as kind of like the opportunity to write the accompanying editorial to an article you just read. It's also a good strategy, I find, to read articles more closely if you're gonna be explaining them. It's like, it's a journal club. And I think importantly, you can tell your followers what you think is good about this paper, how or if it changes your clinical practice, and what future work you think is necessary. So I think this is a really valuable way to have more than N of three peer reviewers in one sense. Next, you can sort of think about the clinical pearl, right, that small learning point. Today I learned, and whether this is an EKG finding you'd never seen, or a drug reaction you'd forgotten about from med school, or something else, there's a great opportunity to share those little pearls, the kind of thing that you might stop rounds outside a room and just give a 30-second remember this. And this can be very valuable for learners. And it takes advantage of the micro part of microblogging. But it doesn't have to be small. You can also give larger teachings about a topic. You can string tweets or threads together, and you can take a lecture, and you can basically put it in this media. And that has the advantages of reaching more people, allowing them to comment. And plus, you can do things like you can have polls. You can make the audience interact and vote about what they would do or what they think is going on. And I think that the ability to reach more people with your work and the ability to engage them in a conversation adds a lot of value to it. I certainly feel like you can give a talk to a room full of people who are nodding their heads, but you give the same talk to Twitter, and you will get feedback, good or bad. And that can be a very, very useful thing for helping your thinking evolve. And then finally, I think of social media, when used properly, as a means for connecting over our shared experiences in healthcare. Sharing the joy of sending someone home who you thought might not survive, or the sadness and frustration of sharing the hardship of somebody who didn't. Obviously, with respect to not sharing the details of that, but I think the ability to have a community with other people who understand what you're feeling is very valuable. And I think in the pandemic, this in particular brought solace to many and gave us a great sense of camaraderie to see what others were going through. So I'll conclude with sort of some rapid fire tips for how to do this. First, and I think David made a fantastic point that you might get sued if you share images, but I think there is a lot of value when you share a paper of sharing the figure that you thought was important. And I would say that this is an opportunity to fair reuse. So like, for example, if you screenshot and you circle the part that is it, or you circle only part of it, I think there's a good argument that that's done for good purposes. I would also say, always include links so people can go read it themselves and so that the journal is getting the traffic that they deserve. It's good to add people, to cite other people and get attention for them and to use hashtags, but use them sparingly. Whenever I get one of these tweets that has me in it and it's just all blue and it's just like 50 people, I'm just like, next. So, one or two people, one or two hashtags, no more. Many people are kind of afraid to share their opinion, but your opinion is why you're there, right? If I wanted to read the article, I'd read the article in the journal, right? If I'm following you, I care what you think about the article. So don't be afraid to share it. And it's okay to have an opinion. I don't know what to think about this, right? And that's actually the next point, which is that we should ask questions, whether that's in the form of a poll or whether we should ask colleagues, hey, will this new study change your practice? I think that's a very engaging way to share content. And it's a great way to learn from the content you've just read. That goes along with the idea of interact. I think it's very important to assume good intent. 280 or 300 or 500 characters is not a lot of space. Not everyone speaks English as a first language. It's very easy to misconstrue the tone of a question or a comment. And I think it's really important to assume the most charitable interpretation when somebody writes something. That said, absolutely do not hesitate to block the bad actors and block them freely. People where it's really obvious that it was not a misunderstanding, there's no time for them in life. Just block them, move on. To another one of David's great points, share the pearl, not the patient. And I honestly, I was looking to see who coined this great term, and I can't remember who coined this. And I searched, I couldn't find it. So if you know who said this, this is a great saying. But the point here is you should say what you learned from the patient, not a photo of the patient, not something identifiable about the patient. That's actually the part that's valuable, not the, oh my God, look at this. Along with that, I should be crediting somebody else there, but I can't remember who I saw that from. And then be authentic. I think people often strike sort of a milk toast, don't want to offend anyone attitude. And you can be yourself. People want to hear what you as an individual have to say. Wow, exactly 15 to the second. All right, well, you can tell me what you think of this in all those places. You can download the slides right there. And I will shamelessly plug my own things here as we transition to the next slide. Thank you very much, everybody. Thank you. Great, well, good to see everyone here. I'm Christina Montemayor. I think I'm the last person standing between you and your next Mai Tai. But hopefully you're enjoying the session. I know the four of us today really appreciate you being here. As we've heard from Nick, Gretchen, and David, the different types of social media, I was gonna focus on podcasts for the next 10 minutes together and what's currently out there and resources that you could use. No disclosures. As far as a disclaimer, I am co-founder of Plum Peeps. Missing my other half, Dave Ferfaro, is currently doing amazing things at BIDMC. He's recently a new dad. And some of you that may have followed us, he's really embracing the dad jokes in some of our episodes. So hope you're enjoying that. We're gonna, for time purposes, I had a poll, but we're not gonna use the audience response system. We'll just do old school. So just, I have three questions of, you know, who has listened to a podcast? And we'll just do, it's supposed to be A, B, and then C. But who's listened to a podcast at least once in their lifetime? We could show of hands, nod a head, say aloha. So I think most people here, and I think we're self-selection biased, have listened at least once in their lifetime. What about in the last 30 days? Perfect, so I think everyone is pretty, the majority of people are raising hands. And what about education focused? Again, so most people here are here for a reason. So great. So if you answered yes to any of those questions, you are likely one of the 177 million individuals in the U.S. who have listened to podcasts in the year 2022. So you can see here that there's been an increasing trend, specifically 11% of, or 11 million in 2006, up to 177 million in 2022. I think the uprise we start seeing here is in 2019, which is likely multifactorial because of the pandemic. So an increase in both educational as well as entertainment podcasts during that time. So you're probably asking yourself, well, if I'm listening to podcasts, who else is listening to podcasts? And this is just podcasts in general, not necessarily education focused. But 50% of monthly U.S. podcast listeners are between the age of 12 to 34. So this really encompasses medical students, residents, fellows in training, as well as some early career faculty. Majority of individuals prefer to listen at home or during the commute. I've also heard some people like to listen to episodes while working out or doing things around the house. And 65% of individuals prefer listening to podcasts on their smartphone or tablet. So this is just another question to think about. So you're working with a trainee who wants to learn more about the use of vasopressors and shock. Which of the following asynchronous educational content are they most likely to use? So say A, journal article, B, textbook, C, up-to-date, D, podcast, or probably you're looking for E, all of the above. Which I think E, all of the above is probably fair. What's a textbook? I know. And I wanted to shift a little bit because a lot of the literature, which was starting to be published in 2012, 2014, really was centered around the role of emergency medicine trainees and podcast utilization. So they were really the first adopters of podcast use. 88% of EM residents listen to educational podcasts monthly. And in some EM programs, they have up to an hour per week per ACGME guidelines where they can actually incorporate podcast use into their didactic time. And they viewed podcasts as more beneficial than textbooks and journals. And this was published from a 2014 paper. So at that time, over three million downloads of the podcast EMcrit were noted. And you can imagine how much that's advanced over the last nine years. So what is, I thought it would be important just, what is EMcrit? So it's a podcast started in 2009. I was looking at information that was published or available in 2012, which was the time that the study was done. And I found one, they had several content things. This was specifically procedural related. So this was actually a YouTube video showing anatomical landmarks and really talking through the process of endotracheal intubation. In the literature, it also shows that people are most likely to listen to a podcast based on a recent patient experience. So I know Gretchen brought up Torsades Management earlier. This was also a popular one published by EMcrit in 2018. And then the last delivery method can actually be more like a literature and review. Several of you probably in here packed the session yesterday for the critical care year in review, both sessions one and two. So this is a monthly platform that EMcrit uses and they talk about resuscitation and critical care literature on a monthly basis that's available. So I think another high yield opportunity that exists. When you're thinking about podcasts, you're probably like, well, what makes a great podcast? And there's not a lot of consensus or literature on this. I found one article which involved a self-selected group of 44 individuals who were at a social media summit. So Nick, I think there's some type of social media summit exists. We were talking about that earlier, whether or not there's a conference on that. But so out of 44 people, they looked at really three domains, credibility, content and design. And there was 100% consensus among the participants that if conflicts of interest being listed as well as accurate resources being listed, 100% agree that that was a top quality indicator, not only accurate resources, but where resources identified. And the last two you could see here, it was fact versus opinion identified. And is technology readily available as in is the software platform being used readily available to listeners? So putting this together, and I think the three speakers before me have alluded to some of this in some way, but I thought these were kind of six benefits of podcasts and medical education. So accessibility, one, again, is the platform and software accessible? Is it available on your smartphone or tablet? But I also think this is accessibility to experts. I think podcasts can really combine people from various institutions, various specialties that may not have been in the same room before. Is it current? I think we just asked, David just asked a question, what's a textbook, right? So textbooks can take a long time to really incorporate advanced data. So a podcast can really take up and coming information. Is it engaging? Nick and Gretchen, both podcasts hosts as well, two of the most engaging people I know. Active learning, I think is really important. Can a podcast be complimentary? So in addition to the didactics that they're getting, maybe some people had issues understanding a concept, this can help solidify that. And again, I think really just being this community and really having both national and international presence and having a global reach. So I'm gonna shift a little bit. I know I talked about some of the EM specific use of podcast but what about just podcast use in medical education in general? And this was from a 2019 Google based review of current podcasts by specialty. And over 19 specialties had at least one podcast that was active. EM had 28 IM and pediatrics tied for second and third with 13 podcasts available. And the average episode length was approximately 30 minutes. What about trends of podcasts in internal medicine? So Rodman and colleagues in 2021 published that at a US based IM podcast were being utilized in over 192 countries. 2 billion downloads of bedside rounds, core IM and the curbsiders, many of you may be familiar with, were downloaded between 2017 and that should be 2019. And then they found that it was utilized more in high income countries compared to low and middle income countries. You know, and so who's actually listening to these IM podcasts? And this was from Burke and colleagues who basically identified over 10,000 subscribers to the curbsiders. And you could see here that the largest percentage of listeners had completed training. So they were either internists or specialists. This was followed by residents and fellows with 23%. 20% was next with advanced practice providers and then students at 15. And then you can see just a small slice of the pie with pharmacists and nursing. As a prior nurse myself, I think this can expand and I think there's an opportunity. So one of my own personal agendas, I think there's a need for that. What about role of podcast during the COVID-19 pandemic? So several podcasts that I have listed here, Cardio Nerds, Dan and Amit, both really great guys. They actually pivoted to what they were doing and they did a 10 episode series on the acute inpatient management of COVID-19, which was really, really remarkable. And sometimes I still go to those. But you know, what about the outpatient setting curbsiders provided a COVID-19 update. So I think many of us at the time were wondering, and what do we tell our patients? Do we do Moderna? Do we do Pfizer? Can we mix them? What arm do we do? When do we get it? What do we recommend boosters to our patient population? So this podcast helped identify and answer some of those questions that was readily available to the public. And then many of you that hopefully got to see Jamie Rutland yesterday at the keynote talked about his barbershop medicine podcast where he talked about the importance of COVID-19 vaccination in black communities, which he thought was a need at that time. So what about, just what about pulmonary content? Most of, we're here at CHESS for either having an interest in pulmonary critical care or sleep medicine. So the really kind of started with inner IM podcasts that either had a pulmonary series or pulmonary content. Just listing here as an example of the curbsiders and I know Nick was able to be a guest on this episode. So it was a rapid response series talking about acute hypoxemia, which was pretty amazing. I still refer that to some trainees that I'm working with that had really nice infographics. If you haven't checked it out, you should. But what about that? So kind of staying on hypoxemia, the curious clinicians, so Tony Brew and Avi Cooper, again, they're talking about hypoxemia but asking a very nuanced question. Why do PE cause hypoxemia? So this, you know, I refer to sometimes med students when they may not get it in our didactic sessions when they're doing the pulmonary course but they can refer to this afterwards and kind of work through things on their own. And then Core IM, Shreya Trivedi and her team talking specifically about COPD and steroid use for treatment. When I talk about these podcasts though, I think you could see it's, you know, people working on their own who are doing this and maybe they did it, you know, they were colleagues, they were friends but they're creating this content, they're putting in resources on their own time. But what's really the role of professional societies in podcasting? And I know Gretchen mentioned some of these already, obviously here at CHESS and they have CHESS Pulse as well as CHESS Journals that have podcasts associated with it. The American Lung Association has LungCast. Several of you have probably been to the Society of Critical Care Medicine, they have their own podcast as well. And then the ATS has Breathe Easy. They have a recent overcoming imposter syndrome in academia. Anissa Doss talked about this yesterday in the training lounge and if any of y'all were there, but this was also another great opportunity for professional societies to be involved in the podcast sessions. I just want to end with a few more slides just so that those that are here today, you know, this may be relevant for you and your training, but what are some current PCCM podcasts? And Nick, I have no issues plugging you. This episode actually dropped today in critical care time, cardiac arrest, running a code. And critical care time is with Nick Mark and his partner, Cyrus Askin. There is ICU Cast with Eddie and Todd, which many of you may have listened to discussing recent literature. And then Dave and I, while we do some critical care, we really felt there was a void for pulmonary content. We just released this with Nick and Jessica from Washington Hospital Center on Solitary Pulmonary Nodules. Some important things though about podcasts, you can listen to it, but there really haven't been studies, you know, how much our listener is actually retaining and what else can we do to help retain in addition to the audio. And I think the benefit of a lot of podcasts now are they actually have infographics. So this is actually the infographic associated with Nick and Cyrus's running a code that was released today. And then Nick Gaoni and Dave Ferfaro worked on this infographic for us for our Solitary Pulmonary Nodules. But what else can we do? And I'm wanting to include Pulm peeps, but obviously this is applicable to all of the podcast hosts, those in the room and those that are not here today. But you know, so podcasts we just talked are not necessarily, they've been around at least since 2009 with EM crit. So podcasts in general aren't innovative, but how are we gonna, as a community of pulmonary critical care and sleep medicine, how are we gonna keep things innovative? So one thing is if there's any trainees in the room, Dave and I recently launched fellows case files. So we wanna work with fellows in training. We want your APD or PD to join. And we wanted to highlight and talk about your program. So if anyone interested, please let us know. You know, some of you may have also, we were able to meet with Anissa, Subani and Gabe, as well as Jusufa, to talk about a preview of the CHESS meeting. So this was another avenue to have podcasts available. We partnered with ATS Critical Care and talked about the DEI Pipeline in Pulmonary and Critical Care Medicine, which was a session that they had programmed in this last year's ATS. And then also another thing that we also found, as I said, average length is 30 minutes. Sometimes people like 10 or 15 minutes. So we also did a 10 minute rapid fire journal club within Pulp Heaps that has recently launched. So where are we going with future of podcasts and PCCM? I think there's still a potential need for continued collaborations and attempts to make content accessible to a global audience. I think as you can see here, there's a lot of EM and IM literature, but there's really no PCCM specific literature. So we have scholarly efforts that need to better understand use in our field. As you can see, I don't think, I feel like we're competing with the sleep sessions right now, but there's no gap. There's definitely a gap in sleep related content. And there's a use of podcasts. You know, what's the use of podcasts? I think there's a big role in VOID for using podcasts for both patient and family education. And I think we are at time, but I know any four of us will be around here for a few minutes. If anyone has questions, we're happy to welcome them. Thank you.

social media

podcasts

medical education

accessibility

interactivity

global audience

Twitter

evidence-based resources

professional societies

future directions