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 Table of Contents  
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 93-97

From “pearls” to “tweets:” How social media and web-based applications are revolutionizing medical education

1 OPUS 12 Foundation, Inc., Bethlehem, Pennsylvania, USA
2 Department of Surgery, Rutgers University School of Medicine, New Brunswick, New Jersey, USA
3 Department of Emergency Medicine, University of Florida School of Medicine, Jacksonville, Florida, USA
4 Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
5 College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
6 Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA

Date of Web Publication30-Aug-2018

Correspondence Address:
Dr. Thomas J Papadimos
Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_37_18

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How to cite this article:
Stawicki TT, Peck GL, Galwankar SC, Bahner DP, Papadimos JS, Stawicki SP, Papadimos TJ. From “pearls” to “tweets:” How social media and web-based applications are revolutionizing medical education. Int J Acad Med 2018;4:93-7

How to cite this URL:
Stawicki TT, Peck GL, Galwankar SC, Bahner DP, Papadimos JS, Stawicki SP, Papadimos TJ. From “pearls” to “tweets:” How social media and web-based applications are revolutionizing medical education. Int J Acad Med [serial online] 2018 [cited 2023 Mar 25];4:93-7. Available from: https://www.ijam-web.org/text.asp?2018/4/2/93/240138

Social media (SM) has revolutionized not only the way humans communicate but also the way we share our experiences, including learning and propagation of knowledge.[1] This applies to all levels of education, from elementary to postgraduate.[2],[3],[4] As a consequence of the SM revolution, increasing volumes of information are reaching larger and more diverse audiences, with noteworthy adoption rates and efficiency.[5],[6]

Over the last 5 decades, computer technology has evolved significantly, surpassing many predictions in terms of processing speed, miniaturization, and cost.[7] The overall process of societal transition to using electronic devices has been referred to as the analog to digital transformation. This process now impacts virtually all aspects of our lives, including medical education. Introduction of the Internet provided a powerful impetus for further amalgamation of computing resources, wherein ever more efficient (and smaller) computing machines functioned synergistically, effectively enabling unrestricted sharing of information around the globe.[8],[9] As end-users transitioned from large, slow, cumbersome, and expensive desktop computers to small, handheld, and inexpensive devices, both the overall adoption rate and the number of specific practical applications increased markedly.[10],[11]

As predicted decades ago, the above factors cumulatively contributed to an exponential growth of information available to end-users on the Internet, with steadily decreasing “information doubling times.”[12],[13] Despite its relatively recent adoption by the broader public, the World Wide Web has evolved into an intricate network for the exchange of knowledge, culminating with academic faculty gravitating away from analog “pen-and-paper tools” to entirely digital-based methods of scholarly exchange that both enhance end-user experience and help ensure that active learning is taking place through interactive assessments and feedback mechanisms.[14],[15] Given the totality of the above-described changes, it can be reasonably expected that the amount of classically understood “classroom time” will be significantly reduced, with the majority of learning done using increasingly interactive didactic tools (e.g., immersive simulation) requiring the student to spend the better part of his or her learning experience in front of a computer or portable device screen.[16],[17] This concept has been referred to as the flipped classroom where fundamental learning can occur through digital media before coming to the class to learn more about the context and practical application of the informational content.

The Internet provides instant access to limitless amount of information. Although web usage is embraced increasingly by all segments of the population, the more recent generations X, Y, and especially Z (those born after 1990) enmesh virtually every aspect of their lives in “continuous connectedness.”[18],[19] Knowledge management, entertainment, and communication are among the many areas completely transformed by the implementation of the World Wide Web and subsequent layers of applications that supplement and enhance this primary resource.[20],[21] Currently, more information can be accessed within seconds – after typing a question or speaking it out loud toward a “smart device” – than ever before.[22] Computers, laptops, cell phones, touch screen devices, “smart homes,” and “virtual assistants” are all becoming pervasive throughout our lives, giving rise to the “Internet of things.”[23],[24] In the past, hours could be spent in a library researching a topic, finding appropriate sources, and cross-referencing and double-checking scholarly information. Nowadays, the same process may take seconds, with complete literature search reports being available almost instantaneously, featuring custom sorting and stratification tools that can “slice and dice” the data in every way imaginable.[25] At this juncture, several important questions emerge: How can academic medicine and medical education benefit from – and contribute to – such developments? Should further incorporation of web-based tools be encouraged in medical education? How do we go about sorting and categorizing information according to its contextual relevance and quality standards? And finally, how do we set appropriate limits and standards of “online behavior and integrity” to optimize the user experience while minimizing negative interactions

Selected practical uses of Internet-based tools in medical education include but are not limited to: (a) management and application of predetermined didactic content; (b) self-assessment and other testing tools, including interactive participation; (c) SM-based platforms for instantaneous sharing of small bits of high-yield information; (d) lifelong learning and continuing professional development; and (e) immersive simulation involving remote stakeholders.[26],[27],[28],[29],[30],[31],[32],[33] How can the next generation of physicians not only learn but also effectively reinforce their knowledge, skills, and reputation through multimodality didactic approaches? One possibility is the incorporation of Internet-based SM platforms to disseminate knowledge that in the past was the primary foundation for what may be termed “quick facts” or “clinical pearls.”[34],[35],[36] After all, experience- or problem-based learning is one of the most effective educational approaches and, when combined with virtual platforms and spaces, may result in better knowledge retention, access, and reproducibility than other didactic methods.[37],[38],[39]

Due to the vastness of the general topic of Internet-based education, we will now focus strictly on the much smaller domain of using SM to disseminate targeted, high-yield “clinical pearls” and “shared experiences” as approaches to facilitating experience- and problem-based learning and improvement.[40] People tend to learn from experiences – both their own and others' – and synthesize these experiences into a unique, highly personalized framework of growth and self-improvement.[41],[42],[43] According to the US National Library of Medicine National Institutes of Health, “clinical pearls are best defined as small bits of free-standing, clinically relevant information based on experience or observation. They are part of the vast domain of experience-based medicine and can be helpful in dealing with clinical problems for which controlled data do not exist.”[40] “Clinical pearls” are often formatted as “mnemonic devices” – a way of framing things that facilitate recall and application of information. They are also meant to be conveyed and/or transferred in a memorable and readily recognizable fashion, much like a catchy song or humorous joke. Finally, “clinical pearls” tend to target new learners, primarily through their general appeal and content simplicity. Not infrequently, educational experiences incorporating “clinical pearls” through the use of SM will also include lifelogging or an activity that involves end-users sharing aspects of their lives through visual abstracts, images, videos, or text entries.[16],[37] The latter aspect may present a unique set of challenges to active users of SM in the context of medical education, as discussed in subsequent paragraphs.

The first and perhaps most difficult challenge is the fact that SM provides an active interface between the “real world” and the “virtual world.” It is easy to forget – as we are often reminded by various news reports and anecdotal stories – that the “virtual-to-real world” interface can be quite blurry, and one's activities and/or statements in one will readily affect the other.[44],[45],[46],[47] The so-called “online disinhibition effect” has been described in the early 2000s by Suler,[48] who found that online presence tends to be associated with self-disclosure or acting out more frequently or intensely than comparable “in-person behaviors.” Examples of unacceptable “online behaviors” include cyberbullying, stalking, and harassment.[49],[50],[51] The authors of this editorial recommend the “think before you type/send” approach to minimize any unintended consequences associated with such “online disinhibition effect.”[52] The second major challenge is the necessity to ensure patient confidentiality and privacy while discussing case-based experiences in an online format. Consequently, all medical personnel, students, and other trainees must be educated regarding the proper use of SM platforms in the context of the Health Information Portability and Accountability Act (HIPAA).[53],[54] Optimally, “clinical pearls” should focus on concepts and avoid describing actual cases. However, if case-based context is required to better or more effectively convey content, such cases should be purely fictional and should not include any identifiable information (including photographs and/or other visual aids). Third, “clinical pearls” often rely on individual or collective “memory of an event,” which has the potential to introduce significant bias into the didactic content being conveyed. Thus, “clinical pearls” should be considered with a healthy degree of skepticism and categorized under “anecdotal evidence” in terms of their medical value.[55],[56] Finally, all users of SM should have rudimentary understanding of intellectual property rights (and associated laws). Unlicensed use of materials – although protected to some extent in the educational setting – can result in serious legal ramifications for the individual(s) involved.[57],[58]

There are many different forms of what is broadly defined as “SM,” from various text-based applications, to video-based platforms, to hybrid concepts that incorporate elements of all types of “multimedia.”[59],[60],[61] Moreover, an increasing number of web-based educational materials are dedicated to knowledge management and testing, including “virtual notecards,” “online quizzes,” “content gamification,” surveys/questionnaires, and other more advanced/adaptive forms of medical content-based interactive assessment.[62],[63],[64],[65] SM-based offerings are often bundled with promotional content in the forms of “daily clinical pearl” or “clinical trivia of the day,” although the authors caution users to take such offers with a dose of healthy skepticism. The ability to discern facts from fiction or hyperbole is essential when viewing any online media from nonpeer-reviewed sources. Moreover, web-based applications have been created to help distribute medical information to the public in format similar to that of “clinical pearls,” often augmented by “online patient communities.”[66] Such developments will likely result in patients having better baseline knowledge about their disease and bringing a much more informed perspective to individual health-care encounters.[67],[68],[69],[70] Finally, web-based consultative services are being made available to patients who wish to seek independent medical advice.[71],[72] Such endeavors should be viewed with extreme caution, primarily due to obvious limitations of “remote medical evaluation” but also because the regulatory environment surrounding online medical consultations is nebulous at best.[71],[73],[74],[75]

Another very important aspect of incorporating SM-based approaches into medical education is the growing problem of quality and validity of health-care-related information available on the Internet.[76],[77] Within this broader context, it is critical to ensure that the content is used responsibly and that inadvertent propagation of unhealthy behaviors or habits does not occur.[77],[78],[79] Finally, how should medical schools incorporate faculty SM contributions in the broader context of academic promotion and tenure? There is growing support for formal recognition of SM as a valid avenue for faculty advancement.[80],[81],[82]

The authors of this editorial hope that they have provided a sufficient high-level overview of key topics involving SM in medicine [Figure 1], more specifically focusing on medical education. With the adoption of web-based interactive technologies, including emerging virtual reality tools, it is expected that the concept of “clinical pearl” will continue to evolve and take on new forms within the broader context of experience- and case-based medical education. As always, with any great opportunity comes great responsibility. As we continue along this analog-to-digital metamorphosis, we should remember that knowledge dissemination happens much faster and more efficiently when using SM, the Internet, and various digital devices. This is only the beginning of a significant transformational megatrend in medical education.
Figure 1: Key concepts involved in the process of adaptation of social media-based approaches in medical education. The complexity of the topic far exceeds considerations typical to traditional curriculum development

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