If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM. — From International EM Education Efforts & E-Learning by Joe Lex 2011
The growth of social media for medical CPD has been astronomical over recent years. More and more healthcare professionals are taking to Twitter to share useful papers and educational resources. The emphasis on encouraging Free Open Access Medical Education (FOAM) is embedded throughout these interactions. We have no intention of reinventing the wheel with this one, but have tried to combine the wealth of information already out there with a few of our own experiences. Hopefully this will help newcomers to Twitter, and perhaps persuade those still resisting to come on board.
What is Twitter?
• Online social networking/microblogging platform enabling users to send and read text-based messages ('tweets').
• Limited to 140 characters [see highlighted text below to see how long that is!].
• Photos can be tweeted.
• You only read tweets of people you follow.
• Anyone can follow you, although you can block them if you wish.
• Global conversation with like-minded individuals interested in the latest medical practice and literature.
• It’s acceptable just to watch if you prefer.
• Follow conferences even if you are not there.
• Social networking and friendships develop and can be consolidated at conferences, with colleagues across the globe.
What does it mean to follow someone on Twitter?
This means that you've chosen to subscribe to their Twitter updates. You can unfollow them at any time. Similarly, anyone is able to follow you. If you decide that you do not wish for them to do this, you can always 'block' them. You can easily see who is following you.
Who should I follow?
Have a look at someone you know, who is already using Twitter for medical education purposes, and look at their list of people they are following. You will quickly learn to recognise the Twitter characters who are reliable and useful, and after a period of Twitter interaction, you should start building up your own following.
What's @ and # all about?
@TwitterID directs your message to that person. You can add other names if you want to send to multiple, but beware the character limit. If ‘@’ appears at the start of the tweet it will go to that person AND anyone who is following both you and them. If ‘@’ appears later in the tweet, it will go to that person and ALL of your followers.
To illustrate this, if you send the following tweet ‘@avkwong this blog is rubbish’ – I will receive this message and anyone that is following both of us. If you send ’This blog is rubbish @avkwong’ or ‘This blog by @avkwong is rubbish’ - I will receive this message and also ALL of your followers – thanks!
A Direct Message (DM) This is a private message and visible only to you.
# (hashtag) is used to mark keywords or topics in a tweet. Anyone can make a hashtag at any time, simply by typing a phrase of the form '#topic' in a tweet (again no spaces). This creates a page specific to that hashtag and whenever someone tweets and includes this hashtag, it will be visible on this page as well as to anyone who follows them.
Many hashtags have already been created, and medical conferences will advertise the ones they are using e.g. #isicem15 (International Symposium on Intensive Care and Emergency Medicine 2015), #ISCSOA2015 (State of the Art Meeting, ICS 2015) and #smaccUS (Social Media and Critical Care Conference 2015). The days of writing notes at conferences (if you did in the first place) have also gone if the conference is well covered by avid Twitter users. Photos of conference slides, posters and equipment at trade exhibitions can also be tweeted and shared.
What's Twitter not so good for?
Apart from your social life, it is not a great platform for having extensive discussion and debate. This often is difficult to fit in 140 characters, and results in huge number of tweets about one topic, and the context of these key messages can often be lost in translation.
A word of caution with using Twitter
You should comply with the General Medical Council (UK)’s 'Good Medical Practice' (http://www.gmcuk.org/guidance/good_medical_practice.asp) or equivalent in your country, and it is worth having a look at the brief GMC regulations (http://www.gmc-uk.org/guidance/ethical_guidance/21186.asp).
We have found Twitter a fantastic vehicle for learning, sharing and discussing the latest literature, resources and details at conferences. It still amazes us that we were able to have discussions about the TTM trial on Sunday 17 November 2013 as it was being discussed in Dallas (have we decided yet 33oC or 36oC?!). Access to information, working collaboratively and encouraging each other in a really friendly and supportive way must be credited to Twitter and all the incredible FOAMites involved (see Figure 1). Join now!
• Register at Twitter.com
• Install the App on your mobile device(s)
• Follow users and hashtags (#)
• No, you DO NOT have to contribute
• It is OK to watch
A few suggestions of who to follow to get you started….
Intensive Care Network
Twitter - @I_C_N
Website - intensivecarenetwork.com
Intensive Care Network is a site designed by Oli Flower and Matt MacPartlin as an educational and networking resource for critical care.
Figure 1. Twitter Discussion
Life In The Fast Lane
Twitter – @sandnsurf
Website – lifeinthefastlane.com
“We are Australasian critical care physicians and nurses exploring the changing world of eLearning, emergency medicine, critical care and toxicology through clinical cases, fictionalized anecdotes and medical satire.”
European Society of Intensive Care Medicine
Twitter – @ESICM
Website – esicm.org
European Society of Intensive Care Medicine is an international association promoting intensive care medicine, education, research, and professional development.
Wessex Intensive Care Society
Twitter – @WessexICS
Website – wessexics.com
Twitter feed for the Wessex Intensive Care Society (WICS). Supporters of#FOAMed. Twitter stream collated by@stevemathieu75
The Bottom Line
Twitter – @WICSBottomLine
Website – wessexics.com/
The_Bottom_Line Summary and Critique of the landmark papers in the Critical Care and EM literature #FOAMed #FOAMcc
Twitter – @emcrit
Website – emcrit.org
“I am an ED Intensivist in NYC. I host the EMCrit Podcast where I explore my obsession with all things ED Critical Care. Vociferous supporter of #FOAMed.”
Twitter – CritCareReviews
Website – criticalcarereviews.com
Free updates and links to newly published critical care articles, plus the largest structured archive of free critical care review articles on the web.
Twitter – @stemlyns
Website – stemlynsblog.org
A virtual hospital in the heart of post industrial Virchester. Emergency medicine cases, BestBets and evidence based practice. Also @ EMManchester#FOAMed.
The RAGE Podcast
Twitter – @RAGEpodcast
Website – ragepodcast.com
The Resuscitationist's Awesome Guide to Everything by @precordialthump @cliffreid @criticalcarenow @karelhabig @Mjcartner and @ docjohnhinds#FOAMed #FOAMcc
Twitter – @scancrit
Website – scancrit.com
Twitter feed of the http://ScanCrit.com website. A blog on anaesthesia, intensive care and emergency medicine. In-hospital and outside. #FOAM #FOAMed #FOAMcc
Twitter - @ICU_Management
Website – icu-management.org
The Official Management and Practice Journal of ISICEM. Providing the latest intensive care and emergency medicine news and practice management solutions.
Part 2: Beyond the Basics - CPD Records
The world of medical education is changing. Gone are the days of textbook learning. Medical developments and practice are evolving so quickly that print as a medium is becoming obsolete. So you’ve read the first part of the guide and are really enjoying the newfound source of information and education. You’ve even started communicating and engaging in lively discussions with colleagues from all corners of the globe.
You now need to convince your colleague/ manager/organisation of its value. Despite the social media label, this is far from being a plaything, and is actually educational and relevant. The fact that it is fully electronic makes compilation of evidence and/or records possible. As part of the appraisal and revalidation process, doctors and other healthcare professionals must now provide evidence that they are keeping up with the latest medical developments. The GMC UK has defined five domains in the Duties of a Good Doctor document
In this section we suggest a few ways of expanding the use of Twitter to support continual professional development beyond a simple reading list and conversation tool.
Journal Alert – the “ex-” Printed Press
We are expected to keep up-to-date, and reading journals has traditionally formed a large part of it. The more diligent amongst us may keep a record of the articles that we read. Some publications also have a short quiz accompanying the article in order to test understanding and act as proof that the article has indeed been read.
The Internet has revolutionised the spread of information. Traditional medical journals are now available online in addition to their printed forms. The use of smartphones, tablets and other mobile devices is now common in the medical workplace. For the reader, articles can be downloaded and read whenever convenient. Such is the impact of social media, journals and professional societies/ organisations now have their own Twitter accounts (see Figure 2). By following these accounts, you can access the articles immediately, and some of the latest articles are available online even before the printed edition. Greener colleagues amongst us would also welcome the paperless option. The digital format means you can easily generate an electronic record of your activity. As evidence for keeping up-to-date, this is more credible and permanent than a written record (See Figure 2).
Figure 2. JAMA Twitter page
The Conference Hashtag
From our initial guide, you've managed to follow the conference. At last year’s ESICM LIVES congress, results of five major ICM trials were presented and discussed on Twitter by colleagues across the world. The use of social media at medical conferences has been increasing. Most major conference organisers have dedicated hashtags which are promoted to encourage delegates (and indeed non-delegates) to engage with colleagues and presenters. ISICEM 2015 has the hashtag #ISICEM15. The upcoming ESICM LIVES 2015 Conference in Berlin has the hashtag #ESICMLIVES2015, Social Media and Critical Care #smaccUS, and the ICS State of the Art Conference in London is #ICSSOA2015.
It's now time to put it all together as your record of the conference. You might want to share your notes with colleagues within the department. The organisers have even written a blog of the day to add to the myriad of tweets by delegates. You could use a pen and paper, but given that all of this is online and digital, there can be an easier way to compile this information.
The search function on Twitter can be used to produce a list of tweets with the appropriate hashtag. The Symplur website (www.symplur.com/) allows you to find relevant healthcare conference hashtags in your field of expertise. Most of us already use word-processing software to compile our notes. It is then a simple matter of reviewing the tweets, cutting/pasting and formatting. It does require a certain degree of discipline to look through the list of tweets, but it does provide insight from multiple delegates. Appraising the presentation/publication is immediate and of obvious value when compiling such notes. You no longer have to wait for next month’s issue to read the correspondence section.
We have no doubt that as technology evolves methods of compiling notes will evolve. Last year’s ESICM LIVES conference app had a note section, recorder function, etc. in addition to conference planning tools. It was a 1.0 form but a clear indication of future direction. Mobile apps for conferences are becoming a common occurrence – download them and see what you think.
Maintaining a CPD Diary
Electronic logbooks are common across a variety of specialties. These include simple procedural logbooks to more detailed diaries of meeting activities, teaching activities, courses and conferences. The Royal College of Anaesthetists in the UK has an online CPD diary for members who use their educational portal.
Cloud-based storage allows access to these regardless of location and device, provided there is online access. The record can be updated from your conference laptop or tablet device on the journey back home.
As an example, after your attendance at a conference, the following could form part of your appraisal portfolio:
• Conference attendance certificate;
• Conference handbook;
• List of tweets contributed which may include analysis of retweets;
• Notes compiled from various online sources – tweets, blogs, article references
Apps at Your Service
In addition to an Internet browser and word processor, there is a myriad of tools/apps to help you work more efficiently/smartly.
From tablets to smartphones, netbooks to desktops, we’re using more devices on a daily basis than ever before, and toggling files between each of these devices can be cumbersome and complex. Not so with online storage services. You can access your account from any Internet connection, whether you're on a mobile browser or your work computer. Other advantages include:
• Syncing – all files automatically updated across your devices;
Being an organised professional, we are sure that you already have your own way of organising your digital resources and files. Software such as Evernote (www.evernote.com) works on a variety of devices and complements the benefits of cloud storage.
3rd Party Twitter Tools
There is nothing wrong with the official Twitter app or website. However, apps such as Tweetdeck (web.tweetdeck.com) (see Figure 3) allow a greater degree of flexibility and an enhanced experience. Features include the ability to view multiple accounts at the same time and a dedicated column for each hashtag (especially useful during conferences) (See Figure 3).
Figure 3. Screenshot of Tweetdeck