Incorporating Web 2.0 tools in a Workshop on Web 2.0 tools for lifelong learning

Recently I organized a workshop for 1st year medical students on using Web 2.0 tools for lifelong learning.



Some educators have assumed that medical students are digital natives or early digital immigrants and thus just because of the year of their birth have an innate understanding of the Web and Web 2.0 tools.  This is an assumption that people are now questioning.



People currently in their 30s to 60's straddle the Web era having spent a significant portion of their "cognitive" lives prior to 1990.  They experienced "traditional education" and are in the unique position of understanding Social Media by activating their prior knowledge.



As I set about planning this workshop I had several questions:

• How could I gauge the students' prior experiences with these tools? (begin without assumptions of the students experience and understanding due to being early digital immigrants)


• How could I get them engaged in this topic?


• I did not want to use a traditional lecture format to help them understand Web 2.0 education tools.  How could I incorporate actual Web 2.0 use into the education experience?

This is how I set up the workshop:

Preparation:

1. Asked the class to create Google and Twitter accounts (could create an account that they could delete later if they did not want to share their real accounts with class).


2. Created a spreadsheet on our internal Sharepoint site for students to enter their names, Google account and Twitter handles


3. Invited the class to Google+ and put them all in one Circle.


4. Asked the students to include me in one of their Circles so they could see my post.


5. Asked students to follow each other on Twitter.  They did not have to follow everyone but maybe the colleagues from their PBL small groups.


6. Asked the students to go to Google Reader and subscribe to PLOS  One Alerts (http://www.plosone.org/article/feed).


7. Click on the drop down next to PLOS One Alerts and click on "More like this" and choose Science Current issue.
   
   I could also have asked them to do the following but did not think of this then:


8. In the search box type Google and Memory and see the results show the article we were discussing on Google+


9. Read any article they liked from the 2 feeds and send to Twitter.  

Pre-Workshop Activities:

1. Posted the Science article on how use of Google has changed the way we remember on Google+.  I limited this to the circle of students.  No one outside the Circle could see their comments.  Also disabled re-sharing of the post to keep the conversation private.


2. Put some guiding questions under the link to the article:


1. When you read information on the Internet/Web do you
   
   Remember the information or
   
   Remember how to find it or
   
   Both orNeither? 


2. How does this apply to how you study and learn medicine?


3. Asked the class to comment on the article and these questions.


4. I checked back and added comments to students' responses

At the Workshop:

1. This was a 2-hour session.  I planned to spend the time covering


1. Concept of Information Overload


2. Need to use Web 2.0 tools to create filters


3. Transactive and external memory


4. Use of Google Reader and Diigo as examples of creating a Web 2.0 external memory system


5. Define Social Media and types of SoMe


6. Community of Inquiry model (Randy Garrison et al)


7. Social Constructivism (Vygotsky) and how it relates to Social Media


2. What we actually did:


1. Audience response to gauge use of FB, Twitter, Google+ (could have used PollEverywhere.com but just went with our clickers)


2. ARS to see how many had tried the Google Reader exercise


3. Discussion on these 2 topics


4. Discussion on formal and informal learning and need to become life long learners


5. Demonstration of Google Reader and how I use it, including sharing articles and commenting on them with residents and students.


6. Demonstration of Diigo - especially the ability to highlight bookmarked pages and to take notes.


7. Ask them to log into Twitter and post what they thought about the use of Google Reader and Diigo using a specific hashtag


8. Break - I started Twitter Fountain and projected the posts with the hashtags on the screen.  As students came back into the classroom, they were able to see what everyone else had posted about what they had learned.


9. Reviewed the discussion on the post on Google+ on the Science article.


10. Examples of Twitter case discussions, Twitter journal clubs, Google Hangout


11. Discussion and close


3. What did I learn?


1. Awareness of Feed readers and social bookmarking tools was very low.


2. These were very enthusiastically received by the students.  A number of twitter posts were about how they planned to start using these.


3. Students felt use of Social Networks in education was more appropriate for later stages of their training when they were more scattered and in less formal settings e.g. during practice, during clinical rotations etc.

Health care and the Social (Media) Anxiety Syndrome - Do we need Baby Steps?

Let me state first off that there is no defined entity called "Social (Media) Anxiety Syndrome"*.  I am using it just as a metaphor. Social Media holds a lot of potential for the health care professionals.  Is fear of the medium inappropriately leading to professionals avoiding this "social situation"? Have we created a Social Media Anxiety syndrome?





We are aware of the social anxiety disorder or social phobia.  Among its many features are (this is a convenient list for the purpose of this post and not a strict definition):

• Avoidance of interaction with others


• Fear of being in a group, or being the center of attention


• Fear that is made worse by a lack of social skills or experience in social situations


• Possibly false beliefs about social situations


• These factors lead to avoidance to of social situations.

Let us take a health care worker who has not used social media.  

• It is possible that s/he would equate the term "Social Media" with Facebook and Twitter


• Will likely be exposed to reports of unprofessional conduct on FB and Twitter and is afraid of getting in trouble


• May be unaware of how one can have a closed Facebook account (so no patient can send you a friend request), how one can have protected tweets so only authorized people can see them.


• Is quite unaware of useful applications of social media (e.g. RSS and feed readers to stay current with literature, use of Twitter to create a personal learning network, use of blogs to practice reflection etc.)


• As a result avoids the entire medium. 

While there are clearly legitimate concerns about the use of Social Media by health care professionals, some of the potential problems can be averted by taking appropriate safeguards and some of the beliefs may be false.  It is possible that the voice of some experts is missing from the social media universe due to unfounded fears about this "social situation". 

Have we created a social media anxiety syndrome that prevents the voice of key people from being heard?  Do we need to develop some "baby steps" to help them?  Something like these:

Baby steps for Twitter:

• Create a private account (Called protecting your tweets) and practice tweeting  - try adding a link to an online journal article and a short comment.  No one else can see this tweet unless you authorize it.  


• Under “Whom to Follow” find someone whose ideas and writings you want to follow e.g.Atul Gawande.  His Twitter handle is Atul_Gawande.  You will now see their comments and links to articles and speeches.  


• After you have added a few tweets, ask a friend or colleague who uses twitter to follow you.  You will need to authorize this.  They can give you feedback and show you some tips and tricks.


• Create a private group twitter account - you can use GroupTweet for this.  This can be used to share informal learning objectives between residents on hospital service or longitudinal clinic)


• Once you feel comfortable, you can unprotect your account and move towards creating a global learning network for yourself.

Do you believe that Social Media has some value for a health professional? If so would it be more valuable if more professionals were to participate in this medium? If so what is stopping them? Can we help remove some barriers? Should we even bother?





* [Since writing this I found that the term "Social Media Anxiety Disorder" has been used in 2010 by Phil Baumann for describing Pharma's Social Media Anxiety Disorder. The term "Social Network Anxiety Disorder was used in 2008 by Nicole Ferraro]

Using Social Media in Medical Education

Recently I gave a medical informatics grand rounds on the topic of Social Media in Medical Education.  The overarching goal of the presentation was:

• to expose the audience to various examples of use of SoMe in education and


• to let them draw connections between some of the theories of learning (and knowledge) and these examples

The outline of the presentation:

• Get beyond the issues of Professionalism.  While a very important issue it should not scare students and physicians away for a potentially very useful and powerful medium for learning


• Brief overview of some theories of learning and knowledge.  To make the point, I somewhat oversimplified these - took some editorial liberties with the descriptions.  This was done keeping in mind the needs of the audience.  Also this was not the focus of the topic.  I was making the point that some of these create a good framework to help understand the role of social media in education. 


• Differentiate Social Media and Web 2.0 from static one-way media like print media.


• Types of Social Media - Publishing, Sharing, Discussing, Networking, Location, Commerce etc.


• Reference to recent Talk of the Nation on NPR re' the education of Net Generation.


• Examples of use of Social Media for education


• Blogs - opportunities for conversations with thought leaders (George Siemens), place for personal reflection, and sharing those with society.


• Watching a Khan Academy video and summarizing it in a blog post.


• Google+ example of deep and rich conversations with experts whom you would not normally be able to communicate with.


• Twitter example of #meded chats and #twitjc journals clubs (reference to one on surgical checklists that had Atul Gawande participating, case discussions (Nick Bennett's #micro140)


• Hangout - examples of use - can we use this as a model of office hours for professors (Stephen Downes)


• The web 2.0 learning cycle from Google Reader to Blogs and Social Learning Networks with examples of how interacting with people in these networks has generated rich discussions and new ideas. 


Using social media in medical education (link to Slideshare - view with speaker notes) (These slides were edited from a presentation at medical informatics grand rounds.  The slide notes were added to substitute for the lack of an audio recording).

Conclusions:

• Our trainees grew up with online social media, this is how they collaborate, interact.


• When they enter the medical profession, they can leverage these skills to enhance their learning. 


• While they need to be aware of how to be professional in this space, let us not scare them away from this potentially useful tool. 


• Our educators need to keep an open mind and personally experience this medium before passing judgment.

Making EHRs More Meaningful for Physicians - Part I

Using Social Media/Networking and Web 2.0 Ideas for EHRs.



While EHRs have a lot of potential, their design could be much better. There is a feeling that the needs of the physicians have been ignored during the design process. It is high time, physicians spoke up loud and clear on their needs.



As more information is collected within the EHR, it becomes progressively more difficult to review it in an efficient manner. This is due to several factors but I am going to focus on just 2 right now:

• The office visit notes tend to be very long with the meaningful portions buried amongst all the requirements for medico-legal and billing and coding needs.


• The information is not appropriately tagged or categorized.  For example, when I am managing a patient's reflux disease, I like to look at all the related notes, medications, tests etc. in one place. This would prevent overlooking something and provide better care while saving the physician time.

Web 2.0 means that users create content and help create meaning from the content by appropriately tagging and curating it.  In EHRs while care givers create content, it is not at present easy to make sense from it.  We rely on various system solutions like ICDs and CPTs which are often like fitting square pegs in round holes.  They serve the purpose for everyone but the physicians taking care of the patient.  It is high time, physicians did something to make sense of the EHR data for themselves.  So here is a proposal.

1. With every note, the care giver will create a short Twitter-like post to summarize the thoughts and plans.


2. This summary will be tagged with the appropriate organ-system or category (one or more)


3. The patient's EHR will have an overview page with the (reverse) chronologically arranged Twitter-like summaries from every encounter.  These could be sorted/filtered/searched.


4. The tags from these summaries would be used to create a wiki where each tag would be a topic and all summaries created by various physicians tagged by that topic would be automatically collated under that header.

Here is a mock-up of what this could look like.  To explore how this works, pause the presentation and click on the various tabs, hyperlinks and tags to see the proposed functionality.

Social EHR

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Or just take a quick look at the non-interactive images below:

A twitter feed of summaries from encounters.  Each summary is linked to the full note.

Office visit note with Summary at top.  Appropriate tags added.

A Wiki for the GI topic with all encounter summaries tagged with [gi].  Additionally has timeline for GI related decisions.

Medication tab showing timeline of medication changes with links to encounters notes when changes were made.

These are "back of the envelope" designs and clearly need to be thought through in detail.  The concept though should be quite obvious from these.  Any EHR company out there listening?  Someone want to build an open-source EHR based on these principles that will truly help the physician and the patients?  

The astute reader must have noticed the "Part-I" next to the title of this post.  Yes there is more to come.