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A beginner's guide to using social media and #FOAMed resources to teach and learn in postgraduate medical education programs.

February 2020

Publisher: Apple iBooks

Authors:

Manchester Metropolitan University

All clinicians and educators understand that the internet has changed the way that we work and live. In the last decade the way that we interact with the internet and with others through the internet, social media and other web enabled communications has shaped almost every part of the society we live in. Medical education is no exception to this; trainees and trainers are increasingly interacting with social media platforms such as Twitter and Facebook together with websites containing blogs and podcasts as principle sources of information. As educators we must understand how to optimally and safely guide trainers and trainees to use these tools wisely.

provides case based images on a wide range of clinical topics https://www.instagram.com/figure1/

…

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Content uploaded by Simon D Carley

Content may be subject to copyright.

Chapter1

EXECUTIVESUMMARY



Allcliniciansandeducatorsunderstandthattheinternethaschangedthewaythatweworkandlive.

Inthelastdecadethewaythatweinteractwiththeinternetandwithothersthroughtheinternet,social

mediaandotherwebenabledcommunicationshasshapedalmosteverypartofthesocietywelivein.

Medicaleducationisnoexceptiontothis;traineesandtrainersareincreasinglyinteractingwithsocial

mediaplatformssuchasTwitterandFacebooktogetherwithwebsitescontainingblogsandpodcastsas

principlesourcesofinformation.Aseducatorswemustunderstandhowtooptimallyandsafelyguide

trainersandtraineestousethesetoolswisely.



Onlinesocialmediaplatformsareincreasinglybeingusedinmedical

education

Manyonlinelearningeventstakeplaceinopenaccesssites.However,

asignificantbutunquantifiablenumbertakeplaceonpassword

protectedandhiddensitesthatmaynotbeaccessibletoalltrainersor

trainees.

Thereissignificantvariabilitybetweenspecialitiesintheuptakeof

newtechnologiestofacilitatelearningandprofessionaldevelopment.

Anumberoflegitimateconcernshavebeenraisedabouttheuseof

socialmediainmedicaleducation:Notablyconfidentiality,quality,

speedofadoptionandrelevance.

Trainersneedtounderstandhowtheirlearnersareusingnew

technologiestolearnandchangetheirpractice.

Trainersneedtounderstandhowtohelptraineesnavigatethenew

digitallandscapeoflearning.



#FOAMedstandsforFreeOpenAccessMedicalEducation.Itisaneducationalmovementthataimsto

providehighqualityeducationviasocialmediaplatformswhichisfreelyavailabletoall.

Thisbookandembeddedaudiofilesexplainswhyeducatorsneedtobeawareofthechanginglandscape

ofonlinesociallyenablededucation,howtoengagewithit,andforthosewithaninterestwepresenta

suggestionsonhowtocreateit.



Chapter2

BACKGROUNDANDRATIONALE



Technologyisubiquitousinthedailylivesoftrainersandtrainees.Mobiletechnologies,theinternetand

theonlineinteractionsenabledthroughthesehavechangedthewaythatwelive,thewaythatwe

experiencetheworldandthewaythatwelearn.

Traditionalmodelsofeducationthatrelyontrainerscontrollingthelearningagendaandlearning

materialsareincreasinglydisruptedbytraineeaccesstoawiderangeoflearningmaterialsunrestricted

bytimeorgeography.

IntheUKorganisationssuchasHealthEducationEngland,theGMCandmanyjournalsrecognisethat

onlinetechnologiesrepresentsubstantialbenefitsfortraining,togetherwithsomecautionsandcaveats

aroundtheirusewithintheconfinesofconfidentialityandgoodmedicalpractice.

Thisbookoutlinesandsignpoststrainersandtraineestowardsresourcesandstrategiesthatmaybeused

toenhancethelearningexperienceforall.Althoughprimarilydirectedtowardsspecialisttrainees,the

principlesandideasareequallyapplicabletoalliedhealthprofessionalsatpostgraduateand

undergraduatelevels.

Ihavedividedthisbookintothreegeneralsections.Thefirstsection(chapters2-6)outlinestherationale

andprinciplesaroundonlinetechnologyenhancedlearning.Thesecondsection(chapters7-8)signposts

thereadertospecialityspecificinternational,nationalandregionallearningresources.Finally,section

three(chapter9)outlinesstrategiestodeveloplocaltechnologyenhancedlearning.

Ifyouwanttogetthepracticaltipsthenskiptochapter7.Ifyouwanttoreadthebackgroundtothis

projectandtheexperiencesofdevelopingtheStEmlyn’swebsitethenreadthroughchapters2-6.

Thisbookwillprovidetherationaleandpracticalskillsrequiredtodevelopyouronlineeducational

skills.



Chapter3

EDUCATIONINTHEAGEOFSOCIAL

INTERACTION,TECHNOLOGYANDTHE

INTERNET.



Technologyisincreasinglypervasiveinourdailylives.Theacademic,socialmediacommentatorand

authorJulianStoddhasdescribedtheconceptofusincreasinglylearningandinteractinginwhathe

describesasthesocialage(1).Thesocialageischaracterisedlessbytheemergenceofnewtechnologies

butratherthewaysinwhichweinteractwiththem;thesociologyandthepsychologythatunderpinsour

interactionsratherthanthedigitalarchitectureofthehardwareorsoftwareitself.Educationhasalways

involvedinteractionbetweentutorsandlearnersandbetweenlearnersthemselvesandthustheutilisation

andengagementwithsocialtoolstofacilitatethisisnothingnew.However,thewidespreaduseofsocial

media,theinternetandmobilecommunicationsbyclinicianshasallowedthedevelopmentofmethodsto

enhanceorchangelearningthroughtheuseofonlinesocialinteractionwithaneaseandaccessibilitythat

wehaveneverpreviouslyexperienced(2).Clinicians,patients,relativesandthepublicatlargeall

accesshealthinformationviatheinternetwithhealthinformationbeingoneofthemostcommonreasons

forsearchingtheinternet(3).

Onlineeducationisincreasinglyusedacrossmanyestablishededucationalinstitutionssuchas

universitiesandcolleges,typicallythroughtheuseofvirtuallearningenvironmentslikeMoodle(4)or

Blackboard(5).However,mosteducationalinstitutionsusingonlinelearningdosousingcoursesthatare

closedtopublicaccess.Theobviousreasonforthisissothattheythencontrolaccesstothematerials

aroundabusinessmodelrelationshipbetweenstudentsandinstitutions.Similarstrategieshavebeenused

inpostgraduatemedicaleducationbyRoyalColleges,butthesearearguablysimilarlyconstrainedby

curriculaandtraditionalapproachestothedeliveryofmedicaleducation.

Arguablythishasledtothebroaderdevelopmentofnon-traditional,disruptiveandinnovativemedical

educationmodelscommonlydevelopedonsocialmediaplatforms(e.g.blogs,podcasts,videostreaming

etc.).Thesenon-traditionalstrategieshavebeencontroversialwithestablishededucatorswarningof

potentialharm,astheymayunderminetraditionalmodels,especiallythroughmovementssuchas

#FOAMedwhereopenaccessishighlyvalued(6-8).

Onlinelearninglendsitselfwelltotheincreasinglychronologicallyandgeographicallydispersedtrainee

workforcewhofrequentlystruggletoattendtraditionaltimelimitededucationopportunities(e.g.weekly

teachingsessions)(9).Closedsystemsofferadvantagestolearnersandeducatorswhoarerightly

concernedaboutsafetyandconfidentiality.Closedsystemspermitcontrolbytutorsoverwhat,howand

whenlearnersinteractwithonlinecontent.Itmodelsatraditionalviewofeducationwherethetutors

dictatethepaceandscopeofpractice.Thishasclearadvantagesinfocusinglearningaroundacurriculum

butmaynotreflecttheneedsoflearnerswithcomplexandadvancedlearningneeds(10).Postgraduate

medicaleducationforexamplerequiresablendoflearningdirectlyrelatedtocurriculainthepursuitof

careeradvancementandpostgraduateexaminationsbutalsorequiresclinicianstocontinuallyreflectand

learnonpracticeintheworkplace(11-13).

Thedisadvantageofclosedsystemsisalsoclear.Learningcanonlytakeplaceamongstthosewhoare

registeredandpermittedaccesstothesystem.Thiscomplicatesandrestrictsthereachofanyeducational

interventionstothosewithinthesystem.Whilstthisclearlymeetsabusinessmodelforeducationithas

questionableethicalandmoralissueswhenknowledgeiswithheldfromlearnerswhomightimprove

patientcareasaresultofconsumingandactingonthatknowledge.



Closedsystems–thosethatrequirepermissionand/orpasswordsto

access.Accessiscontrolledbyanorganisation.Oftenlinkedto

paymentbytraineeortrainingorganisation.Contenttypically

controlledbyeducationalentity.

Opensystems–freetoaccesswithoutrestriction.Opentopublicand

clinicians.Contenttypicallycontrolledbytheweaklylinkedand

distributedauthors.

#FOAMEd–FreeOpenAccessMedicalEducation.Ahashtaglinked

toopenaccessmedicaleducationtypicallyincriticalandemergency

carespecialities.

Incontrastsocialmediaplatformsallowengagementacrossamuchbroaderrangeoflearnersand

teachers(14,15).Theyarenotrestrictedbytime,geographyorpermissionsandthuscanengagewitha

muchwideraudience(16).

Openaccess(#FOAMed)learningvariesbetweenspecialities.Itismostobviouslydevelopedin

emergencymedicine,criticalcareandprehospitalcarewherethenumberandrangeofsitesofferingopen

accesseducationhasincreasedrapidlyinthelastdecade(14,17)perhapsreflectinganincreasinginterest

andengagementwithsocialmediabasedlearningresources(18).Thesespecialitiesmayhaveagreater

engagementwithopenaccessresourcesowingtothebroaderscopeofpracticeamongstachronologically

andgeographicallydistributedworkforce.ForexampleintheUS(19)andCanada(20)engagementrates

withnon-traditionalopenaccessonlineresourcesamongsttraineesinemergencymedicineisnearly

universalwithmosttraineesutilizingresourcesonaweeklybasis.Trainerstoohaveincreasinglevelsof

engagementandutilizationof#FOAMedresourcesreflectedbyincreasingnumbersoftrainersinteracting

in#FOAMedspacessuchastwitter.Theseincreaseshavebeenreflectedinanaccompanyingacademic

interestinthegrowth,reachanddevelopmentof#FOAMed(8,19-32).

Itisunsurprisingthattrainersandtraineesareusingnewtechnologiesformedicaleducation.Thetools

anddevicesrequiredareanintegralpartofdailylifethusthetranslationofthatintomedicaleducationis

aninevitableconsequence.Asmedicaleducatorsitisessentialthatwerecogniseandunderstandhow

newtechnologiesareinfluencingmedicaleducationinordertooptimiseitseffectivenessandreach.

Thebottomlineisthatthemoderneducatormustunderstandtheinfluenceofnewtechnologieson

learning.



Chapter4

CHANGEMANAGEMENTINTHESOCIAL

AGE



Theinternetofferstheabilityforlargeamountsofinformationtobereadilyaccessibletoclinicians,

initiallythroughcomputers,butnowincreasinglythroughtheuseofappsandmobiledevices.Itis

thereforetemptingtothinkthatbysimplyimprovingaccesstoinformationaninevitablechangeinpractice

willresult.However,thereislittleevidencetosupportthisasshownbycontinuedevidenceof

knowledgetranslationgapsfrom2003(33)to2014(34)(albeitindifferenthealtheconomies).

OnlinedatabasessuchasNICE,Cochrane,SIGNandotherorganisationwebsitesareclearly

opportunitiestoimproveaccesstoinformationtoclinicians,buttheeffectivenessoftheseincreating

changeinbehavioursthattranslatetochangesinpatientcarearerelativelyunproven.Whilsttheseand

manyotherwebsitesimprovetheopportunitytochangetheyarenoguaranteeofsuchchangetakingplace

(35).

Ina2004articleSeowoutlinesthedifficultiesofchangemanagementwithinthecomplexandchaotic

environmentoftheemergencycaresystems(36).Althoughfocusedonorganisationalchange,itisclear

fromthatreviewthatsimplyhavingknowledgeoragoodideaisnotenoughtomeaningfullyand

sustainablyinfluenceachangeinpracticewithinanEDsetting.Communicationwithstaff,encouragement,

powerandinfluencecancreateeitherinertiaormomentumtopracticechange.Whatisclearisthatthe

modeofcommunication,andtheusersandlearner’sskillsinusingtechnologieswillsignificantlyaffect

whetherchangewilltakeplaceatall,andifitdoes,thespeedatwhichitwillembedintopractice.Asyet

wedon’tknowhowsocialcommuniationtechnologieswillaffectthepaceofchange,butitisnot

unreasonabletoassumethatitwillhavesomeinfluence.

Currentlythereareanumberofonlineopenaccessprojectsseekingtoexaminewhethertechnological

enhancedcommunicationthroughtheuseofonlineresourcescanimprovethetranslationofevidenceto

patients.KenMilne,leadauthoroftheSGEM(Skeptic’sGuidetoEmergencyMedicine)(37)isworking

withtheCanadianJournalofEmergencyMedicineandAcademicEmergencyMedicinetoexamine

whetherhighlightinginterestingandpracticalpapersthroughsocialmediacaninfluencepracticeandin

particularwhetheritmightreducetheknowledgetranslationgapthoroughthe‘HotoffthePress’seriesof

blogs,podcastsandarticles(38-41).

InrecentyearsUKemergencymedicinehasfocusedonQualityImprovementmethodologiestoimplement

andsustainchangeinpractice.Thisisrecognisedbytherequirementforalltraineesinemergency

medicinetocompleteaQualityImprovementProject(QIP)aspartoftheirfinalprofessional

examinations(38,39).SuchprojectsarenowfeaturinginotherhealtheconomiessuchasCanada(40-42),

Australia(43)andmanyothers.

Whilstthesemightappeartobedistinctfromsimplyprovidingaccesstoknowledgeandnewinformation,

thisisclearlynotthecase.AllQIPprocessesworkonthebasisoffindingandthendeliveringthebest

availableevidencewithwhichtoenactandsustainchangeinclinicalpractice.Thus,theacquisitionofthe

bestavailableevidencewilltypicallyfollowsimilartechniquesofevidencefindingandsummarisation,

asdemonstratedinprojectssuchasBestBets.

Similarly,allQIPsrequirestaffandorsystemstochangewhattheydo.Inordertoachievethisthen,some

formofeducationalinterventionisnecessarytofacilitatethechange.Thereisthereforescopetoimprove

changemanagementandqualityimprovementstrategiesthroughtheuseoftechnologyenhancedlearning.

Thisisespeciallythecasewhendealingwithageographicallyandchronologicallydistributedworkforce

suchasthatwhichtypicallystaffsemergencydepartmentsandwhosubsequentlyfinditdifficulttoattend

facetofaceteachingsession.

Socialmediaandothertechnologiesareinfluentialinthetransfer,amplification,disseminationand

deliveryofchangeinmedicaleducation.



Chapter5

INTEGRATINGONLINELEARNINGINTO

TRADITIONALTEACHINGMETHODS.



Technologypermitstheengagementwith,andthedisseminationofknowledgethroughavarietyofco-

createdplatforms.ThisisastrategythatIhaveadoptedalongsidetheconstructionofsocialmedia

learningplatformsandblogs.

ForexampleasaconferencepresenterIamacutelyawareofthedifficultiesofeffectivelytransmitting

factualinformationusingthetraditionallectureformatwheretheknowledgetranslationislostthroughthe

lackofactivelearninginthetraditionalformatofapresentation(44).Despitethislecturesand

conferencepresentationsareapopularandoft-requestedformattoshareandenhancelearning.Howthen

canweenhancethetraditionalmodeloflecturingtoimprovelearning?Inthemodernagethischallenge

maybemetbyusingamulti-platformapproachtoeducationasdescribedbelow.

Acasestudywouldbethewayinwhichatopicsuchas‘In-situsimulation’canbeenhancedthrough

multi-platformengagementanddelivery.Thisisatopicthatwasinspiredthroughdiscussionsontwitter

wheretheworkthatwehaddonelocallywassharedanddisseminatedglobally.Inturnthisledto

invitationstopresentatconferencesonthesubjectofsimulation.In-situsimulationdescribesaprocessof

usingsimulatedpatients(usuallymannequins)torunamockemergencyinthelearner’snormalplaceof

work(45)incontrasttosimulationdoneinsimulationcentresawayfromtheworkplace.Thereare

advantagesanddisadvantagestobothapproacheswhichareoftdebatedatconferences,workshopsandin

publication,itthereforemakesaninteresting,emergingandcurrenttopicinemergencymedicineandacute

careeducation(46).

Invitationstospeakatconferencesarewelcomebuttheypresentchallengesingettingthekeymessagesof

apresentationacrosstoanaudienceofbetweenof50-500people(typicalnumbersinnon-plenaryEM

conferencesession).Itisalsodifficulttotryandembedthecoremessagesinapresentationsuchthatthe

learnerswillrememberthecontentafterthepresentationhasfinished.Thishasbeenaproblemwiththe

lectureformatformanyyears.Thelackofclarityandsubsequentrecallofcoremessagescanbepartly

mitigatedbyhandouts,butthisisnotalwaysfeasibleorfinanciallyviabletodeliver.Inthiscasethe

presentationonin-situsimulationwasdesignedinconjunctionwithamulti-platformapproach.This

requiredtheco-creationoffourseparatemediatocarrythesamethemesinwidelyaccessibleformats.

ThepresentationitselfdeliveredfortheyoungemergencyphysiciansgroupattheEuSEMconferencein

Viennaattendedbyapproximately100people(47).

TheSt.Emlyn’sPodcastoninsitusimulation(48)downloadedby2844people(upto26/1/18)

TheSt.Emlyn’sBlogpostonSimulationinsitu(49)3657downloads(upto26/1/18)

Thetraditionaljournalpublicationonin-situsimulation(50)with682downloadsfromEMJsite(upto

26/1/18)

Thesedifferentmodalitiesareallindependentlyvalidasreusablelearningobjects,andarealsomutually

supportive.Thosepresentatthemeetingwhomaybeinspiredorchallengedbyaconferencepresentation

canbedirectedtoadditionalresourcesonlinetodeliveramuchgreaterdepthofcontent.Thoseengaging

thetopicthroughwrittenmediaontheblogmaythenchoosetoviewandengageintheaudio/visualmedia

ataconferenceorseminar.Learnerscanthusaccessthesamecontentthroughavarietyofdifferentmedia

thatallcontributetotheoveralltopic,butwhichallhavestrengthsandweaknessesinaccessibility,with

noonemediacapableofdeliveringtheentiretyofthelearningexperience.Itisinterestingtonotethatthe

podcastandblogfarexceedtheengagementstatisticsascomparedtotraditionalmodelsofknowledge

dissemination(lecturesandjournalpresentations).

Additionallyanyorallofthemediacanbeusedinaflippedclassroommodelofeducationwhereby

learnersareinvitedtoreviewtheopenaccesscontentinadvanceofafacetofacelearningsession,so

thatthebenefitsoffacetofaceteaching,namelydiscussionandinteraction,aremaximisedinthetime

available(51-54).

Thiscasestudydemonstratesamodernapproachtoacademicpublishingandeducation.Eachofthe

communicationmodalitiesdescribedhavestrengthsandweaknessesinreachingdifferentaudiencesand

forlevelsofengagement.However,byinterconnectingandmutuallysupportingeachotherthecore

messagesaresharedinanaccessibleandmutuallysupportiveway.Theendresultisanamplificationof

theacademicandeducationalpotentialofthelearningmaterials.Thishasonlybeenachievedthroughthe

recentdevelopmentofsocialmediatechnologiesandrepresentsanovelandcreativeoutputofsocial

mediainpractice.

Practicallyspeakingthismeansthatifyouareputtingtogetherapresentationinfuturethinkabouthowthe

informationyouintendtoteachoncouldbepresentedindifferentways.Perhapsbackupyour

presentationwithaguestblogpostonarelevantblog,oramplifyyourkeymessagesontwitteror

facebook.Perhapsevenoffertorecordapodcastwiththeconferenceorganisers.Whateveryoudo,think

abouthowyoucanamplifyyourkeymessages.

Casestudyblendingonlineandtraditionallearning:#FOAMedonprescription

#FOAMedonprescriptionissomethingwehavebeendoingforsometimeintheVirchesterED.It’sa

wayofcementingjustintimelearningamongstclinicians.ForexampleapatientmaypresenttotheED

withanewonsetSVT(supraventriculartachcardia).Beingyoungandfitheisnotespecially

cardiovascularlycompromisedbutdoesrequiretreatemnttogetthembackintosinusrhythm.Recently

newevidencehasbeenpuvlishedintheLancetthatclearlyshowedthatavalsalvafollowedbyahead

downpositionismoreeffectivethanvalsalvaalone.

Inclinicalpracticeitislikelythatnoteveryonepresentwillbeawareofthenewtechniqueandsoanad-

hocteachingsessionwilltakeplace.Suchteachingsectionsareincrediblycommoninclinicalpractice

buttheyarerarelyfollowedupinanystructuredfashiondespitethefactthatweknowthatweforget

thingsveryquicklyiftyheyarenotreinforcedandrepeated.Thisistheprincipleofspacedrepetitionthat

isdifficulttoachieveinabusyclinicalpractice.Howdowetryandembedthatlearningandfacilitatea

degree(wellatleastthestart)ofspacedrepetition?

Simple:Getyoursmartphoneoutandcopyalinktotherelevant#FOAMedresourceintothebodyofthe

email.Thenpassthephoneroundsocolleaguescan(onlyiftheywish)entertheiremail.Pressgoand

you’vehopefullyreinforcedtheirlearningexperience.Thistechniquecansendlinkstoblogs,podcasts,

videos,oranyotherwebbasedlearningresource.

Importantly,andinkeepingwiththeconceptofthesocialage,thefollowupinformationisdesignedtobe

accessibleonamobiledevice,andthusthroughthemediathattheywillreceivethereminderon.Alinkto

theircomputer,tabletorphoneshouldbeabletoone-clickstraightthroughtoit,anditshouldworkright

thereandthenonthedevicethatreceivesit.#FOAMedisdesignedtobeconsumedelectronicallyandso

thelinkismade.

Wedescribedthisasa#FOAMedprescription.Theprescriptioncanbefollowedupbyaskingthe

clinicianaboutitafewdays/weekslaterandifnecessaryaseconddoseadministered.Thetechniquealso

leavesasearchablelinkontheircomputerthattheymaywellbeabletofindagaininthefuture.

Theimportantpointisthatonlinelearningwithnewtechnologiesarenotsimplyanalternativeto

traditionalteachingmethodssuchasbedsideteaching.However,aneffectiveteachercanuseonline

materialstoenhancetraditionallearningtechniques.



Chapter6

QUALITY,CONCERNSANDSOLUTIONS

Therehavebeenconcernsregardingthequalityandqualitycontrolofmaterialsthatarefreelyavailable

toallontheinternet.Concernscanbroadlybedividedintothreeareas,quality,confidentialityand

adoption.



Quality

Agreatdealofinformationontheinternetiscreatedbynon-traditionalorganisations,rangingfrom

individualsthroughtospecialinterest,politicaland/orpressuregroups.Materialisoftenself-published

withouttheabsoluterequirementtopassthroughaneditorialfilterorsensecheck.Thisleadstothe

potentialformisinformationtobepromotedwidelywithoutproperreview.Forthereaderorlistenerit

maybeunclearhowtoassessthequalityofsites.Therehavebeenattemptstoidentifycharacteristicsof

medicalsitesthatarelikelytobeofahigherquality.Forsitesassociatedwithestablishedorganisations,

suchasRoyalColleges,thereisanassumptionthatthoseorganisationswillhavetheirowninternal

qualityassuranceprocesses.

Itispossibletostartablogorpodcastwithnospecificfundingandinaveryshortspaceoftime(we

havepreviouslydemonstratedhowamedicalblogcanbecreatedwithinanhour).Publicationisno

longerlimitedtoestablishedauthorsandanyonecancreateawebpresenceregardlessoftheirexpertise,

orthequalityoftheinformationpresented.Thisisasignificantconcernforwebsitesthatcontainmedical

information(similarargumentshavebeenmaderegardingconcernsforwebsitesdealingwithfinancial

matters).

Determininganddifferentiatingqualityonlineisacomplextask.Comparedtotraditionalpublishingthe

methodsarelessclearandinmanycasesstrugglingtokeepupwiththepaceofchange,newtechnologies

andthesheervolumeofavailableresources.Forblogsandpodcastsresearchershaveexploredanumber

ofmethodstodefineproxymeasuresofquality.

Anumberofscoreshavebeenproposedtodeterminethequalityofonlineteachingmaterialsin

medicine(25,27,55-57).Someoftheserequirespecificdatatocalculate(suchaspagevisits,Facebook

engagementetc.)andsoaredifficulttouseinpractice.TheMETRIQ-8scoreisaneightpointscorethat

canbeeasilyusedfromdataaccessibleonthesiteandwhichshouldgiveanindicatorofquality

processes.

Figure1Metriq-8score

Trainersandtraineesshouldbemindfulthatsuchscoresonlymeasureprocess.Theyshouldremain

scepticalandmindfulthatthereisalwaysaresponsibilityontheconsumertocriticalappraiseany

evidencepresentedandtoweighthatevidencealongsidetheirown,andtheirinstitutions,prior

knowledgeandpractice.Insimpletermsthecriticalappraisalskillsthatshouldformpartofthecore

practiceofallcliniciansshouldbeextendedto,andexplicitlytaughtinrelationtotheconsumptionof

onlineresources.

Confidentiality

TheGMC,researchers,commentatorsandjournals(58-62)haveissuedguidanceontheneedtomaintain

publicfaithintheprofessionbyrespectingtheconfidentialityofourpatients.Inessencethesamerules

applyonsocialmediaasinothersettings.Patientconfidentialitymustbemaintainedinourpractice

irrespectiveofthefactthatitmightbetakingplaceonline.Manysenioreducatorswillbefamiliarwith

confidentialitybreachesasaresultofaccidentalorintentionalsharingofdatathroughelectronicmedia.

Mostlearnersunderstandthisasaprinciplebutfailtounderstandhowdigitalcommunicationsmaytrap

theunwary.Thefollowingarecommonreasonswhytraineesandtrainersmayinadvertentlybreach

patientconfidentiality.

Notremovingmetadatafromimages.Metadataisdatawhichisembeddedintheimagefileandmay

containinformationsuchasname,place,time,dateetc.thattheimagewastaken.Thisinformationmay

notbevisibleontheimageitself,butishiddenwithinthefile.Therearemethodsofremovingsuchdata

(dependingontypeandsystemused).

Cliniciansoftenmistakeplatformsecuritywithindividualsecurity.Whilstitispossibletohaveavery

secureplatform/programthatencryptsdatabetweenusers(e.g.WhatsApp),assoonasitisinthe

possessionoftheenduserthenitcanbecopied,transformedandusedacrossinsecuresystems.For

example,ImightWhatsAppamessagesecurely,butthepersonIsendittocanthencopythatimageand

postitonFacebook.Securityisthereforeacombinationoftechnologyandpersonalbehaviours.

Asanexample,aclinicalimagesuchasanX-rayorimagecanbeinstantlysharedwithcolleagues

(potentiallyinbreachofconfidentialityrules)withlittleeffortorcontrol.Inaddition,oncetheimagehas

beensentitcanusuallythenbeforwardedontootherrecipients.Theoriginalsenderlosescontrolover

wheretheimagemightsubsequentlybedistributedassoonasitsent.Oncecontrolofafileislostthe

rapiddisseminationandsharingcapabilitiesofsocialtechnologiescanrapidlyleadtotheamplification

ofanerrortoamuchwideraudience.

Thesecurityofcommunicationisdependentmoreonthebehaviourofthesenderandrecipientthanofthe

technology.

Adoption/Influence

Thedecisionaboutwhentoadoptnewtechniquesortherapiesiscomplex.Whilstweknowthatthespeed

ofknowledgetranslation(thetimeittakesfromgoodevidencetobepublishedtobegiventopatients)is

toolong,therearealsolegitimateconcernsabouttheuncontrolledadoptionofnewtechniquesor

therapiesthatmayhavebeenpromotedthroughsocialmedia.

Fromatrainingperspectivethereisalsotheconcernthattherapidtranslationofnewevidencethrough

non-traditionalmeansmaybefasterthantraditionallearningresourcesandexaminationscankeeppace

with.Seniorcliniciansandtrainersmustbemindfulthatlearnerscannowaccessarangeofeducational

resourceswhichtheynolongercontrolandwhichmaybemoreinfluentialthantraditionalteachingand

learningstrategies.

Thereisnosimpleanswertothispotentialproblembeyondtheneedforeducatorstounderstandwhere

learnersgettheirinformationfromandforthemtobeequippedwiththecriticalappraisalskillsneededto

assessthequalityofonlinematerials.

Therisksassociatedwithonlineteachingarearguablyverysimilartothosethatexistfortraditional

teachingmethods.However,thereachandspeedofdisseminationmeansthatanymistakesmaybe

impossibletocontrol.Educatorsmustunderstandtheregulationsthatadheretotheirpracticeand

workwithinthesetoensurethesafetyofpatients,educatorsandlearners.



Chapter7

TYPESOFRESOURCESACCESSEDUSED

FORLEARNING.



Thefollowingsectionprovidesbriefdescriptionsofthetypeofopenaccessresourcesavailableto

trainersandtrainees.Thereisnointentionheretoprovideacomprehensivegeneralorspecialityspecific

resourceasthebreadthandscopeoftheavailablelearningmaterialsisextremelybroad.Ratherthe

examplesherearedesignedtoillustratewhatcanbedone.Readersareinvitedtosearchfortheirown

resourcesrelevanttotheirownandtheircolleagueslearningneeds.



Blogs

Mostreaderswillbefamiliarwithonlineblogs.Inmedicaleducationblogsareonlinearticlesthatare

typicallyshortandfocusedontopicsrelevanttothewebsite/specialitytheyreferto.Instylethereare

oftenakintocommentary/editorialpiecesinmoretraditionalacademicjournals.Indeedmanyjournals

nowruntheirownblogstopermitabroaderrangeofcontemporaneousdebateanddiscussionthancanbe

achievedthroughtraditionalpublishingmeans.Thereareblogsrelevanttoalllearnersandtrainers.



Examples

BMJJournalslistofblogshttps://blogs.bmj.com/

NEJMblogshttps://blogs.jwatch.org/

Labmedicinebloghttps://labmedicineblog.com/category/hematology/

SkepticalScalpelhttp://skepticalscalpel.blogspot.com/

Societyforacuteinternalmedicinehttp://www.acutemedicine.org.uk/blog/

StEmlyn’sbloghttp://www.stemlynsblog.org

Podcasts

Mostreaderswillbefamiliarwiththeconceptofpodcasts.Inmedicaleducationpodcastsareusually

audio(occasionallyvideoasvodcasts)whichprovidespokenupdatesonabroadrangeoftopics.Their

scopeofcontentistypicallysimilartothatofblogsandoftenblendsevidencewiththeopinionand

practicalexperiencesofthepresentersandguests.Inthisregardblogsarecommonlyvalued(ordecried)
asawayofobtaininginsightintotacitknowledgeandthehiddencurriculumofpracticewhereasthe
audionatureofpodcastsmayprovideamorepersuasiveandpersonalrelationshipbetweenlistenerand
broadcasterandthusmayactasadriverforchangeinpracticethatexceedsotherprimarilyvisualmedia.
Examples
TheResusRoomhttp://www.theresusroom.co.uk
EMCRIThttps://emcrit.org/
BritishJournalofSportsMedicinehttp://feeds.bmj.com/bjsm/podcasts
Behindtheknifehttp://surgerypodcast.behindtheknife.org/
Thehaematologisthttps://www.hematology.org/Thehematologist/Podcasts/
BroomeDocshttps://broomedocs.com/
Onlinelibrariesandresources
Justintimelearning,andflippedclassroommodelsofteachingcanbefacilitatedbyaccesstoonline
databasesandrepositoriesofcasesandsupportinglearningmaterialssuchasECGs,radiologyandcases.
Examplesaregivenbelow.
Radiopaediaisanincredibleresourceforradiologyteachingandforprovidingopenaccessteaching
materialsforalleducators.https://radiopaedia.org/?lang=us
ECGlibrariesareavailabletocreatecasesorcomewithready-madecasesfordiscussionand
interpretation.
https://ecglibrary.com/ecghome.php
https://litfl.com/ecg-library/
http://www.stemlynsblog.org/ecg-library-st-emlyns/
Instagram
Instagramisprimarilyavisualplatformandsoworkswellwithclinicalimagesratherthandiscussion.It
isnotagoodplatformforconversationbutcanbeusedasareminderandlinkagetoothervisualbased
resources.TherearerelativelyfewactivemedicaleducationsitesonInstagramatthistime,althoughthey
aregrowing.ItismoredifficulttosearchwithinInstagramandthereforeitismoredifficulttouseasa
repositoryforreusablelearningobjects.However,thereareafewsitesofferingcasebasedlearning.
TheX-raydoctorprovidesbriefclinicalcaseswithsupportingandexplanatoryradiologyimagesand

interpretations.https://www.instagram.com/thexraydoctor/

Figure1providescasebasedimagesonawiderangeofclinicaltopics

https://www.instagram.com/figure1/

Twitter

Twitteristhemostwidelyusedsocialappinmedicaleducation.Althoughlimitedto280charactersit

actsasatooltodisseminateanddiscussothersocialmediaformats,clinicalproblemsandevidence

basedmedicine.Asapublicplatformtwitterisopentoallwithusershavinglimitedcontrolovertheir

audienceandthereachoftheircontent(seesectiononstayingsafeandconcerns).Twitterisanexcellent

formatforinteractingwithothercliniciansbeyondchronologicalandgeographicalconstraints.Itisa

usefultoolinkeepinguptodatewithnewinnovationsinspecialitiesandaneffectivetoolinformingand

sustainingacademicinterestswithothercliniciansandacademics.

Facebook

Facebookisoneofthemostwell-knowntoolsinsocialmediaandmanyreaderswillbefamiliarwithit.

Asatoolformedicaleducationithassignificantlimitationsowingtodifficultiesinthecurationand

classificationofcontent.Thetimelineformatoffacebook(similartothatofInstagram)meansthatnew

contentisdisplayedfirstandwithrelativelyfewtoolstocurateandorganiseoldcontent.Facebookis

mostcommonlyusedamongstclinicianstoformclosedgroupswheretraineesand/ortrainerscandiscuss

administrativeandsometimesclinicalcontent.Suchgroupsrequireadegreeofadministrativeoversight

(typicallyaseniorgroupmemberandoriginalcreatorofthegroup).

InrecentyearsWhatsAppmessaginghasdevelopedasarelativelysecureplatformforthediscussionof

issuesamongstaclosedgroupoflearners(59,63-67).Ithastheadvantageofveryhighlevelsoftechnical

endtoendsecuritybetweenusers(68).Itisfrequentlyusedbyclinicianstodiscussarangeoftopics

includingclinicalandsensitiveissues.Asdiscussedelsewhere,significantcautionmustbeobserved

here.Althoughtheplatformallowssecurepeertopeercommunication,oncethecontentisdownloaded

theendusermaytransferandadaptitintootherlesssecureplatforms.Theperceivedsecurityofthe

systemmayleaduserstofailtoanonymisecontentand/orprotectindividualconfidentiality.



Avarietyofplatformsexisttosupportonlinelearning.Thisnon-exhaustivelistoutlinesthe

strengthsandweaknessesofthemajorplatforms.



Chapter8

EXAMPLESFROMSPECIALITYGROUPS

ThefollowingareexamplesofblogsrelatingtotherangeofspecialityschoolscoveredbyHEE.In

commonwithotherbroadspecialitygroupings,bloggersandpodcasterstendtofocusonsubspeciality

areasratherthanthebroadscopeofthespecialityschoolsasawhole.



Thereisclearlyasignificantvariationintheengagementofdifferentspecialitiesinonlinelearning.Some

specialitieshavewellestablishedonlinelearningtoolsviatheircollegesandrelativelylittlelocallyor

independentlycreated.Itisuncertainifthiswillchangeinthefuture.



Emergencymedicine

Internationalblogwithbroadcontentandreadership:LifeintheFastLane.

LITFLisacomprehensiveemergencymedicineandcriticalcareblog.Itisagoodexampleofablend

betweenregularblogupdatescombinedwithasearchableandreadilyaccessiblelibraryofclinically

relevantinformation.Examplesofavailableandrelevantresourcesareshownbelow.Aswithmany

onlinesitestheinformationcrossesspecialities,healtheconomiesandtraditionalprofessional

boundaries.


Mainpageandblog-https://litfl.com/
Weeklyupdates-https://litfl.com/category/review/litfl-review/
Criticalcarecompendium-https://litfl.com/ccc-critical-care-compendium/
ECGLibrary-https://litfl.com/ecg-library/

Theseresourcesareusefulinkeepinguptodateinrelevantspecialitiesandinadditionthe
library/compendiumelementsareusefulinflippedclassroomorjustintimelearningscenarios.

UKbasedblog/podcastfromRoyalCollege:RCEMLearning
Thisisagoodexampleofanopenaccessresourcelinkedtoacollegeorinstitution.Whilstmanycolleges
havechosentoprotectcontentbehindpaywalls,RCEMhavemademuchoftheircontentopenaccess.
Thissiteusesacombinationofcases,blogs,podcastsandlinkstosupportlearnersinemergency
medicine.

Mainsitehttps://www.rcemlearning.co.uk/
Twitter:https://twitter.com/RCEMLearning

Thisdemonstratestheblendingoftraditionalcollege-basedoutput(e.g.CPDdiariesandexamquestions)
withmorecontemporaneousapproachessuchasleanercreatedblogsandpodcasts.Allareproduced,and
thustosomeextentqualityassured,fromwithintheRCEMgroup.

UKbasedindependentblogandpodcast:StEmlyn’s
StEmlyn’sisanindependentUKproducerofblogsandpodcastsrelevanttoemergencymedicine.Iwill
declareaconflictofinterestaschiefeditorofthisgroup.Itisanexampleofanindependentgroupof
clinicianswhofocusonUKemergencymedicine,personaldevelopmentandevidencebasedmedicine.
TheimpactandreachofindependentsitessuchasStEmlyn’sarequiteextensivewithbroadUKand
internationalaudiences(69).

Mainsite:http://www.stemlynsblog.org
Podcast:http://www.stemlynspodcast.org
Facebook:https://www.facebook.com/pg/stemlyns/posts/
Twitter:https://twitter.com/stemlyns

Instagram:https://www.instagram.com/stemlyns/?hl=en



Thissitedemonstrateshowindependentproducerscandeliveruptodateandqualitycontenttoabroad

audienceout-withthetraditionaleducationsystems,curriculaandportfolios.Itisimportantthattrainees

andtrainersunderstandhowqualityassuranceworksforthesesitesandforthemtoensurethattheycome

fromreputablesourceswithwelldescribededitorialandqualityprocesses.Therehasbeenan

exponentialriseinthenumberofindependentblogsandpodcastsintheacutecarespecialitiessince

2012.Inthelastyearthenumberofnewsiteshasdeclined,buttheoverallactivityonthesiteshas

continuedtoincrease,withevidenceofdifferentsitesmerging,consolidatingandbecomingmore

organisedintheircontentproduction,collationandcuration(70).



Radiology

Internationaldatabase/library:Radiopaedia

Radiopaediaisarguablythelargestopenaccessmedicaleducationsiteintheworld.Itisaradiology

basedresourcethatprovidesacomprehensivedatabaseofradiologyimageswithlinkedcases,

commentaryandeducation.Thescoperangesfromcasesrelevanttoallpractitioners,rightthroughto

complexandinnovativeradiologicaltechniquesthatareonlyavailableinasmallnumberofhealth

economies.Itisanexcellentresourceforteachingmaterialsthatmaybeusedinothersettings(e.g.inthe

flippedclassroommodeloflearning).



Mainsite:https://radiopaedia.org/

Twitter:https://twitter.com/Radiopaedia

Facebook:https://www.facebook.com/Radiopaedia.org/

Instagram:https://www.instagram.com/radiopaedia/?hl=en



Thesitehastheaimofbecomingthelargestdatabaseandresourceofradiologyanywhere.Ithasalmost

alreadyachievedthatgoalandisaninvaluableteachingandlearningresource.



UKbasedInstagramsite@thexraydoctor

Instagramisarelativelynewtoolinmedicaleducationandislargelybasedaroundthedistributionof

imagebasedcontent.Itthereforelendsitselfwelltospecialitieswherethisisaparticularfocus,for

exampleinradiology.



Mainsite:https://www.instagram.com/thexraydoctor/

Twitter:https://twitter.com/DrVikasShah



Thissiteisrunbyaradiologistwhoreceivescontributionsbasedonradiologypracticefromaroundthe

worldandthenrepublishestheseviaInstagram.ItisanexcellentexampleofhowInstagramlendsitselfto

avisualbasedtopic.



Paediatrics

Internationalblogonacutepaediatriccare:Don’tforgetthebubbles.

Don’tforgetthebubbles(DFTB)isaninternationalblogtargetedatimprovingthecareoftheacutely

unwellchild(althoughit’sscopeextendsbeyondthisintootherareasofpaediatricpracticesuchaspublic

health).



Mainsite:https://dontforgetthebubbles.com/



DFTBisagoodexampleofablogthatstraddlesspecialitiesinitsscopeandcontent.TheDFTBscopeis

acrossacutecarepaediatrics,butthatencompassespaediatrics,anaesthesia,emergencymedicine,

surgery,intensivecare,retrieval,worldmedicine,politics,publichealth,pathologyandmore.



Surgery

RoyalCollegeofSurgeonsofEngland

TheRCS(Eng)hasasitetypicalofmanytraditionalorganisations.Itcontainsrelativelylittleclinical

informationbutfocusesonpoliticsandbroaddisseminationofcollegeactivities.Ihaveincludedthisto

illustratethecommoncontrastbetweenblogsfromestablishedorganisationsvs.thosecreatedlocally

and/orbynon-traditionalgroups.



Mainsite:https://www.rcseng.ac.uk/news-and-events/blog/



USbasedblogongeneralsurgery.

SkeptikalScalpelisagoodexampleofaspecialityspecificblogaimedatamplifyinganddiscussing

EBMtopicsinsurgery.

Mainsite:http://skepticalscalpel.blogspot.com/



ThetraumaprofessionalblogisaUSsitethatbringsevidencebasedmedicinetotraumasurgery.

AlthoughitiswrittenfromaUSperspectiveitdeliversaregularandreasonablyobjectivediscussionon

themanagementoftraumaticinjury

Mainsite:http://regionstraumapro.com/



IntensiveCareMedicine

CriticalcareNorthampton

ThisisaUKbasedblogandpodcastfocusingonICUmanagement.Ithasaspecialinterestinthe

developmentofICUultrasound

Mainsite:https://criticalcarenorthampton.com/



TheBottomLine

TBLisanexemplaryevidencebasedmedicinesitethatseekstohighlightanddisseminatethebest

evidenceincriticalcare.ItisbasedintheUKbuthasaninternationalauthorshipandreadership.

Mainsite:https://www.thebottomline.org.uk/



Medicine

DrSmith’sECGblog

AUSbasedsiteontheinterpretationof12leadECGs.Topicsrangefrombasictoadvancedusually

basedaroundclinicalcases.

Mainsite:https://hqmeded-ecg.blogspot.com/



Societyofpointofcareultrasound

Acollationsiteoflinkstootherblogsandpodcastsontheuseofultrasoundbynon-radiologists.

Increasinglyrelevanttoacuteinternalmedicineandgeneralinternalmedicinetrainees.

Mainsite:https://spocus.org/FOAMED



Cardio-respiratoryphysiologyshortlectures

Freeandshort(3min)animatedlecturesoncardiacandlungphysiology.

Mainsite:http://www.heart-lung.org/about.html

Usefulasrapidrefreshersoraslinksthatcanbesendtolearnerstoconsolidatelearning(asinthe

#FOAMedprescriptionapproach(71)).



Ophthalmology

RootEyeNetwork

TimRoothasawell-establishedOphthalmologyYouTubechanneldevotedtoOphthalmology.Itisan

excellentexampleofblendingentertainmentwitheducation(72).

Mainsite:https://www.youtube.com/user/eyevideofan

Itisaveryusefulresourceforeducatorstolinktoteachingmaterialsandtoembedlearninginaflipped

classroom(51)(73)oreducationalprescriptionmodel(71).



Genericresources

Mindtools

Thisisapilotprojectforalearningandskillstoolkit.MindToolsisnowavailabletoyoualimited

numberoftrainersandtrainees.Registeringallowsfullaccessto2,000+learningresourcestoaidin

trainingdeliveryandcareerdevelopment,aswellaspersonalisedresourcestailoredtotheGMC

CapabilitiesFramework.

Togetyoustarted,youwillneedtoregisterhere:

https://healtheducationyh.onlinesurveys.ac.uk/mindtools



Onceyouregister,pleaselookoutforanemailfromMindToolswithyourlogindetails.Pleasecheck

yourjunkassometimesitfallsintothere.Onceyouloginonce,youshouldn’thavetologinagain,

howeverkeepyourdetailssafejustincase.



Facebookgroupsonwellbeing:TeaandEmpathy

Facebookisnotanidealplatformformedicaleducationasthewayinwhichcontentisorganisedis

primarilyaroundthetimelinewithnewcontentsequentiallyreplacingold.However,facebookgroupsare

aneffectivewaytopromotediscussionamongstcolleaguesandtherearemanysuchgroupsinexistence.

However,mostofthemareclosedtothegeneralpublicandcanonlybeaccessedviaaninvitefromthe

groupleaders.



AnexampleofanopenaccessfacebookgroupistheTeaandEmpathysite



Mainsite:https://www.facebook.com/groups/1215686978446877/



Itisanopenaccesssitewhere(largelyjunior)doctorsandmedicalstudentsdiscussmattersrelatingto

health,supportandcareers.Asasenioreducatoritcanbeinsightfultoseewhattopicsareconcerning

cliniciansandinmanycaseshowstrategyandpolicycanimpactonthelivedexperienceofourtrainees.



AlthoughFacebookislesswellusedasaformalisededucationplatform,manyjuniordoctorsareengaged

inspecialityorworkplacebasedgroups.Thesearenotopenaccessandasaresultthediscussionsthat

takeplacearemorecandidinvolvingprofessionalorclinicalissuesthatmaynotalwaysbeinkeeping

withguidanceonconfidentialityandprofessionalism.Whilstclosedgroupsarenotdirectlyaccessible,

thecontentcanbecopiedandtransferredintootherformatsfordistribution,thusanonymityandsecurity

onlyextendstothesystemandnottheendusers.InadditioncommunicationsinFacebookarenot

encrypted(asopposedtosystemslikeWhatsApp)andareaccessibletoFacebookasanorganisation.



Thissectionoutlinesexamplesfromcommonspecialitygroups.



Chapter9

GETTINGSTARTEDWITHONLINELEARNING

Thissectiondoesnothopetopresentacomprehensiveguidetodevelopingonlinelearningsystems.The

ideaspresentedhereareindicativeofhowcliniciansmayusesocialtoolsineducation.



Toptips

1. Defineanddevelopaspecificareaofinterest.Havinganareaofexpertise/interesthelpsfocus

contentandassistslearners.Considerthedevelopmentofa‘brand’thatidentifiesyourinterestsand

expertise.Behonestaboutwhoyouareandidentifyyourselfopenlyandhonestly.

2. Onlinemediarequiresadifferentwriting/speakingstyletotraditionalacademicactivities.Learners

areinterestedinacombinationofscience,practicality,narrative,experience,interestetc.Think

commentary/editorialratherthanadrypasttenseacademicstyle.

3. Useandquoteoriginalsourceswhereverpossible.Althoughonlinemediaisstylisticallymore

relaxedthantraditionalpublishingthescienceandacademicrigourbehinditshouldbeequally

apparent.

4. Contactthedevelopers/authorsofanestablishedonlinelearningresourceandaskforhelp.Inmany

casestheymayoffertohelpyougetstarted.Thereisastrongcommunityofonlineeducatorswho

arewillingtoadviseandhelp.

5. Formateamofeducatorswhoarewillingtosupporttheproject.Ateamisimportantbothto

generateideas,butalsotoprovideresiliencetoanonlinepresence.Weallneedtotaketimeoutfor

personalorworkreasonsandit’simportantthatwhicheverprojectyouundertakethatthereare

sufficientnumbersofpeopleinvolvedtokeeptheprojectalivewhenyoucannot.Useyourteamto

reviewandeditallcontent.Thisisespeciallyimportantformaterialsthatareopentopublic

access.

6. Considerthecostsofdevelopinganonlineresource.Whilstitispossibletopublishonlineusing

freesoftwareandastandardinternetaccessaccountrememberthatyourtime(andthatofothers)

hasacost.Bemindfulofthecoststoyourselfintermsoftimeandtheopportunitycostsofnotdoing

somethingelse.

7. Evenifyouarepublishingasanindividualitiswiseandprotectivetoinformyouremployerofyour

intentions.Irecommendthatyouletthecommunicationdepartmentandyourclinicaldirectorknow

ofyourintentions.Ascliniciansourpersonalreputationsarelinkedtothereputationsofour

employersandthewidermedicalprofession.Ingeneralorganisationsdon’tlikesurprisesinthe

unlikelyeventofsomethinggoingwrong.

8. Rememberthatanythingpublishedonlineiseffectivelypermanent(evenifyoudeleteit),easily

sharedandisopentomisinterpretation.

9. Donotgivespecificmedicaladviceout.Alwaysredirectpatientsandcolleaguestotheirpersonal

clinicians/organisations.

10. Avoidonlineargumentsatallcosts.Theinternetisfullofstrangepeoplelookingforafight.Ioften

quotethefollowing:

Nevergetinvolvedinafightwithapig...Youbothendupcoveredin****butthepigenjoysit.



Startingablog.

ItispossibletostartablogusingthefreeplatformWordpress(74)inamatterofhours.Simplysetupan

accountviathislinkandthenfollowtheinstructionstogetablogupandrunning.Otherplatformsare

availablesuchasBloggerandWix.However,thevastmajorityofmedicalblogsarebasedinwordpress,

itisthereforeahugeadvantagewhenaskingforhelpifyouareusingthesameplatformasmostother

authors.



Freeaccountsworkwellbuthavelimitedfunctionality.Costsdoincreaseasmorefeaturesareadded,but

evenalargeblogwithmultiplefunctionscancostlessthan£100/month(forexampleablogwith500,000

visitsperannum).



Startingapodcast

Podcastsaremorecomplextosetupandinmyopinionworkbasedwhenlinkedtoablog.Anumberof

platformsexistwithfreeorlowcoststartupcosts.Someexamplesareshownbelow.

• Podbean

• Libsyn

• Blubrry

AllthesesitesincorporatethesoftwareandsystemstopublishthepodcastsoniTunesandother

platforms.



Beyondthatyouwillneedamicrophone,headphonesandacomputerwithaudioeditingsoftware(e.g.

GarageBand).Podcastingtakesalotoftimeandthisshouldnotbeunderestimated.Ittypicallytakes1-2

hourstoedita15minutepodcast.



Socialmediaenabledcasediscussions

Thiscanbedonethrougharangeofplatformsincludingfacebookgroups,WhatsAppgroupsetc.

Inessencethesearegroupsofclinicianswhocanaccessaprotectedspacethroughtheuseofapassword.

Aspreviouslydescribededucatorsmustbeextremelycautiousaboutconfidentialitybreacheswhenusing

thesesystems.Myrecommendationistouse‘madeup’casesratherthanactualclinicaldetails.



Itisquickandeasytosetupagroup(perhapstoquickandeasy)

• Identifyatopic.

• Createagroupnameandinvitepeopletojointhegroup.

• Ensurethatallmembershavereadandunderstandacodeofconductforparticipation.Thisshould

coveracceptablebehaviour,safetyandconfidentialityissues.

Usethesocialmediaplatformtodiscusshypotheticalorimaginedcases.



Wewouldrecommendthefollowingcharacteristicsofsuccessfulgroups.

Don’tgiveafullaccountofacase.Startwithlimitedinformationandtheninviteresponses.Forexample,

postanECGoftrifascicularblockwithjust’75yearsold,collapseinstreet,nowfeelsfine.Whatdoyou

reckontothisECG?’

Avoidseniorsgivingdefinitiveanswerstooearly.Encouragejuniorcontributions(evenifwrong).

Neverhumiliateordenigrateparticipantseveniftheysaysomethingdangerous.Respondinakindand

supportiveway.Manyjuniorsarefearfulofparticipating,don’treinforcethatbeliefthroughyour

behaviour.

Encouragejuniorstopostcasesthatseniorsthenrespondto.Flattenhierarchiesandopinionswherever

possible.

Peerleadershipworkswell.Anenthusiasticjuniorwhocanpromoteengagementappearstobeastrong

determinantofgroupsuccess.

AsearchthroughPubMedwillrevealmanyexamplesofhowWhatsApphasbeenusedforeducation

purposes,mostoftheseareinundergraduateeducationbuttheprinciplesstillapply(63-66,75,76).



Thesetwoexamples(blogsandwhatsappgroups)aretheeasiestwaytostartengaginginonline

learning.Manyotherplatformsareavailable,butifyouwishtostartwithalocalprojectthatis

achievablewithabasiclevelofcomputerskillsthenthesearegoodplacestostart.

Chapter10

SUMMARY



Medicaleducationneedstounderstandhowonlinelearningcansupporttraineeandtrainerdevelopment.

Therearenumerousopportunitiestoenhancecurrentstrategiesineducationthroughonlinelearning.



Alleducatorsshouldbeawareoftheinfluenceofonlinelearningamongsttrainersandtrainees.

FormoreinformationpleasecontacttheStEmlyn’steamviathewebsiteatwww.stemlynsblog.org



Chapter11

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