Technology and Healthcare Communications

The Evolving Role of New Media in Online Learning: Lessons for Healthcare Communications

Lawrence Sherman, FACME, CCMEP

Stony Brook University October 5, 2010

Who Am I And Why Am I Here?

16+ years in medical education Ahead of the curve using new media and

technologies Use new and old media in my teaching

and lecturing

Needs Assessment – You Tell Us First! What can I tell you today? What do you hope to get out of this

session? What has been your experience using new

technologies?ProfessionallyPersonally

When Considering New Technologies Remember, professional and personal

often merge Think of physician as consumer

News delivered in lay press often emerges before that through professional channels

Make sure that you use them correctly!

Overview

Nature of the practice of medicine Social media tools and technologies Examples of eCME (the good, the bad,

and the ugly) Evaluations Speculations on future directions

When I Say Social Networks

What do you think of?

Most People Say

Facebook LinkedIn Twitter MySpace Sermo*

*Physicians regard Sermo highly as a Social Networking platform

Refrain

Do you use any of these Social Networking sites/tools?

Why or why not?

My Thoughts:

Facebook – about people you used to know (but changing)Many untapped uses in healthcare

Twitter – about people you want to know betterMicroblogging is an art

LinkedIn – about people you want to work withBest professional resource

Facebook in Healthcare

Twitter in Healthcare

More on Twitter and Healthcare

LinkedIn in Healthcare

Another Medium

Evolution Not Revolution

Talking Medicine

How do physicians communicate? Formally

Journal articles, print and e-books, conferences

Informally Conversation, ‘on the wards’, online, with residents

Community of practice (Lave & Wenger)

Web 2.0 & medicine, Giustini – April 2007

The Effect of Web 2.0 on Medical Practice and Education: Web 2.0 is a term describing new collaborative

Internet applications Primary difference from the original World Wide

Web is greater User participation in developing and managing

content, which changes the nature and value of the information

Increasing role in providing health information "any time, any place"

McLean, R., Richards, B. H., & Wardman, J. I. (2007). The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Medical Journal of Australia, 187(3), 174-177.

The Effect of Web 2.0 on Medical Practice and Education: Web 2.0 tools include:

Blogs – own content; to describe new trends Wiki – participatory content; to share knowledge Google, Gmail, maps, Ajax

Enriching the user experience MySpace – social networking Flickr, del.icio.us – photo sharing,tagging Youtube – video, tagging, social network Really Simple Syndication (RSS) – rapidly disseminate

awareness of new information Podcasts – make information available "on the move"

McLean, R., Richards, B. H., & Wardman, J. I. (2007). The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Medical Journal of Australia, 187(3), 174-177.

Doctors are Social

Web 2.0 creates conversations Tools, ‘social-software’

Blogs, wikis, podcasts, video, RSS feeds Socialization

Conversation, ‘on the wards’, online, rounds with residents

Knowledge begins with conversations*

* Kenneth Megill. Thinking for a living: the Coming Age of Knowledge Work. 2004


Maximizing Physician Participation Goes Beyond Just Attracting an Audience

RIGHT CONTENT

New Science

Updates to Guidelines

Patient Education

Engage physicians with education that will improve their competence and performance in practice

RIGHT CLINICIAN

Degree

Patient Population

Practice Demographic

RIGHT EDUCATION

Channel

Format

Design

Today, A Confluence of Factors Are Complicating the Physician’s World

PHYSICIANClinical Practice GuidelinesPatient Inquiries

Technology Enablement

Pay for PerformanceQuality Improvement

• Point-of-Care software• Self-Assessment tools

• Guides treatment decisions based on evidence-based medicine• Published by med associations, payors or gov’t

• Payment model • Rewards physicians for meeting certain performance measures of quality and safety

• Improve practice performance• Analyze records, implement an intervention, report results for re-certification

• DTC Growth • Health information online

60% of Physicians Interested in Social Networks

Physicians participating in such online communities are more likely to:

Be primary care physicians Be female Own a PDA or Smartphone Go online during or between patient

consultations Be slightly younger than the average

physician

Results are based on a Q1 2008 telephone and online survey of 1,832 practicing U.S. physicians conducted by Manhattan Research

Don’t Forget the Patients!

ePatient phenomenon Society for Participatory Medicine Involvement in care

Qualify informationAppropriate resources

The new generation of patients and providers!

The Leader

Blog Discourse in Medicine

Blogs stimulate discussion, self-directed learning & reflective practice

Useful educational tools Clinical Cases & Images,

Ves Dimov, M.D. Kidney Notes blog, Joshua

Schwimmer, M.D. Over!My!Med!Body!,

Graham Walker, Stanford medical student

Medical librarian search blogs To help find medical

information, rapidly


Clinical Cases & Images blog


Good Medical Wikis

AskDrWiki.com FluWikie.com Ganfyd.org Just The Facts PubDrug Wikisurgery.com


Adult Learning Principles for Physicians – Application? Achievement and competency Active engagement in a supportive learning process Management of their own learning experience Ability to utilize what is learned in practical setting Ability to interact with peers Immediate feedback regarding their performance Use of self-evaluation

Educational Effectiveness Adult Learning Principles

LESS EFFECTIVE MORE EFFECTIVE

Faculty-centered Learner-centered

Passive participation Active engagement

Knowledge-focused Application-focused

Generalized content Personalized content

One media method Multiple media methods

One intervention Multiple interventions

Sources: AHRQ, Grimshaw et al, and many others

Communications – Integrated Approach Standalone eCME can be more effective when

integrated into an educational curriculum Permits evaluation of individual activities

Comparisons can me made Multiple interventions can be measured Aggregate outcomes can be evaluated

Addresses various learning style preferences

How Do You Measure Success Of Various Online Formats? Isn’t just about the delivery Use of 2.0 technologies for

Needs assessments Interactive Credible Gaps identified? Multiple components

Audience Generation Quantify those participating solely as a result

of social network invitation Outcomes measurements

Compare educational impact measurement with controls from outside network

Post-activity dialog related to impact of education

Faculty planning and training Sharing of data/information

Just the Tip of the Iceberg Satisfaction Surveys

Evaluation of faculty / activity Content Delivery Practice Relevance Handouts and AV

“To what extent were you pleased with… ?” “How can we improve in the future ?”“Other speakers / topics to suggest ?”

Going Below the Surface

Self-Assessed Learning Surveys To what extent was ___ learning

objective met? To what extent are you more

[aware of, prepared to, confident about, proficient at] ___?

To what extent are you [planning to, prepared to, committed to] apply this learning in your practice?

When / how will you measure the impact on your … [practice or patients]

ACCME Accredited Providers:Trends in Total # Activities by Modality

ACCME Report, 2006-2009

41,898 40,284 40,342 35,990

23,939 26,763 28,72331,213

5,902 4,6996,581 6,866 7,714

6,821

10,427 11,803 11,40711,830

3,8353,127

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2006 2007 2008 2009

Courses Internet (Enduring Materials) Manuscript Review

Other Enduring Materials Regularly Scheduled Series

eCME – Web Based Education

eCME Is not simply a tactic New Media, encompassing individual education programs orcomprehensive, clinically-focused web portals Benefits:

Available globally, 24/7 No constraints of time, space, expense or logistics Capacity for interactivity allows for instant feedback Cost-effective method for reaching a large audience with common

educational needs Must be developed to take advantage of the power of the platform Must have a strong audience generation strategy

Drawbacks: Difficulty in engaging physicians in-depth and building enduring

“communities”

What Qualifies As Good eCME -- CME/CPD 2.0?

My thoughts and findings… Appropriate use of technologies Use of social media/social networking as a tool at all

stages in CME activities design, development, implementation and evaluation

True POC needs based education that is user driven Validated references Blogs Other resources

It needs to use technologies based on their application to activities, and not simply for the sake of using technologies

Use ePatients?

Is This Good eCME?

eCME Uses Multiple Platforms

eCME Simulates Clinical Practice Environments

eCME Can Do Both!

eCME Provides a Mechanism For Using The Latest Information Presented

Assessment Phase

Quiz and Commentary Activity(Knowledge / Mini Case

Questions with Faculty Commentary)

and self reported frequency of use of practice strategies

Doctor’s Channel VideoData Presentation

RealCME Virtual PatientsData Application to Practice

» Separate 0.50 point CME activity

» Released 60-90 days before conference

» Data can be assessed regionally, by profession and specialty

Conference Post Conference Assessment Phase

Intervention 1 Intervention 2

Email Survey(Knowledge / Mini Case

Questions with Faculty Commentary)

current frequency of

use of practice strategies

»» Released 180 days afterconference

» Data can be assessed regionally, by profession and specialty

eCME - A Positive Force for Change How do we know eCME drives positive change?

Methods for measuring change in knowledge, competence, behavior, etc

Physician changes in behavior (eg, case-studies as a surrogate to demonstrate decisions made in practice)

Improved performance (eg, health plan data, JCAHO, ARHQ, NCQA, medical system measures achieved)

Better patient outcomes (eg, chart audits) Needs Assessments Patient Surveys

Evaluation should be …A basis for continuous improvement:

Useful educational outcome dataNew needs assessment data Insights for planning future educational activitiesVerification that content is relevant and unbiased

Not just a “necessary requirement”

Evaluate at the Level PromisedCommunity Health

(Level 7)

How many healthcare providers participated?

Can participants state what the activity intended them to know?

Were participant expectations met?

Did the health status of patients improve due to changes in the practice behavior of participants?

Did the health status of a community of patients change due to changes in the practice behavior of participants?

Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. JCEP. 2009 Winter;29(1):1-15.

Can participants state how to do what the activity intended them to know how to do?

Can participants show in an educational setting how to do what the activity intended them to know how to do?

Can participants do what the activity intended them to be able to do in their practices?

What is Next for eCME?

More and better simulation of clinical practice environments

Continued enhancements based on ongoing assessments of learners needs and wants

True 2.0 learning environments Incorporation of Social Media and ePatients What else…?

References: Casebeer L, Bennett N, Kristofco R, Carillo A, Centor R. Physician Internet medical information

seeking and on-line continuing education use patterns. J Contin Educ Health Prof. 2002 Winter;22(1):33-42.

Bennett NL, Casebeer LL, Kristofco RE, Strasser SM. Physicians' Internet information-seeking behaviors. J Contin Educ Health Prof. 2004 Winter;24(1):31-8.

Casebeer L, Brown J, Roepke N, Grimes C, Henson B, Palmore R, Shanette Granstaff U, Salinas GD. Evidence based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants. BMC Medical Education 2010, 10:42.

Wutoh R, Boren SA, Balas EA: eLearning: a review of Internet-based continuing medical education. J Contin Educ Health Prof 2004, 24:20-30.

Fordis M, King JE, Ballantyne CM, Jones PH, Schneider KH, Spann SJ, Greenberg SB, Greisinger AJ: Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial. JAMA 2005, 294:1043-1051.

Casebeer L, Engler S, Bennett N, Irvine M, Sulkes D, DesLauriers M, Zhang S: A controlled trial of the effectiveness of internet continuing medical education. BMC Med 2008, 6:37.

Peabody JW, Liu A: A cross-national comparison of the quality of clinical care using vignettes. Health Policy Plan 2007, 22:294-302.

Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M: Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med 2004, 141:771-780.

Thank You!

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