1. VCU Internal Medicine Grand Rounds

2.  Mark Ryan, MD, FAAFP
 Assistant Clinical Professor, Department of
Family Medicine and Population Health
 Founding member of the External Advisory
Board for the Mayo Clinic Center on Social
Media

3. 1. Participants will be able to define social
media.
2. Participants will identify five major social
media tools, and discuss differences
between them.
3. Participants will explain potential benefits
and limits of social media use by healthcare
professionals and students.
4. Participants will identify potential uses for
social media in medical education.

4.  During this talk:
 Looking down at your smartphones is a
compliment.
 The clacking of phone and computer
keyboards is the same as applause.

5.  Isn’t social media just a way to get celebrity
gossip and share funny cat pictures and
photos of my dinner?

6.  Defined by Merriam-Webster online as:
 “forms of electronic communication (as Web sites
for social networking and microblogging) through
which users create online communities to share
information, ideas, personal messages, and other
content (as videos)”

7.  Social media incorporates a set of online
tools and websites that allow users to share
ideas and user-generated content while
engaging with individuals and networks
without regard to distance or location

8.  E-patients:
 Not an abbreviation for “electronic patient”.
 Equipped, enabled, empowered, engaged, equals,
emancipated and experts.
 E-patients use internet resources and social media
to educate themselves and others and to enhance
health care for patients (and for providers).

11.  "I don’t know, but I can try to find out" is the
default setting for people with health
questions.
 "I know, and I want to share my knowledge"
is the leading edge of health care.
 Pew Internet & American Life Project: The Social
Life of Health Information, 2011

12.  According to a Research Corp’s Ticker survey
reported in Feb 2011:
 20% used social network sites to find health
information—of these, 94% Facebook, 32%
YouTube, 18% Twitter.
 33% reported “high” or “very high” level of trust, 24%
reported information on social media was “likely” or
“very likely” to impact healthcare decisions.
 Only 7.5% reported “very low” level of trust.
 Social media users tended to be young and affluent.

15.  Health 1.0: Health care providers control
medical information, provide information to
patients, and direct treatment.
 Health 2.0: Patients become increasingly
involved in care, asking questions of their
healthcare providers, collaborating in
treatment.

16.  “A concise definition of Health 2.0 is the use
of a specific set of Web tools
(blogs, Podcasts, tagging, search, wikis, etc)
by actors in health care including
doctors, patients, and scientists, using
principles of open source and generation of
content by users, and the power of networks
in order to personalize health
care, collaborate, and promote health
education.”

17.  In health 2.0, communication crosses in all
directions between patients, patient
advocates, health care providers, etc.
 This communication includes user generated
content in which individuals produce the
material being distributed.
 The goal is to enhance individuals’ health
and health care via participatory health care.

18.  The goals of empowering patients and
developing collaborative relationships
between patients and health care providers
align with the concept of the patient-
centered medical home (PCMH):
 “Enhanced access to care is available through
systems such as open scheduling, expanded hours
and new options for communication between
patients, their personal physician, and practice
staff.”

19.  “patients who were more knowledgeable, skilled
and confident about managing their day-to-day
health and health care (also known as “patient
activation,” measured by the Patient Activation
Measure) had health care costs that were 8
percent lower in the base year and 21 percent
lower in the next year compared to patients who
lacked this type of confidence and skill. These
savings held true even after adjusting for patient
differences, such as demographic factors and
the severity of illnesses.”
 Judith Hibbard and Jessica Green

21.  Blogs
 The most “traditional” of social media tools
 Online publications/diaries, whose content varies
on the author’s interests.
 Allow for long, detailed discussions, and can
include embedded pictures, videos, etc.
 Dialogue/discussion via comments.

22.  Facebook
 Largest social network: “where the eyes are”.
 Allows individual and organizational or
professional accounts.
 Posted material can be public or private.
 Groups with specific areas of interest can be
formed and can be made public or private.

23.  Twitter
 Very short (140-character) messages.
 Accounts can be public or private.
 Users identified by their “handle”.
 Posts (“tweets”) are shared among account
“followers”, and can be shared (“re-tweeted”, or
“RT”) with other users.

24.  Making sense of Twitter
 Hashtags (the # symbol, followed by letters and
numbers) help categorize tweets. They are
searchable within Twitter, and allow users to
follow specific topics.
 Hashtags allow for shared, live discussion on
these topics (e.g. TweetChat), and are catalogued
at the Healthcare Hashtag Project.
 User-defined lists help organize the stream.

25.  YouTube
 Users can record videos on any topic and upload
them for viewing at any time.
 These videos can be collected under a “channel”
and could range from patient education
information to medical education topics.
 Can use to record and publish short video
blogs, lectures or lessons, etc.
 YouTube is part of Google = easily searchable.

27.  Audio podcasts
 Users can record radio shows and podcasts for
listeners.
 Allows for live, interactive discussions during the
recording.
 Material can be available live, or recorded and
listened to on-demand.

29.  Professional benefits:
 Information gathering and sharing.
 Connections and collaborations: grants, research
projects, presentations, etc.
 Public outreach/public health.
 Promotion and tenure: online engagement opens
up new opportunities.
 Twitter to Tenure: 7 ways social media advances
my career

30.  Teaching:
 Many of our trainees are already on social
media, and we can (should?!) help them use social
media professionally.
 In 2009, JAMA reported “60% of medical schools
surveyed reported incidents of students posting
unprofessional content online”—including
profanity, discriminatory language, and alcohol.

31.  Teaching: Address core competencies of residency
education via social media engagement:
 Medical knowledge: Increased access to new sources of
information; opportunities to discuss information with
multiple contacts.
 Interpersonal and communication skills: as social media
becomes more widely used, we need to teach learners
these skills.
 Professionalism: Accountability to society and the
profession, and sensitivity to diverse populations.
 Systems-based practice: Enhanced awareness of team-
based care and the roles of other professionals and of
patients.

32.  Teaching strategies and tools:
 Blogs:
 Asynchronous teaching sessions
 Didactic review and teaching sessions:
http://hcwetherell.blogspot.co.uk/
 Teaching and study guides:
http://www.anatomyzone.com/

33.  Teaching strategies and tools:
 Facebook:
 Share teaching ideas, curriculum development, and
instructional approaches.
 Can use private or public groups:
 “Social Media in Medical Education” Facebook Group.
 Virtual journal club? Could post and share articles, and
allow for asynchronous discussion.
 Virtual office hours? Discuss and clarify class material.

34.  Teaching strategies and tools:
 Twitter:
 Cataloging information (#PM101).
 Augment PowerPoint presentations, and enhance Q&A.
 Encourage students to learn from patient experiences: “I
follow patients to understand…to avoid
complacency…to maintain compassion.” – Danielle
Jones,
 Sharing information and support: #TwitterStudying
 Virtual case discussions:
presentation, H&P, labs, discussion of DDx, review of
management, and discussion of key learning points:
http://storify.com/GuerrillaMedEd/he-s-just-not-feeding

35.  Privacy. Remember what is visible by the
public, and to be professional.
 Cannot practice medicine in this setting.
 Not reimbursed.
 Patient interactions: OK or not?
 Time constraints.

36.  No standards of use or official “best
practices”. The AMA guidelines are not much
help, and do not encourage use.
 There is no definitive guide to best practices.
Role is still developing, meaning that best
practices, etc. are still unclear.

37.  Physicians should be active participants in
social media in order to liberate their
expertise.
 Patients are more likely to trust physicians
they know, they can identify, and who are
local.
 Claim your “share of voice”.
 ROI: Risk of ignoring.
 Moral imperative?

38.  Look for good contact points as you get
started—resources and people you trust.
 Start by watching, then commenting and
interacting, and then creating your own
content.
 Look for experienced users, and ask for help.
Trust the community!

39.  My contact information:
 mryan2@mcvh-vcu.edu
 @RichmondDoc
 A Life in Underserved Medicine
 Social Media Healthcare
 Minutiae and Detritus