technology and healthcare communications
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Lecture to MPH class at Stony Brook UniversityTRANSCRIPT
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
Facebook in Healthcare
Facebook in Healthcare
Twitter in Healthcare
Twitter in Healthcare
Twitter in Healthcare
More on Twitter and Healthcare
More on Twitter and Healthcare
More on Twitter and Healthcare
LinkedIn in Healthcare
LinkedIn in Healthcare
LinkedIn in Healthcare
Another Medium
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
Web 2.0 & medicine, Giustini – April 2007
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
Web 2.0 & medicine, Giustini – April 2007
Clinical Cases & Images blog
Web 2.0 & medicine, Giustini – April 2007
Good Medical Wikis
AskDrWiki.com FluWikie.com Ganfyd.org Just The Facts PubDrug Wikisurgery.com
Web 2.0 & medicine, Giustini – April 2007
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.