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.

Sharing from Google Reader to Google+

One of the tenets of social constructionism is that learning is most effective when a learner's experience includes constructing a meaningful object.  In the world of online social media, this can include a blog post or a comment on an article.

I tend to read all my journals as an RSS feed in Google Reader.  I have blogged about this model before.  I then use Google Reader's "Send to" feature to share certain articles on Facebook or Twitter with a few additional comments summarizing my take home points on the article.  This can generate some additional comments from followers and friends sometimes leading to rich discussions.

Googleplus is a terrific tool for such discussions.  

• I have a chance to share with a wider audience (since I don't limit my circles like I did on facebook) 
• There is no 140 character limits like on Twitter and the comments are organized like a conversation.

Big Problem:

Google Reader does not have a Send to Google+ feature!!  Google what were you thinking?  Sparks is no replacement for Google Reader.

Now there is a nice workaround

• On Chrome:  
• Set up Buzz to connect to your Google Reader shared items
• Share from Google Reader to Buzz
• In G+ profile page to to the Buzz tab
• Click on Share in the Google bar at the top right of the page
• Drag the hyperlinked title from item in Buzz to the share box, select your circle and share
• In FireFox (courtsey http://davidvielmetter.com/tricks/share-google-reader-items-on-google-plus/) 
• You can drop links from Google Reader items directly to the Share box on the top right.  
• In both cases, make sure you first click to open the share box.  Then drag and drop the link.

Have fun!

Educational Applications of Google+ Hangout

Google+ has taken off like a rocket growing to an estimated 4.5 million users in 1 week.  One of the "wow" features of G+ is Hangout.

Hangout allows you to create a multi-user video chat with up to 10 participants.  You see feeds from all 10 webcams at the bottom of the screen.  When person speaks, the software automatically presents the speakers webcam feed in the main window.  The quality is remarkably good depending mainly on the connection speed of individual users.

An additional neat feature is a G+ user can start a Hangout session that is visible only to a specified group of contacts.  There is also the ability to carry out a concurrent text chat session.

So how can we use this educationally?  Here are some examples:

• Pose a question to a Twitter chat audience e.g. #meded and allow groups of participants to discuss the question in a Hangout Session and then report back to the Twitter stream.
• Upload a YouTube video of a hypothetical case - use an animation tool to simulate a doctor patient encounter.  Launch this video during a Hangout session so all participants can watch it together, and follow this up with a moderated discussion.
  
• Invite thought leaders to discuss a controversial topic on a Hangout session.  Record the session using something like CamStudio.  Then upload the entire recording to YouTube to share with viewers.  Can use this YouTube vodcast as focus of a future Hangout session.
  

So what do you think?  The technology bar has really been lowered.  You can with this free tools bridge geographic and logistic divides to have a real conversation!

Lesson from Agatha Christie: Rediscovering Windows Tablet and OneNote for education

In the last 3 months I feel like I am living an Agatha Christie murder mystery.  Agatha Christie had several tricks for preventing us from guessing who the murderer was.  One trick she used multiple times was to have a person be the prime suspect early on in the book.  Then they would be exonerated and we would start thinking of someone else.  In the end, that would be the person who would be revealed to be the murderer.  So what is the point of this?

Instead of a murderer, suppose the question is "What is the right computer and software for (medical) students?"
Many years ago I had thought it would be a convertible Windows tablet computer with OneNote.  After trying it out for 2 years our study showed that students did not find it useful.   Since then having explored many other options, including netbooks, PDAs, regular laptops and iPads, I am gravitating back to the Windows convertible with OneNote.  Why do I say that?

Lets start by identifying some requirements:

1. A device that is portable (relatively speaking) - size, weight, battery life
2. Has both a keyboard and ability to write on the screen - ideally with both stylus and finger - drawing concept maps, take notes, 
3. Options for installing from a wide menu of open source useful software.
4. Capture digital information from multiple formats (documents, presentations, web pages) and store it for annotation, highlighting etc.
5. Flexibility in organizing all the artifacts in various ways - at various levels - e.g. move things around easily on a page, organize pages under sections etc...
6. Share working material with multiple collaborators and with multiple computers 
7. Allow multiple collaborators to work on same document
8. Be able to work online and offline - with automatic/seamless syncing of material.
9. Mechanism for someone who does not have the software to be able to at least see the material.  (The assumption in this model is that all students have the same setup.

So the solution I am looking at is a smallish convertible HP elitebook 2740p with Windows 7 and Office 2007 or 2010 which includes OneNote.  

The HP 2740p has a screen that supports both stylus and multi-touch.  It has a very slim unobtrusive battery that extends its life to 10 hours.  

OneNote has terrific features - everything I mentioned above - with some outstanding features being:

1. The file organization is built into the software itself - thus no need to look for the file explorer to find what you need 
2. There is a superb search feature - that catalogs every artifiact
3. You can grab any web page or part of it with a screen clipping tool
4. Handwriting recognition tool
5. Print to OneNote option from your list of printers
6. Ability to move artifacts around on a page like post it notes
7. Awesome and flexible heirarchy of organizing - Notebook>Section Groups>Sections>Pages>Subpages
8. Internal hyperlinks to any page or artifact on a page
9. Live sharing by IP address with anyone over the Internet
10. Shared notebook feature for working with collaborators
11. Audio narration, video captures
12. Tag pages/artifacts with question mark, star, to-dos
13. Am sure there is a lot more.

Here is an example of me working on my thoughts regarding Google+ and how it is similar to and different from Facebook and Twitter.

I created a new Social Media Notebook

Created sections for each of the 3

On page one of Facebook you see a list of topics I planned to write about. 

2 of them are checked off

There is a diagram of who sees whose posts on Facebook.

On the next page I am collecting artifacts that I can use to think about the Facebook privacy settings.

These are screen clippings with my annotations - was quickly able to scratch over the identifiers on the screen clipping.  

In the last few months I saw the HP elitebook 2740 with it stunning features and immediately recalled the thrill I had felt in the early 2000's when the first windows convertibles came out.  

I saw how one of our medical students used OneNote on a regular windows (non-tablet) laptop to collect all the information he had come across in year 1 of medical school

I saw how a local middle school has every student use a similar convertible laptop to collaborate with each other and with the teacher for 4 years, collaborating on group projects even from off campus, submitting assignments by sharing sections with the teacher who can annotate the assessment in a shared space and build their portfolio of learning.

I saw how we can keep a shared notebook on a shared folder on dropbox and use the live.com online OneNote app.  

Sometimes the best solution is the one that is right in front of you.  Just like an Agatha Christie book, the solution was the first suspected one!

OneNote might be the best software that did not get marketed!  It may be time to rediscover this. 

A 2 circle Google+ Migration Strategy for Newbies.

There has been a lot of agonizing over the Google+ circles.   People are trying to sort their "friends" and family and acquaintances into all kinds of groups and overlapping subgroups.  Opinions range about how many busy people will take the time to understand the nuances of the asymmetric circles.  Will this scare people away from trying Google+?

A very simple solution could be as follows

Create 2 circles

1. Former Facebook folks
• These are all the friends and family that you "friended" on FB.  This meant you saw everything they posted, and vice-versa.  - This maybe a good time to clean house ;-)
• This assumes that like the majority of FB users you did not care to select a subgroup of your friends when posting.
• You will immediately start seeing anything these friends post in your stream.
• When posting something you decide if you want it to go out to all your former FB friends.
• When reading your stream, with one click you can convert it to a FB equivalent
2. Former Twitter folks
• These are all the folks you followed on Twitter.
• This will allow you to read all their comments just like in Twitter
• You can post publicly what you would normally post to twitter.

You cannot control who will read your posts.  You can hope that folks you add to your circles will reciprocate.  Then they can read your posts depending on how they filter their stream. 

Now you are all set.

When posting in FB mode, post to just your FB circle

When posting in Twitter mode, post publicly

When reading in FB mode filter by FB circle

When reading in Twitter mode, filter by Twitter circle

As time passes and need arises, start creating subgroups of your major circles.  Periodically check who is adding you to their circles and reciprocate appropriately.  Once all your contacts are in G+, may be tempted to stop checking FB, Twitter, (and your mail?)!  Till then there is a Chrome extension to share on FB and Twitter from Google+.  You can find it here.

Fortunately for Twitter Google+ has no hashtags.

Now this is not what I did when I started but trying to explain Google+ to a couple of friends, I realized that we learn by comparing anything new to what we know.  Since we know FB and Twitter, we keep comparing Google+ to these.  That is fair enough, and this model will help folks get used to Google+ and they can figure out the exceptions and limitations.  There are many nuances but rather than become a case of paralysis by analysis, just start and be extra careful about what you post till you get the nuances.  

Meaningful Use of Meaningless data - Lesson from the Teachers in Atlanta.

People are shocked by the story that teachers who are supposed to be setting good examples for school kids were involved in cheating.  The teachers were erasing incorrect answers on students standardized tests and entering the correct answers.
From CBS evening news:

 " It was to show phony progress at often troubled schools, what the report calls "the pressure to meet targets in the data-driven environment." Educator Diane Ravitch, author of "The Death and Life of the Great American School System: How Testing and Choice Are Undermining Education," blames it on a federal law that links funding with test performance.

"We have a terrible federal law called No Child Left Behind that says that all schools have to have 100 percent of their students proficient in reading in math by the year 2014 or their schools will be shut down," Ravitch said.

From CNN

"I think the overall conclusion was that testing and results and targets being reached became more important than actual learning for children," (Gov. Nathan) Deal said. 

So is anyone surprised that this would happen?  When a single number becomes more important that the process, in high stakes situations, people will do what it takes to improve that target number rather than improve the process that the number is supposed to measure.  

Why is this an important lesson for Medicine?
1.  We have for long struggled with the USMLE scores as being a single number that is used to measure the quality of a medical student.  This is what is used as one of the most important criterion for selection to residency training programs.  This is in spite of there being no good data that scoring high on the USMLE equates to potential to be a good doctor.  Recently there was a an article in the leading journal on medical education highlighting this problem.  The USMLE has 3 steps.  Students who score well on Step 1 will postpone taking step 2 till they have finished interviewing for residency programs - just in case they get a lower score on step 2 and jeopardize their chances!  Many medical schools give students dedicated time to prepare for the USMLE.  So students who have been getting a curriculum that medical educators believe is appropriate to make them good doctors for 2 years take a couple weeks off to read for a test!  USMLE is a test of medical knowledge and it also tests whether a student can apply this to the clinical environment.  But it cannot measure a lot of other important competencies like communication skills, professionalism, ability to be lifelong learners etc.

2.  The recent mandate for Meaningful Use (HITECH Act) of EHR data has the risk of falling into the same trap.  While well-intentioned, it has several measures of very important clinical processes.  If done right, these processes have the potential of improving healthcare.  The problem is that these measures are linked to incentive payments from the Center for Medicare and Medicaid Services which make them high stake for doctors working on razor thin margins.  Doctors who fail to use EHRs meaningfully with their Medicare patients are at risk of penalties. Let us take an example:

One of the 25 measures of meaningful use is to show that doctors are doing reconciliation of medications (checking what patients are taking and where there are discrepancies, updating the medical record or educating the patient appropriately).  One popular EHR system has a system for putting a check mark against each medication as you confirm it or to delete it if the patient is not taking it.  Doctors and nurses go over this exercise with the patients and it can be extremely time consuming.  One would assume that after you have gone through the entire list of medications, you should have complied with the meaningful use requirement.  Unfortunately, after doing all this, to record in the database that you reviewed the medications, you have to click a button that marks that you reviewed the medications.  As doctors get pressured to see more patients in less time, guess what is going to happen?  Yes, they may be tempted to click that button whether or not they went through the process of reconciling the medications.  This is an example of how poorly designed software will lead to physicians targeting a number (% of office visits where reconciliation occurred) rather than do what is a critical part of a visit - making sure the patient is taking the right medication.  

The teachers in Atlanta has taught us a valuable lesson.  Even people who are expected to set examples of high moral values, when forced to meet requirements that are measured by numbers without actually getting the support they need to do their job right, will take shortcuts to make the numbers look better.  In today's data-driven society, this is a valuable lesson.

Google+ Circles Simplified

While Google Hangout is a unequivocal home run, Google+ Circles have a lot of people (including myself) scratching their heads.

Courtesy mbensen on YouTube

After 2 days of using Google+ in the limited testing phase, it seems that we need 2 sets of circles:

1. Circles to filter the feed (flood) of posts in Google Stream- this is mostly a convenience issue.  Depending on your mood and available time you can decide to see few, some, more or all the posts in your stream.  My guess is that I will create circles for this somewhat like this:
1. Priority (Not sure of this yet) 
2. Educational and Engaging, 2-way conversations - folks that I tend to learn from or interact online in a meaningful manner.
3. One way but informative - folks that generally provide useful information in posts but we don't usually have conversations.
4. Casual  
2. Circles to share information with. - This is mostly targeting and privacy issue.  You want to post information that is meaningful to the viewer and you want to decrease the chances of it ending up with inappropriate audiences.  The privacy is not water-tight and thus with very sensitive information, you want to avoid posting online - use some other medium.  Some examples of using circles for this purpose are, sharing the place and time of an event with local friends, or wedding photographs with family, making colleagues aware of a journal article published by one of the doctors, reminding members of a professional organization to vote on a political issue etc.
   Why should we bother to do this?  Why not just post publicly and leave the filtering to the reader?  If you think about how the clinical decision support system became almost completely impotent due to alert fatigue, we would not ask this question.  As the amount of data in people's information (Google) Stream becomes overwhelming, it will be critical to do our part in reducing the noise:signal ratio.  It is just part of being good digital citizens.  

A point to note.

All your circle names appear on the left side of the Stream.  Right now Google does not allow rearranging these.  You can be creative by adding a Digit in front of the names you want to show up at the top.  Thus  "1 Engaging&Entertaining will appear near the top after the 4 default Google circles (Family, Acquaintances, Following and Friends).  You can of course rename these or delete these default circles and then they go away or get arranged in alphabetical order. 

Google+ Early Impressions - Lots to Like - A Few Things to Tweak.

July 4th long weekend with a long list of to dos and fabulous sports on tap (Wimbledon, Womens' Soccer and India-WI test match) dissolved into a Google+ tire kicking session.  It all started when I woke up Saturday AM with an invitation from Pauline Sweetman via Anne Marie Cunningham.

The past 1 and 1/2 days I have been trying to understand the new Social side of Google keeping the education perspectives in mind.  A lot has been written about Google+ already.  So lets take a look at some of the key features of Google+ and what they are missing.

1. The Stream - this is a very Facebook like UI.  The best part of this the ability to filter this stream by specific users.  You do this by creating circles of users and this list is visible on the left side of the page.  The other nice feature is that posts can be quite long allowing for a true conversation like experience.  The comments are not threaded so you cannot reply to a specific persons comment.  The last comment appears at the bottom of the conversation.  The conversation is protected from external viewers - it shows up only on the stream of people in the circle selected by the original poster.  There are several nuances and exceptions to this but as long as the folks in the circle adhere to certain rules, this conversation will be "private".  You can disable re-sharing of the posts but at the time of this writing, Google+ allows you to grab a link to a post and pasting this in a browser allows one to view the post even without logging into Google+!. Will this level of privacy be sufficient to overcome educators' and parents' resistance to getting school kids on Google+?
2. Circles - Uniquely Google+ designed visual approach to organizing your contacts.  As long as the folks in the circle don't break the trust, the content of the conversations, photos etc will stay in the circle.  I think this set the bar very high for adopting Google+ to share any kind of sensitive information in a circle.  This is still much better than FB but users will probably leave all their sensitive information shareable only with immediate family or very close friends.  
3. Hangout - This is probably the biggest home run of Google+.  The ability to do up to 10 user video conference at the drop of a hat is awesome.  You can "hangout" with your circle and any circle member who is around can drop in for a chat.  The other evening I joined Anne Marie's hangout session and we had the most interesting and educational conversation for over 90 min.  I know because Hangout asks you at 90 minutes if you are still there!  You can imagine using this with students and other learners.  Since Hangouts are not stored, the privacy is even better protected.  You can see a webcam feed of every one in the session.  The only part missing is a white board sharing feature which will be coming soon I guess (hope).
4. Sparks - Users can select or create a feed of regularly updated data in their area of interest.  As they read this, they can share with their Google+ Stream.  Unfortunately it does not support Google Reader and it does not support RSS feeds.  I hope this gets fixed quickly.  Most users will want to decide what goes into their feeds rather than let Google+ decide this in the background.  I like to go through my stream of information from Journals, Blogs etc on Google Reader.  I like to tag, share with notes, and send to Facebook or Twitter.  Right now there is no way to do this with Google+.  The shared articles show up on Buzz but that is buried 3 clicks down from the Google Stream.  

Conclusions:  So there you are.  There are many good things about Google+.  Google has hundreds of millions of people who use its products on a daily basis.  It has had the opportunity to study other social networking apps and seen what the deficits are.  It has so many different apps like the Google Calendar, Google Groups, Google Reader and Blogger that are hugely successful.  Google must have a strategy of pulling these together seamlessly into Google+.  If not it will be a case of unfulfilled potential.  

A lot of information here may become irrelevant very quickly as Google+ gets feedback and makes changes based on its limited roll out and beta testing.  I hope it does.