There's Little to Fear, Much to Gain from 'Web 2.0,' Say Educators

Family medicine educators say that today's social media resources, collectively known as "Web. 2.0," can have many positive uses in medical education, including opening up new communication channels and allowing for immediate feedback during lectures and presentations. However, many of these same educators say they hold back from using social media tools because of concerns about losing control of a course or about students posting unprofessional content.

Incorporating Facebook, Twitter, wikis and blogs into a course has the potential to engage tech-savvy students more actively and create a give-and-take community of learning. At the same time, however, "one has to minimize the risk when incorporating social media into a course," according to Alexander Chessman, M.D., a professor of family medicine at the Medical University of South Carolina, Charleston.

"HIPAA (Health Insurance Portability and Accountability Act) fears or unprofessionalism fears are probably an organization's first concerns," Chessman told AAFP News Now.

But he and other family medicine educators point to the pioneering work of Jacob Reider, M.D., formerly associate dean of biomedical informatics at Albany Medical College, Albany, N.Y., and now chief medical informatics officer at Allscripts, a medical information technology company. In the early 2000s, Reider created a weblog, or blog, for his students, which later became a wiki -- a website that allows users to create and edit content. Through the wiki, medical students could help each other use an evidence-based approach to answering clinical questions.

"Dr. Reider had to adjust the use of blogs and wikis to accommodate privacy issues and -- in so doing -- proved that it can be done," Chessman said.

Chessman said he is a "half-step away" from creating a Facebook page or incorporating the use of Twitter -- a social networking and microblogging service in which the user posts "tweets," or messages of as many as 140 characters -- into his own curricula.

Twitter has great potential in undergraduate and graduate medical education, as well as in CME, by permitting users to create a "backchannel" -- or real-time online conversation -- of communication, noted Chessman, who said he first experienced backchanneling at a CME event conducted by John Wiecha, M.D., M.P.H., associate professor of family medicine at Boston University School of Medicine. Wiecha used the Second Life Virtual World -- a user-created, virtual community -- during his lecture.

As he was listening to the lecture, Chessman said, he could post text comments in a side screen, allowing him to write a comment, ask a question or make an additional point without interrupting the presentation.

"This backchannel talk was not disruptive to the lecturer," Chessman said. "In fact, the lecturer could choose to attend to a theme that came up on these text posts or to continue with the presentation without stopping."

Chessman points to other potential uses of backchanneling, such as students or physician-learners tweeting what they learned and what they had trouble understanding from an educational presentation. Conference directors could read this immediate feedback and learn what people liked, disliked or disagreed with, he said.

John Waits, M.D., is program director of the Tuscaloosa Family Medicine Residency Program and associate professor in the department of family medicine/obstetrics and gynecology at the College of Community Health Sciences, University of Alabama School of Medicine.

Waits told AAFP News Now that Web. 2.0 is an increasingly popular communication application that some writers have dubbed the "front porch of the 21st century." He said Facebook, for example, can build rapport between teachers and students.

Waits said he "friends" students and residents on Facebook, telling them about his daily and family life and connecting in a way that is different from a phone conversation or e-mail.

"I know that this may not fit with everyone's idea of the teacher/student-learner paradigm, but I firmly believe that teaching is best done in a relationship," Waits said. "The relationship is enhanced in ways that could not be achieved traditionally without an enormous investment of relational time -- time that usually does not exist."

In addition to his use of Facebook, Waits said he has a public blog that he uses to post excerpts from or links to medical journal articles and other information. The benefits of the blog include convenient distribution via e-mail or RSS feed, automatic archiving, comment features and sharing features, Waits said.

Ryan Palmer, M.F.A., administrative director of the Principles of Clinical Medicine curriculum at the Oregon Health & Science University School of Medicine, Portland, told AAFP News Now he is particularly excited about the potential of Google Wave, a Web 2.0 manifestation that he called a combination of real-time chat, wiki, blog and content repository.

Palmer said Google Wave can be a way to deliver and interact with content to actively engage students. He said students take notes on a Wave during class and let the group edit and refine them throughout the term.

"Students are coming into medical school with an information abundance model; everything is accessible all the time," Palmer said. "Facebook is not the point -- having a repository for content and information that can easily be shared among friends and family is."

Palmer said he doesn't blog as part of his medical teaching, but he is interested in the power of group blogging to give medical students an outlet for their ideas and experiences. He created the MedTech blog so that he and his students could discuss the uses and implications of technology in medical education.

Finally, to help with rural education at his institution, Palmer said he created a Web-based distance learning system that uses Web 2.0 technology. Select family medicine clerkship students, equipped with a mobile broadband modem and an inexpensive netbook, use it in the field.

"If you accept that Web 2.0 is a gold mine of opportunity rather than a black hole for control, then you can start asking some really precise questions and start experimenting with some answers," Palmer said. "This new type of communication does more good than harm. We will need to work through some of the issues it brings up, but medical schools need to start really understanding that this technology is transformative and is here to stay.

"It is a brave new world, and one I find incredibly exciting."