SoME and Physician learningExpertPeerReviewStamp2x200I was delighted to see the News and Perspectives piece in this month’s Annals of Emergency Medicine about “Social Media and Physician Learning” (free PDF). I had totally forgotten that Jan Greene, the author, had called to talk with me several months ago. In the piece, she discusses many of the issues with which I struggle:

  • Is peer review good or bad?
  • What is the role of blog and podcast sites in the future of medical education?
  • With the ease of how anyone can be “published” on blogs, how can one decide on the trustworthiness of open educational resources such as FOAM?
  • Can or should social media education practices be held up to the rigorous scientific standards of original research?

Here are some noteworthy quotes:

Do online collaboration and FOAM-like teachings make a difference?

There aren’t a lot of data to support the idea that physicians learning through online collaboration is any better than the traditional ways. A recent review of the topic found 14 useable studies, only 1 of which was randomized, and concluded only that the technique merited further investigation.

Should online teaching methods of vetting medical ideas be held to rigorous scientific methods?

And although some of that work is ongoing, particularly in such venues as the Journal of Medical Internet Research, they [FOAM boosters] acknowledge the field is so new there’s not a lot to go on so far. “That’s the golden ring of social media,” said Bryan Vartabedian, MD, a longtime medical blogger (33 Charts blog) who develops programs in digital literacy at Baylor College of Medicine. “It’s difficult to achieve, and reliable outcomes have yet to emerge.”

Should critical appraisal of the literature be pre- or post-publication? Where should this appraisal take place?

Dr. Vartabedian supports the idea of the democratization of scientific review online, particularly compared with the traditional debate in journal letters to the editor, which are limited. “I don’t need the New England Journal of Medicine or British Medical Journal as a platform for being critical of any study,” Dr. Vartabedian says. “There are other venues for dialogue besides journals. This idea that we need to be having these conversations within the confines of some traditional construct of a journal. We’re on top of the most remarkable shift in modern medical history, and every physician has the capacity to offer their views.”

… Dr. Mesko agrees that traditional peer review doesn’t have to be challenged by the rise of social media. “These processes should be totally separated to make sure content that is academic must keep its academic nature,” he said by e mail. “But when we need information and don’t know who might have the answer for our questions, curated social media channels can be unbelievably useful.”

Learning in the social media arena is going to happen whether the education community wants to or not. How do we deal with this moving forward?

Older professors may find themselves challenged by a student wielding a Twitter post relevant to a clinical choice being made, and they should welcome that discussion, argues Lin. “We have senior faculty who are amazing clinicians and read journals, but then we have this whole group of residents who are immersed in social media, and they do bring an amazing amount of interesting content and different ways of thinking about the literature.”


Aren’t we talking about two different things: Research and Knowledge Translation?

Personally, I believe that we may be talking about two different issues as Dr. Mesko alludes to above. There are original research and scientific discoveries, which are published in peer-reviewed journals. And then there is “knowledge translation” — the interpretation and implementation from journal publication to bedside practice. They have a complementary, yin-yang relationship.

Blogs and podcasts are playing an increasingly important role in the latter in accelerating this knowledge translation process. There should be a scholarly approach in how we assess the quality of educational blogs and podcasts, but this should be different from the standards and approaches taken for original research. So I find it confusing when we try to lump original research with FOAM-like educational endeavors. One is trying to find scientific truths, and the other is trying to teach these truths to frontline providers to improve patient care. Maybe we should be comparing blogs and podcasts to textbooks rather than journal publications instead?

That being said, I think that the FOAM and the social media community have a lot to be gained by learning about what has and hasn’t worked in the traditional publication world (and maybe vice versa):

  • Is peer review perfect? No.
  • Can it be valuable if used appropriately? Absolutely.
  • Is there value in crowdsourced peer review in the form of blog comments? Sure, if there are is a critical mass of high-quality and thoughtful comments.


Expert Peer Review Experiment

This is partly the reason why we on the ALiEM blog are experimenting with an expert peer review system for selected blog posts. We believe we are the first to formally pioneer this process for educational blogs to help vet the accuracy and quality of our content. Because we typically do not receive many comments on the blog, we don’t consistently have crowdsourced feedback. So instead we target experts such as topic-specific authors from cited publications or nationally recognized topic-specific speakers. Many have been gracious in participating. Their comments are included with the original blog post on a pre- or post-publication basis.

See examples of expert peer review comments on clinical content.

Thoughts and comments?

Let’s keep up the discussion momentum of these hotly discussed topics. Would love your thoughts.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD