Kobner3 squraeOne of my favorite images of medical education is the renowned Eakin’s painting, The Agnew Clinic. It depicts a gilded age operating theater filled with eager pupils looking on as Dr. Agnew prepares to preform a partial mastectomy. Despite being a cross-section of medical training from the late 1880s, any medical trainee today will experience an unspoken bond with those students dutifully taking notes in the tiers of Dr. Agnew’s operating theater. And there is a certain beauty to this lineage of physicians: all of us familiar with the same rite of passage into medicine but separated by a century’s worth of advances in science and society.

The Agnew Clinic by Thomas Eakins, 1889

Figure 1. The Agnew Clinic by Thomas Eakins, 1889

But the more I think about this image, I grow concerned about my familiarity with the experience of these students, some 120 years ago. Medical education today shouldn’t be that familiar. Fortunately, medical education is evolving for the 21st century, and I had the honor of spending a year learning from the world leaders in this emerging domain—Free Open Access Medical education—by serving as the inaugural ALiEM-EMRA medical student fellow.

Over the past year, I had the privilege of diving deep into the inner-workings of ALiEM—peering through the looking glass of one of the most popular FOAM websites to see you on the other side. While I’m not nearly talented enough with a brush to paint the image of medical education that Dr. Lin and the ALiEM team is building, I can share the larger lessons I’ve learned that have re-defined my approach to studying medicine and plans to contribute to medical education.

Digital Collaboration

My year with ALiEM began with a Google Hangout discussion about the rising prescription opioid epidemic. I was in London at the time, yet I was still able to contribute to a discussion with 5 other panelists who were scattered about the United States–bound together by the technology our team infused into the classic practice of critical appraisal. This set the stage for the year to come: I always found myself serving as a member on digital teams that knew no borders and scoffed in the face of differing timezones. I learned to use tools like Google Hangout and Slack to create a digital space for thinkers who may not otherwise cross paths to share and build new knowledge. I was honored to be a part of several publications resulting from these collaborations for the ALiEM Resident Perspective and Journal Club series, in papers capturing the essence of these team work through discussions of the opioid epidemic, the role of social media in EM resident education, and managing patients with spontaneous pneumothoraces as outpatients with pigtail catheters.

The power of digital collaboration also inspired me to connect with academic leaders in my own field of interest: patient communication. Through the ALiEM Book Club, I was able to host a discussion of Dr. Leana Wen’s book, When Doctor’s Don’t Listen, and broaden my own perspectives in addition to the interests of ALiEM Book club followers.

When Doctor's Don't Listen ALiEM Book Club discussion

Figure 2. When Doctor’s Don’t Listen ALiEM Book Club discussion

Design and Redesign and Design Again

In learning to re-think medical education, the ALiEM fellowship also challenged me to re-imagine how medical education should look and feel. Begging the question, how should learners and educators interface with the future of education?

Over the year, my graphic design skills were pushed to their limits by projects such as assembling Ultrasound PV cards and helping with the ALiEM Annual report. These endeavors enabled me to understand how to develop a blend of functionality, professional appeal, and a modern aesthetic to produce visuals for medical education. I translated these skills into my personal website, but also to all of the ALiEM posts I served as copy-editor for. This allowed me to find an editorial style, consistent in design and the quality of work produced.

To top the year off, Dr. Teresa Chan put my skills to the test by daring me to convey a piece of medical education literature as an infographic. After a great design workshop, I am proud to say the final result may capture a novel way to share important research over the internet—gone are the days of the plain-text 250 word abstract.

Understanding Impact

I also learned an immense amount about how to quantify the reach of digital scholarship and how to identify the cohort of online learners the ALiEM team interacted with. Understanding web analytics—a niche topic I would have otherwise never explored—has opened up a world of new research questions concerning how the digital communities of the future will unfold and how learning will best take place.

EM Match Advice- The EM Rotation, ERAS, and Am I CompetitiveWhile learning about analytics, I designed analytic report sheets for authors and ALiEM contributors so that they too could enjoy grappling with the vast, international impact of their work. Though these analytic reports may not be the final academic currency of the future, working to capture the impact of the work published on ALiEM allowed me to realize the importance of analyzing the wealth of data online education produces.

Unlike conventional means of education, analyzing web traffic data is essentially the only way of looking out into the lecture audience to see who has “attended” your talk online. With online education, it is possible to track learning down to the second—to see exactly how many readers pick answer choice A versus B based on how a question was posed. The possibilities are endless. Deciding on how best to interpret this data, and the many questions it presents, will make excellent work for the future.

Mentorship and Independent Work

As part of my fellowship, the ALiEM team also supported my personal sojourn into the FOAM world, by mentoring me while I develop my own website Ed in the ED (short for Education in the Emergency Department). I wanted to create a FOAM resource that addressed an underserved, yet crucial part of being a physician: patient communication and education skills. Approaching the task was a colossal challenge, but with the amazing help and mentorship of the ALiEM team, I am happy to report that the site is well underway and will continue to grow with me throughout my training.

Ed in the ED home page

Figure 3. Ed in the ED home page

I could not have led digital case-discussions with world-renown experts, interviewed an e-patient about her dying mother, or broaden my message with an Ignite! talk, without the incredible support and care of the ALiEM team. As I finish my year of clerkships and head to the 4th year promised land, I cannot wait to expound upon the skills I have learned this year and report back with what I continue to discover.

It is impossible to capture the past year in a single written post: it was filled with fist-bumping excitement, intense work, and a fair amount of awe. I had the chance to meet and work with educators who have been impacting the way I learn medicine for years. As a medical student, I was given the chance to step into the ring and contribute to the revolution that will affect generations of learners for years to come. This entire experience would not have been possible without the generous support of EMRA, so special thanks for supporting me on this journey.

But most of all, this past year has taught me something more about myself. By working with Dr. Lin, Dr. Joshi, and the entire ALiEM team, I learned about the type of doctor I want to be and where I want my future to lead. For that, and for everything else, I am forever grateful.

Thank you for such an amazing year!

Scott Kobner
Medical Student
New York University School of Medicine
2014-15 ALiEM-EMRA Social Media and Digital Scholarship Fellow