The future of Emergency Medicine Education in the Social Age. St.Emlyn’s

It’s a special year for UK Emergency Medicine. 2017 is the 50th anniversary of our speciality and the RCEM is planning a series of events to celebrate this. It’s also the 30th anniverary of the EM section at the Royal Society of Medicine in London1, and arguably the RSM is kicking off a year of reflection with their 30th anniversary meeting in London that took place earlier this month.

Peter Williams, section president, put together a great program highlighting the past, present and future of EM with speakers from the UK, North America and South Africa. My contribution was to talk around the social future of emergency medicine education and to illustrate how technology and social interaction is disrupting the traditional education model.

There are 3 key messages in the talk linked to past blog posts and presentations. I’ve collated them here as a record for the day and as a way of sharing the message as far as we can.

  1. Techology, Memory and Processing
  2. The social age
  3. Impact and engagement

Technology, Memory and Processing

Technology is all pervasive in 2017. Data from the Pew research group2 shows that interaction with social media rises year on year and not only amongst the youngsters. Social media and technology is everywhere and even if you think that you are not a user yourself, it’s inevitable that your colleagues will be an thus you will be ‘contaminated’ by what they learn. In other words it’s impossible to escape the influence of social media even if you are not a direct user yourself.

Most current medical education models seem to be based on pre-internet learning styles and are increasingly lagging behind technological development. When I look back to my early career it was very different. We did not have smartphones, the internet hardly existed, computers were slow and difficult to use and they were not really accessible in the clinical environment. Bedside clinical medicine  relied upon the ability of doctors to memorise and access facts using our own minds. Undergraduate and early postgraduate training focused on the acquisition and regurgitation of facts. We learned anatomy such that we could recite, draw and describe it. Hours and hours were spent learning facts to impress our tutors and to make us look good at the bedside.

Those days are gone.

We all have access to the internet, and nearly everyone has access to the internet by a portable device. That device has the abilty to rapidly access all the knowledge that I’ve learned, forgot and never knew in a matter of minutes. This is a profound change in the way that we access information. My early career was characterised by the need to know things, today it is arguably more important to know about the existence of facts and how to find them. We are less the memoriser of facts but rather the indexing, searching and processing system required to find and use them.

The world has changed but our education systems, and particularly our assessment systems have not. Let’s think that through. Think about the exams that we set, typically they require the recitation of facts, and yet is there really a need when we can access facts almost instantly. Should we really expect our trainees to be able to draw the brachial plexus from memory if we can access that knowledge in seconds? Ask your consultants to draw the brachial plexus, they won’t be able to (well virtually none will), and they may well pull out their smart phone for a reminder. The reality is that we don’t store information in the way that we previously had to and our exams, which should be there to define whether we are fit to progress in practice, should reflect that.

In simple terms – why are we examining in a way that we don’t practice? The answers are complex, but arguably it’s because it’s easy and because we’ve always done it that way.

If you’re in a public space as you read this, look around and see how people interact with social media and smartphones. It probably looks like the picture below as we all sit in a world of continuous partial attention. I might ask if you have you been distracted as you read this? Did you check an email, read a tweet, see a notification from facebook on your device. It’s only been a matter of minutes since you read the opening line and yet I’ll be that many of you are already distracted. This is typical of the modern world and it means that we are constantly in competition with other potentially more engaging attractions. Our learners can now access high quality and engaging media and if learning is to work then we as educators need to make our presentations and learning materials engaging too.

stemlyns conference photo social age continuous partial attention

We know that lectures struggle to impart knowlege well, and yet formats such as TED are hugely popular and engaging. Their use of narrative, short length and visually appealing media is how our learners reach engagement. These are lessons that we need to learn.

The Social Age3

Julian Stodd is an academic who has studied how organisations work with social media. He makes the really important point that we have moved from a manufacturing age, to a knowledge age, to a digital age but that the digital age is really already established and we have moved beyond that time. The present and immediate future is characterised by the way that we use digital technologies in a social way. If you are interested in educational technology, learning and/or social media then I strongly recommend you visit the blog and read Julian’s books.

https://julianstodd.wordpress.com/2016/04/05/beyond-digital-into-the-social-age/

Our tradtional model of education is that knowledge which is created by academics is packaged, assessed and distributed through journals, curricula and by the belief of educators. In the social age the filter function of educators and established organisations like colleges and academic institutions is disrupted and the fitler is subverted. In a social age where we can communicate across the planet the control of information is lost and our learners can not only access a much broader knowledge source, but they are also in a position to define their own values and worth. The control of information which was once the preserve of the educationalist is now subverted. An analogy would be the way in which the US presidential campaign in 2016 was defined by Donald Trump’s use of social media to by pass and engage directly with the electorate.

https://julianstodd.wordpress.com/2017/01/23/trump-communication-in-the-social-age/

At St.Emlyn’s we understand that clinicians construct their knowledge on the basis of what they already know, and that we reinforce and embed that knowledge through discussion and debate. This socio-constructivism4 model of learning reflects what is happening in the social age. Clinicians have always come together to socially interact around new knowledge in departments, meetings and journal clubs. There is nothing new in social interaction being linked to learning; what is new is that that interaction is now longer bound by physicial space or time. We cannot communicate across the planet in an asynchronous fashion developing personalised learning networks that are not defined or controlled by anyone but ourselves. The picture below shoes a PLN from Anand Swaminatham outling key clinicians that give value to his learning journey. If you recognise the faces you will see them as Mavens from across the globe. This is an incredibly powerful way of sustaining personal learning, created and maintained through online social interaction.

personal learning networks in the social age stemlynsClearly there are risks with this direct and unflitered information flow  (see Trump & Brexit) and we can see similar concerns in medical education. Traditional educationalists are worried that they will lose control of what their learners access and then believe. They worry that they may not have the skills to understand and appraise what is good and what is not. In reality they’re right, we need to empower our trainees and colleagues to develop those skills rather than to pretend that they are not needed. For anyone involved in education today it should be clearly apparent that web based learning requires critical appraisal skills. As an educationalist the message is clear, we need to work, learn and educate in the same space that our learners inhabit and that is online.

 

Impact and engagement.

We’ve already highlighted studies that illustrate the engagement statstics for junior clinicians in the US5 and Canada6 and that data is reasonably compelling, but what effect does it have on patient care?

We know that we have a problem with getting good quality data from clinical trials through to patients. Studies have shown that the delay may be as long as 14 years and that this results in many of our patients  not getting high quality care.There are many potential reasons why this may be, but certainly the limitations of only having information published through the journal route before slowly winding it’s way into textbooks and curricula results in a glacial rate of change.

The impact of social learning has the ability to change this and to speed the transfer of knowledge from source to bedside. Take something that I’m sure you now do, the REVERT method for converting SVTs7. Just think about how you found out about that study and answer these questions.

  1. Do you know which journal it was published in?
  2. Do you subscribe to that journal?
  3. Did you read the abstract?
  4. Did you read the full paper before you adopted this technique (the FULL paper, every word)?

It was published in the Lancet btw and I’m going to bet that for >90% of clinicians they will have adopted this technique without reading the full paper. When we published a blog on this paper it rapidly led to over 12000 views and messages from across the globe, we got messages from clinicians within hours of how they were using the technique. That’s a real impact and a fanstically fast adoption of new knowledge.

REVERT stemlynsIf you’re reading this then I’m pretty confident that most of you will have learned it through #FOAMed. You will have seen or participated in online or face to face discussions to clarify and debate and then I suspect that you will have contaminated non-#FOAMed colleagues with this knowledge. It’s a good example of how new methods of social interaction and communication can accelerate learning and practice.

 

So what does all this mean?

This 30th anniversary meeting had a real focus on looking to the future of emergency medicine and I think it was really fitting that this talk on education ended the meeting. Education is really a time machine. We invest in teaching and learning to change the future of healthcare. What we do now influences the care that we will give for future generations and for ourselves.

As educators we have such a privilige to invent the future and I was delighted to play a small part on what has been a fabulous day.

vb

S

Before you go please don’t forget to…

References

1.
Emergency Medicine Section. Royal Society of Medicine. https://www.rsm.ac.uk/sections/sections-and-networks-list/emergency-medicine-section.aspx. Published 2017. Accessed February 7, 2017.
2.
Social Media Usage Trends. Pew Research Group. http://www.pewinternet.org/2015/10/08/social-networking-usage-2005-2015/. Published 2016. Accessed February 7, 2017.
3.
Julian Stodd Learning Blog. Julian Stodd Learning Blog. https://julianstodd.wordpress.com/. Published 2017. Accessed February 7, 2017.
4.
Social and Constructivism. St.Emlyn’s. http://stemlynsblog.org/educational-theories-you-must-know-constructivism-and-socio-constructivism/. Published 2015. Accessed February 7, 2017.
5.
Pearson D, Bond M, Kegg J, et al. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty. WestJEM. 2015;16(5):715-720. doi: 10.5811/westjem.2015.7.26128
6.
Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine residents and program directors. CJEM. 2015;17(02):101-106. doi: 10.1017/cem.2014.73
7.
Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015;386(10005):1747-1753. [PubMed]
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