Social Media: Are med students SoMe-philes or SoMe-phobes?

As with any question about human behavior, I don't think whether students love or hate social media has a definitive answer.  If you talk to students about it, you'll find answers vary from one to the next.  I have talked to many students about this, and I have found the continuum of students thoughts on social media was more varied than I originally anticipated.

The main thing that surprised me at first is that not all med students have active social media accounts.  I had this vision in my head of these students getting through their college years with the prototypical laptop open with multiple chat windows going, Twitter and Facebook windows chock full of 'lol's and 'rofl's, streaming a soccer game from Sweden, video chatting on Skype with a friend at Harvard, and working on a paper on Word researched through a Wikipedia page.  While some of that might be true for some of them.  I've found a healthy percentage (at least 1-2 in 10 in informal talks) do not have any social media accounts including a Facebook account.  This crowd is usually a little sheepish to admit it, but they are a substantial chunk of current medical students.  Also, in a class of about 120, I usually find 2-3 students who have a Twitter account which I thought was a bit lower than I'd expect.  I don't think my initial perceptions are that unique, as in a recent #meded chat on Twitter, this subject came up, and many academic physicians on the chat were surprised by the numbers I just shared with you.  (I haven't yet done a formal survey of med students, but that may not be a bad idea...)

It's easy to assume that the Millenials are the 'digital' generation, so they must all be on social media.  So why are they not there?  I think part of it is that there are genuinely some younger people who still prefer an analogue life.  I don't mean this in a negative sense, but there are people out there (even young people) who are aware of the technologies available, and understand the potential benefits, but don't feel it is worth the time and effort.  Some have even tried it out, and didn't like the experience.

The second reason I hear is that there are a good number who are scared of its potential harm, and feel this risk outweighs the benefit of seeing pictures of their college roommates baby.  You don't have to be in medical school for very long before someone from the front of a lecture hall tells a story of social media gone horribly wrong, and these stories usually end up with suspensions and expulsions of students.

Another thing I've picked up in talking with students is that very few of them realize they can use social media as part of their job as a physician.  They also don't realize its potential positive impact, so few of them are engaged in it.  Many are worried about it.  I've even interacted with a few med students on Twitter who have a nice presence, but were seriously weighing whether to include their blog/Twitter profile on their residency application.

What has your experience been at your medical school?  Do the confines of your school promote social media friendliness or social media angst?

Evidence based medicine in second year courses: Too much too soon or just in time?

Once again sitting in the back of the neuroscience and behavior class, and I've noticed another interesting phenomenon as the course as gone on.  As we cover stroke, the clinical presenters are presenting much more clinical trial data than the other clinicians did (including myself for example as I the presentation on Parkinson's disease).  Part of this is due to the veritable glut of evidence from strokologists.  As stroke is very common, it is not hard to get large trials together, and the stroke literature is now quite robust.  And, rightfully so, the stroke physicians are proud of their work, and want to communicate the data.

This raises a bit of a tension in the second-year neuroscience class.  This tension is that these students were introduced to vascular anatomy yesterday, and stroke pathophysiology earlier in the morning.  So how soon is too soon to talk about EBM?  The focus of the course is more on learning the basic science, and getting an introduction to differetial diagnosis and treatment.  Hence, when I talked about the clinical context of Parkinson's disease, I presented a lot about the clinical syndrome, and the differential diagnosis, and initial treatment options with pharmacologic information.  As I'm a clinician, the pharmcology focused on adminstration route and side effects.  But I didn't really show any primary literature in my slides.  The stroke people showed a lot of primary literature - SPARKLE, CLOSURE, CREST, ECASS, NINDS tPA trial, the list of acronyms paraded across the screen.

So the tension lies in the fact that students do need to know that there is evidence which supports our clinical decisions.  This evidence is often cited when I do ward attending rounds with the residents and the fourth-year students.  But how much belongs in the first and second year coursework?  When does it become overload when the student is still trying to grasp the basic concepts of pathophysiology?  I'm not sure I have answers to these questions.  As my lectures tend to show, I'm more for presenting basic data, and pivotal trial data in measured doses at this stage in training, and allow the learners to delve more deeply into EBM during the clinical years, and into their residency training.  What do you think?

Are laptops/ tablets connected to WiFi forces for good or evil in lecutre hall?

This post is in response to several things I've read and heard lately about the use of devices to connect to the internet in medical school large group teaching sessions.  Essentially these posts or comments have been either strongly in favor of the introduction of these technologies, or strongly against.  I haven't found much of a middle ground.

Those against argue from the idea of distraction.  The argument is laid out in several recent research studies looking at the effects of multitasking on cognitive performance.  The basic idea is summarized pretty well here, in an article from the San Fransisco Chronicle.  This is the view held by many basic science course directors who make comments to the effect of, 'if they have their laptops out, they are likely playing solitaire.'  I've also seen some people speaking about generational differences in learning styles who state that the Millenial generation has grown up with multiple electronic devices going.  This falls back on the data that they feel like they have done this for a long time, and should be good at it, but they are not really.  As they don't have any insight into this potential hazard, we as course directors should act to squash this tendency by telling everyone to turn off their electronic devices.  Hence, the common wisdom among these presentations is that it is important to have the learners switch off their devices on entering the classroom for their own good.

On the other hand, there are many potential up sides to having a wired classroom.  First, audience response systems using web-based or local networks are becoming more sophisticated and more robust.  This is much more than the audience clicker system where the audience can push a button to answer usually a multiple choice question (A,B, C, or D).  But there are systems like Twitter that can allow 'back-hallway' discussions or ability to ask questions which can be answered by the presenter in real time.  Newer platforms can collate rich text entries and also collect images.  Many of these allow ability to catch if the audience is out of step more efficiently by than the traditional method of waiting for someone to raise their hand.  Secondly, there is also the ability for the individual learner to go down a 'rabbit hole' right away to pursue a question they may have had.  For example, I interjected a clinical example of hemiballism after a lecturer was talking about subthalamic nucleus anatomy.  I had not shown a video, as I just stood up and extemporaneously gave the discussion.  As soon as I was done talking, a student in front of me had called up a video of hemiballism with a video demonstrating it.  And these are just a few brief examples of the good that can come from online activity during a lecture.

The last point I'd like to bring up, is that this will likely not be a point of discussion soon.  Our med school is considering going to a paperless system where all notes are distributed electronically. Our med school is likely a bit behind the curve on this.  My point is the same devices that allow you to read PP slides, and take notes on them also play Angry Birds.  There's not currently a good way to facilitate one task while blocking the other.  My point is that the ability for a lecturer to demand that everyone turn off their devices.  Thus, this may be analagous to a record company trying in the late Nineties to divert attention from digital devices playing their music and focusing only on
CD's.  Who's bought a CD recently?

So, where do we go from here?  As I look over the neuroscience course this morning, most electronic devices (except mine) are showing slides on epilepsy treatment (which is the lecture we're having today).  So most people are using the technology wisely.  However, with email only a click away, the temptation is strong for attention to wander?  What are your thoughts?