Medical Education
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Are doctors being duped through medical education? Could social media help?

Are doctors being duped through medical education? Could social media help? | Medical Education |

I made a discovery this week about the novel anticoagulant medications,dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban(Lixiana). I was looking into the often-asked question of how these new drugs compare to the old standard, warfarin.

The discovery felt like a Eureka moment. I ran it by my stats guy–my son–and a couple of colleagues, and they confirmed, that my discovery was truth. I’m working on a post now that discusses the details of how the medical world has been misled about these drugs. Stay tuned.


Medical Education:

For now, though, this revelation got me thinking about medical education. How does it happen that doctors (and patients) can be misled?


Many smart people think medical misinformation occurs in large part because industry pervades medical education. Examples abound, but look no further than the dronedarone (Multaq) blemish. The short story is that dronedarone was touted as a new wonder drug for AF. The marketing held it up as a metabolite of amiodarone that had the mother drug’s efficacy but none of its toxicity–an amiodarone light. This was hogwash. The drug was evaluated in studies designed to obfuscate. It was hyped by thought leaders with deep financial ties to the drug maker. And then, even when trial data and real-world experience demonstrated inefficacy, the hype persisted. Thought leaders continued to make dinner rounds in cities throughout Europe and the US. Not until the PALLAS trial showed that dronedarone increased mortality in patients with permanent AF, did the noise die down. The excessive hype was an embarrassment for the cardiology community.


This brings me back to continuing medical education or CME. Currently, most CME is offered to doctors free of charge. But, of course, everyone knows about free lunches. The way doctors get free (or discounted) CME is through industry funding. For-profit medical companies happily provide dollars and expertise for medical education. They hire thought leaders, often guideline writers, to do lectures and webinars. They fund medical societies who then curate the content of the education. Industry entwines itself in medical education.


Medical education, however, is not supposed to be like an advertisement. Ads are declared as ads. The lines blur when industry sponsors CME.

A skeptic might posit that a thought leader can easily tout a dubious drug during a CME activity. Mind you, not in a criminal ProVasic kind of way. Rather, the nimble-of-mind academic can hide behind relative risk ratios and dodgy study designs. The skeptic might say this is worse than an evening news ad or glossy spread in a print journal. I wonder: is it worse because it’s tricky? Or worse because it’s effective? Or both?

The same idea holds true for medical journal editors. They suspect a study is dubious but let it pass because they are conflicted by the need to sell journals and advertising space. A possible scenario: Let’s say a pacemaker company supports a journal with big advertising dollars. Then let’s say that pacemaker company suffers a ghastly lead recall. How easy will it be for editors to publish negative editorials or studies on that lead? I’m just asking. These are humans playing the game after all.

This stuff is important. I often find myself shaking my head at conferences. I think to myself: Are doctors really this gullible? They can’t see the manipulation?


Such examples lead some skeptics to say that medical education should be funded by only one source–the person consuming the education. Namely the doctors. This makes a lot of sense on paper. The problem comes in deciding how much CME should cost? How much will the teachers make? Who will do the teaching? Who will certify the teachers and the information?

Consider that I give CME lectures at my hospital. Lots of regular doctors do. We do it for nearly nothing. We do it as an avocation, not a vocation. But lectures at the home hospital are just a drop in the bucket of CME need. And who is to say that an unpaid Mandrola lecture is worthy? I gave lectures before I read Ben Goldacre. Maybe I misled the herd?


Social media — a potential solution?

Perhaps social media can outsource/crowdsource medical education? Social media and the Internet is changing the landscape of learning. Look at theFOAM experience, and PLOS, for instance. In education, look at what Sal Kahnhas done.


Medical education is a tough problem. The practice of Medicine depends on the availability of effective medicines and devices. We need industry to educate us about their products. I can’t easily ablate AF without eye-popping technology from Johnson & Johnson.


The line separating skepticism from paranoia and nihilism is also blurry. One has to believe that humans, for the most part, are good. Medical thought leaders are no less human than any of us. We are all just ambling along trying to better ourselves first and humanity second. Right?


Call me naive, but I believe it’s possible that doctors and patients could be (partially) inoculated against industry manipulation. We can teach ourselves to look at absolute risks, NNT and study design. We can learn from the work of Drs. Harlan Krumholz, Sanjay Kaul, Eric Topol, Ben Goldacre, and many other voices of reason. We can learn to discern quality journalism from hype. Go read my colleagues at heartwire. I challenge you to find industry hype in their reporting.


And yes, doctors might even be able to learn from each other, on platforms like this.

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Bringing Social Media to Medical Education

Bringing Social Media to Medical Education | Medical Education |

Providing hard data about the extent of social media use regarding healthcare, Ms. Fox made a strong case for medical professionals to meet their patients where they are. Dr. Pho acknowledged that while there are legitimate professionalism concerns about social media use by physicians, they can be handled, and the benefits that can accrue to patients outweigh the risks. I went home, drafted this blog post and signed up to follow both speakers on Twitter. Then I reflected on my own social media trajectory.


A number of years ago, when my kids were still in high school, I asked if I could “friend” them on Facebook. They looked at me with disdain and didn’t bother to reply. Now mature twenty-somethings, they have allowed me in—admittedly using high-privacy settings so that I can view only certain posts they generate. I think they felt sorry for me, realizing that I was working on a project related to social media and I didn’t know much about it.


The project—“Social Media and Medical Professionalism: Perfect Match or Perfect Storm?”—is supported by a grant from the Institute of Medicine as a Profession and the Josiah Macy Jr. Foundation. It developed from the recognition that the emergence of social media has altered every aspect of society, and medicine is no exception. Doctors tweet to get advice about challenging cases. Patients blog about their experiences with illnesses. And medical students…well, we weren’t entirely sure how medical students used social media, although they seemed constantly engaged. We hoped they used social media with appropriate caution.


Social media seemed foreign at first. But as with any complex project, if you break it down into pieces and assemble the right group of bright, hardworking people, you can make progress quickly. Our seasoned steering committee of medical educators and social media experts consists of Marti Grayson, Felise Milan, Patrick Herron, Dan Myers, Mimi McEvoy, Jacki Weingarten, Chris Coyle, Paul Moniz and David Flores.

The first task was to educate our faculty in order to bridge the “digital divide,” wherein the students knew more than their teachers. Building on a successful 2012 faculty event called Davidoff Education Day that featured social media experts Katherine Chretien and Kent Bottles, we held several more educational events.


In September 2012, we hosted David Stern, M.D., an expert in medical professionalism from Mount Sinai, and Allison H. Fine, an author, speaker and blogger on social media issues. They joined members of Einstein’s faculty to talk about professionalism in the connected age and how best to teach medical students about social media. A workshop focused on challenging patient scenarios involving social media followed the lectures. This workshop was presented at the International Conference on Communication in Healthcare on September 30 in Montreal.


After hearing concerns about how social media use could adversely affect a physician’s professional image, we wanted to learn how it could be used in positive ways. So on June 14 this year, Farris Timimi, M.D., medical director of the Mayo Center for Social Media, traveled to Einstein to talk about how healthcare providers can use social media to engage professionally and effectively with patients online in a session called “Health Care Social Media in the Digital Era.”


As our faculty members ramp up their social media expertise, we have begun to conduct some interesting research about how we—as well as our students—use social media at Einstein. We presented preliminary results at the Research in Medical Education (RIME) meeting in Philadelphia on November 4. We have also introduced social media into the curriculum of three of our preclinical courses. As we enter the second year of the grant, we look forward to engaging our third-year students in a project to determine how our own Bronx patient population uses social media.


The goal is to create additional channels for meaningful connections between doctor and patient and to develop and share content that will improve the patient’s health—a lofty aim, but one that we eagerly aspire to reach.


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The bureaucracy that has engulfed medical education -

The bureaucracy that has engulfed medical education - | Medical Education |
Medical education succeeds when one creates a culture demanding excellence and the leaders help the learners become more excellent.
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In Medical Education, Should Technology Lead or Follow?

In Medical Education, Should Technology Lead or Follow? | Medical Education |

The latest rapidly expanding trend in online education is MOOCs (Massively Open Online Courses). These courses provide a forum for excellent lecturers to teach a large number of students simultaneously.


The same virtual class can have thousands or even hundreds of thousands of students.


MOOCs generally rely on lectures and frequent assessments. While MOOCs do encourage communities of students to participate and work with each other to learn the materials, most do not require such interactivity to complete the course. And, significantly, the objectives are those set and assessed by the instructors.


In other words, MOOCS are a new way to reach a lot of people so that we can do what we’ve always done.


Another trend in many medical schools is to provide iPads to students when they arrive on campus. While the practice may be effective at recruiting students and attracting media attention, a closer look reveals that students tend not to use the iPads to take notes or produce materials, and often abandon using them in courses that are not image intensive.


One might ask why someone who is seemingly so negative about new technologies is leading the educational informatics effort at a medical school.


Without question, I believe that new technologies are critical and essential elements of contemporary medical education. However, the technologies should not define the education we provide students; they should help the learning take place.


These are tools—important tools that will help us educate future generations of physicians who must be digitally literate—but still, tools only.


Tablets may not be effective tools for writing or producing new materials. But they are incredibly useful for looking up information, demonstrating information to patients in the clinical setting and gaining access to electronic medical records. Medical students across the country often complain that they do not know how to use these tools effectively; addressing that need ought to be one of our educational objectives.


Technology must be used to provide support for effective education. Educational objectives need to be clearly defined and the appropriate tools selected to meet those objectives. Our medical education ought not to be digital simply because it is digital at other institutions. The digital format needs to serve a greater purpose—the goal of helping students develop educational competencies.


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Steph's Journalism Group 2013's curator insight, October 21, 2013 9:42 AM

This is one of the best insights. Technology has become very diverse and widespread in society but that doesnt mean we have to use all of it for teaching becasue even though some things are more modern or more ground breaking, it doesnt mean they are going to help students learn any faster. the right technolgy has to be selected to teach students.

Vinicius Cagnotto's comment, November 26, 2013 12:42 PM
the interesting news about health, and how this issue has repercurçao worldwide, and how various countries have problems in this area. lamentable! health should be a priority everywhere.
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Educational Strategies to Promote Clinical Diagnostic Reasoning



This report focuses on how clinical teachers can facilitate the learning process to help learners make the transition from being diagnostic novices to becoming expert clinicians.

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A Prescription for What Ails Medical Education - Chronicle of Higher Education (subscription)

A Prescription for What Ails Medical Education - Chronicle of Higher Education (subscription) | Medical Education |
Chronicle of Higher Education (subscription) A Prescription for What Ails Medical Education Chronicle of Higher Education (subscription) One flaw in contemporary medical education is the growing tendency to treat learners as though they were a...
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Professional use of social media in medical education

Lecture to first year uOttawa medical students by Pat Rich and Ann Fuller

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