Social Media and (Pre) Medical Education

I joined Facebook back in 2004, only months after the site was launched. The internet, though I didn’t realize it at a time, was still a very disconnected place. Social media was fundamentally in its infancy, with Facebook joining only a few other social networking sites (MySpace and Friendster come to mind). Twitter and many other social media sites were just thoughts at that stage. Aside from Facebook, the only way I connected with other people was through AOL Instant Messenger, if even that.

Eight years and some 900 million Facebook users later, social media has exploded onto the scene. Rare are the websites that DON’T have a share button that allows users to share the site with users on many different social media outlets. Early on, I used Facebook exclusively to keep in touch with close friends. In contrast, I created this blog to disseminate information. Soon after I started blogging, I discovered Twitter and the medical community that was burgeoning there. I then began to explore using social media for learning more about healthcare and medicine.

People are slowly recognizing the vast potential of social media, especially in the context of healthcare. Not only is it poised to be an important tool in clinical practice, but also in training new generations of physicians. There is a hashtag #meded for a Twitter conversation that takes place weekly, where participants discuss medical education, any problems observed, and potential solutions. It, along with the #hcsm (Healthcare Social Media) Twitter conversation, represents a great forum to propose innovative ways to improve the field of medicine and medical education. I think for students, especially, it is an incredible asset. One can get a very broad perspective of medical education in general, and can reach out to others who are encountering similar problems and situations on their way to a career in medicine.

Speaking for myself, I am pre-med. When I will shed the “pre” part is unknown at this time, but that’s an entirely different topic. I am working, but I am still thinking about entering medical school down the road. I love Twitter, and I use it in part to connect with doctors and students, and to keep abreast of issues that are going on in both the education side and the clinical practice side. I tend to lurk in the background for both the #meded and #hcsm conversations, observing and learning, but not directly participating. I have learned a great deal, but this is information that will probably come in handy further down the road, when I officially start on the road to becoming a physician. What would be nice right now is a similar community for pre-meds.

There is a somewhat more cohesive community that exists on the Internet to provide a resource for pre-meds, as well as medical students and practicing physicians and other healthcare professionals to pose questions and get answers: Student Doctor Network. This is something that has been around for years, and many students have embraced. I have used this multiple times and I think it’s fantastic. However, it is somewhat static, compared to Twitter at least. Yes, people post answers, but it’s not quite the same. Twitter has the feel of a conversation among friends. The rapid-fire exchange of questions and answers feels more natural, and more human in some ways.

Now of course there is a community of sorts on Twitter. There are many pre-meds who have taken to Twitter for one reason or another, and who sometimes connect with other pre-meds along the way. Yes, we all come together to bond, complain, rage, and sometimes exult about classes, the MCAT, and medical school applications. Yet it would be nice to have a way to discuss issues that plague pre-meds from freshman year to the post-graduate years. Ideally the conversation could be fostered and archived under a hashtag. The resulting posts/tweets can be accessed readily later.

There are so many questions that arise for pre-meds even before they reach college. Which school should I apply to? Should I opt for a combined BA/MD program, or go the “traditional” route? In college, the questions can range from the general (What should my GPA be? What about my MCAT? Where should I do community service? Which doctor should I shadow?) to the painfully specific (What the heck is a racemic mixture? How much acid-base chemistry can one expect on the MCAT? What is the average GPA of students accepted to medical school X?). Pre-med is a label that encompasses a wide range of students from at least the age of 17 or 18 to those who are often in their mid to late 20s, if not older (as is the case for many non-traditional students). A social media community dedicated to pre-med issues would be a wonderful way to not only allow these questions to be answered and grievances aired, but it represents a great opportunity for mentoring of younger students by older ones who have had more experience. Having pre-medical advisers, medical school admissions staff, and medical school professors potentially join these conversations would add much needed perspective about what lies on the other side of that seemingly impervious wall called medical school admission.

I’ve been talking about Twitter quite a bit, because that’s what I tend to use most of the time, but other social media tools can be used as well. Facebook’s potential as a teaching tool is being explored in the context of medical education. However, there are some who have reservations with regard to its use in this context, especially if educators are involved, as outlined in this great blog post by Anne Marie Cunningham of Cardiff University in the UK. Blogging, though considered antediluvian by some nowadays, represents another opportunity to detail experiences and forge bonds with others who are in similar situations, and get answers from those who have walked down the same path.

Think of how great it might have been for you to have a community right at your fingertips, where most (if not all) of your pre-med questions can be answered, and readily at that? It’s something that I definitely wished I had early on. While SDN has its benefits, at least on Twitter, there is a greater sense of openness and trust that enhances the learning experience in that context. I have communicated with students and doctors, and they have been wonderful sources of insight. I consider many of them to be friends and invaluable sources of information. It would be wonderful to see universities embrace social media as a powerful source of information and a teaching tool not only for pre-meds, but for all students. Social media participation should be encouraged, but it would be nice to see classes being offered to students that taught them about using social media wisely and managing their online reputation. Perhaps professors can get in on the act and provide information to their students on the social media groups, sites, and hashtags where conversations about topics that are being covered in their class. The possibilities are endless.

Thoughts? Comments?

Social Media as a Tool for Patient Empowerment in Developing Countries

When I was in India recently, I spent time with one of my relatives. While I was there, he came down with a minor cold, and walked to the doctor’s office just down the road. I stayed at home until he came back. When he did return, he had with him a packet of various pills all mixed together. None of them were labeled, nor did they come with a set of instructions. He didn’t know what any of them were, just that his doctor gave them, so he took them.

A week later, I found myself talking to the servant that had come to clean our apartment. Her son had been ill for sometime, and I knew something about the condition from which he had been suffering, because someone had explained to me earlier. Yet when I talked to her soon after she had come back from meeting with her son’s physician, the way she tried to explain his condition to me struck me as completely inaccurate, given the condition in question.

In other instances, I have seen relatives sitting in the doctor’s office. Oftentimes they don’t say anything, and don’t ask anything, instead simply nodding in agreement. Yet when they were out of the office, the questions and doubts start flying. Usually the condition in question remained nebulous even after the appointment, or the procedures were not explained fully. Other times, they would take a decidedly cynical stance when it came to evaluating the doctor’s suggestions, believing that they were more interested in extorting as much money as possible instead of actually treating the condition.

To my eyes, at least in developed countries, patients seem to be more empowered in the context of the doctor-patient relationship. In the ideal scenario, the patient and doctor work together for a solution, with the patient actively engaging the doctor with questions and concerns, and the doctor giving the due attention and compassion. The patient may also have access to additional information through the internet.

Yet in developing countries, including India, many patients still to cling strongly to the doctor-patient hierarchy. What the doctor says, goes, in most cases. In areas with dense populations, few physicians, or a combination of the two, giving the patient the time they deserve can be a formidable task. Among those with less education, a lack of basic medical literacy can further complicate matters.

I recently attended NYMCSPAD (New York Medical College Student Physician Awareness Day). The theme for the day was Social Media in Medicine. All of the speakers–who are very active in social media applied in healthcare and medical education–discussed their personal experiences using social media, as well as advice on how to effectively use social media. One of the points that really stuck out is that patients who continue to ascribe to the “traditional” doctor-patient hierarchy are likely to be left behind. I thought back to my relatives and other people I know who are still content being passive, and not actively taking charge of their care.

There is no denying that social media has taken hold globally. Its value as a tool for patient education and empowerment is slowly being realized in the United States as well as in other countries. Patients, in many cases, vet their doctors by searching for them on social media sites to learn more about them and what they do. Social media is also being embraced in developing countries among physicians, medical students, and public health workers alike. However, I still believe there is still more work to be done to promote patient empowerment in those countries.

The doctor-patient hierarchy–though in many cases a cultural mainstay especially in developing countries–presents a very real barrier when it comes to tightening and improving the healthcare system. According to the World Health Organization, patient empowerment can allow for a more efficient use of resources. Poor medical literacy is another barrier that makes patient empowerment that much difficult among patients who are unsure about the particulars of their own health. While for many in developed countries, information is quite literally at one’s fingertips thanks to smart phones, the same is not necessarily true for the majority of people in developing nations.

While the knee-jerk reflex for many is to develop an app that can be used on smart phones, it doesn’t solve the whole problem, especially considering that smart phones aren’t as pervasive a presence in most of the world as they are here. In India, there are about 20 million smart phones available, but given that there are just over a billion people in India, it represents a very small percentage of the population. However, there are over 900 million cell phones in use. Similar trends are true for other developing nations, with cell phones being available to at least 50% of the population in many cases. Cheap cell phones are often readily available to the majority of the population. I have often observed the very poorest toting a cell phone.

Facebook, Twitter, and other social media platforms are all useful in their own right. Among social media tools, Twitter seems particularly well suited as a way to improve medical literacy and increase patient empowerment in developing countries. While most users use Twitter through Twitter apps and clients on their smart phones and computers, even those with cell phones can send and receive tweets. Before I got my first smart phone back in 2009, I used my regular cell phone to tweet.

So who would these patients tweet or follow? Doctors, medical organizations, medical schools, and other research institutions are just a few that come to mind. The issue with developing nations on the whole is elevating the patient so that they are on an equal playing field with their doctors. They need to feel like they can ask questions of their healthcare providers, that they can trust these providers, and be well-informed about their health and any prescribed treatment. While part of this can be solved by trying to impress upon the patient that the doctor is a partner in their healthcare, part of it can also be solved by improving the patient’s medical literacy.

Medical literacy has been of particular interest to me ever since I took a class on immigrant health for my public health program. A lack of medical literacy can contribute to a whole litany of problems, including early deaths. The issue in many developing countries is not only the lack of medical literacy but the lack of literacy in general. Combining this with the fact that many still cling to preconceived notions and superstitions can further complicate things. Here, the use of a non-written medium, such as Youtube, can be used to effectively transmit information about various aspects of healthcare. The use of video allows for not only circumventing text entirely, but easily adapting the content to the local languages and cultures. Given the likely poor access to technology in poorer communities, the onus is on physicians and public health officials to make this information available to them.

This is something I have thought about for a while, but revisited with renewed interest after attending NYMCSPAD. Do you know of programs currently utilizing these and other approaches that have been conducted to date? What are they? Do you have any other thoughts on how to promote patient empowerment in these regions? Comment away!

My Twitter One-Year Anniversary

I first joined Twitter on New Year’s Eve last year, and didn’t really think much of it early on. One year later, it has become a key networking tool for me. 2009 was the year Twitter exploded in popularity, mostly because of Oprah and the legions of celebrities that joined.

I have been lucky enough to get to know many incredible people from all walks of life. Some, I’ve even had the chance to get to know in real-life, and have been a great source of advice, wisdom, and friendship. Many are doctors, medical students, and scientists, but I’ve also gotten to know people who are newscasters, musicians, bloggers, and just generally interesting and inspiring people. As a rule, I don’t generally follow celebrities unless they have something vaguely interesting to say.

Twitter is great, but not perfect. It is still plagued by spammers, following people en masse, trying to hawk their products, marketing/entrepreneurial skills, or naked photos. There is no adequate mechanism in place to remove them before they start following people, so removing them becomes the responsibility of the user (and is a painfully slow process). It would also be nice if their “Suggested Users” function did not include just celebrities/other accounts with large followings. I’d like to follow people who may actually interact with me on some meaningful level.

While people may tend to think Twitter could supplant Facebook or vice versa (Facebook has enabled the @ function in their statuses possibly in an attempt to imitate Twitter), I think they can coexist. What I think (and this view is generally shared across many of my friends) is that Facebook is best reserved for keeping in touch with your close friends, while Twitter is great a way to meet new people.

So all in all, I’m pretty happy with my experience so far. I hope the next year brings new friendships and contacts who will help me achieve my goals, and perhaps I, theirs.

If you would like to follow me, my Twitter username is @sospokesaroj (original I know).

Twitter is a Slice Through Humanity

I think, at first, I wasn’t a huge fan of Twitter. It seemed like it was Facebook stripped down to just the status updates. Yet, I’ve slowly come to like Twitter after having used it for somewhere around two months. Really though, you either love it, or you hate it. I think I may love it.

Twitter represents the next best thing and the next worst thing as far as technology goes.

First, the best. It takes networking to the next level, putting you in contact with people with similar interests (and even opposite interests) more readily than even Facebook. Among my followers, I have many neuroscientists, doctors, bloggers, baristas, and just generally cool people. A lot of their tweets are relevant to my interests, and I gain a lot from my association with them (and I hope the same is true for them). Twitter also introduces new ways to forward interesting tweets (retweet or RT) and categorize them (hashtags #).

Now, the worst. Where AIM started the move to truncate the English language with its lols and rofls and lmaos, Twitter continues it, and then some. Its 140 character limit forces users to be especially clever in how they shorten their words. For someone like me, who prefers writing in (relatively) grammatically-correct, whole sentences, it makes me cringe just a little to see the preponderance of “u” over “you” and “2″ over “too.”

Then, there are the Twitterers themselves.

Looking at a snapshot of tweets from any given period of time gives you a wide range of people from all parts of the globe, spanning a wide range of ages, languages, and different occupations. It is, quite literally, a slice through the collective consciousness of humanity (at least the percentage who is on Twitter). There are many different types of people who Twitter, at least as far as I can ascertain (all attempts at clever names are my own creation):

1. The Twitter whores: The ones who voraciously seek out followers and update every 5-10 min, mostly with unbelievably useless nonsense. The number of people they follow far outstrips the number who follow them. They may or may not be trying to promote a website. They also are probably permanently welded to their Blackberrys.

2. Passive Twitterers: The ones who update, but not very often, and acquire followers with the same intensity of a tumbleweed blowing through the desert. Most of their followers are Twitter whores.

3. “Mountains from molehill” Twitterers: These are the ones who update often, mostly making a big deal about the mind-numbingly boring details from their lives. They may or may not seek out followers. Most come to them, many of them are Twitter whores.

4. Genuine Twitterers: Those who tweet only with curious or interesting links or facts, seeking to enlighten those who may read them.

5. Organization Twitterers: Institutions, schools, government agencies (ex. NYC MTA) who tweet updates of relevance to those associated with them in some way (ex. those who travel by the MTA).

6. Celebetwits: Celebrities who may or may not be writing their own tweets. They have legions of followers, many of whom are under the delusion that they and the celebrity in question are actually friends. Some, though, actually are right.

I am not sure where I fall (though I’m definitely not 6 and I’d like to think I’m not 1). I probably vacillate between 3 and 4, sometimes leaning toward 3 since my life just isn’t that interesting on a regular basis. The same goes for most grad students I suppose.

So it looks like Twitter is here to stay, and won’t go the way of the dodo. I’m curious to see what evolution (if any) Twitter will undergo next.

P.S. If you’d like to follow my updates on Twitter, the feed is on the left side of this blog. Otherwise, you can access my tweets here.

The Emerging Facebook Culture

I’ve wanted to write this one for a while, considering how I’m the self-proclaimed Facebook addict.

I started using Facebook back when Facebook was open only to the Ivy League universities, and maybe a few more outside of that (this was maybe around May 2004). I wasn’t really into the whole MySpace scene, and this seemed like a clean-cut version of MySpace. It also was a more organized version of Cornell’s attempt at uniting our incoming class of 2008. Back then, Facebook was relatively simple. You had a profile, a friend’s list, inbox, and the poking feature. Beyond that, there wasn’t really a whole lot.

Oh how times have changed.

Now Facebook is no longer restricted to university students, or even just to students. Everyone is on Facebook. Yes your little brother, your neighbor from down the road, perhaps even your parents–they all have profiles. Facebook has grown and morphed into this social-networking juggernaut that keeps changing to meet the demands of the public. There are very few people nowadays who don’t know what Facebook is.

Facebook has become its own cultural phenomenon. It comes with its own set of social norms. You don’t believe me? There is a whole set of connotations that can be associated with, say, a poke. If a girl pokes a guy, or a guy pokes a girl, it can be viewed as flirtatious. If friends poke each other, it’s more a sign that they’re both silly and very bored. A person you don’t know who pokes you is viewed as creepy. I can probably create a hundred other scenarios that center on a poke. The same goes for messages, wall posts, and other modes of communicating that Facebook provides.

You can probably categorize people into a host of loose categories based on their Facebook habits. There are those who friend everyone, accept all friend requests, join every group, and add every application. They are probably better off on MySpace. Then there are those who do…nothing. They are probably better off not creating a profile to begin with. Then there are those who fall somewhere along that spectrum. There are those who probably have lives and occasionally update their Facebook profile, and don’t necessarily seek out new friendships, but keep the ones they have alive through Facebook. Then there are those (like me) who tend to go on Facebook often more to utilize it for a specific purpose (like plugging my blog and keeping in touch with friends). The possibilities are endless.

Facebook has even begun to serve as a method for finding potential dates, and that too, comes with its own set of unspoken rules. It’s no surprise that it is being used that way. One’s profile has (usually) all the information a person needs to learn about another person enough to decide whether or not it’s worth getting to know them better. Yet sometimes, actually opening the channel of communication through Facebook whether through a message, poke, friend request, or other method can be viewed very differently between different people. I tend to overextend my definition of creepy to cover a whole set of possible actions on Facebook, but that’s also because I’m very cautious by nature. These include the compliments about photos, pokes, and random friend requests. I have only now begun to realize that sometimes, it’s not so much that people are creepy, and it could be explained by the fact that they are perhaps shy. Sometimes you have to give people the benefit of the doubt, but in the context of the Internet, sometimes it is better to exercise caution. Many do actually turn out to be very creepy.

Now that Facebook is open to everyone, there are legitimate concerns about privacy. Parents are using this as a means of keeping tabs on their children, while employers and graduate schools are using it as a means of investigating their applicants’ private lives (with special attention to partying, drinking, and drug use). Facebook has become the new Big Brother, in that regard. It’s legitimate that it would be used in that sense, it is a useful tool that way. Obviously the first thing to do is either a) stop drinking to the point of stupidity b) stop underage drinking and c) stop drug use, but really that’s just wishful thinking. So I guess the best thing to do is don’t put up pictures that portray you in an unfavorable light. While sure, you may have had fun at that frat party, house party, or bar, you don’t necessarily want that to ruin your chances at a great future or ruin your parents’ trust. I can understand employers using Facebook to assess applicants, but seriously, parents shouldn’t be so eager to make a profile to spy on their children. For the most part, we know what we’re doing, and sometimes we may stumble…but we can pick ourselves up. Just have a little faith.

Facebook has become a tool for reporters, celebrities, and musicians to gain fans and keep them up to date on various happenings. I can be informed when Nicholas Kristof writes a new column or blog post, or when the date for the start of a new season of Monk, Heroes, or House is announced. I think its fair to say that Facebook is slowly supplanting MySpace as the social networking site of choice, for both regular Joes and celebrities alike.

It seems that Facebook is probably here to stay, much like AIM, as a novel method of communication and networking. I’m curious to see how it will evolve to meet changing times and changing generations. Hopefully it will all be for the best.

I’m going to leave you with two videos relating to Facebook. The first is Penn Masala’s homage to Facebook, and is a parody of Enrique Iglesias’ “Hero.”

The second is a brilliant video that takes Facebook actions and looks at what would happen if we did those things in real life.