Social Media in Healthcare Not Just for Socializing

Ryan Werblow, CRNA, MSNTwitter: @werbrj

PLEASE TURN ON ALL ELECTRONIC DEVICES,

CAMERAS, CELL PHONES, IPADS, TABLETS, and/or

PHABLETS

Thank you for your cooperation in sharing new information with others.

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Social Media

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Top 5 Reasons A CRNA Should Join Twitter

1. It’s safe.

2. It’s the most efficient way to keep up to date on the literature.

3. It’s where the experts are.

4. You can attend a conference from your bathroom.

5. It’ll make you a better CRNA.

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Social Media Defined

“Social media is a social interaction among people in which they create, share, or exchange information and ideas in virtual communities and networks.” 1

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Don’t Pre-Judge Social Media Based on How Most People Use It

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VERSUS

Criticisms of Social Media

• Unprofessional

• Amateur

• Anti-social

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It’s Anything BUT !!!

Criticisms of Social Media

Lectures 5 Years Ago

– Be careful!

– Don’t engage!

– What about HIPAA?!

– Personal privacy?

The focus was on the NEGATIVES

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Social Media is Here to Stay

• Like the fax machine of the 1980s, or email of the 2000s, social media has gone from optional to essential.

• There’s still time to be an ‘early adopter’

• But the concerns from 5 years ago still exist…

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Top 5 Reasons A CRNA Should Join Twitter

1. It’s safe.

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Concern #1: Patient Privacy

Three Rules to Follow 3

1. Don’t be stupid…

2. Don’t be stupid…

3. Don’t be an idiot…

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BBC News Corporate Policy…

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“A useful summary always has been, and remains:

‘Don’t do anything stupid.’ ”

Concern #2: Personal Privacy

• iCloud hacking

• Edward Snowden

• NSA wiretapping

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PRIVACY ON THE INTERNET DOES NOT EXIST. PERIOD.

Refer to my previous slides on how to protect yourself on social media.

Concern #3: Accuracy & Quality of Information on Social Media

• Everyone can contribute – even non-experts

• Facts get distorted quickly

• However…

– No one is shy on social media

– If you post something dumb or inaccurate – it’ll get noticed!

– The internet is the ultimate peer review

– Sharing of ideas happens in real time

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Top 5 Reasons A CRNA Should Join Twitter

2. It’s the most efficient way to keep up to date on the literature.

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If you want to know how we practiced anesthesia 5 years ago, read a textbook.

If you want to know how we practiced anesthesia 2 years ago, read a journal.

If you want to know how we practice anesthesia today, attend a conference.

If you want to know how we will practice anesthesia in the future, use social media.

- @JoeLex5 , Dr. Joe Lex (alterations in italics)

Diffusion of Ideas

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Diffusion of New Ideas

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Social Media0 years

Conference1 year

Journals2 years

Textbook5 Years

DogmaNever

- Credit: @srrezaie , Twitter, 2/2/2015

Knowledge Translation How Many Years From Research To 90% Clinical Uptake?

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How Many Years From Research To 90% Clinical Uptake?

• Routine use of PEEP

• Cuffed ETT in children

• Smaller tidal volumes + PEEP

• Use of PA catheters in cardiac surgery

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16 YEARS!!!

Another study….17 years

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We Can Do Better

Journals, Textbooks, and Conferences Are No Longer the Only Way to Get Educated

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Is Social Media a Feasible Alternative?

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Residents favored open access social media tools, such as youtube, blogs, and podcasts as being more beneficial (70.3%) than textbooks( 54.3%), and journals (36.5%).4

Recording Lectures Enhances Learning

• Two groups of residents

– Group that attends the lecture, and records the lecture to playback later.

– Group that doesn’t attend lecture, but has access to the recording.

• Who retained the information better?

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New Frontiers in EducationAnd Continuing Education, Too

• Free

• Multi-media (or multi-modal?)

• Easily accessible

• Immediate peer review/feedback

• Crowd sourced

– Not just 5 peers reviewing each publication

– 1000s get to view it and critique it

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FOAMed : Free Open Access Medical Education

• Free

• Open access – easily available to EVERYONE

• Peer-review on steroids

– Crowd sourced peer review

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Twitter allows ALL of this!

#FOAMed

Free, open source, evidence based education is the idea.

Twitter is the classroom.

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Top 5 Reasons A CRNA Should Join Twitter

3. It’s where the experts are.

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Why Twitter?Why not Facebook or Myspace?

• Posts appear in real time

• Less personal information

• Short and to the point

• More INforming, less MEforming

• Sharing of ideas and knowledge

– Twitter > Facebook

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What is Twitter?

• A social media app/website that lets users post messages (+/- pictures) of 140 characters or less

• These messages are called Tweets

• Many tweets contain links

• You follow people. People follow you.

– You may also block people

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Only 140 Characters??6

• Average English word is 4.5 letters

• This equals roughly 30 words per tweet

• 30 words per PowerPoint Slide = Optimal

• Optimal PP Slide = Optimal Tweet

• It’s almost as if Twitter was designed with teaching in mind!

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What is a #Hashtag?

• Hashtag: # -- it is NOT the pound sign…it is NOT the number sign.

• It precedes a word or phrase.

• Can give context to a Tweet. #sarcasm

• Hashtags can also categorize a Tweet so it can be searchedfor easily. #anesthesia #DeweyDecimalSystem

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What Twitter Does

• Fosters global conversations on the latest and greatest in anesthesia.– Most efficient way to stay up to date on the literature

• Allows one to make professional connections – It’s not anti-social

• Allows one to attend conferences from…anywhere.

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Top 5 Reasons A CRNA Should Join Twitter

4. You can attend a conference from your bathroom.

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• Emergency Medicine Journal, May 20147

• Analyzed all tweets from the 2012 International Conference on Emergency Medicine (#ICEM2012).

• Over 400 people tweeted about the conference– Only 34% were physically present at the

conference!

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Twitter at #MYA14

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Twitter at #AANA2014

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Symplur.com

Twitter During #CRNAWeek15

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Symplur.com

Twitter at #AANAMYA ??

ONE MILLION?

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Top 5 Reasons A CRNA Should Join Twitter

5. It’ll make you a better CRNA.

@werbrj

Maslow’s Four Stages of Learning

1. Unconscious Incompetence*

– I don’t know what I don’t know.

2. Conscious Incompetence

– I know what I don’t know.

3. Conscious Competence

– I know what I know.

4. Unconscious Competence

– I don’t know what I know.

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How Do You Know What You Don’t Know?

Get social, and avoid unconscious incompetence.

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What I’ve Learned From Twitter

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What I didn’t know that I didn’t know

There’s a new analog of Etomidate undergoing Phase I trials. It eliminates the imidazole ring and the associated adrenocortical effects.8

AFE is A-O-K: Atropine-Ondansetron-Ketorolac for Amniotic Fluid Embolism.9

Have a tiny IV in the hand, but need a big one in the AC? Tourniquet, instill 100ml of Normal Saline. Genuis!10

What I’ve Learned from Twitter (cont.)

1 min of N2O at 500ml/min has the equivalent greenhouse effect of driving a car 1 km. So, 2 hr anesthetic = 120km!11

Succinylcholine, because of the 02 consumption associated with fasiculations, results in quicker desaturation than Rocuronium for RSI.12

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What I’ve Learned from Twitter (cont.)

Ketorolac has an analgesic ceiling effect of ~10mg in acute pain, doses beyond that have no more benefit, and many more side effects.13

Confirming the ability to ventilate before giving a paralytic is not based on science, but rather dogma. May be more harm than good.15-17

Lastly, this is how to do an inhaled induction on a chinchilla…

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What Now? Step #1: Join Twitter

• Download the Twitter App

• Create a new account

– Pick your twitter handle, aka username, “@username”

• Start following people

• You DO NOT have to post

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Twitter Without Tweeting..It’s Possible

• You can be a passive Tweeter

– View Tweets without contributing

• Wall Street Journal, April 2014

• After watching for a while, many begin contributing to the #anesthesia, #CRNA, #FOAMed, or #FOAMgas conversation.

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Top 5 Reasons A CRNA Should Join Twitter

1. It’s safe.

Don’t do anything stupid.

@werbrj

Top 5 Reasons A CRNA Should Join Twitter

2. It’s the most efficient way to keep up to date on the literature.

Not 16 years.

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Top 5 Reasons A CRNA Should Join Twitter

3. It’s where the experts are.

I’m not one of them.

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Top 5 Reasons A CRNA Should Join Twitter

4. You can attend a conference from your bathroom.

Hashtag #GameOfThrones

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Top 5 Reasons A CRNA Should Join Twitter

5. It’ll make you a better CRNA.

Don’t be an Unconscious Incompetent.

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Questions?

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Credit For the Content Goes To

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1. Ahlqvist, Toni; Bäck, A.; Halonen, M.; Heinonen, S (2008) "Social media road maps exploring the futures triggered by social media". VTT Tiedotteita – Valtion Teknillinen Tutkimuskeskus (2454): 13.

2. Twitter account, @EliLanger. “@Brilliant_Ads Updated Version: pic.twitter.com/v5s6Oc6ZEi.” Microblog. @Brilliant_Ads, March 30,2014. https://twitter.com/Brilliant_Ads/status/450249797761372160/photo/1.

3. Dawson, M. (2013). Lecture from American College of Emergency Physicians Scientific Assembly 2013 [PowerPoint Slides]. Social Media in Medical Education. Retrieved from http://www.ultrasoundpodcast.com/2014/05/acep_pt1/.

4. Mallin, M., Schlein, S., Doctor, S., Stroud, S., Dawson, M., & Fix, M. (2014). A Survey of the Current Utilization of Asynchronous Education Among Emergency Medicine Residents in the United States: Academic Medicine, 89(4), 598–601. doi:10.1097/ACM.0000000000000170

5. Creation Healthcare (2014). Prepared for a presentation at Stanford Medicine X 2014. Healthcare Professionals Using Twitter. Retrieved from: http://www.creationpinpoint.com/stanford-medx-100000-healthcare-professionals-analysed-twitter/ .

6. Faust, J. (2013). Lecture 3: Medical Education & Twitter. [Powerpoint Slides]. Navigating the waters of medical education and social media. Retrieved October 1, 2014, from: http://www.aliem.com/navigating-the-waters-of-medical-education-and-social-media/.

7. Neill, A., Cronin, J. J., Brannigan, D., O’Sullivan, R., & Cadogan, M. (2014). The impact of social media on a major international emergency medicine conference. Emergency Medicine Journal: EMJ, 31(5), 401–404. doi:10.1136/emermed-2012-202039

8. Awad, N. (2013, November 22). Emergency Medicine PharmD: Carboetomidate: The Answer to the Prayers of the Intubated Septic Patient? Emergency Medicine PharmD. Retrieved October 1, 2014, from http://empharmd.blogspot.com/2013/11/carboetomidate-answer-to-prayers-of_22.html.

Credit…(cont.)

9. Copper, P., Otto, M., Leighton, B., (2013). Abstract S47; Society for Obstetric Anesthesia and Perinatology2013. Successful treatment of amniotic fluid embolism with ondansetron, metoclopramide, atropine, and ketorolac: A case report. Retrieved October 1st, 2014, from http://soap.org/display_2013_abstract.php?id=S%2047.

10. Quinn, L. M., & Sheikh, A. (2013). Establishing intravenous access in an emergency situation. Emergency Medicine Journal: EMJ. doi:10.1136/emermed-2012-202106

11. McGain F. Why anaesthetists should no longer use nitrous oxide. Anaesth Intens Care 2007; 35:808-9. Retrieved October 1, 2014, from http://dea.org.au/news/article/green_doctors_anaesthetic_life.

12. S. K., El-Khatib, M. F., Baraka, A. S., Haidar, Y. A., Abdallah, F. W., Zbeidy, R. A., & Siddik-Sayyid, S. M. (2010). Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia, 65(4), 358–361. doi:10.1111/j.1365-2044.2010.06243.x

13. Staquet, M. J. (1989). A double-blind study with placebo control of intramuscular ketorolac tromethaminein the treatment of cancer pain.Journal of Clinical Pharmacology, 29(11), 1031–1036. Retrieved October 1, 2014, from http://socmob.org/2013/02/nsaids-part-2-the-ceiling-effect/.

14. Marcus, D. (2013). Lecture 1: Medical Education & Twitter. [Powerpoint Slides]. Moving on. A six step guide to academic independence. Retrieved October 1, 2014, from: http://www.aliem.com/navigating-the-waters-of-medical-education-and-social-media/.

15. Salem MR, Ovassapian A. Difficult mask ventilation: what needs improvement? Anesth Analg2009;109:1720 –2

16. Warters RD, Szabo TA, Spinale FG, DeSantis SM, Reves JG. The effect of neuromuscular blockade on mask ventilation. Anaesthesia 2011;66:163–7

17. Calder I, Yentis SM. Could ‘safe practice’ be compromising safe practice? Should anaesthetists have to demonstrate that face mask ventilation is possible before giving a neuromuscular blocker? Anaesthesia2008;63:113–5

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