The use of social media is rapidly growing for medical education and practice sharing, and emergency medicine has been on the forefront of these developments. However, there is limited published information about social media’s role in CPD and there are challenges in its use for CPD that educators and learners need to be mindful of.

Social media, collectively defined as interactive web-based tools for computer-mediated communication,[1] has had a growing impact over the past decade as a platform for sharing medical education and practice approaches among health professionals. A recent article that discussed the benefits, risks, and opportunities in leveraging social media for the education of health professional trainees[2] highlighted a relative lack of evidence in the literature for using social media in support of continuing professional development (CPD) for practising health professionals. This article intends to illuminate how social media has been effectively used among practitioners in the discipline of emergency medicine[3] and highlights some good practices of CPD in this field. The insights gleaned will be instructive not only for other medical specialties but also for the design and implementation of a social media network for doctors practising emergency medicine in BC as a core component of a provincial Emergency Medicine Network that the University of British Columbia Department of Emergency Medicine is establishing.

Opportunities and challenges
Active and longitudinal participation in CPD is a cornerstone for physicians to maintain competence and excellence in their practices, as espoused by both the Royal College of Physicians and Surgeons of Canada[4] and the Canadian College of Family Physicians.[5] Online CPD activities have been recognized as useful approaches to CPD,[6-8] with advantages in terms of improved access and convenience over in-person CPD activities. 

Social media can be considered a special form of online CPD by introducing additionally novel educational principles such as constructivism and connectivism.[2]

Studies have suggested that physicians hold a positive attitude toward technology and social media, though this sentiment is not ubiquitous.[9,10]

Many studies with small sample sizes and surveys of convenience samples described the popularity and utility of different social media platforms for education. In countries where there are no restrictions to the Internet and social media, Twitter, blogs, podcasts, and media translation platforms such as YouTube consistently rank highly. While Facebook is popular with many physicians for personal use, they would not consider this platform for professional purposes.[9,11,12] Arguments in favor of using social media as part of medical practice point to its ability to help people stay connected, reach and network with a larger audience, and share knowledge; the ease of accessing CPD; benchmarking (becoming aware of new clinical practices); and opportunities for personal branding.[9] However, there are also concerns raised—the difficulty of maintaining confidentiality, lacking time for active participation, the challenge of establishing trust of authorship or comments from contributors, difficulty gaining workplace acceptance and support, and information anarchy (i.e., lacking a formal information management policy and difficulty finding relevant information).[9] 

Social media in emergency medicine
Dr Mike Cadogan, an author at the popular Australian blog/website Life in the Fast Lane (LITFL), has coined the term “free open access medical education” (FOAM) as the important principle that underpins the use of social media for medical education.[3,13] FOAM does not refer to one specific platform but rather to a collection of resources that are based on social media.[11] The popularity of LITFL attests to it being a contemporary staple for emergency medicine practitioners and trainees alike. The LITFL website also provides an extensive (but still not exhaustive) list of emergency medicine and critical care blogs for interested individuals to discover and follow.[14] 

A major issue of debate in the literature about FOAM (and about social media for CPD in general), which consists primarily of opinion pieces and observational studies, focuses mainly on peer review and its influence on knowledge dissemination. It has been suggested that the current system of peer-reviewed publication—in which it takes months for articles and letters to the editor to be published—may be too slow to promote effective and timely knowledge dissemination. Most journals are now publishing articles online ahead of in print and encouraging open and online discussion through various forms of social media. While the opinions expressed in online discussions are not peer reviewed prior to being released, experts in their field are able to expedite the commenting process based on both the evidence presented and personal experience, and shed important insights to bridge the gap between literature and application in clinical practice. Further, social media facilitates global discussion in real time, something that articles in print journals cannot replicate.  

One study has touted the influence of social media in garnering input and discussion from individuals who were not physically attending an emergency medicine conference.[15] Two other studies on the Global Emergency Medicine Journal Club showed a rapid increase in the use of social media in consecutive years of study—a 47% increase in participant traffic from the first year to the second year was noted. Authors of the articles being discussed could also engage in real time with participants of the journal clubs on a global scale.[16,17] Furthermore, a systematic review of journal clubs that are accessed via microblogs indicated that Twitter-based journal clubs are an expanding method of CPD and a unique way for those with busy schedules to engage.[18]

However, a noteworthy counterpoint to the benefits of social media is that opinions skew toward the more extreme in forums where there is a low volume of traffic. Various solutions have been proposed to counter this challenge, such as introducing clinician moderators and forums for discussion to promote expression of a variety of opinions, but no approach has been accepted broadly.[11,19,20] 

Providing CPD credits for social media use may lead to its increased acceptance. For example, Dr Scott Weingart has an active website and conducts popular podcasts titled EMCrit on emergency medicine and critical care topics. While access to some of the materials is free, registration and payment is required to gain access to all the content and to obtain CME credits.[21] A local example is the UBC website, This Changed My Practice, where physicians are able to gain CME credits by reading posts from guest authors that focus on scientific literature that changed their patient care practices.22 Formal research studies to validate the effectiveness of these models and their impact on changing clinical practice behaviors are lacking.

Overall, the use of social media to support practice and CPD has become more prevalent over the past decade, and it will continue to become more popular as an approach physicians use to maintain clinical excellence. It has even been asserted that a clinician’s influence on the medical world will eventually be heavily reliant on their online presence and ability to generate online content.[20]

Social media in emergency medicine in BC
More research is needed to further evaluate the benefits of using social media for CPD. With this in mind the UBC Department of Emergency Medicine launched a social media strategy focused on exchanging emergency medicine practice tips relevant to British Columbia. Our Facebook page is BC Emergency Medicine, and our Twitter handle is @BC_Emerg. We welcome interested physicians to join and provide insights, suggestions, and thoughts on how we can leverage this platform to support excellence in emergency medicine practice in BC, facilitate the exchange of knowledge, and provide excellence in health service to our patients. For access to the BC Emergency Medicine Facebook group, search for the group on Facebook and click Join to request access.

References

1.    Grajales III FJ, Sheps S, Ho K, et al. Social media: A review and tutorial of applications in medicine and health care. J Med Internet Res 2014;16:e13.
2.    Davis WM, Ho K, Last J. Advancing social media in medical education. CMAJ 2015;187:549-550.
3.    Cadogan M, Thoma B, Chan TM, et al. Free open access meducation (FOAM): The rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J 2014;31:e76-77.
4.    Royal College. MOC Regulations. Accessed 27 May 2015. www.royalcollege.ca/portal/page/portal/rc/members/moc/regulations [12].
5.    College of Family Physicians of Canada. Continuing Professional Development. Accessed 27 May 2015. www.cfpc.ca/CPD [13].
6.    Wutoh R, Boren SA, Balas EA. eLearning: A review of Internet-based continuing medical education. J Contin Educ Health Prof 2004;24:20-30.
7.    Fordis M, King JE, Ballantyne CM, et al. Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: A randomized controlled trial. JAMA 2005;294:1043-1051.
8.    Casebeer L, Engler S, Bennett N, et al. A controlled trial of the effectiveness of Internet continuing medical education. BMC Med 2008;6:37.
9.    Panahi S, Watson J, Partridge H. Social media and physicians: Exploring the benefits and challenges. Health Informatics J 2014;pii:1460458214540907.
10.    McGowan BS, Wasko M, Vartabedian BS, et al. Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information. J Med Internet Res 2012;14:e117.
11.    Nickson CP, Cadogan MD. Free open access medical education (FOAM) for the emergency physician. Emerg Med Australas 2014;26:76-83.
12.    Cheston CC, Flickinger TE, Chisolm MS. Social media use in medical education: A systematic review. Acad Med 2013;88:893-901.
13.    FOAM. Life in the fastlane (LITFL). Accessed 27 May 2015. http://lifeinthefastlane.com/foam [14].
14.    FOAM. Emergency medicine and critical care blogs (EMCC). Accessed 27 May 2015. http://lifeinthefastlane.com/resources/emergency-medicine-blogs [15].
15.    Neill A, Cronin JJ, Brannigan D, et al. The impact of social media on a major international emergency medicine conference. Emerg Med J 2014;31:401-404.
16.    Chan TM, Rosenberg H, Lin M. Global Emergency Medicine Journal Club: Social media responses to the January 2014 online emergency medicine journal club on subarachnoid hemorrhage. Ann Emerg Med 2014;64:88-94.
17.    Radecki RP, Rezaie SR, Lin M. Annals of Emergency Medicine Journal Club. Global Emergency Medicine Journal Club: Social media responses to the November 2013 Annals of Emergency Medicine Journal Club. Ann Emerg Med 2014;63:490-494.
18.    Roberts MJ, Perera M, Lawrentschuk N, et al. Globalization of continuing professional development by journal clubs via microblogging: A systematic review. J Med Internet Res 2015;17:e103.
19.    Weingart SD, Faust JS. Future evolution of traditional journals and social media medical education. Emerg Med Australas 2014;26:62-66.
20.    Greene J. Social media and physician learning: Is it all Twitter? Ann Emerg Med 2013;62:11A-13A. 
21.    EMCrit CME Site. Why join? Accessed 27 May 2015. http://cme.emcrit.org/why-join [16].
22.    UBC Faculty of Medicine. This changed my practice (UBC CPD). Accessed 27 May 2015. http://thischangedmypractice.com [17].

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Dr Millar is a resident in the Royal College of Physicians and Surgeons of Canada emergency medicine program at UBC, Fraser Site. Dr Ho is a professor in UBC Department of Emergency Medicine, director of the eHealth Strategy Office at UBC, and an emergency physician at Vancouver General Hospital. Dr Carvalho is a clinical assistant professor in the UBC Department of Emergency Medicine and an emergency physician at Vancouver General Hospital.