#MedEd Goes Social

Like medicine itself, medical education is moving into a futuristic reality. We now have online forums for case presentations, simulated patients to help us learn, and even computers that can assist us in diagnostic decision-making. But not every advance comes from the top down; some educational approaches are rapidly – and perhaps unexpectedly – gaining ground. Chief among those is the use of social media, which many pathologists and laboratory medicine professionals now cite as a valuable learning tool.

In fact, social media is so popular for disseminating information that a group of “tweeple” – the Twitter community’s term for themselves – got together to establish a grassroots award for pathology education via social media: the Educational Pathology Tweet Award, or #PathTweetAward. Twitter users who create educational tweets for others are encouraged to use the hashtag so that they become more visible to the learning community, as well as to the judges who select the best of the best. And the award has certainly had a significant impact. In its inaugural year, two prizes were awarded to trainees for their outstanding education tweets, and two further prizes were given to pathologists in the open category. We spoke to the winners – Tiffany M. Graham, Mariam Molani, Raul Gonzalez, and Angel Panizo – to learn more about their tweets and their views on the future of medical education.

Tell us a bit about yourself and your path to pathology…

For a quick whirlwind tour of myself: I grew up in the mountains of North Carolina and graduated with a Bachelor of Science degree in biochemistry from East Carolina University. I then attended American University of the Caribbean School of Medicine in St. Maarten, which afforded me the opportunity to complete one year of my clinical training at a hospital in London and several elective rotations at various prestigious hospitals in the United States.

Being exposed to such diversity in both patient populations and healthcare systems, learning more about how disease affects people and how we can help treat them, was fascinating to me. It was not until my fourth year of medical school, while in the process of narrowing down “what I wanted to be,” that I even considered pathology as a career option. I had always enjoyed learning pathology, but did not realize exactly what it entailed until I completed an elective rotation. I distinctly remember the moment I decided that pathology was the career for me. I walked into the grossing room/histology lab and saw the words “Pathology Rules” written in the form of neutrophils with hyperlobated nuclei. It made me giddy to see that others shared my nerdy sense of humor!

Fast-forward four years: I am now finishing up my fourth year of anatomical and clinical pathology residency at the University of Alabama at Birmingham and will be completing my fellowship training in gastrointestinal and hepatobiliary pathology at the Medical University of South Carolina in Charlton. After that… exploring the job market!

What inspired your interest in education?

Ironically, I used to have a huge fear of public speaking. It was after a lot of coaxing from my anatomy professor at medical school that I agreed to be the sole anatomy tutor for the upcoming class of 200+ students. I was terrified, but quickly realized how much I enjoyed sharing my knowledge with others. I was even more pleased that they seemed to really appreciate my teaching style and notes. Since then, I jump at the opportunity to teach others. I’m honored that my hard work is being recognized; I was awarded the Jay M. McDonald Award for Excellence in Laboratory Medicine Presentation in 2017, the Outstanding Trainee Teaching Award for Multidisciplinary and Medical Student Education in 2018, and now the #PathTweetAward.

How do you use social media and the Internet for educational purposes?

I first started using social media for educational purposes while in medical school. During that time, I blogged about my experience as a means to stay connected with friends and family back home. However, I soon became flooded with questions from people all around the world (mostly medical students or those interested in becoming a doctor) who had somehow stumbled upon my website. Most of these questions were trivial: “Do you have any tips for how to study?” “What are the hours like in the hospital?” “What resources do you recommend so I can prepare for [insert rotation/class]?” Although there are a few published resources that discuss these issues, many can only be answered by conversing with someone who has already gone through the process. Thus, I viewed this as an opportunity to share various tips, tricks, and study notes on a larger scale.

Being in residency now (and in the process of studying for board exams), I decided to take a similar approach by creating a “study blog” (IHeartPathology.net) dedicated to those who “heart,” or love, pathology. I designed the website to serve as a centralized source of information from which I could quickly reference material during sign-out, prior to being on call, or when starting a new rotation. Much of the content posted is geared toward sharing the “bread and butter” information commonly seen in clinical practice. It is great for pathology residents, but anyone who loves pathology and wants to learn more about it can use the website as a free resource.

When I heard that many pathologists use Twitter, I decided I would give it a shot and started to share my study notes there. Since winning the #PathTweetAward, more people are cognizant that Twitter is becoming a big deal and that it’s a great way to collaborate with other pathologists. I like that it brings pathologists out from behind the scenes and emphasizes our prominent role in patient care. I think social media is just one tool we can use to help change the slightly skewed stereotype of a pathologist (very smart; socially awkward; “hates people”) and may entice more medical students to consider pathology.

Tell us about your educational tweet…

This is an example of a high-yield summary created after I reviewed an excellent presentation created by Richard DeMay regarding the foundations of cytology. This infographic exemplifies how 20 slides can be summarized into a single concise review.  I find lecture slides to be a great study tool; they are often used by residents in lieu of a textbook as their “ground zero.”

What are the qualities of a good educational presentation?

I think it’s important to acknowledge that everyone learns differently. There is no one right way to study. Personally, I am a “visual” or “hands-on” learner. I struggle to retain the same amount of information using traditional study methods, such as reading text, as I do when that information is presented pictorially. For me, creating infographics and mind maps allows me to easily visualize the key points and appreciate the delicate interrelationships between entities. This has been tremendous for solidifying my pathology knowledge base and bridging the gap between what the textbooks say and what we actually see at the microscope. Regardless of one’s learning style, I think it is critical to never lose sight of the “big picture.” To learn (and teach) a topic, there must be a solid foundation upon which to build.

Lecture slides can be a great study tool and are often used in lieu of a textbook. However, given this medium’s static nature (the lectures themselves are not often recorded), its educational benefit is highly dependent upon the quality of the presentation slides. Additionally, it can be easy to lose sight of the relationships between various diseases if structure and organization is lacking. Keeping in mind that others will be referencing the material secondhand, there are quite a few things one can include in the content to make it “better.”

1. Overview and summary slides. These are helpful whenever there is a topic change as it keeps things in perspective for the reader. Creating a mind map first helps to establish a hierarchy and show the big picture. Adding on the details as you study allows you to appreciate the subtleties between various entities.
2. Emphasis on the key point you want to get across. This can be done via a variety of methods: bold, italics, underlining, highlighting, colorful text, using different fonts, circling something, using arrows, and so on.
3. Labels for all [histology] images. As they say, a picture is worth a thousand words – but what happens when the picture comes along with zero words? The reader can only guess what you are trying to illustrate. It’s important to remember that we, as pathologists, view histology on a daily basis. However, to someone trying to learn this new material, having things spelled out is always nice.
4. Keep it simple. Yes, we know you have a big brain. Does that mean you have to purposely use big words to prove it? No! The best presentations are the ones that help explain difficult concepts by relating them to everyday scenarios. Relatability = memorability.
5. Narrative. Keep in mind that there is a big difference between giving an oral presentation and providing slides/material for review. Someone reading the content should have access to the same information as someone who was at the presentation. This narrative can be put in the comments section of a slide set or included in the main text box.

What is your best advice on educating via social media?

Don’t be afraid to post about something you find interesting – or any time you learn something new. You may think that everyone else already knows it, but chances are that someone else struggles with the same concept or may have additional insight that helps further your understanding. Social media is not about trying to get a zillion likes or followers. It’s about creating connections with colleagues, gaining new perspectives, refreshing your knowledge on infrequently seen entities and, most importantly, sharing your knowledge in the hope that you learn something new in return.

I have been blown away by the amount of support and encouragement from my fellow pathology “tweeples.” Knowing that my charts and website helps others encourages me to continue producing and maintaining them. It is certainly rewarding to know my hard work is appreciated!

I became interested in pathology during medical school. I had the opportunity to shadow several physicians, and the pace of pathology clicked with me. I liked being able to take my time, stare at a slide, pull down a textbook, and really give thought to difficult or interesting cases. My interest in education probably also stems from this aspect of my personality – if I am pondering something, I want to share my thoughts and incorporate the experience of others. I believe education is at its best when it’s two-sided in that way. Like many tweeting pathologists, I was introduced to social media via Jerad Gardner (@JMGardnerMD). We met while we were both in training and his passion for social media made me decide to jump in.

Tell us about your educational tweet…

I chose to create a tweetorial after seeing Sanjay Mukhopadhyay (@smlungpathguy)’s excellent tweetorials on lung disease. I have experience with diagnosing, researching, and lecturing about gastroenteropancreatic neuroendocrine neoplasms, so I felt that topic would be the best fit for my first tweetorial. What I most wanted to impart upon my colleagues was how to approach these neoplasms, making sure to use the correct terminology and workup, and also that they must consider the importance of site of origin.

A tweetorial is, as the name implies, a tutorial in tweet form. Because a single tweet has a limited amount of available characters, it can only dive so far into a topic. String a bunch of them together in a coherent narrative, though, and you’ve basically got a lecture or a review article. I have only created one so far, but I think that it succeeded due to my efforts to make the tweets clear, cohesive, conversational, and supported with good references and photographs. I do plan to create new tweetorials in the future, as time allows – they’re not something to rush! My upcoming tweetorials will focus a little more on clinical aspects of disease; although I composed my first imagining other pathologists as the target audience, much of the positive feedback I received came from patients with neuroendocrine tumors, so I will endeavor to craft future tweetorials to suit their needs as well.

What is your best advice on educating via social media?

One thing that always helps me is making sure I teach myself first. Any time I’m about to post a case, I first write what I know off the top of my head, then double-check to make sure I am including all of the correct information. By doing this, I’ve found new twists on old ideas and corrected mistaken notions I had. Even more importantly, it has kept me from spreading inaccurate information. It takes extra time, but it’s definitely worth it.

I am a second year anatomic and clinical pathology resident at the University of Nebraska Medical Center. I grew up in Louisiana and went to medical school in Kansas City, where I completed a dual degree program with a simultaneous MBA in healthcare leadership. When I was in my third year of medical school, I struggled to find a specialty that called to me – but once I completed an elective rotation in pathology, I fell in love with the field because it was visual, cerebral, diverse, and challenging.

I have always wanted to become an educator, and I became fascinated with social media as a teaching tool after an interactive presentation on Twitter medical education in one of my MBA classes. Although many of my classmates labeled social media a professional faux pas, I saw immense educational potential through free platforms that offered unlimited information sharing and instantaneous communication with people around the world. I became very active online and started my own personal #MedEd social media accounts, and my first year of residency, I started a pioneer social media #MedEd account for my residency program.

Tell us about your educational tweet…

My mesothelioma flash card is part of a larger series of digital drawings I make to review various diseases and tumors. I sketch them on my iPad because they are easy to edit, organize, and – best of all – share. I tweeted a photo of my notes with the idea that digital flashcards might be a helpful study tool for other residents as well. I did not anticipate the interest that others would have in my sketch, or the overwhelming support of the Twitter pathology community for online trainee medical education!

Creating and sharing my digital notes was a very fulfilling experience not only because it might have helped other trainees, but also because I learned a lot in the process. Some experienced pathologists suggested the addition of new markers that I had not included in my table; others pointed out additional clarifying information about the malignancy. It was a collaborative social and educational experience – all while scrolling!

What is your best advice on educating via social media?

Step away from the PowerPoint! Adapt to your audience and take advantage of new and exciting resources to optimize your educational experience. I love it when I go to a lecture and the lecturer says, “Pull out your phones and tablets! Let’s use a new app to learn today’s subject!” This kind of approach changes passive learning into an interactive experience. I say: don’t be afraid of change. Jump on innovative platforms like livestreaming, videos, chats, applications, and cutting-edge software to keep learning hands-on, visually stimulating, and dynamic.