#Twitter Homework

“When I was younger, we used to index and find these articles by hand,” she said with a hint of disdain, proceeding to explain the fantastical comparative world of PubMed and RefWorks, and the ease with which things are done today. I was sitting in my fortnightly Medical Education Research certificate class. We were all ears, listening to our librarian relay tips and tricks of the trade. The room was teeming with many budding (and some fully bloomed) medical education aficionados. Everyone chuckled.

I remembered my PhD mentor describing how he had done polymerase chain reactions (PCR) using five different water baths, all at varying temperatures, with a rack of tubes that he had to manually move from one bath to the next. His arms flailing, he would emphasize how easy we have it now that a modern thermocycler can easily configure a “simple” PCR and run it automatically. Like magic. There’s no doubt that things are orders of magnitude easier than they once were, and information is much easier to garner.

My mind wandered to my pathology elective students. I felt instantly older thinking about how easy it is for them to learn – million-dollar mannequins, virtual reality simulations, hands-on training, wonderful visuals, the ability to “Google” every word I say, in real-time, as I say it (oh, dear)! Jokes aside, it is an amazing time to be any type of student, but especially a medical student. In my practice, I try my best to relay the tremendous benefit of social media in medical education (or #MedEd) to my students – every chance I get. My residents always hear me say things like “amazing case, definitely tweetable,” and I hear them groan. I persistently pester all trainees not on Twitter about their absence. “When are you going to get a Twitter account? Wouldn’t you like to tweet about this lecture? This case? This department-catered lunch?”

It should come as no surprise, then, that I am getting a reputation for being crazed – at least with regard to adapting social media for teaching. Specifically, the value of Twitter for pathology education. Over the past year or so, I have instituted “Twitter homework” for my pathology elective students. Unlike residents and fellows (over whom I have no actual control), I am the director of the pathology elective – and I delude myself into thinking my medical students listen to me, understanding the benefits I so fervently advertise.

At the beginning of the pathology elective rotation, I ask all of my students to create Twitter accounts, reactivate their old ones, or – in rare cases – continue using their existing active accounts. Students do not have to put their real names or pictures on these accounts if they don’t want to, and they are free to delete the accounts after the rotation is over. Tweeting (so far) is not part of their grade. Their mission is to tweet at least one pathology-related pearl of wisdom every single day. All information, naturally, has to be HIPAA-compliant and appropriate disclaimers about not representing the views of the institution should be in place. Although it hasn’t exactly gone viral, I am proud to say that this project has definitely taken hold – and my students, at least anecdotally, do notice the benefits of #TwitterHomework. It gives me great pride to say that other pathology departments are now starting to notice our hashtag (#PathElective), and some even use it themselves! Isn’t that superb?!

This new pedagogical paradigm is derived from a continuation of the idea that we can, and should, access information immediately – because it’s right there at our fingertips, if only we look. The Twitter pathology community’s hashtags index diseases, criteria, classifications, morphologic appearances, variants, and innovations in diagnostic technique better than any book chapters ever could – and they do it all in real time. Often (especially in the world of molecular pathology), material is outdated by the time it is printed in books. Not only does Twitter index updated information well, it presents it in a highly succinct form – neatly tucked into 280 (formerly 140) characters and enhanced by the ability to add photomicrographs. It is a visual diagnostician’s dream, and it also sits well with our millennial learners, who are used to whizzing from one social media app to another, picking up nuggets of information from many sources at high speed.

If the correct sources are followed, Twitter knowledge is easily accessible at the touch of a button. In many ways, the platform is even more powerful than Google – because, in the world of tweets, one can reach out to the President of a society, a residency or fellowship program director, the head of the Centers for Disease Control, the surgeon general, or even the Secretary of Health and Human Services for the entire United States!

My students are required to tweet one thing every day. It has to be indexed with the #PathElective hashtag, and they have to mention my Twitter handle, @kmirza. Nothing else is mandatory, but it helps if they also hashtag #TwitterHomework and mention our department, @loyolapathology. This can be overwhelming to students who have never tried their hand at Twitter (and don’t have a lot of experience turning information into tiny sound bites). I get it; when I first began, it took me days to come up with something I felt was smart enough to tweet. Thus, students have the option of simply retweeting something pathology-related that they find interesting. However, they can also up the ante by composing an original tweet related to their day, documenting what they did, or sharing any tidbit of pathology-related information they learned. In a very short time, I have seen some amazing gems come from these students; some have written tweets that are retweeted several dozen times. Just last week, one of my spectacular #PathElective students, Olivia (an aspiring ENT clinician who tweets under the brilliant handle @otolaryngolivia) was re-tweeted by the President of the UK’s Royal Society of Pathology! Isn’t that wonderful? These fantastic medical students have tweeted microbiology identification algorithms, blood bank tests (on their own blood!), molecular algorithms in oncologic testing, the physics behind chemistry analyzers, the history of Auer rods, links to amazing literature from all walks of medicine, pictures of them grossing de-identified organs, and beautifully captured images of the histologic stains they are seeing under the microscope every day. Imagine the pleasure experienced pathologists gain from seeing the next generation begin to explore their world – and imagine the enthusiasm the general public sees radiating from the all-too-quiet discipline of pathology!

What I learned early on in my own Twitter experience is that distilling something down to the correct number of characters really makes you think about what you want to say. This cerebral act, I would argue, makes the pearl of information real and easily memorized. A factoid that not only goes out into the Twittersphere, but remains with my students for the long term. If a student goes into a lecture thinking, “Can I get a good tweet out of this?” then trust me when I tell you they will be paying attention to find that tweet.

Fringe benefits that I didn’t even recognize when I started #PathElective include my ability to monitor what my students are learning on a day-to-day basis, even when they aren’t rotating with me. This helps me individualize the program a bit more, so that I can make sure they are achieving both their goals and the objectives of our rotation at the same time.

The threads generated by these tweets can be fascinating. To make my point, while writing this narrative, I went to Twitter and looked up the #hemepath hashtag. The first tweet was a beautiful image of a common finding in the peripheral blood – although familiar, the images were superlative! The second tweet had images of an extremely tough case with a broad differential diagnosis. Possible answers were discussed in extensive threads that explored nuances to appeal to pathology learners at every level. The third was a tweet about the immunostaining pattern of an extremely rare tumor, and the fourth was a “zebra” diagnosis (something no one would have thought of) in a lymph node. It took me perhaps one full minute to skim through these tweets… and in that minute, I learned some amazing things. Better yet, because of Twitter’s character limit, these educational points were all succinct, to-the-point, and well-articulated. The scenarios are never-ending: a student tweets, an attending replies and retweets, thousands of pathologists see the discussion (if the correct hashtags were used), and you expand your knowledge base a millionfold, because you opened it up to the entire world. True, the same could happen in any subject with engaged users – but it works exceptionally well in more visual careers like pathology and radiology.

The benefits of social media in education have been discussed and published at length. So have its benefits in publicizing pathology as a discipline; leveraging social media is now undoubtedly a key strategy in letting the world know who we are. But its innovation, up-to-date information, global education, critical evaluation, extensive outreach, and instant gratification all lend Twitter homework pedagogical benefits for zennials and millennials alike. It behooves pathology educators to fold some social media use into our teaching. Try it – I assure you that you won’t regret it.