April 26, 2014 by 

Everyone agrees that doctors should be informed and up-to-date. Perpetual medical education has always been a vital component of doctoring. But now, as the rapid pace of healthcare innovation pushes against the limits of biology, and really, our humanity, medical education gains even more importance. Doctors (and patients) must know what can and cannot be accomplished. We must know the evidence. And these days, evidence pours in.

Doctors are essentially teachers, and thus, a central question in medical education parallels that in regular education: What is the best means for teaching the teachers?

I’ve written before that disruption in med-ed is coming soon, via social media. It seems like a bold statement, but then there is Sal Kahn and Dr. Mike Evans.

I recently came across a blog post in the British Medical Journal that validates my thesis: Social media is indeed a new brand of medical education.


Currently, there are two legacy models of medical education, and both have come under intense, and in my opinion, deserved, criticism. The CME (or continuing medical education) model has taken criticism for its conflicts of interest with industry. These are legitimate concerns, and examples of folly abound. Look no further than dronedarone. An argument can be made that a major deficit in today’s model of medical information transfer comes in the form of irrational exuberance from conflicted sources–e.g. marketing hype. The good news is that industry influence of CME is decreasing. The bad news is not all industry-supported CME was bad.

The second major model of medical education is the board certification process. Here, we have a case study in monopoly. The American Board of Internal Medicine (ABIM), in alliance with major professional organizations, has long controlled the lucrative market of certifying doctors. Being “board-certified” used to entail passing a multiple choice test every ten years. It was a rigorous test that required significant prep work and oodles of memorization–the latter being a dubious exercise in the smartphone era. That said, it was hard to fuss too much about a once-decade review. Recently, the ABIM has upped the ante, and front-line doctors must now comply with onerous, untested and expensive two-year “Maintenance of Certification” intrusions. The overreach is breathtaking, and criticism from doctors has been robust. Even I, a test proponent and Choosing Wisely disciple, called the foul.

The disruption:

Dr.Ryan Radecki is an assistant professor in Emergency Medicine and a “clinical Informatician.” He writes in the BMJ about the revolution in the transfer of medical knowledge. His example centers on the FOAM movement. FOAM stands for Free Open Access Meducation – Medical education for anyone, anywhere, anytime.

This from the Life in the Fast Lane Blog:

FOAM is the movement that has spontaneously emerged from the exploding collection of constantly evolving, collaborative and interactive open access medical education resources being distributed on the web with one objective — to make the world a better place. FOAM is independent of platform or media — it includes blogs, podcasts, tweets, Google hangouts, online videos, text documents, photographs, Facebook groups, and a whole lot more.

FOAM should not be seen as a teaching philosophy or strategy, but rather as a globally accessible crowd-sourced educational adjunct providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles.

Ok. I know what you may be thinking: that all sounds nice but how does it educate doctors?

Here’s the example. Radecki uses recent data on cooling (therapeutic hypothermia–in medical-speak) patients after cardiac arrest. He describes a Global Journal Club series featuring an online FOAM discussion of recent publications regarding therapeutic hypothermia.

He writes, “within a handful of days of publication, no fewer than 18 experts in emergency medicine and resuscitation had provided commentary, whether through blog posts or podcasts.”

I’ve looked at these free posts. I read a few on my laptop, others on my smartphone. I saved two of the better ones on Evernote. Yes, it’s true that not all of the 18 posts are perfect. But the bottom line is that I now have a great handle on the issue. I’m informed and educated. I also can’t emphasize enough how nice it was to read real language rather than journal-speak.

Perhaps the most notable facet of this new brand of knowledge transfer is its democracy. There are no paywalls; patients get access too. Let’s emphasize the value of patients learning alongside caregivers. This democracy of knowledge is vital. For instance, do you think we would have the current humanitarian crisis in futile end-of-life care if patients were aptly informed? Do you think we’d have droves of kids on brain stimulants if all parties were educated on the actual data–and long-term risks? You can fill in many other examples.

Challenges remain:

I’m not suggesting doctors take to Twitter and Facebook for all their medical information. But…Aglobal journal club? Reflect on that for a moment. And this: 18 posts from motivated learners on one medical topic. That’s a lot of (free) transfer of knowledge.

An often cited challenge comes in the vetting of information. Skeptics of social media and the Internet have asked me how one knows the truth. Their bias, of course, is that prose written in peer-reviewed journals is accurate and free of conflict. That’s a laughable bias these days.

Make no mistake, I don’t aim to bash medical journals or journal editors. Peer-reviewed science is the engine of medical progress. That’s the point.

Done well, social media, and the conversation it induces, the learners it inspires, the skepticism it allows, can be the megaphone that broadcasts the results of the scientific method. This is key. For it is in knowing the absolute benefits and risks and expectations of treatments that lead to the best medical decisions.

Times are changing. It’s a fun time to be a learner.


This post first appeared on his website. Dr. Mandrola is a cardiologist who specializes in heart rhythm disorders. He writes about doctoring and cycling at and is a regular columnist at
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