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Using Social Media to Promote <br />Evidence-Based Practice:<br />A Primer on Blogs, Wikis & Twitter<br />Cochrane Canada 9th Annual Symposium <br />February 16-17, 2011<br />Vancouver, British Columbia<br />Canada<br />Presenters:<br />Dean Giustini (@giustini)<br />Francisco J. Grajales III (@ciscogiii)<br />Daniel Hooker (@danhooker)<br /> Using Social Media to Promote Evidence-Based Practice: <br />A Primer on Blogs, Wikis & Twitter<br />Cochrane Canada Symposium, February 16-17, 2011 <br />Dean Giustini, Francisco Grajales III & Daniel Hooker<br />Table of ContentsPage<br />Introduction2-3Cochrane Canada Workshop Agenda<br />Introduction to learning materials <br />Methodologies used to create workshop<br /> <br />What is social media?4-5<br />Definition(s)<br />Social media in health<br />Blogs, wikis & Twitter 6-11<br />Definition(s), background, aims<br />Mapping social media12-13<br />Mapping Social Media<br />Map social media to your needs<br />Video – discussion in groups, report back14<br />Social media frameworks15-17<br />The POST Method <br />Develop an implementation plan<br />Using social media: Tips and best practices<br />Appendices18-24<br />Appendix A: Annotated bibliography<br />Appendix B: Other relevant literature<br />Appendix C: Author contact information<br />All learning objects from this workshop are available from:<br />http://hlwiki.slais.ubc.ca/index.php/Using_Social_Media_to_Promote_Evidence-Based_Practice<br />Workshop Agenda<br />DurationSectionContentPedagogical Rationale10 minutesIntroductionOverview of presenters learning objects & agendaLearners like a roadmap; adult learners like to see a learning plan15 minutesPresentation:Primer on blogs, wikis & TwitterDefinitions of blogs, wikis, Twitter (e.g., sharing, collaboration, networking)Some examples of how tools are used in evidence-based medicineTo provide some common vocabulary for learning during workshop10 - 15minutesViewing:YouTube videoSmall group discussion:Questions | reactionsFacilitated discussionImportance of Social Media in Medicine“…evidence-based medicine does not always answer all the questions we have.”Trigger ideasUsing social media for evidence-based practice15minutesGroup reports:Q & AIn-class with Cochrane delegates | participants Share your understandingRecognize relevance to your own workBuild your knowledgeTimepermittingDiscussionPOST Method -- People, Objectives, Strategy and TechnologiesFramework for social media Feedback essential in evidence-based teaching5minutesEvaluationQuestionnaire<br />Introduction<br />Cochrane Canada Workshop Overview <br />Background <br />This workshop provides an overview of three popular social media tools: blogs, wikis and microblogging (e.g., Twitter, Yammer). The authors will show where to locate medical blogs and wikis on the social web and the type of information that can be found there to support evidence-based practice. Through a mix of didactic lecture, hands-on practice and group discussion, this workshop provides an entry point for social media beginners.<br />Learning Objectives <br />At the end of the workshop, participants will:<br />Understand blog, wiki and microblogging tools and how they are used in medicine<br />Have some basic knowledge of how to select one of the social tools examined to support evidence-based practice and medical education<br />Identify major blogging and wiki platforms to create accounts, content and social networks<br />Be able to assess issues of privacy on various social media platforms<br />Contextualize workshop information for personal use in practice, research and continuing education<br />Methodology <br />The presenters conducted a thorough review of the literature (see appendices)<br />We reviewed previous Cochrane workshops regarding social media<br />Identified the best practices for blogs, wikis, and microblogs from our personal experience, expert opinion, and peer-reviewed literature<br />Engaged experts through e-mail, Twitter, blogs & on social networks<br />Received feedback from experts to identify most important content<br />The workshop is a result of that review, discussion and planning <br />What is evidence-based practice?<br />“'Evidence-based practice (EBP)' is... a documented, reproducible process of <br />systematically reviewing, appraising and using clinical research to aid <br />in decision-making and the optimum delivery of patient clinical care...”<br />What is social media?<br />"...social media or web 2.0 is the use of digital media, via desktop, mobile and all interconnected devices, for collaborating, to create user-generated content and form self organizing communities. Typical aspects of social media include the ability to:<br />Create personal profiles<br />“Friend” or follow other people<br />Create content in the form of text, photos, audio, or video and<br />Share, tag, rate, comment on, or vote on content created by others. <br />“…social media refers to tools that enable collaboration, two-way interaction and sharing – also known as web 2.0 services that contain text, images, audio and video… popular types of social media include blogs, wikis, Twitter and …?”<br />The Power of “10”<br /> <br />Location-basedmediaVirtual WorldsRating services<br />Image: <br />http://www.socialmediaonline.com/the-power-and-value-of-social-networking/<br />Social media resources at the Cochrane Collaboration<br />http://www.cochrane.org/about-us/evidence-based-health-care/webliography/web<br />Ways social media is used in health<br />Social media tools are the subject of medical and health research in the following areas:<br />Recruitment for clinical trials<br />Professional development and training <br />Inter-professional communication and collaboration<br />Medical procedure, biopsy and other training simulations<br />Illness support groups; health advocacy <br />Development of interactive, self-management tools for the improvement of chronic conditions (e.g. smoking cessations, weight loss, diabetes)<br />Raising public health awareness (e.g., vaccines, H1N1)<br />Infectious disease monitoring / i.e. flu tracking<br />Did you know?<br />The Cochrane Library is best place to find up-to-date evidence-based systematic reviews: http://thecochranelibrary.com<br />AND<br />The Cochrane Library has a Twitter feed:<br />http://twitter.com/CochraneLibrary<br />Patients participate in improving access to evidence via The Cochrane Consumer Network<br />http://www.cochrane.org/consumers/about.htm<br />AND<br />The Cochrane Consumer Network has a Twitter feed:<br />http://twitter.com/CochranConsumer<br />Blogs<br />Definition: A blog (short for “weblog”) is a free, easy to publish, website where authors share information, ideas and media in a sequential or chronological order. Blogs may be authored by one or more writers and provide forums for conversation, debate and reflective practice.<br />Key characteristics:<br />Often open and free to access<br />Facilitate two-way interaction (e.g., allow visitors to leave comments)<br />Published and syndicated using Really Simple Syndication (RSS)<br />RSS feeds are collected and displayed using tools like Google Reader and Bloglines<br /> <br />RSS Feed symbol<br />Background: The modern blog evolved from online diaries in the 1990s where users kept accounts of their personal lives. Early bloggers were called online diarists, journalists and even journalers. Blogs are rich in web links and provide photos, video, sound, slide presentations, PDFs and animations. Two popular blogging platforms include Blogger and WordPress. <br />A recent (peer-reviewed) article on a survey of medical bloggers noted:<br />“Medical bloggers are highly educated and devoted writers, faithful to their sources and readers. Sharing practical knowledge and skills as well as influencing how people think are major motivators for bloggers. Medical bloggers frequently pick up new stories from the mainstream media… [and, as a result] influence medical and health policy” (Kovic, 2008).<br />Top Fifty (50) Health and Medical Bloggers 2011 http://hlwiki.slais.ubc.ca/index.php/Top_Health_%26_Medical_Bloggers_2011<br />Aims: Individual blogs serve to improve communication, foster discussion and reflection between actors in healthcare systems (e.g., doctors, allied care providers, and patients). They are commonly used in (continuing) medical and health education. <br />Challenges: Two major barriers in blogging stem from large numbers of blogs and bloggers, and the challenges of verifying a blogger's identity. Some medical bloggers say that there has been a drop in blogging interest due to hybrid blogging and social networking tools like Twitter.<br />Ethical issues: The quality of information on blogs is diverse and linked to authors and their reputation on the health blogosphere. Two not-for-profit groups - The Health on the Net Foundation and The Healthcare Blogger Code of Ethics - foster ethical conduct and high quality information. Both “endorse” bloggers through an electronic ribbon system as criteria are met by the blog. The ribbons are subsequently embedded into the blog by its authors.<br />http://reader.google.com<br />Further reading<br />BMJ Blogs. http://blogs.bmj.com/<br />Better Health. http://www.getbetterhealth.com/<br />Cochrane Collaboration. Web 2.0 (social media) resources: Blogs. http://www.cochrane.org/about-us/evidence-based-health-care/webliography/web<br />Giustini, D. Top Health and Medical Bloggers 2011. http://hlwiki.slais.ubc.ca/index.php/Top_Health_%26_Medical_Bloggers_2011<br />Grand Rounds (A summary of the best blog posts for the week) - http://getbetterhealth.com/grand-rounds/<br />Kovic I, Lulic I, Brumini G. Examining the medical blogosphere: An online survey of medical bloggers. J Med Internet Res. 2008. http://www.jmir.org/2008/3/e28/<br />Mesko B. How to create and manage a medical blog. http://www.webicina.com/how-to-create-and-manage-a-medical-blog/inside-the-medical-blogosphere/<br />Wikis<br />Definition: A wiki is a website where content can be quickly and easily edited. They are used to support collaboration and feature multimedia such as slides, photographs and video. Some wikis allow anyone to edit but others are password-protected. The openness and accessibility of wikis make them somewhat controversial due to open editorial policies and weak safeguards. <br />Also, a wiki is:<br />…a collaborative web site where each visitor can participate in the editorial content…<br />Background: The best-known wiki is Wikipedia which has ~3.5 million articles in English. Since 2005, several wikis have emerged in medicine such as Ask Dr Wiki, Ganfyd (UK), Medpedia (US). <br />http://www.medpedia.com/<br />Key characteristics of wikis:<br />Open; collaborative; simple; dynamic<br />A ‘living document’; something of value; to share knowledge, research and lists of links<br />Some knowledge of simple mark-up language required for creation of online documents<br />No knowledge of HTML is needed. Some simple coding may be necessary to format pages but visual editors are now often used.<br />Aims:<br />Training, conferences, education, group authoring, peer-review, etc.<br />In evidence-based teams, wikis can be used to centralize information, create communal knowledge and provide opportunities to do team building and knowledge-creation, etc.<br />Wikis provide an environment where communities of learning and practice can be developed and so that researchers can share ideas and peer-review manuscripts<br />Wikis are used for note-taking at meetings, journal clubs and discussion groups<br />Challenges:<br />“...training is required to make people comfortable when using wikis; collaborators or teams should be given incentives of some kind to contribute.” HLWIKI Canada<br />“...the very process of collaboration [on wikis] leads to a Darwinian type 'survival of the fittest' [and] these resources can be assured through careful monitoring... Empirical research is needed [however] to build our pedagogic evidence base about these tools in the context of medical/health education” (Kamel Boulos, 2006)<br />http://hlwiki.ca/<br />Key sites and platforms:<br />Ask Dr Wiki (US), Ganfyd (UK), Medpedia(US), MedSkills wiki project (Europe)<br />Mediawiki – locally-hosted, Wikipedia-like<br />Wikispaces & PBworks – in the cloud (no local maintenance of software)<br />Further reading:<br />Kamel Boulos MN, Maramba I, Wheeler, S. Wikis, blogs and podcasts: a new generation of web-based tools for collaborative practice and education. BMC Med Ed. 2006;41.<br />Kardong-Edgren SE, Oermann MH, Ha Y, et al. Using a wiki in nursing education and research. Int J Nurs Educ Scholarsh. 2009;6(2):1-10.<br />Mirk SM, Burkiewicz JS, Komperda KE. Student perception of a wiki in a pharmacy elective course. Curr Pharm Teach Learn. 2010;2(2):72-8.<br />Murray S, Giustini D, Loubani T, Choi S, Palepu A. Medical research and social media: Can wikis be used as a publishing platform in medicine. Open Medicine. 2009;3:121–2.<br />Varga-Atkins T, Dangerfield P. Developing professionalism through the use of wikis: a study with first-year undergraduate medical students. Med Teach. 2010;32: 824-9.<br />Younger P. Using wikis as an online health info source. Nurs Stand. 2010;24(36):49-56.<br />Zickuhr K, Rainie L. Wikipedia, past and present. Pew Internet & American Life Project. January 2011. http://pewinternet.org/~/media//Files/Reports/2011/PIP_Wikipedia.pdf<br />Twitter<br />Definition: Twitter is a “microblogging” (“tiny” blog) service that allows networks of users to send short updates to each other in less than 140 characters. Initially used as a way for friends to share personal information, Twitter is now a global platform for information dissemination, social networking and real-time communication.<br />Background: Launched in 2007 as a tool for personal updates shared by cell phone, Twitter has expanded in popularity due to its simple way to connect with others. Twitter has an estimated 190 million users, generating 65 million tweets a day and more than 24 billion search queries per month. Today, Twitter allows for updates to be sent using SMS but has expanded to include software for the Web as well as smartphones (e.g. iPhone, Android, Blackberry). <br />Key characteristics of Twitter:<br />Platform for sharing short updates called “tweets” of less than 140 characters <br />Tweets often include links (URLs) or “mentions” of other Twitter users<br />Personalized profiles include updates from people you choose to “follow”<br />By including a topic keyword preceded by a ‘#’, users can find and track only those tweets related to a specific topic (e.g. #ehealth) or event (e.g. #ccsymp11)<br />All tweets are public by default (i.e. users can follow you) but can also be made private <br />Uses:<br />Sharing links and opinions about news/literature (e.g. blog posts, literature) <br />Short conversations with other users and sharing of personal/professional opinions and expertise. (“Don’t underestimate this platform”)<br />Collecting a broad view of current news and important events in real-time <br />Challenges:<br />Detailed conversations and debate are difficult in 140 characters <br />Tweets are meant for consumption by the public; some may be uncomfortable with the “broadcast” nature of Twitter<br />Spam and fake accounts are common. Requires proactive maintenance of your followers<br />Recommended Twitter users in health:<br />@Berci: Medical doctor, founder of Webicina.com, health 2.0 consultant, blogger, Second Life resident, Wikipedia administrator doing PhD in genetics<br />@cochranecollab: Cochrane Collaboration: working together to provide best evidence <br />@DrVes: Assistant Professor at University of Chicago, Allergist/Immunologist, Internist Former Cleveland Clinic Assistant Professor and NEJM Advisory Panel Member<br />@laikas: Medical Librarian, scientist, mom, wife and human<br />Build your Twitter network http://wefollow.com/twitter/medicine<br />Recommended hashtags:<br />A hashtag is a commonly used way to index or “tag” conversations to find relevant information on Twitter with ease.<br />#ccsymp11: Cochrane Canada Symposium, 2011<br />#hcsm: “Healthcare communication and social media”<br />#hcsmca: Healthcare communication and social media in Canada<br />#med2: Medicine 2.0<br />Other hashtags to explore: #ehealth, #healthlit, #pharma<br />Further reading:<br />Baumann P. 140 Health Care Uses For Twitter. http://www.slideshare.net/philbaumann/140-health-care-uses-for-twitter-presentation <br />Chew C, Eysenbach G. Pandemics in the age of Twitter: content analysis of tweets during the 2009 H1N1 outbreak. PLoS One. 2010;5(11):e14118.<br />Cunningham AM. What I have learnt about Twitter [blog post]. 2011 Jan 23. http://wishfulthinkinginmedicaleducation.blogspot.com/2011/01/what-i-have-learnt-about-twitter.html <br />Hawn C. Take two aspirin and tweet me in the morning: how Twitter, Facebook and other social media are reshaping health care. Health Aff. 2009;28(2):361-368.<br />Mandavilli A. Peer review: trial by Twitter. Nature. 2011;469(7330):286-7.<br />Mapping Social Media<br /> PAGE * MERGEFORMAT 12Viewing (Passive)Contributing (Active)ContentFocusPeopleFocusWikisBlogsSocialNetworkinge.g. Twitter & FacebookDonald H Taylor 2009Giustini, Grajales, Hooker | Cochrane Canada Symposium Workshop 2011 PAGE * MERGEFORMAT 12<br />Map social media to your needs<br />Social media allows you to:<br />Find more useful, accurate information – to deal with information overload<br />Share ‘real-time’ information and evidence <br />Create shared value (esp. wikis) <br />Exchange information in “small, bite-sized” sections “on-the-go” / via mobile device <br />Engage in daily, informal learning "spaced education" <br />Create social networking opportunities; social filtering is very valuable <br />Do some work in knowledge translation; knowledge management<br />Share informal feedback and ideas for ‘peer review’ <br />Move towards digital “communities of practice” <br />Extend interventions beyond reach of traditional healthcare <br />Contribute to evidence-based web 2.0 <br />See differences between social media (and other forms of communication medium/message) <br />Evaluate the technologies & literacies of using these tools<br />Use a simple model for learning the new communication medium; to be advanced in a new medium, the culture of the language will influence how you think <br />Write a blog for a year and see how your writing (and thinking) changes <br />Use Twitter for a time to get a sense of being connected but understanding your network on different levels <br />See patterns emerge on the social web over time<br />Make connections with people to form a network by connecting to existing relationships or by creating new relationships <br />See how digital spaces are different and how they influence your identity <br />Experiment with the new language of social media <br />Will you create a ‘roadmap’ for your use of social media?<br />Small Group Discussions<br />The Importance of Social Media in Medicine <br />http://www.youtube.com/watch?v=T0w9yIc76zo<br />“Evidence-based medicine does not always answer all the questions we have…” <br />Dr. Scott Strayer<br />1. What is your opinion of the video? <br />And, Dr. Stryer’s views of social media?<br />2. Can social media be used to boost productivity? <br />How might it support learning / build communities of practice?<br />3. What are the benefits and harms of social media use?<br />What concerns you most about using social media? <br />Social media framework:<br />The POST Method<br />POST stands is an acronym that stands for People, Objectives, Strategy and Technologies<br />POST is a good way to define your objectives and priorities in using social media. By identifying parts of your personal social media strategy, you can clarify a clearer vision and purpose for your use of social media. By having appropriate goals, strategies and tools, you are more likely to have a positive experience using social media as a health researcher.<br />P is for People<br />Who are the people you want in your network? Imagine you were entering health and want to build a network of contacts. You have many choices about who to get to know, which organizations to join, and which meetings to attend. Do you want mentors, colleagues, strategic partners, researchers, physicians or other health providers? <br />O is Objectives<br />What are your primary objectives for using social media? Your objectives must be clearly formulated. Your objectives can be to support existing research, networking and communication with collaborators, introducing a new project, etc.<br />S is Strategy<br />What social media strategy will you use? How will you find and create content to share with your network? Are you trying to improve communication between research team members or are you looking to advertise a product? Is your organization in an exploratory phase? Or are you ready to establish guidelines or writing a policy for your employees?<br />T is Technology<br />What technologies will you use? Many tools are chosen depending on the goals of the user. Will you have a blog and a Twitter profile? Will you explore LinkedIn and Facebook, or start a wiki? Consider your People, Objectives and Strategy to select the tool(s) that suit your needs.<br />BONUS: M is for Method<br />Advanced users may consider adding an “M” to POST for METHOD or MEASUREMENT. Will you track your social media use? Metrics, analytics and influence tools like Klout can be useful to gather information on how people are interacting with your social media profiles.<br />POST Method<br />Implementation Plan<br />Social media project _____________________________________________________________<br />Organization | Department _______________________________________________________<br />Implementation Date ____________________________________________________________<br />(P) – People<br />With whom do you want to communicate? Who will be reading and commenting on your social media? Who are you trying to engage?<br />(O) – Objectives (or purpose)<br />Why do you want to establish a digital presence? What do you want to accomplish? What do you plan to achieve with this social tool? Inform? Encourage dialogue? Share information? What kind of information? How will this differ from your primary Web site? <br />(S) – Strategy<br />How will you ensure your strategy will be successful?<br />(T) – Technology (tools)<br />Which social media tool will you use?<br />(M) – Methods <br />Who will manage and maintain your accounts? Who will be your administrator? <br />How will you measure success? What metrics will you use?<br />How often will the tools you selected be updated? (Depending on type of tool, updates may be expected frequently.) <br />How will you promote your social media presence? <br />How will you make connection to your official web sites? <br />Using Social Media: Tips and Best Practices<br />Ask yourself: who is your audience? Who do you want in your network?<br />How much interaction do you want? A little, once in a while, every day?<br />Do you want a local, national or international reach in your network?<br />Do you want synchronous or asynchronous contact? Or a mix?<br />Find out whether the learning curve with social media is sharp and find a buddy <br />Do you want to start a blog? A wiki? How much upkeep is required? <br />Select your social media tools based on your needs, or needs of your organization<br />Start (and keep) it simple<br />Start with reading some of the literature<br />Start following a few blogs<br />Start with basic activities and test the digital space(s)<br />Be yourself<br />Be honest about who you are, your knowledge, your limitations – earn others’ respect<br />Own up to any social networking gaffes<br />Do not use pseudonyms or false identities<br />Ensure that you are familiar your privacy settings<br />Not much different than email, or conversations face-to-face!<br />Participate and share<br />Networks are built on trust and reciprocity<br />Others want to hear from you! Be willing to contribute to the conversation<br />Connect with any people you know first, and ask them how to get started<br />Keep up to your network<br />Know what people in your network are saying, and what they might want<br />Let people know what you think<br />Share (or re-share) something new or exciting a few times a week<br />Choose what tools you want to use<br />Find tools and approaches that fit for you and that you enjoy<br />Use the POST method or devise your own framework<br />Keep in mind many tools (Blogs, Wikis and Twitter) can work together<br />Appendix A: Annotated bibliography<br />While there is considerable interest in using social media for evidence-based practice, the research evaluating its utility is lacking. Some studies examine social media in adopting more efficient information and management behaviours but the research tends to focus on surveys of medical school students, content analysis and the use of various social tools and platforms. The emphasis is mostly on the most popular tools such as YouTube, Twitter and Facebook.<br />Black EW, Thompson LA, Duff WP. Revisiting social network utilization by physicians-in-training. Journal of Graduate Medical Education. June 2010;2(2):289-293. <br />This study measures the use of social networking among medical students and residents (2007 and 2009). It evaluated Facebook profiles for 2 cohorts of medical students (n = 528) and residents (n = 712) at the University of Florida in Gainesville. Measures included existence of profiles, whether they were private or contained identifiable information. Subjective outcomes included photographic content, affiliated groups and personal information not usually disclosed in doctor-patient encounters. Social networking is common among physicians-in-training with 39.8% of residents and 69.5% of medical students maintaining Facebook pages. Residents' participation significantly increased (P < .01) when compared to 2007 data. 2009 cohort had more “friends” (P < .01), belonged to more “groups” (P < .01), and were more likely to limit public access to profiles through privacy settings (P < .01) than 2007 cohort. <br />Buyl R, Nyssen M. MedSkills: a learning environment for evidence-based medical skills. Methods of Information in Medicine. 2010;49(4):390-5. Epub 2010 Apr 20. <br />In 2004, the University of Brussels initiated a wiki project called MedSkills to create copyright-free reference work of evidence-based information on medical skills for all levels of healthcare professionals (paramedics, nurses and physicians, teachers of medical skills and students). The wiki framework suits different users in ‘cellular’, ‘organ’, ‘body’ and ‘best treatment’ maps. <br />Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011;305(6):566-568.<br />This study describes how physicians use Twitter, with a specific focus on professionalism. Descriptive characteristics were extracted from pages of self-identified physicians with 500 or more followers in May 2010. Content analysis of 5156 tweets was performed using users’ most recent tweets at time of data extraction. Three authors coded tweets, iteratively refining the coding until κ > 0.78 for all categories or interrater agreement was 100%. One hundred forty-four tweets (3%) were categorized as unprofessional. Thirty-eight tweets (0.7%) represented privacy violations, 33 (0.6%) contained profanity, 14 (0.3%) included sexually explicit material, and 4 (0.1%) included discriminatory statements. <br />Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA. 2009 Sep 23;302(12):1309-15. <br />This paper examines the content postings by medical school students using a survey methodology. Sixty percent of US medical schools responded (78/130) to the survey; 60% (47/78) reported incidents of students posting unprofessional content. Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were reported. 45 schools reported incidents and responded to disciplinary actions; 30 gave informal warnings (67%) and 3 reported student dismissals (7%). <br />Fischer MA, Haley HL, Saarinen CL, Chretien KC. Comparison of blogged and written reflections in two medicine clerkships. Med Educ. 2011 Feb;45(2):166-75. <br />Internal medicine clerks at two US medical schools in 2008-2009 were randomly assigned to two study arms and asked to write either a reflective essay and join in faculty-moderated small-groups (n = 45) or do two blogposts for faculty-moderated discussion (n = 50). Student writing was coded for themes and levels of reflection by two blinded authors; coding reached inter-rater reliability of 91% and 80%. Students addressed seven themes: (i) being humanistic (ii) professional behaviour (iii) understanding caregiving relationships (iv) being a student (v) clinical learning (vi) dealing with death and dying and (vii) the health system, quality, safety and public health. Level of reflection did not differ between study arms. Post-clerk surveys showed student preferences for the method they had used in study. This study suggests no significant difference in levels of reflection achieved when students complete similar assignment on blogs versus traditional essays. Faculty should be comfortable using blogs for reflective exercises.<br />Garner J, O'Sullivan H. Facebook and the professional behaviours of undergraduate medical students. Clin Teach. 2010 Jun;7(2):112-5. <br />A voluntary anonymous online survey was devised by the University of Liverpool and emailed to medical students about their use of Facebook, privacy settings and their professional behaviours. A majority had Facebook accounts and saw photos they found embarrassing. The response rate was 31%; half of respondents reported they had seen unprofessional behaviour by colleagues on Facebook. Students said they were aware of UK's General Medical Council (GMC) guidance on professional behaviours. The study highlights the issues for medical students who use social media. Guidance is needed to help navigate social media. <br />Gray K, Annabell L, Kennedy G. Medical students’ use of Facebook to support learning: Insights from four case studies. Medical Teacher. 2010;32:12:971-976. <br />University students are active in supporting their learning with Facebook. This study aimed to see how it was used by 759 medical students in four study groups. 25.5% reported using Facebook for educational purposes and 50.0% said they were open to doing so. Technological affordances and group dynamics are major factors in contributing to the successful use of Facebook by medical students and educators.<br />Hughes B. Joshi I. Lemonde H. Wareham J. Junior physician's use of web 2.0 for information seeking and medical education: a qualitative study. International Journal of Medical Informatics. 78(10):645-55, 2009 Oct. <br />With no detailed research describing how Web 2.0 influences physicians' daily practices, this JAMA study examines web 2.0 use by 35 junior physicians in clinical settings. Diaries and interviews encompassing 177 days of internet use or 444 search incidents were analyzed via thematic analysis. Internet visits employed user-generated, and Google and Wikipedia are used by 80% and 70% of physicians. Web 2.0 represents a departure from previous learning and decision processes. There are concerns with risks of poor quality information. Three alternative policy options are identified to manage this risk and improve efficiency. <br />Kind T, Genrich G, Sodhi A, Chretien KC. Social media policies at US medical schools. Med Educ Online. 2010 Sep 15;15. <br />The websites of 132 accredited US medical schools were assessed by two investigators for their presence on Facebook and Twitter. 100% (n=132) of US medical schools who had websites 95.45% (126/132) had a Facebook presence. 25.76% (34/132) had official pages on FB, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups. 10.6% of medical schools (14/132) had Twitter accounts. 128 medical schools (96.97%) had student guidelines or policies. 13 of 128 schools (10.16%) had guidelines/policies for social media usage. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible. 53.85% (7/13) encouraged thoughtful and responsible social media use.<br />Landman MP. Guidelines for maintaining a professional compass in the era of social networking. J Surg Educ. 2010 Nov-Dec;67(6):381-6. Epub 2010 Nov 5. <br />This paper discusses the use of Facebook among 88 residents and 127 faculty; 56 (64%) and 28 (22%) have Facebook pages; 50% are publicly-accessible; 31% of publicly-accessible pages contain work-related comments and 14% reference specific patient situations or were related to patient care. Social media guidelines consistent with the Accreditation Council for Graduate Medical Education and the American College of Surgeons are recommended.<br />McGee JB, Begg M. What medical educators need to know about “web 2.0.” Med Teach. 2008; 30:164–169.<br />"Web 2.0" describes a collection of technologies where users participate in content creation and open collaboration as members of communities of practice. Students in medical school use web 2.0 sites such as Facebook and MySpace. Medical educators and designers of software can benefit from understanding web 2.0 concepts. Health schools are experimenting with wikis, blogs and other applications and have identified both advantages and disadvantages. This paper reviews the features of web 2.0 and addresses questions about potential pitfalls.<br />MacDonald J, Sohn S, Ellis P. Privacy, professionalism and Facebook: a dilemma for young doctors. Medical Education. 2010;44:805–813. <br />This cross-sectional survey looks at Facebook use by medical graduates. Subjects were 338 doctors. A total of 220 (65%) graduates had Facebook accounts; 138 (63%) of these had activated privacy options, restricting information to ‘Friends’. Of the remaining 82, 30 (37%) revealed users’ sexual orientation, 13 (16%) revealed religious views, 35 (43%) indicated relationship status, 38 (46%) showed photographs of the users drinking alcohol, eight (10%) showed images of users intoxicated and 37 (45%) showed photographs of users engaged in healthy behaviours. A total of 54 (66%) members had used their accounts within the last week, indicating active use. Young doctors are active in Facebook; 25% of doctors in the survey did not use privacy options, rendering information they reveal available to the public. <br />Moubarak G et al. Facebook activity of residents and fellows and its impact on the doctor–patient relationship. J Med Ethics. 2011 Feb;37(2):101-4. Epub 2010 Dec 15. <br />An anonymous questionnaire was emailed to 405 residents at Rouen University Hospital in 2009. 202 questionnaires were returned (50%); 147 (73%) had Facebook profiles; 138 (99%) displayed their real names, 136 (97%) birthdates, 128 (91%) personal photos, 83 (59%) current university and 76 (55%) positions. Default privacy settings were changed by 61%, more frequently if they were registered for >1 year (p=0.02). If patients requested them as a ‘friend’, 152 (85%) participants would automatically decline requests. 88 participants (48%) believed the doctor–patient relationship is altered when patients see their doctors have Facebook.<br />Rietmeijer CA, McFarlane M. Web 2.0 and beyond: risks for sexually transmitted infections and opportunities for prevention. Curr Opin Infect Dis. 2009 Feb;22(1):67-71.<br />This paper reviews available web 2.0 tools to help patients understand the risks associated with STDs. It looks at the internet as a risk environment as well as a venue for public health interventions. Its potential is “untapped and providers for services lag behind their target audiences in the creative and innovative uses of new media.”<br />Appendix B: Other relevant literature<br />Agichtein E, Castillo C, Donato D, Giones A, Mishne G. Finding high-quality content in social media. In: Proceedings of the international conference on Web search and web data mining; 2008; Palo Alto, CA. P. 183-94.<br />Atreja A, Messinger-Rapport B, Jain A, Mehta N. Using Web 2.0 technologies to develop a resource for evidence based medicine. AMIA Annu Symp Proc. 2006:847.<br />Bastian H, Glasziou P, Chalmers I. Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med. 2010;7(9):e1000326.<br />Boulos MNK, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of web-based tools for virtual collaborative clinical practice and education. BMC Med Educ. 2006;6:41.<br />CADTH. Podcasts and Social Media for Improving Patient Compliance and Physician Prescribing: Clinical Effectiveness. http://www.cadth.ca/media/pdf/j0466_podcasts_social_media_htis_1.pdf<br />Chou WY, Hunt YM, Beckjord EB, Moser RP, Hesse BW. Social media use in the United States: Implications for health communication. J Med Internet Res. 2009;11:e48.<br />Chu LF, Young C, Zamora A, Kurup V, Macario A. Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education. Curr Opin Anaesthesiol. 2010;23:218–27.<br />Eaton L. Evidence based research for coping in emergencies goes online. BMJ. 2005;330(7497):926.<br />Eysenbach G. Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. J Med Internet Res. 2008;10(3):e22.http://www.jmir.org/2008/3/e22/<br />Fraser AG, Dunstan FD. On the impossibility of being an expert. BMJ. 2010;341:c6815.<br />Grajales F, Clauson K. To tweet or not to tweet? Exploring the role of social media for [public] health. http://www.slideshare.net/ciscogiii/to-tweet-or-not-to-tweet-exploring-the-use-of-social-media-for-public-health<br />Gambadauro P, Magos A. Office 2.0: a web 2.0 tool for international collaborative research. Lancet. 2008;371(9627):1837-1838.<br />Greysen SR, Kind T, Chretien KC. Online Professionalism and the Mirror of Social Media. J Gen Intern Med. 2010;25(11):1227-9.<br />Hemmi A, Bayne S, Land R. The appropriation and repurposing of social technologies in higher education. J Comput Assist Learn. 2009;25(1):19-30.<br />Hughes AL, Palen L. Twitter adoption and use in mass convergence and emergency events. Int J Emerg Manage. 2009;6(3-4):248-260.<br />Idriss SZ, Kvedar JC, Watson AJ. The role of online support communities: benefits of expanded social networks to patients with psoriasis. Arch Derm. 2009;145(1):46-51.<br />Kapp JM, LeMaster JW, Lyon MB, Zhang B, Hosokawa MC. Updating public health teaching methods in the era of social media. Public Health Rep. 2009;124(6):775-7.<br />Lupianez Villaneuva F, Mayer MA, Torrent J. Opportunities and challenges of web 2.0 within the health care systems: an empirical exploration. Inform Health Soc Care. 2009;34(3):117–26.<br />McNab C. What the media offers to health professionals and citizens. Bull World Health Organ. 2009;87:566. http://www.who.int/bulletin/volumes/87/8/09-066712/en/http://www.who.int/bulletin/volumes/87/8/09-066712/en/<br />Scanfeld D, Scanfeld V, Larson EL. Dissemination of health information through social networks: Twitter and antibiotics. Am J Infect Control. 2010;38(3):182-8.<br />Spallek H, O'Donnell J, Clayton M, Anderson P, Krueger A. Paradigm shift or annoying distraction – emerging implications of web 2.0 for clinical practice. Appl Clin Inform. 2010;1(2):96-115.<br />Straus SE, Haynes RB. Managing evidence-based knowledge: the need for reliable, relevant and readable resources. CMAJ. 2008;180(9):942–5.<br />Terry M. Twittering healthcare: social media and medicine. Telemed J E Health 2009;15(6):507-10.<br />Tharyan P, Clarke M, Green S. How the Cochrane Collaboration is responding to the Asian Tsunami. PLoS Med. 2005;2(6):e169.<br />Tian Y. Organ Donation on Web 2.0: Content and audience analysis of organ donation videos on YouTube. Health Comm 2010;25:238-46.<br />Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, Black NP. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008;23(7):954-7.<br />US Centers for Disease Control and Prevention. The Health Communicator’s Social Media Toolkit. August 6, 2010. http://www.cdc.gov/healthcommunication/ToolsTemplates/SocialMediaToolkit_BM.pdf<br />Vance WH, Dellavalle RP. Social Internet Sites as a Source of Public Health Information. Dermatol Clin. 2009;27:133-6.<br />Wilson K, Keelan J. Coping with Public Health 2.0. CMAJ. 2009;180(10):1080.<br />Appendix C: Author contact information<br />Dean Giustini<br />Biomedical Branch Librarian<br />UBC Library<br />Blog: http://blogs.ubc.ca/dean<br />Twitter: http://twitter.com/giustini<br />Wiki: http://hlwiki.ca<br />Francisco Grajales III<br />Trainee, Western Regional Training Centre for Health Services Research<br />UBC Graduate Student Researcher<br />eHealth Strategy Office, Faculty of Medicine, UBC<br />Website: http://ww.franciscograjales.com/contact/<br />Twitter: http://twitter.com/ciscogiii<br />Daniel Hooker<br />Researcher<br />eHealth Strategy Office, Faculty of Medicine, UBC<br />Blog: http://danielhooker.com/<br />Twitter: http://twitter.com/danhooker<br />Facebook: http://facebook.com/danhooker<br />http://hlwiki.ca<br />All learning objects from this workshop are located here:<br />http://hlwiki.slais.ubc.ca/index.php/Using_Social_Media_to_Promote_Evidence-Based_Practice<br />