APDIM_Combating_Misinformation
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This is a plenary presentation delivered during Academic Internal Medicine Week sponsorewd by the Association of Program Directors in Internal Medicine (APDIM), April 12, 2022.
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APDIM_Combating_Misinformation
- 1. M I C H AE L A . G I S O N D I , M D V I C E C H AI R O F E D U C AT I O N D E PAR T M E N T O F E M E R G E N C Y M E D I C I N E S TAN F O R D S C H O O L O F M E D I C I N E COMBATING HEALTH MISINFORMATION
- 2. @MikeGisondi #AIMW I have no pertinent disclosures to report, financial or otherwise. Views are my own and not endorsed by AAIM or APDIM. APDIM – Academic Internal Medicine Week – April 12, 2022
- 3. How can you teach your residents to combat health misinformation?
- 6. Spend Time with Patients Deliberating Vaccines
- 8. Spend Time with Patients Deliberating Vaccines “Have you received other vaccines?” “May I ask why not the COVID vaccine?”
- 9. Engage Patients With Empathy “I understand why you’re concerned.” “May I share some information with you?” “Thank you for letting me share what I know.”
- 10. Personalize the Message “Let’s focus on how the vaccine can help you.” “You’re healthy, yet COVID can still make you sick.” “The vaccine can prevent you from getting seriously sick.” “You won’t need to worry as much.”
- 11. Describe How Misinformation Happens “I understand your worry about side effects.” “The vaccine has been safely administered to half of the world.” “Inevitably some will get sick from another illness.” “It doesn’t mean the vaccine caused them to get sick.”
- 12. Learner-Centered Educational Frameworks Safe learning environments Internal Learner Motivation Scaffolding and Framing Social Acceptability Sheng et al. AEM ET. 2021
- 13. 6-Step Myth Debunking Strategy 1. State the misinformation once. 2. Immediately state a fact. 3. Explain why the fallacy was once considered true. 4. Explain why we know it to be false. 5. Explain why the alternative is correct. 6. Close by stating the fact again.
- 14. 6-Step Myth Debunking Strategy 1. The vaccine was made too quickly and its unsafe. 2. The vaccine is among the safest ever made. 3. Some worried that vaccine testing was rushed. 4. Vaccine was tested in an appropriately large population. 5. It has since been given safely to half the world. 6. The vaccine is among the safest ever made.
- 15. Teach Residents Motivational Interviewing: Respectful Dialogue Listen and Validate Provide Facts Patient Draws Conclusions
- 18. Celebrities on Social Media 70% of Attention 20% of Misinformation
- 20. Healthcare Provider Social Media Hesitancy Physicians not using their platform = Public health threat
- 21. Common Barriers to Social Media Engagement Lack of measurable outcomes Harassment and bullying Lack of institutional support Lack of social media training
- 22. Facilitators of Social Media Engagement Misinformation training Social media training Building social media presence
- 24. 5-Step Method to Combat Misinformation Online 1. Identify and Label Misinformation 2. Provide Correct Information 3. Reference a Source 4. Repeat the Correct Information 5. Respond Immediately
- 25. Things that might happen after a COVID-19 vaccine
- 28. A Stanford Conference on Social Media and COVID-19 Misinformation Stanfordinfodemic.org August 26, 2021
- 29. INFODEMIC: TOO MUCH INFORMATION… (1) confusion (2) mistrust (3) lengthens outbreaks WHO
- 30. The COVID-19 INFODEMIC: COMPLEX and CONTRADICTORY INFORMATION… (1) origins of the virus (2) treatment options (3) lifesaving vaccines Gisondi et al. JMIR. 2022
- 33. Engage patients online Partner with: Online influencers Social media companies Mass media
- 36. Engage in public health education online Use social media to connect to new strategic partners
- 37. Teach Residents How to Use Their Platform: Engage in Social Media Identify Misinformation Provide Facts Partner with Stakeholders
- 39. ("social media" [tw] OR "social media" [mesh] OR twitter [ti] OR Instagram [ti] OR facebook [ti]) AND ("covid 19" [tw] OR covid [tw] OR covid19 [tw] OR "ncov 2019" [tw] OR "novel coronavirus" [tw] OR "sars cov 2" [tw] OR "sars cov-2" [tw] OR "ncov 2019" [tw] OR sarscov2 [tw] OR (wuhan [tw] AND coronavirus* [tw]) OR "corona virus*" [tw] OR "coronavirus disease 2019" [tw] OR "coronavirus disease 19" [tw] OR "2019 ncov" [tw] OR 2019nCoV [tw] OR "coronavirus 2" [tw] OR "Coronavirus"[Mesh:NoExp] OR "SARS-CoV-2"[Mesh] OR "COVID-19 Testing"[Mesh] OR "COVID-19" [mesh] OR "COVID-19 Vaccines"[Mesh] OR "Receptors, Coronavirus"[Mesh] OR "Spike Glycoprotein, Coronavirus"[Mesh] OR "SARS-CoV-2 variants" [Supplementary Concept]) AND ("Patient Education as Topic"[Mesh] OR "Patient Education Handout" [Publication Type] OR "health literacy" [tw] OR "patient education" [tw] OR "Health Literacy"[Mesh] OR "Health Promotion"[Mesh])
- 41. Residents launched an awareness campaign about health inequities on Twitter
- 43. Residents filmed 60 TikToks about COVID 600,000 views
- 44. Residents made health infographics, videos in Chinese WeChat group of 500 patients
- 45. Provider-moderated online health communities Disproportionately young people High demand for health-related content Susceptible to unreliable content
- 48. Educators and Educational Institutions Evidence-based Educational Programs Information Literacy Metrics
- 49. Health Professionals Healthcare Institutions Proactively Engage with the Public Use Technology to Share Information Partner with Community Groups
- 50. Researchers Research Institutions Assess the Impact of Misinformation Target Interventions to Communities Evaluate Interventions and Policies
- 51. Teach Residents to Use Social Media in New Ways: Support social media use Develop new policies Teach best practices Find research opportunities
- 52. Surgeon General Murthy, 2021 “Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”
- 53. How can you teach your residents to combat health misinformation?
Editor's Notes
- Thank you so much for having me
- Excited and honored to be here, Thank you especially to Dr Awar, Dr Mourad, and the Conference Planning Committee. I have no disclosures.
- Excited and honored to be here, Thank you especially to Dr Awar, Dr Mourad, and the Conference Planning Committee. I have no disclosures.
- I’d like to discuss three ways in which you can train your residents to combat health misinformation. How they act in the clinic, online, and as a residency program
- Let’s go to the clinic first, where I will give you 5 teaching tips
- Tip 1: Target the right audience, my residents would like to know where best to spend their time and effort
- Vaccine hesitancy is different than the anti-vax movement. Anti-vaxxers refuse all vaccines including childhood vaccines. Vaccine hesitant individuals live in the middle of this continuum of vaccine acceptance, in which they may refuse or delay certain vaccines but not all vaccines. Misinformation clearly impacts vaccine hesitant people who believe seemingly believable information that they heard from a family member, or on a podcast, or at work, or at church. And these are trusted sources, so the information is therefore trusted. Even knowing that there are vaccine advocates and anti-vaxxers is enough to confuse and can prolong hesitancy.
- How do you know if your patient is vaccine hesitant or a vaccine denier? Ask
- This brings us to Tip 2. Meet people where they are at. Approach these conversations from a place of partnership and empathy
- Tip 3 is to personalize the message. Initially, we thought that we could convince young healthy people to get vaccinated as a civic duty to protect their neighbors. This is an approach that was used by many religious leaders and politicians. Research now suggests that those who would be swayed by such arguments have likely already been vaccinated. Now it is time to personalize the message with you statements.
- Tip 4: Simply explain how misinformation happens. It is confusing for patients when they hear misinformation from otherwise trusted individuals and you can’t simply say “you’re wrong”… there needs to be some dialogue and explanation
- Before I close this section I would like to point out an interesting paper by Sheng et al in AEM Education and Training from last year in which they suggest that the clinical spaces in which we counsel patients should be treated like our classrooms, using known educational frameworks such as…
- The final teaching tip is a misinformation debunking strategy that has 6 steps
- So, when in the clinic, teach your residents to combat health misinformation using my motivational interviewing, the principles of which underpin my 5 teaching tips
- Now lets turn to combating health misinformation online
- So who’s to blame for misinformation? There are many fingers that can be pointed, but certainly social media companies are somewhat culpable. In one study, over half of all information considered misinformation originated on social media platforms. Misinformation is propagated online at lightning speeds, due in part to the search algorithms that push such content to certain users, trapping them in an information bubble where new content enters but no new ways of thinking or facts.
- And trusted individuals in our society, politicians, professional athletes, and celebrities are a huge source of misinformation. This is Joe Rogen, he has the number 1 podcast on Spotify, and he routinely has guests on his show that misinform his millions of listeners about the covid vaccine. Celebrities garner 70% of user attention on social media platforms and account for 20% of misinformation in our society. And they go unchecked by many platforms who live and die by user activity. If the users want to follow celebrities online, it isn’t in the best interests of social media companies to ban or censor them when they are discussing clear falsehoods about the virus or the vaccine.
- Many of you likely have concerns about engaging about these issues in the social media space…
- Like anything, the more training that you have, the more comfortable that you can become… today is the start of a conversation…
- Much like our 6 step debunking method for the clinic, there is a 5 step method for combating misinformation online
- Here is an example. This is the rapper Nicki Minaj, who has 24.4 million Twitter followers. She tweeted last fall, during the height of the public discourse on vaccines and hesitancy… Leave it to the Aussies, they responded immediately with…
- Tito’s vodka followed the formula. They included a source, offered an alternate explanation, repeated the correct information in two places in their tweet, responded immediately…
- Examples on Instagram from Stanford in the lead up to the INFODEMIC conference
- 2020 was a dark year for me and my students, we decided to do something more productive than simply rage tweet. We wrote a grant to an ethics foundation and they funded us to put a conference called INFODEMIC, last August, who went, why, etc. From this conference came two papers that I will share with you
- The WHO offers a comprehensive and actionable definition of an infodemic…
- My colleagues and I published an editorial earlier this year in which we define the covid-19 infodemic
- My colleagues and I published an editorial earlier this year in which we define the covid-19 infodemic
- My colleagues and I published an editorial earlier this year in which we define the covid-19 infodemic
- So to summarize my remarks about combating health misinformation online, I recommend you lean in and teach residents how to use their platform, or prepare them to do so responsibly when they leave your program. I’m not suggesting you send them out to go rouge, instead work with them as they experiment with a professional facing social media account
- Over 3 month period created appx 60 one minute Tiktoks based on new literature of the day and had 600,000 views
- Chicago, Chinese speaking community, WeChat, health resources
- A year later, in summer 2021, the scale of COVID misinformation was staggering, exploding from mistrust and distrust of health officials during vaccination campaigns. This led to our Surgeon General, Dr. Vivek Murthy (an internist by the way, who trained at the Brigham) to declare health misinformation a public health crisis. And by that time, about 8 months after the first vaccines were given, we knew a lot more about the US population, who was and wasn’t getting vaccinated, and misinformation in general. We know that misinformation directly affects vaccination rates by increasing vaccine hesitancy, leading to preventable deaths.
- GOAL: Target the right audience
- GOAL: Target the right audience
- GOAL: Target the right audience
- Excited and honored to be here, Thank you especially to Dr Awar, Dr Mourad, and the Conference Planning Committee. I have no disclosures.
- Excited and honored to be here, Thank you especially to Dr Awar, Dr Mourad, and the Conference Planning Committee. I have no disclosures.