SlideShare a Scribd company logo
Social Media in Medical Education:
       Embracing a New Medium
                        Ryan D. Madanick, MD
                   Assistant Professor of Medicine
           Center for Esophageal Diseases and Swallowing
             Division of Gastroenterology & Hepatology
                       UNC School of Medicine

Twitter: @RyanMadanickMD
Blog: Gut Check (ryanmadanickmd.wordpress.com)
                                                  #uncaoe
Learning Objectives
The information presented at this educational activity
should improve your ability to:
1. Explain how social media is currently being
   employed for medical education
2. Describe risks, limitations, and opportunities
   with regard to the use social media in
   medicine and medical education
3. Incorporate social media into teaching
   medicine and the competencies

                                          #uncaoe
What is (are) Social Media?
You may have heard of some of these:
• MySpace
• Facebook
• Twitter
• LinkedIn
• Sermo
• Various blog sites

                                   #uncaoe
#uncaoe
What are the Risks of Being involved in
           Social Media?
•   Patients “friend” or “follow” you
•   HIPAA violations
•   Professionalism issues
•   Time issues




                                        #uncaoe
“Twitter is a big cocktail party that you are
        dropping in on from time to time to listen
        to what people are saying and join in.”
                                        -- Vineet Arora (@FutureDocs)
                            Top Twitter Myths & Tips, FutureDocs Blog




http://futuredocsblog.com/top-twitter-myths-tips/         #uncaoe
Why Should Medical Educators Care
       About Social Media?
• Our students/learners are already there
  – Whether or not you like it
  – We need to educate about it
• Our patients/the public




                                    #uncaoe
How Can Social Media Be Used to
       Advance a Medical Academic Career?




http://futuredocsblog.com/2011/05/02/twitter-to-tenure-7-
ways-social-media-advances-my-career/                       #uncaoe
How Can Social Media Be Used to
         Advance a Medical Academic Career?


     •   Media interviews
     •   Workshop presentations
     •   Acquisition of new skills
     •   Lecture invitations
     •   Committee invitations
     •   Grant opportunities
     •   Dissemination
http://futuredocsblog.com/2011/05/02/twitter-to-tenure-7-
ways-social-media-advances-my-career/                       #uncaoe
Competency 1:
   Medical
  Knowledge


            #uncaoe
#uncaoe
The Blog as a Teaching Tool




http://casesblog.blogspot.com/        #uncaoe
Competency 2:
 Patient Care


            #uncaoe
Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
The e-Patient Revolution




        “Participatory Medicine is a movement in which networked
        patients shift from being mere passengers to responsible
        drivers of their health, and in which providers encourage
        and value them as full partners.”

http://e-patients.net/
http://participatorymedicine.org/                    #uncaoe
e-Patient Dave




                 #uncaoe
Competency 3:
Interpersonal and
 Communication
      Skills

              #uncaoe
Blogging (and Micro-blogging)




                       #uncaoe
Networking




Some leaders in the #SMIME arena




                                   #uncaoe
Blogging




http://tworabbits-
medicaleducation.blogspot.com/2011/10/my-third-day-at-   #uncaoe
Competency 4:
Professionalism


             #uncaoe
#HCSMGATE: A Lesson about
                        Professionalism



                                                                                  @Doctor_V




http://33charts.com/2011/05/unprofessional-physician-behavior-twitter.html   #uncaoe
Physicians on Twitter: A Study in
                    Professionalism
    • Identified 260 docs on Twitter*
         – With at least 500 followers
         – Analyzed last 20 tweets
         – Total 5156 tweets analyzed
    • 148 (3%) considered “unprofessional”
         – Potential pt privacy violations: 38 (0.7%)
              • 27 users (10%), 25 were identifiable
         – Profanity: 33 (0.6%)
         – Sexually explicit: 14 (0.3%)                *Doctors identified
                                                       between in May 2010


Chretien KC et al. JAMA 2011;305: 566.                    #uncaoe
“…social networks may be considered the new
           millennium’s elevator: a public forum where
           you have little to no control over who hears
           what you say, even if the material is not
           intended for the public.”




Mostaghimi A, Crotty BH. Ann Int Med 2011;154: 560.   #uncaoe
Our Students Future Employers May
                   Be Watching




http://www.allfacebook.com/facebook-law-schools-students-2011-10   #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     a. Physicians should be cognizant of standards
        of patient privacy and confidentiality that
        must be maintained in all environments,
        including online, and must refrain from
        posting identifiable patient information
        online.




http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     b. When using the Internet for social networking,
        physicians should use privacy settings to
        safeguard personal information and content to
        the extent possible, but should realize that
        privacy settings are not absolute and that once
        on the Internet, content is likely there
        permanently. Thus, physicians should routinely
        monitor their own Internet presence to ensure
        that the personal and professional information
        on their own sites and, to the extent possible,
        content posted about them by others, is
        accurate and appropriate.
http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     c. If they interact with patients on the Internet,
        physicians must maintain appropriate
        boundaries of the patient-physician
        relationship in accordance with professional
        ethical guidelines just, as they would in any
        other context.




http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     d. To maintain appropriate professional boundaries
        physicians should consider separating personal
        and professional content online.




http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     e. When physicians see content posted by
        colleagues that appears unprofessional they
        have a responsibility to bring that content to the
        attention of the individual, so that he or she can
        remove it and/or take other appropriate actions.
        If the behavior significantly violates professional
        norms and the individual does not take
        appropriate action to resolve the situation, the
        physician should report the matter to
        appropriate authorities.

http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
AMA Policy: Professionalism in the Use
                of Social Media
     f. Physicians must recognize that actions online
        and content posted may negatively affect
        their reputations among patients and
        colleagues, may have consequences for their
        medical careers (particularly for physicians-
        in-training and medical students), and can
        undermine public trust in the medical
        profession.

http://www.ama-assn.org/ama/pub/meeting/professionalism-social-
media.shtml                                                       #uncaoe
Competency 5:
Practice-Based
  Learning &
 Improvement

             #uncaoe
“Instant” Feedback from Experts




                        #uncaoe
Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
Cycle of Online
     Information and                                                          Cycle of
     Physician                                                                Patient
     Education                                                                Education




                                          Image source: https://www.iot-at-work.eu/downloads_press-related.html

Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
Competency 6:
Systems-Based
   Practice


            #uncaoe
Systems-Based Practice
• Teamworking
  – Nurses, Pharmacists
  – Patients
• New technologies to advance care/education




                                  #uncaoe
Lessons from Being at the Crossroads
          of Healthcare and Social Media
     1. Getting involved in Social Media means
        starting small
     2. It is easy to feel overwhelmed in Social Media
     3. “If you post it, they will come”
     4. Both the compliments and the criticisms
        come more quickly



http://ryanmadanickmd.wordpress.com/2011/07/11/lessons-from-my-first-six-months-at-the-
crossroads-of-healthcare-and-social-media/                                          #uncaoe
Lessons from Being at the Crossroads
          of Healthcare and Social Media
     5. Venturing into Social Media is great way to
        communicate with a broad audience
     6. Don’t enter Social Media expecting to
        become wildly successful
     7. The proliferation of Social Media is not a
        passing fad
     8. Getting involved in Social Media is not for
        everyone
http://ryanmadanickmd.wordpress.com/2011/07/11/lessons-from-my-first-six-months-at-the-
crossroads-of-healthcare-and-social-media/                                          #uncaoe
Final Thoughts…
With Social Media, medical educators have
OPPORTUNITIES and RESPONSIBILITIES
• For ourselves
• For our patients
• For our learners
• And for the public


                               #uncaoe
Social Media in Medical Education:
       Embracing a New Medium
                        Ryan D. Madanick, MD
                   Assistant Professor of Medicine
           Center for Esophageal Diseases and Swallowing
             Division of Gastroenterology & Hepatology
                       UNC School of Medicine

Twitter: @RyanMadanickMD
Blog: Gut Check (ryanmadanickmd.wordpress.com)
                                                  #uncaoe

More Related Content

What's hot

Using Twitter in Medical Education
Using Twitter in Medical EducationUsing Twitter in Medical Education
Using Twitter in Medical Education
Paul Sufka
 
You Are What You Tweet - Physicians, Professionalism, and Social Media
You Are What You Tweet - Physicians, Professionalism, and Social MediaYou Are What You Tweet - Physicians, Professionalism, and Social Media
You Are What You Tweet - Physicians, Professionalism, and Social Media
David Marcus
 
There's an App for That!
There's an App for That!There's an App for That!
There's an App for That!
Ali Bonar
 
Humanising medicine through social media: Practical guidance for using social...
Humanising medicine through social media: Practical guidance for using social...Humanising medicine through social media: Practical guidance for using social...
Humanising medicine through social media: Practical guidance for using social...
Ali Bonar
 
Social Media in Medicine: A Podium Without Boundaries
Social Media in Medicine: A Podium Without BoundariesSocial Media in Medicine: A Podium Without Boundaries
Social Media in Medicine: A Podium Without Boundaries
Ali Bonar
 
Social Media for Nursing Clinical
Social Media for Nursing ClinicalSocial Media for Nursing Clinical
Social Media for Nursing Clinical
Dr. Jaclyn Engelsher, DNP
 
Social Media And Nursing
Social Media And NursingSocial Media And Nursing
Social Media And Nursing
Renee Bell
 
Social Media in Medical Education #SIMEC16
Social Media in Medical Education #SIMEC16Social Media in Medical Education #SIMEC16
Social Media in Medical Education #SIMEC16
Michael Gisondi
 
Use of Social Media in Healthcare
Use of Social Media in HealthcareUse of Social Media in Healthcare
Use of Social Media in Healthcare
Helen Madamba
 
Social Media in the Healthcare Industry
Social Media in the Healthcare IndustrySocial Media in the Healthcare Industry
Social Media in the Healthcare Industry
Jaimie Olson
 
Healthcare Social Media: how to make a positive impact on your practice and ...
Healthcare Social Media:  how to make a positive impact on your practice and ...Healthcare Social Media:  how to make a positive impact on your practice and ...
Healthcare Social Media: how to make a positive impact on your practice and ...
Vandna Jerath, MD
 
Healthcare, Social Media and Risk Management
Healthcare, Social Media and Risk ManagementHealthcare, Social Media and Risk Management
Healthcare, Social Media and Risk Management
Ed Bennett
 
The use of internet and social media by
The use of internet and social media byThe use of internet and social media by
The use of internet and social media by
gjc104
 
Exploring the Professional and Ethical Standards of Using Social Media as a T...
Exploring the Professional and Ethical Standards of Using Social Media as a T...Exploring the Professional and Ethical Standards of Using Social Media as a T...
Exploring the Professional and Ethical Standards of Using Social Media as a T...
Mark A.M. Kramer
 
Pertinent Primer: Social Media in Health Care
Pertinent Primer: Social Media in Health CarePertinent Primer: Social Media in Health Care
Pertinent Primer: Social Media in Health Care
Makala Arce
 
How to Create a Professional Social Media Image
How to Create a Professional Social Media ImageHow to Create a Professional Social Media Image
How to Create a Professional Social Media Image
Makala Arce
 
Mayo Clinic DLMP Grand Rounds
Mayo Clinic DLMP Grand RoundsMayo Clinic DLMP Grand Rounds
Mayo Clinic DLMP Grand Rounds
Lee Aase
 
Social Media Compliance for Healthcare Professionals
Social Media Compliance for Healthcare ProfessionalsSocial Media Compliance for Healthcare Professionals
Social Media Compliance for Healthcare Professionalsdata brackets
 
Medicine in the tech age
Medicine in the tech ageMedicine in the tech age
Medicine in the tech age
gdymd
 

What's hot (20)

Using Twitter in Medical Education
Using Twitter in Medical EducationUsing Twitter in Medical Education
Using Twitter in Medical Education
 
You Are What You Tweet - Physicians, Professionalism, and Social Media
You Are What You Tweet - Physicians, Professionalism, and Social MediaYou Are What You Tweet - Physicians, Professionalism, and Social Media
You Are What You Tweet - Physicians, Professionalism, and Social Media
 
There's an App for That!
There's an App for That!There's an App for That!
There's an App for That!
 
Humanising medicine through social media: Practical guidance for using social...
Humanising medicine through social media: Practical guidance for using social...Humanising medicine through social media: Practical guidance for using social...
Humanising medicine through social media: Practical guidance for using social...
 
Social Media in Medicine: A Podium Without Boundaries
Social Media in Medicine: A Podium Without BoundariesSocial Media in Medicine: A Podium Without Boundaries
Social Media in Medicine: A Podium Without Boundaries
 
Social Media for Nursing Clinical
Social Media for Nursing ClinicalSocial Media for Nursing Clinical
Social Media for Nursing Clinical
 
Social Media And Nursing
Social Media And NursingSocial Media And Nursing
Social Media And Nursing
 
Social Media in Medical Education #SIMEC16
Social Media in Medical Education #SIMEC16Social Media in Medical Education #SIMEC16
Social Media in Medical Education #SIMEC16
 
Use of Social Media in Healthcare
Use of Social Media in HealthcareUse of Social Media in Healthcare
Use of Social Media in Healthcare
 
Social Media in the Healthcare Industry
Social Media in the Healthcare IndustrySocial Media in the Healthcare Industry
Social Media in the Healthcare Industry
 
Healthcare Social Media: how to make a positive impact on your practice and ...
Healthcare Social Media:  how to make a positive impact on your practice and ...Healthcare Social Media:  how to make a positive impact on your practice and ...
Healthcare Social Media: how to make a positive impact on your practice and ...
 
Healthcare, Social Media and Risk Management
Healthcare, Social Media and Risk ManagementHealthcare, Social Media and Risk Management
Healthcare, Social Media and Risk Management
 
The use of internet and social media by
The use of internet and social media byThe use of internet and social media by
The use of internet and social media by
 
Exploring the Professional and Ethical Standards of Using Social Media as a T...
Exploring the Professional and Ethical Standards of Using Social Media as a T...Exploring the Professional and Ethical Standards of Using Social Media as a T...
Exploring the Professional and Ethical Standards of Using Social Media as a T...
 
Pertinent Primer: Social Media in Health Care
Pertinent Primer: Social Media in Health CarePertinent Primer: Social Media in Health Care
Pertinent Primer: Social Media in Health Care
 
Demystifying Social Media Webinar 10-20-09
Demystifying Social Media Webinar 10-20-09Demystifying Social Media Webinar 10-20-09
Demystifying Social Media Webinar 10-20-09
 
How to Create a Professional Social Media Image
How to Create a Professional Social Media ImageHow to Create a Professional Social Media Image
How to Create a Professional Social Media Image
 
Mayo Clinic DLMP Grand Rounds
Mayo Clinic DLMP Grand RoundsMayo Clinic DLMP Grand Rounds
Mayo Clinic DLMP Grand Rounds
 
Social Media Compliance for Healthcare Professionals
Social Media Compliance for Healthcare ProfessionalsSocial Media Compliance for Healthcare Professionals
Social Media Compliance for Healthcare Professionals
 
Medicine in the tech age
Medicine in the tech ageMedicine in the tech age
Medicine in the tech age
 

Viewers also liked

Social media in medical education - final deck for acehp15
Social media in medical education - final deck for acehp15Social media in medical education - final deck for acehp15
Social media in medical education - final deck for acehp15
Brian S. McGowan, PhD, FACEhp
 
Professional use of social media in medical education
Professional use of social media in medical educationProfessional use of social media in medical education
Professional use of social media in medical education
Pat Rich
 
The Dark Side of Social Media in Medical Education
The Dark Side of Social Media in Medical EducationThe Dark Side of Social Media in Medical Education
The Dark Side of Social Media in Medical Education
Adrian Wong
 
Social Media in Medical Education Presentation April 2016
Social Media in Medical Education Presentation April 2016Social Media in Medical Education Presentation April 2016
Social Media in Medical Education Presentation April 2016
Azeem Majeed
 
Masters in Healthcare Management
Masters in Healthcare ManagementMasters in Healthcare Management
Masters in Healthcare Management
Badrukaeducation
 
Social media and Patient Participation Groups
Social media and Patient Participation GroupsSocial media and Patient Participation Groups
Social media and Patient Participation Groups
Jennifer Skillen
 
Patients and Social Networking
Patients and Social NetworkingPatients and Social Networking
Patients and Social NetworkingTeri Robert
 
Healthy Applications of Social Media
Healthy Applications of Social MediaHealthy Applications of Social Media
Healthy Applications of Social Media
Lee Aase
 
Professional use of social media in medical education - 2014
Professional use of social media in medical education - 2014Professional use of social media in medical education - 2014
Professional use of social media in medical education - 2014
Pat Rich
 
Bhide e professionalism.ppt resident talk revised 3 16
Bhide e professionalism.ppt resident talk revised 3 16Bhide e professionalism.ppt resident talk revised 3 16
Bhide e professionalism.ppt resident talk revised 3 16
Vandana Bhide
 
Social Media in Education
Social Media in Education Social Media in Education
Social Media in Education
Shannon Miller
 
NU Innovation in Teaching Series: Social Media in Medical Education
NU Innovation in Teaching Series: Social Media in Medical EducationNU Innovation in Teaching Series: Social Media in Medical Education
NU Innovation in Teaching Series: Social Media in Medical Education
Michael Gisondi
 
Professional Ethics: Facing New Challenges
Professional Ethics: Facing New ChallengesProfessional Ethics: Facing New Challenges
Professional Ethics: Facing New Challenges
John Gavazzi
 
GPC Manejo paciente con Dispepsia
GPC Manejo paciente con DispepsiaGPC Manejo paciente con Dispepsia
GPC Manejo paciente con Dispepsia
Marta Puig-Soler
 
Cáncer de esófago - Tratamiento
Cáncer de esófago - TratamientoCáncer de esófago - Tratamiento
Cáncer de esófago - Tratamiento
asociaciongastrocba
 
Webquest nutricion 2013 bachillerato
Webquest nutricion 2013 bachilleratoWebquest nutricion 2013 bachillerato
Webquest nutricion 2013 bachilleratomaguedawg
 
IP Crammer Presentation 2015
IP Crammer Presentation 2015IP Crammer Presentation 2015
IP Crammer Presentation 2015
Fuulido Narrative
 
Crowdsourcing, innovacion abierta
Crowdsourcing, innovacion abiertaCrowdsourcing, innovacion abierta
Crowdsourcing, innovacion abierta
JCI Gualeguaychú
 

Viewers also liked (20)

Social media in medical education - final deck for acehp15
Social media in medical education - final deck for acehp15Social media in medical education - final deck for acehp15
Social media in medical education - final deck for acehp15
 
Professional use of social media in medical education
Professional use of social media in medical educationProfessional use of social media in medical education
Professional use of social media in medical education
 
The Dark Side of Social Media in Medical Education
The Dark Side of Social Media in Medical EducationThe Dark Side of Social Media in Medical Education
The Dark Side of Social Media in Medical Education
 
Social Media in Medical Education Presentation April 2016
Social Media in Medical Education Presentation April 2016Social Media in Medical Education Presentation April 2016
Social Media in Medical Education Presentation April 2016
 
Masters in Healthcare Management
Masters in Healthcare ManagementMasters in Healthcare Management
Masters in Healthcare Management
 
Social media and Patient Participation Groups
Social media and Patient Participation GroupsSocial media and Patient Participation Groups
Social media and Patient Participation Groups
 
Patients and Social Networking
Patients and Social NetworkingPatients and Social Networking
Patients and Social Networking
 
Healthy Applications of Social Media
Healthy Applications of Social MediaHealthy Applications of Social Media
Healthy Applications of Social Media
 
Professional use of social media in medical education - 2014
Professional use of social media in medical education - 2014Professional use of social media in medical education - 2014
Professional use of social media in medical education - 2014
 
Bhide e professionalism.ppt resident talk revised 3 16
Bhide e professionalism.ppt resident talk revised 3 16Bhide e professionalism.ppt resident talk revised 3 16
Bhide e professionalism.ppt resident talk revised 3 16
 
Social Media in Education
Social Media in Education Social Media in Education
Social Media in Education
 
NU Innovation in Teaching Series: Social Media in Medical Education
NU Innovation in Teaching Series: Social Media in Medical EducationNU Innovation in Teaching Series: Social Media in Medical Education
NU Innovation in Teaching Series: Social Media in Medical Education
 
Professional Ethics: Facing New Challenges
Professional Ethics: Facing New ChallengesProfessional Ethics: Facing New Challenges
Professional Ethics: Facing New Challenges
 
GPC Manejo paciente con Dispepsia
GPC Manejo paciente con DispepsiaGPC Manejo paciente con Dispepsia
GPC Manejo paciente con Dispepsia
 
Cáncer de esófago - Tratamiento
Cáncer de esófago - TratamientoCáncer de esófago - Tratamiento
Cáncer de esófago - Tratamiento
 
Doc1
Doc1Doc1
Doc1
 
Aserti
AsertiAserti
Aserti
 
Webquest nutricion 2013 bachillerato
Webquest nutricion 2013 bachilleratoWebquest nutricion 2013 bachillerato
Webquest nutricion 2013 bachillerato
 
IP Crammer Presentation 2015
IP Crammer Presentation 2015IP Crammer Presentation 2015
IP Crammer Presentation 2015
 
Crowdsourcing, innovacion abierta
Crowdsourcing, innovacion abiertaCrowdsourcing, innovacion abierta
Crowdsourcing, innovacion abierta
 

Similar to Social Media in Medical Education: Embracing a New Medium

Social Media and Ethics
Social Media and EthicsSocial Media and Ethics
Social Media and Ethics
DovMurtazaHashmi
 
The “Meaningful Use” of Social Media by Physicians
The “Meaningful Use” of Social Media by PhysiciansThe “Meaningful Use” of Social Media by Physicians
The “Meaningful Use” of Social Media by Physiciansyan_stanford
 
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
Brian S. McGowan, PhD, FACEhp
 
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
Niraj Gusani
 
AOTA 2016 Addiction, Mental Health & Recovery Resources
AOTA 2016 Addiction, Mental Health & Recovery ResourcesAOTA 2016 Addiction, Mental Health & Recovery Resources
AOTA 2016 Addiction, Mental Health & Recovery Resources
Allison Sullivan
 
Use of Social Media in Medicine
Use of Social Media in MedicineUse of Social Media in Medicine
Use of Social Media in Medicine
Helen Madamba
 
Social media & Medical Practice
Social media & Medical PracticeSocial media & Medical Practice
Social media & Medical Practice
Iris Thiele Isip-Tan
 
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
David Townsend
 
Utilization of social media to enhance continuing medical education
Utilization of social media to enhance continuing medical educationUtilization of social media to enhance continuing medical education
Utilization of social media to enhance continuing medical education
Brian S. McGowan, PhD, FACEhp
 
Social media and health care provider
Social media and health care providerSocial media and health care provider
Social media and health care provider
Naveen Pareek
 
Social media for the Gynecologic Oncology Practitioner and Researcher
Social media for the Gynecologic Oncology Practitioner and ResearcherSocial media for the Gynecologic Oncology Practitioner and Researcher
Social media for the Gynecologic Oncology Practitioner and Researcher
Emil Lou, M.D., Ph.D, FACP
 
Stfm pci 2011
Stfm pci 2011Stfm pci 2011
Stfm pci 2011
Mark Ryan
 
Best practices in HCSM
Best practices in HCSMBest practices in HCSM
Best practices in HCSMnwenderlich
 
social media bootcamp at #ccme14
social media bootcamp at #ccme14social media bootcamp at #ccme14
social media bootcamp at #ccme14
Anne Marie Cunningham
 
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
pkressler
 
Professional use of social media by residents - 2015
Professional use of social media by residents - 2015Professional use of social media by residents - 2015
Professional use of social media by residents - 2015
Pat Rich
 
Best practices in HCSM
Best practices in HCSMBest practices in HCSM
Best practices in HCSM
nwenderlich
 
Best Practices in HCSM
Best Practices in HCSMBest Practices in HCSM
Best Practices in HCSMnwenderlich
 
Bhide e professionalism.ppt resident talk revised 12 13
Bhide e professionalism.ppt resident talk revised 12 13Bhide e professionalism.ppt resident talk revised 12 13
Bhide e professionalism.ppt resident talk revised 12 13
Vandana Bhide
 
Use of social media for public health promotion
Use of social media for public health promotionUse of social media for public health promotion
Use of social media for public health promotion
Helen Madamba
 

Similar to Social Media in Medical Education: Embracing a New Medium (20)

Social Media and Ethics
Social Media and EthicsSocial Media and Ethics
Social Media and Ethics
 
The “Meaningful Use” of Social Media by Physicians
The “Meaningful Use” of Social Media by PhysiciansThe “Meaningful Use” of Social Media by Physicians
The “Meaningful Use” of Social Media by Physicians
 
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
Meaningful use of Social Media by Physicians - Slides from Medicine 2pt0
 
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
#SoMe for Surgeons: Opportunity & Peril - 2018 - St. Agnes Grand Rounds - final
 
AOTA 2016 Addiction, Mental Health & Recovery Resources
AOTA 2016 Addiction, Mental Health & Recovery ResourcesAOTA 2016 Addiction, Mental Health & Recovery Resources
AOTA 2016 Addiction, Mental Health & Recovery Resources
 
Use of Social Media in Medicine
Use of Social Media in MedicineUse of Social Media in Medicine
Use of Social Media in Medicine
 
Social media & Medical Practice
Social media & Medical PracticeSocial media & Medical Practice
Social media & Medical Practice
 
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
The Health Educators Guide to Social Media - ANZAHPE AMEA 2015
 
Utilization of social media to enhance continuing medical education
Utilization of social media to enhance continuing medical educationUtilization of social media to enhance continuing medical education
Utilization of social media to enhance continuing medical education
 
Social media and health care provider
Social media and health care providerSocial media and health care provider
Social media and health care provider
 
Social media for the Gynecologic Oncology Practitioner and Researcher
Social media for the Gynecologic Oncology Practitioner and ResearcherSocial media for the Gynecologic Oncology Practitioner and Researcher
Social media for the Gynecologic Oncology Practitioner and Researcher
 
Stfm pci 2011
Stfm pci 2011Stfm pci 2011
Stfm pci 2011
 
Best practices in HCSM
Best practices in HCSMBest practices in HCSM
Best practices in HCSM
 
social media bootcamp at #ccme14
social media bootcamp at #ccme14social media bootcamp at #ccme14
social media bootcamp at #ccme14
 
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
NH Nurses Association Keynote Address Benifits, Barriers And Best Practices O...
 
Professional use of social media by residents - 2015
Professional use of social media by residents - 2015Professional use of social media by residents - 2015
Professional use of social media by residents - 2015
 
Best practices in HCSM
Best practices in HCSMBest practices in HCSM
Best practices in HCSM
 
Best Practices in HCSM
Best Practices in HCSMBest Practices in HCSM
Best Practices in HCSM
 
Bhide e professionalism.ppt resident talk revised 12 13
Bhide e professionalism.ppt resident talk revised 12 13Bhide e professionalism.ppt resident talk revised 12 13
Bhide e professionalism.ppt resident talk revised 12 13
 
Use of social media for public health promotion
Use of social media for public health promotionUse of social media for public health promotion
Use of social media for public health promotion
 

Recently uploaded

Biological Screening of Herbal Drugs in detailed.
Biological Screening of Herbal Drugs in detailed.Biological Screening of Herbal Drugs in detailed.
Biological Screening of Herbal Drugs in detailed.
Ashokrao Mane college of Pharmacy Peth-Vadgaon
 
The Diamonds of 2023-2024 in the IGRA collection
The Diamonds of 2023-2024 in the IGRA collectionThe Diamonds of 2023-2024 in the IGRA collection
The Diamonds of 2023-2024 in the IGRA collection
Israel Genealogy Research Association
 
Pride Month Slides 2024 David Douglas School District
Pride Month Slides 2024 David Douglas School DistrictPride Month Slides 2024 David Douglas School District
Pride Month Slides 2024 David Douglas School District
David Douglas School District
 
Best Digital Marketing Institute In NOIDA
Best Digital Marketing Institute In NOIDABest Digital Marketing Institute In NOIDA
Best Digital Marketing Institute In NOIDA
deeptiverma2406
 
Lapbook sobre os Regimes Totalitários.pdf
Lapbook sobre os Regimes Totalitários.pdfLapbook sobre os Regimes Totalitários.pdf
Lapbook sobre os Regimes Totalitários.pdf
Jean Carlos Nunes Paixão
 
Chapter 3 - Islamic Banking Products and Services.pptx
Chapter 3 - Islamic Banking Products and Services.pptxChapter 3 - Islamic Banking Products and Services.pptx
Chapter 3 - Islamic Banking Products and Services.pptx
Mohd Adib Abd Muin, Senior Lecturer at Universiti Utara Malaysia
 
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdfMASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
goswamiyash170123
 
Digital Artifact 1 - 10VCD Environments Unit
Digital Artifact 1 - 10VCD Environments UnitDigital Artifact 1 - 10VCD Environments Unit
Digital Artifact 1 - 10VCD Environments Unit
chanes7
 
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
TESDA TM1 REVIEWER  FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...TESDA TM1 REVIEWER  FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
EugeneSaldivar
 
CACJapan - GROUP Presentation 1- Wk 4.pdf
CACJapan - GROUP Presentation 1- Wk 4.pdfCACJapan - GROUP Presentation 1- Wk 4.pdf
CACJapan - GROUP Presentation 1- Wk 4.pdf
camakaiclarkmusic
 
A Survey of Techniques for Maximizing LLM Performance.pptx
A Survey of Techniques for Maximizing LLM Performance.pptxA Survey of Techniques for Maximizing LLM Performance.pptx
A Survey of Techniques for Maximizing LLM Performance.pptx
thanhdowork
 
Multithreading_in_C++ - std::thread, race condition
Multithreading_in_C++ - std::thread, race conditionMultithreading_in_C++ - std::thread, race condition
Multithreading_in_C++ - std::thread, race condition
Mohammed Sikander
 
How libraries can support authors with open access requirements for UKRI fund...
How libraries can support authors with open access requirements for UKRI fund...How libraries can support authors with open access requirements for UKRI fund...
How libraries can support authors with open access requirements for UKRI fund...
Jisc
 
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
MysoreMuleSoftMeetup
 
Francesca Gottschalk - How can education support child empowerment.pptx
Francesca Gottschalk - How can education support child empowerment.pptxFrancesca Gottschalk - How can education support child empowerment.pptx
Francesca Gottschalk - How can education support child empowerment.pptx
EduSkills OECD
 
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Dr. Vinod Kumar Kanvaria
 
The basics of sentences session 5pptx.pptx
The basics of sentences session 5pptx.pptxThe basics of sentences session 5pptx.pptx
The basics of sentences session 5pptx.pptx
heathfieldcps1
 
Introduction to AI for Nonprofits with Tapp Network
Introduction to AI for Nonprofits with Tapp NetworkIntroduction to AI for Nonprofits with Tapp Network
Introduction to AI for Nonprofits with Tapp Network
TechSoup
 
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)
Academy of Science of South Africa
 
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Levi Shapiro
 

Recently uploaded (20)

Biological Screening of Herbal Drugs in detailed.
Biological Screening of Herbal Drugs in detailed.Biological Screening of Herbal Drugs in detailed.
Biological Screening of Herbal Drugs in detailed.
 
The Diamonds of 2023-2024 in the IGRA collection
The Diamonds of 2023-2024 in the IGRA collectionThe Diamonds of 2023-2024 in the IGRA collection
The Diamonds of 2023-2024 in the IGRA collection
 
Pride Month Slides 2024 David Douglas School District
Pride Month Slides 2024 David Douglas School DistrictPride Month Slides 2024 David Douglas School District
Pride Month Slides 2024 David Douglas School District
 
Best Digital Marketing Institute In NOIDA
Best Digital Marketing Institute In NOIDABest Digital Marketing Institute In NOIDA
Best Digital Marketing Institute In NOIDA
 
Lapbook sobre os Regimes Totalitários.pdf
Lapbook sobre os Regimes Totalitários.pdfLapbook sobre os Regimes Totalitários.pdf
Lapbook sobre os Regimes Totalitários.pdf
 
Chapter 3 - Islamic Banking Products and Services.pptx
Chapter 3 - Islamic Banking Products and Services.pptxChapter 3 - Islamic Banking Products and Services.pptx
Chapter 3 - Islamic Banking Products and Services.pptx
 
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdfMASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
MASS MEDIA STUDIES-835-CLASS XI Resource Material.pdf
 
Digital Artifact 1 - 10VCD Environments Unit
Digital Artifact 1 - 10VCD Environments UnitDigital Artifact 1 - 10VCD Environments Unit
Digital Artifact 1 - 10VCD Environments Unit
 
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
TESDA TM1 REVIEWER  FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...TESDA TM1 REVIEWER  FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
TESDA TM1 REVIEWER FOR NATIONAL ASSESSMENT WRITTEN AND ORAL QUESTIONS WITH A...
 
CACJapan - GROUP Presentation 1- Wk 4.pdf
CACJapan - GROUP Presentation 1- Wk 4.pdfCACJapan - GROUP Presentation 1- Wk 4.pdf
CACJapan - GROUP Presentation 1- Wk 4.pdf
 
A Survey of Techniques for Maximizing LLM Performance.pptx
A Survey of Techniques for Maximizing LLM Performance.pptxA Survey of Techniques for Maximizing LLM Performance.pptx
A Survey of Techniques for Maximizing LLM Performance.pptx
 
Multithreading_in_C++ - std::thread, race condition
Multithreading_in_C++ - std::thread, race conditionMultithreading_in_C++ - std::thread, race condition
Multithreading_in_C++ - std::thread, race condition
 
How libraries can support authors with open access requirements for UKRI fund...
How libraries can support authors with open access requirements for UKRI fund...How libraries can support authors with open access requirements for UKRI fund...
How libraries can support authors with open access requirements for UKRI fund...
 
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
Mule 4.6 & Java 17 Upgrade | MuleSoft Mysore Meetup #46
 
Francesca Gottschalk - How can education support child empowerment.pptx
Francesca Gottschalk - How can education support child empowerment.pptxFrancesca Gottschalk - How can education support child empowerment.pptx
Francesca Gottschalk - How can education support child empowerment.pptx
 
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
 
The basics of sentences session 5pptx.pptx
The basics of sentences session 5pptx.pptxThe basics of sentences session 5pptx.pptx
The basics of sentences session 5pptx.pptx
 
Introduction to AI for Nonprofits with Tapp Network
Introduction to AI for Nonprofits with Tapp NetworkIntroduction to AI for Nonprofits with Tapp Network
Introduction to AI for Nonprofits with Tapp Network
 
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)
 
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
 

Social Media in Medical Education: Embracing a New Medium

  • 1. Social Media in Medical Education: Embracing a New Medium Ryan D. Madanick, MD Assistant Professor of Medicine Center for Esophageal Diseases and Swallowing Division of Gastroenterology & Hepatology UNC School of Medicine Twitter: @RyanMadanickMD Blog: Gut Check (ryanmadanickmd.wordpress.com) #uncaoe
  • 2. Learning Objectives The information presented at this educational activity should improve your ability to: 1. Explain how social media is currently being employed for medical education 2. Describe risks, limitations, and opportunities with regard to the use social media in medicine and medical education 3. Incorporate social media into teaching medicine and the competencies #uncaoe
  • 3. What is (are) Social Media? You may have heard of some of these: • MySpace • Facebook • Twitter • LinkedIn • Sermo • Various blog sites #uncaoe
  • 5. What are the Risks of Being involved in Social Media? • Patients “friend” or “follow” you • HIPAA violations • Professionalism issues • Time issues #uncaoe
  • 6. “Twitter is a big cocktail party that you are dropping in on from time to time to listen to what people are saying and join in.” -- Vineet Arora (@FutureDocs) Top Twitter Myths & Tips, FutureDocs Blog http://futuredocsblog.com/top-twitter-myths-tips/ #uncaoe
  • 7. Why Should Medical Educators Care About Social Media? • Our students/learners are already there – Whether or not you like it – We need to educate about it • Our patients/the public #uncaoe
  • 8. How Can Social Media Be Used to Advance a Medical Academic Career? http://futuredocsblog.com/2011/05/02/twitter-to-tenure-7- ways-social-media-advances-my-career/ #uncaoe
  • 9. How Can Social Media Be Used to Advance a Medical Academic Career? • Media interviews • Workshop presentations • Acquisition of new skills • Lecture invitations • Committee invitations • Grant opportunities • Dissemination http://futuredocsblog.com/2011/05/02/twitter-to-tenure-7- ways-social-media-advances-my-career/ #uncaoe
  • 10. Competency 1: Medical Knowledge #uncaoe
  • 12. The Blog as a Teaching Tool http://casesblog.blogspot.com/ #uncaoe
  • 13. Competency 2: Patient Care #uncaoe
  • 14. Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
  • 15. The e-Patient Revolution “Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.” http://e-patients.net/ http://participatorymedicine.org/ #uncaoe
  • 16. e-Patient Dave #uncaoe
  • 17. Competency 3: Interpersonal and Communication Skills #uncaoe
  • 19. Networking Some leaders in the #SMIME arena #uncaoe
  • 22. #HCSMGATE: A Lesson about Professionalism @Doctor_V http://33charts.com/2011/05/unprofessional-physician-behavior-twitter.html #uncaoe
  • 23. Physicians on Twitter: A Study in Professionalism • Identified 260 docs on Twitter* – With at least 500 followers – Analyzed last 20 tweets – Total 5156 tweets analyzed • 148 (3%) considered “unprofessional” – Potential pt privacy violations: 38 (0.7%) • 27 users (10%), 25 were identifiable – Profanity: 33 (0.6%) – Sexually explicit: 14 (0.3%) *Doctors identified between in May 2010 Chretien KC et al. JAMA 2011;305: 566. #uncaoe
  • 24. “…social networks may be considered the new millennium’s elevator: a public forum where you have little to no control over who hears what you say, even if the material is not intended for the public.” Mostaghimi A, Crotty BH. Ann Int Med 2011;154: 560. #uncaoe
  • 25. Our Students Future Employers May Be Watching http://www.allfacebook.com/facebook-law-schools-students-2011-10 #uncaoe
  • 26. AMA Policy: Professionalism in the Use of Social Media a. Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 27. AMA Policy: Professionalism in the Use of Social Media b. When using the Internet for social networking, physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently. Thus, physicians should routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others, is accurate and appropriate. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 28. AMA Policy: Professionalism in the Use of Social Media c. If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 29. AMA Policy: Professionalism in the Use of Social Media d. To maintain appropriate professional boundaries physicians should consider separating personal and professional content online. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 30. AMA Policy: Professionalism in the Use of Social Media e. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 31. AMA Policy: Professionalism in the Use of Social Media f. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians- in-training and medical students), and can undermine public trust in the medical profession. http://www.ama-assn.org/ama/pub/meeting/professionalism-social- media.shtml #uncaoe
  • 32. Competency 5: Practice-Based Learning & Improvement #uncaoe
  • 33. “Instant” Feedback from Experts #uncaoe
  • 34. Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
  • 35. Cycle of Online Information and Cycle of Physician Patient Education Education Image source: https://www.iot-at-work.eu/downloads_press-related.html Slide courtesy of Dr. Ves Dimov: AllergyCases.org/@DrVes
  • 36. Competency 6: Systems-Based Practice #uncaoe
  • 37. Systems-Based Practice • Teamworking – Nurses, Pharmacists – Patients • New technologies to advance care/education #uncaoe
  • 38. Lessons from Being at the Crossroads of Healthcare and Social Media 1. Getting involved in Social Media means starting small 2. It is easy to feel overwhelmed in Social Media 3. “If you post it, they will come” 4. Both the compliments and the criticisms come more quickly http://ryanmadanickmd.wordpress.com/2011/07/11/lessons-from-my-first-six-months-at-the- crossroads-of-healthcare-and-social-media/ #uncaoe
  • 39. Lessons from Being at the Crossroads of Healthcare and Social Media 5. Venturing into Social Media is great way to communicate with a broad audience 6. Don’t enter Social Media expecting to become wildly successful 7. The proliferation of Social Media is not a passing fad 8. Getting involved in Social Media is not for everyone http://ryanmadanickmd.wordpress.com/2011/07/11/lessons-from-my-first-six-months-at-the- crossroads-of-healthcare-and-social-media/ #uncaoe
  • 40.
  • 41. Final Thoughts… With Social Media, medical educators have OPPORTUNITIES and RESPONSIBILITIES • For ourselves • For our patients • For our learners • And for the public #uncaoe
  • 42. Social Media in Medical Education: Embracing a New Medium Ryan D. Madanick, MD Assistant Professor of Medicine Center for Esophageal Diseases and Swallowing Division of Gastroenterology & Hepatology UNC School of Medicine Twitter: @RyanMadanickMD Blog: Gut Check (ryanmadanickmd.wordpress.com) #uncaoe

Editor's Notes

  1. Also look at what he says at the bottom…