Twitter to Tenure: 7 ways social media advances my career

2 05 2011

As part of our SGIM Social Media Workshop “From Twitter to Tenure” our workshop lineup of ’twitterati’ will be posting each day this week about how social media affected their career.   So yesterday was @AlexSmithMD on GeriPal.   Here is the schedule for the week:  Monday – me (@FutureDocs) here on Futuredocs; Tuesday – Bob Centor (@medrants) on DB’s Medical Rants; Wednesday – Kathy Chretien (@MotherinMed) on Mother’s in Medicine; Thursday – Eric Widera (@ewidera) on GeriPal (and hope to see you in Phoenix for our workshop!)

For the Twitter to Tenure workshop at this year’s Society of General Internal Medicine Meeting, I was asked to think about how social media enhanced my career.  This may sound ridiculous at first- after all, social media is a big waste of time right? Wrong as some of you have discovered.  Social media has opened doors for me by connecting me to a variety of people I would not have met.  Here is just a brief list of the ways social media has impacted my academic career.

  • Media interviews – I was interviewed by Dr Pauline Chen through the New York Times who located me through – you guessed it Twitter!  She actually approached me for the interview by direct messaging me through Twitter.  She was following me and noticed my interests in handoffs on my Google profile which is linked to my Twitter account.  She was also very encouraging when I started the blog which was exciting!
  • Workshop presentations- I presented a workshop on social media in medical education (#SMIME as we like to call it), at 2 major medical meetings with 3 others (including @MotherInMed who encouraged me to start a blog and also is my copresenter at SGIM).  The idea was borne on Twitter…and the first time I actually met one of the workshop presenters (who I knew on Twitter) was at the workshop.
  • Acquired new skills  – My workshop co-presenter who I only knew through Twitter ended up being Carrie Saarinen, an instructional technologist (a very cool job and every school needs one!).  She is an amazing resource and taught me how to do a wiki.  After my period of ‘lurking’, I started my own ‘course’ wiki  dedicated to helping students do research and scholarly work which we are launching in a week.
  • Lecture invitations – Several of my lecture invitations come through social media.  Most notably, I was invited to speak for an AMSA webinar on handoffs and also speak to the Committee of Interns and Residents on teaching trainees about cost conscious medicine.  Both invitations started with a reference to finding me through Twitter or the blog.
  • Committee invitations – I am now on the SGIM communications task force as a result of my interest in social media.  Our most recent effort was a piece about ‘tweeting the meeting’ with @medrants and an older piece focused on the top Twitter Myths and Tips.
  • Grant opportunities – I recently submitted a grant with an organization that I learned of on Twitter – Initially, I had contacted Neel Shah from Costs of Care asking him if they had a curriculum on healthcare costs.  They did not, but were interested in writing a grant to develop a curriculum so they brought my team on board and we submitted together (fingers crossed).
  • Dissemination - One of the defining features of scholarship (the currency of promotion in academic medical centers) is that it has to be shared.   Well, social media is one of the most powerful ways to share information.   In a recent example, we entered a social media contest media video contest on the media sharing site Slideshare.  Using social media, we were able to obtain the most number of ‘shares’ on Facebook on Twitter which led to the most number of views and ultimately won ‘Best Professional Video.’  To date, this video, has received over 13,000 views, which I was able to highlight as a form of ‘dissemination’ in a recent meeting with our Chairman about medical education scholarship.    While digital scholarship is still under investigation with vocal critics and enthusiastic proponents debating the value of digital scholarship in academia, digital scholarship does appear to have a place for spreading nontraditional media that cannot be shared via peer review.

Part of being a good citizen on social media is giving back.  I try to give back when I can through helping anyone who contacts me for something specific – so I have read personal statements, reviewed websites, and offered input to others who are interested in my perspective on their work.  I can’t always keep up since I have a day job and alas, this is an extracurricular activity.  The good news is a tweet is only 140 characters  – so like the blue bird, I can keep it short but sweet.

–Vineet Arora, MD


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Physician Advocacy: Staying in Place and Telling Your Story

25 04 2011

This month, I have talked to two former trainees who are contemplating major changes in their career- -to leave medicine.  Both are in private practice and are frustrated by many different things that they see in their practice and are inspired to improve the practice of medicine.   While their desire to leave medicine is concerning enough and could be the subject of this entire post,  I was actually struck that both of them contacted me to find out how they could find out more about health policy and get involved.   One of them wondered if they needed to get a Public Policy Degree like I did.  The other one thought maybe she would have to move to DC to become more active in the health policy arena.   I also recall wondering how to get involved many years ago and thinking the same thing.  Fortunately, I was able to find a way to balance my interest in advocacy without giving up my job.  So, before I sent them packing to the Hill or back to school to read seminal texts in public policy and weekly economic homework assignments, I thought there are a few things they could do to engage while they stay in their job if they choose to.

  1. Learn from professional society advocacy experiences.  Some people will react and say that they have a negative opinion about “lobbying” or the special interests of their professional society.  My advice is that if you don’t have a basic terminology of healthcare reform and the healthcare system (i.e. SGR, ACO, etc.), then this is a great place to start -with other physicians who are also learning.
  2. Read the news foraciously – the best way to understand what is happening on the Hill is to keep up with the news.  While this may seem like a tall order, customizing Google news and setting alerts for healthcare reform or whatever it is that you are interested in can be helpful.  In addition, the iPad has amazing news applications that aggregate your favorite news sources and blogs (my personal favorites are PulseNews and FLUD, which even touts itself as the sexy news ecosystem).   My go to sources are still the New York Times Health Section and NPR Health, especially anything written by Julie Rovner.  Another excellent source for health policy which you can add to your reading list include The Healthcare Blog, Kaiser Health News, and the “Bob Blogs” as I refer to them (see the blogroll below) .  Even if you can’t read the article right away, you can often ‘favorite’ it to read later or send to InstaPaper.
  3. Engage in Social Media – Social media has become one of the best ways to stay on top of health policy news, especially thanks to KevinMD and his steady stream of diverse and eclectic contributors that include medical students, patients, physicians, and health policy wonks.  In addition to the usual news sources listed above, you can also keep on top of professional society news (see the medicalsocieties Twitter list) or use healthcare hashtags to stay abreast of the situation.   However, the key to effectively using social media is more than just staying informed, but also interacting and engaging and contributing to the dialogue.  So that brings us to the last way to get involved….
  4. Write – whether it be a comment on a newspaper article or blog post, a letter to the editor to your local newspaper, or a blog post about a specific health policy issue, writing is a great way to get the word out.  Policy narrative has become increasingly valued among physicians.   That is because there is nothing more compelling to the general public or legislators like a personal story. One of our own faculty has specialized in this area and teaches our students how to use policy narrative in their practice.

While some have a natural tendency to write, it may not be intuitive to others.  Fortunately, this year I was lucky enough to attend a session at the IHI meeting led by disciples of Marshall Ganz and dedicated on how to tell your story in a compelling way in 5 easy steps:

  1. Write the story of self (personal narrative)
  2. The story of us (to build a shared vision)
  3. The story of now (to highlight the urgency)
  4. Then present a choice (to raise the tension)
  5. End with asking for a commitment

One of our homework assignments was to practice so I actually chose to write a story to convincing others to come with me to DC for the American College of Physicians Leadership Day since I am leading this year’s Illinois delegation.  So here is my narrative for why you should join me:

When I first went to DC to lobby with ACP Leadership Day, I remember feeling awkward and relying on a medical student who showed me how to approach legislators.  The next year, I remember our student had graduated so I assumed the mentor position for the new people.  Two years later, I got a call that they needed a young physician to testify to Congress about the need for physician payment reform and I was thrilled to be able to do so on my 33rd birthday.  I know you have also wondered about how to get involved with healthcare policy but like me, you are very busy and overcommitted.  The key is that time is of the essence as the future of healthcare legislation is being debated in this election year and your input is critical to shaping the future.  So, I know that this May, you could stay at work and continue your everyday activities or you could decide to take action and go to Washington to witness and contribute to the political dialogue around healthcare.  So, I am asking you to commit to joining me as internists will come together to communicate the importance of affordable healthcare and preserving primary care for Americans. 

Look forward to hearing your stories too.

–Vineet Arora, MD MAPP


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Nature vs. Nurture in Medical Education: The Case of Student Bedside Manner

13 03 2011

Sir William Osler at the bedside

Believe it or not, it’s been a major news week about the soft stuff in medicine, bedside manner.   First, a Time magazine story about a new study showing that patients cared for by physicians with greater empathy had better diabetes control.  That study comes on the heels of an editorial in the New York Times written by a patient (who also happens to be a science journalist and an outstanding writer) with mitral valve prolapse who graciously volunteered herself to be examined by preclinical medical students learning to do the physical exam and lived to vividly document the experience for all of us.  As she eloquently describes, some students seemed like naturals, whereas others were awkward and clunky.   

These articles add more fuel to the fire for the most hotly contested question in medical education – Can you teach these behaviors?  One on side, you have the nature supporters, saying that the role of admissions committees is to screen these behaviors out.  The nurture supporters say that these behaviors can be taught and its medical schools responsibility to do so.  While it is true that some pathologic behaviors need to be screened in admissions, the question for most students is more refined—is it true that some students come in ‘empathetic’ and others are just hopeless oafs that can’t empathize with patients?  Well, it was refreshing to read Number Needed to Treat blog written by a medical student who says the NYT article was eating away at her soul…She nails it by saying the following:

“Almost every single med student I know is, in fact, an affable person. Yet it doesn’t always come through in the exam room.”

Why is this so hard?  Well, it is not easy to learn how to do a physical exam while also forming your bedside manner.  Our students have to pass a national standardized exam that requires doing the over 100 step “head to toe” physical exam.  As a ‘dinosaur’, I never had to take such a test. I’m not even sure what all the steps are but have asked my colleague, Dr. Farnan, who runs our Clinical Skills program for medical students who informed me of all the points and that they are to be memorized.  Let’s be honest- most of our faculty could not do this without referring to a cheat sheet.  If they had to memorize it for a test, they may even come across robotic and unempathetic at first. 

So, what does this mean for students’ bedside manners while they are learning?  Well, mental capacity is finite.  Workload has been well described as a construct that includes the mental and physical challenge of the work.  For complex tasks, it is important to consider how much ‘spare capacity’ one has after the ‘primary task’ is dealt with.  Elegant studies have shown that experienced physicians are BETTER at performing a secondary task than novice physicians when both are doing the same primary task.  Why?  The experienced physicians have more ‘spare capacity’ to deal with the second task.  

So what is the primary and secondary task in interviewing a patient?  Well, the primary task is learning the physical exam and how to take a history.  As we celebrate this week’s residency match, the job of medical school is to produce physicians that can perform these basic functions during residency training.  While our medical students acquire these skills, of course some will be naturals, and therefore have more spare capacity to key in on their bedside manner.  In contrast, others may struggle with basic skills and have difficulty with both.  The majority, however, will first initially put all their mental effort into learning how to do a history and physical, leaving little ‘spare capacity’ for bedside manner.  Is there hope?  Yes, as these students get better at taking a history and physical, they will be more at ease.  This will then free up the necessary spare capacity to be continuously cognizant of their bedside behaviors.  Consistent with this philosophy, one school has had success actively reinforcing bedside manner skills while prerounding during the third year clerkship.

This progression is important, and highlights the learned art of medicine.  This was articulated beautifully by our recent keynote speaker, Dr. Joel Schwab, for the Gold Humanism Society senior student honorees.   On the subject of being humanistic, he said that he THINKS about the landmark article on etiquette-based medicine every time he sees the patient and he follows the 6 steps –

  1. Knock on the Door (wait permission to enter)
  2. Introduce yourself (with name badge on display)
  3. Shake hands (wear glove if needed)
  4. Sit down (smile if appropriate)
  5. Briefly explain your role on the team
  6. Ask the patient how he or she is feeling 

While working at a free clinic last Saturday, I too thought about this article for every patient I saw.  The first year students I was working with came from a variety of medical schools in Chicago and were volunteering their Saturday to do this.  I had no doubt that they all cared about the patients.  But, I did notice that they were taking time to think very hard about the chief complaint, figure out the right questions to ask, and how to present it coherently.  So, the role of medical education is to make sure that doing a history and physical becomes second nature for our students, and that thinking about bedside manner becomes the primary task.

–Vineet Arora, MD


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