The role of emergency physicians in the fight against health misinformation: Implications for resident training

Abstract

Emergency physicians on the frontlines of the COVID‐19 pandemic are first‐hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

INTRODUCTION

Health misinformation and disinformation pose unique challenges for emergency physicians on the frontlines of the COVID‐19 pandemic. We define health misinformation as unintentionally false or misleading information related to health or health care, while disinformation is inaccurate information spread with malintent ¹ ; the difference between misinformation and disinformation lies in intentionality. ² , ³ Although misinformation and disinformation denote different motivations, there is considerable overlap in meaning (e.g., patients who hear disinformation may go on to share misinformation) and parsing or attributing motivations is complicated. For simplicity, we will use the term misinformation to refer to any sharing of mis‐ or disinformation.

Misinformation fuels the concurrent COVID‐19 infodemic, which is an overabundance of information, including true, misleading, and false information about the virus, its origins, potential treatments, and the lifesaving vaccine. ¹ Infodemics cause accurate scientific information to be overlooked or misinterpreted, leading to patient confusion and poor compliance with preventive health measures, resulting in vaccine hesitancy in the case of COVID‐19. ⁴ The U.S. Surgeon General's advisory to building a healthy information environment identified health care professionals and health organizations as important stakeholders for combating misinformation. ⁵ Dr. Vivek Murthy stated that addressing misinformation is “a moral and civic imperative” that will “require a whole of society effort.” ⁵ Similar messaging came from the United Nations through its digital first responders initiative. ⁶ These statements imply that all health care professionals, including emergency physicians, have an obligation to be stewards of factual health information and actively correct health misinformation.

The spread of health misinformation has dire real‐world consequences. ¹ , ² , ³ , ⁷ , ⁸ Online misinformation confuses many public health issues such as vaping, substance use, and gun safety. Inaccurate COVID‐19 information is of particular concern currently due to the scale of the pandemic. ⁹ COVID‐19 misinformation significantly contributes to the prolonged duration of the pandemic and to a large proportion of the 6.4 million COVID‐19 deaths to date worldwide. ¹⁰ , ¹¹ Misinformation enables persistent viral transmission by sowing mistrust in vaccination efforts, government responses, public health guidance, and scientific recommendations. Disinformation has led to violence against government response facilities and health care personnel ¹² ; stigmatization of and violence against those who are infected; and exacerbation of anti‐immigrant, xenophobic, and racist sentiments. ¹³ , ¹⁴ , ¹⁵ , ¹⁶

There has been a global rise in the spread of health misinformation in recent years fueled by the internet and social media. In online communities, the public is no longer simply a passive consumer of health information; instead, they can be unknowingly culpable in the fabrication and dissemination of false content. Misinformation communicated by family members or other trusted individuals can influence a patient's health care decisions, culturizing beliefs within households or social networks. ¹⁷ While it can be difficult for emergency physicians to address such beliefs, useful frameworks for debunking misinformation are available. However, most physicians lack the specific communications and social media training needed to address health misinformation with patients. ¹⁸ , ¹⁹ This represents an important training gap for emergency physicians.

In this article, we describe methods for addressing misinformation in person and online, acknowledge the challenges of tackling misinformation from our physician colleagues, and highlight implications for education and training in emergency medicine. Finally, we offer several actionable interventions that define the role of the emergency physician in the management of health misinformation.

METHODS

We convened a panel of academic emergency physicians with expertise in health misinformation to present a 1‐h panel discussion, “The Role of Emergency Physicians in the Fight Against Health Misinformation and Disinformation,” at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. We used the mechanisms of motivational interviewing as our conceptual framework in preparation for the panel discussion and this paper. ²⁰

The panel was composed of emergency physicians who taught and conducted research about health misinformation. Panelists had published peer‐reviewed manuscripts about health misinformation, presented invited national lectures on the topic, edited a special theme issue of a journal addressing COVID‐19 misinformation and social media, and taught a university research course about COVID‐19 misinformation. ¹ , ⁹ , ¹¹ , ¹⁹ , ²¹ , ²² , ²³ The panelists represented the following geographically diverse institutions: Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University.

We iterated the panel objectives and content through a series of Zoom meetings and asynchronous preparatory work using a cloud‐based shared document. We identified four main session goals: (1) to describe the impact of misinformation on patients, the public, and the health care system; (2) to delineate the roles of emergency physicians in addressing health misinformation with patients and families in the clinical environment; (3) to educate the audience on effective misinformation debunking strategies; and (4) to teach prebunking or inoculation strategies to be used on social media. Our anticipated audience was peer academic emergency physicians affiliated with residency training programs, so we made specific teaching recommendations throughout the panel discussion.

We agreed upon scripted questions from the moderator and drafted answers for the panelists ahead of time. These notes were updated immediately following the panel to serve as a final record of the proceedings.

These efforts yielded a conceptual understanding of the role of an emergency physician in the management of health misinformation, summarized in Figure 1. Effective communication strategies are central to the role. With those skills, physicians can act against various sources of health misinformation by describing its impact, broaching the topic in person with patients and families, debunking it, labeling, and correcting it when encountered online and prebunking it (“inoculating” others with factual information before exposure to misinformation). Each of these actionable interventions mandate effective communications skills and strategic approaches.

FIGURE 1.

The role of the emergency physician in addressing health misinformation.

THE SCOPE AND IMPACT OF MISINFORMATION

Misinformation impacts health care in several ways. Informed by the micro/meso/macro conceptual model, ²⁴ misinformation can lead to changes at three levels: the individual patient–physician interaction, the global health care system, and the public's health and well‐being at large. Understanding these layered effects of misinformation can help inform discussions with patients and identify areas vulnerable to misinformation as well as topics well suited for more productive interventions.

The first stage (micro) involves the direct impact of individual patient decisions on physician–patient relationships. Misinformation can lead to patients taking ineffective or potentially dangerous medications (e.g., antibiotics for the common cold, hydroxychloroquine, ivermectin, and bleach for COVID‐19), ²⁵ , ²⁶ while avoiding effective interventions (e.g., vaccination). ²⁷ These decisions can cause significant harm to patients and damage the therapeutic alliance. Patients may feel mistrust or the perception of being judged by their physicians, which can lead them to be less likely to take prescribed medications, share new concerns with their physician, or engage with the health care system at all. ²⁸

The next stage (meso) impacts health care practitioners and systems. ²⁹ , ³⁰ , ³¹ The battle against misinformation can be taxing on physicians, particularly in the context of existing pandemic‐related stressors. Burnout from constantly addressing misinformation may cause some physicians to develop a more passive role, no longer seeking to either understand patients’ views or help engage patients more actively in their care. This disconnect is unfortunate, as over the past decade there has been increased shared decision making and more active engagement of patients in their health care. ³² , ³³ , ³⁴ However, as the information divide widens between provider and patient, it becomes increasingly difficult to appreciate others’ viewpoints, and shared decision making suffers. Further, disengagement can decrease patient autonomy and increase medical parentalism. ³⁵

At the last stage (macro), misinformation can affect the public's health and well‐being in two important ways. First, there is the multiplicative effect of health information in an increasingly digital world. After all, social medial algorithms are designed to promote user engagement to maximize profit through the generation of advertising revenue. Emotionally provocative content is often more “engaging” than factual ones. ³⁶ Ideas and anecdotes can outweigh evidence‐based information purely by the quantity and catchiness (also known as clickbait) of the story. Misinformation can rise to the top of news and social media feeds, overpowering scientific data and evidence. Digital platforms increasingly tailor content to subpopulations and users self‐select their news sources, creating echo chambers and information silos. These bubbles increase the risk of search satisficing while reducing access to conflicting viewpoints. People then experience the illusory truth effect, wherein repeated health information appears more likely to be true simply due to familiarity and repetition without high‐quality supporting scientific evidence. ³⁷ The second main impact is an eventual override of trust in information as a whole. A combination of poor public understanding of the imperfections of science combined with frequent highly contrasting opinions and data sources can breed information nihilism. ³⁸ As the public loses trust in experts within the scientific community, other sources can fill in this gap, further widening and damaging the physician–patient relationship.

ADDRESSING MISINFORMATION IN PERSON

Approximately 20% of physicians have been formally trained to address the spread of health misinformation. ¹⁸ Most physicians are left to navigate challenging conversations about misinformation through trial and error, potentially wasting valuable time, energy, and emotional resources. ³⁹ , ⁴⁰ , ⁴¹ Some providers dismiss or even belittle those whose health beliefs fall outside of scientific consensus. Doing so alienates patients who are already disaffected by misinformation, leading to further entrenchment of their beliefs and positions. ⁴² Finally, other physicians simply convey facts or label misinformation in an information deficit model. However, an overreliance on this response to misinformation rarely changes patient behavior, and it may even be harmful because people's medical beliefs are closely connected to their identity, values, and culture. ⁴³ , ⁴⁴ , ⁴⁵

Fortunately, several communication strategies aimed at the mechanics of difficult conversations can help emergency physicians address misinformation with patients. For instance, motivational interviewing is a nonjudgmental, active listening framework that has demonstrated utility in addressing vaccine hesitancy. ⁴⁶ , ⁴⁷ Instead of ignoring underlying cultural, emotional, cognitive, and social factors that make misinformation attractive to many, ⁴⁵ motivational interviewing focuses on showing empathy, validating others, building trust, demonstrating respect, and relaying correct information. (Table 1.) This bidirectional conversation between patient and physician is superior to unidirectional information transfer about misinformation.

TABLE 1.

Language to use for motivational interviewing.

Have you taken other vaccines previously?

May I ask why you haven't taken the COVID‐19 vaccine yet?

May I share some of the information that I know about the vaccine?

Would you be willing to be vaccinated today?

If not, that's ok. Please return for the vaccine anytime if you change your mind.

Thank you for letting me share the information I have.

Another effective strategy for discussing misinformation is conversational receptiveness, the use of a set of linguistic markers by those in conflict to show engagement with another's perspective. ⁴⁸ Conversational receptiveness consists of concrete words and phrases that can be incorporated into one's speech on any topic, which can emphasize agreement and positively reframe ideas (Table 2). Using conversational receptiveness makes one seem more trustworthy, objective, and intelligent when discussing divisive issues, such as politics or the COVID‐19 vaccines. Conversational receptiveness is also mimicked, such that expressions of receptiveness by one party in a conversation affect the level of receptiveness deployed by their counterpart. Importantly, conversational receptiveness makes both parties more willing to interact with each other in the future, increasing the likelihood of a continued and more effective patient–physician relationship. ⁴⁸ , ⁴⁹ While motivational interviewing can take time to learn and implement during a busy emergency department shift, conversational receptiveness is more quickly taught and more easily integrated into daily practice. ⁵⁰

TABLE 2.

HEAR mnemonic for conversational receptiveness ⁵⁰

Hedge your claims	“Sometimes”	Soften assertions
	“Often”	Acknowledges uncertainty
		Shows humility
Emphasize agreement	“We both want what's best for your child”	Improves the tone of the conversation
Acknowledge other perspectives	“I understand that finding a natural remedy is important to you”	Demonstrates active listening
Reframe your ideas in positive terms	“Your daughter will feel much safer having your grandson around you after you are vaccinated against COVID‐19”	Establishes constructive tone Increases likelihood that the other person will reciprocate

There are several other brief communications frameworks that emergency physicians can use when approaching difficult conversations about health misinformation. Elicit–share–elicit (elicit–provide–elicit) is a specific type of motivational interviewing in which physicians elicit the patient's existing knowledge about a health topic, share information, debunk misinformation, and then elicit reactions and understanding. ⁴⁴ This dialog increases engagement and builds rapport. Similarly, the three Cs model recommends using compassionate understanding, connection, and collaboration when discussing divisive health issues, which includes those muddled by misinformation. The model promotes trust building in the patient–physician relationship by demonstrating empathy, promoting curiosity, and acknowledging limitations. ⁵¹ Another approach is to view clinical spaces as learning environments in which physicians can apply learner‐centered approaches with patients. These include the creation of a safe “learning” environment, establishment of an educational alliance, the use of scaffolding and appropriate framing when providing patient education and recommendations, and consideration of the sociocultural factors that impact the way patients learn and make health decisions. ²¹

While the approaches described so far may benefit discussions on contentious health topics, for cases specifically having to do with vaccine hesitancy, strong recommendations from health care providers matter; and the language physicians choose to make those recommendations is especially important. For instance, stating “You are overdue for your vaccination” is more effective than saying “What do you think about getting the COVID vaccine today?” ⁵² , ⁵³ , ⁵⁴ Strong recommendations display physician confidence and respect for patient welfare.

The various communication frameworks described above have demonstrated effectiveness for navigating difficult conversations. However, we acknowledge that there is limited or indirect grounding in experimental evidence for use in addressing misinformation specifically. Further research is needed to determine which approaches work best in cases of health misinformation. The methods determined to be most effective in addressing contentious topics such as misinformation can have broad implications and benefits far beyond the COVID‐19 pandemic, such as improving patient satisfaction, decreasing inappropriate prescribing of antibiotics, curbing the overuse of opioids, and rebuilding trust in health care, especially among historically marginalized populations.

ADDRESSING MISINFORMATION ONLINE

Although health misinformation is commonly discussed during clinical encounters with patients, some of the most dangerous misinformation finds its origins on social media. ⁵⁵ As such, there is a need for providers to engage with the public on social media to provide corrections and facts. ¹⁹ Addressing misinformation on social media reduces misperceptions ⁵⁶ , ⁵⁷ and facilitates better health decision making, such as being more willing to accept a COVID‐19 vaccine. ²²

Health care provider social media hesitancy refers to physicians’ reluctance to use their social media platforms to engage the public about health matters. Although studies show that approximately seven out of 10 physicians use social media for professional networking, it is assumed that far fewer engage in public rebuttals of health misinformation online. ⁵⁸ This is unfortunate considering that physicians are the most trusted sources of vaccine‐related information ⁵⁹ and their absence on social media can be considered a public health failure. The true prevalence of social media hesitancy among U.S. physicians is unknown, as is the number of physicians who have received social media training of any kind.

Physicians face significant barriers to professionalizing their social media presence for the purpose of correcting health misinformation online. ¹ , ¹¹ , ²³ , ⁶⁰ Importantly, physicians can be subject to retaliation and intimidation online, with one study showing that approximately one in four physicians have experienced personal attacks and/or sexual harassment on social media platforms. ⁶¹ Additionally, institutional barriers include lack of support for addressing misinformation from hospital stakeholders and the absence of training programs to address health misinformation. Personal barriers include lack of social media training, lack of time, avoidant behavior, and a perception that correcting health misinformation on social media is futile. ¹⁹ Finally, physicians might be discouraged to correct health misinformation on social media if they do not have a large social media following. ¹⁹

Despite these barriers, some residency programs and physician collaboratives have positively engaged the public by providing health education on various social media platforms. For instance, a pediatrics program used Twitter to document COVID‐19–related health inequities at the beginning of the pandemic. ⁶² Likewise, another residency program produced TikTok videos to disseminate credible COVID‐19 information that reached 600,000 views. ⁶³ Another group of residents produced COVID‐19 videos for a Chicago‐based WeChat group composed of 500 non–English‐speaking patients. ⁶⁴ Finally, the Illinois Medical Professional Action Collaborative Team (IMPACT Team) utilized Twitter to combat misinformation during the COVID‐19 pandemic. ⁶⁵

Curriculum development is necessary to provide appropriate social media and misinformation training to physicians and residents. Current works by Bautista et al. ²³ and Yilmaz et al. ⁶⁶ can be used to design such curricula. Efforts would ideally include training combined with hands‐on practice establishing professional social media accounts, mentorship, and feedback on social media presence. Training would focus on teaching physicians to identify and correct misinformation on various platforms. ¹⁹ Table 3 provides a five‐step method for debunking health misinformation online that can be integrated in training curricula. ⁶⁶

TABLE 3.

Five‐step method of debunking health misinformation online.

Label misinformation found online Respond immediately to identified misinformation Provide correct medical information State correct information twice Include a reference

Finally, hospital administrators should sponsor social media training and encourage online misinformation debunking by their physician employees. ⁶⁷ Hospitals must revise their social media policies to better support and not deter physicians from engaging the public on social media. Research shows that U.S. nurses and physicians who perceive support from hospital stakeholders (e.g., administration, superiors, coworkers, and patients) in correcting health misinformation were more willing to do so. ⁶⁸

ADDRESSING MISINFORMATION FROM COLLEAGUES

Misinformation may be confused with accurate health information, particularly if technical language is used or if misinformation is spread by health care providers. It can be particularly difficult for laypeople to sort reliable information from credentialed health professionals, and repeated exposure to debunking and repeated misinformation may also degrade their sense of a knowable, objective truth. ⁶⁹ Physician‐spread misinformation can have deleterious consequences on patient health, undermine the patient–physician relationship, and affect policymaking.

Emergency physicians are obliged to be truthful with patients about their diagnoses and treatments. As professionals, we have an ethical duty to use our privileged position as licensed practitioners with specialized knowledge and clinical experience to make relevant health information available to the public, including combating misinformation from other health professionals. ⁶⁵ , ⁷⁰ , ⁷¹ Refraining from debunking when others—including other health professionals—spread misinformation is not just an abdication of our duty, but essentially cedes the “debate” to the purveyors of misinformation.

The Federation of State Medical Boards (FBMS) and the American Board of Medical Specialties (ABMS) released statements in 2021 that physicians who spread disinformation and misinformation related to COVID‐19 risk sanctions and disciplinary action from state medical boards. ⁷² , ⁷³ A physician‐led grassroots organization, No License for Disinformation, was created to empower physicians to report colleagues’ spread of misinformation and to call for disciplinary action. ⁷⁴ Board actions and other official sanctions are incredibly rare, however, possibly discouraging physicians from reporting colleagues. ⁷¹ However, physicians can take critical and immediate action by debunking misinformation from colleagues via traditional media and social media. And while medicine has historically been a profession that polices itself via medical societies, professional, and state boards, for various reasons our existing oversight organizations may not have the wherewithal to sufficiently combat purveyors of misinformation. If we do not keep our own profession in line, we will erode public trust in all physicians. ⁷¹

DEBUNKING

Debunking is the labeling or exposure of falsehoods, and physicians can effectively debunk health misinformation. Because of enduring public trust, health professionals can communicate information that changes beliefs, attitudes, and behaviors. ⁶⁹ Those exposed to misinformation and subsequently corrected by trusted sources are less likely to share the misinformation on social media. ⁶⁹ Simply put, debunking can make a difference. Maintaining professionalism while debunking is essential to maintaining our role as trusted sources of expertise.

Much of the audience for debunking is often hidden. Many participants in social media are lurkers, passive readers who follow conversations and act as consumers of misinformation debunking without overtly contributing to conversations. Lurkers’ participation may be receptive only but likely represents a sizable audience who receives similar benefits of debunking as active discussion participants. ⁷⁵ We posit that lurkers may benefit from learning counterarguments to common misinformation, which can help them understand why the misinformation is incorrect so they can correct misinformation when encountered in the future. Concerns that debunking misinformation may lead to a backfire effect whereby the act of debunking inherently repeats, and therefore reinforces the misinformation, are likely overblown. Experts recommend debunking without concerns for backfire effects. ⁷⁶

Ultimately, the footprint of debunking is likely much larger than what we can see firsthand. In fact, many of those who are peddling misinformation online are not acting in good faith, including content polluters such as paid trolls and automated bots. ¹² Our personal assumptions of patients’ reception to our debunking are almost certainly more negative than the impact we can actually have. Additionally, social media engagement can lead to supportive community building among other health professionals that can provide much‐needed support. ⁶⁵ , ⁷⁷

We recommend considering the source of misinformation and potential audience when debunking. For example, sharing a screenshot of a relevant part of a misinformation article along with the debunking information can provide the audience with the appropriate context and correct information, while potentially mitigating further exposure to misinformation by sharing the link to the source. Ignoring and at times blocking bad faith actors may save both the audience from further misinformation exposure and the debunker from unnecessary stress and distraction. On the other hand, when correcting misinformation from a non–health professional with a large audience, e.g., a celebrity who shares misinformation, it might be advantageous to reply directly to the original post, so other readers can see the accurate information.

PREBUNKING

Efforts to debunk misinformation may have limited reach in certain contexts. There is no guarantee that debunking efforts will reach those who have been exposed to misinformation. Additionally, it is difficult for individuals to unlearn information. Instead, physicians might focus on inoculating against misinformation, or prebunking. Prebunking involves addressing manipulation tactics and falsehoods preemptively. ⁷⁸ Inoculation against misinformation is akin to vaccination—individuals who have been exposed to a weakened or powerless form of misinformation build resistance to future misinformation attacks.

Ripe targets for prebunking includes anticipated questions, areas of confusion, preexisting narratives that could be exploited, or tactics used to manipulate. Prebunking can take several forms. Fact‐based prebunking corrects false claims. If a medical myth or rumor is starting to gain traction or starting to “trend” online, prebunking it before it becomes “viral” can protect others who later encounter the false information. Source‐based prebunking exposes bad information sources. Finally, logic‐based prebunking reveals tactics that bad actors use to manipulate. ⁷⁹ Recognizing tactics can help empower individuals to better identify specific pieces of false information. ⁸⁰

Effective communication over social media includes using the same platforms as a targeted audience, meeting the audience where they are, and using efficacious strategies. If misinformation is being spread over TikTok, then efforts to inoculate against or combat misinformation must be targeted to that platform. In addition, the messaging presentation is critical. Infographics that display simple and alluring data and messages are powerful in social media. Individuals are captured by images more than text. Misinformation campaigns have leveraged these shareable and attractive graphics as a means to engage the audience. Prebunking and debunking efforts can also use this messaging strategy to combat misinformation—simple and attractive images.

Regardless of the audience, one practical way to respond to misinformation is the fact–warn–explain fallacy–fact model. ⁸¹ The premise of this model is that people remember the first and last things better than information that comes in between. So, share a fact that is brief, memorable, and clear. For example, “The COVID‐19 vaccine does not affect fertility.” Then, warn the individual that misinformation is coming. Next, explain the fallacy. Sometimes the fallacy is unintentional and other times intentional tactics are used. In this example, one might say, “Some have stated that the spike protein in the COVID‐19 vaccine is very similar to a protein in the placenta and could attack the placenta. This is not true. Studies have shown the proteins are quite different.” Last, repeat the fact. “The COVID‐19 vaccine does not affect fertility.”

Although strategies of prebunking and debunking may be similar across audiences, effective messaging must be tailored to specific communities. For example, messaging targeted toward physician colleagues may include technical language and be data rich. In a nonmedical population, this same messaging is less likely to be effective.

IMPLICATIONS FOR EDUCATION AND TRAINING IN EMERGENCY MEDICINE

Existing efforts to teach communication skills to residents generally focus on breaking bad news, goals of care conversations, conflict resolution, team leadership, negotiations, and the management of “difficult” patients. ⁸² There is a dearth of instruction aimed at preparing future physicians to effectively address health misinformation. Therefore, the evidence‐based communications frameworks described should at least be offered, if not required, as part of the emergency medicine residency curriculum. In addition, in‐person and online communication skills to address health misinformation should be included in the next iteration of Model of the Clinical Practice of Emergency Medicine within the category of “Other core competencies of the practice of emergency medicine” spanning “interpersonal and communication skills,” “system‐based practice,” “professionalism,” and “practice‐based learning and improvement.” ⁸³ Programs and institutions, in collaboration with their offices of graduate medical education, should provide guidance to help residents establish professional social media accounts, disseminate factual information, and correct health misinformation. ⁹ , ⁸⁴

Faculty role‐modeling of proper responses to misinformation, as well as coaching and mentorship on the use of social media, are critical components of a sufficient education and training response to the spread of health misinformation. If faculty themselves have not been trained in misinformation communication or professional use of social media, educational opportunities should be made available to them as well. ⁶⁶ Further research is needed to evaluate the optimal instructional design that best achieves patient level outcomes. ⁸⁵ Best practices are needed to guide further generations of emergency physicians to more effectively combat health misinformation.

CONCLUSIONS

Effective communication skills are essential to the role of emergency physicians in addressing health misinformation in person and online. There is a need for formal misinformation and social media training for emergency medicine residents and faculty physicians. Implications of health care provider social media hesitancy are significant and must be addressed. Future research must determine effective educational interventions and optimal approaches to addressing health misinformation that promote behavioral change.

AUTHOR CONTRIBUTIONS

All authors made substantial contributions to the conception of the work. Each author was assigned one or more sections of the manuscript, performed the literature search, and drafted their assigned section(s) of the manuscript. Alexander Y. Sheng, Michael A. Gisondi, and Michael Gottlieb contributed to critical editing the manuscript. Michael A. Gisondi provided supervision throughout the entire process and made extensive edits to the manuscript. Alexander Y. Sheng prepared it for publication. All authors gave final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Sheng AY, Gottlieb M, Bautista JR, Trueger NS, Westafer LM, Gisondi MA. The role of emergency physicians in the fight against health misinformation: Implications for resident training. AEM Educ Train. 2023;7(Suppl. 1):S48–S57. doi: 10.1002/aet2.10877