New media and critical care ultrasound

Abstract

The paper discusses the issue of spreading medical knowledge, connected particularly with ultrasonography, by the social media. Such a way of sharing knowledge and experience results from the needs of recipients – physicians who daily have limited free time. The paper presents the phenomenon of the free open access medical education (FOAM) along with its genesis, an open and global nature as well as the main communication channels. It is emphasized that education via the social media is becoming an element of the mainstream medical didactics. The aforementioned phenomenon is depicted in greater detail in the context of emergency ultrasonography. US imaging is one of the more popular issues in the FOAM community. The paper focuses on the Ultrasound Podcast and the initiative associated with it. Our native (Polish) project, CriticalUSG, is also presented together with its numerous editions. Apart from these two projects, other initiatives, which are equally important not only due to ultrasonography, are also briefly mentioned. The aim of the paper is to interest the reader with the FOAM phenomenon as an open access, free and global medical discussion.

The revolution, which is the application of ultrasound in life-threatening conditions, happens also in the age in which medical education has spread beyond the textbooks and lecture halls.

Practicing physicians refine their knowledge by searching for answers to given clinical questions. With limited free time, they cannot devote it to reading thick tomes. They can, however, access the Internet and the social media. This way, a community of physicians was created who share their knowledge freely. The natural need for professional training in limited free time has found the solution in the free open access medical education (FOAM) – a new initiative based on internet resources and a community of enthusiasts. It is worth adding that the cradle of this “movement” is Australian emergency medicine and intensive care.

It is difficult to precisely describe this phenomenon in such a brief discussion since it is an extensive, alive and evolving subject. It is based on the activity of enthusiasts who operate with a certain ethos in mind and who use the social media. One might say that this is a global medical agora that teems with life. It can be found in blogs, podcasts, Twitter, Google+, Facebook, on-line videos and presentations, articles and graphics – the list is not exhaustive. The content contributors, recipients and commentators meet together, and their authority is not based on the university degree, but rather on clinical experience and didactic gift. The idea of FOAM is to share high-quality and reliable knowledge with colleagues free of charge. Some even argue that it is a contemporary form of the principles of Hippocrates: “…to teach them this art – if they desire to learn it – without fee and covenant”⁽¹⁾. FOAM is not a form of e-learning that consists in presenting a portion of knowledge and monitoring progress of the learner. A textbook-based and static pattern gives it a rather academic tone, which is contrary to what FOAM is. FOAM has a dynamic nature and is characterized by high freedom.

However, the fact that this is not an unserious or silly initiative is proven by the fact that after a comment criticizing the data analysis was published on the “Intensive Care Network” blog, the authors of the paper from a prestigious “New England Journal of Medicine” were forced to correct their article^{(2, 3)}. Moreover, the wide usage of FOAM discussions and materials in the emergency medicine and intensive care teaching programs are also discussed, which is associated with research on effective ways of teaching.

Therefore, the issue of ultrasound in life-threatening conditions seems to be created for shearing the knowledge connected with it on a social networking platform. It is not surprising then that there exist at least several excellent sources devoted to it.

One of the most popular is the Ultrasound Podcast – a broadcast created by three American physicians: Matta Dawsona, Mike Stone and Mike Mallin. Most of the episodes are simply conversations in which recent news, case reports and conference reviews are discussed. The episodes are conducted by invited experts who discuss both clinical problems and basics concerning ultrasonography. The broadcasts are characterized by natural language, sense of humor and undoubted enthusiasm. The creators of the podcast are also authors of an electronic textbook and hosts of the CastleFest conference which quickly gains popularity and is entirely devoted to ultrasonography in emergency medicine and intensive care. They have also “crafted” a new mobile application called One Minute Ultrasound which presents the essence of ultrasonography in life threatening conditions in several one-minute long films. These US courses are “icing on the cake” but surely the trio has not said the last word yet⁽⁴⁾.

Attention should be paid to our native, Polish part in the world of FOAM, i.e. to the CriticalUSG, at least for patriotic reasons. At the beginning, it was an independent initiative of the Polish group promoting education and usage of ultrasonography in emergency medicine, anesthesiology and intensive care. Now, it is under the auspices of the Polish Society of Anesthesiology and Intensive Care. The operation of this group is multidirectional, with their own published textbook, internet website, renowned courses and activity in the social media. In 2012, the CriticalUSG started its operation on one of the social networking platforms and has gathered about 700 followers and commentators of the presented materials, courses and conferences⁽⁵⁾.

The two examples mentioned above are just a tip of an iceberg. How to start and keep up with the knowledge and discussions concerning ultrasonography with the use of such scattered resources, the numbers of which keep increasing? The personal experience of the author indicates that following discussions on Twitter and Google+ – two social networking services – allows all important events in the community to be witnessed. The key word (the hashtag) which filters the topic of ultrasonography in this flood of information is “#FOAMus” (a blend of FOAM and ultrasound). By following entries marked by this hashtag, interesting case reports, discussions and reports from ultrasound conferences will not be overlooked.

Moreover, the community called EMCrit (Emergency Medicine and Critical Care) is also worth joining by means of the Google+. It was formed by Scott Weingart, a physician from New York who is acknowledged for his openness, passion and professionalism. He discusses the issue of ultrasonography in the emergency room very frequently. He emphasized that it is one of the elements that “bring upstairs intensive care downstairs.”

There are a lot of people like Scott Weingart or Mike Cadogan from Life in the Fast Lane – also the pioneer of the “movement.” Owing to the idea of open education and social networking platform, we know about these people and can take advantage of their experience.

When discussing the issue of sharing experience, it must be mentioned that the new media and the immediate nature of passing information enable interventions to be implemented overnight. This has happened with US-guided cannulation methods or visualizing the localization of the endotracheal tube cuff. This makes a huge difference compared to, for instance, “bringing back” news from conferences or waiting for publications the publishing cycle of which takes months.

To sum up, it must be admitted that medical education is changing due to technology and is becoming open and global. Ultrasonography in life-threatening conditions and in anesthesiology is one of the most common issues discussed in the FOAM community, which proves its usefulness and growing commonness. Passing on information by means of the social media is convenient for an anesthesiologist because the main area of interest is not ultrasonography as such, but merely answers to selected clinical problems. Finally, I would like to encourage the readers to conduct their own investigations in this matter.

Conflict of interests

The author reports no conflict of interests.