Multiple Wins: Embracing Technology to Increase Efficiency and Maximize Efforts

Abstract

Clinician educators (CEs) are challenged to produce meaningful scholarship while balancing various clinical and administrative roles. The increasing availability of technology provides new opportunities for scholarly output and dissemination. This article proposes three strategies for utilizing technology to enhance scholarly output for the busy CE. The strategies are supported by real examples of these techniques, followed by a discussion of potential limitations and future directions.

Clinician educators (CEs) juggle competing roles as clinicians, teachers, and program administrators.1 In most institutions, there is the added expectation that faculty produce scholarship as part of the institutional academic mission, as well as for career advancement. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) requires faculty to regularly participate in research and insufficient scholarly activity by faculty is the most common citation within emergency medicine (EM).2, 3 The question for many CEs is: What defines scholarship and how can they align their education roles to produce scholarship that advances their work of educating the next generation of physicians?

Boyer4 refined the definition of scholarship in academia and Glassick5 built on his framework by proposing criteria to adjudicate scholarship: it must demonstrate clear goals, adequate preparation, appropriate methods, significant results, effective presentation, and reflective critique.4, 5, 6 The Canadian Association for Medical Education's definition of education scholarship is “an umbrella term which can encompass both research and innovation in health professions education. Quality in education scholarship is attained through work that is: peer‐reviewed, publicly disseminated, and provides a platform that others can build on.”7

Educators often struggle to create meaningful scholarship that aligns with and integrates their other education duties. In contrast to the clinician scientist, whose training, role, and protected time typically prepare and facilitate scholarship, CEs may feel inadequately prepared and/or resourced for their additional scholarship mandate. Medical educators report challenges to achieving the level of scholarly productivity they aim for, including time, funding, access to expertise, mentorship, and a lack of intrinsic and extrinsic reward from attempting to produce scholarship in the existing academic paradigm.8, 9, 10 While systemic interventions to help CEs accomplish the academic mission of institutions to produce scholarship are needed,11 we propose three principles to enhance scholarly output through the use of technology.

Embrace the Virtual Communities

In the past decade, inspired by the growing influence of social media to connect and facilitate collaboration, the Free Open Access Medical education (FOAM, or #FOAMed) movement has emerged. Within this movement, there has been the development of virtual communities of practice that have transcended institutions and time zones. A community of practice is a voluntary, collaborative network of professionals working together to develop shared understandings and engage in knowledge building.12 In these virtual communities of practice, the lines between “learner” and “educator” are blurred, and members come together in a digital shared space to develop, discuss, and disseminate education resources.13, 14, 15, 16 Although this movement was inspired to improve learning, it has also created an environment of scholarship, as educators discover the power of the virtual community to facilitate efforts to collaboratively produce, peer review, and disseminate innovations.

Clinician educators can embrace social media to improve access to peers and mentors in geographically disparate locations.17 CEs at institutions without adequate mentorship can more easily connect with mentors at other institutions in a virtual space. CEs can locate peers with similar interests outside of typical institutional limitations to discuss novel ideas and collaborate on multi‐institutional projects. A further value may be the utilization of social media platforms (e.g., Twitter, Facebook, Instagram) to crowdsource the global EM community regarding opinions on a specific topic or to assist with targeted literature reviews.18 Finally, study collaborators can utilize open access software with real‐time editing (e.g., Google Drive, Google Docs) to write and edit a paper simultaneously with their geographically dispersed coauthors.

A prime example of this is the Academic Life in Emergency Medicine (ALiEM)/Annals of Emergency Medicine Global Journal Club.19, 20 This series harnessed the power of Twitter conversations, live video chats with the study authors, and written discussions hosted on the ALiEM website to facilitate international virtual journal clubs discussing new and important publications. This approach allowed for both extensive scholarly discussion and dissemination of modern research, as well as partnership with the Annals of Emergency Medicine editorial staff to turn the discussion itself into a peer‐reviewed and published product.

Consider Alternate Channels to Disseminate your Work

In the digital age, self‐publishing is easy. Digital platforms (e.g., blogs, e‐books) offer an accessible channel to disseminate scholarly innovations. A recent consensus conference articulated the academic merits of social media–based scholarship.17, 21 Although there has been skepticism about the quality of these publication platforms, many scholarly blogs are beginning to incorporate peer review procedures to increase the academic rigor of their work.22, 23 In fact, some institutions are beginning to incorporate social media publications into their tenure and promotion processes.24

Regardless of whether educators receive academic credit for their social media–based scholarship, alternative digital publishing portals can be a great way of disseminating work. Using virtual social networks to engage in knowledge translation can be a great way to ensure that good ideas reach more people than with traditional print media. For educators who lack the time to run their own blog, a number of academic EM and medical education blogs invite guest contributions as well. Multiauthor blogs (e.g., FemInEM.org, ALiEM.com, ICEnetblog.royalcollege.ca, CanadiEM.org) have mechanisms for external submissions that can give new authors greater reach when they are first starting out. Additionally, peer‐reviewed repositories of educational scholarship, such as MedEdPORTAL (MedEdPORTAL.org) and Portal of Geriatrics Online Education (POGOe.org), provide further routes for dissemination. For further examples of virtual dissemination opportunities, see Table 1.

Table 1.

Potential Dissemination Opportunities

Name	Website
Academic Life in Emergency Medicine CanadiEM Cureus EM Sim Cases FemInEM iCollaborativea International Clinician Educators MedEdPORTAL Portal of Geriatrics Online Education Journal of Education and Teaching in Emergency Medicine	http://www.ALiEM.com http://www.CanadiEM.org http://www.cureus.com http://www.emsimcases.com http://www.FemInEM.org https://www.mededportal.org/icollaborative/ ICEnetblog.royalcollege.ca http://www.MedEdPORTAL.org http://www.POGOe.org http://escholarship.org/uc/uciem_jetem

^aNot peer reviewed.

Finally, many writers find it fruitful to publish curated collections of their blog posts as e‐books. The Apple iTunes platform allows authors to publish for free if the publications are released for free. ResearchGate (ResearchGate.net) also allows users to upload PDFs of their work to their network. The ALiEM Medical Education in Cases (MEdIC) Series has used both of these routes. With additional copyediting, the ALiEM MEdIC blog post series (http://www.aliem.com/medic) was curated into two volumes of faculty development e‐books.23, 25 Other examples of academic blogs that have assembled their work into e‐books are the Emergency Medicine Cases Digest series (https://emergencymedicinecases.com/em-cases-digest/) and the Skeptics Guide to Emergency Medicine podcast e‐book (http://thesgem.com/2015/06/sgem125-im-so-excited/).

Go for Multiple Wins

Educators are constantly brainstorming innovations to solve education problems. However, it is important to have a process to systematically capture and evaluate these innovations to determine which ideas are best suited for carrying forward through the additional steps required of scholarship. Although well‐meaning mentors may encourage educators to constantly “write that up,” a more selective approach is necessary. Not every project should be carried forward to the stage of scholarship. For innovations meriting a scholarly approach, attention to multiple wins will ensure that the busy CE is efficient and effective in their career.

Bear in mind that multiple wins does not mean submitting one innovation to multiple journals for publication (i.e., self‐plagiarism) or artificially separating out study elements to create multiple publications from a study addressing one concept (i.e., “salami slicing”).26 Rather, applying a scholarly approach to education problems that are novel and widely applicable ensures that the resulting innovation can both influence the education community and earn recognition from one's institution. Educators will find that a rigorous approach includes sequential steps, many of which can be translated into scholarship, which results in a thoughtful educational intervention and opportunities for recognition and career advancement and may facilitate educators developing a niche or program of scholarship.

It is important to consider that you may use digital technologies differently for each phase of your scholarly work. For instance, some collaborators have harnessed the Internet to connect and “beta test” their ideas. As a digitally connected scholar, you might workshop your ideas with other like‐minded individuals online. To our knowledge, there is at least one such instance has led to a subsequent work of scholarship.27

Another way to beta test an idea would be to write blog post sharing your early work on an educational intervention so that you may share these ideas openly with colleagues. Venues where you might submit an early report of an interesting educational idea include ALiEM.com's Ideas in Didactics and Educational Activities series or CanadiEM.org's Featured Education Innovations series. If you have a simulation case, you can submit it for peer review and distribution at EMSimCases.com. These academic blogs have an active following, and the post is often vetted by a large and interested audience of CEs. This can allow for rapid feedback prior to study completion or journal submission. Additionally, by showing your early work, other like‐minded individuals can find you, which may lead to subsequent collaborations. Since medical education journals are now looking for more multisite, collaborative studies, putting yourself out into the blogosphere may be a great way to create and expand your network.

When performing a literature search for a study or publication, consider maximizing your existing efforts by converting the newly cultivated knowledge into a blog post or podcast on the topic. This allows other readers to benefit from the cultivation of resources and knowledge, while also allowing you to further develop your niche.

Box 1 features a biographical case study of a junior CE whom has found success in using a multiple wins strategy and merging both traditional and atypical avenues for scholarship.

Box 1.

A Case of Multiple Wins

An example of effectively merging traditional and atypical avenues for scholarship has been demonstrated by one of our coauthors (TC) and her colleagues.

Step 1: Creating a New Blog Series

Early in 2013, fresh out of residency, TC noted that there was a paucity of faculty development resources within the online EM education landscape. Along with a colleague (Dr. Brent Thoma), she approached the editor‐in‐chief (Dr. Michelle Lin) of a major online educational outlet (ALiEM.com) about an idea to develop an online problem‐based learning (PBL) case series. This series would later be named the Medical Education in Cases (MEdIC) series. Each month, the blog would post a messy, fictional case that featured a common situation in medical education. The blog hosts would then welcome participants from the online readership to comment, tweet, and interact with the case moderators (TC, BT, and ML) about the case. These responses were then curated into a single commentary (“curated community commentary”) and posted as a second post that would act as the debriefing and wrap‐up for the previous case discussion. Alongside these posts would be two presolicited expert commentaries that would add further depth to the case.

Step 2: The First Traditional Scholarly Win

Over the first 6 months, these cases became very popular and resulted in vigorous discussion. Consequently, the collaborators collected Web‐based demographics and descriptive statistics on usage for the cases over the first 6 months. The results of these were then assembled into a conference abstract at the International Conference on Residency Education in Toronto 2014, which was chosen as a Top 5 “What Works” innovation abstract for this conference.

Step 3: Following Through From Abstract to Paper

Riding off of the series’ success, the same scholarly group then went on to write an innovation report about the MEdIC series within a major medical education journal.30 They expanded upon the underlying education theories that powered the series’ success and reported these findings to explain to others how their process occurred.

Step 4: Repurposing the Blog Posts Into an e‐Book

Knowing that many readers may not have the time to assemble and download individual posts, the MEdIC series editors saw an opportunity to use other forms of electronic distribution to ensure maximal impact for the cases. With the assistance of a professional copy editor and fairly significant layout expertise from one of the editors (TC), the first year's worth of MEdIC series cases were compiled alongside the expert responses and curated commentaries into a singular e‐book (https://itunes.apple.com/us/book/medical-education-in-cases/id929609481?mt=13). The second year's worth of cases has also been compiled into a book, and the third year's worth of cases is presently being edited.

Step 5: Other Scholarly Pursuits

Meanwhile, the open data presented by this online case‐discussion series posed an opportunity for research‐based scholarship. With the assistance of trainee investigators, this scholarly team was able to conduct a study examining the effect of anonymity on the comments within the MEdIC series online discussions. This work was subsequently published within a new online open access journal, Cureus.com.31

Step 6: Conference Workshop

The editors of this series have also been invited to provide workshop experiences based on these cases. This team has run a workshop at the Social Media and Critical Care (SMACC) conference in Chicago 2015 wherein they taught an international assembly of CEs their method for generating cases.

To date, the mixture of both traditional and atypical scholarly efforts surround the medical education in cases (MEdiC) series has created a mixture of opportunities for blending online scholarship with new forms of scholarship.

Limitations

There is a danger in the endorsement of technology as a panacea to the challenges of scholarly production. The incorporation of technology does not change the standards required of scholarship as articulated by Glassick.5 Neither do the standards for authorship established by the International Committee of Medical Journal Editors change.28 Technology can improve efficiency and aid the junior investigator in rapidly developing a professional network; however, the hard work of design, implementation, and measurement must still be carried out.21

Digital scholars should also be attentive to issues of copyright and misrepresentation. Reposting of original content accepted by print media on digital or social media platforms without consent is not permitted. Attention should also be given to not representing a single innovation as multiple innovations on a CV or portfolio, when posting the innovation on multiple digital platforms without acknowledging the original source. The ease of transfer of an idea onto a digital platform should be cautiously governed to ensure that the ownership of the scholarship and how it is represented are appropriate.

Furthermore, the speed of publication on digital platforms removes the previously built‐in publication process pause for sober second thought. Specifically, a period of reflection and critique is frequently not incorporated into digital publication cycles. A thoughtful scholar will insert an intentional delay to allow personal reflection, and ideally prepublication peer review, to ensure that the quality and design of the innovation is of a standard to enhance and not tarnish their reputation. To be explicit, not every innovation needs to be built to the standard of education scholarship, nor does every innovation need to be disseminated. Effective scholarship will triage and curate their innovations to determine the most promising to evaluate and disseminate. Effective scholars will ensure in‐house peer review before wider dissemination occurs and the postpublication peer review process is initiated.

At our home institutions, there is variable uptake of these various formats of scholarship. At one institution, there has been much excitement about the distributive qualities of some of these online educational modalities. Senior members of the administration have taken note and have requested that the authors assist with incorporating e‐scholarship into departmental merit systems. Meanwhile, the promotion and tenure committee members are still primarily making decisions based on traditional scholarly outputs (e.g., papers published, classes taught). As a result, this one institution remains in a transitional state wherein the e‐scholarship (e.g., blog authorship/editorship, podcast creation) have still not been fully integrated. In the other authors’ institutions, despite departmental support for virtual scholarship, the promotion and tenure committees are not perceived to recognize digital scholarship as carrying the same value and import as traditional scholarly activity.

Future Directions

Futurecasting is fraught with danger. However, with that acknowledgement, digital technology may evolve education scholarship in at least two areas. The first area involves opening the dialogue between a scholar and their audience. Rapid postpublication peer review is possible with digital channels. Crowdsourced review specifically helps identify issues of generalizability. Virtual journal clubs29 help a scholar identify issues of translation and implementation in contexts different from the source of the innovation. Digital platforms allow scholars to expand and clarify their work. This type of dialogue is one of the criteria of scholarship endorsed by the Social Media Summit on Health Professions Education.21

Finally, digital platforms facilitate alternative metrics to establish the influence and impact of scholarship. Current scholar metrics focus on how a scholar has influenced others via their citation rate (e.g., h‐index). Digital platforms can determine how a scholar influences an audience via surrogate markers of downloads, shares, and endorsements (e.g., retweets, Facebook likes). This expansion of the zone of influence (from other scholars to the wider education community) allows a refocusing of the priorities and appropriate stakeholders for education scholars.

Conclusion

Clinician educators are challenged to produce scholarly output in addition to their clinical and administrative responsibilities. This article discussed three strategies for utilizing technology to increase efficiency and improve scholarly output. While the individual needs of each educator can vary, it is the hope of these authors that the above techniques prove valuable to the busy clinician educator.

AEM Education and Training 2017;1:185–190. © 2017 by the Society for Academic Emergency Medicine