Social media is being adopted by healthcare professionals as a platform for education. For the busy, multitasking, and millennial learner, the interest and appetite for free open access medical education (FOAMed) continues to grow. This presents challenges to the educator by shifting from didactic based learning (behaviorist learning) to collaborative creative learning (constructivist learning). Behaviourism is instructor centered with a passive learning style, however constructivism involves student centered construction and is a more active method of learning.(L. Flynn et al., 2015) Social media and FOAMed are fraught with critiques of how one ensures high quality educational materials which are externally valid. In the Emergency Medicine literature, organizations have tried to develop different criteria and scoring systems.(Chan, 2018; Lo et al., 2018) Arguably even when compared to one another, recommended quality appraisal tools may be no better than looking at popularity and gestalt.(Ting et al., 2020) However, others argue that the open access forum itself helps to police the dissemination of erroneous information and foster open and instant communication.(Nettle, 2018; Panahi et al., 2016)
The Skeleton Key Group (SKG), named after the classic “fishbone” skeleton (Fig 1) used by clinicians to write down serum electrolytes in shorthand form, is an online collective of nephrology fellows dedicated to learning and teaching electrolyte pathophysiology. The group started in September 2019 with one faculty member and two fellow editors. The vision was to develop a collective of trainee-based, peer to peer education involving nephrology fellows around the world. The primary goal of the group is to further participants’ education on electrolytes. Group members teach each other skills of electrolyte pathology and how to present and teach electronically via social media. group members are continually added based on expressed interest and include interns, resident physicians, and fellow physicians and are as involved in the discussion and construction of group materials per their discretion.
Fig 1. Derivation of the “Skeleton Key” based off “fishbone” skeleton format to write in shorthand form serum electrolytes
Multiple educational materials from this collaboration are generated. First, a foundational case report is constructed with key learning points. The case report follows a familiar “morning report” premise with case presentation, detailed discussion on differential diagnosis, further work-up, and management. There is a focus on electrolyte abnormalities in terms of symptoms, work up, pathophysiology, and management in terms of manipulating the kidney’s ability to handle electrolytes. The monthly case reports are constructed off de-identified, real-patient case data. Group members discuss the case and other materials using a private message service on Twitter to provide critique, constructive criticism, and additional bits of knowledge. Other materials build on the case report to cater to different learning styles and to enhance the educational value and key points of the case report. These include visual abstracts, tweetorials, follow up quiz questions. Group members volunteer to construct any of the materials, and input from all members are encouraged.
What little data exists on the impact of social media and tangible educational outcomes is conflicting. Overall social media is considered to have a positive impact on learners, and in one medical school, up to 50% of students utilized social media to enhance their learning.(Cheston et al., 2013; Friedman et al., 2019) Despite most people reporting utilization of social media to stay engaged in continuing medical education (CME) and benchmarks for clinical practice, social media did not result in an uptake of CME materials despite using a varied media approach.(S. Flynn et al., 2017; Panahi et al., 2016) Tangible results regarding measurable outcomes is varied. There is little data about use of social media affecting educational performance. In a review, there was no difference in test scores among students who did and did not use social media for medical knowledge, however active participants in online blogs did have higher test scores than those who posted less often.(Cheston et al., 2013; Panahi et al., 2016) This suggests that a reported positive educational impact may translate to measurable educational outcomes.
In light of this history, we sought to identify the educational impact of the SKG. Our primary objective was to determine if trainees involved in the SKG felt the experience added to their medical education in terms of medical knowledge and manuscript construction. Secondarily, we assessed whether involvement in the group was able to impact the self-reported ability to cultivate skills needed for scholarly activity, such as ability to evaluate and edit manuscripts and the ability to collaborate and teach. We were also interested in assessing if our readers/users found our educational materials useful especially during the COVID-19 pandemic.