The ultimate responsibility of health professions educators is to improve patient care through knowledge translation, which is defined as “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health” and also as the “know-do gap.” This is at the core of the educator’s mission. However, the pace and processes for such knowledge translation in medical education have been sluggish and inefficient. Previous studies have found that it takes up to 17 years for original research to change clinician behavior in regard to patient care. Since these articles were published, however, the emergency medicine online education community has seen a rapid adoption rate of social media platforms (eg, blogs, podcasts, Twitter) to facilitate information delivery. These new media platforms for education could help minimize the delays in knowledge translation.
Journal Clubs: Critically Appraising Original Literature
Emergency medicine residency programs uniformly implement a journal club or evidence-based medicine series to meet emergency medicine Residency Review Committee curricular requirements. These sessions are often inconsistent, of variable quality, and difficult to execute, given the lack of resources and available expert facilitators to critically appraise articles.
In 2013 and 2014, the Academic Life in Emergency Medicine (ALiEM) blog-based organization partnered with Annals of Emergency Medicine to launch a 1-year pilot series to conduct an online, global emergency medicine journal club. This partnership aimed to create a novel approach to accelerating knowledge translation in today’s digital era. The online journal club selected articles already featured in the Annals Journal Club and Residents’ Perspectives series, and used social media technologies and facilitation techniques already developed by the ALiEM team.
We used a multimodal social media strategy to encourage awareness, participation, and engagement with the online community. The goal was to minimize barriers for participation by hosting discussions on multiple platforms such that participants would not have to learn a new social media platform. The ALiEM team, Annals team, and journal article authors promoted the upcoming week-long journal club discussion through social media channels in the week leading up to the launch. Midweek, a live Google Hangout on Air videoconference was recorded and shared on YouTube, featuring the journal authors or topic experts. For online journal club events hosted later in the series, podcasts were created with audio segments from the videoconference. During the journal club week, discussions were concurrently facilitated on the ALiEM journal club blog post, Twitter, Facebook, and Google Plus. Two weeks after the journal club launch, participant comments and social media analytics were collected and curated. The summaries were published in Annals , highlighting the diverse critical appraisals and shared experiences by clinicians from around the world. The Figure summarizes the timeline, and Table 1 lists each journal club’s resources.
| Journal Club Period | Featured Article Title | Blog Post URL | Curation Summary Published in Annals , Reference No. |
|---|---|---|---|
| November 13–19, 2013 | Emergency department computed tomography utilization in the United States and Canada | http://www.aliem.com/inaugural-global-em-journal-club-hosted-by-aliem-and-annals-of-em/ | 12 |
| January 20–26, 2014 | Clinical decision rules to rule out subarachnoid hemorrhage for acute headache | http://aliem.com/journal-club-clinical-decision-rule-subarachnoid-hemorrhage/ | 13 |
| March 20–26, 2014 | Targeted temperature management at 33°C versus 36°C after cardiac arrest | http://aliem.com/aliem-annals-em-journal-club-targeted-temperature-management/ | 14 |
| May 7–14, 2014 | Does the multiple mini-interview address stakeholder needs? an applicant’s perspective | http://www.aliem.com/multiple-mini-interviews-annals-em-resident-perspective-article/ | 15 |
| July 28–August 3, 2014 | Integration of social media in the emergency medicine curriculum | http://www.aliem.com/social-media-in-the-em-curriculum-annals-em-resident-perspective-article/ | 16 |
| August 11–18, 2014 | The opioid prescription epidemic and the role of emergency medicine | http://www.aliem.com/opioid-prescription-epidemic-annals-em-resident-perspectives-article/ | 17 |
| August 25–31, 2014 | Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study | http://www.aliem.com/adjust-pe-study-aliem-annals-em-journal-club/ | 18 |
| November 10–16, 2014 | Ambulatory management of large spontaneous pneumothorax with pigtail catheters | http://www.aliem.com/aliem-annals-em-journal-club-spontaneous-pneumothorax-pigtail-catheters-outpatient-management/ | 19 |
| December 1–7, 2014 | Lack of association between Press Ganey emergency department patient satisfaction scores and emergency department administration of analgesic medications | http://www.aliem.com/aliem-annals-global-em-journal-club/aliem-annals-of-em-journal-club-satisfaction-scores-ed-analgesic-medications/ | 20 |
Interpreting the Analytic Numbers Across the Social Media Platforms
The sheer volume of analytic numbers from the multimedia platforms suggests that objective outcome measures for success exist for this online journal club series. Web traffic analytics, such as page views, have traditionally been key performance indicators for initiatives that rely heavily on viewership numbers, such as ad-based or subscription-based Web sites. The ALiEM- Annals online journal club, however, is different. Our outcome measures are community building, learning, and ultimately improved patient care. Web analytics indirectly can measure some level of engagement and success. On one extreme, if there were zero traffic, the journal club would be considered a failure. For nonzero traffic, however, it is unclear what denotes a successful endeavor in terms of engagement, value, and impact.
Table 2 highlights the aggregate analytic data from the 9 online journal clubs. Multiple confounders exist, including how practice-changing or mainstream the featured article is, whether the author has a large, preexisting social media following, and whether the journal club is featured on a blog with an existing readership base (ALiEM has approximately 1 million page views and 250,000 to 450,000 users annually). How does one compare 10,000 blog post page views with very few comments to 100 page views with thoughtful worldwide commentary? Similarly, how does one compare page views on a blog post hosted on a Web site with an existing readership base versus a new blog launched just for the journal club? Practically, what does a Twitter “impression” count of 300,000 mean? Impressions depict how many potential views of the journal club tweets appear in users’ Twitter streams. This metric is often reported to reflect reach and exposure for continuing medical education conferences and Twitter-based journal clubs. It is calculated by multiplying the number of tweets per participant by the number of followers that participant has. So is the event equally successful if one person with 30,000 Twitter followers tweeted 10 times compared with 3,000 people with 10 followers each who tweet once? Both yield a Twitter impression count of 300,000. One metric that distinguishes the online journal club blog post from other ALiEM blog posts is an increased mean time of each page view, from 2 minutes (mean time for the entire site, with >1,600 blog posts) to approximately 3 to 5 minutes for the journal club posts. This suggests that readers are more engaged with the content. Although this may be a helpful metric to measure and trend, it is not generalizable to other sites and journal club initiatives.
| Featured Article | Blog Post Publication Date | Blog Post Analytics During the First 2 Weeks From Publication Date | Blog Mean Time per Page View, Minutes | Number of Blog Comments | Number of Tweets | Twitter Impressions ∗ | Google Hangout Video Views | Podcast: 1-Week JJ † Downloads or 2-Week S Listens | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Page Views | Cities | Countries | ||||||||
| Emergency department computed tomography utilization in the United States and Canada | November 13, 2013 | 1,171 | 148 | 25 | Unknown ‡ | 43 | 142 | 231,058 | NA | NA |
| Clinical decision rules to rule out subarachnoid hemorrhage for acute headache | January 20, 2014 | 1,717 | 501 | 59 | 4:36 | 28 | 206 | 267,894 | 154 | NA |
| Targeted temperature management at 33°C versus 36°C after cardiac arrest | March 20, 2014 | 1,401 | 433 | 60 | 4:23 | 31 | 195 | 313,229 | 124 | NA |
| Does the multiple mini-interview address stakeholder needs? an applicant’s perspective | May 7, 2014 | 1,284 | 353 | 41 | 3:11 | 21 | 140 | 221,946 | 128 | NA |
| Integration of social media in the emergency medicine curriculum | July 28, 2014 | 1,222 | 325 | 32 | 4:11 | 36 | 285 | 569,403 | 120 | 435 (S) |
| The opioid prescription epidemic and the role of emergency medicine | August 11, 2014 | 1,262 | 433 | 41 | 3:49 | 17 | 210 | 408,498 | 168 | 273 (S) |
| Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study | August 25, 2014 | 1,169 | 391 | 52 | 4:24 | 26 | 206 | 502,485 | 159 | 3,962 (JJ), 221 (S) |
| Ambulatory management of large spontaneous pneumothorax with pigtail catheters | November 10, 2014 | 1,023 | 347 | 49 | 4:45 | 28 | 158 | 279,027 | 88 | 8,684 (JJ) |
| Lack of association between Press Ganey emergency department patient satisfaction scores and emergency department administration of analgesic medications | December 1, 2014 | 978 | 342 | 33 | 3:37 | 17 | 231 | 464,345 | 83 | 186 (S) |
∗ Twitter impressions are defined as how many potential views of the journal club tweets appear in users’ Twitter streams.
† The Journal Jam series belongs to the existing podcast entity EM Cases, and the download statistics reflect the overall podcast download numbers for it.
‡ The blog Web site immediately crashed after the journal club, and this metric was not previously saved.
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