All A Twitter in the Annals of EM

The Annals of Emergency Medicine has published a few feature articles on Web 2.0, FOAM and social media over the past few years (such as this). The latest is titled ‘Social Media and Physician Learning: Is it All Twitter?’ (free PDF). Michelle Lin has summarised the key points from this article over at ALIEM, and asked me for my comments. So here is my perspective.

The article itself features nothing that hasn’t already been discussed over and over on countless FOAM blogs and Twitter conversations, but it is always nice to see these issues being packaged for mainstream dissemination.

Firstly, yes, we all know that FOAM and social media lacks an ‘evidence-base’ — just like much of medicine and almost all of education, there are no RCTs or similarly high level studies demonstrating benefit. This is partly because the use of social media in medical education is relatively new, partly because it is difficult to assess, and partly because those who find it useful just want to get on with it. Attempts to define the utility of social media and FOAM in medical education are to be welcomed.

There is a discussion of peer review, and whether it should be pre- or post-publication. I believe the traditional peer review process used for medical scientific publications is flawed (see  Time to Publish Then Filter?, The Wisdom of Crowd Review and Peer review: a flawed process at the heart of science and journals). Yet, until now, in the context of scientific publication, peer review has reminded me of Churchill’s assessment of democracy: “… the worst form of government except all the others”. In my mind, post-publication peer review must be explored — and Michael Callaham’s commentary at the end of the ALIEM post makes a lot of sense on the whole. In some ways, post-publication peer review is already happening in the FOAM world using social media. Blogposts, such as this from the Intensive Care Network, have led to corrections in high profile journals such as the New England Journal of Medicine. Online journal clubs abound and there are entire blogs dedicated to critical appraisal (such as Emergency Medicine Literature of Note and EM Nerd). However, post-publication peer review needs to be formally integrated into the medical scientific publishing model. Indeed, Pubmed Commons is now being trialled.

I will pull up Michael Callaham on one point though — I think he underestimates the potential impact of social media when he states:

The more I think about it, I don’t see social media as providing anything truly new in terms of approach or content. It is simply a much improved technological mechanism for providing a prompt public forum for the thoughts of many who did not get to participate in the process before, and who previously did not overcome the barriers of slow correspondence and publication. Increasing their participation would be a good thing.

While I agree that free and open debate — the anvil on which ‘Truth’ is forged — existed before social media, my experience tells me that social media transforms this utterly. We must not underestimate the impact of technology (after all weren’t the discovery of fire, the invention of the wheel and the Gutenberg press simply technological advances?) Social media has revolutionised my capacity to track and participate in cutting edge controversies and discussions of the merit of breaking research. It enables me to exchange ideas with some of the brightest minds in my field anytime and anywhere. This is amplified even more so for those in remote locations and for those with limited resources.  Importantly, whether you like social media or not, it is here and it is here in a big way. Increasingly social media is integrating into day-to-day living and anyone interested in the exchange of information ignores it at their peril. The game has changed.

Michelle also hits the nail on the head with her comment that scientific publication and knowledge translation are different things (together with my colleagues Paul Young and Dashiell Gantner, I have an editorial for Critical Care and Resuscitation on the role of social media in knowledge translation currently in press). FOAM is not scientific research — it is a way of disseminating, discussing, dissecting and deliberating over the products of that research — as well as issues where research findings do not apply, or do not exist. FOAM is more akin to editorials and commentary articles in journals  (which are usually not peer reviewed but written by invitation) than to the research articles themselves. Pre-publication peer review can be of use in FOAM for fact checking and so forth, but it also runs the risk of diluting arguments and opinions before they’ve had a chance to live or die in the melee of truly open discussion. What we should strive for in FOAM, however, is scholarship — appropriate referencing to journal articles and the FOAM that came before.

Over to you.

PS. Impact factors suck!