By Joel Topf, MD
Social media is proliferating. More and more of our real-life experiences are being enhanced by social apps. We tweet about sports and entertainment; Instagram our meals; and announce our relationships, births, and deaths on Facebook.
Social media wound its way into medical education in a bottom-up fashion: Med students created private Facebook pages for their classmates, where students participate in a spirited back channel for classroom snark. Students share educational resources while complaining about droning professors using Power Points dripping in Comic Sans.
Moving up the food chain in social media in medicine, emergency medicine docs created FOAMed (Free Open Access Medical Education), a loosely bound community making rigorously evidence-based medical education freely available. The social media angle of FOAMed is in the wide adoption of the hashtag #FOAMed, tying the educational resources together.
Internet chats are finding new life on Twitter. Some are synchronous, like Ryan Madanick’s fascinating MedEd chat, and some are asynchronous, like the one urologists are using for their journal club, #UroJC, where a twitter conversation revolves around an article for 48 hours, allowing people from time zones around the world to participate.
The contributors of eAJKD, the official blog of the American Journal of Kidney Diseases, are experimenting with a novel application of social media in medical education. We developed a month-long game called NephMadness. The goals of the project are threefold:
- increase nephrology knowledge
- entice people to engage in nephrology-related social media with the hope of bringing more people into the community
- increase interest in the specialty.
NephMadness is an homage to the NCAA Men’s Basketball Tournament, also known as March Madness. Like the basketball tournament, we created a field of 64 teams to compete in a single-elimination tournament. However, in NephMadness, the teams are nephrology concepts. The field is divided into eight regions, each with a content expert:
- Toxins: Warren Kupin
- Hypertension: George Bakris
- Renal replacement therapy: Glenn Chertow
- Regeneration: Stuart Shankland
- Acute kidney injury: Sarah Faubel
- Electrolytes: Helbert Rondon
- Kidney Stones: David Goldfarb
- Biologics: Jonathan Hogan
Each expert was interviewed and consulted on which concepts to add to the field and their importance. The NephMadness contributors then wrote short, pithy descriptions of each concept. The details were referenced and evidence-based with the goal of educating and intriguing the readers. Here is an example from the epic battle between convective and diffusive clearance, the two core technologies behind renal replacement therapy:
Unlike dialysate, which flows past venous blood in the dialyzer, replacement fluid is infused directly into the veins, so not only does it need to be electrolyte balanced, it needs to be ultra-pure and sterile. Providing that ultra-pure replacement fluid, hundreds of liters a week for each patient, was prohibitively expensive. The breakthrough that allows this to be used in outpatient dialysis is a technique termed online purification. Online purification is the creation of sterile replacement fluid straight from the public water system in the dialysis unit. This is a major breakthrough.
However, this major breakthrough has not yet translated into breakaway results. In multiple randomized controlled trials hemodiafiltration has failed its primary end-point. Only in subgroup analysis has it been better than traditional hemodialysis. Then in 2013, the ESHOL study hit its primary end-point with a 30 percent risk of all-cause mortality. However, they did not do an intention-to-treat analysis and in a subsequent meta-analysis, no signal was found for improved all-cause mortality, non-fatal cardiovascular events or hospitalization, though there was a modest reduction in cardiovascular mortality.
Players signed up for the contest by predicting which concepts will win each match-up and advancing the winners. This is called filling out the brackets. After we unveiled the brackets, participants had 10 days until they were closed to new participants and we began announcing the results. We unveiled the winning teams round-by-round every few days.
The winners have been preselected by the editors of NephMadness. With each announcement we post further content explaining why each team won.
Blood pressure guidelines: JNC8 versus KDIGO
If you think clinical practice guidelines are a snooze, try to watch the authors of said guidelines play basketball. Pathetic. Neither team could shoot, dribble or pass. The final score was football-like: 17 to 14. These codgers better step it up or it will be a short tournament for the winners.
Both teams emerged in the last days of 2013 and have been eating up publicity since publication. The JNC8 is the last guideline to be initiated by the National Heart Lung and Blood Institute, NHLBI (but in a confusing twist, the NHLBI does not endorse these blood pressure guidelines) and it is a doozy. This is a massive simplification of blood pressure management. No more splitting hairs for diabetes, or proteinuria. The JNC 8 guidelines are pretty simple, especially in regards to CKD patients.
We have seen an interesting divergence between the pre-selected winners and the most popular choices. We think these are particularly rich areas to explore with further content currently under development. There could be three reasons for this:
- Our picks were wrong and the choice we valued is wrong
- The concept is poorly presented so that participants don’t understand what we were getting at. We are pretty sure people were confused about an entry called ACEi and ARB combination therapy. Some participants thought it was asking about the value of ACEi and ARBs have to nephrology (invaluable, if you are not aware). We intended to ask people about the problem of using them simultaneously.
- People did not use the learning materials to make their choice but sped through it, because, get over yourself, it’s just an Internet game.
The response to the project has been great. We have 260 people participating in the contest and have had a spirited discussion on Twitter.
On April 8, we announced that JNC8 won the second NephMadness tournament. The top finisher was Carlos Machado.
We are delighted by the response we have received to NephMadness and feel that online games have a strong future in social media medical education.
Joel Topf, MD, is an Assistant Clinical Professor of Medicine at Oakland University William Beaumont School of Medicine, and teaches residents and fellows at St. John Hospital and Medical Center in Detroit. Follow him on Twitter @kidney_boy.