To blog, or not to blog (in medical education)

A quick search of the literature revealed only a handful of relevant articles which address blogging in medical education. This did not surprise me. Web 2.0 tools just recently entered into the realm of medical education and their implementation has been very recent; therefore, analyses of the effects of Web 2.0 tools in various medical education setting would be few.

As noted in my teaching philosophy, I believe in the powerful learning gained from self-reflection. Medical students constantly engage in non-reflective learning, particularly in courses where students learn the material through memorization and the instructors evaluate students solely on the recall of information. As we transform these courses, the addition of case-based learning tasks would encourage reflection, particularly if the students were working in small groups and the instructor built in time for reflection.
I also believe there are valuable opportunities for reflection during the clerkships where students benefit from hands-on learning with real patients as part of a medical team. After clinical encounters, students could reflect on not only the clinical skills employed, but also the interpersonal aspects of the interaction such as the team dynamics and process and how they treated the patient with integrity and respect.

However, I’m not convinced that blogs are the answer. I also believe in evidence-based education, so I thought I would look to the literature to see what effects others have observed after implementing blogs and other Web 2.0 tools.

Exhibit A

“The rising popularity of digital applications, such as social networking, media share sites, and blogging, has significantly affected how medical trainees interact with educators, colleagues, and the public. Despite the increased popularity and use of such applications amongst the current generation of trainees, medical educators have little evidence or guidance about preventing misuse and ensuring standards for professional conduct. As trainees become more technologically savvy, it is the responsibility of medical educators to familiarize themselves not only with the advantages of this technology but also with the potential negative effects of its misuse. Professionalism, appropriateness for public consumption, and individual or institutional representation in digital media content are just some of the salient issues that arise when considering the ramifications of trainees' digital behavior in the absence of established policies or education on risk. In this commentary the authors explore the rising use of digital media and its reflection of medical trainees' professionalism. To address possible issues related to professionalism in digital media, the authors hypothesize potential solutions, including exploring faculty familiarity with digital media and policy development, educating students on the potential risks of misuse, and modeling professionalism in this new digital age.”

Farnan JM, Paro JA, Higa JT, Reddy ST, Humphrey HJ, Arora VM. Commentary: The relationship status of digital media and professionalism: it's complicated. Acad Med. 2009 Nov;84(11):1479-81.

Exhibit B

“PROGRAM DESCRIPTION: Students were asked to contribute two reflective postings to a class web log (blog) during their rotation. They were able to read each other's postings and leave feedback in a comment section. An instructor provided feedback on entries, aimed to stimulate further reflection. Students could choose anonymous names if desired.
PROGRAM EVALUATION: Ninety-one students wrote 177 posts. One-third of students left feedback comments. The majority of students enjoyed the activity and found the instructor's feedback helpful. Assessment of the posts revealed reflections on experience, heavily concerned with behavior and affect. A minority were not reflective. In some cases, the instructor's feedback stimulated additional reflection. Certain posts provided insight to the hidden curriculum.
DISCUSSION: We have discovered that blogs can promote reflection, uncover elements of the hidden curriculum, and provide opportunities to promote professional development.”

Chretien K, Goldman E, Faselis C. The reflective writing class blog: using technology to promote reflection and professional development. J Gen Intern Med. 2008 Dec;23(12):2066-70. Epub 2008 Oct 2.

Exhibit C

“If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.”

Boulos MN, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ. 2006 Aug 15;6:41.

After reviewing these pieces of evidence, I’m convinced that blogging can and should have a place in medical education. While there are certainly issues such as professionalism, HIPAA guidelines, and institutional representation that need attention, there are limitless opportunities to enhance learning. As noted, there is a need for more research. Maybe I'll encourage our course to implement the use of blogs for reflection and report findings...