JMIR Publications

ABSTRACT

Background:

Case-based learning exercises are valuable to trainees, but growing clinical demands hinder consistent attendance. Social media increasingly acts as a venue for trainees to supplement their education asynchronously.

Objective:

To adapt morning report-style, case-based teaching to an asynchronous format on social media.

Methods:

Starting in February 2018, clinical vignettes were posted to a dedicated Twitter account with the prompt “What else do you want to know?” to stimulate discussion. The authors replied in real-time when case discussion participants requested additional details. Summaries of the elicited information were posted at regular intervals to the discussion thread to advance the overall case discussion. Participants were asked to explain their reasoning and support their conclusions, when appropriate. Each case concluded with relevant clinical pearls. Online engagement was assessed using Twitter Analytics. Interactions among participants and case moderators were qualitatively categorized with special attention to aspects of the clinical reasoning process. Local engagement and attitudes at our institution were assessed by surveying internal medicine trainees (n=182) and faculty (n=165) after 6 months.

Results:

Over a 6-month period, 11 live case discussions were engaged with by users 1,773 times. A total of 86 Twitter profiles spanning 22 U.S. states and 6 countries contributed to robust discussions among participants and the authors. Participants from all training levels were present, ranging from students to faculty. Interactions among participants and the case moderators were most commonly driven by clinical reasoning, including hypothesis-driven information gathering, discussing the differential diagnosis, and data interpretation or organization. Participants interacted not only with the moderators but also with each other to reach conclusions. Of 71 respondents to the local survey, 29/71 (41%) reporting having a Twitter account and 17 reported interacting with the cases. Respondents agreed that case participation increased both their clinical reasoning skills (15/17, 88%) and clinical knowledge (13/17, 76%).

Conclusions:

A social media-based, serialized case discussion was a feasible and popular asynchronous teaching method for engaging online learners of all levels in a clinical reasoning discussion. Further study should examine what factors drive trainee participation in online case discussions and under what circumstances asynchronous discussion might be preferred over in-person teaching activities.