I joined Twitter to teach. In May 2016, I started tweeting “questions of the day” for my inpatient hospital medicine team at Thomas Jefferson University Hospital from @RJmdphilly. #GreenQOD (“Green” is our teaching service, and “QOD” for question of the day) was born in the days of only 140 characters per tweet (now expanded to 280), which placed a potentially daunting onus on brevity in phrasing—and answering—clinical questions.
My inaugural question? “What’s the real story with beta blockers in reactive airway disease? If increase risk is real, how do you balance risk/benefit?”
Rules of the game? I would tweet a question in the afternoon; my trainees would have until rounds the next morning to investigate the question and tweet a response back. We’d spend the first 10 minutes of rounds discussing what they found.
In that first week, we covered Bayesian reasoning and C. diff assays, interpreting coronary CT scans, high-value utilization of inpatient physical therapy consults, late complications of gastric bypass, and climate change’s effect on tick-born illness. We also investigated the mechanism of heliotrope cyanosis observed in the 1918 influenza pandemic and learned about one of our patient’s days of civil disobedience with Dorothy Day.
But how did this idea originate, and were we achieving any of my goals? #GreenQOD was born from a feeling of stagnation regarding inpatient teaching. As an enthusiastic early-career educator, I was reading about flipped classroom models, adult learning theory, methods to maximize information retrieval, and self-directed learning. However, the reality of teaching while on service was disappointing—educators and trainees spent much of our day separated in time and space, juggling competing priorities. We raced to meet target discharge times, manage acute medical problems, attend lectures and meetings, and mentor students all with the added pressure of complying with duty hour restrictions. Teaching during the small fraction of the day we were rounding felt stale—the well-intentioned Socratic method undermined by performance anxiety for teachers and learners alike.
In Twitter, I found a learning platform that was flexible in time and space. Conversations and curiosity continued long after rounds, and we were able to use interstitial time like commutes, meals, or elevator rides for small episodes of team teaching and learning. Choosing a question relevant to our patients also allowed me to capitalize on several adult learning tenets. The motivation for learning was intrinsic, and the content was problem-centered with immediate relevance. Instead of testing recall, I could evaluate a learner’s ability to find answers and apply them through iterative inquiry. I could also model my approach to filling my own knowledge gaps, rather than upholding a false ideal where I was expected to have encyclopedic knowledge. Our learning community expanded—by leveraging Twitter as a social network, others at Jefferson (like our library Twitter account @SMLibrary_TJU) and across the country gained access and contributed to our learning.
As published in a recent Academic Medicine article, my colleagues and I developed the Bloom’s taxonomy for Twitter to make sense of the success of our respective #MedTwitter engagements, including #GreenQOD. Through this structure, we understood that educators and trainees could each engage at any of the 4 levels, depending on their teaching and learning needs and comfort with the platform. As with the application of Bloom’s taxonomy in other settings, it is not a strict hierarchy or linear progression. Even as an attending now seasoned with Twitter-based education, my use is fluid—sometimes I’m creating, and sometimes I “just” consume.
I joined Twitter to teach, but I’ve stayed for an increasingly rich education.
By: Rebecca Jaffe, MD, and Avital O’Glasser, MD
R. Jaffe is a hospitalist within the Division of Hospital Medicine at Thomas Jefferson University Hospital (TJUH). She is the associate designated institutional official for quality and safety education for graduate medical programs and the director of learning environment improvement for TJUH.
A. O’Glasser is a hospitalist within the Division of Hospital Medicine at Oregon Health & Science University (OHSU) and the medical director of OHSU’s Pre-Operative Medicine Clinic. She is also the assistant program director for social media and scholarship for the OHSU Internal Medicine Residency Program.
- Jaffe RC, O’Glasser AY, Brooks M, Chapman M, Breu AC, Wray CM. Your @attending will #tweet you now: Using Twitter in medical education [published online ahead of print March 17, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003314