Lightning rounds #28: Online learning with Callie Tennyson

Hey everyone, I'm Brandon Odo. And I'm Brian Bowling. And this is Critical Care Scenarios, the podcast where we use clinical cases, narrative storytelling and expert guests to impact how critical care is practiced in the real world. Hello, hello everyone, it is Brandon Odo back with Critical Care Scenarios. We have lightning rounds for you today. And the topic we're going to get into is medical education using the internet, using the available tools to push along your self-directed training, particularly tools like social media, blogs, podcasts, Twitter, TikTok, whatever else is out there. And what we kind of wanted to look at was the transition that we seem to be living in right now between the old days, which was a free for all. This material was being developed and being consumed in a purely grassroots way. People just thought it was helpful to make material and other people thought it was helpful to consume it. And we're kind of getting into the later stages. Maybe you could say the more mature or grown-up stages, which has downside. People are not as passionate or zealous about this stuff. Many cases are no longer doing it for no reward. But it also, I think, is a time when we should put some more thought into what it is we're doing. And if we're using these tools with the optimal amount of rationality, efficiency and thoughtfulness, and just give it the same thought that we give many other educational and pedagogical tools, because that's essentially what it is now. So if you're confused, have no fear. This is lightning rounds, which in the past was just Brian and I having a discussion. But Brian and I were discussing the other day and saying, I think we've kind of reached the point where you guys have heard the two of our opinions on most topics. And rather than subject you to us just repeating them for all time, like an old married couple, we're going to start bringing guests for some of these lightning rounds. So there's no case it is just a discussion. But we have a third perspective that we thought would be of a huge amount of help. So we have joining us today, Callie Tennyson, who's a nurse practitioner down at Duke. Does a lot of great cardiac stuff down there clinically as well as educational projects. And I believe Callie, you could tell me if I'm wrong, as of recently is going to be the new director of the acute care nurse practitioner program there. Am I right? Yes. Callie and Brian have given some talks recently and just put a lot of thought into this topic of social media and the internet and not just how we're using it for medical education, but perhaps how we should be doing it. So I'm going to try to be a fly on the wall here and just kind of get some good thoughts from these two because I know they both have them. Yeah. So we were talking a little bit before we started recording and I said, we may geek out a little bit with some educational stuff, but I think that's okay because I've been giving talks on this topic for, I don't know, five, six years now, I think it conferences and meetings and around to anybody who'll listen to me, you have it wrong. But I think there's a difference between, but Brandon was saying, at first we kind of all got into this. We're all on Twitter. We're all on Facebook back in the day. We're all on YouTube and podcasts and blogs. And it's sort of haphazard and we just sort of go at it like that, but maybe it is time to be a little bit more adult about it, more professional about it, have some structure to it and maybe even gasp some underlying foundational philosophy from education. Yeah, I'm a big fan of remote learning and virtual stuff in general. We've been doing it in this world long before the pandemic came along and made Zoom a thing that everybody did. But I think it's got a lot of potential for people who can't get to places, right? You used to have to move to a different state if you wanted to go to a certain program. Or what about people in parts of the world who they don't have the luxury of just packing up and moving to the United States or Great Britain or Australia to go to college, but they need to learn so they can better their own communities. And I think it's got a lot of potential. And of course, it's got a lot of potential for those of us who just want to continue learning every day. So Cali, let's talk a little bit about education via the internet and social media. And I think, you know, it's 2023 and I think that one of the things that good things that did come out of the pandemic is it made this sort of thing more socially acceptable and mainstream. But I think a lot of people still think that this is not real, right? This is not like real, real education where you sit in a classroom. I guess what do you say to people like that? I think that there's definitely an undergogy behind micro learning. Like we're all adult learners. So if we think about how adult learners, particularly in, you know, nursing and medicine where we're lifelong learners, this, there's been an intersection between full med and online learning and that's been combined with I think a lot of people who are getting really skilled at developing micro learning content. And so when I think about micro learning, I think about it from like multiple perspectives. One is from the learner and the other is that it can be an excellent teacher. So just to kind of summarize, if you don't know what micro learning is, social media is a great example of it and it's basically the best example of ways to deliver micro learning content. So that's why sometimes they overlap. We think about social media and we think about micro learning because we see micro learning delivered on social media frequently, but they're not exactly the same thing. So micro learning is really a structured educational approach. So it's brief, it's focused. There's usually only one or two learning objectives and it's content that stands on its own. So a really great example of this is a tutorial where there's maybe one or two things that they're trying to get across like there's a great tutorial on lay six that I love. So it's only about one medication. It is flexible in that the learner or the, you know, whoever's coming along on Twitter, they're reading it and taking it in on their own time. So they're kind of in control of it in a way. And so, you know, academics talk about micro learning being interactive in that the learner can also share it or comment on it or ask a question. And so one thing that we've done at Duke is we said, okay, micro learning is really cool. You have to know what you're talking about to develop the content. So let's see how students do in developing their own micro learning content. So there's like a lot, lots of different ways that you can take in micro learning and then if you're someone who develops content, you can also benefit from understanding the structure of it because you'll develop higher quality educational content for social media. So there's lots of different avenues and perspectives, I think. Yeah, I want to back up real quick because you said a big word that many of our listeners may not know and may not have heard Andrew Gogey because I think this is an important concept because I think a lot of times people think like, oh, you know, Twitter, TikTok, Instagram, that's like for the kids or for lazy people who, you know, micro learning, oh, I can't sit through an hour lecture. So I want to watch something short. But Andrew Gogey, the principles of adult learning, really the research shows like, so this is where we're going to get into educational stuff because those of us who are in like higher education study this sort of thing. The research shows that that's how adults learn better, right? The grown adults don't respond well to sitting through an hour lecture and has nothing to do with the fact that we're lazy or that we don't have attention spans or that we're, I mean, God, I'm certainly not Gen Z. I'm not even a millennial, right? I'm Gen X and I do much better. I feel like I learned more watching a 10 minute YouTube or a tweet reading a tweet tutorial than I was sitting down in a book chapter or listening to an hour long lecture on everything associated with diariesis, right? Right. And I think that's, that is the quintessential macro learning, right? It's not that it just takes more time. It's that it's like hierarchical and that it doesn't stand alone. It fits within a longer curriculum. Traditionally, that's how academics have, you know, presented information in the past. But yeah, you're right. There are a lot of learning theories that apply to micro learning. The two that I primarily think of is constructivism, meaning adults come to Twitter or social media or whatever with the baseline level of understanding that is diverse. But we all have experiences that shape our understanding of, you know, intubation and sepsis and all this. So we, everybody has a different foundation and micro learning builds on that. So that's one is constructivism. And then I think social learning is the other kind of learning theory, which, you know, our podcast is a perfect example of a social learning kind of being operationalized in that you're having a conversation. Someone is listening to the conversation, they're hearing multiple points of view. You are critically thinking about different approaches to clinical care. And so the listener is having a social learning experience. So I think those two, those two things really play into the androgy of micro learning. To what extent do you guys think that the reason we're talking about these things increasingly is due? Because it seems like there's maybe three factors that are all present. One is maybe a growing number of adult learners in the kind of concepts we use to teach kids things or don't always apply. The second one is the technology having advanced. So these tools like, you know, internet-based formats like podcasts and websites and social media just didn't exist 20 years ago and those had progressed. But also, I don't know if we have changed kind of culturally in our psychology of learning and I know that a lot of us at least feel subjectively like our attention spans are shorter. And maybe that is part of the reason why we're turning to tools like this because, yes, we're older and there are other tools, but maybe we just don't have the interest or even ability to use some of the learning formats we used to. I mean, I can't imagine honestly how I used to sit through an entire day of lectures in school. Do you think that these are all kind of relevant factors? Well, I think, yeah, I mean, I think there is something to do. I mean, I think objectively, you look, there's research that shows our attention spans are shorter, right? Because we are exposed to even if it's an hour long, like watching any hour long TV show and you see fast cuts between scenes and jump cuts and stuff instead of these long, like go watch an old show from the 50s and you'll be amazed at how infrequently the camera moves. So I think we are conditioned to that a little bit. But one of the things I was thinking, as Kelly was talking a minute ago, is she's describing this social learning experience and stuff and to me, that sounds like rounds, right? That sounds like how we traditionally teach in medicine where we're standing in a hallway in front of a patient's room and there's a situation that's come up and the attending leading rounds goes off on a talk about that, not even necessarily related to this patient, but let's talk about lay six real quick, right? And that's what we've been doing for a hundred years. So I would say, you know, for the, right, this is a little preaching to the choir because if you're listening to this podcast, you're probably bought into this idea, right? But for the older crowd out there, and I'll count myself in that too, because like I said, I'm coming up on 50. I'm not a kid, but for people out there of my generation and older who say, oh, this, this is a new fad because of a very short attention spans and stuff, I would say it's really not. It's the same way we've been doing it, but now we have new tools. Would you agree with that, Kelly? Yeah. Yeah, I do agree with that. And I think that does lead to one really important point that micro learning and learning on social media is also not good for some topics. Like micro learning is great for repetition and memorization. Like in my classes, we have an Instagram account where like all I put up on there is chest x-rays and EKGs and CTs so that people are seeing. I ask one simple question and like, that's the repetition that they need as novice learners. But introducing those concepts is not the best, it's not the best way to kind of deliver that with micro learning. So complex topics or things where there's not a background, like thinking about constructivist theory, if you have no background and you come to the table, then micro learning is not, is not going to be efficient. So much like those discussions on rounds, which are more about application, the getting the structure is better done before. And again, so from that perspective, a lot of these things we're doing online now with the Twitter discussion or the case-based podcast are the same thing we might have done traditionally on your rounds or formats like that. It's just you're not relying on the people being physically around you or you being in that formal training program and you can get perspectives from around the globe. So the same idea just expanded. Yeah, exactly. If you're in rounds and you're talking about a really complex patient and someone in rounds doesn't have the baseline building blocks of minor tropes, let's say, then that's probably not the best place to just watch an hour discussion about that. Just as an example. But I don't think you can say, hey, we can do away with NP School and PA School and everybody can just learn via Instagram and podcast, right, because you have to have that foundation. And I think there are programs that are out there that are 100% online and it's more just like, here's a bunch of recorded videos to watch and here's a test to take. And those are, I don't think people are going to succeed like that. They have to have a mix of, there is some foundational teaching, there is some foundational interaction, there is some structure, right, because that's I think the other problem with this teacher's cell phone social media is it's real easy to just pick and choose the stuff that you think is cool, right, the stuff that you think is fun and interesting or, you know, like, you know, one example I always give my students is when I was studying for boards, right, I would do all of these like flashcards. And the stuff that I had, cardiac physiology was never a struggle for me, right, I was a cardiac ICU nurse for 10 years. I would review those flashcards and feel really great about myself, but I probably just needed to throw those flashcards away and pick up the neurology cards because that was where I was weak. But if, if nobody was making me study neurology, I probably wouldn't have, right. So I think that if you're, if it's left totally up to you to just go out and find your own, then you're going to have deficits in your education. So I think like Kelly saying you need some structure, you need some foundation that you can't just get by going out and finding podcasts that are fun to listen to. Right. And I think that is where a lot of the skepticism comes from, you know, is, oh, everything's micro these days, just make it shorter. And that's, you know, it's not, micro learning itself is not, is not that simple. But Brian, what you said about it being fun and enjoyable, that's, that's a great point and that, that is unfortunately, you know, what the evidence says about micro learning is really, is low level. It's like people enjoy it. They think it's fun. And they think it's easy to engage in. We know that. But there's not a lot of higher level evidence saying, okay, if we deliver education via text or email or social media, how it positively affects patients, or it positively affects their performance on boards, like we don't have that data yet. And what, but what we do know is that learners enjoy it. It's fun. It's engaging. It seems to me that part of the challenge there in showing educational impact of these types of tools is that they tend to not, at least as much, pursue educational objectives that are based on specific objectives as a traditional educational program would. These are the things we need people to learn, perhaps based on something like a licensing exam or something, but certainly based on clinical needs. And here's how we're going to get there. A lot of things like this podcast are more free form. You have it maybe a general theme, you on develop and you explore it using the format you have, and you sort of trust that education is happening along the way. And whether it does or doesn't, you may not know what you have until it's done. So, but in a way, I don't know how much that differs from, again, tying it together with traditional education. You know, a lot of medical education was always about immersion. You just kind of expose people to concepts enough and they soak it up in a more implicit way. That's what, you know, physician education was always kind of structured and, you know, you give them X years of a residence to your fellowship or whatever. And yeah, there are more structured things along the way. But a lot of it is just that time and you trust people are learning. Can you prove that a six month period of time for a medicine resident just practicing medicine on the wards, help some be a better doctor? Maybe, but that sounds hard to do because there's so much of what your learning is very implicit. And maybe it's the same idea with a lot of this. I always feel like when I'm learning something online, a lot of it is very small scale implicit stuff, but cumulatively over time, and yes, with enough background and structured learning behind it, it's still very valuable. Well, I think it's hard to tie any educational intervention directly to patient outcomes, right? So I did my doctoral work in simulation training and, you know, we looked at when we put people through these simulation training courses, how did they, how did that affect them, right? Do they do better? You know, we showed that their confidence and their abilities was better. Their knowledge on a written test was better. Even at six months, right? So at six months out, we would test them again, and they still, you know, so it wasn't just regurgitating what we just learned, but they learned. But, you know, then somebody said, well, how do you tie that to patient outcomes? I don't know. How do you tie it, right? Because I can look at, well, we put every, but every nurse in the CTICU through this training program, and then did patient outcomes improve over the next two years. God, there's so many variables there. How do I show that it was this training program that did it, right? Yeah, did it save lives? Okay. Well, it does happen and save a lot, you know, it's a tough thing to move for anything. Yeah. Yeah, that's a good point. I don't know. The, because of all the things that you just said, I think of social media and microlearning, you know, in whatever way it's delivered as kind of adjunct extra, with another word for adjunct. It's just, yeah, it's supplemental material. And, you know, the other, the other reason it's really hard to study is because researchers haven't labeled their interventions as microlearning, always. Like there, there are studies about text messaging and emailing, but they don't label at microlearning. So if you search for microlearning, you don't necessarily find all of those. You have to, you have to search for the tools or the application itself to really get a good picture of what evidence is out there. I certainly feel like, and maybe COVID contributed to this, as well as those factors we talked about, but we've all been trying to explore these new avenues of education. And what that also means is exploring what aspects of how we used to do things are or are not necessary. Kelly and I were both just speaking at a conference a month or two ago, and we're talking about, I mean, it was, it was partly virtual, the audience, and some people were physically there. And it, you know, it raises the question of what's the value of physically being at a conference, which is a big burden for everyone. It would make a lot of sense in some ways to do these sorts of things virtually, and it applies to probably sitting in a lecture and many other things. But it starts to, I think, create, I guess, slippery slopes where you start to say, well, maybe we never need to be physically present for anything. And you get these all virtual programs. And I think the question is less, how much value is there? Because you could easily say the burden of requiring, let's say you're running a training program, 100 people to every day come sit in these rooms for eight hours and maybe some have long commutes or kids or all kinds of other demands on their time. That's a big burden and it's not worth it. So we should do everything virtually. But then you could ask, is there any value in people being physically there? And probably we would say yes. It's just harder to pin down. It's that more nebulous thing you get from being with your peers, talking to someone in a hallway, that sort of thing. But is that worth having? And that's sort of hard to say. I mean, I guess it depends on the person. If you're prospectively planning a program, the conference or your school or whatever, it'd be hard to prove to a table full of people that it's worth all the burden on people. And yet looking back, do you wish you had it? I mean, is the result so much different? And I think in some ways it can be. I mean, a lot of us would say the conferences are not the same when they're all virtual. And maybe a training program is not the same. But I have a hard time saying what the objective value to doing it the other way is. I think there is definitely benefit in being in person in times, obviously for certain things. If you're in a training program where you're going to teach practical skills, there's definitely benefit to being in person. I can only teach you so much ultrasound over the internet. I can't only teach you so much airway management virtually. But beyond that, I think there is, you know, you go back to the conference example. And I think we've all probably had the experience of going to the conference versus doing the conference virtually. And if you go to the conference, yeah, you might be like, well, I'm in this cool city and the weather is really beautiful and I'm tempted to kind of bail out on these lectures because I know I can watch them later and go do fun things. But I also kind of invested a lot of time and money in getting here. And so, you know, maybe I'll go, and once you're there, you're not going to get up and walk out in the middle of it. I mean, most of us aren't. I'm going to get up and walk out in the middle of a lecture. But I think if you are like sitting in your office and you turn on a recorded lecture and any number of things, very minor things happen, right? You're tempted to just walk away from the lecture and let the recording keep playing. Like, you know, somebody knocks on the door, right? It doesn't take much. Whereas to get up and leave a physical room is a big deal. So I think that's one example. But yeah, or you run into the speaker in the hallway and you ask them a question. And then you could say, all right. It cost me a thousand dollars and two days of my time to come. Was it worth running into this guy and asking one question? Maybe no. But you also kind of don't know. Maybe four years from now, you're collaborating on a project and you reach out to this person because you physically met them and you wouldn't have done that otherwise. These kinds of value can be so hard to lay on a table and look at. And yet in some ways, these are the little things that kind of build up to sort of robust careers and educational infrastructures. Yeah, I think on the flip side, though, I've seen a ton of like a sharper focus on socialization at conferences like, for example, there's more time in between sessions. There's like a larger set up cafe. There are events that are intended for socialization. Because I think you're right, people are realizing that they can just jump on the recorded lecture later and what really matters to them is the socialization. And I mean, professional development, honestly, because if you do make that connection with the speaker, then they put a face to your name and you email them. Or you get to go out to dinner and talk about a podcast and boom, here we are, we're developing our profession, right? So that's another point about social media is that that can be used and hard as for professional development when you can't be in person. You can kind of apply the concept of microlearning to teaching other people about you. Make a standalone tutorial about your expertise or post your paper with some highlights. Make that standalone educational stuff to share what you're doing. And so many people are also using social media for that. And then when you get to the conference, you feel like you know somebody's work already. So I think it is a really cool shift. It has pros and cons, I think. But that's another takeaway for the audience is to, you know, if you have work or expertise or, you know, patient scenario or de-identified imaging or whatever, you know, you can share that in a microlearning format online and show people your skills. And so like most of the talks that I do about microlearning, the title is microlearning and professional development. Because we can use it to continue our, you know, our lifelong learning, can use it for learning. And also use it to socially interact and share ourselves and our expertise with others in the field. Kelly, where do you think we're at as far as these types of online activities being recognized in academic setting as kind of value-adding activities in the way that more academic activities have been recognized? So when you do give that talk at a conference, you, you're giving lectures, you run a course, you write a book or a paper, these are all kind of within the currency of academia, certainly academic medicine. Whereas a lot of these online things were, in the past, seen as perhaps originally completely outside that, there's just some weird hobby you had. And then at some point, I think, became maybe something that could supplement those traditional activities, but they didn't, they didn't really have hard value. If you're looking for something like academic rank or, you know, get some kind of promotion or even just this, let me Brian and I have talked in the past about this kind of nebulous idea of building a career in academia and how it's, it's both on a lot of these soft achievements that nevertheless mean something. And you know, these online sorts of things like you, you have a blog or a podcast or you do a thread on Twitter and you could even have sort of celebrity in these circles, but it wouldn't really apply to your job. And I think we're starting to see that change, but it's been pretty slow and very, I think very dependent on where you are. Where do you think the current progress of that has gotten to? Because I mean, we have people who, I would say a lot of their achievements or their activity in this area are online and it would be a shame to think that that has not, I guess, reaped them any benefit in their, in their everyday job. Right. Well, yeah. And I'd love to hear what Brian has to say too, but my perspective is that many academics are still stuck on the manuscript being the like number one achievement that you must strive for to, you know, be promoted. But I think people are also warming to the idea that social media and, you know, involvement on social media has value and has impact. And that is because of alt metrics, because, you know, the manuscripts, I mean, some of them are still behind paywalls, like how do we know how many people have read our manuscript? I don't know, but I can see how many times a podcast has been downloaded. I can see how many times my tweet has been shared or viewed, you know, that's one reason that we have to train clinicians to understand alt metrics so they can advocate for their work. Like, you know, med Twitter has been doing this since, you know, 2010 or whatever. And so they have more and more data using alt metrics to say that I had this impact when I did this podcast or I did this journal club. Journal club is another cool thing that I think some academic institutions are diving into because it's social and fun and you can also measure participation. So when you're thinking about student involvement, it's easy to see that. So you're saying when you go to your boss looking for promotion, you say, well, yeah, I've only written two papers in the past few years, but I, you know, I have 50 million Twitter followers and I had, you know, two billion impressions on my tweets, which are all educational in nature and, you know, that has meaning to. Yeah. So on my CV, I put how many times, you know, podcast has been downloaded. And, you know, I don't know if the person who's looking at my CV really cares or understands what that means, but I think some people do and some people are, you know, working it into academic promotion standards slowly, but surely. Yeah. I think, I think podcasts definitely are becoming more common. I mean, pretty much every time we have a guest on who's in academics, they'll ask me, like, you know, how can, can you give me the information of this so I can put it on my CV? Now, whether or not that translates into, like you said, maybe that's just them being hopeful, right? I'll put it on my CV and hopefully it'll help when promotion comes around. I don't know, but I think all metrics is something that's good. And I think it's something that I don't know people know about, but I think it is a good thing to, because like you said, things like podcasts is one thing, right? I can put on my thing, oh, I did an episode of a podcast, you know, talking about such and such. And okay, we'll count it kind of like you gave a talk, right? But how do you put Twitter, right? How do you justify that? And so alt metrics is a way to sort of quantify that this is making an impact. It's not just me putting stuff up on a free website that I, yeah, I spent some time on about who cares. Can you guys share what you mean by alt metrics? That's the, so the concept of alternative metrics are that you can, like these numbers that express interaction outside of journals is also valuable to our community is the way I see it's, it's metrics to show the community's interaction with it. So instead of just an objective number of manuscripts, it's, this is how many times the manuscript was tweeted about. And this is how many times the manuscript was downloaded or requested, like that kind of thing. So what those metrics are may depend on the platform and things like that, but it is just ways of looking at impact and reach that go beyond traditional ones. Yeah. So was it shared? What were the impressions? How many comments? That kind of thing. Yeah. And I think you can look at it. If you want to, like a more traditional measurement at the impact factor of a journal, right? So like the every journal, those, okay, so this is more geeking out right into academics and publishing. But if you're not aware of this, every journal has an impact factor and it's based on the circulation of how many people read that journal. So like the New England Journal of Medicine, impact factor is very high because it's got a very diverse audience. It's very famous, et cetera. Whereas the Northwest Indiana Regional Journal of Pre-Ospital Medicine, the impact factor is fairly low because it's probably mostly a professional publication to that area. And the idea in academics is you want to be published in journals that have a higher impact factor because it's more prestigious, right? Now I think there is something to be said about niche publishing versus big impact, right? If I publish something in a journal that is really targeted at my target audience, it's probably better than something that gets published in JAMA that's deluded and have to people who won't read it. Altmetrics, I think, looks at more like that, right? So yeah, maybe I published something in a journal that has a low impact factor. But it is a manuscript that is targeted to a very small audience and everybody in that audience read it, right? So everybody who does, you know, every APP and neurocritical care read this paper, it doesn't matter that the whole world didn't read it. And so if you look at just something like an impact factor, it says that wasn't very important. But it really was because it accomplished your goal. And I think Altmetrics is a way of saying that, right? So how many people read this paper just because it was published in JAMA doesn't mean anybody read it? Yeah. And ultimately, any of these things we're using as, like I said, currency in your field, they are fiat currencies. They are largely recognized because they are recognized. We've agreed that publications are something we accept in academia, but it could be otherwise. Why is that important? I mean, there are reasons because it's affecting your field or whatever. But that applies to a lot of these other tools as well. So if there's increasing recognition, or you could say, and I think a lot of people have gone this way, I'm going to do these things. Brian and I have talked about the kind of golden age of online education being completely free as probably in the past. People want to get something out of these major productions now. But it doesn't have to be career advancement in the traditional avenue. It could be other things. It could be money. You might be able to make money in some kind of commercial way for these activities. So people have turned some things into that. It could be recognition outside of the professional context. Some people have spun off into more mainstream recognition. You're the doc who goes on TV to talk about things or has mainstream popularity in their social media accounts, talking about one thing or another. There's probably pitfalls here because I think the reward system when you get into that becomes less one that prioritizes truth and more one that prioritizes high visibility or even inflammatory statements. That's how you get these guys spinning off into alternative medicine and things like that. But whatever. As far as pay back on what you're doing, that's one way to go. Your reward is not in your job. I mean, some of these guys would even see and have left their jobs because now they're making money, I don't know, selling snake oil or something. But it's one way to go. You can find a way to kind of find pay back for what you're doing. That is not necessarily the way we used to do it. Yeah. I think the impact factor, it's supposed to be a quality metric and talking about pitfalls. You do, if you are going to be learning on social media and developing content for social media, then you do have to think about quality metrics in that content as well. Is there a citation attached to this tutorial? And did the author put a disclaimer or disclosure on there, like those kinds of things are also really important? Right. Because it's such an easy way to put information out that there's no barrier. You don't even have to get a pass to an editor and never mind a peer reviewer. All you have to do is sound convincing. And of course, some of this applied in the past too. You have expert authorities probably publishing nonsense based on authority, but it's just all the easier now. I mean, literally anyone could say anything as long as it sounds good. Heck, now you can get chat GPT to turn it out for you and it just has to sound really good. Kelly, do you have any approaches for people trying to make sure they're getting good information online? And obviously a lot of the same stuff applies that always has and just kind of using your brain. Someone who's posts are mostly typos, you might not want to put a lot of faith in it, but it's still a challenging area, right? Oh, yeah, definitely. And I think finding quality accounts and sites means looking for some of those quality metrics like, you know, adequate citations and accountable publisher, someone who discloses whether or not they're an expert in the field or maybe they're not, they need to disclose whether X, Y, or Z is an opinion or a fact and if it's a fact, it needs to be cited. But you know, find good lists, honestly, that's one that's one really good kind of functionality that Twitter has is that people make lists of their microlearning and their foamed content. So that's one way is to find a list and find the kind of find your people, if you will. But I think citations are the most important and disclosures for opinions versus fact. I mean, if we're really being honest, I mean, in the old days, I mean, still now too, if you read a journal article in theory, you know it's true because all of the sources for the information are cited. In practice, are you ever going to check on them? Probably only in occasional cases, right? This is an area of your own interest and your pursuance, or you're writing your own paper or something like that. So in practice, then as now, a lot of the credibility you give information is based on the credibility of the source, either the person who wrote it or it's something like a journal, the journal itself, or in the mainstream world, you know, the newspaper who published it or something, you're trusting that they wouldn't give you nonsense. So the decision is less based on that individual information and more kind of a one-time thing you're saying, I'm going to trust the stuff that this source puts out. And I think that's much the same still, right? You're listening to a Twitter account or a podcast or something. We, as most sources, are not going to sit here and give a reference for everything we say, partly because of a lot of its opinion, but even if the stuff is fact, because frankly, it's just too much trouble. It's like not, it creates a barrier to doing the thing that people are not going to very often overcome. So you have to decide, is this podcast going to be something I generally put trust in? And if they have a guest on, am I going to generally trust that they wouldn't put a guest on who's spouting nonsense? And you kind of go on with your life. I think it's hard to imagine people on a routine basis vetting things much more thoroughly than that. Now, if you come across a Twitter post by somebody you never heard of saying that aspirin cures cancer or something, then you have to sort of start from scratch there. But then maybe people who you trust are saying, hey, there's something here and maybe you give it some more credibility. I mean, these are the same processes I think that we always had to use. Yeah. I think people who credible sources are going to say, this is a nebulous area of medicine. And this is my personal perspective. And this is what I would do. I would choose this fluid over x, y, z. And you can cite something, but if you frame it that way, then that makes you a trustworthy source, in my opinion. And that's what you all do all the time. Okay, here's a scenario. I would do this. I would do that. Why? Why? And this is what gets people to critically think. And it's kind of like what I tell my students, you know, make a decision and whatever it is. Just tell me why. Yeah. As long as you have a why, then that's great. Let's work through it. Yeah. And I have to think that a lot of the room for people to have opinions both good and bad has come from the fact that, I mean, I'll just talk about critical care because that's all I know. The evidentiary base for so much of what we do is so slim. And the theme in most of our literature and for a long time now has been negative trials that say it doesn't seem to matter which of these things you do. So what does that leave? It leaves a lot of opinion and personal practice. So that's what you have to talk about. Obviously, when there's clear evidence for something we should be doing, we should all be doing it. But that's more the exception than the rule. So you can easily, if you're teaching your training people, you could say, here's the basket of things you should clearly do. Everything else, here's how I do it, you know, here are practical reasons to do it this way. You know, Jim over here does it a different way. Here's why. And then you're in that realm of evidence and it's just a matter of the craft of it. And when people talk about that, it makes it sound very special. But no, it's not better than doing it the scientific way. It's just there is no scientific way. It's what you have left. All right, guys, what else should we say about this topic? People are going to wander off having listened to this podcast about podcasts. Is there some way they should be changing their perspective on the internet and social media and how it's, you know, being used in their training? I think my takeaway is would be, you know, if you're creating content to do a little bit of a deep dive into micro learning because your content will be better. It will be more flexible. It will be more simple and digestible. It will be more interactive, you know, linking things, having hashtags, putting in citation, putting in a visual like those things make your content interactive. So I would say, you know, just kind of learn a little more about the concept and your content will be better. And then the other takeaway would be, you know, that by engaging with alt metrics and using social media for professional development, I think that we can kind of fight the bias that's around social media. Something like fake news and political and yada yada, you know, I think if we deploy these things professionally and with an eye towards the androgy of it, that it will be higher quality and it will, you know, benefit audiences and really truly democratize education, which is what, you know, the mission of FOMET is. Yeah, I think it's like any disruptive technology, right? But people are going to be distrustful of it at first and then it's become more common. But really social media is not any different than what we've always been doing. It's just a different way of doing it, right? Like take it out of the medical realm, for example, and look at the social aspect of shopping online, right? You read reviews that people post and maybe you agree with them, maybe you don't agree with them, but you use it to decide what you buy. Before this was a thing, you did this in real life. You just talked to people you knew. Has anybody bought this, you know, hedge tremor that I'm looking at? Is it good? Does anybody like this dentist or whatever? And so I think that the temptation to look at social media as something totally foreign and new and scary I get, but I think just look at it like you approach your regular life, right? You wouldn't just willy-nilly trust everything that comes down the pike in real life. So you got to do a little bit of investigating. But can it be beneficial? Sure, absolutely. Well, I think that's been a good chat. I'm going to press both these guys if they have any good resources or reading to pass me along. We'll put them in the show notes, because like Callie was saying, this is probably an area that warrants a little bit of focus thought, whether you're a learner or an educator. But otherwise we'll chat with you next time, Callie, we're so glad to have you. Thank you so much.