Maximizing Your Academic Medicine Social Media Impact

By Kristina Dzara, Ph.D., M.M.Sc.
August 17, 2017

[The third post in a three-part series exploring the use of social media by medical professionals seeking greater academic impact.]

Remember, once you make the decision to embrace social media, move forward not backwards!

Although Twitter is the social media of choice for academic medicine,1,2 more and more individuals and organizations working in healthcare have Facebook, LinkedIn, and Instagram accounts. Although lesser used, newer social media platforms specifically related to academic medicine – for example, Doximity and Medshr – are emerging.3,4

In my previous posts, I wrote about embracing social media in academic medicine, and social media’s educational purpose. Here, I offer some ways that those of us working in academic medicine can maximize our social media impact.

The three sites I see used most often in academic medicine are Twitter, Facebook, and LinkedIn. Twitter allows users to interact using ‘tweets’—brief posts restricted to 140 characters—as a way to share information with others. Users register a handle—for example, mine is @KristinaDzara—which allows others to follow them. Generally speaking, the more followers you have, the more impact your tweets can have on Twitter, in the form of likes, retweets, and overall impressions. Unless you have a private account, any other Twitter user can follow and interact with you.

Facebook allows users to ‘friend’ or ‘follow’ other individuals or organizations. Facebook users are able to control who follows them by accepting or declining friend requests. Although Facebook is more often thought of as a way to connect with family and friends, it can also be effective for professional networking. Many organizations have Facebook accounts and share information about upcoming conferences, events, and opportunities. More recently, Facebook Live has been utilized as a way to broadcast from live academic roundtables and events.

Consider LinkedIn your digital rolodex for professional networking. In many ways an online curriculum vitae, on LinkedIn you can clearly indicate your educational and employment history, as well as publications, presentations, and certifications. Like Facebook, you can request to connect with others and have the power to accept or decline connections. Some prefer to connect only with those they know in real life, while others utilize it as a way to connect with those outside their close professional network. LinkedIn also allows users to post updates—for example, new publications or blog posts—which may be of interest to connections. Another feature is groups, which allows professionals in the same field to make contacts, post and view jobs, and share information.

Regardless of platform, there are a few general principles which can help you maximize your social media impact:

1. Tell a clear and consistent story about who you are and what you do.

Make sure your social media profiles use the same high-quality professional headshot across all platforms. Keep your social media bios up to date, especially if you have had any recent transitions, promotions, or new duties. It is important that if someone views more than one of your social media profiles, the information is similar across platforms.

2. Follow and be followed.

Growing your professional social media networks requires cultivation! Start by connecting with colleagues you already know – they are likely to accept your request and follow you back. Twitter, Facebook, and LinkedIn all recommend people to connect with, which is a great place to start. Scroll your social media newsfeeds and look for posts of interest, see who posted them, and consider following them. However, never feel obligated to follow or engage with another user for any reason. For the most part, I reserve LinkedIn as a way to connect with those I have met or worked with. However, I am more flexible with those I follow on Twitter, provided they have some connection to academic medicine, healthcare, or my discipline, medical education.

3. Share what you are doing.
There is a small part of social media that feels like a bit of self-promotion. Although this may feel boastful, offering professional updates may help you connect with others who have shared interests. You may find that this transparency sparks new conversations about scholarly collaboration or mentorship! When sharing articles or resources, include your opinion or a one liner about what you learned (use a URL shortener like goo.gl or bit.ly to keep the link brief).

4. Use social media to your benefit.
One of my favorite purposes for social media is to follow broad trends in academic medicine. Twitter is exceptionally useful here, as hashtags are a way to quickly identify and find content of interest. Identify a few hashtags based on your interests, subspecialty, or conferences you attend. Some of my favorites include Medical Education (#MedEd), Free and Open Access to Medical Education (#FOAMed), and Healthcare Leadership (#HCLDR). #AcMed (Academic Medicine) also seems to be gaining some traction. Identify a few journals and professional organizations that align with your interests and check their posts. Within minutes you’ll be updated about new articles, conferences, and topics of interest.

5. Be a social media leader!
Utilize social media when at national, regional, and local academic events. This is a quick and easy way to be recognized by both colleagues and experts. When posting, tag an organization, event, or individual by including them in your post to increase your visibility. Provided it is acceptable to the conference and/or speaker, contribute to the conversation by tweeting or retweeting take-home points from the session or links to articles discussed. This can be a powerful networking tool, and you will be recognized by others for it. Don’t forget to have a little fun by posting a photo with colleagues you know or new followers you meet in person. By actively posting to social media during academic events, you will be viewed as someone who is not only approachable, but also savvy to social media.

Remember, once you make the decision to embrace social media, move forward not backwards! Don’t be afraid to engage with others and share the good things you, your colleagues, and your organization are doing. Your social media engagement may lead to opportunities for scholarly collaboration and professional growth – it certainly has for me! Social media has a strong foothold in our community of practice, a trend which shows no sign of slowing anytime soon.


For the latest information on trends in medicine and continuing medical education, follow HMS Global Academy on Twitter and LinkedIn.

For an example of how one doctor uses Twitter to impact his practice, HMS Global Academy recommends the Ted Talk: Twitter Has Made Me a Better Doctor.


References:

  1. Gallo T. Twitter is Trending in Academic Medicine. 2017. https://goo.gl/grJz1w.
  2. Choo EK, Ranney ML, Chan TM, et al. Twitter as a Tool for Communication and Knowledge Exchange in Academic Medicine: A Guide for Skeptics and Novices. Med Teach. 2015; 37(5):411-416.
  3. Doximity. 2017. https://www.doximity.com/.
  4. MedShr. 2017. https://en.medshr.net/.

Kristina Dzara_100x125Kristina Dzara, Ph.D., M.M.Sc. (@KristinaDzara) is a medical educator and researcher with 5+ years of experience in academic medicine. She is a recent graduate of the Harvard Medical School Master’s in Medical Education program and serves as Harvard Macy Institute’s Social Media Strategist. Her areas of professional interest include evaluation and assessment, faculty development, and social media in medical education.

Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment

By Sarah E. Wakeman, MD, FASAM
August 11, 2017

It is not enough to simply say addiction is an illness. If we truly believe this, then we must ensure our language and approach mirror how we care for patients with other illnesses.

The need for treatment modification is a hallmark of disease management, particularly for complex, chronic illnesses like diabetes or HIV. We expect that for many patients a typical treatment course will include periods of remission and recurrence with associated adjustments in medication or other interventions. We even have a term for treatment for the most severe cases of refractory disease; we call it “salvage therapy.” For cancer, salvage therapy refers to “Treatment that is given after the cancer has not responded to other treatments.”1 Note that the lack of response is focused on the disease, appropriately, and not the patient.

This framing of the illness as the agent of harm is the norm for most disease states, with the notable exception of addiction. When the illness is breast cancer, we see imagery of smiling women wearing pink ribbons, and we call patients “survivors.” Despite the association between breast cancer and various environmental or lifestyle factors such as exercise, no one would ever blame the patient (i.e., the victim) for her illness and certainly not for a lack of treatment success.2 Substitute addiction for breast cancer and all of a sudden the approach and even the language changes. Patients with addiction are “abusers,” their test results are “dirty,” and they are frequently described as “failing treatment.”

For an example of how patients with addiction are commonly portrayed, take this Business Insider article.3 This well-intended piece told the story of a young woman who was only offered medications for addiction treatment to manage withdrawal symptoms instead of for ongoing maintenance treatment. As a result, she suffered repeating, and predictable, recurrences of active opioid use. The article ends with this description: “Peterson was finally able to get and stay clean while serving a year in prison for narcotics possession. But many are not as lucky— when users fail out of treatment, they can go into an endless relapse cycle.” Let’s pause for a minute and consider the words used in this description. How would we react if this were a patient with diabetes instead?: “She was finally able to get her blood clean of hemoglobin A1C after a year in prison for sugar possession. But many are not as lucky—when diabetics fail out of treatment, they can go into an endless relapse cycle.” Ludicrous, right?

It is popular now to talk about addiction as a public health issue. And yet of the more than two million people incarcerated in this country, the majority are there for substance-related crimes, meaning they either have a history of substance use disorder, were intoxicated at the time of their crime, or committed their offense to get money to buy drugs or alcohol.4 Worldwide, as many as 90% of people who inject drugs will be imprisoned during their lifetime.5 Our long history of punishing and imprisoning people who use drugs doesn’t only impact policy, it also influences the way we speak about and treat people with the disease of addiction.

Recently, I sat listening to a clinical case conference about a patient who called his doctor to ask about restarting buprenorphine treatment. As the discussion unfolded it became clear there was deep discomfort that this patient was asking specifically for medication to treat his addiction; this sort of “behavior” is called “drug-seeking” when it relates to buprenorphine. But how would we react if it were instead a patient with HIV calling to restart antiretrovirals? I imagine we would say the patient was advocating for himself and his health.

It is not enough to simply say addiction is an illness. If we truly believe this, then we must ensure our language and approach mirror how we care for patients with other illnesses. A starting place might be to remember that treatment can fail patients, but patients don’t fail treatment.


Learning to recognize and replace stigmatizing language in medical practice encourages treatment for opioid use disorder. Learn more best practices in Harvard Medical School’s free online Opioid Use Disorder Program.

CME credits provided for physicians, PAs, NPs, nurses, and social workers.


References:

  1.  https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=44176
  2. Holmes MD, Willett WC. Does diet affect breast cancer risk? Breast Cancer Res. 2004; 6(4): 170–178.
  3. http://www.businessinsider.com/heroin-addiction-why-many-fail-out-of-rehab-medication-assisted-treatment-suboxone-2017-4
  4. https://www.centeronaddiction.org/download/file/fid/487
  5. http://www.unaids.org/sites/default/files/media/images/gap_report_popn_05_idus_2014july-sept.pdf

Dr. Sarah Wakeman headhsotDr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School and course director for Understanding Addiction, part of a free online CME program from Harvard Medical School to help train medical providers in best practices for working with OUD patients. Twitter

An Education Purpose for Social Media in Medicine

[The second in a three-part series exploring the use of social media by medical professionals seeking greater academic impact.]

By Kristina Dzara, Ph.D., M.M.Sc.
August 3, 2017

“Importantly, the choice to use social media must be made purposefully.”

As the number of millennials in medical school, residency and fellowship programs, and in faculty and leadership grows, the use of social media will become more common as a way to reach and engage with learners. When effectively designed, social media does have an educational purpose, offering an opportunity to engage our millennial learners and tap into their technological savvy. As educators, we would be remiss not to utilize various social media platforms to further engage with our learners and provide another context for them to transfer and deepen their learning.

Importantly, the choice to use social media must be made purposefully. When optimized, social media aligns with principles of both cognitive science and adult learning theory [Figure 1]. Adult learners desire relevant, timely, and useful information and learn better when they can positively transfer knowledge, skills, and understanding from one context to another.1,2 An example could include residents participating in a series of online journal clubs and then developing and cultivating a residency-program Twitter account to communicate with peers. Additionally, reflection upon educational experiences can deepen learning. Reflection could be encouraged by asking learners to anonymously post about a recent educational experience on a backchannel chat platform, such as Today’s Meet,3 and then comment on another learner’s post. Notably, both of these educational activities would allow the teacher to assess the learner at the ‘does’ level, which is increasingly more important in the age of competency-based medical education.

Figure 1.

Infographic depiciting learning theory and cognitive science merging with social media.

However, it is essential that educators also consider the potential unintended consequences of social media when used to supplement or replace a more traditional curriculum.4,5 Learners must maintain their professionalism online and follow organizational guidelines and HIPAA standards. There is also concern that social media and online resources are of inconsistent quality. Scholars are now investigating how we might best determine the quality of Free Open Access Medical Education (#FOAMed) resources including blogs, websites, and podcasts.6,7

In my last post, I considered why we should embrace social media in academic medicine. In addition to the many professional benefits, social media has numerous educational implications. Below, I offer three ways social media can be applied to medical education:

  1. Tweet chats and online journal clubs:
    Twitter has become popular in academic medicine, and in some cases, may offer advantages compared to more traditional educational activities.8,9 Both tweet chats and online journal clubs can be delivered synchronously (occurring at the same time as a scheduled learning activity) or asynchronously (not occurring at the same time) and offer learners the opportunity to engage in scholarly debate and reflection online. The flipped classroom—where content is introduced prior to the class session and class time is for knowledge assimilation—is an example of how tweet chats and journal clubs might be utilized as part of a broader curriculum.10 Having taken place before an in-person class session, either would situate the learner in the day’s problem space.10
  2. Podcasts:
    Podcasts allow for streamlined content related to topics interesting to learners in various fields, including medical education. One of my personal favorites is the scholarly KeyLIME Podcast (#KeyLIMEPodcast) which offers “…the main points of a medical education article in just 20 minutes.”11 This is a prime example of leveraging technology and social media to support either self-directed or instructor-led learning. New information delivered to learners in this format has the potential to expand existing knowledge bases and encourage critical thinking.
  3. Blogs:
    Writing for an academic or organizational blog can be used to explore topics of interest or reflect on educational and clinical experiences.12 Writing a blog post may be a helpful exercise for trainees with limited writing and research experience. Some journals—such as Health Affairs and BMJ—have blogs and encourage guest authorship. Moreover, writing for a blog offers learners an opportunity to engage in online educational scholarship, gain academic confidence, and grow their CV’s.

[Read part one of this series: Embracing Social Media in Academic Medicine]


Harvard Medical School Global Academy has blogging opportunities
available for credentialed health professionals.

Learn more about submitting a blog post to Lean Forward  or Trends in Medicine.


Kristina Dzara_100x125Kristina Dzara, Ph.D., M.M.Sc. (@KristinaDzara) is a medical educator and researcher with 5+ years of experience in academic medicine. She is a recent graduate of the Harvard Medical School Master’s in Medical Education program and serves as Harvard Macy Institute’s Social Media Strategist. Her areas of professional interest include evaluation and assessment, faculty development, and social media in medical education.

References:

  1. Weidman J, Baker K. The Cognitive Science of Learning: Concepts and Strategies for the Educator and Learner. Anesth Analg. 2015; 121(6):1586-1599.
  2. Knowles MS, Holton III EF, Swanson RA. The adult learner: The definitive classic in adult education and human resource development. 8 ed: Routledge; 2015.
  3. TodaysMeet LLC. What is Today’s Meet? 2017. https://todaysmeet.com/about/backchannel.
  4. Pereira I, Cunningham AM, Moreau K, Sherbino J, Jalali A. Thou shalt not tweet unprofessionally: an appreciative inquiry into the professional use of social media. Postgrad Med J. 2015; 91(1080):561-564.
  5. Hors-Fraile S, Atique S, Mayer MA, Denecke K, Merolli M, Househ M. The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions. JMIA Yearb Med Inform. 2016; (1):47-52.
  6. Thoma B, Chan TM, Paterson QS, Milne WK, Sanders JL, Lin M. Emergency Medicine and Critical Care Blogs and Podcasts: Establishing an International Consensus on Quality. Ann Emerg Med. 2015; 66(4):396-402 e394.
  7. Lin M, Joshi N, Grock A, et al. Approved Instructional Resources Series: A National Initiative to Identify Quality Emergency Medicine Blog and Podcast Content for Resident Education. J Grad Med Educ. 2016; 8(2):219-225.
  8. Mehta N, Flickinger T. The times they are a-changin’: academia, social media and the JGIM Twitter Journal Club. J Gen Intern Med. 2014; 29(10):1317-1318.
  9. Forgie SE, Duff JP, Ross S. Twelve tips for using Twitter as a learning tool in medical education. Med Teach. 2013; 35(1):8-14.
  10. Hillman T, Sherbino J. Social media in medical education: a new pedagogical paradigm? Postgrad Med J. 2015; 91(1080):544-545.
  11. Frank JR, Snell L, Sherbino J. KeyLIME – Key Literature in Medical Education. 2017. http://www.royalcollege.ca/rcsite/canmeds/keylime-podcasts-e.
  12. Khadpe J, Joshi N. How to Utilize Blogs for Residency Education. J Grad Med Educ. 2016; 8(4):605-606.

 

 

 

 

 

 

Embracing Social Media in Academic Medicine

[The first in a three-part series exploring the use of social media by medical professionals seeking greater academic impact.]

By Kristina Dzara, Ph.D., M.M.Sc.
July 12, 2017

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature.

Sample Altmetrics Score Depiction
Sample Altmetrics score

Academic medicine is harnessing the power of social media for networking, professional development, education, and dissemination of information.1 An ever-growing cadre of individuals and organizations in healthcare have Twitter, Facebook, and Instagram accounts, e-newsletters, podcasts and blogs.1-3 In fact, Twitter is the social media of choice for academic medicine.3,4 Although there is debate about professionalism and social media—as well as a concern that we spend too much time using social media without concrete evidence of educational and academic worth—social media has a strong foothold in our community of practice.3,5-7

The journal article remains the gold standard for dissemination of scholarly work. Yet, the publication process continues to be disrupted by new models of publication—prime examples are open access e-journals such as MedEdPortal and MedEdWorld. These advances are symbiotic with social media, especially Twitter. A number of journals have started including author Twitter handles in their publications and encourage tweets about new articles. Several offer a link providing free access to a limited number of readers, to be used for social media dissemination.

Blogs are multipurpose and can allow for the rapid spread of information.2 Blogs are colloquially written, and authors can write without the time and resources required to construct a full-length research article. Blogging can also help authors explore areas of early professional interest to increase familiarity with the topic. Certainly, the content and quality of blogs vary, but studies are being conducted to offer objective, scientific evidence of quality.8 Moreover, some journals, such as Health Affairs and the British Medical Journal, have blogs and encourage participation.

Although traditional journal-based citation metrics such as the impact factor and h-index  remain the standard, researchers are embracing new alternative metrics including usage (views, downloads, clicks), mentions (blog, media coverage), citations (Scopus, Web of Science, Pubmed), and number of tweets and Facebook likes for their own articles to supplement journal impact factors.4,9,10 These and other alternatives, such as the Altmetric Attention Score, are becoming more commonly used in academic medicine.4,9,10 Altmetrics are social-media based, have both a numeric score and a visual depiction of reach, and can objectively measure the impact of articles, webinars, educational videos, and blogs in real time.4,9,10 Although there is some concern that Altmetric scores can be gamed or manipulated, overall they can be utilized as an additional measure which can be triangulated with traditional metrics to gain a more comprehensive portrait of impact.4,5,9,10

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature. We know that our millennial learners and colleagues have embraced social media, and that the technology which allows us to engage worldwide is expanding by the day. If information truly is power, social media offers us more than we could have ever previously imagined.


Already using Twitter? Be sure to follow HMS Global Academy @AcademyHMS.


Kristina Dzara_100x125

Kristina Dzara, Ph.D., M.M.Sc. (@KristinaDzara) is a medical educator and researcher with 5+ years of experience in academic medicine. A recent graduate of the Harvard Medical School Master’s in Medical Education program and a Harvard Macy scholar, Kristina’s areas of professional interest include evaluation and assessment, faculty development, and social media in medical education.

References:

  1. Chisolm MS. Social Media in Medicine: The Volume that Twitter Built. Int Rev Psychiatry. 2015; 27(2):83-84.
  2. Khadpe J, Joshi N. How to Utilize Blogs for Residency Education. Journal of Graduate Medical Education. 2016; 8(4):605-606.
  3. Gallo T. Twitter is Trending in Academic Medicine. 2017. https://goo.gl/grJz1w.
  4. Chisholm MS. Altmetrics for Medical Educators. Acad Psychiatry. 2016.
  5. Wise J. Promoting Research on Social Media Has Little Impact. BMJ. 2014; 349:g7016.
  6. Choo EK, Ranney ML, Chan TM, et al. Twitter as a Tool for Communication and Knowledge Exchange in Academic Medicine: A Guide for Skeptics and Novices. Med Teach. 2015; 37(5):411-416.
  7. Kesselheim JC, Batra M, Belmonte F, Boland KA, McGregor RS. New Professionalism Challenge in Medical Training: An Exploration of Social Networking. J Grad Med Educ. 2014; 6(1):100-105.
  8. Chan T, Trueger NS, Roland D, Thoma B. Evidence-based Medicine in the Era of Social Media: Scholarly Engagement Through Participation and Online Interaction. Cjem. 2017:1-6.
  9. Handel MJ. Article-level Metrics-It’s Not Just About Citations. J Exp Biol. 2014; 217(Pt 24):4271-4272.
  10. Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article’s Academic and Societal Impact. Aesthet Surg J. 2014; 34(7):1123-1126.

Supervised Injection Sites: A Boston Doctor Speaks Out

(photo: Massachusetts General Hospital, Boston. Ma.)

June 29, 2017

Dr. Sarah Wakeman speaks about the process that informed her opinion on supervised injection facilities:

Opening supervised injection sites to address the opioid crisis in America is a controversial subject. Dr. Sarah Wakeman, the medical director of Massachusetts General Hospital’s Substance Use Disorder Initiative and Addiction Consult Team, has something to say about it.

As a staunch supporter of evidence-based treatment for patients with substance use disorders, you may hear her expert opinion by clicking on the brief video below…

Do you have an opinion to share as well, or questions for Dr. Wakeman? Use the comment section to start a conversation about supervised injection sites.

Read more posts by Dr. Sarah Wakeman:

Waiting for Addiction Treatment: A Deadly Proposition
Summary: Dr. Wakeman discusses the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.


Harvard Medical School is offering free online accredited CE/CME courses in identifying and treating opioid use disorder for physicians, physician assistants, nurse practitioners, nurses, and social workers. Each course contains additional resources to assist health care providers in treating patients with opioid use disorder. Select a course below to learn more and enroll:

Understanding Addiction

Identification, Counseling, and Treatment of OUD

Collaborative Care Approaches for Management of OUD


Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School and course director for Understanding Addiction. Twitter

(photo credit:https://commons.wikimedia.org/wiki/File:MassGeneralHospital.jpg)

Effective Clinical Teaching on Rounds: Microskills Worth Practicing

By Martina M. McGrath, MD
May 24, 2017

On-the-job clinical teaching of students and physicians in training is a central aspect of medical education. For trainees, skilled teachers can become mentors and role models; often inspiring them choose a particular specialty and also having a formative influence on their clinical practice. For the teacher, it can be one of the most rewarding and enjoyable aspects of their practice. However, due to the frenetic nature of the clinical work environment with many competing demands, clinical teaching is frequently rushed, disjointed, and interrupted. Most of us would like to be better teachers, but how do we best make use of our limited time to impart some clinical pearls and support our trainees in their professional development?

Using a structured approach to teaching during a clinical encounter can maximize the learning opportunity without placing excessive burden on busy clinical teachers. Many approaches have been proposed but one of the more appealing ones, due to its simplicity, is The One minute preceptor: Microskills model of clinical teaching as proposed by Neher.1 This model distills a large body of learning theory into a manageable, five-step approach to a clinical teaching encounter:

Step 1: Get a commitment:  “What do you think is going on?”
Encouraging the trainee to commit to a diagnosis/plan of evaluation helps them to synthesize their thoughts and focus on the question at hand. Committing also helps them recognize their own learning needs, which encourages self-directed learning.

Step 2: Probe for supporting evidence: “Why do you think that?”
At this point, the temptation on the part of the teacher is to simply provide the correct answer or begin an explanation. However, encouraging active participation by the trainee will give them a much better learning experience. The aim is to encourage the trainee to reflect and work through the problem. This will in turn allow the teacher to provide more directed instruction related to the trainee’s level of knowledge and expertise.

Step 3: Teach general rules
Teaching is frequently more transferable and applicable when provided as general rules.1 An approach such as ‘when this happens, do this…’ can be very helpful. Having encouraged the trainee to work though the problem will allow the teacher to appropriately target this information to the trainee’s level.

Step 4: Reinforce what was done correctly
Feedback, which is specific to the task at hand and delivered in a timely manner, is an important way to reinforce learning. As many trainees are still developing their professional identities, reinforcing positive professional attributes also encourages their personal development.

Step 5: Correct Mistakes
Many teachers struggle to give negative feedback. Encouraging the trainee to reflect on his or her own performance is a nonconfrontational way to open the discussion of any errors that were made. Similarly, criticism should be of the approach rather than the individual (‘this aspect of the case could have been better dealt with by xx…’ as opposed to ‘you handled this case badly’).

Informal, opportunistic teaching is a central component of medical education. Applying an outline structure can improve the efficiency and effectiveness of a given teaching opportunity. By encouraging a discussion rather than a lecture, this type of approach can give educational benefit, and more enjoyment, for both the learner and the instructor.

References:

  1. Neher, et al. A Five-step “Microskills” Model of Clinical Teaching. Journal of the American Board of Family Practice. 5:419-424, 1992.

Developing Essential Skills in Clinical Research

This 1.25 credit CME course is designed for medical doctors who desire to pursue a career in clinical research in the US. The course will help you develop knowledge on key elements required to be an effective clinical investigator, understand what it takes to become a clinician-investigator, understand the importance of mentorship in your career trajectory, and develop specific skills in writing proposals, crafting scientific papers, and making effective presentations. Click on the title link to learn more.


Headshot of Dr. McGrathDr. Martina McGrath is an Instructor in Medicine at Harvard Medical School, and a member of the Renal Division, Department of Medicine, at Brigham and Women’s Hospital, both in Boston. Dr. McGrath is the Medical Editor for the Trends in Medicine blog.

Waiting for Addiction Treatment: A Deadly Proposition

By Sarah E. Wakeman, MD, FASAM
May 3, 2017

In a 2016 research letter to the New England Journal of Medicine, Dr. Sigmon and colleagues describe the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.1 Interim buprenorphine dosing means offering medication alone to people on a waiting list to get into a buprenorphine treatment program, which generally involves medication plus counseling. This study randomized patients to either staying on the waiting list or getting just the buprenorphine administered at home by an automated and locked pill dispenser. The results were compelling. All of the participants who remained on the waiting list continued to use illicit opioids. In contrast, the majority of those treated with buprenorphine stopped using opioids completely, with abstinence rates of 88%, 84%, and 68% at 4, 8, and 12 weeks (P<0.001 for all comparisons).

Given the requirement to offer counseling with buprenorphine treatment and the emphasis placed on psychosocial interventions in the treatment of addiction, these results may seem surprising. It is important to highlight that Sigmon’s findings build on a robust base of evidence which calls into question counseling requirements. It turns out that effective counseling for people getting buprenorphine doesn't have to come from a therapist; another trial found that medication management visits with the prescribing physician providing counseling in the office were as effective as additional psychosocial interventions.2 Previous research has also shown that interim methadone treatment significantly reduces drug use and improves clinical outcomes.3 In fact, no rigorous study has ever been able to show that the addition of psychosocial services to opioid agonist therapy alone improves outcomes in the treatment of opioid use disorder.4,5 So why then do we continue to limit access to these lifesaving medication treatments? In a thought-provoking piece about the history of addiction treatment in the US, Dr. Walter Ling, a renowned physician-scientist, reflects on our approach to limiting access to methadone and buprenorphine.6

From the very beginning our policy has been: Addicts are sick, they need help; but they also sin and must suffer a little. So we built treatment programs and put up barriers making it difficult for patients to get into treatment. The justification was to prove their motivation... We as a society basically … think addicts should just get off drugs and by strenuously hauling up on their own bootstraps and should stay off no matter what. Policymakers and some clinicians continue to promote detoxification as treatment,even though detoxification does nothing to help people stay off drugs.

If today is like any other day in the US, 144 people will die in the next 24 hours from a lethal overdose including 91 from an opioid overdose.7 The World Health Organization estimates that treatment with methadone or buprenorphine reduces an individual’s risk of overdose death by nearly 90%.8 And yet, less than half of the 2.2 million Americans with opioid use disorder are receiving treatment, with waiting lists for medications for addiction treatment the norm rather than the exception. In Vermont alone there are 500 people on a waiting list to access buprenorphine.9 Waiting lists are not merely an inconvenience, they are quite literally deadly. A study of people on a waiting list for methadone treatment found the risk of death to be ten-fold higher than in those on the medication.10 A recent news article made personal the devastating impact waiting lists can have by sharing the story of Taylor Wilson, a young woman who waited 41 days to get buprenorphine treatment and died from an overdose hours before the clinic called to finally offer her an appointment.

[Are Supervised Injection Facilities an Answer to Saving Lives in the Opioid Epidemic?]

Voltaire’s famous quote, “Don’t let perfect be the enemy of the good,” is frequently referenced in medicine as a reminder to not let lofty ambitions prevent important progress and innovation. Yes, opioid addiction is a complex disease ideally treated with comprehensive care. Yet the evidence is clear that medications alone can be highly effective. Deaths due to opioid use and addiction now kill more Americans than car accidents or firearms. Why limit access to these medications which can substantially reduce opioid use and overdose death? As Ling describes, stigma and belief have historically influenced treatment models for addiction to a far greater degree than science. In the midst of an epidemic we can no longer afford this unscientific approach. We have the tools to end the crisis, so the question now becomes whether we have the will.


Opioid Use Disorder Education Program

Learn more about the latest medical and psychosocial treatment options, best practices, and legal guidelines for identifying and treating OUD in a free online program produced by Harvard Medical School.

The Opioid Use Disorder Education Program (OUDEP) is comprised of three CE/CME courses produced by Harvard Medical School with scientific contributions from The National Institute on Drug Abuse (NIDA). These courses are intended for nurses, nurse practitioners, physician assistants, physicians, and other health care providers collaborating to treat patients with substance use disorders.


References:

1. Sigmon SC, Ochalek TA, Meyer AC et al. Interim Buprenorphine vs. Waiting List for Opioid Dependence. N Engl J Med. 2016 Dec 22;375(25):2504-2505.

2. Fiellin DA, Barry DT, Sullivan LE, et al. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med. 2013 Jan;126(1):74.e11-7.

3. Schwartz RP, Kelly SM, O’Grady KE, Gandhi D, Jaffe JH. Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. Addiction. 2012 May;107(5):943-52.

4. Schwartz RP. When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids: A Comment on Dugosh et al. J Addict Med. 2016 Jul-Aug;10(4):283-5

5.  Ling W, Hillhouse M, Ang A, Jenkins J, Fahey J. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013 Oct;108(10):1788-98.

6. Ling, W. A Perspective on Opioid Pharmacotherapy: Where We Are and How We Got Here. J Neuroimmune Pharmacol (2016) 11:394–400

7. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452.

8. United Nations Office on Drugs and Crime/World Health organization (UNODC/WHO). Opioid Overdose: preventing and reducing opioid overdose mortality. 2013. Retrieved from https://www.unodc.org/docs/treatment/overdose.pdf Accessed on April 13, 2017.

9. http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/02/11/waiting-lists-grow-for-medicine-to-fight-opioid-addiction

10. Peles ESchreiber SAdelson M. Opiate-dependent patients on a waiting list for methadone maintenance treatment are at high risk for mortality until treatment entry. J Addict Med. 2013 May-Jun;7(3):177-82.

Sarah Wakeman_100x150Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School. Twitter