TELL ME at Dundee University through Twitter

In July 2012, the Tell Me project produced a report on the past and previous uses of social media during pandemics. One of the chapters focused on stakeholder engagement of healthcare professionals who have an interest in using social media and its role in healthcare communication. Project partners at BMJ conducted two hour-long Twitter chats in collaboration with @nhssm (NHS social media); a Twitter community dedicated to NHS staff who are interested in discussing the uses of social media in healthcare. The first chat was entitled: Social media and emergency planning –what has worked in the past? For the second chat, we worked with Chloe Sellwood (‎Pandemic Influenza Resilience Manager and Horizon Scanning Lead at NHS England) and Alex Talbott, who founded and organises @nhssm, to devise a #fluscenario blog. The purpose of the blog was to understand how healthcare professionals would react on social media to an unfolding flu pandemic.

Since then #fluscenario has been adapted by Ellie Hothersall,  Consultant and Undergraduate Teaching Lead for Public Health, to help medical students learn and think more about the role of social media  in pandemic communication. She tells us about the #fluscenario module she has been running at the University of Dundee.

Medical students here at the University of Dundee have been learning about pandemic flu and social media in a new way: through Twitter. As part of the first year respiratory block, students take part in a 4 week series of scenarios, describing the development of a pandemic of influenza through the four phases of background, epidemic to early pandemic, full-blown pandemic and recovery and aftermath.

Early in the planning process, they happened upon the #nhssm blog and the TELL ME website. NHSSM had thought through much of this before, and they had written a series of scenarios based on the 2009 swine flu pandemic. Alex Talbott and Chloe Selwood very generously allowed us to modify their work and thus the project was born. We decided to use the #fluscenario hashtag from the original #nhssm Twitter Chat to allow some continuity.

The four scenarios were posted on a blog (www.dundeepublichealth.wordpress.com), and were discussed mostly during private study periods during the weeks the scenarios were running. We used a publicly accessible website so that members of the public could follow or join in the conversation. We also encouraged staff and students from outside the medical schoolto take part. Using an online, interactive scenario gives students insight into pandemic influenza and emergency planning, areas that historically don’t get much coverage within the curriculum (although every doctor needs to understand them).

Public Health is in fact a difficult subject to teach well at medical school. The core elements of the discipline are so fundamental to medicine that we need students to “internalise” the information, even if they neveranswer an exam question on the subject.

With this in mind, the learning objectives the project set out to deliver were at once imprecise and ambitious:

• To understand why influenza is a cause for serious concern;
• To understand what process might underlie emergency planning;
• To understand a doctor’s role in that process;
• To understand a doctor’s role in information sharing in social media and within other settings.

We have now run the scenarios twice. In 2012 we allowed students to make comments via the blog, or discuss on Twitter. The longer text answers on the blog were more like essays, and did not include the conversational aspects of Twitter that seemed to be its strength so in 2013 we pushed Twitter far more strongly. Students were told they were required to contribute to all the scenarios, either through Twitter, or by emailing their reflections on the process directly -the UK General Medical Council likes doctors to reflect. It was really exciting to see themgetting involved and “following” the @DundeePublicH Twitter account in preparation. We have found the four weeks running the scenarios exciting and invigorating: the students express many profound insights and the long conversations between students and tutors develop into many useful themes. Many concepts are clearly held in implicit faith by most students: social media for sharing information; television adverts; public consultations, hand-washing and education in schools all appeared again and again as the solution to any problem that vaccination couldn’t address.

The frenetic pace of the Tweets can be difficult to keep up with – over 800 messages in the first few hours of the first scenario. Students unfamiliar with Twitter found this confusing and disorienting.  Furthermore, some complained later that the 140 character limit on Twitterrestricts the conversation’s flow.One kind student’s online feedback summed the criticisms up neatly:

“Every(one)… basically wanted to get their name ticked off as having contributed to the discussion, then get back to actually learning/studying the respiratory block.”

…but others cited the novelty/pace/enforced succinctness/participation of outsiders as strengths of the project.

The anonymous feedback suggested that Twitter is certainly not as commonly used and trusted as one might initially assume. Intriguingly, it became clear that students don’t really feel like they are learning if they are using Social Media: 47% in 2012 and 33% in 2013 did not feel that using Twitter helped to consolidate their learning.

The students seemed to be well engaged at the time. So did we misjudge the value of social media for this kind of medical education? The majority got very involved and seemed to be developing their arguments well. It was very fast-moving, and in the first scenario in particular it was probably difficult to understand properly what was going on. But for all that many of the conversations whirling around were gratifyingly understandable. The publicity of Twitter might have inhibited people from commenting, but we would argue that the input from outside the university made the whole event more interesting, and also that maintaining professionalism online is a vital component of medical education. As mentioned previously, the posts on the blog from the 2012 version were well-considered, but read like short essays produced to answer the questions. To our mind, this response style disadvantaged students: their work was visible to all, but they had no power to interact with the readers.

The contradiction between the students’ faith in social media for engaging the public, and their apparent inability to view it as an educational tool is perhaps not a new discovery, but it is one that needs to be considered within both an educational and emergency planning context. We would be interested in hearing from other institutions who have suggestions for more well-received ways to run this or other similar scenarios in the future.

Ellie Hothersall, University of Dundee

Acknowledgements:

Thanks to Annalisa Manca, Julian Davis, Natalie Lafferty and Craig MacLean for their help with running #fluscenario. Alex Talbott and Chloe Selwood wrote the original scenarios and thanks go to them for allowing their hard work to be reused.