AAMC Reporter: April 2006

Blogs, Podcasts Make Their Mark in Academic Medicine

Every day, we are confronted with the innovations of a never-ending technology revolution. People and industries have little choice but to adjust their sails to these changing winds or be left behind.

Academic medicine is no exception. Students, faculty, and institutions are taking advantage of some of the technological tools gaining popularity in mainstream culture by applying them to both the medical education process and to the exploration of related issues. Two of the most notable technologies currently being tried are blogs and the iPod, including podcasting.

Blogs — an abbreviation of "Web log" — are Web pages containing content selected and updated by an individual or group of individuals. Blogs are accessible free of charge through popular sites like the Google-owned Blogspot, or LiveJournal; a blog takes approximately 20 minutes to set up. Technorati, a blog search engine, counts almost 30 million blogs in its database. Like the Internet itself, blogs are trumpeted by aficionados as a highly variable instrument, capable of being almost anything a user wants them to be.

Robert Centor, M.D., says his blog, www.medrants.com, gets 700 to 1,000 hits each day

"Blogging is a very flexible modality," says Robert Centor, M.D., a professor of internal medicine at the University of Alabama School of Medicine and associate dean of the school's Huntsville Regional Medical Campus, as well as the mastermind behind www.medrants.com, a medical blog that he estimates gets between 700 and 1,000 hits each day.

"It's really just an open journal that you can take in any direction," Centor said.

A newer phenomenon is podcasting — the popularity of which has exploded in direct proportion to the iPod, Apple Computer Inc.'s pervasive MP3 player. The iPod, a portable device not much larger than a pack of gum, can download and store hundreds of hours of audio and video data. Podcasting is a method of publishing files to the Internet; podcast users can download these files into their iPod or other MP3 player, or to receive new files automatically by subscription.

"Podcasting is really catching on," says Jeffrey Taekman, M.D., director of the Duke Human Simulation and Patient Safety Center, assistant professor of anesthesiology, and assistant dean for educational technology at Duke University School of Medicine, which recently began offering video podcast downloads of some lectures and special presentations to medical students.

"You want to make the materials available in ways that students will use," Taekman said. "I think the students want this, and I think it's only a matter of time before it is universally adopted."

Of the two, podcasting seems to be the technology currently gaining a strong foothold in direct medical practice and education. For example, Grayson Wheatley, M.D., a cardiovascular surgeon at the Arizona Heart Institute in Phoenix and immediate past chair of the AAMC's Organization of Resident Representatives, recently launched a series of podcasts ranging from two minutes to one hour that educate patients on the procedures they are about to undergo — and the lifestyle changes they'll need to make afterward — as they sit in the waiting room.

Podcasts have practical applications in the classroom as well. Michael Barrett, M.D., clinical associate professor of medicine and cardiologist at the Temple School of Medicine and Temple University Hospital, recently developed a method of using iPods to help students memorize various heart sounds, such as murmurs, in order to detect the presence of certain conditions — a considerable challenge for medical students.

"I had a hunch the problem [of students unable to properly detect heart sounds] was a technical skill, like tying knots," Barrett says. "And for that, all you need is repetition."

After studies determined that the "magic number" of times one needed to hear the beats to memorize them was 500, Barrett, then with Drexel University College of Medicine, sprang into action.

Michael Barrett, M.D., of Temple University Hospital (left) with cardiology fellow Behnam Bozorgnia

"I made the different heartbeat sounds into files and burned them onto a CD," he says. "I gave out the CDs to students and thought, 'Wow, I'm at the cutting edge!' A little later I asked students if they were listening to the CDs, and they told me no one listens to CDs anymore but that they had put it on their iPods."

Now, Barrett posts the different heart sounds on a university Web site. After logging in, students download the files to their computers, iPods, or other MP3 players. According to Barrett, subsequent studies on 235 students who downloaded the heart sound files revealed that of the 110 students who used an iPod or other MP3 player to listen to the sounds, 95 percent found the exercise useful in their memorization, and 90 percent have since heard one of the sounds in a patient. Effectiveness of the memorization between CD and MP3 players was the same.

"Now, they can listen to it everywhere, and it's a convenient way for them to get the sounds and to learn them," Barrett says. "So why even spend the time and money making CDs?"

At Duke, the podcasting pilot program making some lectures and special presentations available is going well so far, Taekman says. He adds, however, that issues of intellectual property and privacy — specifically, compliance with the privacy rules in the federal Health Insurance Portability and Accountability Act (HIPAA) — create significant challenges that still must be ironed out.

"The professors producing these lectures and lecture materials need to retain ownership," Taekman says. "So we need to protect that information. We have a setup here that ensures the information only gets to Duke students and staff, but security measures are not quite at the level they would need to be at for widespread adoption."

Taekman says the files are behind security firewalls, with access and authentication procedures controlled by Blackboard, a company providing products enabling universities, schools, and corporations to host classes on the Internet. The school plans eventually to move the system to a virtual private network (VPN). To safeguard against privacy violations, Duke administrators digitally remove any potentially sensitive patient-specific information from the lectures or lecture materials before they reach Duke's network.

Privacy concerns are also very real in the blogosphere, which is still not uniformly policed.

"I definitely am hyper-aware of confidentiality issues," says Graham Walker, a third-year student at Stanford University School of Medicine, who in 2001 started www.grahamazon.com, a blog dedicated to his experiences in pre-med and medical school. "I often stagger the timing of events, change the symptoms, the age, the gender, and names. And if there's any concern that the story itself might reveal something that would give away who the patient is, I just won't reveal that story."

While privacy and similar concerns have yet to be thoroughly addressed in the ever-evolving Internet world, Walker says bloggers are carving out a legitimate niche in the way people, including those in the medical community, communicate.

"Blogging lets me give my own perspective on medical school and practicing medicine," Walker says. "Blogs add to the discussion. The nice thing is that you're able to find things you click with, and it can help you filter information. If you're a nephrologist, you can start or find a kidney blog with all the latest kidney research. There's so much info out there nowadays; this is a good way to keep up."

Walker adds that blogging has been an asset to him throughout his medical education.

"Blogging has absolutely helped me in medical school. It has allowed me to vent and connect with other medical students on a lot of the challenges of medical school, be they emotionally dealing with dissecting a cadaver for the first time, or the death of a patient, or the frustration of working so hard through my 20s. It has also helped academically, because when I explain something on my blog in a way that non-medical personnel can understand, that helps me to understand it better."

Centor, of the University of Alabama, says blogs could have direct applications in the classroom or the clinic. "In terms of medical education, it's possible you could use a blog in a curriculum," he says. "You could blog about specific cases and how they were or should be dealt with. There's really no limit to what you can do."

Centor, who calls his Medrants blog "reasonably popular," says the experience has opened professional doors for him. He now sits on the editorial board of Medscape, a Web site administered by WebMD that provides health care professionals with clinical information, and has published articles in USA Today and elsewhere — all the result, he says, of blogging.

"I think blogs are a bit like those soap boxes in Hyde Park in London. I'm yelling out into the universe, and people are reading it. Do I influence the wider debate? I think I'm starting to," Centor says.

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