Abstract
Objective
To describe the process of creating the Family Medicine Vital Signs blog, curated and edited by residents and faculty at the University of Utah Family Medicine Residency Program and to obtain feedback from participants regarding educational impact.
Methods
Each resident and faculty member contributes at least one blog post per year (with other invited authors), resulting in one post per week on the blog site. An editorial board composed of residents and faculty provides direction and editorial assistance for each post. Residency staff assist in providing authors with reminders and logistical support. A survey was conducted of blog contributors to understand their perceptions of the blog’s educational value.
Results
The Family Medicine Vital Signs blog was started in July 2014, with 40% (n = 68) of the 170 posts provided by residents, 38.2% (n = 65) by faculty, and 21.8% (n = 37) by invited authors through June 2017. It has averaged nearly 100 unique readers per week and has had 15 posts republished in different venues. The participant survey demonstrated scores above the median-possible score, showing positive impact in support of the educational goals.
Conclusion
A residency blog provides a venue for educational instruction, supporting physician development of communication skills, community engagement, and advocacy.
Introduction
The use of blogging and other social media modalities (such as Facebook and Twitter) in graduate medical education (GME) has been encouraged in multiple settings as a way to better communicate in a more widespread and general way with learners and expand the reach of that information.1,2 However, the use of these modalities is not yet widespread.
Although many institutions have created training programs for the professional use of social media,3–5 few have documented success in meeting educational goals using these various social media platforms. A review from 2013 shows that while some GME programs have shown an increase in knowledge, attitude, and skills among learners through the use of social media tools, many more have been unsuccessful due to significant barriers to implementation. 6 For the GME programs that have set up blogs, the majority have primarily used the sites as repositories of information.7–9 Some residency programs have found utility in using blogging for personal reflection.10–12 Documentation of the use of blogs by health-care professionals for advocacy, public education, or professional development is not common in the literature, 13 despite the growing importance of physician training in public communication. 14
Due to the ubiquitous public use of social media, blog postings are a potential avenue for medical education. In 2012, the Accreditation Council for Graduate Medical Education (ACGME) introduced outcomes-based educational directives through the Milestones program. 15 This program requires regular evaluation of an individual resident’s progress in many core areas throughout their training. Among them, core competencies related to professionalism, effective communication, communicating with the public through technological means, and community engagement can be taught through participation in a residency blog. The literature is devoid of particular examples of such blogs, successes or failures, or the potential value of such an endeavor.
This article describes the process and outcomes of developing a residency blog, 16 Family Medicine Vital Signs, 17 at the University of Utah Family Medicine Residency Program (UUFMRP). The UUFMRP is an academically supported program, whereas a majority of residency training is done in community hospitals and clinics. We will describe the factors of success in creating the blog, observed markers of its impact, and feedback from faculty and resident blog participants. Given that there are no known descriptions in the literature of implementation of such a residency blog, this article will add greatly to an area lacking in evidence.
Method
Implementation
The UUFMRP hypothesized that a residency blog would develop residents’ advocacy interests, writing skills, and professional communication. The notion was initially presented by one of the authors (KBJ), who created initial objectives. Buy-in was achieved from the residency leadership so as to support the above educational goals. All residents and faculty were notified both in person and through e-mail messaging in Summer 2014 that the residency program was developing a family medicine blog intended to achieve the following objectives: (1) to increase interest in family medicine among medical students; (2) to improve understanding of the field of family medicine within the medical community; (3) to establish the University of Utah as a national leader in family medicine education and innovation; and (4) to engage residents and faculty in community and legislative advocacy efforts on issues related to patient health and the specialty of family medicine. These goals were refined through discussion including the authors of this article, the blog editorial board, and interested residents, incorporating residency program goals, and ACGME Milestones.
We aimed to post one blog entry per week, with residents and faculty each contributing one blog post per academic year, as a required activity. The UUFMRP includes 8 residents for each of the three years of residency, as well as 22 core faculty members (at the time of survey distribution). In addition, we invited participation from writers outside of UUFMRP, including medical students, interprofessional trainees, residency alumni, adjunct faculty, and national leaders in family medicine. Authors signed up for a scheduled date and were instructed to write a 600-word blog on a topic of their choice, broadly related to promoting family medicine education. Topic ideas were provided upon request that would fit within the general categories of education, practice, research, leadership, or innovation. The audience was intended to be medical students, family medicine residents, and family medicine faculty throughout the United States. A residency coordinator oversaw the blog’s schedule, e-mailing reminders to authors several weeks ahead of the publication deadlines. When there were sufficient numbers of submissions, two articles were posted in a given week.
Many residents and faculty initially resisted to a new requirement on their time, but buy-in from the participants was increased once intent was clarified and support from the board was offered. This has also led to some posts being submitted late. Back-up posts were kept for such times, and multiple reminders were provided to blog authors to ensure on-time submission. When topic suggestions were requested, exploration of an author’s passion was explored and ideas given on how to address the topic in a personal or advocacy manner.
Editorial board
We developed an editorial board of interested UUFMRP residents and faculty. The monthly meeting attendance ranged in number from 3 to 15, with roughly 66% of the board members routinely attending being residents. A faculty member (KBJ) served as chair of the board. The board’s mission was to guide the direction of the blog, assist participating writers as needed, and to inform the residency program’s content on its Facebook page and Twitter feed. Each editorial board member served as editor to blog entries assigned to them, which they received two weeks prior to the publication deadline. In the rare event that material in the entry was considered unusually controversial, residency leadership was asked to determine whether the content was appropriate for publication.
Understanding impact
We measured the impact of the blog by trending readership over time, as well as tracking when blog entries were referenced in other online or print forums.
Understanding resident and faculty perceptions
We developed a survey to explore the perceived impact of our blog meeting the stated objectives. The survey was sent to 22 residents and 18 family medicine faculty members who had authored blog posts. The four faculty authors of this article and two residents, who assisted in survey development, did not participate in the survey. Respondents assessed the importance of each goal, how well the blog supported each goal, and their personal experience as a reader or writer of the blog via a Likert-type scale (1 = Not very important/Not at all/Strongly disagree; 5 = Very important/Very well/Strongly agree). See Table 1 for a list of survey questions.
Survey questions and results.
aIncludes six first-year residents, six second-year residents, and six third-year residents. bWilcoxon–Mann–Whitney test.
Bold indicates significant findings at p<0.05.
The survey was emailed as an anonymous response format to all residents and faculty, with weekly reminders, for a total of two reminders beyond the initial e-mail. As the Likert-type scale questions provided ordinal data, we used the Wilcoxon–Mann–Whitney test to evaluate group differences. The survey was approved by the University of Utah Institutional Review Board, supporting its use as an evaluation of an educational innovation tool.
Results
Writing participation and readership
The blog averaged 107 unique visitors (range: 19–108) per week from July 2014–June 2017 (Table 2). Of 170 posts over three academic years, residents provided 40% (n = 68), faculty wrote 38.2% (n = 65), and 21.8% of posts came from invited authors outside of the UUFMRP (n = 37). Fifteen posts were republished through local and national venues including KevinMD.com (10 posts), the Utah Medical Association magazine (2 posts), and the University of Utah’s Algorithms for Innovation Blog (3 posts). Each of these republished articles were chosen by the respective editors of the three different forums and republished with permission from the submitting authors.
Blog contributors and readership (July 2014–June 2017).
Perception survey results
Sixteen of eighteen faculty members and 18 of 22 residents responded for an overall response rate of 85%. Table 1 summarizes the descriptive variables and scores. Both residents and faculty rated the goals of the blog as important and felt the blog had a positive impact toward those goals (with total scores consistently above the median Likert value or above a score of 3). The only statistically significant difference in response between faculty and residents (p = 0.04) suggested that residents were more likely than faculty to view the Family Medicine Vital Signs blog as an effective tool in increasing interest in family medicine among medical students. Open comments were allowed but were minimal and so are not included.
Topics
Posts on the blog have covered multiple different topics (Table 3). Posts by residents and students tend to have a higher viewership, as do those that cover personal experiences with patients and individual wellness.
Common blog topics.
Discussion
UUFMRP saw an opportunity to develop a residency blog to enhance resident education. The program believed that the blog would provide experience in advocacy and scholarship for our writers and engage family medicine advocates in social dialogue. The blog’s success in outreach is evident in the broad audience that we have reached and the interest garnered from stakeholders, both locally and nationally.
The infrastructure for a sustainable blog is achievable with staff, resident, and faculty champions, and resident and faculty authorship. The board itself has been essential to long-term sustainability as it prevents reliance on, and time demands of, any one person. Including the perspectives of both residents and faculty to guiding the blog as well as assisting contributing authors have provided for more well-rounded viewpoints for the readers.
For residents and faculty who may have little experience and comfort with writing and advocacy in a public sphere, the blog posts provide an opportunity to venture into writing for a broad audience, with a supportive editorial process and structure. Allowing authors to select topics of personal interest and providing readily available editorial assistance from the board are believed to be essential components to the blog’s success.
The participant survey showed that a substantial number of participants perceived that the blog had a positive impact (total scores above 3) in all aims, though it was not as profound as the board would have hoped. The survey is limited by its inherent measure of the opinions of the participants instead of more objective measures. The results were likely affected by resident and faculty preferences; specifically, we did not query the level of interest in social media by our participants. That we required faculty and resident participation, even among those who do not endorse social media, would affect the range of opinion regarding the value of this experience, especially as an additional activity in the life of a busy resident or faculty. Furthermore, it is unclear in such a survey as to whether an educational activity, such as blogging, will affect future activities in writing, social media contributions, and advocacy.
Residents were more likely than faculty to believe that the blog has a greater impact on medical student interest in family medicine as a specialty. This difference may be related to the residents’ proximity of having been students, and/or having more direct interactions with students than faculty. This is worth exploring in future work.
A residency blog provides a venue for educational instruction, supporting physician development of communication skills, community engagement, and advocacy. Participation in a residency blog addresses the ACGME Milestones of professionalism, effective communication, communicating with the public through technological means, and community engagement. The UUFMRP identifies blog participation as one aspect of resident performance along the Milestones. Future work could describe the impact of the blog on resident Milestone progress.
Additional research could query residency graduates about how blog participation as a resident has affected their community engagement as a graduate. Further research should explore perceptions among our blog readership regarding the personal and professional impact and value of such articles. Reader comments are allowed on the site, though few are left. Exploring participant perception of the worth of the blog compared with other time demands and activities, evaluating whether different goals or emphases should be included for the blog, and including more qualitative comments through focus groups could all be illustrative in future success.
Footnotes
Acknowledgments
A Letter to the Editor providing a brief description of the blog was published in the Journal of Graduate Medical Education: Jones KB, Sanyer O, Fortenberry K, Van Hala S. Resident education through blogging and other social media platforms. J Grad Med Educ 2017; 9: 256.
This study was presented at the 38th Forum for Behavioral Science in Family Medicine on September 2017 in Chicago, IL.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.