The Utility of Social Media in Continuing Healthcare Education

Allison Kickel is Founder & President of Bonum CE. I kept coming across Allison at meetings and via LinkedIn posts and knew I wanted to have a conversation with her. She's smart—that goes without saying—as well as funny and warm.  Most discernibly she thinks outside of the box and is unafraid to both challenge convention and try new things. It's perhaps unsurprising then that she has a background in visual arts—photography and design—and uses this to full effect in the context of designing education for consumption via a range of channels including learning management systems and social media.

Join us to explore the benefits of:

✅ Appreciation for design in education 
✅ Thought diversity
✅ Social media based continuing education

Book Recommendations
The Overstory
The Language of Kindness

Resources
American College of Gastroenterology
Global Education Group
Project ECHO
@MondayNightIBD
Episode 2 of Write Medicine on Design Thinking with Dr. Andrew Chacko

Connect with Allison: Twitter, Secondary Twitter, LinkedIn
Connect with Alex: LinkedIn, www.alexhowson.com

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Transcript

Alexandra Howson  00:25

Hello, and welcome to Write Medicine. I'm your host, Alex Howson, and I'm super happy to be here today with Allison Kickel.Welcome, Allison.

Allison Kickel 00:32

 Hello, thank you for having me.

Alexandra Howson  00:35

It's good to see you. We're going to talk today about social media based CME and the role of patients in CME or patient education in the continuing medical education space. I want to start first, though, I know you're an avid reader. So, what are you reading right now?

Allison Kickel  00:55

Oh, about six things. But I am reading a book. I cannot remember the name of it. But it's about a young woman. She's I think 22 years old, or 25 years old, and she's diagnosed with AML, and it talks about her whole journey through transplant. I wish I could remember the name of it, I will come back and let you know. But it's excellent. And then I just read The Overstory, which is all about sort of the interconnected network of trees, which that was amazing. And I read a lot of books at the same time. What are you reading?

Alexandra Howson  01:31

Yeah. What are you reading? Yeah, that's good question. I'm actually reading a book memoir called The Language of Kindnessby Watson, I think her second name is Taylor. So, she's a nurse in the UK. And she's actually written two books, the language of kindness and the courage to care. And it's really about her life as a as a nurse. She's a professor of nursing at some university in the in the UK, but I'm loving it because I originally trained as a nurse when I left school, and so she's speaking my language. And when I first went to nursing school, my oldest friend's grandmother, who had been a nurse and a midwife, pulled me aside and said, “Here's the one thing that you need to know about being a nurse, always give more kindness than is necessary.” And I always thought that was an interesting but slightly strange way of giving advice, but she was absolutely right. People need kindness. And it's one of those unexpressed and unremunerated aspects of nursing. But I think it's really important. And this is what Christy Watson talks about. So very good. I’ve added it to my list. All right, yeah. I hope you I hope you enjoy it. So I like to start these conversations by getting a sense of who you are, and how you find your way into continuing healthcare, education, continuing medical education, what do you call it?

Allison Kickel  03:04

Well, that's always a funny question. It's like when I was a little girl, and I wanted to be a CME professional, I actually have a background in photography and design. So I went to art school, and then proceeded to leave art school and realized very much that all those romantic aspects of like an art life that you think you could get with an arts degree are totally unrealistic. And I really enjoyed the business side of things more than I had anticipated. And then just fell into this industry, I worked for an accredited provider that worked exclusively in in joint providership. Joint sponsorship, I guess, is what we called it at the time. And then I went on to work for a large oncology Live Meeting provider. And now I have sort of spent the past few years working for a very small boutique med Ed company. And it's really interesting, because I went there to figure out how to do things different how to really take chances and CMEC because there were a lot of sort of barriers to change with larger companies, and I just wanted to, you know, come into it with a mindset of like, burn it all down. Let's try it, it's not worth it. Let's do something different. Um, and so that's professionally, personally, I have three kids under nine. So you know, the pandemic that's been interesting. And I'm really a pretty avid outdoors person. So whatever gets me outside, if it's a walk around the block or to the top of a 14,000-foot mountain, I am happy to be there.

Alexandra Howson  04:44

Right. Are you based somewhere where there are mountains?

Allison Kickel  04:48

Yeah, I'm in Colorado. I live in Denver, but I probably I'm definitely in the weekend warrior pool, where pretty much every weekend or try to do a lot of long weekends. I'm slowly Getting to as far out into the middle of nowhere as I can get.

Alexandra Howson 05:05

That's wonderful. Yeah, I love that, especially with three kids under nine that's kind of, I'm exhausted.

Allison Kickel  05:11

It's well, you know, and the different the different kids have different levels of resilience and being able to be outdoors, my daughter. I mean, she's fine. She just turned five, and she still expects to be carried, she weighs 50 pounds, so I get a good workout. Half the time. My middle son can literally and he's seven he could he can hike almost as far as I can. It's really incredible. And my oldest son, just requires a significant number of candy bribes. He'll get there. But you have to have enticements all the way up, and then down. It's like, well, you got to get down. So here we go figure it out.

Alexandra Howson  05:51

It sounds like you think carefully as a parent about how to involve your kids, engage them and make sure that they are learning what they need to learn.

Allison Kickel  06:02

I hope so thank you. I mean, my father-in-law says, you know, if you want to like your kids, when they get older, try to wrap them in what you enjoy and what you like and why you like it. And then let's give them the opportunity to pick it. And I really have taken that to heart. And luckily, a lot of my kids seem to enjoy the Colorado lifestyle.

Alexandra Howson  06:24

That's good. That's good to hear. Yeah, I know what you mean by that. I think I think we tried that my girls are in their 20s. I think I think I tried that when they were kids. But they didn't. They didn't like the outdoor life quite so much. But they're phenomenal young women. Are they loyal to you? Actually, they've been living with us for most. Okay. So that's, that's interesting having four, four adults, all working from home. This in this time, but I feel like wings are starting to spread. And so I think by the end of this year, the composition of our household will be quite different.

Allison Kickel 07:04

Okay, well, good luck.

Alexandra Howson  07:06

Yeah, thank you. So, art and design background show up in your professional work at the moment?

Allison Kickel  07:18

That's a very thoughtful question, because I don't think we ever consider the two aligned at all, really. But I have found my art background incredibly helpful to the work I do. Because I think, you know, we talk about diversity from a number of different aspects, you know, we're talking about gender diversity and racial diversity, but I really think there needs to be thought diversity, it just in general, in our space, and we sort of source a lot of people from similar institutions or similar fields of work. But, you know, that's my mindset behind burn it all down is like, well, your job is to create if it's not working, you create. And so, you know, my art school education, more than sort of technical expertise in photography, and the like, taught me how to be really resourceful, and to look at a problem. And your goal is to fix it, right? So, if you've got to light something, one way, you just figure it out, you know, you might be using the bottom of a trash can to shine light. I mean, there was all these different things we did. And I feel like those life skills really, really benefited me, because now we sort of look at something and I don't look at it as well, this is what we've done. I look at it as like, okay, let's look at this from a ton of different angles, like how can we approach this differently? Or how can we shift our mindset to optimize whatever the situation is, um, and then, you know, I think that I traveled a lot in my 20s, I actually traveled for five years straight. And that resourcefulness I learned in art school definitely benefited me there. But I see, I see it following through in my career, and I think specific to the work I'm doing, and I know, you know, visual design and you know, infographics and data visualization has become more and more important for good reason. And I think, well, and clinicians, clinicians are also human beings, and we tend to like to look at things that are nice to look at. Why would we, you know, why would clinicians be any different than normal human beings? So, I think I think, you know, the benefits of design can definitely be felt in continuing education, healthcare education,

Alexandra Howson  09:34

right, actually, Episode Two of Write medicine. I spoke to Andrew Chaco, and he, he kind of is a proponent of design thinking in in healthcare education. So, I'm curious how, of course design thinking depends on that cross fertilization of ways of approaching things from a number of different perspectives, whether we're talking about the visual perspective to give or, you know, other kinds of diversity, how much do you see that kind of cross fertilization in continuing medical education in terms of education, design and delivery?

Allison Kickel  10:18

I think that we have generally considered if you put up a webinar, you put up a webinar, you put up a webinar, and that's it. And the people who are going to watch a video and audio are going to watch the video and audio, or the people who listen to a podcast are going to listen to a podcast, I think diversifying the forms that we provide the same content is important. And we've been doing that slightly over the past few years. So, if there's a podcast do a transcript, if there are, so what happened, our subtitle it for people who don't want to listen to the audio, we have been doing, you know, I've been working on a lot of social media education. And so, we take the information and we translate it both in an image. So, we have a designer, draw the image is a very infographic style, we also write the text and that 280-character limit, that's the key takeaway. And what we found is that the learners who are reading the text based are just reading the text base, and the learners were looking at the pictures, just looking at the pictures, it's a subconscious motivation to be drawn to the one that you enjoy. And so, I think, again, sort of getting back to the diversity is, you know, providing the content in a multitude of ways. And thinking about that from the beginning. You know, there's some generational drivers. And I think that there are some traditional sort of gender drivers that when we look at a nurse practitioner audience, that tends to be more predominantly female, and, you know, coming out of training at a certain age, I will almost always provide a monograph if I can, because you can print that and take it to soccer practice if you need to. And so, I think we need to think about the practicality of people's lives as well. And so, when we're looking at a program, you know, I mean, and oncology, for example, I work a lot in oncology. And then you look at the academic oncologist, something you at the community colleges, and they're almost like two totally different universes for how they have to work. And so, you know, I just, I think if we take as a sort of a catchphrase, or as corny as it sounds, but really take a step back, and think about how people are going to utilize it, and then how can we address those stakeholder needs better or easier for them? So, if I post something on Twitter, I also want to post it on a traditional LMS, because I don't expect to hit everyone with one activity of cast is brought in not as I can. But you know, I think it's, it's having that mindset of we're going to do everything we can within the resources available.

Alexandra Howson  12:53

So, you said you said a number of things there that, that I want to kind of dig into a little bit one is what you're seeing as social media education. So, let's start there, can you talk a little bit about what that means for you and how you're approaching?

Allison Kickel  13:13

Absolutely, I also didn't realize this is this is somewhat of a controversial topic. I mean, I get people who have very different opinions on the utility of social media in CME. Um, and as I'm sure I've touched on a number of times, I'm all for trying something new. Try it, see if it works, if just, you know, keep along that path of evolution. So, for the past few years, I've been working on education that's hosted primarily in social media formats, I'm utilizing Twitter the most heavily. And those could consist of a tutorial activity, which are a string of tweets, that are used to communicate best practices or sort of a knowledge topic. They're pretty concise. So, they're about 10 to 20 tweets, and you would combine with images as I was referencing before, also, maybe short videos, commentary, links to resources, you know, things that are hosted, like webcast that could be hosted somewhere else, but also streamed across all the social media platforms. 

Alexandra Howson  15:07

Can you define what social media based continuing education continuing medical education is for listeners?

Allison Kickel  15:26

Absolutely. So, when I say continuing education on social media channels, I mean, primarily hosted within those channels, not just simply promoted through which we've done that for a long time, it's been effective, but I'm talking about programs that live and all the content is presented on social media channel. So, for a few years, I've working been working in these formats, primarily on Twitter, but it could be things like a tutorial, which are strung together, text, images, videos, resources, in a series of tweets, and those, you know, in participation with the faculty network, communicate a very concise topic. So, they're like 10, to 20 tweets, for example, and it could be you know, jak inhibitors and atopic dermatitis. And we're talking about something very specific. And those are, we usually are presenting a series of those type of educational initiatives. But then there are things that are really robust initiatives, I work on a program called Monday night IBD. Every week, we have a group or an invited co moderator, bring in a case vignette present a polling question to the audience. And then it really opens up a discussion for a live Twitter chat on management of the case. And the idea behind those Monday night IBD cases is we're trying to get sort of that patient who falls in the gaps of the guidelines, or it's really unclear. And then you have this crowd sourced information for what best practices look like what different institutional barriers might be, and how to get around them. And it's a very active conversation. And then a few days later, we actually have a patient advocate or patient leader lead a discussion under the hashtag patient experience related to that prior Monday's case. And so, the discussion amongst the patient could be surrounding, for example, like how was your biologic therapy managed, when you were planning a family, and it really provides a community for the patients, but also, the clinical learners tend to go into that patient discussion. And there are major takeaways. For example, a recent co moderator said, you know, we're scientists, we love to order tests, we love to have data on hand, but the consideration of the burden of colonoscopy and how regularly that's done, we have to balance that with a patient need. So, we're seeing a lot of really thoughtful commentary in that discussion. And then later on in the week, we're actually providing a wrap up of the sewer, what consensus from both of those conversations is achieved, and we're tying the two together. So we're taking the clinician conversation and the patient conversation and working them into the same algorithm. And then the weekend prior to the Monday case, I always sort of talked about this backwards. But the weekend prior to the Monday case, we have a back to the basics, a presentation, it's a tutorial. And that's for trainees to really understand sort of the knowledge acquisition topic that there are the knowledge acquisition items that they're going to need to go into the case on Monday. That's, you know, we're doing about 30 to 35 of those series of events a year. So, it's quite a big initiative. And then, yeah, I'm starting to do it, as you know, molecular tumor boards and gastrointestinal malignancies, and then GU oncology. And there's so many benefits, it's for a certain type of learner, definitely. But the ability for a trainee or even someone to we often see a learner come in and say, well, this case is sort of tied. Here's my case, it works in that Project ECHO model idea. Like you're all these people. And you can ask them whatever question and it's a really a community, people are very willing to be candid, to be share what they do, and also to open up these mentoring opportunities. So, we've had a lot of offshoots that go off of Twitter, and then people are continuing this engagement throughout their practice, so it's me, especially with the pandemic, it's created a network that we were all pretty desperate for.

Alexandra Howson  19:53

I mean, this sounds so exciting for me. I love that idea of you know, you're really building a community of friends. selection, then people can use to kind of, you know, crowdsource information and generate their own responses to problems and challenges that they're having in their own practice. Are you seeing that there are, you know, particular?

Alexandra Howson  20:15

So do you see more residents and fellows, for instance, then you might see, you know, at a later stage in a physician's career or in another kind of clinicians' career,

Allison Kickel  20:31

I think we expect to see all these generational divides on social media platforms in different social media platforms, Facebook, to Twitter to Instagram to Clubhouse, we're not seeing it as clearly defined as I thought we were when I started doing this four years ago. So, you know, the average a, that demographic of 40 to 60 is the most prominent on Twitter, for example, but when we translate those tutorials to an Instagram story, we're trending younger, for example. And so I think that there's some of those things that by platform, you know, just by interest in the platform, generational interest in the platform, you're seeing that, but we actually have a really good mix between IBD specialists, General GI’s, residents, trainees, and then, you know, the allied health professionals, we also have specific conversations that will address you know, we could be having a conversation specifically on selecting your training program, or, you know, right, what happens during the match process. So, there are different things to support the different groups, typically the fellows' trainees, that's our primary audience for the back-to-basics tutorials. But during the regular conversation, it's pretty varied. Trainees tend to be less conversational. During the clinical conversations more, they're more presenting inquiries rather than providing information. But I think that's a great unity of feedback mechanism with the others who are commenting to understand what they're actually seeing what the questions what the gaps in training are. We also asked a number of demographic questions at the beginning of every conversation. And then we work with a third party to pull all the handles of the those that are contributing or commenting on liking, retweeting, quote tweeting. And then we analyze those and look at yours and practice and practice institution. So, we actually get pretty in depth on the demographics. And we have a series of publications that we just, we just presented our first abstract. And we have a whole series for one at ACG that looks at the IBD specialist learner and Monday night IBD. How are you using it? The general GI? How are you using Monday night IBD, the resident trainee patients, for example. And so we're constantly the audience is really good, because we're constantly peppering them with surveys. And they're incredibly responsive to say, you know, what do you want? What do you need? How are you using this, but we really want to look at what's working, and the utility for the different groups.

Alexandra Howson  23:21

And it sounds like it's a format that does that does work for your groups? And you're obviously able to, through your third party partner able to kind of pull information from the social media platforms, what other kinds of data are you able to pull that allows you to analyze or to evaluate? You know, learning impact and behavioral change, impact and those kinds of things.

Allison Kickel  23:47

This is probably the most common question I get, all this information is out there. But so what does it mean? How are you measuring outcomes, and it's actually quite simple. We're measuring outcomes in the same way that we measure them for almost everything else is pre and post surveys follow ups, we might have some focus groups for looking more in depth on some for some self-reported performance change data. But essentially, when we present the CME information at the beginning of every certified activity, we have a full sort of off-site landing page that has all of the information in depth opt in policy, I mean, really down to the nitty gritty. And then we also provide the frontmatter information and an image in the one of the first tweets and so on. Immediately following that we have a series of questions. So, when we're promoting the activity, we are asking pre and posttest or pretest questions rather, for learners to reply either within Twitter or off site in a traditional LMS format, and then we track the learners you know, and then present the posttest with the weekly algorithm, the wrap up, and then learners respond there or within Twitter or on the LMS. The one thing to keep in mind about that line of inquiry, and I will always disclose this is, Twitter has been very clear to say that polling data is anonymized, and they are not going to change that. So, there can't be matched pair level data, but we will take a small sample, or we'll reach out to our network and say, you know, we've randomly selected you from our database list of people who have participated and we'd like to go more in depth and sort of follow you through. These have been certified as an RSS because they're regular, and there are a lot of repeated groups. And so that allows us the capacity to look at a large data set, I was actually talking to one of our comms managers the other day, and he said, we have 80 questions for this outcomes report. We have to, you know, narrow this down. And so, we've looked at some really creative ways on, you know, how we're looking at what's important. Looking at some trends and patterns that we're seeing grouping topics, I will say it requires a very high level of chairperson engagement, as well as a very high level of scientific knowledge in that area. I've worked in IBD GI malignancies. That's pretty much my career. So, you know, I can't imagine doing this like for me and psychiatry, it would be I'm sticking with what I'm good at, I guess.

Alexandra Howson  26:42

Right? Just overload. Yes. For sure, too. You mentioned earlier about? I said, let me just pause for a moment, because I had a question all lined up there, and it's an ad copy yet. I wanted to ask about one of the things that you talked about earlier, is about really kind of knowing where your learners are at and what they need. And you mentioned specifically, you know, a nurse practitioner, you know, downloading a monograph and taking it to soccer practice, it always feels to me as though CME providers don't necessarily do enough of that digging to really learn more about their learners and how they work. So can you talk a little bit about that, and how you do that digging, and how you think we should be digging for that kind of information.

Allison Kickel  27:52

So, there is data, there are some data out there that you can get from publications about preferences, and, and a lot of meta ad companies have done some really good work in this area. I know CMEology has done some things Global Education Group on, there are a few others maybe see outcomes, looking at preference-based data for different specialties. But you know, you're generally working with a pretty limited data set. One of the things that I like to do, so I think, you know, you take your hard data on those surveys, etc. And that's one factor, there's a level of observational data, you know, how are people responding and reacting on the platforms. So, you know, you need to sort of know, different groups and what they're gravitating to, just by watching, I think environmental scanning is really important. And sometimes we don't recognize the impact of the information you can get from those mechanisms. Also having a diversified group of faculty and asking them what they are seeing, because if I'm having a conversation, you know, with someone who's treating AML and MD, I'm asking what sort of questions are you getting into your email from the community? How are they wanting to communicate with you what's working from the sort of the outside in, you know, what's working for you to communicate this information? And there's some preference also for faculty. So, you know, looking at where are you the most effective teaching? I also think talking about patient education, it's really important here to think about how clinicians are communicating education with patients, and then how we perceive those needs because I do think they're different. So, I have often found, if I am talking to a physician, key thought leader, about say immunotherapy, a specific tumor type and I talk about management recognition, mitigation of adverse events, or, you know, sort of the Impact of immune checkpoint inhibitors. They say, I don't know, my nurse does that. I mean, I honestly get that response so often. And the trigger for me is okay, well, we need it, we have to have a nurse faculty. And so, I've learned that long ago. But then when I pull the nurse in, or the NP or the PA whomever the health in the health care team is responsible, I'm asking them what's working when you're communicating with your patients. And, you know, I think that diversification of Yes, we have an app and it works great for a certain subset of patient. But my urothelial carcinoma patient whose over average age of diagnosis is over 70, I literally have a paper chart, I put together a folder for them, I have a backup file digitally, because if they lose it, I can reprint it out. And, that's what works. And I mean, that's not based just based on what they're seeing in their practice. But I think we have to take that into account as an important factor. And again, I do think this comes to knowing your therapy area, because that average age of diagnosis is really important for how that learner group might respond to information. So, you do need to be have sort of a full awareness of the spectrum of the disease, and the different members involved in caring for those patients.

Alexandra Howson  31:22

Absolutely. 100%. And I really like that picture that you paint from the environmental scan right down to the kind of very granular conversations that you are having with your learners to kind of figure out what they need in their own education. So, you talked about a couple of things. One is, you know, the role of patients in continuing medical education. And so let's start with that. Are you involving patients in your education design? And if so, how do you do that? Or are you developing education that you are targeting to patients, as a kind of complement to the work that you're doing with clinician learners?

Allison Kickel  32:15

Both. So, essentially, I wish we had a patient steering committee member on every single activity. Unfortunately, that's not always possible. There are some disease states that just are really prohibitive, I think specifically about very aggressive cancers, for example. And so, you sort of have a limited, availability of patients who are going to be able to commit that time and that sort of resource burden of their own human resource. I also, but we're doing it very regularly. So especially for larger initiatives, the steering committee can look, that whole spectrum of the care, so an oncology pharmacist and a pathologist and a medical oncologist and a surgical oncologist and a patient, generally, they're patient advocates, or patient leaders and or a patient navigator. And I think it's really important to see the spectrum now when there's a patient component, the patient education component, will have very similarly to what we have in a CME/CE program, a steering committee of clinicians, we have a steering committee of patients. And so, what we do is we host and we just did one of these two weeks ago, a patient focus group, I find that actually one of the most invigorating or energizing portions of my work on you know, it's like a two-and-a-half-hour call. And I did not want it to end. I was just so curious about the experience of these patients and so appreciative of their willingness to share that experience in such a candid way. So, I am the daughter of a solid organ transplant recipient, but 12 years ago, my mom had a heart transplant. And she was at the club, she's doing very well. But she was at the Cleveland Clinic and very fortunate to be their true Center of Excellence. They had a fantastic family caregiver Patient Support Program, I mean, truly fantastic. And this is prior to my entry into the CME/CE world we're like right about at the same time actually. And I've learned so much from that sitting in that seat with just that overwhelming amount of information. And the fact that they were so kind and careful about repeating it over and over taking the time to really mentor all of us into to what it looks like to care for this person. And I really think that's impacted my work that perspective. So, you know, it's over said and probably under done. But if the patient is not remembered through the entire process, then there's no point in doing what we're doing. Because the health care system is there to care for the patient, not really to care for the specific needs of the health care provider, they're not selfless. But at the same time, that should always be central to our thinking.

Alexandra Howson  35:32

That's a very poignant example to carry through your professional experience.

Allison Kickel  35:42

It was a very interesting time. But we all have those experiences. I mean, as personally, as a patient, or my children, or my family members, or my loved ones. And I really think, you know, bringing back to that center of knowing, you know, that deeper knowing of what's important, we can get lost in the business side of this work. And it's the patient connection really, really centers me. So, I find it incredibly valuable to my work.

Alexandra Howson  36:19

It's very powerful. You've mentioned a couple of times, this idea of cross collaboration and cross fertilization of ideas and working with different people and working with diverse groups. And at one point, you actually drew attention to three other CME providers, can you talk a little bit about the role that cross collaboration between different CME providers plays in developing quality education?

Allison Kickel  36:58

This isn't something we talk about very often, either, so I'm glad you asked. So I am the one of the Alliance Mecca section co-chairs. And the myth I'm really hoping to dispel is that we don't, you know, everything's proprietary, and we don't want to work together. And, and that's so error prone in a number of ways. I started my career at Global Education Group, which worked exclusively in joint partnership. And I think that is really colored my view of how we can all work together, and sort of figuring out what each group is good at. Because the reality of it is once something is public, there's very limited proprietary information or formats in our space. And I feel like every, you know, I feel that the work I'm doing, especially in social media based CMEC II is very innovative, but I'm, by the time it's produced, I'm on to the next thing, I've got to be. And so again, sort of the infusion of my arts background, it's like what's next, keep, keep moving, keep evolving. And, for example, I've had folks reach out to me who I've known through my professional network and say, we had a grant funded, it's on social media education, we have no idea what we're doing, I'm happy to help you on because I don't think that there's anything if I'm a proponent, and I say that I believe this education works, I have data to show this education works. Why would I not want to share that you have to protect your business interests to a certain level. But, you know, a rising tide raises all ships. So I really do feel like the benefits of collaboration are incredibly important. And I think it's not just within the mech community. So, the hospital community and the medical specialty society, community and the industry community. If we don't have if everything is kept in house and siloed, you lose again, that diversity of thought process, and within compliant conversations, we should have an open transparent discussion. I don't need to tell you exactly how to build the activity and beta tested, you can figure that out by yourself. But there's no reason that I should try to, you know, like, be the kid in the corner hoarding their candy. That doesn't help us as a community at all, in my opinion.

Alexandra Howson  39:29

I love that. You also mentioned that social media is our social media-based education is somewhat controversial, and I think that these two things might be linked in some ways, I just wanted to explore that a little bit that sense of resistance to cross fertilization resistance to social media-based education which is which is very public and very kind of transparent can transparent in a way. So, I guess there's two questions there. Do you think those two things are linked? And? And if not, where? I'll rephrase the question, do you think those two things are linked? And where does that kind of resistance come from?

Allison Kickel  40:21

Again, we're human change is hard. We believe that our preferences should be the preferences of all. And generally, that's sort of our deep emotional response. What I like everyone should like, you know, as humans, we generally are trying to change those that are not like us to be more like us shaped them more in our image. And so, I believe this is best. Does everyone have to think this is best? No, absolutely not. But I think it's controversial for a number of ways. A, it's new, it's relatively quite new. And we're starting to amass data sets that show the effectiveness of this education, lining that up with, you know, requirements from training programs, and how these different programs, these different social media-based e-programs line up with those. I think, at ASCO, this past year, there were at least four or five abstracts that I pulled that dealt specifically with how oncologist and hematologist oncologists are using information from Twitter, and how it's evolved over the years. different specialties have larger datasets. But when we talk about information, you know, we're looking at 2016 to 2019. Not grand rounds, that I mean, how old are they hundreds of years. Um, so. So, I think that we have to understand that that data set is going to grow. And that there's some trust, you have to put in the process. With any social media program, there's a level of risk management. I have been accused of being overly thoughtful about things, I'm a very detail-oriented person. So, I want to figure out everything on the back end, it's not something you go into lightly, it might look like it's simply curated or very quick, whatnot, it's not everything is tested, to copious levels on the back end that learners cannot see. While it's a very public, obviously. And, you know, I worked very closely with a large external group and a number of different consultants on, you know, what does risk management look like in CME on social media? How do we respond? When do we let the community respond to on our behalf? Because it's very different from how we might respond in a live satellite symposium environment, but the reality of it is, it's no different. I have worked on a satellite. Suppose you were my group was the producer of the education. And definitely had someone from industry stand up and ask a question. That's wrong, too. It's just less visible, and maybe not documented for all of eternity, but it happens. So, I think you have to think about, you know, live meetings, we have this red book that says everything that could possibly happen will happen. And here's how we deal with it. The exact same thing as for social media, so stepping back and being really thoughtful about it. And I think if people understood the professional behaviors of clinicians on social media platforms, and how they're segmenting their personal accounts, from their professional accounts, and the amount of work you have to do on the back end, from a risk mitigation standpoint, you really do need to be quite aware of what risk mitigation strategies look like. And then be around and see coming back to it after every single one and saying, what can we do better? What what's, you know, what, what can we do different? What can we do better? what went well, what can we optimize? I've heard the comments that, you know, professional, professional behavior on social media profiles, or personal behavior on social media profiles never ties back to their professional behavior. And I just can't even wrap my brain around that comment, because everything I've talked about in this discussion, but in my life, personal life impacts my professional behavior. I'm one person I, you know, we don't have multi but most of us hopefully don't have multiple personality disorders, or thankfully, I guess don't have multiple personality disorders. We're constantly segmenting who we are. And so, I cannot see how something you view on Twitter would be any different than standing at the front of a satellite symposia. So the controversy to me is actually a little baffling. And, you know, it's one of those things that I sort of keep asking like, if there are reservations, I'd like to have an open discussion about it, because I want to understand the other side. And if there are things that are not working, how do we fix them? You know, it this is I can't just be optimized education does not occur in a vacuum. So, I sort of welcome the discussion. I'll say that.

Alexandra Howson  45:26

So it sounds like there's work to be done there in terms of more clearly characterizing professional and personal behaviors on social media platform to really kind of dig into whether there are differences and whether people are segmenting and the way that that some people think clinicians might be, I don't know, if that's a way of posing that.

Allison Kickel  45:54

I'm like, well we're gonna have to activate the learner network, again, because I really need to re-survey groups. Now there's going to be self-selection, you know, there's, there's going to be select self-selection bias, because the people who are on Twitter and who are going to engage with that survey are going to be more apt to say, yes I use it, I interact and engage. So I think that's one important thing to note, when we're serving and looking at preference data or impact, you know, satisfaction and impact on practice, you know, we're surveying in multiple ways. So, I got a great idea from a partner about using those that perform on an activity and traditional LMS, using them as a control group, and looking at the social media group, and really segmenting by that and seeing how they perform. And so that information that publicly available yet, but I expect it to be probably before the January Alliance. And I am very excited to talk about that, because it revealed some things that further support the mission that I that I have, um, hold on one second, I want to go back to one thing, you asked something a personal professional,

Alexandra Howson  47:10

And I didn't ask the question very clearly. I was just kind of trying to think through that. Because I was thinking, how you get that picture of, you know, whether clinicians are making a distinction between their professional and their personal social media engagements, or whether you're getting that data from? Yeah, so I was just kind of trying to think through myself how you get that picture.

Allison Kickel  47:48

I think as we watch different people and how they're engaging on the social media channels, there's a spectrum. So, there are those that are highly academic and will just literally stay in that lane. It's about the data, it's putting it out. I mean, it's very scientific. And that's it. There are the group that are primarily using the channels, and might not even be listening to scientific information, but they happen to be clinicians and might follow a few other clinician accounts, but are really using it for personal, you know, pictures of kids kind of thing. And then there's somewhere in the middle, which is generally the most common, and that's one of the things for example, faculty selection. You would think that very traditional solely scientific academic personality would be best present your program because it's safest. The learners on the social media channel are not engaging with those folks the same way they are right with someone who falls in the middle of the spectrum. And the perfect example of this is I released a practice pattern survey, in VOD SOS, and worked with a hematologist who is earlier in her career. And she posts some personal, some academic some, you know, women in medicine, like lead different topics, but all you know, great to see very informative. I have done these surveys as well these practice pattern surveys with other KLOs. Literally within I think it was the first two hours I had 35 responses to an open-ended case question and how you treat VOD, of posts, you know, BMT transplant, it's like a very niche area, and that many people who are willing to share I don't see that anywhere else. And I do believe that is partly because of how she's engaging with the learners within her network. And so, you know, faculty selection, I think for anyone who is wanting to do this, spend a lot of time thinking about your faculty and thinking about them differently than you've ever thought them before. That it's a given that they have to have content expertise. But beyond that, you really have to watch their behavior. We, you know, I should probably, like increase the fees for faculty management, coordination selection in my grants exponentially, because I spent a ton of personal time curating that list, and then forced ranking them. And I'm usually having a conversation with that while before the grant goes in, but that personal professional, I think the pandemic has also rolled back some of those layers of the onion to say like, we're all human beings, there can be some, you know, have you heard about the med bikini thing, so there was a big controversy, women in medicine, I don't want to tangent too much, you'll probably want to cut this later, but where a bunch of female physicians and clinicians posted pictures of themselves in bikinis under med bikini, and the whole idea was, you know it's not a monolith, you're not a monolith, you can be a human being and be a physician and have a life. And that genuine, that authentic person is better received than someone who's a cardboard cutout of what they should be. So, when we think about our learners, segmenting their personalities, and how they receive information, will there be people who are still doing that? Absolutely. But we would be remiss to not consider how society as a whole is changing how people receive information, and who they trust and what they trust.

Alexandra Howson  52:05

I think that's a really great place to stop our conversation because I'm mindful of time, but I feel like there's potentially a part two. But drawing attention to that sort of pulling back the curtain that has happened over the last 18 months, and how education really needs to kind of respond to that, I think is a good place to kind of hit pause. You've talked about trust, openness, transparency, sharing, generosity, and thoughtfulness and kindness as kind of core values in the work that you do. And I think that many listeners would want those to be core values in the work that they do as well. Thank you so much, Allison Kickel for your time and your generosity today in this podcast.

Allison Kickel  53:05

Well, thank you. It was quite an honor. You've had an a very illustrious cast on previously. So, I very much appreciate it's been a lovely discussion. Thank you.