Twitter is a tool for physicians to increase engagement of learners and the public, share scientific information, crowdsource new ideas, conduct, discuss and challenge emerging research, pursue professional development and continuing medical education, expand networks around specialized topics and provide moral support to colleagues. However, new users or skeptics may well be wary of its potential pitfalls. The aims of this commentary are to discuss the potential advantages of the Twitter platform for dialogue among physicians, to explore the barriers to accurate and high-quality healthcare discourse and, finally, to recommend potential safeguards physicians may employ against these threats in order to participate productively.

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Background Quality assurance concerns about social media platforms used for education have arisen within the medical education community. As more trainees and clinicians use resources such as blogs and podcasts for learning, we aimed to identify quality indicators for these resources. A previous study identified 151 potentially relevant quality indicators for these social media resources. Objective To identify quality markers for blogs and podcasts using an international cohort of health professions educators. Methods A self-selected group of 44 health professions educators at the 2014 International Conference on Residency Education participated in a Social Media Summit during which a modified Delphi consensus study was conducted to determine which of the 151 quality indicators met the a priori ≥90% inclusion threshold. Results Thirteen quality indicators classified into the domains of credibility (n=8), content (n=4) and design (n=1) met the inclusion threshold. Conclusions The quality indicators that were identified may serve as a foundation for further research on quality indicators of social media-based medical education resources and prompt discussion of their legitimacy as a form of educational scholarship.

The practice of keeping admitted patients on stretchers in hospital emergency department hallways for hours or days, called "boarding," causes emergency department crowding and can be harmful to patients. Boarding increases patients' morbidity, lengths of hospital stay, and mortality. Strategies that optimize bed management reduce boarding by improving the efficiency of hospital patient flow, but these strategies are grossly underused. Convincing hospital leaders of the value of such solutions, and educating patients to advocate for such changes, may promote improvements. If these strategies do not work, legislation may be required to effect meaningful change.

The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice. RÉSUMÉEncore aujourd'hui, il s'écoule un certain temps entre les découvertes et l'intégration des nouvelles connaissances dans la pratique clinique. L'arrivée du mouvement Free Open Access Meducation (FOAM) a bouleversé les communications entre les médecins d'urgence, en permettant aux praticiens d'interagir facilement avec des homologues de partout dans le monde pour discuter des derniers travaux de recherche et de ceux qui ont la plus forte incidence. Le mouvement FOAM peut certes combler des lacunes en matière d'application des connaissances, mais son utilisation soulève des préoccupations quant à son influence grandissante : 1) l'application trop rapide des résultats de la recherche peut s'avérer préjudiciable si les constatations sont erronées; 2) la documentation en ligne échappe en grande partie à la supervision rédactionnelle; 3) des personnes de renom en ligne peuvent finir par exercer une influence trop grande en pratique clinique. Aussi les auteurs de l'article proposent-ils que de nouveaux types d'érudits voient le jour afin de régler le monde en mutation de l'application des connaissances. Ainsi, les cliniciens critiques feraient l'évaluation critique de la recherche à la manière des critiques profanes de restaurants; les formateurs en application des connaissances, versés dans le domaine des nouvelles techniques, travailleraient en collaboration avec les chercheurs à la diffusion efficace des résultats de leurs travaux; et les chercheurs interactifs s'engageraient dans des échanges avec les cliniciens afin de s'assurer que leurs résultats trouvent bel et bien écho dans la pratique clinique. La formation de ces groupes d'érudits pourrait prendre appui sur les grands p...

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Introduction: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship. Methods: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019. Results: We discussed consensus guidelines for evaluation and promotion of digital scholarship with the intent to develop specific, evidence-supported recommendations to P&T committees and applicants. These recommendations included the following: demonstrate scholarship criteria; provide external evidence of impact; and include digital peerreview roles. As traditional scholarship continues to evolve within the digital realm, academic medicine should adapt how that scholarship is evaluated. P&T committees in academic medicine are at the epicenter for supporting this changing paradigm in scholarship. Conclusion: P&T committees can critically appraise the quality and impact of digital scholarship using specific, validated tools. Applicants for appointment and promotion should highlight and prepare their digital scholarship to specifically address quality, impact, breadth, and relevance. It is our goal to provide specific, timely guidance for both stakeholders to recognize the value of digital scholarship in advancing our field. [

Background: Online resources for emergency medicine (EM) trainees and physicians have variable quality and inconsistent coverage of core topics. In this first entry of the Society for Academic Emergency Medicine Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to comprehensively identify, collate, and curate online content for topic-specific modules. Methods: A list of module topics and related terms was generated from the American Board of EmergencyMedicine's Model of the Clinical Practice of Emergency Medicine. The authors selected "renal and genitourinary" for the first module, which contained 35 terms; all MeSH headers and colloquial synonyms related to the topic and related terms were searched both within the 100 most impactful online educational websites per the Social Media Index and the FOAMsearch.net search engine. Duplicate entries, journal articles, images, and archives were excluded. The quality of each article was rated using the revised METRIQ (rMETRIQ) score.Results: The search yielded 13,058 online resources. After 12,717 items were excluded, 341 underwent quality assessment. All renal/genitourinary topics were covered by at least one resource. The median rMETRIQ score was 11 of 21 (interquartile range = 8-14). Calculus of urinary tract was most prominently featured with 60 posts. Thirty-four posts (10% of full-text screened FOAM articles) covering 12 core topics were identified as high quality (rMETRIQ ≥ 16). Conclusions:We demonstrated the feasibility of systematically identifying and curating FOAM resources for a specific EM topic and identified an overrepresentation of some subtopics. This curated list of resources may guide trainees, teacher recommendations, and resource producers. Further entries in the series will address other topics relevant to EM.T he well-documented growth and use, both formally (in residency curricula 1,2 ) and informally, 3-5 of free online medical education resources (FOAM) in emergency medicine (EM) have been remarkable. 3,4,6,7 However, resources are scattered across an enormous number of sites, of variable and difficult to evaluate quality, 8-10 and may not be at the appropriate level for all learners. 11 Additionally, various topics are covered extensively while others receive no or scant coverage 12 with no synthesis describing specific topics coverage, extent, level of intended learner, and quality.