Why is Emergency Medicine the leader in social media and #meded?

Today’s post is from Michelle Lin, who is the editor-in-chief for Academic Life in Emergency Medicine (ALiEM).  AliEM has > 2M unique visits each year, an indirect marker of the influence of this site.  Michelle has received an endowed chair in emergency medicine education at the University of California, San Francisco, in part, for her work in social media.

ALiEM is not an isolated phenomenon in emergency medicine. Life in the Fast Lane is an Australian-based site founded by Mike Cadogan (@sandnsurf) and Chris Nickson (precordialthump) that is equally influential within emergency medicine.  (Bias alert… I’m an emergency physician…) So, why is the clinical specialty of emergency medicine at the forefront of social media and education? 33 Charts asked the question last month and suggested an answer. Today, Michelle gives her take.

– Jonathan (@sherbino)


By Michelle Lin (@M_Lin)

There are a myriad of free and commercial blogs, podcasts, and websites in the field of emergency medicine (EM). In 2002, there were only 2 blogs and 1 podcast publicly available. In 2013, this skyrocketed to 141 blogs and 42 podcasts [1]. Today it continues to grow exponentially, seemingly disproportionate to most other medical specialties. But why? What is the secret sauce?

Having grown my educational blog Academic Life in Emergency Medicine over the past five years, I have reflected and narrowed it down to 8 reasons. These reasons collectively seem to make emergency physicians a natural fit to lead the social media wave in medical education.

1. We are uncomfortable with the unknown

Tues post_pic 2A hypotensive patient presents with wide complex tachycardia and a dialysis fistula in her arm. In the Emergency Department, we reach for the calcium chloride before the serum potassium level results return. This is an extreme example, but as emergency physicians, we deal with more undifferentiated patients than any other specialty. We often have incomplete information at hand before we have to act. We weigh the probabilities, consider the pros and cons, and then make our best-effort judgment to do what is right for the patient. We often do not have the luxury of time on our hands.

Similarly, when I first thought about blogging, I was terrified. There was so much unknown about what I wanted my digital footprint to look like, whether anyone would read my stuff, and what the future ramifications would be. After debating for weeks, I weighed the pros and cons using the best available evidence and then just took the leap. One can theorize to no end if given the chance. At some point, you just need to take action. After writing my first post in 2009, I haven’t looked back.

Emergency physicians excel in this ability to act with the best available evidence despite some unknown elements. We are uncomfortable with the unknown.

2. We work 24-7 alongside our learners.

We are one of the few specialties whereby attending physicians in academic institutions staff the clinical area 24-7 alongside our trainees (medical students and residents). We are not taking call from home. Being constantly “on the front line” in the Emergency Department with our learners, we are learning and teaching alongside our trainees and colleagues, modeling the concept that we are all lifelong learners and teachers. We enjoy sharing our tricks of the trade and bedside tips, as well as teaching about evidence-based medicine, in a social fashion. It naturally follows that we learn and teach with reach beyond the clinical area through social media.

3. Our busy work environment constantly pushes us to think how to work more efficiently.

Tues post_pic 1Emergency_roomIn the busy Emergency Department, we are constantly looking for ways to work more efficiently and juggle our tasks more fluidly. This sometimes means bundling our efforts to minimize time-wasting tasks, such as calling the radiologist for multiple reads rather than a read for a single patient, or giving discharge instructions with cellulitis precautions WHILE suturing the patient’s laceration.

This constant eye towards efficiency, I find, translates into medical education.

  • How can one teach more efficiently on a local, regional, and global scale?
  • Are traditional CME lectures REALLY the most effective for learner retention?
  • How can one maintain an archive of lessons so that learners can quickly access this information without your needing to explain things again?

Let’s work smarter and not necessarily harder to answer these questions. It was in response to these questions and dilemmas that I started an educational blog. It just makes sense from an efficiency and effectiveness perspective.

4. Emergency medicine is a young specialty

The field of EM is relatively young field, which was recognized as a medical specialty by the American Board of Medical Specialties in 1979. Our specialty is constantly growing and evolving, such as with the addition of Critical Care fellowship training opportunities and the continued integration of bedside ultrasonography for patient care. So change, such as teaching through social media, is no big deal. It seems more readily accepted by our physician and non-physician community. We do not have a long legacy of tradition, which may thus allow us to innovate more nimbly and disruptively.

5. Early pioneers in social media-based education are emergency physicians

Fri post_pic 4No successful movements occur without visionary leaders. When I first joined the blogging community in EM, I was welcomed with open arms by the few pioneers already blogging in the field. Thanks go to Drs. Graham Walker (@grahamwalker), Allen Roberts (@gruntdoc), Mike Cadogan (@sandnsurf), and Chris Nickson (@precordialthump) among others. They set the tone and a welcoming stage for both bloggers and readers alike.

6. Ability to be extroverted

The stereotypical personality of the emergency physician has been one who is very extroverted and gregarious. In reality (as a gross generalization), however, I think emergency physicians are inherently introverts with the proclivity to be extroverted. Having this “extrovert-on-demand” switch makes blogging and podcasting the ideal educational tools for emergency physicians. We like belonging to a gregarious community of practice and sharing what we know with others; however, we also enjoy our “me” times so that we can thoughtfully shape our words before sharing them with the global audience.

7. EM is a hierarchically flat, team-based specialty

When an acutely sick or injured patient arrives in the resuscitation suite, everyone has the singular focus on saving the patient. “It’s not my job” never is a consideration. If I need to prime the IV tubing for the nurse, so be it. If the medical student is the only one available for chest compressions, let’s do it (of course with supervision).

Tues post_pic 3EM is a team sport whereby everyone gets a say. We are usually all on a first name basis – administrative staff, nurses, learners, and attendings. We jump in to where we might be needed. Strong communication skills are an essential element toward team success. We welcome questions asked by the team in the spirit of improving patient care in this non-hierarchical, team-based approach.

The same analogy could be said on a more global scale regarding medical education. In this case, the team is the global EM community of lifelong learners. We see a need for high quality and easily accessible education, and so we jump in to help. Blogs and podcasts provide an easy solution whereby we can use our communication skills to provide education with little to no technical knowledge. Because we are also comfortable with people questioning our decisions and management plans, we welcome blog/podcast comments and discussion.

8. We rarely get and appreciate good feedback.

“Do you remember that patient you saw whom we admitted?”

This question almost NEVER results in positive feedback from the inpatient team. Because emergency physicians care for undifferentiated patients using the limited information available in a time-sensitive framework, we often are criticized for our treatment decisions through a “retrospectoscope”. Furthermore, extremely ill patients often credit the inpatient teams (and rarely the Emergency Department team) for their recovery. While we entered Tues post_pic 4EM specialty fully aware of this downside and don’t expect any positive feedback, I think it does slightly erode at one’s sense of work pride.

When I started my blog, I never expected the subtle impact that positive feedback from readers would have in sustaining me in this volunteer-based endeavor. Social media platforms now make it easy for readers and learners to provide positive feedback to the producers of educational content. With robust analytic data engines now (e.g. Google Analytics), we can receive real-time feedback about the value, impact, and reach of one’s educational work on blogs and podcasts. Just last week, I informed one of our guest blog authors that his article received 700+ page views from 300+ cities in 39 countries over a 48 hour period. If these statistics aren’t enough positive feedback and appreciation, I’m not sure what is.

Question for you: Why do you think EM is leading the medical education wave in social media?



Cadogan M, Thoma B, Chan TM, Lin M. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J. 2014 Feb 19. doi: 10.1136/emermed-2013-203502. [Epub ahead of print] PMID: 24554447.

Michelle Lin, MD
Editor-in-Chief, Academic Life in Emergency Medicine
Academy Endowed Chair for EM Education
Associate Professor of Emergency Medicine
University of California, San Francisco

 Image 1 courtesy of  ALiEM

 Image 2 courtesy of  Stuart Miles/ FreeDigitalPhotos.net

Image 3  courtesy of  Thierry Geoffroy, via Wikimedia Commons

Image 4 courtesy of  Stuart Miles/ FreeDigitalPhotos.net

Image 5  courtesy of  Jackhsiao, via Wikimedia Commons 

 Image 6 courtesy of  Stuart Miles/ FreeDigitalPhotos.net