Building Effective Communication Networks – Part I: Home Bases, Embassies, and Outposts

By Felix Ankel (@felixankel) and Michelle Lin (@M_Lin)

You are a new medical education leader in an integrated care delivery system, charged with training a practice-ready clinician workforce of the future. In the past, most health-professions education in your system focused primarily on medical student and resident training associated with one medical school and occurring in one hospital.

You are now poised to implement a vision of a system-wide educational approach that includes multiple hospitals and clinics with multiple health-professions schools.
You would like students and their preceptors to have the skills and competencies to flourish in a team-based environment focused on improvement science, patient- and family-centered care, and stewardship.

How do you develop communication networks to disseminate this vision? How do you know if you are communicating effectively?

The Three Components of Effective Communication Networks

Effective communication networks have a 3-pronged platform that includes a “home base,” “embassies,” and “outposts.”

  1. Home bases are centralized inventories of information that networks can access (e.g., a web site, blog, or SharePoint).
  2. Embassies are external tools that can steer traffic to and from a home base (e.g., LinkedIn, Facebook, Twitter, Yammer).
  3. Outposts are analytic tools that allow you to scan the environment for communications involving your home base (e.g., Google Alerts).

In 2009, Michelle Lin founded the blog ALiEM, which focuses on disseminating information on Emergency Medicine (EM) education.

Read on to see how her first-person story is an excellent case study on how to build an effective communication network that includes all 3 components:

Home Base: The Birth of ALiEM

When I first started ALiEM as a blog, I had no intention of creating networks, much less effective networks. The goal was to experiment with a relatively novel platform for information dissemination about my academic niche of EM education. Over time, it became difficult to sustain this blog as the sole author, so I grew the team by adding a diverse group of health-professions educators with an amazing depth of and thirst for knowledge. As a result, the readership exploded from single digits to over 3,000 per day in its first few years.

Once I realized the potential, capabilities, and reach of social media in delivering educational content online, we started experimenting with integrated tools. For instance, I created a series of Paucis Verbis (PV) cards. In Latin, this phrase means “in a few words,” and I used it to describe a set of pocket clinical cards that I had started during residency to help me remember evidence-based guidelines from journal articles, textbooks, and lectures. Today, about 150 PV cards exist, covering such topics as Anaphylaxis Diagnosis and Treatment, Antibiotic Selection for Urinary Tract Infection, and Dental Trauma.

Despite the diverse resources, topics, and initiatives launched on ALiEM, what remains constant is our blog site. It is our home base. New projects are described there. Updates are announced there. New educational content is published there. It is our central platform to keep the readership informed about us as an organization and about the field of EM. Of note, I have always favored blogs over podcasts as a home base platform, primarily because all of our content is easily Google-searchable. With 1 million views per year worldwide today, we remain humbled and grateful to be in such a position of influence and trust in EM.

Embassies: Not Just One-Way Communication Channels

As the blog readership grew by word of mouth and as the microblogging platform Twitter was becoming more popular in medical education, we started building out our embassies. We started announcing each day’s new blog content on Twitter, Facebook, and Google Plus to expand our reach with each going out at a different time of day to capture various time zones. This follows best practices in the blogging industry: to disseminate content across different platforms to reach potentially different audiences.

But we wondered if we could do better than using these real-time communication platforms as one-way amplifiers of our blog content. In 2013, we launched a one-year pilot series with the Annals of Emergency Medicine to host a Global Emergency Medicine Journal Club every 2-3 months. One example was the journal club on temperature-targeted management.

Over the course of 1 week, the featured paper was highlighted and discussed on the blog site. The blog comments section allowed readers to view and participate in the ongoing conversation. Simultaneously, our journal club team monitored and facilitated Twitter conversations, tracked by the hashtag #ALIEMJC. A live Google Hangout on Air video-conference was held during the week, often with the paper’s author, along with key experts and discussants. The conversation reflected on the paper, journal club questions, and often on comments made on the blog and Twitter.

The amalgamation of the dialogues for each journal club event was curated, summarized, and published back into Annals of Emergency Medicine as a foundational piece for others to use as a springboard for further discussion [1-5]. For information on the basic framework on setting up a virtual journal club, see our JGME tutorial article.

Although the year-long Global EM Journal Club project is over, the model continues in the annual Health-Professions Education Journal Club series, co-hosted with the Journal of Graduate Medical Education. This initiative offers topics such as resident-level teachers.

We have learned that embassies can be used for more than just an amplifier of one’s message. They can also help create dynamic bridges to bring together a virtual community of practice, whose members’ common interest is in sharing, debating, and learning about a relevant, current topic.

Outposts: Analytics Provide Constant Feedback and Shape the Network

I prefer an expanded definition of Michael Hyatt’s term “outposts.” While we have set up Google Alerts that email me whenever ALiEM is mentioned on the web, I find that mentions are only one form of feedback. We value the rich data provided by web analytics. This includes Google Analytics (blog), YouTube Analytics (video), and Soundcloud Analytics (audio podcast). Based on this systems-level feedback, we continually are learning and adjusting our educational content and delivery methods. Furthermore, these analytics are reported back to our guest authors for their CV.

Here is an example of one of our Analytics Reports, demonstrating both the power of visual design and of analytic data.

ALiEM Analytics Report

Communication Networks In Context

Communication networks are part of a broader informal network of information—beyond the organizational chart—that informs the work done in any organization. Part II of “Building Effective Communication Networks” discusses this context and highlights more of Michelle’s experiences with ALiEM to illustrate the 3Cs of communication networks: curation, communities of practice, and creation of value.


  1. Chan TM, Rosenberg H, Lin M. Global emergency medicine journal club: social media responses to the January 2014 online emergency medicine journal club on subarachnoid hemorrhage. Ann Emerg Med. 2014 Jul;64(1):88-94.
  1. Thoma B, Rolston D, Lin M. Global emergency medicine journal club: social media responses to the March 2014 annals of emergency medicine journal club on targeted temperature management. Ann Emerg Med. 2014 Aug;64(2):207-12.
  1. Rezaie SR, Swaminathan A, Chan T, Shaikh S, Lin M. Global emergency medicine journal club: a social media discussion about the Age-Adjusted D-Dimer Cutoff Levels To Rule Out Pulmonary Embolism trial. Ann Emerg Med. 2015 May;65(5):604-13.
  1. Westafer L, Hensley J, Shaikh S, Lin M. Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia. Ann Emerg Med. 2016 Jan;67(1):49-55.
  1. Trueger NS, Murray H, Kobner S, Lin M. Global Emergency Medicine Journal Club: A Social Media Discussion About the Outpatient Management of Patients With Spontaneous Pneumothorax by Using Pigtail Catheters. Ann Emerg Med. 2015 Oct;66(4):409-16.
  1. Sherbino J, Joshi N, Lin M. JGME-ALiEM Hot Topics in Medical Education Online Journal Club: An Analysis of a Virtual Discussion About Resident Teachers. J Grad Med Educ. 2015 Sep;7(3):437-44.