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How we set up an online education quiz on Twitter for improving GPs' ECG-reading skills

Dr Heather Wetherell explains how she set up a quiz about reading ECGs online and on Twitter.

The problem

It is well recognised that clinicians often rely on analysis provided by digital machines to read ECGs.

At the same time, we recognised social media was becoming increasingly recognised as in important education medium. It allows conversation and learning, whilst removing the constraints of a traditional classroom environment. The simple technology is widely available across multiple platforms (PCs, smartphones, tablets) and works like a ‘virtual classroom’. Learning can take place at a time and location that is convenient for the user. Participants can learn ‘on-the-move’, and can freely drop-in-and-out of conversations in their leisure. There is no registration, or sign-up, required.

As a GP with a Special Interest in cardiology I wanted to use social media to improve clinicians’ ability to read ECGs.

How we got started

What started out as a very small and casual Twitter forum among a handful of medics, became surprisingly popular, and so #ECGclass was born. The site was launched in June 2012.

www.ECGclass.co.uk is an online discussion forum of ECGs launched with the aim of keeping the art of ECG interpretation alive. The ‘educational blog’ which runs alongside the Twitter forum, can be accessed as a stand-alone learning site for those not quite ready for Twitter yet.  It aims to offer some easy to follow ECG ‘refresher’ notes for clinicians who have previous, but somewhat rusty, knowledge. The aim is to keep the learning atmosphere casual, non-threatening, and fun.

A new ECG quiz is launched most Monday evenings, in term time. Cases are generally aimed at primary care, but are popular not only with GPs, but also with medical students, paramedics, nurses and secondary care clinicians.

All scenarios are completely fictitious - so no issues of confidentiality or use of patient data - but they are based on commonly occurring presentations in general practice. The class addresses the diagnostic dilemmas posed, when a ‘routine’ ECG throws up something slightly unexpected.

It was easy for users to get started. You simply:

1 Sign up for a Twitter account at twitter.com

2 By ‘following’ the user @ECGclass you will receive updates about new cases and developments

3 To view the case details, visit the blog at www.ECGclass.co.uk (stand-alone) or simply follow the link contained within the Tweet.

4 To view everyone else’s responses in a chronological order ‘search’ for #ECGclass. (This is known as a ‘hashtag’ and identifies a particular conversation thread). Don’t forget to include ‘#ECGclass’ in your own response too so that they appear as part of the conversation.

5 Use the hashtag #ECGclass if you want to ask the ‘patient’ any questions, or request any further investigations.

ECG interpretation is an art-form, often open to debate, and possible diagnoses will usually change, or evolve, as new information becomes available. Everyone’s opinion is valid, and useful to others, as this evolution process takes place.

Challenges

Not everyone is comfortable with the use of social media for learning. Experience shows, however, that once people grasp how Twitter works, they realise how powerful it can be. The use of ‘hyperlinking’ within tweets enables quick sharing of web pages, images and documents – all of which can be organised and saved for later. Hits on the blog page each week gives an idea of the class size, even if visitors do not always choose to contribute to the discussion on Twitter. Feedback suggests there are a lot of ‘quiet’ learners out there, who just enjoy watching and reading without interacting.

Outcomes

Six months on, the site and hashtag are still running on a weekly basis. We’re on case number 25 and @ECGclass has 159 followers on Twitter.

Dr Heather Wetherell is a GP in Middlesbrough with special interest in cardiology.

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