Clubhouse and Twitter Spaces: Medical Education and Networking Through a Pandemic

By Steven T. Haywood, MD and Rodrigo G. Gerardo, MD, on behalf of the SAEM Virtual Presence Committee

Historically, opportunities for networking and education for physicians and other medical professionals/trainees have largely been through in-person society meetings, continuing medical education (CME) events, and other professional gatherings. Over the last 10-15 years, social media has become a growing source for networking and medical education. A gradual transition towards digital meetings and education has been predicted for many years. With the onset of the COVID-19 pandemic in the spring of 2020, most major medical conferences have either been canceled or held virtually. While a virtual conference has similar didactic offerings, the networking aspect is largely lost. A virtual wine and cheese event over Zoom is undoubtedly much different than casually strolling around a room meeting colleagues in person. While social media has been shown to overlap with medical education conferences, it now may be the answer to filling the void left by their cancellations. Traditional social media platforms such as Twitter, Facebook, Instagram, and even TikTok have played a larger role in filling this networking void left by canceled and virtual conferences. However, many have felt that these platforms still lack a similar personal connection often made at conferences. This is likely because these platforms lack live interactive features where multiple users can hold a conversation in real time. In the networking vacuum created by the pandemic, Clubhouse and Twitter Spaces have emerged as excellent platforms for meeting other medical professionals. continued on Page 46

VIRTUAL REALITIES

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Clubhouse

Clubhouse is an audio-based social networking mobile application launched in March 2020 in the early months of the COVID-19 pandemic. Clubhouse had over 10.1 million users as of February 2021, highlighting its vast reach and potential impact. Clubhouse users expanded with the addition of an Android compatible version in the Summer of 2021.

Clubhouse allows users to create and join “rooms.” Each room has a title and topic. Inside of the room, users can just listen from the audience, or they can “raise their hand” and come to the stage to join in on the discussion. The creator of each room can moderate who is on the stage. The creator can also promote other stage members to moderator.

Users can also create and join “clubs” focused on specific topics or themes. Several emergency medicine and critical care education clubs have been created such as “Emergency Medicine ED,” “CriticalCareNow,” and “EMCrit.”

“In the networking vacuum created by the pandemic, Clubhouse and Twitter Spaces have emerged as excellent platforms for meeting other medical professionals.”

Twitter Spaces

Building on the success of Clubhouse, in November 2020 Twitter launched Twitter Spaces. Twitter spaces allows for voice-based discussions like Clubhouse. Users can join with their Twitter profile. Currently, Twitter spaces limits each space to one host and up to

“Medical education Clubhouse rooms and Twitter Spaces are being led by some of the top educators and researchers in emergency medicine.”

two cohosts. The number of speakers is limited to 13.

Medical Education

Medical education Clubhouse rooms and Twitter Spaces are being led by some of the top educators and researchers in emergency medicine, such as Haney Mallemat, MD, Esther Choo, MD, MPH, Jeremy Faust, MD, MS, and Scott Weingart, MD. They are providing live lectures covering the latest publications and evidence that lead to best practices. Physicians have access to these educators to ask questions and interact on a level that is not possible at live conferences while other listeners also benefit from hearing the responses and information that is shared

In addition to focused emergency medicine topics, interspecialty education is occurring in ways that have rarely been achieved at live conferences. Surgeons have discussed best practices and techniques to help an emergency medicine physician complete a surgical airway. Cardiologists have offered pearls for discovering subtle signs in an ECG that may change management. This emergency physician was able to provide tips to an inpatient physician who was placing an esophageal balloon tamponade device for the first time.

In addition to the interspecialty discussion, discussions among health care professionals and trainees from various continents can open eyes to the global practice of medicine in a way that live conferences never will.

These multidisciplinary discussions have led to real change in the practice of medicine. For example, a pediatric surgeon at Cincinnati Children’s Hospital Medical Center (CCHMC) hosted a Clubhouse room on pediatric abdominal trauma with the intention of discussing how to perform a splenectomy in the setting of trauma. The conversation was joined by an interventional radiologist from UCLA Harbor. She presented the utilization of a hybrid operating room and collaboration between interventional radiology (IR) and surgery for the management of solid organ injury in trauma. Instead of performing a splenectomy, she discussed intraoperative endovascular embolization to spare any functional spleen, especially in the pediatric patient. This novel approach was then discussed at multidisciplinary meetings at CCHMC between IR and surgery, with the intention of implementing a hybrid operating room for pediatric trauma.

Limitations

The possibility for visibility and education that social media provides to physicians is tremendous, but this seemingly limitless potential can also be seen as a doubleedged sword. Social media has long been a source of medical misinformation. Social media applications provide users with the ease of sharing medical claims whether they are founded in scientific literature or not. Users can curate their following, adding or deleting other users whose beliefs align or don’t align with their own. This leads to an “echo chamber” or “information silo” in which similar users can spread false medical claims amongst each other with little contradiction or debate.

ABOUT THE AUTHORS

Dr. Haywood is assistant professor of emergency medicine, clerkship director, and core faculty at Summa Health. Dr. Haywood is the chair of the SAEM Virtual Presence Committee. He has a passion for online education contributing and editing multiple FOAM sites and is senior editor of CriticalCareNow.com. Dr. Gerardo is a general surgery resident at Wright State University and currently doing dedicated research at Cincinnati Children’s Hospital Medical Center with the department of pediatric general and thoracic surgery. Dr. Gerardo has an interest in digital surgical education and hosts the Stay Current in Pediatric Surgery podcast.

A Picture of a Smiling Face: Humanizing Front Line Workers During the Pandemic

By Mia Karamatsu, MD; Al’ai Alvarez, MD; Anya Waterstone, MD; Danielle McTaggart; and Nancy Ewen Wang, MD on behalf of the SAEM Wellness Committee

As we enter the second year of the COVID-19 pandemic, wearing masks and personal protective equipment (PPE) has become second nature to all of us. While the masks, gowns, and goggles serve to protect us, they also make patient interactions less personal and somewhat disconnected.

At Stanford Emergency Medicine (EM), we implemented an intervention focused on humanizing the experience between front line workers and our patients. We wanted to explore the effects of wearing a “smiling” selfportrait on staff well-being and patientstaff interactions. The project originated from Mary Beth Heffernan’s Personal Protective Equipment (PPE) Portrait Project. During the Ebola crisis in Africa in 2014, Mary Beth Heffernan recognized the value of seeing the face of health care providers and called her project “PPE Portraits.” Health care workers, donned in PPE from head to toe, wore large portraits of their smiling faces while caring for their patients. This provided a human connection and improved the patient (and provider) experience. Based on Mary Beth Heffernan’s work, Dr. Cati Brown-Johnson used PPE Portraits at

“This project really made a difference in building a meaningful patient-physician relationship, for them to see the person behind the mask.”

a Stanford COVID drive-through testing site for a one-week pilot project, which produced similar results. Since the start of the pandemic, the PPE Portraits project has been implemented across 25 institutions.

Photos of health care worker faces with a “smile they wish their patients could see” were made into 3” x 4.5” reusable, laminated PPE portrait badges. This low-cost intervention immediately caught the eyes of everyone we worked with within the emergency department (ED). One front line worker shared, “Children would smile and point at my picture or tell me they liked my portrait. Families would comment positively as well.”

This allowed front line workers a much-needed connection with their patients during the time of fear, loss, and isolation. Our portraits, worn at “heartlevel,” became a conversation piece; “I like your smile!” and “Oh, that’s what you look like!” It was clear that patients enjoyed seeing the now-missed faces of physicians and staff, “Babies loved looking at my badge. Parents gave overwhelmingly positive feedback about how nice it is to see what my face looks like under my mask and goggles.”

This was equally important for Stanford EM residents, many of whom volunteered to work in the COVID ICU in addition to their clinical shifts in the ED. Dr. Wil Gibb, a PGY-3 EM resident, shared, “My badge helped me feel more connected with patients in this extremely stressful time. Even though my often-worried face was covered in PPE, it was nice to know my patients could always see my smile.”

Dr. Christine Scullywest, a PGY4, added, “My portrait showed them the face behind the PPE and helped to develop trust between patient and physician.”

Chief Resident Dr. Sarabeth Maciey also shared, “This project really made

WELLNESS

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a difference in building a meaningful patient-physician relationship, for them to see the person behind the mask. This intervention is making a positive impact on our patients and staff. Being able to see our entire face in pictures ease patients’ fears of health care workers, while also allowing us to maintain safety.”

Shortly after our pediatric ED piloted this intervention, faculty, residents, nurses, and other staff members from our adult ED started reaching out to participate. We knew we joined in an effort that is bigger than us; a project that allows our colleagues to remind both our patients and each other that we stand in solidarity and that our welcoming smiles carry our commitment to see them beyond their disease processes.

“It helps me connect better with others, both staff and patients. It brings a smile to my face when I see others with their portrait, and it’s an easy way to give a heartfelt compliment!”

As staffing naturally changed during the demands of the pandemic, this project also allowed us to meet new members of our ED in a better light: “Some coworkers started in our ED after masking guidelines were in place, and I never knew what they looked like!”

The portraits serve as a reminder that behind the mask, beyond the tasks and to-do lists on patient care and our daily work, there are human beings needing connection with each other.

The toll of the pandemic goes beyond just the death and trauma that we see as front-line workers. We carry these traumas at home and with us at work. The PPE Portrait Project allows us to be seen again. One staff member shared that the PPE portraits “made me feel that I'm not hidden from my families anymore. Our work matters, and who we are matters.”

We have made more than 150 PPE portraits in total. The beauty of this project is that it is a simple, cost-effective way to for front-line workers to make a human connection. As we continue to care for those who are suffering during this pandemic, it is comforting to know that even with the simplest gesture of showing a friendly smile, we can extend compassion and help our patients and each other heal.

Acknowledgments: We would like to extend our gratitude to Mary Beth Heffernan for allowing us to use PPE Portraits in the Stanford ED. We also would like to thank Dr. Cati BrownJohnson; Dr. Bernard Dannenberg; Paige Parsons; Michelle Lin, RN; Lindsay Post, RN; and the Stanford ED staff for their support. ABOUT THE AUTHORS

Dr. Karamatsu is a clinical assistant professor in pediatric emergency medicine at Stanford Emergency Medicine.

Dr. Alvarez is director of wellbeing, Stanford Emergency Medicine, @alvarezzzy

Dr. Waterstone is a PGY-4 emergency medicine resident, Stanford Emergency Medicine

Danielle McTaggart is a child life specialist in Lucile Packard Children’s Hospital, Stanford Pediatric Emergency Department

Dr. Ewen Wang is professor and associate director, pediatric emergency medicine, Stanford Emergency Medicine

“It helps me connect better with others, both staff and patients.

It brings a smile to my face when I see others with their portrait,

and it’s an easy way to give a heartfelt compliment!”