Case Study: Social Networks Upgrade Residency Programs

A closer look at the process for creating and launching a social learning website for surgical residency programs.

In January 2009, I attended ASTD TechKnowledge, which emphasizes developing and managing e-learning. During the conference, I was introduced to a vast array Web 2.0 concepts and constructs that were new to me, including Twitter, wikis, social bookmarking tools such as delicious.com for; social networking sites like LinkedIn and Ning; and such RSS readers as Google Reader and Bloglines.

I was a stranger in a strange land trying to comprehend a language that was foreign to me, but before the conference concluded, I joined Twitter, visited a number of Web 2.0 sites, and began to formulate how I could leverage the information I learned to improve communication and collaboration in the general surgery residency program for the Hospital of Saint Raphael. Initially, I thought it might be useful to develop a wiki as a way to post notes from administrative meetings with residents and to pose clinical case scenarios to which residents could collaborate, respond, and comment. In addition, we could also use the wiki as a vehicle to solicit ongoing input for research topics and ideas.

However, I soon felt myself broadening the original scope beyond the boundaries of a single residency program and began focusing on the idea of how to use social media tools to potentially affect all general surgery residency programs. I decided to leverage the interactive features found in social networking sites to develop a website for the purpose of enhancing communication, collaboration, and the exchange of ideas among all general surgery programs. The goal was to create a nexus where program directors, coordinators, and staff could go and take advantage their collective wisdom to improve resident training and residency programs.

Understanding the basics

The interactivity that makes social networking sites like Facebook, MySpace, Youtube, and Flickr appealing is driven by technologies known as Web 2.0. According to Wikipedia, Darcy DiNucci coined the term Web 2.0 in her 1999 article "Fragmented Future." DiNucci writes, "The Web will be understood not as screenfuls of text and graphics but as a transport mechanism, the ether through which interactivity happens."

With Web 1.0, users browsed static content such as articles and newspapers, exchanged emails, and sold and bought goods and services. Although there was basic interaction, the goal was to deliver information rather than bring together people with like interests to share common experiences. Web 2.0, which describes the current stage of the Internet, uses many of the same technologies as the Internet's earlier phase, but it also offers additional layers to create interactivity and engagement, as well as increases the dynamic interfaces on web pages so users can actively contribute information to create content.

What does this mean? Users can easily share ideas, contribute information, and communicate with each other, thereby enabling more meaningful interactions. While Web 1.0 was passive, with participants basically able to view information that was provided to them, Web 2.0 is active.

Although social networking sites are frequently used as places to develop personal relationships, they also can be leveraged to share and learn new information. Consider Wikipedia, which uses a Web 2.0 platform to deliver content created by its users and encourages participants to contribute value to the site by adding or updating existing entries.

Social learning meets surgical setting

As a surgical educator, my experience has been that residency programs tend to operate in silos and collectively behave more in line with Web 1.0 concepts. There seems to be limited cross-pollination of ideas even though programs in the same sub-specialty have similar goals and interests.

Exceptions do occur. For instance, during regional and annual meetings, program directors, coordinators, and staff renew old acquaintances, share problems and issues with colleagues, listen to research presentations, and participate in workshops. As beneficial as these meetings are, many viable concepts and ideas die at the exit door or invariably get buried or forgotten when faculty and staff return to the reality of the day-to-day tactical challenges of managing or participating in the running of a residency program.

Enter Web 2.0. As a developer of the residency training program at The Hospital of Saint Raphael, I wanted to be able to learn about and take advantage of best practices at other residency programs. As a result, I decided to create a social media site where medical educational professionals could go to leverage the collective wisdom of colleagues 24/7/365 - a place to share ideas, techniques, strategies, tips, forms, and so forth that spawn throughout the year, as well as a means to continue dialog about issues generated at a recent meeting.

The next step was to determine how to operationalize the vision of creating a social learning network for residency programs. With limited web programming and design experience, the prospect of developing one from scratch did not seem practical. Fortunately, due to the popularity of social networking, sites offering Web 2.0 templates have sprung up - and many are free. As the popularity of social networking grows, more free Web 2.0 templates are sure to follow.

After much investigation and testing, we decided to use the Ning platform. Ning is a popular web-building and hosting tool that currently has approximately 2 million networks created on the platform, with a total of 40 million users. Site creation was free, templates were appealing and easy-to-use, technical support was extremely responsive, and the site was highly customizable. While Facebook and Myspace seems geared more toward connecting people to friends and family, Ning gathers users around more common interests.

A test site was launched to garner feedback from colleagues and potential users. Improvements were made and The Graduate Medical Education Learning Network (www.graduatemedicaleducation.ning.com) was officially launched regionally. The site is described as "an educational community for faculty, program directors, and coordinators to improve surgical residency programs and resident education." Major areas of the site are organized using tabs to delineate content. For example, the Forum tab is for members to share practical information about teaching and learning. Members can upload to the forum any strategies or techniques they have used or know to be particularly effective. Additional features include a calendar for listing events, a Blog tab, a Resource tab for useful references, RSS feeds from two medical publications, and a chat option. Also, members have their own profile pages that they can easily customize.

Lessons learned

The site continues to be a work in process, and members may encounter some struggles - which most new sites experience. There are barriers to success of any social networking site, including culture-based resistance to adoption and participation, as well as a tendency for some to practice knowledge-hoarding rather than knowledge-sharing.

Also, currently there is limited use of the site. At the time of launch, it was too late to schedule a presentation at the annual program directors' meeting. More recently, I used our program directors' list serve to solicit feedback. This strategy has provided useful information and additional members. Emails to coordinators in the New England area have garnered constructive responses and new members.

In order to overcome barriers and expand membership, the next step is to deliver a presentation about the site at the upcoming annual spring meeting of program directors and coordinators - its primary target audience. This should provide useful feedback about the design and content of the site, as well as address concerns faculty and staff have about using a social networking site in the workplace. More important, it will get the word out and hopefully grow members.

The changing workplace is starting to acknowledge and address that younger employees embed social networks in their daily tasks because they use such virtual tools to stay connected with their peers personally. This virtual connection gives them instant access to answers they need on personal level, so it follows suit that they will use the same tools for business-related issues - retrieving information, sharing best practices, and collaborating on projects. Consider the example Google has set as an early adopter of social networking concepts: To capture employee intellectual capabilities and creativity, all of its employees have had the opportunity to blog and contribute to the company's wiki since 2006.

To be sure, social learning network sites will eventually become part of the fabric of the workplace. Although The Graduate Medical Education Learning Network has not reached its full potential, I am convinced the concept is viable. Like most Web 2.0 initiatives, the site is evolving. We continue to evaluate whether we have all the features and tools residency programs want or need.

Jack Contessa is a surgical educator at Hospital of Saint Raphael; jcontessa@srhs.org.