Professional development poses challenges for healthcare simulation educators.1,2 While some health professionals work in large simulation centers with robust faculty development programs, most simulation educators function in smaller departments and institutions that are geographically removed from larger centers. They often collaborate with colleagues without similar knowledge, experience, and/or enthusiasm for simulation. Although conferences provide opportunities for professional development, they occur infrequently and are costly.3,4
Virtual communities of practice (vCoP) foster communication, personal development, and the exchange of resources.5 Social media facilitates the development of a vCoP by connecting individuals with common areas of interest and by making their knowledge publicly accessible. A growing group of simulation educators is developing a vCoP on social media channels that provide a support network for educator development. Deliberate orchestration of this simulation vCoP could support simulation educators worldwide.
In this article, we explore how the developing simulation vCoP on social media may overcome challenges simulation educators face. The field of emergency medicine (EM) has an established vCoP6 and serves as an exemplar for the simulation education community. We provide resources and practical advice to support simulation educators in their efforts to engage in this promising vCoP that may support faculty development efforts.
DEFINING COMMUNITIES OF PRACTICE
Lave and Wenger7 define “communities of practice” (CoP) as groups of people who share an interest and profession that provide a social context for participatory learning. A CoP is an environment where “people can share a concern, a set of problems, or a passion about a topic and can deepen their knowledge and expertise in this area by interacting on an ongoing basis.”8,9 Learning in a CoP is a collaborative and social process with thinking that is situated in a cultural context.10,11 As groups interact, they develop a social identity where common concepts, knowledge, power, language, and other social tools become communal properties and products of the members of that community.12,13Table 1 outlines several types of CoP, although they may span or blend multiple types.
Wenger17 identifies the following three main principles of an effective CoP: mutual engagement, a joint enterprise, and a shared repertoire. Mutual engagement occurs when members, in the process of practicing together, create relationships that bind them together into a social entity. When members set goals in their own developmental process and work toward those commitments, they engage in joint enterprise. A shared repertoire is established when knowledge, techniques, ideas, and materials to achieve personal goals are shared. Communities of practice naturally develop when new members, technological developments, and the adoption of new knowledge build on shared repertoires. This creates a dynamic learning environment that can scale to meet the learning needs of the community. The proactive, systematic, and strategic development of the CoP can increase the learning potential of that community.18
DEFINING SOCIAL MEDIA
Although ubiquitous in modern life, social media is an amorphous and evolving term. Merriam-Webster defines it as “forms of electronic communication (such as websites for social networking and microblogging) through which people create online communities to share information, ideas, personal messages, and other content.”19 Commonly recognized social media that are popular in global cultures include the following: Web sites (Facebook, Twitter, LinkedIn) and other social media technologies (blogs, photo sharing, social bookmarking, video and audio sharing).20 Healthcare simulation educators also use these resources to advance their practice. Table 2 provides examples and definitions of many different types of social media. Many resources could fit under multiple resource types.21 For example, the blog Debrief2Learn.org (Wordpress) publishes podcasts on an audio-sharing site (iTunes), video on a video-sharing site (YouTube), and interacts with its followers on both a social network (Facebook) and a microblog (Twitter).
Obar and Wildman20 identified four commonalities among social media resources: (1) web 2.0 (users as participants rather than consumers) internet-based applications; (2) user-generated content; (3) site-specific profiles for users that are maintained by a social media organization; and (4) the facilitation of the development of social network by connecting a user's profile with others. This definition of social media has many intuitive links to the dimensions of a community of practice (Table 3).5
DEVELOPING A VIRTUAL COMMUNITY OF PRACTICE
A Virtual CoP shares the characteristics of a CoP, but their members interact primarily in a virtual environment using online communication technologies.22 One example of an active vCoP within the simulation education community is the Society for Simulation in Healthcare's Sim Connect Web site. Although this self-contained, password-protected Web site contains many elements of a social network and vCoP, its closed nature inhibits the use of social media to facilitate the development of a broader vCoP. As social media becomes more popular, online vCoP are expanding in a variety of fields, including medical education. One prominent vCoP in healthcare has developed within EM and critical care. This vCoP operates largely under the banner of Free Open Access Medical education (FOAM),23 frequently communicates via Twitter,6,24,25 tweets extensively regarding conferences (the recent Social Media and Critical Care Conference generated 109 million impressions and 58000 tweets for 4 days from 5900 participants—more than twice the number of conference attendees), and has developed an extensive network of blogs and podcasts.26,27 These resources are used by learners and practicing professionals for educational purposes, while also allowing for debate and discussion of clinical issues among community members.28,29 We see that a similar vCoP is emerging within the simulation community, although growth potential exists to engage more simulation educators online.
ADVANTAGES AND DISADVANTAGES OF A SOCIAL MEDIA–BASED VCOP
Participants can benefit from vCoP in several key ways: consumption of knowledge presented online, curation and critique of other scholarly resources, and connection with fellow practitioners. Higher levels of engagement potentiate these advantages. Many simulation educators will begin as, or permanently remain, consumers of the online educational resources produced by others. These individuals benefit from a robust vCoP by following its activities but not contributing directly to them. Simply by following prominent Twitter accounts, blogs, and podcasts, participants gain access to a range of ideas that they would not encounter in isolation.
Given the breadth of the published simulation literature, busy practitioners need help identifying the latest and most important content. Blogs and podcasts often review and summarize the latest papers and evidence on a topic in a manner comparable with a narrative review. Better still, this distilled information spreads rapidly and often goes through postpublication peer review via comments and discussion within the social media resources.30,31
Global connectivity represents a critical feature of social media's role in education and practice by enabling peer discussion for simulation providers. This connectivity can be purely online—Twitter chats,32 online journal clubs,33,34 comments on blog posts, or online discussion on platforms such as Google Hangouts.34 However, in-person connectivity compliments these interactions when vCoP members meet at conferences and can interact in both the real and virtual worlds while “live tweeting” about their insights and experiences.35 For example, the 2016 International Meeting in Simulation in Healthcare garnered nearly 5000 tweets for 6 days, with a maximum of 1350 tweets on a single day. This activity on social media helped disseminate content to simulation educators who were unable to attend the conference, while bringing the community together through an online presence.
Finally, a smaller group of practitioners creates/produces online educational resources in simulation, either through publishing original research or through writing/recording commentary on primary resources. Few barriers to entry into this group now exist—publishing on Web sites and podcast recording are within easy reach in terms of technology and price. This “democratization” of authorship supports diversity and global perspectives.36
Barriers and Threats
Educators new to social media who begin wading into the online world often worry about safety.37 Although it is certainly possible to “lurk”—observe but not contribute to the vCoP, many of the advantages outlined previously require participation. Many hesitate to participate because of fears of dismissal or harassment or that one “wrong” comment may lead to negative consequences. In our collective experience, the former concern is minimal; professional vCoP generally welcome engaged participants warmly.38 The concern about negative consequences is not entirely unfounded because the potential for social media to serve as a megaphone and amplify a message may also be a potential disadvantage. Rude or negative messages, even if unintentional or misunderstood, may lead to unexpected consequences.39
A second concern relates to what aspects of simulation will receive coverage on social media. Although vCoP have an impressive ability to curate the literature, some areas may be overemphasized, thus leaving others underemphasized.40 This underemphasis based on popularity or personal bias may lead to blind spots. For example, this problem emerged in EM when it was determined that a significant proportion of the total field remains undiscussed, whereas the more exciting aspects bask in the spotlight because of their extensive and frequent coverage.40 If social media–based resources are viewed in isolation, novices unaware of this disparity may develop a skewed perspective of the field.
A final persistent concern involves the perception that the interactions and resources one encounters may be of low quality. As the barriers to enter the realm of social media lower, it is increasingly possible to find resources and interactions that are questionable.41 However, strategies outlined hereinafter can help participants navigate and filter the landscape of social media to identify high-quality resources.
JOINING THE SOCIAL MEDIA–BASED vCOP
Reminiscent of Maslow's hierarchy of needs, an online hierarchy of needs has been described to portray the entry of a new member into a vCoP.37 New members join the social media community (stage 1: existence), become comfortable with using social media (stage 2: safety), begin using vCoP resources (stage 3: consumption), interact with other members (stage 4: collaboration), and begin sharing their own resources (stage 5: creation). Simulation educators getting started can use this framework as they increasingly engage with the vCoP.
To assist with this journey, we offer several tips to simulation educators wishing to join the growing healthcare simulation vCoP:
- Join a social media platform: we recommend starting with Twitter, because there is an active simulation-based vCoP that regularly engages in sharing relevant content and debate/discussion.
- Follow simulation educators on social media: an easy strategy to find simulation-related resources is to follow leading simulation educators on social media Web sites, where they often share resources. Their tweets often direct participants to high-quality resources. Table 4 lists educators recommended by our authorship group for their popular Twitter accounts and frequent tweeting about simulation.
- Use the #FOAMsim hashtag: hashtags help new users or members find content on a topic. A derivative of the #FOAMed hashtag,23 #FOAMsim is a purposely specific hashtag that focuses on sharing freely accessible materials pertinent to healthcare simulation practice. In this manner, #FOAMsim aims to serve to flag, promote, and grow the vCoP interested in creating, curating, refining, connecting, or consuming healthcare simulation resources. Appendix 1, outlines the reach of the #FOAMsim hashtag as measured by Symplur.
- Use Really Simple Syndication (RSS) readers: RSS readers compile content from Web site specified by the user, thus making it easier to gather information from multiple resources.27 RSS readers such as Feedly (all platforms) gather and deliver articles from subscribed blogs into a sort of newsfeed.
- Download a podcast application: podcast-listening applications such as AntennaPod (Android) or Podcasts (iOS) automate the process of downloading and playing podcasts and are freely available on all varieties of smartphones.
- Identify Web sites that share relevant simulation content: Table 5 lists blogs and podcasts that publish content focused on simulation education. Many of them can also be followed on Twitter accounts and Facebook pages and all have an international reach.
SOCIAL MEDIA AND SCHOLARSHIP
As the social media–based vCoP in simulation grows, the lack of academic recognition for social media–based resources relative to traditional outputs such as peer-reviewed publications could limit its expansion. Quality education scholarship requires peer review, public dissemination, and a platform on which others can build42 and has well-defined standards of assessment.43,44 The expansion of these standards to account for alternative metrics of influence may address this concern.45 Sherbino et al46 proposed that social media–based scholarship exists if it is original; builds upon theory, research, or best practice; is archived and disseminated; and allows transparent comments or feedback to inform wider discussion. Social media portfolios have been proposed as a way to support applications for promotion and tenure, and some forward-thinking academic centers already consider digital and social media scholarship among in making promotion decisions.47 Academicians versed in social media scholarship may also benefit from increased translation of their standard scholarly work.48,49
A nascent simulation vCOP exists, connecting people and practices within the healthcare simulation community. Social media offers diverse platforms to support this emerging vCOP, and simulation practitioners should consider engaging with this community for their own professional development, as well as to build global capacity for effective healthcare simulation. Although evolution in online platforms and behaviors will likely change how we connect within the vCOP, the principles of sharing and supporting professional development are perennial enablers. We encourage readers to investigate these platforms and join the growing vCoP.
1. Lee J, Cheng A, Angelski C, Allain D, Ali S. High-fidelity simulation in pediatric emergency medicine
: a national survey of facilitator comfort and practice. Pediatr Emerg Care
2. Eppich W, Cheng A. Competency-based simulation education: should competency standards apply for simulation educators? BMJ Simul Technol Enhanc Learn
3. McLean M, Cilliers F, Van Wyk JM. Faculty development
: yesterday, today and tomorrow. Med Teach
4. Cheng A, Grant V, Dieckmann P, Arora S, Robinson T, Eppich W. Faculty development
for simulation programs: five issues for the future of debriefing training. Simul Healthc
5. Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Evolution of Wenger's concept of community of practice
. Implement Sci
6. Roland D, Spurr J, Cabrera D. Preliminary evidence for the emergence of a health care online community of practice
: using a netnographic framework for Twitter Hashtag Analytics. J Med Internet Res
7. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation
. New York: Cambridge University Press; 1991.
8. Wenger E. Communities of Practice: Learning, Meaning, and Identity
. Cambridge, UK: Cambridge University Press; 1990.
9. Wenger E, McDermott R, Snyder WM. Cultivating Communities of Practice
. Boston, MA: Harvard Business School Press; 2002.
10. Farnsworth V, Kleanthous I, Wenger-Trayner E. Communities of practice as a social theory of learning: a conversation with Etienne Wenger. Br J Educ Stud
11. Pyrko I, Dörfler V, Eden C. Thinking together: what makes communities of practice work? Hum Relat
12. Machles BD, Bonkemeyer E, Mcmichael J. Community of practice
: a workplace safety case study. Prof Saf
13. Barton D, Tusting K. Beyond Communities of Practice: Language, Power, and Social Context
. Cambridge, New York: Cambridge University Press; 2005.
14. Vangrieken K, Meredith C, Packer T, Kyndt E. Teacher communities as a context for professional development: a systematic review. Teach Teach Educ
15. Wenger E, Snyder WM. Communities of practice: the organizational frontier. Harv Bus Rev
16. Pan Y, Xu Y (Calvin), Wang X, Zhang C, Ling H, Lin J. Integrating social networking support for dyadic knowledge exchange: a study in a virtual community of practice
. Inf Manag
17. Wenger E. Communities of practice: learning as a social system. Syst Thinker
1998. Available at: https://thesystemsthinker.com/communities-of-practice-learning-as-a-social-system/
. Accessed July 12, 2017.
18. Wenger E, McDermott RA. Cultivating Communities of Practice: A Guide to Managing Knowledge
. Boston, MA: Harvard Business School Press; 2002.
19. Social Media
. Merriam-Webster Dict
2017. Available at: https://www.merriam-webster.com/dictionary/socialmedia
. Accessed February 15, 2017.
20. Obar JA, Wildman S. Social media
definition and the governance challenge: an introduction to the special issue. Telecomm Policy
21. Grajales FJ 3rd, Sheps S, Ho K, Novak-Lauscher H, Eysenbach G. Social media
: a review and tutorial of applications in medicine
and health care. J Med Internet Res
22. Dubé L, Bourhis A, Jacob R. The impact of structuring characteristics on the launching of virtual communities of practice. J Organ Chang Manag
23. Nickson CP, Cadogan MD. Free Open Access Medical education (FOAM) for the emergency physician. Emerg Med Australas
24. Lulic I, Kovic I. Analysis of emergency physicians' Twitter accounts. Emerg Med J
25. Riddell J, Brown A, Kovic I, Jauregui J. Who are the most influential emergency physicians on Twitter? West J Emerg Med
26. 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
27. Thoma B, Joshi N, Trueger NS, Chan TM, Lin M. Five strategies to effectively use online resources in emergency medicine
. Ann Emerg Med
28. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A survey of the current utilization of asynchronous education among emergency medicine
residents in the United States. Acad Med
29. Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine
residents and program directors. Can J Emerg Med
30. Thoma B, Chan T, Desouza N, Lin M. Implementing peer review at an emergency medicine
blog : bridging the gap between educators and clinical experts. CJEM
31. Sidalak D, Purdy E, Luckett-Gatopoulos S, Murray H, Thoma B, Chan TM. Coached peer review: developing the next generation of authors. Acad Med
32. Hawkins CM, Hillman BJ, Carlos RC, Rawson JV, Haines R, Duszak R. The impact of social media
on readership of a peer-reviewed medical journal. J Am Coll Radiol
33. Chan TM, Thoma B, Radecki R, et al. Ten steps for setting up an online journal club. J Contin Educ Health Prof
34. 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
35. Neill A, Cronin JJ, Brannigan D, O'Sullivan R, Cadogan M. The impact of social media
on a major international emergency medicine
conference. Emerg Med J
36. Boulos MN, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ
37. Weingart SD, Thoma B. The online hierarchy of needs : a beginner's guide to medical social media
and FOAM. Emerg Med Australas
38. Dimitri D, Gubert A, Miller AB, Thoma B, Chan T. A quantitative study on anonymity and professionalism within an online free open access medical education community. Cureus
39. George DR, Rovniak LS, Kraschnewski JL. Dangers and opportunities for social media
. Clin Obstet Gynecol
40. Stuntz R, Clontz R. An evaluation of emergency medicine
core content covered by free open access medical education resources. Ann Emerg Med
41. Brabazon T. The Google effect: Googling, blogging, Wikis and the flattening of expertise. Libri
42. Van Melle E, Lockyer J, Curran V, Lieff S, St Onge C, Goldszmidt M. Toward a common understanding: supporting and promoting education scholarship for medical school faculty. Med Educ
43. Glassick CE. Boyer's expanded definitions of scholarship, the standards for assessing scholarship, and the elusiveness of the scholarship of teaching. Acad Med
44. Boyer EL. Scholarship Reconsidered: Priorities of the Professoriate
. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching; 1990.
45. Greenhow C, Gleason B. Social scholarship: reconsidering scholarly practices in the age of social media
. Br J Educ Technol
46. Sherbino J, Arora VM, Van Melle E, Rogers R, Frank JR, Holmboe ES. Criteria for social media
-based scholarship in health professions education. Postgrad Med J
47. Cabrera D, Vartabedian BS, Spinner RJ, Jordan BL, Aase LA, Timimi FK. More than likes and tweets: creating social media
portfolios for academic promotion and tenure. J Grad Med Educ
48. Thoma B, Mohindra R, Artz JD, Chan TM. CJEM and the changing landscape of medical education and knowledge translation. CJEM
49. Chan T, Seth Trueger N, Roland D, Thoma B. Evidence-based medicine
in the era of social media
: scholarly engagement through participation and online interaction. CJEM