Using Twitter as an Audience Response System

Readers of this blog will note that today's post is a departure from my normally medically related posts. However, I felt the need to use this space in the cloud to discuss an incredibly positive experience I had doing what I do when I don't see patients: teaching medical students.

In general, educators are often trying to find unique ways to engage their students. This is certainly true of medical educators, given that little has changed in medical education in the past 100 years, and for that reason there have been many recent efforts to change this. Similarly, there is often a generational gap between teacher and learner, and thus teachers look for ways to connect with the younger generation they are teaching. Social media and other web based technologies are thus a source of recent interest for medical educators. My colleague Dr. Katherine Chretien has been a pioneer in this field, using blogs to promote professional development in medical students and she has also looked at unprofessional behavior of medical students on social media outlets such as Facebook and physicians who use Twitter. There is even a website now dedicated to Social Media in Medical Education.

One technology that has been useful during classroom presentations has been audience response system or ARS. Most ARS systems work by giving students keypads, and at certain points in the lecture, students can key in their responses (usually anonymously) to questions posed by the lecturer. Use of ARS in lectures has many benefits. It allows learners to be more active and it allows the lecturer to gauge students' knowledge and whether or not they are teaching effectively. Also, because responses are generally anonymous, it can sometimes assist in discussing topics that are difficult to discuss openly. In one class I teach, we use an audience response system and trigger videos to discuss cultural competency and the difficult topic of one's own personal bias. Our medical school uses the Turning Point system for ARS, but only our first and second year students have the keypads (they return them before 3rd year), and I teach several 3rd year classes.

Thus, I was very excited when I found a SAP Business Objects Power Point Twitter Tools . This is a completely free download that allows you to integrate Twitter with a live Power Point presentation. There are several tools, but I was most interested in the ability to use Twitter as an ARS. Essentially, the students' web enabled smart phone becomes the "clicker" and they tweet their responses during lecture which the program magically displays on your Power Point slide. In addition, because students are using text and not just numbers on a key pad, you can also collect even more valuable information as live Twitter feeds. Today, I piloted this in an asthma lecture. In addition to the typical knowledge based multiple choice ARS questions I integrated with my lecture, to generate discussion, I also asked them which asthma medications their physician preceptors were most commonly using. By using a preset hashtag (I used #asthmamed) in their tweets, all their responses could be captured on the screen.

Several observations/pitfalls
1. Medical students do not use Twitter. Almost all have smartphones, and many are using Facebook, but very few use Twitter. I was only able to get about a half dozen students to pilot this because they did not have Twitter accounts that they had successfully used on their mobile phones (however, I only gave them 48 hours notice about the activity). Others may wish to comment on this, but based on my brief discussion today, our 3rd year medical students did not see the importance/relevance of Twitter. They found Facebook much easier for social connections, and didn't see the "need to follow Lady Gaga."
2. Delay time. Some of this might have been to student and teacher lack of familiarity with the system, but it is definitely not as fast as the traditional ARS systems. That said, it is probably fast enough.
3. Students can change their answers. This was an interesting occurrence that I hadn't thought of. Typical ARS systems make you commit then "lock you in." This is not necessarily a disadvantage, because you might want to look at changes, but something to consider.
4. Text responses are non-anonymous. When I asked students to tell me what asthma medications their preceptors were using, I could see who wrote what. Hopefully there is a way in the system to see the Tweet without revealing the "tweeter."
5. Technical issues. I was not able to save settings, and had to reset everything before the presentation. I am probably doing something wrong, but it took a lot of playing around on my part to get it to work the way I wanted.

If you are a medical educator and decide to try this, please email me or respond to this blog post with tips, suggestions or questions.