Twitter is a tool for physicians to increase engagement of learners and the public, share scientific information, crowdsource new ideas, conduct, discuss and challenge emerging research, pursue professional development and continuing medical education, expand networks around specialized topics and provide moral support to colleagues. However, new users or skeptics may well be wary of its potential pitfalls. The aims of this commentary are to discuss the potential advantages of the Twitter platform for dialogue among physicians, to explore the barriers to accurate and high-quality healthcare discourse and, finally, to recommend potential safeguards physicians may employ against these threats in order to participate productively.

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Background Quality assurance concerns about social media platforms used for education have arisen within the medical education community. As more trainees and clinicians use resources such as blogs and podcasts for learning, we aimed to identify quality indicators for these resources. A previous study identified 151 potentially relevant quality indicators for these social media resources. Objective To identify quality markers for blogs and podcasts using an international cohort of health professions educators. Methods A self-selected group of 44 health professions educators at the 2014 International Conference on Residency Education participated in a Social Media Summit during which a modified Delphi consensus study was conducted to determine which of the 151 quality indicators met the a priori ≥90% inclusion threshold. Results Thirteen quality indicators classified into the domains of credibility (n=8), content (n=4) and design (n=1) met the inclusion threshold. Conclusions The quality indicators that were identified may serve as a foundation for further research on quality indicators of social media-based medical education resources and prompt discussion of their legitimacy as a form of educational scholarship.

The practice of keeping admitted patients on stretchers in hospital emergency department hallways for hours or days, called "boarding," causes emergency department crowding and can be harmful to patients. Boarding increases patients' morbidity, lengths of hospital stay, and mortality. Strategies that optimize bed management reduce boarding by improving the efficiency of hospital patient flow, but these strategies are grossly underused. Convincing hospital leaders of the value of such solutions, and educating patients to advocate for such changes, may promote improvements. If these strategies do not work, legislation may be required to effect meaningful change.

The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice. RÉSUMÉEncore aujourd'hui, il s'écoule un certain temps entre les découvertes et l'intégration des nouvelles connaissances dans la pratique clinique. L'arrivée du mouvement Free Open Access Meducation (FOAM) a bouleversé les communications entre les médecins d'urgence, en permettant aux praticiens d'interagir facilement avec des homologues de partout dans le monde pour discuter des derniers travaux de recherche et de ceux qui ont la plus forte incidence. Le mouvement FOAM peut certes combler des lacunes en matière d'application des connaissances, mais son utilisation soulève des préoccupations quant à son influence grandissante : 1) l'application trop rapide des résultats de la recherche peut s'avérer préjudiciable si les constatations sont erronées; 2) la documentation en ligne échappe en grande partie à la supervision rédactionnelle; 3) des personnes de renom en ligne peuvent finir par exercer une influence trop grande en pratique clinique. Aussi les auteurs de l'article proposent-ils que de nouveaux types d'érudits voient le jour afin de régler le monde en mutation de l'application des connaissances. Ainsi, les cliniciens critiques feraient l'évaluation critique de la recherche à la manière des critiques profanes de restaurants; les formateurs en application des connaissances, versés dans le domaine des nouvelles techniques, travailleraient en collaboration avec les chercheurs à la diffusion efficace des résultats de leurs travaux; et les chercheurs interactifs s'engageraient dans des échanges avec les cliniciens afin de s'assurer que leurs résultats trouvent bel et bien écho dans la pratique clinique. La formation de ces groupes d'érudits pourrait prendre appui sur les grands p...