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Popular Case-Based Resource Models Online Medical Training
Posted 08/30/2006

Nicholas Genes, MD, PhD

Medscape Med Students. 2006;8(2) ©2006 Medscape

Ves Dimov, MD, has had a busy year. He was recently named the Director of Web-based Education for the Cleveland Clinic's hospitalist group, an outgrowth of his work expanding and improving Clinical Cases and Images, the acclaimed Internet resource for physicians and students. In addition to offering step-by-step guides to EKG interpretation and central line placement, Dr. Dimov's site makes extensive use of a case-based format for exploring challenging clinical dilemmas.

Now, Dr. Dimov is collaborating with another physician to conduct groundbreaking research into the use of an Internet blog in the training of medical residents. I recently corresponded with Dr. Dimov, and he updated me on developments since Medscape last profiled his work.

Dr. Genes: Congratulations on your recent successes! What does your new title mean for residents training at the Cleveland Clinic, and for the rest of us who enjoy and make use of the Clinical Cases Web site?

Dr. Dimov: With the support of the Cleveland Clinic behind us, it looks like "the sky is the limit." Well, almost. Currently, my responsibilities are for the Web-based education of the hospitalist group, which also includes education of medical residents and other members of the Department of General Internal Medicine. Our plans include recording staff and fellows' clinical conferences and posting them on Google Video. Also, we are going to launch a perioperative medicine Web site this year as a follow-up to the well-regarded Perioperative Medicine Summit held annually at the Cleveland Clinic. We are going to ask our readers what they want to see on our Web properties and tailor it to their educational requests.

Dr. Ves Dimov hosts Grand Rounds
September 5, 2006

Dr. Genes: You're working with another doctor-blogger we've profiled, Dr. Joshua Schwimmer, the nephrologist behind the blog KidneyNotes. What question was your research designed to answer? What did you find?

Dr. Dimov: The title of the abstract is, "Assessment of a Blog as a Medium for Nephrology Education." It was accepted for poster presentation at the American Society of Nephrology 39th Annual Renal Week Meeting in November 2006 in San Diego. We cannot release much of the results before they are published in the Journal of the American Society of Nephrology, but in short, we evaluated the effect of using a blog platform on the education of medical residents, as well as its global impact. Residents' responses were overwhelmingly positive. The Web site in question,, has attracted a quarter million visitors since its launch in 2005. It is interesting to see people from all 5 continents and from multiple cities reading articles on the Web site all at the same time.

Our abstract is not the first one about blogs -- there are about 20 results on PubMed with the keyword "blog" -- but it is the first one to evaluate the effect on medical residents and the impact on a large scale with thousands of page views daily.

Dr. Genes: What tips would you give to someone who wants to write a blog or develop a blog-based curriculum? Should they try to make it universally accessible, or tailored to a narrow group? Should they try to make their coverage of a topic comprehensive, like a textbook, or informal and piecemeal?

Dr. Dimov: First, you have to decide what type of blog you want to write. Some people choose to vent their frustration anonymously. But a blog, as a publishing platform, offers much more than an outlet for emotions and ideas. You can use it in a very structured form; with the advantage of the "push button" publishing, it is really easy to upload articles on the Web and to make them accessible to millions.

Writing a blog is beneficial for both professional and personal reasons. It is important to know who your readers are (or who you want them to be). I suggest starting small and getting frequent feedback. When we launched the first blog in a residency program "for the residents, by the residents," we used to ask our colleagues for feedback constantly: "What do you want to see there? What do you want to know more about? A link to procedure videos? It will be there this afternoon; check it out." The residents loved the "instant gratification" of getting responses to their questions. We eliminated the Webmaster as a middle man and decreased the publication time to several hours.

I much prefer starting a blog-based curriculum in an FAQ-style format and building it gradually "brick-by-brick," tailored to the needs of your readers. Starting with the idea that you are going to build the most comprehensive online textbook ever is a daunting task, and most people burn out and give up after the first few chapters. Start small and grow it organically.

I would like to highlight these 4 tips:

  1. A blog can be a springboard for research. It can serve as a place to collect research ideas and interesting clinical cases, which can be used for publication in the peer-reviewed literature later.

  2. A blog can be used as a template for starting a "regular" medical Web site (ie, not a blog). My blog led to the creation of the Web site of one of the largest academic hospitalist groups in the United States, the Section of Hospital Medicine at the Cleveland Clinic.

  3. The medical establishment can benefit from ideas published on medical blogs. We use "persistent search" to power news results about the Cleveland Clinic on the clinic's official Web site. Visitors can subscribe via RSS to receive updates about Cleveland Clinic that are published on any news outlet in the world that is covered by the major search engines. Again, this was a small idea published on my blog, and it made it to the front page of one of the top 3 hospitals in the nation. This shows that blogs do have an impact, and even huge institutions like the Cleveland Clinic can benefit if they have an open mind for new ideas.

  4. Blogs help establish a conversation between medical professionals around the world, which can lead to research collaboration and publications.

The best way for a new medical blogger to become visible is to submit their best posts to Grand Rounds [the weekly collection of medical blog posts], and to comment on other medical blogs. Just a few words of advice: Post and comment regularly; this will bring links and visitors from other blogs and the search engines. Then, before you know it, you will have readers from all over the world. You just have to have something to say, something interesting and new that will make people return to your site. And don't forget to enjoy writing your blog.

Dr. Genes: This week, Dr. Dimov is making the case for medical blogging by hosting Grand Rounds (the link goes "live" on Tuesday, September 5, 2006). Grand Rounds is a weekly compendium of links to the best in online medical writing, submitted by bloggers around the world. Check it out, and be sure to check out Dr. Dimov's ever-growing resource for medical education,

Nicholas Genes, MD, PhD, second-year resident in emergency medicine, Mount Sinai Hospital, New York, NY

Disclosure: Nicholas Genes, MD, PhD, has disclosed no relevant financial relationships.