The podcasting trend has reached internal medicine. Podcasts, or digital audio recordings that are available for download to computers and mobile devices, started to catch on around 2004 and are now soaring in popularity, with more than 550,000 active podcasts and 18.5 million episodes to choose from (and that's just on Apple Podcasts, as the company reported in June 2018). When Apple first supported podcasts on iTunes in 2005, it featured a much smaller offering: about 3,000 of the free audio shows.
While most podcast listeners gravitate to popular genres like comedy and music, a growing number of clinicians and trainees are using podcasts as an entertaining way to learn about medicine from virtually any location.
In resident education, podcasts join Twitter and blogs as the social media platforms most frequently used to engage learners and enhance education, according to a systematic review of the literature published in July 2017 by Academic Medicine. The fields of emergency medicine and critical care adopted podcasts back in 2002 and had at least 42 by 2013, according to a February 2014 paper in the Emergency Medical Journal. Rather than calling podcasts “social media,” however, the authors coined the term FOAM or FOAMed, which stands for free open-access medical education, to more precisely describe the didactic role of medical podcasts, videos, blogs, and, yes, even tweets.
While podcasts are adjuncts to, not a replacement for, traditional medical education, they have grown to become part of the modern physician's learning toolkit. Hosts of some of the top internal medicine podcasts shared how they got started, what keeps them going, and why they think podcasts are here to stay in medicine.
In the beginning
Years ago, Gil Porat, MD, FACP, started looking for an internal medicine or hospitalist podcast but couldn't find one. He did, however, find one podcast, Puscast, that was created in 2005 by Mark Crislip, MD, the attending for his infectious diseases rotation in residency.
“It's much more vibrant than lecture hall learning. It reminded me of being on rotation with him because he podcasts the exact same way he taught me,” said Dr. Porat, a hospitalist with Centura Health Physician Group in Colorado Springs.
In 2012, he recorded the first episode of his own podcast, named simply Hospital and Internal Medicine Podcast, and he still records new episodes from time to time. “When the show got above 10 million listens, it way exceeded what I thought would be a few dozen listeners for each episode,” said Dr. Porat. “It is daunting and exciting to have more peer reviewers than any single hospitalist in history.”
As a fan of several newer medical podcasts, he said he now feels less obligated to cover topics that have already been covered with excellence. “Medical podcasts will keep evolving to something new and different. As long as it stays grounded in the available evidence, it should continue to lead to great things,” said Dr. Porat.
At first, “Podcasts don't seem very congruent with most of the medical literature and publications and rigorous data that people are used to,” said ACP Member Laura Bishop, MD, who helped found the podcast Louisville Lectures with Michael Burk, MD, ACP Member, in 2015. As residents at the University of Louisville in Kentucky, they found that podcasts and other FOAM content can step in to help trainees learn.
The project began after Dr. Burk, an intern at the time, missed a lecture from a faculty member while taking care of a crashing patient during an ICU rotation. Although the lectures were recorded, they were difficult to access (especially from a mobile device), so he worked with Dr. Bishop and faculty to host didactic sessions and grand rounds within a website, YouTube channel, and podcast.
Medical students are big fans of the program. “When you think about it, the amount of medicine that they need to learn is always increasing from what we had to learn in the past,” said Dr. Bishop, who is now faculty director of Louisville Lectures and associate program director for the university's medicine-pediatrics residency program.
The project has expanded to include a new series, called Little Lectures, designed for the on-the-go resident with no time for a full lecture. “You want five or six minutes that you can listen to that review the highest-yield points when you're clinically at bedside and you need that point-of-care resource,” Dr. Bishop said.
Empowering clinicians is the ultimate goal, she said, noting that the best feedback is seeing how the project impacts patient care. “We have comments [like these] from viewers in remote locations across the world that demonstrate our goal of making medical knowledge increasingly accessible: ‘I don't feel like I have to refer to pulm anymore when I treat latent [tuberculosis]; I feel like I can handle most of it myself unless it's a more complicated case,’” Dr. Bishop said.
A labor of love
One of the most popular internal medicine podcasts to date, The Curbsiders, premiered in February 2016. Episodes are about an hour long and feature the podcast's creator, Matthew Watto, MD, ACP Member, and his fellow early-career physician cohosts, Paul Williams, MD, FACP, and ACP Member Stuart Brigham, MD, as they interview experts on clinical topics. He said the name of the show says it all.
“The term curbside in internal medicine means that you're asking an informal opinion of a colleague, who presumably knows more than you. That's pretty much the whole basis of the show: We're talking to people who know more than we do,” said Dr. Watto, a hospitalist and clinical assistant professor of medicine at Penn Medicine in Philadelphia.
Dr. Watto said he was motivated to make the show, which now has more than 100 episodes, because it's “the kind of show that I wished existed.” Over time, an initial target audience of early-career academic clinicians has expanded to include medical students and advanced practice clinicians, he said. The episode on hyponatremia is the most popular to date, and other well-rated episodes cover basic topics like anemia, chronic obstructive pulmonary disease, and hypertension, Dr. Watto said.
Beginning in May, ACP partnered with The Curbsiders to develop certain episodes of the podcast that offer CME/MOC points for ACP members through ACP's Online Learning Center (see sidebar for link). A new project launching this fall will offer exclusive content to ACP Resident/Fellow Members as well. The residency-focused episodes will be geared toward helping residents function better and succeed during training, said Dr. Watto.
The Curbsiders has also started a Women in Medicine series about gender equity issues. Podcasts present a prime opportunity for women physicians to be heard, said Shreya Trivedi, MD, a contributor to the series and executive producer of the Core IM podcast. The typical Core IM podcast is 10 to 30 minutes long, and biweekly segments with experts offer evidence-based pearls, explore knowledge gaps, and present case-based clinical reasoning. She said she always makes sure Core IM episodes feature at least one female voice.
“We're in a more privileged time where we're not limited by institutional hierarchy and we have social media and these other creative platforms where women's voices can be heard just as equally as men's,” said Dr. Trivedi, a general internal medicine fellow at New York University (NYU) Langone Medical Center.
While finishing her residency at NYU School of Medicine, Dr. Trivedi said she was putting in an extra 20 hours per week to start Core IM, which debuted in October 2017. She said the joy of having a creative outlet is worth the extra effort. Similarly, Dr. Watto, who chose to work as a hospitalist to accommodate his podcasting schedule, said that running the show actually helps him prevent burnout. “It keeps things fun, and I always have something to look forward to with the interviews,” he said.
Stirring up controversy
One new addition to the internal medicine podcasting scene is Annals On Call, hosted by Robert M. Centor, MD, MACP, a past Chair of ACP's Board of Regents and professor emeritus of medicine at the University of Alabama at Birmingham. Each 30-minute episode of the show, which launched in August 2018, follows Dr. Centor as he discusses and debates with a guest expert an article published in Annals of Internal Medicine. Like the journal, the podcast is a way to fulfill CME/MOC requirements.
Not all podcasts can dive right into controversies, but Dr. Centor, who started his Medical Rants blog in 2004, is not one to shy away from them (the first two episodes of the show are called “The Gout Wars” and “Hypertension Limbo”). He said podcasts can meet people's desire for storytelling while putting clinical controversies into context.
“This is a great opportunity for any of us to be able to listen to the story of what's going on,” he said. “I think it's much more granular and much more interesting to have a conversation about the controversy than to just try to read about it on black-and-white paper.”
The podcast, which comes out with a new episode twice a month, also tackles topics like glycemic targets and oral pharmacological therapies in type 2 diabetes, diagnosing sepsis, and the physiology of diuretic resistance (based on an Annals paper from the 1990s that Dr. Centor said is one of his all-time favorite articles). Among the guest experts interviewed are members of professional guideline committees, he said.
And, as the namesake of the famous Centor criteria, he said he may even be amenable to talking about his own work. “After I've done enough [episodes], I think people would like to hear me talk about sore throats,” Dr. Centor said.
As of September 2018, ACP also partners with Bedside Rounds, a podcast in which creator and host Adam Rodman, MD, FACP, focuses on the history of medicine, offering members CME credits and MOC points for listening to select episodes.
Much like Dr. Centor on Annals On Call, Dr. Rodman happily discusses controversies. The first ACP-Bedside Rounds podcast episode, “Blood on the Tracks” (launched Sept. 10), tells the story of how historical bloodletting controversies led to the birth of population health.
As more internal medicine podcasts come on the air (and offer CME/MOC perks), tuning in is both easy and practical. Still, the biggest challenge for doctors may be finding the right shows—and finding the time.