Abstract
Background
The concept of audio-recordings in medical education is neither new nor novel, and was first documented in 1968 for histology teaching (Cho et al., 2017). Podcasting was first coined as a term in 2004, being used to describe audio-blogging, and has seen an exponential growth in popularity with 40% of Americans regularly using podcasts in 2016. This growth parallels advances in technology, particularly those related to mobile-devices (Cho et al., 2017). The use within medicine is also increasing, with emergency medicine (EM) leading the way in the growth of these resources(Little et al., 2020). Most major medical journals now produce podcasts, representing the tip of the iceberg of medical podcasts. There is widespread recognition of their potential within medical education, and this article will discuss the evidence and the role of podcasts within medical education, with particular reference to primary care.
Podcasts in medical education
Everyone from medical students to junior doctors to GPs and consultants, as well as other health-professionals are now using medical podcasts (Cho et al., 2017). EM has led the way in developing podcasts, although podcast resources are now available across all medical specialties (Little et al., 2020). The volume of doctors listening to medical podcasts is staggering, highlighting the reach, and therefore, importance of podcasting in medical education. A study by Riddell and colleagues in 2017 of over 350 EM trainees, found 88% listened to a medical education podcast at least monthly (Riddell et al., 2021).
Interestingly a review of the literature by Kelly and colleagues highlighted that experiences of podcasts was much more positive in interns and trainees that in medical students (Kelly et al., 2022). It was proposed that the customisable learning experiences offered by podcasts in time-restricted shift working doctors accounted for this difference, with interns and trainees able to combine education with other tasks (for example, commuting). The ‘customisable’ experience offered by podcasts has several elements: ability to choose speed, playback and ease of access (Okonski et al., 2022).
Junior doctors highlighted two reasons for engaging in podcasts: (i) learning and (ii) maintaining currency (Riddell et al., 2021). Listeners report that podcasts are equivalent to, if not better than, classroom learning and led to a change in their clinical practice (Okonski et al., 2022; Riddell et al., 2021). Research has also shown listening to podcasts leads to an increased motivation to learn, and an increased sense of community, due to connection with a host and being able to ‘speak the language’ (Okonski et al., 2022).
Given the nature of medical podcasts, they are often listened to when multi-tasking, and so as an extension of this observation, medical listeners value a combination of education and entertainment, so-called ‘edutainment’ (Okonski et al., 2022).
Despite the plethora of medical podcasts available, the evidence base remains limited. A systematic review by Cho and colleagues explored podcasting in medical education (Cho et al., 2017). Of 24 papers reporting on satisfaction and preferences, podcasts were reported to be both acceptable and beneficial with repeatability and convenience the main attributes. In the review 11 papers reported on attitudes, skills and knowledge, with reported improvements in test scores caveated by lack of control groups. Only one paper has shown an impact on clinical provision, highlighting that proton pump inhibitor prescriptions decreased following a podcast on the topic. This paper, however, did not go onto assess impact on patients (Quitadamo et al., 2014). The research base remains in its infancy, with work required to prove how best to deliver medical podcasts and assess their impact on clinical outcomes.
Podcasts in primary care
Primary care, compared with other specialities, has been slow to adopt podcasting as a means of education. However, now over 30 podcasts in primary care or general practice exist, including but not limited to: GPnotebook podcast, InnovAIT podcasts, primary care knowledge boost and RCGP eLearning podcast. The aims of these different podcasts are diverse and not limited to clinical education. For example, You are not a Frog, was produced to help GPs ‘survive and thrive’ in and out of work.
A literature review of EMBASE, MEDLINE, ERIC and the Cochrane Library for podcasting in primary care (Search terms [abstract, keywords, MeSH term, subject heading, title] were: primary care OR general practice OR family medicine OR family practitioner AND education AND podcast* OR webcast*) revealed 10 papers of which only two were related to primary care (Brust and Yeung, 2014; Brust et al., 2015). Both articles assessed the impact of podcasts on GP trainees’ (in the USA) knowledge of neurological diseases, with positive outcomes. One failed to demonstrate any significant benefit of podcasts at improving knowledge (as assessed via written examination) when compared to a traditional lecture, with no difference in user satisfaction between the two (Brust et al., 2015). The other paper was a ‘needs assessment’ showing high levels of interest in a clinical neuroscience podcast for GP trainees, and that the most important features in a podcast were: credibility, ability to navigate and quality of production (Brust and Yeung, 2014).
The future
Due to the passive nature of podcasts, they need to offer relevant topics in an engaging format. The variation in individual needs can be met by a spectrum of high-quality podcasts (across both topic and delivery style). However, due to the ease and low cost of production, credibility and validity can be a concern. Paterson and colleagues looked to address this in their 2015 review, creating a template for assessing quality (Paterson et al., 2015). This represents an initial step, but requires enforcement; a particular challenge given the volume of podcasts available. Currently listeners are given autonomy to auto-validate, and given the appraisal skills required within medicine, it may continue to be the most appropriate method. I propose two possible methods for regulation:
The creation of a validation and endorsement scheme through our governing bodies that certify practitioners and enforce continued professional development (CPD), could ensure censorship and some level of quality assurance (although clear challenges include cost, workload and bureaucracy) Peer-review process similar to that established within academic journals.
Podcasts are no panacea. Barriers include:
Lack of awareness of podcast existence (often exacerbated by volume) Cost of production and user cost if available only via a charged platform Passivity of learning process, and therefore, easy to disengage if not interesting (Kelly et al., 2022) Concern about quality assurance. Despite this, podcasts offer a flexible source of CPD, which is preferential for clinicians compared with other more traditional methods of CPD (Okonski et al., 2022)
A need to fully embrace the potential of podcasting is required within primary care, with an evidence-based approach likely to maximize success. Therefore further research is required, including:
Subjective experiences related to satisfaction and preference Impact of skills and knowledge Clinical change/outcomes. Establishment of a process of quality assurance and validation.
