key: cord-0762088-ymma6jim
authors: Blutinger, Erik J.; Shahid, Sam; Jarou, Zachary J.; Schneider, Sandra M.; Kang, Christopher S.; Rosenberg, Mark
title: Translating COVID‐19 knowledge to practice: Enhancing emergency medicine using the “wisdom of crowds”
date: 2021-01-16
journal: J Am Coll Emerg Physicians Open
DOI: 10.1002/emp2.12356
sha: bbd76f7c728b781b8d85404bcb9146ff217fc068
doc_id: 762088
cord_uid: ymma6jim

In the spring of 2020, emergency physicians found themselves in new, uncharted territory as there were few data available for understanding coronavirus disease 2019 (COVID‐19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus. In response, knowledge was being crowd sourced and shared across online platforms. The “wisdom of crowds” is an important vehicle for sharing information and expertise. In this article, we explore concepts related to the social psychology of group decisionmaking and knowledge translation. We then analyze a scenario in which the American College of Emergency Physicians (ACEP), a professional medical society, used the wisdom of crowds (via the EngagED platform) to disseminate clinically relevant information and create a useful resource called the “ACEP COVID‐19 Field Guide.” We also evaluate the crowd‐sourced approach, content, and attributes of EngagED compared to other social media platforms. We conclude that professional organizations can play a more prominent role using the wisdom of crowds for augmenting pandemic response efforts.

Given the need for guidance, ACEP used information gathered from its own platform, called EngagED, to create the Field Guide to Care in the Emergency Department for practicing emergency physicians (released in April 2020). Few studies assess whether organizations can effectively use social media platforms to facilitate community discussion and information sharing. This paper highlights important psychosocial elements of the "wisdom of crowds," differences between platforms like Twitter and EngagED, and the successes and limitations of EngagED content. In the end, we use this analysis to support a novel approach for organizations (like ACEP) to plan and manage clinical information during a pandemic, using the wisdom of crowds beyond its membership.

The idea of the wisdom of crowds first originated in 1906 when British statistician Sir Francis Galton, a man who believed "the stupidity and wrongheadedness of many men and women was so great as to be scarcely credible," set out to conduct an investigation to prove the incompetence of the average individual. His experimental design? A weight-judging competition at an agricultural fair where hundreds of individuals placed wagers on the total weight of an ox after slaughter. To his surprise, the average weight guessed by the crowd was off by only a single pound, closer than any one individual guess, including those of the "experts"-the butchers and farmers. 2 In theory, groups make better decisions on account of having more brain power, more information, and diverse perspectives. Yet in practice, we have all been part of groups that we feel did not make a better group decision than could have been made individually. Part of designing a group that achieves remarkable collective intelligence is creating the right circumstances. First, there must be diversity of opinion; 

As physicians, we strive to practice evidence-based medicine. Traditionally, we look to peer-reviewed journals for the best evidence available to help guide our actions; however, even when the highest quality of evidence is published, the issue of knowledge-translationtransforming what is known into what is practiced-is a major obstacle that must be overcome. 3 It has been estimated that evidence-based practices take an average of 17 years to be widely recognized and incorporated, a time interval that implementation scientists persistently work to shorten. 4 Over the past decade, we have witnessed the rise of free, open-access medical education (#FOAMed) as a major mechanism to increase knowledge-translation and shorten the evidence-to-practice gap. 5 The uptake of #FOAMed has also increased physician usage of social media for professional activities and created virtual communities of practice that engage in post-publication peer-review. 6 Beyond sharing, discussing, and challenging emerging research, social media also can be used by physicians to crowd source new ideas, expand networks around specialized topics, and provide moral support to colleagues. 7 Social media has not only changed the way people communicate during their normal day-to-day lives, but also has even played a role during moments of crisis.

As cases of COVID-19 began to rapidly spread across the United States, physicians were desperate for information to help them prepare their pandemic response efforts, and because so little was known about this novel virus, traditional sources of knowledge were of limited use. The best available knowledge was the collective experiences of colleagues in the communities that experienced early surges of cases.

The best available knowledge was the wisdom of crowds, which would come in various forms from individuals and organizations alike.

Now, we see how organizations can even curate social media-based discussions to create resource guides that serve the greater community.

From a social psychology perspective, there are several areas that influence the reach of crowd-sourcing platforms and the kind of attention paid by individuals. One area is "process loss," whereby groups will beat the average member and most members but not always the best member. To reduce process loss, experts can be identified and a multistage procedure followed to ensure integrity. 8 During the COVID-19 pandemic, more published literature becomes available, plus health systems are beginning to collect their own internal data sets. How will platforms adjust to discussing these data and shift away from people sharing their opinions? The relationship between facts (that exist) and personal opinion potentially leads to counterproductive measures while trying to advance the knowledge of members.

The prioritization of knowledge is another possible issue. For example, attention is a limited resource that can intuitively follow false guidance-including what gets priority or what information goes unseen. Intuition often leads individuals to reaching tenuous conclusions while using subjectivity measures like our confidence levels and/or personal experiences-not objective facts. This creates a potential problem with trusting information that feels true even though it may, conversely, be false.

garners their attention. One area is accessibility, how currently presented information that is "top-of-mind" captures more attention than absent information, even if the absent information is more meaningful. Another area is negativity dominance, whereby negative information captures attention more than an equivalent degree of positive information. 9

The psychology of groups captures only part of our understanding for the wisdom of crowds. Equally important are the extrinsic components of platforms like EngagED, Reddit, and Twitter, plus how they differ from one another. For online platforms, the organization, content, degree of polarization, accessibility, and emotional tone are all important areas to consider when weighing the successes and limitations of each.

Searching for individual items can be difficult particularly as individuals do not always start new "threads" for new subjects. This issue can be solved by a daily compilation of the major entries, a task that continues into the pandemic. For EngagED, the compilation was nearly 596 pages long in November 2020, but it is catalogued and searchable. For other platforms like Facebook, content is often organized into groups-both public and private-with some being physician-centric, whereas others remain focused on a variety of discussion topics. Twitter is organized by individual users who build their networks one follower at a time (and conversations happening in public).

Important documents shared on forums can be posted on public websites, requiring permission. Such documents may be used to form other literary sources, such as EngagED, which created the first textbook for emergency care of patients (the Field Guide), which, as of the end of May, had over 5.7 million emails/posts and over 2.5 million views. In addition, these forums could collect data (though not a scientific sampling) on key areas for its membership, allowing for the rapid collection and dissemination of knowledge beyond individual participants. In contrast, the content of Reddit discussion boards remains curated with upvote/down-vote functionality by users. Facebook and Twitter present content based on data-driven algorithms used on the back end.

Online platforms do have some negative aspects. A potentially adverse facet of both discussions about health care and online platforms is that polarizing views and diverse politics can "boil to the surface" across many discussions. Comments may be offensive and counterproductive for educational purposes, requiring checks and balances.

For example on Twitter, messages that are well received get multiple "likes"/"retweets," whereas; with EngagED, messages are either present or not on the entire message board without a built-in mechanism allowing for the highlighting of high-yield messages.

Some forums are open access (ie, Twitter, Facebook, Reddit) and others are closed to membership (EngagED), leading to privacy concerns.

Information can be accessible to hackers and trolls and posted elsewhere on social media. The volume of material can be difficult to control, monitor, and eventually curate.

The wisdom of crowds provides insight into the emotional rollercoaster of individuals during pandemics. Postings show a range of emotions, not dissimilar to the stages of dying/grief described by Kübler-Ross. 10 The initial stage is not denial or shock, but an intense search for knowledge and preparation. There is selfless sharing of information, protocols, and inventions-followed by a brief but intense period of anger, 

After the launch of EngagED, discussions helped to inform content Unlike other platforms, ACEP curated the content of its membership using EngagED to help generate a field guide and to expand knowledge to the greater medical community. However, it is still important to consider "best practices" from other platforms.

Platforms, such as Facebook, Twitter, and Reddit, assist the public with adapting to the unknown, especially during a pandemic. Each platform has its limitations and offers unique ways of providing content during our current pandemic. Similar to EngagED, each platform can be evaluated by the manner in which it organizes content, remains accessible, offers collaboration, and leads to innovation between users. Although information can be readily found online, steps must be taken to ensure content integrity. FOAM content is readily available but occasionally difficult to verify. Some platforms have attempted to catch misinformation and push verifiable data; Twitter will often use a blue-colored "verified" badge to alert users of authentic accounts that may serve the public interest, and EngagED uses Community Administrators to rectify issues and disseminate proper messaging when needed. 

Pandemics place undue pressure upon physicians who will continually seek to improve their knowledge, stay current with innovations, and optimally respond to new challenges using verifiable sources of information. Professional societies can make a novel contribution to society by disseminating the knowledge generated from online discussion forums into practical resource guides available for others. Coincidentally, online collaborative platforms-such as EngagED, Twitter, Facebook, and Reddit-should not be overlooked since they harness the collective wisdom of their members to better serve and care for their patients and communities. Ultimately professional societies, including ACEP, should play a more contemporary role engaging and harnessing the collective wisdom of their members to better serve and care for their patients and communities.

The 

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