The Stanford Global Health Media Fellowship: Training the Next Generation of Physician Communicators to Fight Health Misinformation.

PROBLEM: The COVID-19 pandemic and the spread of related health misinformation, especially on social media, have highlighted the need for more health care professionals to produce and share accurate health information to improve health and health literacy. Yet, few programs address this problem by training health care professionals in the art of science writing and medical journalism. APPROACH: Created in 2011, the Stanford Global Health Media Fellowship aims to train medical students and residents in public communication strategies. Each year, 1 physician-in-training is selected to complete the fellowship, which includes 3 rotations: (1) 1 academic quarter at Stanford's Graduate Program in Journalism, (2) 3 to 5 months with a national news network (previously NBC and ABC, now CNN), and (3) a placement at an international site. During the year-long program, fellows also complete a capstone project tackling a global health equity issue. OUTCOMES: Since 2011, 10 fellows have completed the program, and they have acquired skills in reporting, writing, multimedia, social media, and medical communications. During the news network rotation, they have completed more than 200 medical news pieces and improved the quality of the health information in a myriad of other pieces. Alumni have continued to write and report on medical stories throughout residency, other fellowships, and as practicing physicians. One alumnus is now a medical news producer at CNN. NEXT STEPS: Expanding high-quality training in medical journalism for physicians through partnerships with journalism schools; communications departments; and local, national, and international journalists can greatly improve physicians' ability to communicate with the public. It also has the potential to greatly improve the health information the public receives. Educators should consider embedding mass health communications training in medical education curricula and increasing opportunities for physicians to engage with diverse public audiences.

Problem

In the 4th century BCE, Aristotle taught that the onus of communication falls on those with access to true and just information. [1] As physicians who have access to evidence-based health information, we have a responsibility to improve our own communication skills to better inform and educate the public. However, we do not teach physicians the skills in public communication and information dissemination that they need to share health information and empower the public to make healthy choices.

In medical school and residency, there are few opportunities for physicians-in-training to learn skills to communicate with the general public. Some electives embed medical students or residents in health news teams, including programs with ABC News [2] and SiriusXM’s Doctors Radio (see Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/B236 for a list of other programs). These opportunities typically last a few weeks, which is often not enough time for participants to feel like they have mastered the skills.

After residency, there are postgraduate fellowship training programs for physicians to develop excellence in nonclinical fields, such as health administration, bioinformatics, research, public health, medical education, and advocacy. However, traditionally, no such fellowship existed in health journalism. Physicians can gain training through science communication programs, but many learn how to communicate health information to the public on the job when they are asked to be sources for journalists or share information through their own social media accounts. Physicians without communications training may miss opportunities to share valuable health information simply because they do not understand how journalists work, such as adhering to strict deadlines. These physicians are less effective than they could be in getting their message across.

The need for expert physician communicators has been made even clearer during the COVID-19 pandemic. The World Health Organization called on everyone, especially trusted sources such as physicians, to help fight the infodemic, that is, the massive amounts of information and misinformation that have accompanied the COVID-19 pandemic. [3] It is time for physicians to work alongside journalists, researchers, and public health officials to better inform the public, research best practices for physician communicators, and train other physicians in public communication. A decade before the COVID-19 pandemic made this need more dire, the Stanford Global Health Media Fellowship was established to train more expert physician communicators.

Approach

Origin

In 2010, one of us (Michele Barry), a medical educator in global health, met with the chief medical correspondent at NBC News and discussed the detrimental effects of poor health literacy rates and limited access to quality health information. At the time, 88% of the United States population could not demonstrate proficiency in health literacy. [4] With this in mind, in 2011, Michele Barry and the NBC News chief medical correspondent leveraged their respective institutions and established the first journalism fellowship specifically for physicians-in-training: the Stanford Global Health Media Fellowship.

Selection process

One fellow each year is selected through a national search that is open to all medical students and residents in the United States. On average, 15 to 20 applicants apply for the position each year. Applicants must be willing to take a full year off from their training or practice. The selection committee consists of the head of the school of journalism, the lead communications person for the medical school, the director of the Center for Innovation in Global Health at Stanford (M.B.), the current fellow, and representatives from that year’s participating news network and international site. A medical school communications or administrative staff member ranks the applicants based on their experiences in global health and journalism and the quality of the writing in their application. The top candidates are interviewed by the selection committee.

Fellows receive a stipend that includes a living wage and covers travel-related expenses associated with the fellowship. These costs have been covered by Open Society Foundation, Kaiser Family Foundation, Stanford University, and the participating news networks (NBC, ABC, and CNN). However, securing consistent funding has remained the biggest threat to the continuation of the fellowship.

Curriculum

Since the creation of the fellowship, we have adapted the curriculum based on fellows’ feedback and our partners’ needs and capabilities. The fellowship now contains 3 rotations, including studying at Stanford’s Graduate Program in Journalism, a national news network placement, and an international placement, as well as a capstone project, which can be completed at any time during the fellowship (see Table 1).

Table 1

Activities During Each Rotation of the Stanford Global Health Media Fellowship

Initially, the fellowship began with an orientation alongside the 20 journalists taking part in the Kaiser Media Fellowship in Health Reporting. Our fellows appreciated the Kaiser Health News orientation but found that the focus was more on introducing journalists to important concepts in medicine than on introducing physicians to journalism, so we discontinued this aspect of the curriculum. Originally, fellows completed their international placement before their studies at Stanford’s Graduate Program in Journalism and their national news network placement. We have since changed the order of the rotations, so the international placement now comes at the end of the fellowship. This has helped fellows be more effective at each rotation. The international placement started as an internship with the World Health Organization in the South-East Asia Regional Office’s communications department and has changed yearly based on the fellow’s skills and interest and available mentorship. The participating news network has also changed, from NBC to ABC and now to CNN, based on which network had a physician medical correspondent willing and able to mentor the fellow.

Fellows now start by spending 1 academic quarter (3 months) studying at Stanford’s Graduate Program in Journalism, receiving individualized feedback as 1 of 13 students learning the fundamentals of journalism and beat reporting. Combining their medical training with the skills they develop in these journalism courses allows fellows to successfully transition to a 3- to 5-month placement at a national news network, now CNN. There, fellows use their medical background to research stories and prove their journalism acumen by creating pieces worthy of publication at a national network. Fellows then finish with a placement at an international site. However, COVID-19 has made this rotation more difficult, and recent fellows have expanded their time with CNN instead of completing the international placement.

Throughout the year, fellows work on a capstone project focusing on a global health equity issue of their choosing at one of that year’s participating sites. Fellows are encouraged to focus their capstone project on their international placement. Moving the international placement to the end of the curriculum has allowed fellows to create uniquely impactful capstone projects that use all their medical and journalism training to benefit the site. However, not all fellows have been able to focus their project on their international placement, especially since the beginning of the COVID-19 pandemic.

Outcomes

To date, 10 fellows have completed the program, and they have learned a diverse set of skills to accomplish the goals of each rotation (see Chart 1). As students in Stanford’s Graduate Program in Journalism, fellows were evaluated by the faculty on their reporting, writing, podcasting, and video journalism. In the Peninsula Press, a Stanford Journalism Program news publication, fellows reported on various health topics relevant to the greater Stanford community, including coverage of East Palo Alto, an underserved area adjacent to some of the wealthiest neighborhoods in the world; the effects of wildfires in California on the general public’s health; and discussions of key health topics with medical experts at Stanford (e.g., vaping).

Chart 1

Knowledge, Skills, and Relationships Developed Through Participation in the Stanford Global Health Media Fellowship

During their national news network placement, network producers and editors assessed fellows’ work, including the more than 200 medical news pieces fellows created that met network news standards (see Supplemental Digital Appendix 2 at http://links.lww.com/ACADMED/B236 for a selection of these pieces). Fellows’ unique capstone projects demonstrated expertise in medical communication and advocacy on behalf of global health equity (see Table 2).

Table 2

Stanford Global Health Media Fellows’ Capstone Projects, 2011–2020

After completing the fellowship, all alumni continue to work in global health reporting and advocacy. They have created a community of medically trained communicators working to bridge the gap between medical experts and the public globally, as demonstrated by these select examples.

Dermatologist Dr. Joyce Park educates her more than 300,000 followers about evidence-based skincare and medicine practices on www.teawithMD.com and studies how patients and physicians share dermatology information on social media.

Dr. Kristina Krohn, an internal medicine and pediatric hospitalist, introduces medical students to medical communications and global health as an assistant professor at the University of Minnesota, including a rotation engaging medical students in creating quality social media content about COVID-19. [5,6]

Dr. Edith Bracho-Sanchez, a pediatrician and faculty member at Columbia University, leads the pediatric telemedicine program, teaches medical students and residents about the use of media to advocate for the health of children, writes for CNN, frequently appears on air for both English- and Spanish-speaking networks as a medical expert, and created a Spanish-language podcast on issues of child health.

Five other fellows are continuing their medical training as residents or fellows across the United States in wide-ranging medical fields.

Another alumnus, Michael Nedelman, is a producer on CNN’s health and medical team and mentors each new fellow. He states, “The caliber of work and the value added by the fellow each year raises the bar for health coverage across not just CNN but all news media. One person can make so much impact in this industry and having the right person—someone with a medical background and a nose for the news—is worth even more.”

Next Steps

The COVID-19 pandemic and the spread of related misinformation, especially on social media, have highlighted the need for more health care professionals to be trained in communications and journalism. Every physician does not need to be the chief medical correspondent for a news network, but we all can improve the network of physician communicators who share health information locally, nationally, and internationally by writing op-eds, tweeting, blogging, or engaging with our communities to help the public better understand medicine and make healthy choices.

While the Stanford Global Health Media Fellowship is limited to 1 fellow per year, many aspects of the program are still applicable to other institutions. Medical schools can partner with their local journalism schools and communications departments to create a variety of levels of journalism training for health care professionals. For example, one of us (K.M.K.), a former fellow, is partnering with her local journalism school and communications office to embed training in the basics of journalism and mass health communications in the courses required for medical students at the University of Minnesota. [7] Her classes teach medical students to identify bias online and on social media, the basics of being interviewed, and social media uses and abuses. At Stanford University, physicians can learn the basics of health communications and more through the Health Communication Initiative’s continuing medical education offerings. [8] We hope that more medical schools will create similar introductory courses for physicians and physicians-in-training.

Other partnerships between medical schools and news networks or journalism schools include the University of Toronto–Healthy Debates partnership. University of Toronto residents have the opportunity to complete a 4-week rotation at this online news organization that is focused on Canadian health (see Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/B236). In addition, the University of Toronto’s Fellowship in Global Journalism, which is designed for experts in many fields, including physicians, has its own freelance “bureau” to pitch and create news stories for media partners. Georgetown University’s Health and Media Fellowship places physician fellows at partner media organizations for 40% of their time, with their remaining time spent practicing medicine in an affiliated clinic.

Other institutions may want to start their own partnerships, or they may choose to send physicians-in-training to participate in the existing ABC News elective, which accepts 2 to 4 residents at a time for the 4- to 12-week elective (see Supplemental Digital Appendix 1 at http://links.lww.com/ACADMED/B236). While positions with national news organizations may be limited, local news stations could be excellent partners for short-term electives or long-term fellowship placements. A 2019 Knight Foundation/Gallup study showed that Americans put more trust in local news organizations than in national news organizations, so engaging local media is particularly important. [9]

While there has been significant expansion in available opportunities since the Stanford Global Health Media Fellowship started in 2011, deficiencies remain, especially with regard to the diverse public that requires improved access to quality health information. Partnering with more diverse news sources and more diverse communities is an area where other programs could expand this work.

The COVID-19 pandemic has highlighted how we must invest in expanding training for physicians in communicating with the public. As trusted voices, physicians should be leading the fight against misinformation alongside our journalism and public health colleagues. Physicians in the United States consistently rank second in terms of professions with the highest public trust, behind only nurses and well above journalists and government officials. [10] The World Health Organization called for trusted sources in countries around the world to release more quality health information for the public. [3] We must accept the onus as physicians to communicate true and just health information in response to this call. To do that, we need to expand training opportunities, such as those provided by the Stanford Global Health Media Fellowship, to teach physicians how to adapt health recommendations from one-on-one exam room settings for larger audiences, to enable the public to make healthy choices.

Acknowledgments:

The authors thank all the journalists and communicators who teach the Stanford Global Health Media fellows every year.