To Tweet or Not to Tweet, That Is the Question

Being, becoming, and belonging: reconceptualizing professional identity formation in medicine

Over the last decade, there has been a drive to emphasize professional identity formation in medical education. This shift has had important and positive implications for the education of physicians. However, the increasing recognition of longstanding structural inequalities within society and the profession has highlighted how conceptualizations of professional identity formation have also had unintended harmful consequences. These include experiences of identity threat and exclusion, and the promotion of norms and values that over-emphasize the preferences of culturally dominant groups. In this paper, the authors put forth a reconceptualization of the process of professional identity formation in medicine through the elaboration of 3 schematic representations. Evolutions in the understandings of professional identity formation, as described in this paper, include re-defining socialization as an active process involving critical engagement with professional norms, emphasizing the role of agency, and recognizing the importance of belonging or exclusion on one's sense of professional self. The authors have framed their analysis as an evidence-informed educational guide with the aim of supporting the development of identities which embrace diverse ways of being, becoming, and belonging within the profession, while simultaneously upholding the standards required for the profession to meet its obligations to patients and society.

Cytopathology in the era of social media

In today's medical landscape, social media (SoMe) platforms have expanded their reach beyond mere communication and entertainment, making a significant impact in the pathology field, including cytopathology. In recent years, SoMe platforms have become increasingly adopted by cytopathologists, facilitating continued education, professional networking, enhancing patient engagement, and entertainment. This adoption has influenced the professional growth of cytopathologists, and at its best, has led to the establishment of a robust professional online presence and ultimately contributed to leadership positions, fellowship opportunities, and academic promotions. Moreover, the integration of SoMe into the academic field has shown a profound impact on the visibility of academic journals and has provided a platform for lower-impact factor journals to expand their reach, ultimately increasing article citation rates and positively contributing to journal impact factor growth. SoMe platforms created a modern avenue for conference networking that has revolutionized knowledge dissemination and enhanced real-time engagement. The advantages of SoMe have extended to a global scale, positively enhancing professional expertise sharing, facilitating effective communication and teleconsultation worldwide, and reaching developing countries. Drawing insights from the recent medical literature and the practical insight from the experts' personal experience, this article provides a comprehensive review of how SoMe and cytopathology intersect to create new opportunities, facilitating informed discussions, global collaboration, and advancements in the field of cytopathology. This article also delves into the challenges surrounding SoMe platform navigation and addresses ethical and regulatory concerns, providing guidelines on what to post and what not to post on SoMe platforms.

Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study

BACKGROUND

Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

OBJECTIVE

We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.

METHODS

A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction.

RESULTS

The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

CONCLUSIONS

The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

What's trending? Reach and content of the Society for Maternal-Fetal Medicine on social media

BACKGROUND

The Society for Maternal-Fetal Medicine uses social media to increase awareness of the Society and its key programs and to foster community and discussion around perinatal health, especially on Twitter. The influence and role of the Society for Maternal-Fetal Medicine Twitter account in public discourse around issues relevant to pregnancy have not been studied.

OBJECTIVE

This study aimed to evaluate the trends in engagement with the Society for Maternal-Fetal Medicine on Twitter by analyzing Society for Maternal-Fetal Medicine follower growth and discussion topics on Twitter compared with Facebook and by quantifying public engagement during the Society for Maternal-Fetal Medicine Annual Pregnancy Meeting.

STUDY DESIGN

This retrospective study analyzed follower growth data from August 2019 to July 2022 for the Society for Maternal-Fetal Medicine Twitter (@MySMFM) and Society for Maternal-Fetal Medicine Facebook (@SocietyforMaternalFetalMedicine) accounts. We identified the top 10 tweets and Facebook posts during the study period using Twitter Analytics and Facebook data. The popularity of tweets and Facebook posts was determined by "impressions" and "reach," respectively; these metrics reflect the number of times a post was viewed. To evaluate annual trends in Society for Maternal-Fetal Medicine Twitter engagement, we analyzed data associated with the Society for Maternal-Fetal Medicine Annual Pregnancy Meeting, including the number of tweets using the hashtag (#SMFM(Year)) and overall impressions for the Society for Maternal-Fetal Medicine Twitter account for each meeting from 2016 to 2023.

RESULTS

The absolute number of new followers for the Society for Maternal-Fetal Medicine Twitter and Facebook accounts was similar, but the relative increase and rate of follower growth was higher for Twitter than for Facebook. The Twitter account consistently gained followers, whereas the Facebook account experienced intermittent periods of stagnancy or follower loss. More than half of the top-ranked posts on Twitter and Facebook mentioned the COVID-19 vaccine; other popular topics included COVID-19 and abortion. During the Society for Maternal-Fetal Medicine Annual Pregnancy Meeting, the number of tweets using the meeting hashtag consistently peaked on meeting day 4, coincident with the opening plenary session (mean 1270±499). An upward trend in annual pregnancy meeting tweets was observed each year until 2021-the first virtual Society for Maternal-Fetal Medicine meeting.

CONCLUSION

The trends in Society for Maternal-Fetal Medicine Twitter engagement suggest increasing use and popularity of the platform for timely dissemination of pregnancy-related news, guidelines, and research. The reduction in annual pregnancy meeting tweets and impressions in 2021 and 2022 suggests the potential negative effect of virtual meetings on Society for Maternal-Fetal Medicine member engagement around annual meeting content.

A Scoping Review of Physician Advocacy on Twitter

Twitter has been adopted by physicians across most medical specialties; it allows for the wide dissemination of information and calls to action, brings new stakeholders into collations, promotes academic engagement, and fosters collaboration between academia and private practice. In this review of the literature, we briefly outline the state of advocacy in health care and summarize current Twitter-based advocacy efforts in the major specialties of health care, identifying both successful strategies as well as gaps in Twitter advocacy research. Relevant articles were obtained via PubMed and Google Scholar searches using the phrases "Twitter advocacy healthcare," "[specialty name] Twitter" and "[specialty name] Twitter advocacy." Several overarching themes were found to be widely utilized in specialty-specific discussions of Twitter advocacy efforts: organizing under a specific hashtag, fostering dialogue between stakeholders, and tweeting using personalized, action-oriented language. Fields such as pediatrics, heme/onc, ENT, and ophthalmology have most thoroughly embraced the desire to learn how to most effectively advocate on Twitter. Other fields such as OBGYN, cardiology, and surgery have less academic focus on online advocacy. Outside of advocacy efforts, the research and academic benefits of Twitter are well described in nearly every specialty. In conclusion, while clinicians are encouraged to advocate online, only broad strategies for online engagement are currently offered. Additional research into the details of how to successfully create an online profile and Twitter presence is needed to ensure all physicians are able to maximize their advocacy efforts, with clarification of the goals and objectives of this engagement also required.

The #Tweetorial: an Underutilized Teaching Tool in Undergraduate Medical Education?

Tweetorials are short, self-contained Twitter threads that provide a concise overview of a topic. Recently, they have gained prominence in the Twitter medical community (#MedTwitter) as a medium for teaching and reviewing topics from foundational medical physiological concepts through to complex clinical case presentations. With medical schools increasingly utilizing case-based learning in their curricula, the Tweetorial may have a role in bridging the foundational and clinical sciences while challenging the clinical decision-making acumen of learners. We outline how Tweetorials may be utilized to support self-directed, asynchronous learning amidst increasingly brimming medical curricula and provide undergraduate medical students real-time access to educators, and discuss limitations that may hamper their implementation.

Consume, Contribute, and Create: Succeeding as a Learner and Educator in the Digital Era

From medical student to professorship, the practice of medicine requires lifelong learning. The unforgivingly rapid expansion of medical literature often renders traditional educational resources quickly outdated if not altogether obsolete. Conversely, increasingly popular digital platforms are easily accessible and quickly updated, offering vital adjuncts to traditional resources for the modern student. Further, platforms such as podcasts and social media may be particularly well suited for adult learners who tend to be problem centered, self-directed, internally motivated, and time constrained. Social media empowers all participants, thereby blurring the boundaries between learners and educators. Here we review novel digital educational platforms, discussing both potential benefits and pitfalls, and then provide a three-pillared approach-consume, contribute, and create-to help the modern medical professional harness the potential of both traditional and novel resources to succeed as both a learner and educator.

The use of social media and virtual opportunities by integrated vascular surgery residency programs during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic has significantly affected the 2021 match application cycle as in person sub-internships and interviews have been halted. Given the abrupt change, we aimed to characterize the utilization of social media and virtual open house platforms by integrated vascular surgery residency programs for outreach and networking during the pandemic for the 2021 cycle.

METHODS

A list of accredited integrated vascular surgery residency programs was compiled using the Electronic Residency Application Service (ERAS) website provided by the Academic Medical Colleges (AMC). The social media platforms Twitter, Instagram, and Facebook were queried for accounts associated with the training programs or their associated institutional vascular surgery divisions. Each discovered account was surveyed for date of creation as well as posts outlining virtual interactive events such as open houses, meet-and-greets, and virtual sub-internship opportunities. Slopes of the curves representing total account numbers and account numbers on each platform were compared from pre-COVID to current day using linear regression and t-statistics.

RESULTS

There were 64 integrated vascular surgery residency programs participating in the 2021 match cycle. 70.3% (N = 45) of programs had a social media presence on at least one of the three platforms. 54.7% (N = 35) of programs had an associated Twitter account. 43.9% (N = 28) of programs had an associated Instagram account. Six (9.4%) programs were found on Facebook. The number of social media accounts significantly increased from March 2020 (37 vs 69, p < .001) to March 2021.

CONCLUSIONS

Vascular surgery residency programs have significantly increased use of social media platforms over a 12-month period beginning in March 2020, indicating adaptation to the restrictions prompted by the pandemic.

Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit

Background: Digitally-mediated peer support may improve opioid use disorder (OUD) recovery. Our objective was to examine the types and sources of stigma that people seek support for in online OUD recovery communities (subreddits) on Reddit. Methods: We extracted all posts containing stigma keywords from three subreddits as well as a random sample that do not contain stigma keywords. We conducted deductive content analysis to confirm that the post self-described an experience of stigma and identify the type (condition, intervention) and source (provider-based, public, self, structural) of stigma. Results: Two-hundred and fifty-nine posts self-reported a stigmatizing experience. The majority of posts described an intervention stigma associated with medications for OUD. Posts discussing intervention stigma acknowledged the role of stigma in their treatment decision-making and quality of their treatment program. The most frequent sources of stigma were the public (including family members), provider-based (healthcare and pharmacy workers), structural (workplace, law enforcement, child protective services, and abstinence-based self-help groups), and self. No posts mentioned courtesy stigma. Posts sought assistance in navigating their experiences and participating in advocacy to counter stigmatized narratives. Conclusions: Our study indicates that people in online communities seek support to disclose and manage experiences of stigma on Reddit in similar ways to people in offline communities with the noted exception of an absence of discussions of courtesy stigma. Since each subreddit is a microcosm of varying needs, we suggest areas of future work for collaborative resources developed between stakeholders of these subreddits and public health that work within the preexisting Reddit social norms.

Self-Reported Social Media Use among Ophthalmology Residents

Objective To assess ophthalmology trainees' self-reported use of and attitudes toward social media.

Methods An online survey was distributed by email to ophthalmology residency applicants of the Bascom Palmer Eye Institute between September 2016 and January 2020.

Results Of the 1,688 email recipients, the survey was filled by 208 ophthalmology trainees (12.3%). Nearly all trainees reported using social media for personal purposes (92.3%), while less than half used social media for professional purposes (43.4%). There were mixed sentiments regarding the impact of social media on the patient–physician relationship, with the majority feeling that it challenges a physician's authority (55.2%) but also empowers the patient (57.5%) and encourages shared care (92.8%). Twenty-five percent of trainees had reviewed professional social media guidelines, and most rated the quality of medical information on social media as “poor” (60.9%). There were low rates of trainees looking up patients (13.8%), providing their account information to patients (1.5%), responding to patients' messages (2.6%), following patients' accounts (2.6%), and being followed by patients (2.6%).

Conclusion The majority of ophthalmology trainees are active on social media. As these trainees enter practice, ophthalmology will likely see a rise in social media use. Training programs should consider a formal social media policy that is shared with all trainees as part of their education.

An evaluation of social media utilization by general surgery programs in the COVID-19 era

BACKGROUND

Our study investigates how general surgery residency programs utilized social media to adapt to the challenges of COVID-19.

METHODS

319 participating general surgery residency programs provided by the Electronic Residency Application Service were analyzed in this study. Associated Twitter, Instagram, and Facebook accounts were assessed to find virtual open houses and externships.

RESULTS

Of the 319 program, 188 (59%) were found to have a social media presence. A total of 348 social media accounts were found, as some of the programs had separate residency and department accounts. Of all the social media accounts, 112 (32%) of the accounts were created after March 1, 2020. Virtual open houses opportunities were found to be advertised across all platforms.

CONCLUSION

Many general surgery programs responded to the physical limitations of COVID-19 pandemic by increasingly utilizing social media during the COVID-19 pandemic. Virtual opportunities should be considered as a novel approach for future outreach and recruitment.

Entanglements of affect, space, and evidence in pandemic healthcare: An analysis of Australian healthcare workers' experiences of COVID-19

The COVID-19 pandemic continues to highlight both global interconnectedness and schisms across place, context and peoples. While countries such as Australia have securitised their borders in response to the global spread of disease, flows of information and collective affect continue to permeate these boundaries. Drawing on interviews with Australian healthcare workers, we examine how their experiences of the pandemic are shaped by affect and evidence ‘traveling’ across time and space. Our analysis points to the limitations of global health crisis responses that focus solely on material risk and spatial separation. Institutional responses must, we suggest, also consider the affective and discursive dimensions of health-related risk environments.

Twenty-One for 2021: The Most Influential Papers in Laryngology Since 2000

OBJECTIVES/HYPOTHESIS

To identify the most influential publications in laryngology since 2000.

STUDY DESIGN

Modified Delphi process.

METHODS

Samples of laryngologists drawn from editors of leading journals, organization officers, and thought leaders were invited to participate in a modified Delphi identification of influential laryngology papers. Influential was defined as follows: yielding meaningful practice changes, catalyzing further work as a foundation for an important topic, altering traditional views, or demonstrating durability over time. Quality and validity were not among the selection criteria. Each participant nominated 5 to 10 papers in Round 1. These nominations, augmented with papers from bibliometric analysis, were narrowed further in Round 2 as participants identified their top 20. The 40 papers with the most Round 2 votes were discussed by video conference and then subjected to Round 3 voting, with each participant again selecting their top 20 most influential papers. Final results were collated by the number of Round 3 votes.

RESULTS

Sixteen of 18 invited laryngologists participated overall (all 16 in Rounds 1 and 3; 14 in Round 2). Twenty-one papers were identified as most influential. One paper appeared on all 16 Round 3 lists; three papers with eight (50%) votes each were lasted to make the list. Eleven of these 21 focused on voice; three each related to cancer, airway, and swallowing; and one encompassed all of these clinical areas.

CONCLUSIONS

This list of 21 influential laryngology papers serves to focus further research, provides perspective on recent advances within the field, and is an educational resource for trainees and practicing physicians.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2021.

Enhancing clinical judgement in virtual care for complex chronic disease

The COVID-19 pandemic has transformed traditional in-person care into a new reality of virtual care for patients with complex chronic disease (CCD), but how has this transformation impacted clinical judgement? I argue that virtual specialist-patient interaction challenges clinical reasoning and clinical judgement (clinical reasoning combined with statistical reasoning). However, clinical reasoning can improve by recognising the abductive, deductive, and inductive methods that the clinician employs. Abductive reasoning leading to an inference to the best explanation or invention of an explanatory hypothesis is the default response to unfamiliar or confusing situations. Deductive reasoning supports a previously established goal, but deductive accuracy requires sound premises leading to a valid conclusion. Inductive reasoning uses efficient data sorting, data interpretation, and plan creation without a previously established goal, and allows assessing inferential accuracy over time. In all cases, communication remains the backbone of the clinical encounter. Virtual care for CCD challenges clinical judgement by reducing available information, so even experienced specialists who use induction might default to deduction or abduction. The visit might shorten, decreasing narrative competence and in-turn management quality. Clinical judgement in virtual encounters can be enhanced by allowing sufficient time, employing allied health staff, using an advance script, avoiding dogmatic commitment to either virtual or in-person encounters, special training in virtual care, and conscious awareness of abductive, deductive, and inductive reasoning processes. Clinical judgement in virtual encounters especially calls for Gestalt cognition to assess a situational pattern irreducible to its parts and independent of its particulars, so that efficient data interpretation and self-reflection are enabled. Gestalt cognition integrates abduction, deduction, and induction, appropriately divides the time and effort spent on each, and can compensate for reduced available information. Evaluating one's clinical judgement for those components especially vulnerable to compromise can help optimize the delivery of virtual care for patients with CCD.

The value of healthcare worker support strategies to enhance wellbeing and optimise patient care

Introduction and aim The World Health Organization has recognised the impact of the SARS-CoV-2 pandemic on healthcare worker (HCW) mental health and wellbeing. Anticipating these effects locally, we developed strategies to support our team, to equip them to care for themselves as well as our patients. Methods We implemented a series of interventions to increase staff support, highlighting the importance of team and individual morale. We developed a team of peer supporters, encouraged sub-teams to debrief and disseminated general wellbeing advice. Results Feedback demonstrates that our interventions had a positive impact. Greater benefits were recognised by empowering sub-teams to develop their own wellbeing and support mechanisms. Conclusion A strategy to support HCW teams during a crisis is vital to enhance wellbeing. Interventions implemented within our team have supported the provision of high-quality patient care, innovation and research throughout the pandemic.

Perspectives from the Society for Pediatric Research: advice on sustaining science and mentoring during COVID-19

The COVID-19 pandemic will leave an indelible mark on the careers of current medical trainees. Given the disruptions to medical education, economic impact on institutions, and the uncertainties around future job prospects, trainees are facing unprecedented challenges. This situation is especially concerning for futures of pediatric physician-scientist trainees, where concerns regarding maintaining the pipeline were well documented prior to the emergence of COVID-19. In this Perspectives article, we leverage the unique expertise of our workgroup to address concerns of physician-scientist trainees and to provide suggestions on how to navigate career trajectories in the post-COVID-19 era. We identified and addressed four major areas of concern: lack of in-person conferences and the associated decrease access to mentors and networking activities, decreased academic productivity, diminished job prospects, and mental health challenges. We also suggest actions for trainees, mentors and educational leaders, and institutions to help support trainees during the pandemic, with a goal of maintaining the pediatric physician-scientist pipeline.

A Picture Is Worth a Thousand Views: A Triple Crossover Trial of Visual Abstracts to Examine Their Impact on Research Dissemination

BACKGROUND

A visual abstract is a graphic summary of a research article's question, methods, and major findings. Although they have a number of uses, visual abstracts are chiefly used to promote research articles on social media.

OBJECTIVE

This study aimed to determine if the use of visual abstracts increases the visibility of nephrology research shared on Twitter.

METHODS

A prospective case-control crossover study was conducted using 40 research articles published in the American Journal of Nephrology (AJN). Each article was shared by the AJN Twitter account in 3 formats: (1) the article citation, (2) the citation with a key figure from the article, and (3) the citation with a visual abstract. Tweets were spaced 2 weeks apart to allow washout of the previous tweet, and the order of the tweets was randomized. Dissemination was measured via retweets, views, number of link clicks, and Altmetric scores.

RESULTS

Tweets that contained a visual abstract had more than twice as many views as citation-only tweets (1351, SD 1053 vs 639, SD 343) and nearly twice as many views as key figure tweets (1351, SD 1053 vs 732, SD 464). Visual abstract tweets had 5 times the engagements of citation-only tweets and more than 3.5 times the engagements of key figure tweets. Visual abstract tweets were also associated with greater increases in Altmetric scores as compared to citation-only tweets (2.20 vs 1.05).

CONCLUSIONS

The use of visual abstracts increased visibility of research articles on Twitter, resulting in a greater number of views, engagements, and retweets. Visual abstracts were also associated with increased Altmetric scores as compared to citation-only tweets. These findings support the broader use of visual abstracts in the scientific community. Journals should consider visual abstracts as valuable tools for research dissemination.

Moving towards online rheumatology education in the era of COVID-19

The coronavirus disease-2019 (COVID-19) pandemic has unsettled conventional medical education, hastening a switch to digital platforms and open-access publishing. Rheumatology is a fast evolving academic discipline that stands to gain by this switch. Most rheumatology textbooks are now available in digital formats, and these are complemented with live updating educational hubs such as UpToDate and ClinicalKey. Emerging topics of COVID-19 on these proprietary platforms are now freely available to all specialists. Social media channels, particularly Twitter, are becoming major players in the era of COVID-19 by offering online journal clubs, enabling fast dissemination of influential articles, and facilitating interactive education. Indexed rheumatology journals, in turn, aid online education by opening access to recommendations and other materials that are rapidly changing research and practice worldwide. Research peer review additionally offers learning experience to novice and seasoned researchers and authors. Global rheumatology societies have online learning resources, which are changing their format and geographic reach to meet the changing needs in the times of pandemic. While online teaching lacks emotional connections between mentors and mentees, switch to a more interactive format of education and regular contacts may partly solve the issue. Rheumatologists can take the lead in these challenging times and contribute more to online scholarly activities which are aimed to maintain and enrich education. Key Points • Disparities in rheumatology education are likely to be widened during the COVID-19 pandemic. • Barriers to rheumatology education include limited number of instructors and their limited experience in online teaching. • Online textbooks, didactic materials of indexed rheumatology journals, and frequently updated online educational hubs such as UpToDate serve as a foundation of online rheumatology education. • Online rheumatology education is enriched by peer review and social media activities, which are becoming major players in the time of the COVID-19 pandemic.

Use of Semiprivate Smartphone Communication Applications in Nephrology Education

Advances in information technology have changed human interactions. These changes have had considerable implications for nonmedical and medical educational practices. The use of semi-private applications such as WhatsApp (Mountain View, CA), Slack (Canada), Viber (Israel), and Google Hangouts (Mountain View, CA) has not been well studied in nephrology education. In this narrative review, we review the literature on the use of these communication applications in medicine and nephrology education. Although many of these applications might be used currently in nephrology, there is little published data regarding the use of WhatsApp in nephrology fellowship. Given the easy accessibility of these communication applications by our learners in medical school, residency, and fellowship, the use of such applications can enhance nephrology education.