Analysis of Factors Associated with Increased Hematology/Oncology Fellowship Twitter Account Followership
Authors: Muthiah Chandrasekar , Haider Shabi , Wei Chapman , Carlson Karen-Sue 
Published: December 2023

Background:Twitter has proven to be a powerful tool in medical education by providing a conduit for disseminating research, educating medical trainees, and facilitating discourse between physicians. With training programs transitioning to virtual interviews since the COVID-19 pandemic, programs' social media accounts have also become useful for interaction between applicants and programs and have been shown to influence applicant perceptions of programs (Kapsetaki et al., Interact J Med Res 2023; Schweitzer et al., J AM Osteopath Assoc. 2012). Given Twitter's importance and potential for hematology/oncology fellowship programs, we aimed to analyze its utilization among programs and characterize what attributes increase follower count, an important marker of a profile's influence (Bakshy et al., Association for Computing Machinery 2011).
Methods: All data was collected between July 1st and July 19th, 2023. We identified adult hematology/oncology fellowship programs in the United States using the Electronic Residency Application Service and searched for Twitter profiles for each program. We then analyzed each profile for number of educational, departmental, academic, and social posts. Program demographics, including program size and community or academic status, were obtained from FREIDA. NCI, NCCN, and US News Ranking status were obtained from the respective websites. Analysis included Spearman correlation, ANOVA, and Chi-Square testing.
Results: Of the 180 hematology/oncology fellowship programs identified, 44 (24%) had Twitter accounts. Of these programs, 27 (61.4%) were university-based, 2 (4.5%) were community-based, 1 (2.3%) was community/university based, while 14 (31.8%) were categorized as “other”. NCCN status (p&lt;0.05) was associated with larger Twitter following. Of the Twitter accounts, 39 (88.6%) were deemed to be active, defined as having tweeted since July 1 st, 2022. More Twitter posts (R 2 = 0.49, p&lt;0.001) was associated with higher number of total followers. Amongst post type, more departmental (R 2 = 0.41, p&lt;0.001), academic (R 2 = 0.46, p&lt;0.001), and “Other” (R 2 = 0.35, p&lt;0.001) posts not meeting criteria of the other subsets, were correlated with increased Twitter followers. Increased number of profiles followed by the fellowship program's account (R 2 = 0.2, p&lt;0.05) and increased social posts (R 2 = 0.1, p&lt;0.05) had weak positive associations with Twitter following. Number of fellows per program did not have an association with number of Twitter followers.
Conclusions: In our study, NCCN status and larger tweet volume, specifically about academic and departmental topics, were more strongly associated with increased Twitter following. Higher tweet number offers more opportunity for retweets and commenting from followers, thereby increasing visibility. From a follower's perspective, more frequent posting likely increases the value of the Twitter page as one that is truly providing real time program updates. Highlighting academic accomplishments and achievements of the department's faculty and house staff could be attracting applicants and medical professionals by offering insight into the quality of academic output, staff, and training at the program. Programs with NCCN status could be drawing followers through associated prestige but also tend to be larger programs that are more likely to have the resources to update and develop accounts.
A similar study conducted in pulmonary/critical care fellowships (Gandotra et al., ATS 2021) also showed higher follower count with larger post volume. They noted that social and clinical tweets attracted more followers, but the study utilized differing post classification definitions from our study. An investigation in psychiatry residencies using the same definitions for classifying posts, but instead evaluating Instagram (Bernstein et al., Academic Psychiatry 2021) yielded similar results to ours.
Our data also shows that most hematology/oncology fellowships do not have Twitter profiles. With the growing importance of social media, this offers a clear opportunity for furthering engagement with the medical community and potential fellows. Posting regularly, and about academic and departmental topics, could help maximize the Twitter profile's influence, while also providing fellowship applicants with useful information in the virtual era.