The Times They Are A-Changin’: Academia, Social Media and the JGIM Twitter Journal Club

Journal clubs have long been a core component of medical education. Initially the purpose of the journal club was to update participants about key medical advances. As the medical literature expanded, journal clubs evolved into forums for discussion of advances in focused medical topics and activities to teach critical appraisal and evidence-based medicine.1 Low attendance and poor participation at face-to-face journal clubs led to experimentation with online synchronous or asynchronous journal clubs to overcome geographic and temporal barriers. We are now in the era of Web 2.0 where social media and smart mobile devices have introduced physicians to the usefulness and usability of social networking sites like Facebook. These sites are attractive to academia as they enable easy sharing of ideas, opinions, multimedia resources and references. They allow users to find and connect with other like-minded users and thus build professional learning networks. This exposure has stimulated medical academicians to experiment with social media, e.g., using Twitter at medical conferences, holding Google Hangout panel discussions for continuing medical education, and building professional online communities like GIM Connect for the Society of General Internal Medicine (SGIM). Twitter is a popular online social network that is based on microblogging or “Tweets” to share news, resources and opinions. The use of hashtags and lists allows users to filter content and find others with common interests. Drawn by these features, several medical groups and societies are utilizing Twitter to conduct journal clubs.2,3 Twitter makes it possible to directly connect journal readers at various stages of training with authors and editors; the medium can also involve patients and experts from multiple disciplines. JGIM has begun to explore this medium by launching a new Twitter journal club, bringing readers, editors, and authors together in a real-time online discussion of a recently published JGIM paper. The first JGIM Twitter journal club took place on 5 June 2014 with discussion of a recent paper on the impact of displaying the cost of laboratory tests on primary care physicians’ test ordering behavior.4 It was organized as a Twitter chat session using the #meded hashtag to bring together a worldwide community of Twitter users interested in medication education. Tabor Flickinger, MD (@TaborF) served as moderator. The event was promoted through announcements on Twitter, jgim.org, GIM Connect and SGIM eNews. These announcements linked to the article abstract and included guiding questions that were used by the moderator to frame the journal club discussion. The June 5 journal club was lively, with 367 tweets from 78 participants, with an average of 4.7 tweets per/participant (range 1–37) during the hour.5 Participants included medical educators, clerkship and residency program directors, clinicians, and medical trainees. With the article’s findings as a starting point, the discussion expanded to explore issues of healthcare costs in medical education. It culminated with the sharing of informal teaching and learning experiences and formal curricula at a variety of institutions regarding cost and high-value care. Contributions from the JGIM editors and article authors added an expert perspective to the discussion and stimulated thoughtful debate. In reflecting on the experience, one of the authors, Dr. Horn commented: “It was great to see physicians from across the country converge to passionately discuss cost transparency in healthcare. Holding the journal club via Twitter allowed for a low barrier to entry for potential participants to join in the conversation.” Twitter offers several advantages over traditional in-person journal clubs by bringing together participants with diverse experiences and perspectives, bridging geographic barriers, and promoting the dissemination of timely research and innovations in teaching and practice. Twitter journal clubs can allow researchers to directly connect with not just their readers, but also patients. An interesting feature of Twitter is the use of various metrics like the number of times a post gets shared (retweeted) or marked as favorite, and which topics (hashtags) become popular at a particular time. These features allow not only for crowd-sourcing the identification of popular information, but can also be a key factor determining popularity. There are several challenges to conducting Twitter journal clubs. The diversity of the audience and the 140 character limits for posts make it more conducive to informal exchange of ideas and opinions than in-depth discussion of study methods or statistical analysis. It is important to choose an appropriate hashtag for the event. Using a common hashtag can reach a broad audience, but it can also bring tweets into the chat from other Twitter users who are not actually part of the discussion. Twitter users noticing increased activity around a particular hashtag may join an online journal club spontaneously and may not have had the chance to read the article carefully beforehand. This issue can be addressed by using a targeted hashtag, announcing the article in advance through channels familiar to the chat’s intended audience, and by inviting discussion of the article’s broader implications, which can draw from participants’ own knowledge. Researchers and journals have a responsibility to disseminate advances in scientific knowledge. They need to learn to leverage the power of social networks to this purpose. Some journals already request authors to include their Twitter handles as part of their biographies, while others request authors to submit a question that can be posted on Twitter when their article is published. Twitter journal club offers an exciting new means to support JGIM’s broad mission of disseminating “practice-based evidence for evidence-based practice” by engaging the journal’s current and future readership in discussion of relevant research and innovations. This experiment is part of the journal’s larger web and social media strategy to use innovative methods to develop a stronger community of readers within and outside of SGIM.