Navigating social media: the <i>BJD</i> experience
Authors: J. Guckian, C. Cotter, M. Charalambides, N. Kibbi
Journal: British Journal of Dermatology (2021)

Social media (SoMe) has become a multipurpose tool for academic dermatology, with increasing popularity within medical journals. Prior to this, dermatologists, as individuals, recognized the power of SoMe and established Facebook pages, Instagram accounts and Twitter journal clubs.1 In 2012, journals were lagging behind, with fewer than 20% of dermatology journals active on Twitter.2 As of this year, the top five dermatology journals are all active on at least two SoMe platforms. Indeed, having an online presence appears to correlate positively with traditional journal metrics,3 as the diverse nature of platforms allows journals to inexpensively communicate research and interact directly with readers and authors. This has created the need for a BJD SoMe editorial team, whose responsibility is to disseminate journal content, encourage interactions with the journal, promote the brand and aid in generating content.4 The BJD recognizes the growth in this medium and has established a supportive culture for SoMe innovation, appointing a SoMe editor to head a team of editorial trainees with a passion for developing the journal’s platforms. Our vision is threefold – firstly, to serve as an online voice promoting BJD content and expanding our global readership; secondly, to engage with our followers through commenting and hosting live chats and thirdly, to share our editorial board and authors’ perspectives on cutting-edge issues. Our work aligns closely with the journal’s strategic aims of increasing BJD global brand awareness and enhancing reader engagement through online discussion. With over 7500 followers on Twitter, 9500 on Facebook and 4000 on Instagram (our newest platform), the BJD SoMe presence has successfully grown engagement in the last 6 months as compared with the previous 6 months by 26%, 94% and 110% on each platform, respectively. We are constantly sourcing new and interactive ways of engaging readers with BJD content. Navigating this new space as the BJD SoMe team, we have encountered opportunities and challenges related to informed consent, diversity and inclusion, and the spread of misinformation (‘fake news’). SoMe platforms are well-suited to the visual nature of dermatology, and the use of exemplar or striking patient images on these sites enhances clinical learning and engagement. However, such images bring about challenges related to gathering consent to a sufficient professional standard. In order to obtain informed consent, the contributor must ensure that adequate information surrounding the use of clinical information and photography is provided to the patient.5 This should encompass the intended audience, terms of privacy and acknowledgement that once online dissemination occurs, duplication and storage of the imagery will be unknown. Although a patient has the right to revoke consent, once an image is published online in a public forum, it can be downloaded and reused by any third party, making such a privilege futile. Patients should also be made aware that image sharing on SoMe is rarely for a single purpose. For example, while a journal may share an image primarily to inform or educate, there may be a dual function as marketing for the journal. As guardians of some of the most intrusive patient images, dermatologists and dermatology journals thus have a unique opportunity to set the bar for SoMe consent, thereby protecting patient autonomy. At the BJD, consent that is specific to SoMe is necessary for clinical images to be shared online. The migration of our specialty into the SoMe universe is also not without risk of bias. Navigating the space without broader context or strategy risks leaving large swathes of our community behind, especially as professional standards, learning styles and communication preferences can vary across generations and cultures. Moreover, SoMe is subject to trends which rise and fall, leaving the efforts of scientists and educators dependent on the popularity of large corporations, with implications for intellectual property, privacy and permanence of work.6 Conversely, SoMe presents opportunities to flatten traditional hierarchies and challenge the failings in diversity and inclusivity. Our own outreach efforts encourage trainees and experts of all levels to participate in the online conversation, our editor-in-chief has an active Twitter account (@BJDEditor) and our future SoMe efforts will consider expanding into parts of our global readership that remain underrepresented in our current efforts. Lastly, as healthcare professionals, an online presence brings with it a responsibility to identify and combat misinformation online. This was brought to light most vividly with the coronavirus disease 2019 (COVID-19) pandemic and the well-intentioned, albeit at times hastily executed, publication of low-quality research.7 Low-quality research papers spread rapidly on SoMe platforms, including articles claiming lack of effectiveness of face masks for preventing the spread of COVID-19 and the fallacy of nonsteroidal anti-inflammatory drugs or angiotensin-converting enzyme inhibitors in exacerbating COVID-19. Over 130 low-quality studies were published claiming the effectiveness of hydroxychloroquine, until more rigorous trials debunked such efficacy. Academic journals, being a part of the academic community, share a duty to promote evidence-based medicine through SoMe in order to disseminate clear and safe public health messages that are accessible to both healthcare professionals and patients. For instance, the BJD publishes ‘Plain Language Summaries’ of research papers (in English and Mandarin) and disseminates these on its SoMe platforms, particularly Facebook, where there is opportunity to engage with patient advocacy groups. In this way, patients are empowered to engage with evidence-based research, furthering shared decision making and allowing opportunities for patients to become experts in their own right, such as by engaging with patient advisory groups.8 The impact that this inclusivity has on steering research cannot be understated. The BJD is innovating in the complex and rapidly moving world of SoMe, aiming to improve accessibility across the spectrum of dermatology careers, in addition to reaching out to patients. In expanding our online presence, we have carefully tried to navigate the challenges of informed consent, diversity and inclusivity, and the spread of misinformation. With that in mind, we provide guidance that outlines ‘dos and don’ts’ for ensuring a positive online experience (Table 1). We recognize that new technologies and trends present problems that require rapid resolution and we are ready to engage in scholarly discourse with our readers and community to help find solutions. Become a part of this effort to future-proof our specialty by following @BrJDermatol on Twitter, @bjdermatology on Instagram and @brjdermatology on Facebook. Go ahead and join the BJD conversation! Jonathan Guckian: Conceptualization (lead); Writing-original draft (equal); Writing-review & editing (equal). Chantal Louise Cotter: Conceptualization (equal); Writing-original draft (equal); Writing-review & editing (equal). Maria Charalambides: Conceptualization (equal); Writing-original draft (equal); Writing-review & editing (equal). Nour Kibbi: Conceptualization (equal); Supervision (lead); Writing-original draft (equal); Writing-review & editing (equal). Powerpoint S1 Journal Club Slide Set. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.