In just two years, Twitter use among members of the College has increased dramatically. At the time of the 2010 Clinical Congress in Washington, DC, the American College of Surgeons (ACS) Twitter account, @AmCollSurgeons, had 907 followers, and a modest number of attendees tweeted about their experience or engaged with the College via Twitter. In fact, only 231 tweets included the conference hashtag #ACSCC10. In contrast, at the 2012 Clinical Congress in Chicago, IL, the ACS Twitter account featured 6,800 followers who engaged with the College, with more than 1,881 tweets including the conference hashtag #ACSCC12, representing an 800 percent increase in use from 2010. Through the conference hashtag, Twitter users around the globe were able to follow session presentations, announcements, and contribute to the Clinical Congress without traveling and on their own schedule.
Social media introduced at 2010 Clinical Congress
In 2010, Philip Glick, MD, FACS (@glicklab), moderated a general session titled To Tweet or Become Extinct: Why Surgeons Need to Understand Social Networking. More than 500 surgeons attended the panel discussion, during which speakers encouraged ACS members to embrace social media as a useful tool for networking, continuing education, and professional development. Twitter, in particular, was extolled for its time efficiency, low cost, and lack of geographical boundaries.
Among the 500 surgeons, residents, and other session attendees was Benedict C. Nwomeh, MB, BS, FACS (@bnwomeh), who, like many surgeons, had never used Twitter prior to that session. At one point during the presentation, Dr. Glick asked everyone to visit Twitter on their mobile devices. Impressed by the panel and inspired by the possibilities and potential impact of Twitter, Dr. Nwomeh reached for his phone and logged in. In an e-mail to Dr. Logghe (co-author of this article) in December 2012, Dr. Nwomeh recalled the moment, “Right there, I sent my first. It was that easy. I became Tweetborn, at the ACS Congress!”
As a follow-up to the session, the July 2011 issue of the Bulletin of the American College of Surgeons featured an article titled Using Social Media to Enhance Surgeon and Patient Education and Communication. The article expanded on the information presented at the 2010 Clinical Congress panel discussion and provided further details on how surgeons can responsibly engage in social media for professional and education purposes.* According to that article, a survey by the Pew Internet and American Life Project reported that nearly 60 percent of Americans conduct online searches for health care information, suggesting an opportunity for surgeons to use these online tools to educate and empower their patients through a better understanding of their illnesses and treatment options.
A growing force
Since its inception in 2006, Twitter has experienced rapid growth worldwide. In February of 2010, Twitter users sent 50 million tweets per day, and by March 21, 2012, six years after Twitter was launched, the social networking platform reported users sending 340 million tweets daily. The increased use of Twitter among ACS members mirrors this trend.
The 2012 Clinical Congress marked the first time that the ACS created a designated information booth where members could learn more about social media and how it can be used professionally to stay up-to-date on the latest news and events in the field of surgery. A second, new addition to the College’s social media presence at the meeting was the designation of four ACS Twitter correspondents who were recruited to tweet about their experiences at the Clinical Congress and to encourage retweets and engagement. This year correspondents, in addition to Dr. Nwomeh and Dr. Glick, included Niraj J. Gusani, MD, FACS (@NirajGusani) assistant professor of surgery and public health sciences at Penn State, and Dr. Logghe (@LoggheMD) general surgery residency candidate and coauthor of this article (see photo).
To further encourage surgeon participation, bookmarks were placed in Congress registration packages to remind attendees of the College’s official hashtags—#ACSCC12 for the conference and #ACS100 for tweets related to the College’s history and Centennial celebration. In addition, the Clinical Congress smartphone app included a link that allowed users to follow what the ACS was tweeting during the event. Conference presenters and attendees tweeted announcements of upcoming presentations and room locations, as well as personal observations regarding upcoming sessions. Many attendees tweeted live quotes and comments during presentations, particularly about controversial and stimulating topics such as rural surgery, acute care surgery, bioinformatics, and energy use.
In addition to the designated ACS conference hashtag, the use of individual session numbers as hashtags enabled Twitter users to follow the tweets related to specific sessions in which they were interested. Many presenters found Twitter to be a useful means for providing background and supplemental information as well as for expanding the audience for their presentations. For example, some presenters used Twitter to share references and resources related to the content of their conference presentations. Others shared their presentations by posting their slides on SlideShare and tweeting the link.
During the 2012 Eisenberg Legacy Lecture, which took place at the University of California San Francisco, Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality, noted that Twitter can be an effective tool for communicating across multiple audiences, for training purposes, and to improve quality of care. Twitter is a useful strategy, according to Dr. Clancy’s comments during the meeting, to “globalize the evidence” and “localize the decisions” in health care.
The 2012 Clinical Congress also marked the second ACS panel session on surgeons and social media networking, which was again highly attended, with an audience of nearly 300. Expanding on the previous session in 2010, the 2012 panel session, titled Why Surgeons Need to Understand Social Networking, explored individual surgeon motivations for engaging in social networking, the meaningful use of social media by surgeons, social media’s role in medical education, and legal implications. Dr. Nwomeh prepared a series of tweets with quotes from the presenters’ slides, which were then live-tweeted during the presentations.
During the session, several surgeons were trained in how to tweet and, in fact, many of them sent their first tweets with the ACS hashtag during the session. Panelist Sani Yamout, MD, encouraged surgeons to use Twitter to establish their own “personal learning network” with surgeons who share both similar interests and a goal of organizing educational Web content. Specifically, he suggested that Twitter is useful for surgical education announcements, board preparation, and gathering and sharing resources. Indeed, Dr. Nwomeh has found that “Twitter makes it really easy to learn and share new ideas.” In the question/answer session, participants expressed interest in earning continuing medical education (CME) credits for their future participation and lifelong learning activities involving Twitter. Current programs do not offer CME credit through Twitter, although the College is exploring possible opportunities in this area.
Medicolegal issues and concerns
Henry Fader, Esq. (@PhillyFader) addressed medicolegal concerns of surgeons using social media. He emphasized that expectations of professional behavior are essentially the same on Twitter as they are in any public setting and thus, common sense, good judgment, and caution are prudent. Since the ramifications of unprofessional commentary are magnified by the public nature and electronic record of social media, he advised surgeons to assume that all tweets are public and will continue to exist forever.
Patient identifying information should never be posted on public forums such as Twitter, according to Mr. Fader and other session panelists, to ensure Health Insurance Portability and Accountability Act (HIPAA) compliance. Indeed, most physicians report using Twitter for educational and general public health purposes, not for individual patient-physician communications. To promote patient care coordination, HIPAA-compliant social networks are also available for physician-physician consultation and sharing of identifiable patient data. An issue that remains to be resolved is disclosure of conflict of interest in social media postings, which is particularly challenging on Twitter, given the imposed brevity and character limit.
What’s next for the ACS and Twitter?
A future vision for Twitter and the College was articulated by ACS social media manager Jerry Schwartz (co-author of this article): “Having established a social media presence, our next step is to become a more social organization so that staff members will think of social media as a powerful platform to promote the accomplishments and outreach efforts of the College.”
The rapid growth of Twitter use in 2012 signals the recognition by surgeons of the potential of the platform to improve the delivery of high quality care and to strengthen communication with colleagues. The College anticipates even greater use of Twitter at the next Clinical Congress in Washington, DC, this year.
*Yamout SZ, Glick ZA, Lind DS, Monson RAZ, Glick PL. Using social media to enhance surgeon and patient education and communication. Bull Am Coll Surg. 2011;96(7):7-15.