Tuesday, 24 July 2012

Why does a twittering doctor tweet?- note from ASME 2012

"My very first tweet was made in May 2008.

 I was invited to join Twitter by a friend who works in IT. It just happens that at the time I was still at work thinking about a teaching session so my first tweet has quite a strong medical education flavour. Like many people I wasn't sure what to actually make of Twitter after this and I left it for several months until I went to two medical education conferences and decided that social media could serve a purpose for me.

 But I'm not a techno-evangelist. I believe we have to be very careful about how we use technology and to consider how it impacts on relationships. If you google web 2 (a term for newer social technologies including social media) sceptic then the top result is actually about me, because I have disputed with other doctors in the past that these technologies are having any impact on our clinical practice. And I am still uncertain about this. However I am certain, and have decided that I can allow myself to be evangelical, about the benefits that can be had for anyone who is at this conference and is therefore interested in improving medical education. I started becoming aware of this a short while after starting my own blog in October 2008 which is why in 2009 I gave a presentation at ASME about how social media and networks could develop and support scholarship in medical education. However, this did not lead to the expected paradigm shift in scholarly communication. So I have decided that I might need to be a little more direct with you this time. And this is why I am going to give you 10 reasons why you should be on Twitter now.

10 reasons anyone interested in medical education should be using Twitter 1. To connect

The first is my own initial reason- to develop a network with other researchers, educators and practitioners. This works and it can happen.

2. To engage

The second reason is something I didn't expect. Beyond simple connection you can have meaningful engagement with those whose voices you might not usually hear- students, junior doctors and patients, or the wider public. For me this has been tremendously powerful.

3. To inform

Third, is to inform. I'll use as an example the hashtag of this conference #asme2012. In the past few days more than 1000 tweets have been made by more than 100 participants and reached thousands of people who are mainly not at this conference. But what does that mean? Well, it means that ASME has a higher profile in the global education community. If your mission is to spread the word, then you should be using Twitter.

4. To reflect

Fourth, is to reflect. To illustrate this I've chosen a tweet by a doctor in the US raising the topic of the fall in empathy levels of medical students during the medical course.
 It’s something that we often hear discussed at conferences. I decided to share, or retweet his thoughts, and to ask our UK medical students what their experience was of this phenomenon. I don't have time to show you all the responses (storified here) , but believe me that there was a rich discussion on what was wrong and what we might do better. So if you want to consider how you could make your practice better you could be helped by being on Twitter.

5. To share

The fifth reason is to share things that are important and meaningful to you. To do this best you need a space where you can write more than 140 characters and I would recommend that to get the most out of Twitter you also start a blog. But don't worry if you want to just stick to Twitter for now. In Twitter you can easily share links to content that is online; be that a research paper, or a blog post about your research or someone else's research or just a story that you think needs to be told. But remember you have no editor here. You have to be your own self-censor, but it doesn't matter if you make the odd mistake. Don’t let this fear stop you saying anything at all. The community is forgiving.

6. To be challenged

 But sixth, when you share your thoughts and ideas don't expect everyone to agree with you. Sometimes it is said that people online talk to those who are just like themselves. It can seem as if we are indeed sheep, so much that I have added to my twitter biography that I am determined NOT to be one of the sheep. Near the end of ASME 2011, Professor Trudie Roberts even warned against the ‘filter bubble’. But just as here at this conference we are prepared to defend our point of view, be prepared to be challenged about what you think online. This is a good thing. Don't be surprised if it happens. Enjoy and relish it.

7. To be supported

 But also expect support from your colleagues. My seventh point is illustrated by the development of a list of women healthcare academics by Prof Trisha Greenhalgh. She is someone who I really hoped would join Twitter after she attended AMEE last year, and then she did. If you want to see how a productive academic can get a lot out of Twitter then follow her. This list was started because we were aware that often women are less visible online. It started as a list of 50 but very quickly rose to more than 100 and is still growing. 

8. To lead

Trisha Greenhalgh was exhibiting leadership and if you are interested in leading your community you should be on Twitter. This is my colleague Natalie Lafferty from Dundee who many of you might know. Last year we held a series of discussions on Thursday nights called #meded chat. We picked the topic in discussion with our community and supported the chats with blog posts which helped pull together the learning. One week we discussed how students and trainees felt about the use of the portfolios to assess competency. We knew that this could be an explosive topic and it was. In advance of the discussion 25 people commented on a blog post with detailed descriptions of their own experience of the use of portolios. Many more participated in the chat. A year later a junior doctor has started a blog NHS eportfolio revolution which is bringing the voices of trainees directly to the AoRMC. If you are involved or want to be involved in the development of policy and you want to connect with your community then one way that you can lead is by being on Twitter.

9. To learn

Getting near the end, my 9th point is that you will learn. When you have worked at developing a network, you will have the benefit of other people curating the best of comment, news and research and directing it towards you. Priceless! 

10. To inspire

And lastly, you can inspire others. Do you know this amazingly busy, and productive man? 
Atul Gawande Video Shoot
Image: Atul Gawande Video Shoot by stevegarfield

It's Atul Gawande- surgeon, author and researcher. The eloquent Atul Gawande can teach you about how to use Twitter. Last year, I spotted this tweet one Sunday afternoon.
 Two minutes later I had made my reply to him.
 I invited him to participate in a discussion of his paper in the Twitter Journal Club, a twice monthly discussion of a paper on Twitter, started by a medical student, Fi Douglas, and Natalie Silvey, a junior doctor. This was too good an opportunity to miss. What do you think happened? Well- the discussion started and there was no sign of Atul Gawande. People were making some of the usual complaints about the original surgical checklist paper. It didn't apply to the developed world etc etc. But then he joined in. He started commenting on the discussion. And if you have any doubt about how 140 characters can be used to communicate anything useful watch and learn from this master.
What was the reaction? People were thrilled and informed. Atul Gawande was on vacation with his family but he was able to share his expertise with students and others who asked him questions about his work. He was inspiring. Do you want to inspire others? So this is only a short 10 minute race through how you might be able to contribute through Twitter to the development of the medical education community. Every voice is legitimate from students, to professors. So now I will take questions, but my question to you is what is stopping you from joining this conversation? "

Follow up:
some good introductory blogposts :


  1. Well articulated, Anne Marie. Twitter is a great place for medical professionals (and patients) to gather to listen and learn. The community is richer for your participation. :)

    1. Thank you- you've always been a great support.

  2. Thanks for sharing this. Of course I see a lot of overlaps with other professions but particularly love your list. I'd say that you have definitely been an inspiration to me and I have and do learn a lot so thanks again :) I love that we can find these new ways to communicate and connect in ways that were not as easy previously.

    1. It's all about the network. I was using examples here to make people interested in medical education see why Twitter is relevant to them, but the same reasons could just as easily apply with different examples to other professions. I mentioned connecting to social workers in my talk! I really do believe that once we can convince more people involved in teaching to explore these networks then we can really lead our students to some very exciting educational experiences.

    2. I agree - Twitter has amazing potential as a portable social network, or (imagined?) community. In this way I think it can give people the support they need to be creative, stand out, ask questions, change and ultimately learn. I think we should recommend it as an intervention for struggling students/practitioners/academics! It certainly helped me. Seeing how others traverse the many worlds they are part of is inspiring, not least because they prove it can be done :)

    3. Anne Marie, This is great list. Can I add a couple of others that I think you model well. 1) building community takes time and patience and a consistent approach. I am always impressed at your ability to express a view point. 2) having a clear voice with clear intent. I hope the meded and medical profession value your contribution and demonstrate how the art of being a doctor is about being human and professional. Thank you for posting and I agree with all the other points.

    4. Thanks Suzanne. I'm intrigued by your suggestion that it may be an intervention to support those who are struggling (rather than excelling) - it would be great to hear more about how you have come to that conclusion. But you could be right!

      And Mike, that is very kind. I suppose my aim was to motivate people to explore rather than to tell them how to do it. Fear of it being a time sink is a big issue. I actually mention that in my next post:) Thanks again.

  3. Thanks Anne Marie, I Think most of the reasons for using twitter are include in your post. As a Medicine Professor I will include to educate and of course to learn (Learn its included) . The use of web 2.0 tools can be disruptive in Medical Education. We can think now about a traditional way of teaching a a whole new one that needs experience and assessment . I find twitter really helpful to be concise, concrete and learn how to get key messages also. This its a link to our actually very empiric experience using social media as a learning tool. Its in spanish but i am sure anybody on twitter knows what I am talking about. Like your blog a lot because don't wanna be a sheep also and I learn and enjoy your ¨disruptive¨ thinking. the link its in https://plus.google.com/u/0/101424083178730091027/posts/d1K95tnigqD

  4. Great article! We should also talk about social media and reputation management for doctors/hospitals.

    One of the things I keep telling doctors during conferences and workshops is to Google their names first before going on Twitter/Facebook or planning on establishing a digital presence.

    Why? Because many have such poor reputations and bad reviews that it's almost always asking for trouble. For the doctors that take social media to heart and take their reputations seriously you can check out my last 12 case studies on how profitable their practices/hospitals have become: http://www.healthcaremarketingcoe.com/

  5. A benchmark post. Well done :)

  6. thanks for sharing.


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