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Viewpoint
March 18, 2020

Twitter Journal Clubs: Medical Education in the Era of Social Media

Author Affiliations
  • 1Department of Dermatology, Stanford University, Palo Alto, California
  • 2Division of Dermatology, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin
JAMA Dermatol. Published online March 18, 2020. doi:10.1001/jamadermatol.2020.0315

Twitter, a microblogging platform founded in 2006, reported 321 million active monthly users by the end of 2018.1 Physicians use Twitter to interact and in the process have created Twitter-based journal clubs, a virtual incarnation of traditional in-person journal clubs.2 Twitter journal clubs create opportunities for learning and community building, which can be powerful for small specialties such as dermatology. In this Viewpoint, we discuss how Twitter journal clubs offer a unique platform for connecting dermatologists and provide advantages beyond the traditional journal club.

Journal clubs allow physicians and trainees to practice critical thinking, to keep up with the biomedical literature and to evaluate clinical practice based on new knowledge.3,4 Through these interactions, journal clubs also foster collegiality by providing a venue for academics to converse beyond the clinic.3

Social media, particularly Twitter, provides a unique platform for medical journal clubs. As of 2015, there were at least 24 medical journal clubs covering a range of medical specialties; none focused on medical dermatology, to our knowledge.2 During a Twitter journal club, participants discuss a selected research article virtually using Twitter, often meeting at a set day and time. Twitter journal clubs have at least 5 distinct advantages compared with traditional journal clubs.

First, Twitter journal clubs might allow for a more comprehensive solicitation of pertinent articles in the current literature. Articles and topics are often selected based on suggestions from the large and diverse community of participants, including dermatologists and other specialists. These crowd-sourced articles and topics better represent interests of the broader community.

Second, Twitter journal clubs may facilitate larger and more diverse conversations. Participants are not limited by geographical location. Trainees, academic attendings, community attendings, nurse practitioners, and patients from across the globe can easily communicate about an article of interest. The inclusion of the patient perspective can provide a richer clinical context and is a unique feature because few traditional journal clubs include patients. The virtual format of Twitter journal clubs also allows study authors to participate, providing engagement that would be difficult outside of a conference or invited seminar. This dialogue is valuable to journal club participants, who gain insight into the authors’ thought processes, and to the authors, who receive feedback on their work. Finally, because of the global reach of Twitter journal clubs, clinical and methodological content experts can share their knowledge with those beyond their institution.

Third, for a small specialty like dermatology, Twitter journal clubs can promote the field of dermatology to a wider audience in a quantifiable way. By measuring participation and reach of the journal club, we can gain insight into which topics generate academic interest. On Twitter, influence is measured through impressions, which are the number of times a tweet is seen by users. Twitter journal clubs can generate high levels of impressions, leading to increased visibility for small fields in medicine. One of the largest Twitter journal clubs, #nephjc (a nephrology-based Twitter journal club), had 2500 unique users participating from 2014 to 2016.2,3 The first dermatology-related Twitter journal club was #dermpathJC, founded in March 2017 with topics related to dermatopathology.5 From July 2018 to October 2017, #dermpathjc had 189 unique participants and generated a total of more than 7 million impressions. Engagement with journal articles on Twitter has been linked to increased Altmetric scores (a bibliometric measure of article impact) and to increased citations in some cases.6

Fourth, Twitter journal clubs create a public record of the intellectual discussion, which can be added to and referenced in the future. Although Twitter journal clubs meet at a prespecified date and time, comments often continue beyond the set meeting time because the conversation is always accessible via searchable hashtags. Prior participants, including the article authors, have returned to Twitter to reflect on using knowledge from a Twitter journal club in the clinical setting. This accessible, permanent record is a unique feature of Twitter journal clubs compared with traditional journal clubs.

Fifth, Twitter journal clubs allow cross-specialty discussions. In the clinic or hospital, dermatologists often cotreat patients with other specialists or primary care physicians. Because Twitter journal clubs are open to anyone on the platform, medical professionals from across specialties can comment or ask questions about the topic of discussion. Compared with traditional journal clubs, Twitter journal club conversations are not limited by time and space, so interactions between specialties can occur more readily and do not require advanced coordination, just access to the free Twitter website or application on a smartphone or laptop.

In April 2018, the first medical dermatology Twitter journal club, @DermatologyJC (using #dermjc) was created. Each #dermjc journal club meeting is advertised by posting on Twitter ahead of time and relies on the Twitter community to spread the word through retweets and engagement with the hashtag. The monthly meeting has featured topics ranging from Stevens-Johnson syndrome to psoriasis. Participants can pose questions based on their reading of the monthly article, and the subsequent conversation often includes debate about the validity of the methods and the applicability of the research findings. Notably, cross-specialty Twitter journal clubs have allowed interdisciplinary conversations. In November 2018, the joint #dermjc and #nephjc discussed the article, “Sirolimus for Secondary Prevention of Skin Cancer in Kidney Transplant Recipients: 5-Year Results.”7 Discussion points with nephrologists included the importance of dermatologists in screening for and managing skin cancers in kidney transplant patients. In May 2019, a joint journal club between #rheumjc (rheumatology) and #dermjc discussed the article, “Evidence Supports Blind Screening For Internal Malignancy in Dermatomyositis: Data From 2 Large US Dermatology Cohorts.”8 Dermatologists and rheumatologists discussed how multispecialty teamwork aids in the diagnosis of dermatomyositis and the role of malignancy screening in patients with dermatomyositis.

While Twitter journal clubs provide several advantages over the traditional journal club format, pitfalls exist as well. The large number of participants can detract from the feelings of collegiality at smaller, in-person journal clubs. Additionally, in a Twitter journal club, participants may feel timid about asking clarifying questions on a public forum, and disagreements are publicly recorded. Because Twitter journal clubs are relatively new, they have not been as extensively studied as traditional journal clubs. A systematic analysis of traditional journal clubs supported their value but found little data to support the most effective format for providing educational benefit.4 Likewise, we do not have data on the best format or frequency for knowledge acquisition in Twitter journal clubs.4,9 Assessments of the efficacy of Twitter journal clubs have been mostly confined to survey results from participants rather than prospective trails comparing outcomes. For example, a survey of 282 participants in the #urojc (the urology journal club) revealed that 81% of participants found the Twitter journal club useful for sharing evidence-based medicine, and 39% reported changing their practice based on the discussion in #urojc.9 These findings may be why Twitter journal clubs have flourished despite some drawbacks.

Almost 140 years ago, the first journal club was held in North America by Sir William Osler; now specialty-specific Twitter journal clubs with global reach are held on a regular basis. In the future, Twitter journal clubs may even be a source of continuing medical education credit when coupled with self-evaluation or reflection.10 Dermatologists and trainees should consider joining Twitter to participate in Twitter journal clubs and to contribute to their growth and evolution. This new venue of communication is a powerful means of connecting within and across specialties while also bolstering the profile of dermatology within the house of medicine and the public at large.

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Article Information

Corresponding Author: Roxana Daneshjou, MD, PhD, Department of Dermatology, Stanford University, 450 Broadway, Pavilion C, Redwood City, CA 94063 (roxanad@stanford.edu).

Published Online: March 18, 2020. doi:10.1001/jamadermatol.2020.0315

Conflict of Interest Disclosures: Dr Daneshjou reports personal fees from Enspectra Health outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank Allison Larson, MD (Boston University School of Medicine), and Silvija Gottesman, MD (Northwell health), for their help in starting #dermJC. Compensation was not received.

References
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Gottesman  SP, Klein  WM, Hosler  GA, Veprauskas  KR, Rush  PS, Gardner  JM.  #dermpathJC: The first online dermatopathology Twitter journal club.  J Cutan Pathol. 2018;45(5):370-373. doi:10.1111/cup.13110PubMedGoogle ScholarCrossref
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    1 Comment for this article
    EXPAND ALL
    Twitter Journal Clubs, Transparency And Patient Involvement
    Peter Shah, BSc MA FRCOphth FRCP Edin | University Hospitals Birmingham NHS Foundation Trust
    Daneshjou and Adamson eloquently articulate the power of social media in relation to the concept of Twitter Journal Clubs (TJCs). I would like to offer one thought and one challenge:

    [1] Thought - As clinicians we would be able to record our participation in these TJCs and demonstrate inclusivity and diversity. Participation could be linked to Continuing Professional Development.

    [2] Challenge - In an era when ethics and transparency are rightly valued, is it possible to extend our knowledge forums to include those we are most trying to help - our patients? Could our deliberations on scientific knowledge
    become more 'open-source'?
    CONFLICT OF INTEREST: None Reported
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