Opinion
VIEWPOINT
Ravinder S. Vohra, MD, PhD Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham, England. Michael T. Hallissey, MD Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham, England.
Social Networks, Social Media, and Innovating Surgical Education The way we communicate has changed over the past decade. For example, 40% of adults carry a smartphone, essentially a computer in the guise of a mobile phone in their pockets. However, only a quarter of their “smartphone time” is spent making phone calls. The rest is spent “surfing” the Internet and engaging in social networks.1 This, combined with social media platforms (SMPs), can revolutionize the field of surgery (in particular, surgical education).
Social Networks and SMPs Facebook, Twitter, and other social networks have demonstrated that sharing information is cheap and efficient and produces value. However, the critical technologies that these companies have developed are SMPs. These allow individuals to share information with their social networks despite their geographical location and regardless of whether users are in front of a computer, tablet, or mobile phone. Social media experts Peter Kollock and Marc A. Smith have postulated that the motivation for people to contribute to online communities does not come from a sense of altruism. Rather, individuals appear to have several other aims: they hope that the information they share will be rewarded with valuable information in return (anticipated reciprocity); they hope to gain increased recognition; or they hope to make a difference or gain a sense of community.2 Regardlessofthereasons,morethan1.5billionpeople are registered users of these networks, and 80% of online usersinteractwithsocialnetworksregularly.3 Usersreceive constant, updated, and personalized feeds of information selected by their friends, families, and colleagues, as well as targeted advertising. Because we put more weight on the opinions of the people we trust, the information from SMPs is more relevant and engaging than traditional websites.4 Such characteristics make these platforms and networks ideal for delivering surgical education.
Continued Medical Education in a Digital Age
Corresponding Author: Ravinder S. Vohra, MD, PhD, Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham B15 2TH, England (ravinder.vohra@uhb .nhs.uk). 192
Many surgical organizations, individual surgeons, and journals actively use SMPs to disseminate content to their audience of followers. However, an understanding of how to engage users is vital. The method seems intuitive, but some have realized this quicker than others. One example is the Schoolofsurgery.org. This notfor-profit surgical news channel uses SMPs to generate and deliver free continued medical education to surgeons around the globe. Within 3 years, the Schoolofsurgery.org has amassed more than 60 000 followers on Facebook and Twitter and, during this time, has had more than 10 million page views on Facebook alone. This has been accomplished by a group of surgical trainees in the United Kingdom
who identify popular or “trending” content within SMPs and direct followers to this through short, succinct headlines. In addition, they actively include other users with large social networks in posts (eg, surgical associations or charities). This increases the size of the network of people who see the content and engages other interested parties in open and active conversation. These conversations include the latest surgical research, surgery videos, and lectures. Clinical content is tailored for a general surgeon rather than for a specialist, and the content is carefully moderated by the editors and the editor in chief because ill-judged commentary may be liable to scrutiny by professional organizations. Furthermore, short headlines can be misleading and so need to be appropriately monitored, otherwise they can spread rapidly among social networks. The ability to search for content has been a major limitation of the current SMPs. This has been exploited to allow targeted advertising, which forms part of the revenue models for SMP companies. However, the advent of “hashtags” (#) to mark keywords, allowing SMPs to be searched, has completely changed how these technologies can be used. For example, every entry in Twitter and Facebook marked with “#surgery” can now be searched and viewed. In addition, such terms and such potentially high-quality surgical educational material within SMPs can also be discovered through generic search engines such as Google. Hashtags and SMPs are now considered vital by some in order to follow new findings and developments at international conferences in real time. With data freely available from Symplur (http://www.symplur .com), during the 4-day American College of Surgeons 2013 Clinical Congress in October, the “#ACSCC13” hashtag created more than 5 million impressions on Twitter alone from 3000 tweets. However, this was generated by only 500 users, despite nearly 20 times as many delegates. This disparity suggests either reluctance by many to share information within such platforms or simply the potential benefits of these hashtags and SMPs. The “Tweeters” are likely to be those attending the conference, but this provides an opportunity to engage thosewhoareunabletoattend,especiallythosefromlowand middle-income countries. Evidence from the Pew Research Center suggests that the use of SMPs and smartphones in low- and middle-income countries is growing more rapidly than in high-income countries.5 Limited access to resources means that the potential reliance on these and other free, online, open-access resources (including those in social networks) is likely to be more important than ever before. An example of how this may work in the future is being trialed at the Association of Surgeons of Great Britain and Ireland International Surgical
JAMA Surgery March 2015 Volume 150, Number 3 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a DALHOUSIE UNIVERSITY-DAL-11762 User on 05/18/2015
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Viewpoint Opinion
Congress this year. The organizers will stream sessions live across the web and are encouraging both attendees and nonattendees to join in debates using hashtags. Viewers will be charged a small fee, presumably because if these were completely free some may simply not attend. However, this clearly creates a tension while attracting a truly global audience. Hashtags are also enabling a new generation of SMPs that are akin to individualized newspapers. One example is Flipboard, which allows information to be obtained from across applications. The news feeds generated from hashtags and other users can be selected from social networks and are reformatted to give the appearance of a broadsheet newspaper on a smartphone. Such functionality, combined with the ability to share from within a single SMP, means that this type of platform is certainly more inviting to users. In addition, this allows the content in SMPs to be viewed by those who are reluctant to register with Facebook,Twitter,orothersocialnetworks.Ifusedeffectively,newand existing SMPs could gain traction similar to that seen by other free, higher educational programmes in surgical education.6
Benjamin Franklin
Despite our reliance on networking, evidence-based medicine, and a passion for novel technologies, surgeons are still lagging behind their contemporaries when it comes to fully utilizing social networks and SMPs. This in part may be related to the fact that the type of SMP that we as surgeons want currently does not exist. Platforms that offer a method for collaborative techniques in learning through discussion, clarification of ideas, feedback, and evaluation of other’s ideas would be ideal. In addition, content should be delivered to users in real time based on individual preferences and news that is viewed and shared by colleagues and peers. The current technologies are already involving and educating a generation of surgeons. However, to produce an important paradigm shift in surgery, novel SMPs should be explored to better understand how to engage users in the field of surgery.
2. Smith MA, Kollock P, et al. Communities in Cyberspace. London, England: Routledge; 1999.
ARTICLE INFORMATION Published Online: January 14, 2015. doi:10.1001/jamasurg.2014.1324. Conflict of Interest Disclosures: Dr Vohra is the founder of the Schoolofsurgery.org, a free, social media–driven, not-for-profit, surgical news channel. No other disclosures are reported. REFERENCES 1. Harvard Business Review Staff. How people really use mobile. Harvard Business Review. January 2013. https://hbr.org/2013/01/how-people-really-use -mobile. Accessed November 25, 2014.
jamasurgery.com
Tell me and I forget. Teach me and I remember. Involve me and I learn.
3. Chui M, Manyika J, Bughin J, et al. The Social Economy: Unlocking Value and Productivity Through Social Technologies. London, England: McKinsey Global Institute; 2012. 4. Edwards G, Amos M. Using social networks to improve operations. Harvard Business Review. December 2, 2011. https://hbr.org/cs/2011/12/using _social_networks_to_impro.html. Accessed January 14, 2014.
Center website. http://www.pewglobal.org/2012/12 /12/social-networking-popular-across-globe/. Published December 12, 2012. Accessed March 3, 2014. 6. Editors. Big data makes big inroads into schools. Scientific American. July 17, 2013. http://www .scientificamerican.com/article/big-data-make-big -inroads-into-schools/. Accessed November 25, 2014.
5. Pew Research Global Attitudes Project. Social networking popular across globe. Pew Research
(Reprinted) JAMA Surgery March 2015 Volume 150, Number 3
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a DALHOUSIE UNIVERSITY-DAL-11762 User on 05/18/2015
193
VIEWPOINT
Ravinder S. Vohra, MD, PhD Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham, England. Michael T. Hallissey, MD Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham, England.
Social Networks, Social Media, and Innovating Surgical Education The way we communicate has changed over the past decade. For example, 40% of adults carry a smartphone, essentially a computer in the guise of a mobile phone in their pockets. However, only a quarter of their “smartphone time” is spent making phone calls. The rest is spent “surfing” the Internet and engaging in social networks.1 This, combined with social media platforms (SMPs), can revolutionize the field of surgery (in particular, surgical education).
Social Networks and SMPs Facebook, Twitter, and other social networks have demonstrated that sharing information is cheap and efficient and produces value. However, the critical technologies that these companies have developed are SMPs. These allow individuals to share information with their social networks despite their geographical location and regardless of whether users are in front of a computer, tablet, or mobile phone. Social media experts Peter Kollock and Marc A. Smith have postulated that the motivation for people to contribute to online communities does not come from a sense of altruism. Rather, individuals appear to have several other aims: they hope that the information they share will be rewarded with valuable information in return (anticipated reciprocity); they hope to gain increased recognition; or they hope to make a difference or gain a sense of community.2 Regardlessofthereasons,morethan1.5billionpeople are registered users of these networks, and 80% of online usersinteractwithsocialnetworksregularly.3 Usersreceive constant, updated, and personalized feeds of information selected by their friends, families, and colleagues, as well as targeted advertising. Because we put more weight on the opinions of the people we trust, the information from SMPs is more relevant and engaging than traditional websites.4 Such characteristics make these platforms and networks ideal for delivering surgical education.
Continued Medical Education in a Digital Age
Corresponding Author: Ravinder S. Vohra, MD, PhD, Academic Department of Surgery, School of Cancer Sciences, Queen Elizabeth Hospital, Birmingham B15 2TH, England (ravinder.vohra@uhb .nhs.uk). 192
Many surgical organizations, individual surgeons, and journals actively use SMPs to disseminate content to their audience of followers. However, an understanding of how to engage users is vital. The method seems intuitive, but some have realized this quicker than others. One example is the Schoolofsurgery.org. This notfor-profit surgical news channel uses SMPs to generate and deliver free continued medical education to surgeons around the globe. Within 3 years, the Schoolofsurgery.org has amassed more than 60 000 followers on Facebook and Twitter and, during this time, has had more than 10 million page views on Facebook alone. This has been accomplished by a group of surgical trainees in the United Kingdom
who identify popular or “trending” content within SMPs and direct followers to this through short, succinct headlines. In addition, they actively include other users with large social networks in posts (eg, surgical associations or charities). This increases the size of the network of people who see the content and engages other interested parties in open and active conversation. These conversations include the latest surgical research, surgery videos, and lectures. Clinical content is tailored for a general surgeon rather than for a specialist, and the content is carefully moderated by the editors and the editor in chief because ill-judged commentary may be liable to scrutiny by professional organizations. Furthermore, short headlines can be misleading and so need to be appropriately monitored, otherwise they can spread rapidly among social networks. The ability to search for content has been a major limitation of the current SMPs. This has been exploited to allow targeted advertising, which forms part of the revenue models for SMP companies. However, the advent of “hashtags” (#) to mark keywords, allowing SMPs to be searched, has completely changed how these technologies can be used. For example, every entry in Twitter and Facebook marked with “#surgery” can now be searched and viewed. In addition, such terms and such potentially high-quality surgical educational material within SMPs can also be discovered through generic search engines such as Google. Hashtags and SMPs are now considered vital by some in order to follow new findings and developments at international conferences in real time. With data freely available from Symplur (http://www.symplur .com), during the 4-day American College of Surgeons 2013 Clinical Congress in October, the “#ACSCC13” hashtag created more than 5 million impressions on Twitter alone from 3000 tweets. However, this was generated by only 500 users, despite nearly 20 times as many delegates. This disparity suggests either reluctance by many to share information within such platforms or simply the potential benefits of these hashtags and SMPs. The “Tweeters” are likely to be those attending the conference, but this provides an opportunity to engage thosewhoareunabletoattend,especiallythosefromlowand middle-income countries. Evidence from the Pew Research Center suggests that the use of SMPs and smartphones in low- and middle-income countries is growing more rapidly than in high-income countries.5 Limited access to resources means that the potential reliance on these and other free, online, open-access resources (including those in social networks) is likely to be more important than ever before. An example of how this may work in the future is being trialed at the Association of Surgeons of Great Britain and Ireland International Surgical
JAMA Surgery March 2015 Volume 150, Number 3 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a DALHOUSIE UNIVERSITY-DAL-11762 User on 05/18/2015
jamasurgery.com
Viewpoint Opinion
Congress this year. The organizers will stream sessions live across the web and are encouraging both attendees and nonattendees to join in debates using hashtags. Viewers will be charged a small fee, presumably because if these were completely free some may simply not attend. However, this clearly creates a tension while attracting a truly global audience. Hashtags are also enabling a new generation of SMPs that are akin to individualized newspapers. One example is Flipboard, which allows information to be obtained from across applications. The news feeds generated from hashtags and other users can be selected from social networks and are reformatted to give the appearance of a broadsheet newspaper on a smartphone. Such functionality, combined with the ability to share from within a single SMP, means that this type of platform is certainly more inviting to users. In addition, this allows the content in SMPs to be viewed by those who are reluctant to register with Facebook,Twitter,orothersocialnetworks.Ifusedeffectively,newand existing SMPs could gain traction similar to that seen by other free, higher educational programmes in surgical education.6
Benjamin Franklin
Despite our reliance on networking, evidence-based medicine, and a passion for novel technologies, surgeons are still lagging behind their contemporaries when it comes to fully utilizing social networks and SMPs. This in part may be related to the fact that the type of SMP that we as surgeons want currently does not exist. Platforms that offer a method for collaborative techniques in learning through discussion, clarification of ideas, feedback, and evaluation of other’s ideas would be ideal. In addition, content should be delivered to users in real time based on individual preferences and news that is viewed and shared by colleagues and peers. The current technologies are already involving and educating a generation of surgeons. However, to produce an important paradigm shift in surgery, novel SMPs should be explored to better understand how to engage users in the field of surgery.
2. Smith MA, Kollock P, et al. Communities in Cyberspace. London, England: Routledge; 1999.
ARTICLE INFORMATION Published Online: January 14, 2015. doi:10.1001/jamasurg.2014.1324. Conflict of Interest Disclosures: Dr Vohra is the founder of the Schoolofsurgery.org, a free, social media–driven, not-for-profit, surgical news channel. No other disclosures are reported. REFERENCES 1. Harvard Business Review Staff. How people really use mobile. Harvard Business Review. January 2013. https://hbr.org/2013/01/how-people-really-use -mobile. Accessed November 25, 2014.
jamasurgery.com
Tell me and I forget. Teach me and I remember. Involve me and I learn.
3. Chui M, Manyika J, Bughin J, et al. The Social Economy: Unlocking Value and Productivity Through Social Technologies. London, England: McKinsey Global Institute; 2012. 4. Edwards G, Amos M. Using social networks to improve operations. Harvard Business Review. December 2, 2011. https://hbr.org/cs/2011/12/using _social_networks_to_impro.html. Accessed January 14, 2014.
Center website. http://www.pewglobal.org/2012/12 /12/social-networking-popular-across-globe/. Published December 12, 2012. Accessed March 3, 2014. 6. Editors. Big data makes big inroads into schools. Scientific American. July 17, 2013. http://www .scientificamerican.com/article/big-data-make-big -inroads-into-schools/. Accessed November 25, 2014.
5. Pew Research Global Attitudes Project. Social networking popular across globe. Pew Research
(Reprinted) JAMA Surgery March 2015 Volume 150, Number 3
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a DALHOUSIE UNIVERSITY-DAL-11762 User on 05/18/2015
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