Social media have been promoted within medicine as useful tools with seemingly endless benefits.1 , 2 They have been defined as “forms of electronic communication through which users create online communities to share information, ideas, personal messages, and other content (such as videos).”3 Twitter4 is one such social media platform. In short, it is a microblogging Internet-based service that allows users to publish Tweets (ie, brief posts) with a maximum length of 280 characters, in addition to attaching images, links, or videos.
Twitter use has also been promoted within medicine and specifically the field of anesthesia.5 , 6 Benefits of Twitter use in anesthesia may include its use as a tool for encouraging conversation, dissemination of information,6 promotion of journal articles,7 enhancing conference experiences,8 , 9 and improving journal club experiences.10
One of the barriers to social media use among academic physicians is the lack of familiarity with using the technology.11 To optimize the use of Twitter, it has been encouraged that prospective Twitter users should make the effort to learn the language of Twitter,12 including the use of appropriate hashtags.6 A hashtag is denoted by the # symbol appearing at the beginning of a word. It functions as a label that can be used to search for any posts including that hashtag. One can then join in relevant conversations with specific hashtags on discussion topics of interest or events such as conferences. There is, however, a lack of published guides within the field of anesthesia on the most useful hashtags. For this study, we sought to identify the most popular and relevant anesthesia hashtags and provide recommendations on common hashtags for anesthesiologists.
This study was exempted from ethics approval. Initially, we performed a general, inclusive hashtag search on Twitter for commonly used anesthesia-related hashtags between October 25, 2017 and December 3, 2017. This was performed by generating a list of anesthesia-related hashtags by the study investigators and through searches of Twitter posts using these hashtags, any additional hashtags observed within these searched tweets were also included in our search. We started with common hashtags such as #anesthesia, #anaesthesia, and #pedsanes. We then searched hashtag aggregators and registries such as Symplur (https://www.symplur.com/healthcare-hashtags), for those that were associated with anesthesia and anesthetics. We identified actively used hashtags as those that were included in at least 1 tweet within the search period. In the process, we also collected and recorded a list of nonused and rarely used anesthesia-related hashtags. For very rarely used hashtags, the most recent tweets in existence were confirmed by manual searching of Twitter directly. Conference-specific hashtags were not included in this study. Hashtags that were not related to anesthesia provided to humans were excluded. These included those posted related to animals or veterinary services.
To collect tweet data, we then used a variety of web-based hashtag-tracking services for our tweet data, which included Symplur (https://www.symplur.com/healthcare-hashtags), Union Metrics (https://unionmetrics.com), Keyhole (http://keyhole.co), Brand24 (https://brand24.com), and Talkwalker (https://www.talkwalker.com). Most of these services provide up to 30 days or less of historic data. To include all actively used hashtags, we searched registered anesthesia-related hashtags via Symplur to ensure that we were as inclusive as possible.
A Retweet is a repeat post of an existing tweet. A Reply is a response to another tweet. This helps to delineate the types of tweets generated because, although the total tweet count may be high, a high retweet percentage suggests relatively little original content. We collected data that included the total number of tweets, the number of retweets, the number of replies, the number of original tweets, and the number of different users tweeting with the hashtag. These data were obtained from the web-based tracking services, with Symplur and Union Metrics as our primary sources.
Data were collected on potential impressions and reach of the tweets over our search period. Potential impressions (as defined by Union Metrics) quantify the number of total timelines to which the tweets were delivered. Potential reach measures how many different individual Twitter accounts were reached by the tweets. Data for countries of origin of tweets were gathered and recorded.
All data were entered into an Excel spreadsheet (Microsoft, Redmond, WA). Data were analyzed using descriptive statistics within Excel.
The most frequently used hashtags pertaining to anesthesia topics were #anesthesia and #anaesthesia, with 1618 and 845 tweets, respectively (Table). Between these 2 hashtags, the #anesthesia hashtag had by far the greatest potential reach (2,187,495) and impressions (6,332,537), over 3 times that of #anaesthesia (reach 329,776; impressions 2,439,578). Within airway management, the most popular hashtag was #airway; however, this hashtag was also associated with many tweets from the airline industry. The next most popular airway-related hashtag was #intubation, with 219 tweets over a 30-day period, generating a potential reach of 195,977 and impressions of 387,475. Within the anesthesia subspecialties, the most popular hashtags were as follows: #pedsanes (pediatric anesthesia), #anesJC (journal clubs), #OBanes (obstetric anesthesia), #regionalanesthesia (regional anesthesia), and #neuroanesthesia (neuroanesthesia).
Regarding the activity of the hashtags, #anesthesia observed a lower retweet rate at 43.6% than #anaesthesia at 58.7%. Within the 10 most commonly used hashtags, the retweet rates varied between 37.9% and 73.5%. The hashtag with the broadest international reach was #anaesthesia, which spanned 14 countries with a minority (11.1%) originating from North America. In contrast, #anesthesia had a reach in 7 countries only. Most of the hashtags we searched were posted by North American users.
During the preliminary search for hashtags actively being used, we also made note of potential hashtags that were either not in use or very occasionally being used (Supplemental Table 1, http://links.lww.com/AACR/A209). In addition, we documented hashtags that seemed potentially relevant, but on searching found them to have nonspecific- or nonanesthesia-related uses (Supplemental Table 2, http://links.lww.com/AACR/A209).
Our study demonstrates that anesthesiologists are using a variety of hashtags. We have also identified the most popular anesthesia-related hashtags on Twitter. The use of common hashtags by anesthesiologists may encourage wider and deeper discussions reducing the current fragmentation occurring on social media.
For general anesthesia-related discussions, the most frequently used hashtags were #anesthesia and #anaesthesia. While the use of different spellings was not surprising, the presence of 2 hashtags created 2 separate conversations fragmented along North America and the rest of the English speaking world. Users who seek to engage all English speaking Twitter verse may need to include both #anesthesia and #anaesthesia hashtags for a global conversation. Within anesthesia subspecialties, the #pedsanes hashtag is very actively used; in obstetric anesthesia the #OBanes hashtag. The most frequently used hashtag within regional anesthesia was #regionalanesthesia. Neither cardiac anesthesia nor thoracic anesthesia hashtags appear to be used frequently on Twitter, with the most popular cardiac hashtag (#cardiacanesthesia) included in only 5 posts over 30 days. The shorter #cardiacanes was active but used with reference to The Carolina Hurricanes. Thoracic anesthesia-related tweets were not found in our search, so we would make the practical recommendation of #thoracicanesthesia. Our infographic proposes and recommends social media hashtags to guide anesthesiologists (Figure).
To our knowledge, this is the first study looking into the metrics of anesthesia-related hashtags and identification of the most popular, relevant hashtags. We base these recommendations on a combination of the most tweeted hashtags within each anesthesia subspecialty, as well as considerations for the most relevant and shortest hashtags.
Most of the hashtags we recommended appear to be generated by users from North America, with the exception of #anaesthesia, which is expectedly more popular with users from Europe. We hope that with our recommendations, more users globally will adopt them in their professional tweeting habits. Our work is the first attempt to organize a Twitter taxonomy for anesthesia. We did not search for popular hashtags such as #heforshe or #womeninmedicine because these include broader audiences beyond anesthesia and medicine. However, the combination of such hashtags or conference hashtags with anesthesia-related hashtags such as #pedsanes may widen the reach and conference-related conversations to a global pediatric anesthesia audience. The combination of the hashtags we recommend in combination with registered conference hashtags may also increase the reach of these anesthesia academic and research events.
Limitations of this study include the dependence mainly on a single search engine (Union Metrics) for our tweet data. Data were also compared with results from other search engines. Generally, these were consistent with searches through Symplur; however, Symplur will only perform searches for hashtags registered on their system. Other search engines we used did not provide 30-day data and only data for up to a week or 10 days at a time. Furthermore, we did not analyze the content of the hashtags and so cannot comment on the level of discourse in these tweets. Our data are also limited to the specific time period of 30 days during our search period. We chose to not include days with conference day tweeting as that may overinflate the use of Twitter during the conferences and not reflect regular or baseline usage. Prospective data collection over a longer period will be considered for long-term impact of our recommended hashtag guide.
Twitter can be a powerful tool for anesthesiologists who wish to join conversations with colleagues from around the world. The creation and adoption of standard hashtags for anesthesiologist may increase the reach and degree of discussions in anesthesia social media or Twitter verse.
Name: Nan Gai, MD, FRCPC.
Contribution: This author helped design and conduct the study, analyze the data, and write the manuscript.
Name: Clyde Matava, MBChB, DA, MMed.
Contribution: This author helped conceive, design, and conduct the study; analyze the data; and write the manuscript.
This manuscript was handled by: BobbieJean Sweitzer, MD, FACP.
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