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Twitter-Augmented Journal Club

Educational Engagement and Experience So Far

Udani, Ankeet D. MD, MSEd; Moyse, Daniel MD; Peery, Charles Andrew MD, PhD; Taekman, Jeffrey M. MD

doi: 10.1213/XAA.0000000000000255
Case Reports: Education

Social media is a nascent medical educational technology. The benefits of Twitter include (1) easy adoption; (2) access to experts, peers, and patients across the globe; (3) 24/7 connectivity; (4) creation of virtual, education-based communities using hashtags; and (5) crowdsourcing information using retweets. We report on a novel Twitter-augmented journal club for anesthesia residents: its design, implementation, and impact. Our inaugural anesthesia Twitter-augmented journal club succeeded in engaging the anesthesia community and increasing residents’ professional use of Twitter. Notably, our experience suggests that anesthesia residents are willing to use social media for their education.

From the Department of Anesthesiology, Duke University, Durham, North Carolina.

Accepted for publication July 13, 2015.

Funding: None.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the Duke Anesthesiology Annual Academic Evening.

Address correspondence to Ankeet D. Udani, MD, MSEd, Duke University, DUMC Box 3094, Durham, NC 27710. Address e-mail to

The majority of anesthesiology residents are of the Millennial generation (born after 1980) and considered digital natives, “native speakers of the language of computers.”1 The trend of technology-savvy students matriculating into anesthesiology training programs will continue.2 Medical educators need to learn, design, and implement teaching methods to optimize learning for their digital-native students.

Ninety-four percent of medical students and 79% of residents report using online social networks.3 Examples of social media platforms include Twitter and Facebook. Twitter’s characteristic ease of use, 24/7 connectivity, access to experts, and fostered creation of online community have led to successful medical journal clubs and make it ideal to incorporate into anesthesia resident education.4–8 Specifically, Twitter is a large social network with 302 million monthly active users.9 Twitter users include medical professionals, patients, residents, and more.10 Creating a community of anesthesiologists engaged in journal clubs on Twitter allows for discussion surrounding medical breakthroughs, evidence-based care, and more. Using Twitter, the discussions are not limited to the geographical location or time of day for the user; participation can occur from anywhere at any time. In addition, to facilitate community-building and ease of use, the Twitter hashtag denotes specific, searchable information around topics or events. For example, searching #AnesJC will show all posts of the anesthesiology journal club community and searching #ANES2014 will show all posts of the 2014 American Society of Anesthesiologists meeting. Hashtags are universally searchable, enabling residents from across the globe to find education pearls and follow online communities (Fig. 1).11 Crowdsourcing is enlisting the help of a number of people typically via the Internet. Twitter can be used to crowdsource ideas and keep up to date on relevant articles by following retweeted information (Fig. 2). Retweets are generated by Twitter users and serve as acknowledgments of useful tweets.

Figure 1

Figure 1

Figure 2

Figure 2

The use of social media, specifically Twitter, in anesthesia education remains relatively unexplored. We report the design, implementation, and impact of a Twitter-augmented journal club (TwitterJC) available to the entire anesthesiology community and coupled to the educational curriculum of anesthesiology residents at one institution.

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Design and Implementation

The institutional review board determined this educational study to be exempt. First, to mitigate the risks of Twitter use, all anesthesia residents at a university hospital participated in a mandatory lecture and discussion on the risks and benefits of using social media in health care. The session’s topics included protecting patient, physician, and institution privacy online; critically evaluating user-generated information; and best practices for professional use of social media. The session also instructed students on how to use hashtags, retweets, and other features of Twitter.

Consenting anesthesia residents completed 3 surveys at the following intervals: 1 week before the TwitterJC, immediately after participating in the classroom portion of the TwitterJC, and 2 months later immediately after participating in a traditional classroom-based journal club (TraditionalJC). Each survey asked residents about their Twitter use (differentiating between personal and professional use) and educational engagement with the journal club (Table 1). We defined professional use of Twitter as using tweets for work-related purposes such as news, networking, research, and education.

Table 1

Table 1

Specific instructions for participation in the TwitterJC were published on a web site for the public and anesthesia residents (available at: The TwitterJC took place over 7 days. On days 1 through 4, a daily set of questions was posted to Twitter by the moderators (Fig. 3). Each participant was encouraged to include the hashtag #AnesJC and the question they were responding to when generating a tweet in response to the daily topics. Because each tweet for the journal club included the hashtag #AnesJC, it was searchable and conversations were easily followed by all Twitter users fostering the creation of an online community. Also on day 1, residents were e-mailed electronic copies of the journal article and the same 4 discussion questions as posted on Twitter. The questions were e-mailed to accommodate and include residents who did not want to participate on Twitter. A 1-hour classroom portion of TwitterJC took place on day 5. This was a face-to-face event where all residents convened with the moderators. During the classroom portion of TwitterJC, 2 moderators led discussions based on each of the daily questions that were posted on Twitter. The moderators incorporated user-generated tweets from days 1 through 4 into the classroom discussion. The global anesthesiology community on Twitter, including some residents, generated tweets included in the discussions. During the classroom session, another moderator synthesized comments and discussion of the residents in the room and tweeted important points in real time again using the hashtag #AnesJC. The moderator also interacted with the global community engaged in the #AnesJC in real time. On day 7 of the TwitterJC, all Twitter-based discussion was curated, organized (Storify, San Francisco, CA), and shared via Twitter (Fig. 4). Storify allowed for curating Twitter discussion and creating an enduring resource for the anesthesia community (available at:

Figure 3

Figure 3

Figure 4

Figure 4

Descriptive data of community engagement with the Twitter hashtag #AnesJC were gathered using Symplur (Upland, CA) and TweepsMap (Toronto, Ontario, Canada).

The TraditionalJC took place over 7 days. On day 1, all residents were e-mailed electronic copies of the journal article to be discussed. On day 7, a 1-hour, moderated classroom session took place. This session included critical review of the journal article and supporting literature.

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The TwitterJC took place in January 2015. Over 7 days, 149 tweets were generated using #AnesJC by 26 unique Twitter users located in 3 countries. Each participant generated an average of 6 tweets. No tweets with #AnesJC compromised patient, physician, or institutional privacy or were deemed unprofessional by the moderators.

Thirty-eight of 41 anesthesiology residents enrolled and completed 1 survey, 17 of 41 completed 2 surveys, and 9 of 41 completed all 3 surveys. The average age of participating residents was 31 years. On enrollment, 26 of 36 (72.2%) residents did not use Twitter. Residents who used Twitter (10 of 36 [27.8%]) reported using Twitter professionally for an average of 0.7 minutes (SD, 1.5) per day.

Controlling for prior professional Twitter use, 1 of 16 (6.3%) residents surveyed initiated the use of Twitter before entering the classroom portion of the TwitterJC, 3 of 16 (18.8%) used Twitter in the classroom, and 12 of 16 (75.0%) responded “yes” or “maybe” when asked whether they planned to use Twitter to follow the journal club discussion after the classroom portion ended.

Two months after TwitterJC, controlling for professional use of Twitter before enrollment, 2 of 8 (25.0%) residents surveyed initiated professional use of Twitter. Also 2 months after the TwitterJC, 9 of 15 (60.0%) surveyed residents reported using Twitter professionally for an average of 29.4 minutes (SD, 38.5) per day. Four residents were new users of Twitter since implementing TwitterJC.

Twenty-one residents surveyed spent an average of 61.4 minutes (SD, 33.5) over 1.2 days (SD, 0.5) preparing for the TwitterJC. These residents planned to spend an average of 29.8 minutes (SD, 29.5) over 1.1 days (SD, 1.6) discussing the TwitterJC after the classroom portion. Fifteen residents surveyed spent an average of 40.0 minutes (SD, 28.2) over 0.8 days (SD, 0.4) preparing for TraditionalJC. They planned to spend an average of 25.0 minutes (SD, 24.6) over 0.7 days (SD, 0.9) discussing the TraditionalJC after the classroom portion.

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A TwitterJC provides a platform for residents and the global anesthesiology community to engage in education, share expertise, and generate an enduring resource for the anesthesia community. The amount of tweets generated and users participating in the inaugural TwitterJC supports widespread engagement beyond the residents’ home institutions, including participants spanning 3 countries. Our results are consistent with other inaugural medical journal clubs using Twitter.5–8 To date, however, we are the first to couple Twitter-generated discussion with a classroom event and describe the impact on resident education and social media use.

The emergency medicine specialty group Academic Life in Emergency Medicine (ALiEM) uses a blog and Twitter to host monthly journal clubs that span 7 days.6 The Journal of General Internal Medicine and the British Journal of Obstetrics and Gynaecology host an hour-long “live” Twitter journal club; the latter is followed by a weeklong discussion, which is curated and published online.7,8 In urology, Twitter journal clubs are held monthly for 48 hours each time.5

Mehta and Flickinger7 list advantages to Twitter’s platform, including ease of participation and diversity of users. In their journal club, they invited authors of the article to participate. One of the article authors commented “It was great to see physicians from across the country converge…passionately.” Thangasamy et al.5 recommend inviting article authors and using recently published articles to help engage users.

The amount of time residents spent using Twitter professionally increased over the time of this study. In addition, residents who previously did not use Twitter began to use it for professional purposes. It is not surprising that residents of the Millennial generation would use a familiar technology such as social media for educational purposes. A survey of emergency medicine residents across 12 different programs showed that 98% used some form of social media for learning for at least 1 hour per week.12 Maintaining the materials’ quality, moderating discussion, and encouraging participation are important faculty responsibilities.

Compared with the TraditionalJC, residents spent more time preparing for and discussing the journal club after the classroom portion ended in the TwitterJC. The Twitter platform provides 24/7 connectivity, push notification, and a broad, diverse user group. Preparation for a TraditionalJC is often done independently. The Millennial learner seeks connectivity and collaboration.13 Twitter offers instant connectivity to peers, patients, and experts. In this way, discussion and education are no longer limited to classrooms or certain times of day. The student can prepare or continue discussion whenever, wherever, and with whoever they please.

We report a descriptive study, but there are limitations. The implementation of the TwitterJC was at a single institution. Also, the resident survey response rate decreased over time, and we report our findings on a limited sample size. The survey was voluntary, and our results could be susceptible to response bias. We controlled for prior use of Twitter before enrollment to best calculate the impact of the TwitterJC. The analytics gathered from Symplur did not include an accurate impact of retweets. As mentioned, retweets signify acknowledgment of a tweet and can guide Twitter users to best content. We were unable to quantify this impact of crowdsourcing in our study. Finally, the TraditionalJC and TwitterJC used different articles. The topic itself may have affected the engagement of residents and eventual educational impact. To help mitigate, both journal clubs were moderated by the same faculty and were anesthesia-related.

Our inaugural anesthesia TwitterJC succeeded in engaging the anesthesia community and increasing residents’ professional use of Twitter. Notably, our experience so far suggests that anesthesia residents are willing to use social media for their education.

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