@MondayNightIBD and the Expanding Gastroenterology Twitterverse: A Study on Continuing Medical Education on #GITwitter : Official journal of the American College of Gastroenterology | ACG

Secondary Logo

Journal Logo


@MondayNightIBD and the Expanding Gastroenterology Twitterverse: A Study on Continuing Medical Education on #GITwitter

Goldowsky, Alexander MD1; Billings, Wade MD2; Kickel, Allison BS3; Charabaty, Aline MD4

Author Information
The American Journal of Gastroenterology 118(5):p 855-860, May 2023. | DOI: 10.14309/ajg.0000000000002103
  • Free
  • Infographic



Continuing medical education (CME) is an evolving field offering diverse opportunities for clinicians to stay up to date on the current medical literature, research, and guidelines. In the past, in-person conferences were the primary means by which clinicians maintained their CME requirements (1). This has since been expanded to include knowledge self-assessments by peer-reviewed journals, online activities, and webinars. A novel platform for CME is social media (2,3). Twitter, a social media platform that allows users to post content in the form of 280-character messages, has become a hub for sharing medical information by gastroenterologists, national gastrointestinal (GI) societies, and peer-reviewed GI journals, including published studies and lessons learned at educational conferences. What is now called #GITwitter has seen an evolution over the recent years with the development of interactive and organized medical conversations and journal clubs such as @ScopingSundays, @GIJournalClub, @IBDClub, and @MondayNightIBD (4–8). Literature on the use of Twitter in medical education is limited, involving small numbers of participants, and is largely descriptive in nature. A cardiology-focused CME journal club found that their Twitter-based platform allowed participants to interact with the selected article author and share their insights into the article with the author in a way that could not have been possible otherwise (9). In a survey of internal medicine residents at a single large academic program, 68.9% stated that Twitter enhanced their medical education (10). A study of students taking a public health class found that those actively engaging in Twitter activities had significantly higher end-of-semester grades compared with those who did not (11).

@MondayNightIBD is currently the provider with the most extensive suite of CME-certified activities on Twitter for gastroenterologists and other clinicians in the field of GI, with a focus on inflammatory bowel disease (IBD) education. The handle was established in April 2019 and started offering CME in February 2020. The handle currently has more than 8,000 followers, including gastroenterologists, IBD specialists, colorectal surgeons, GI nurses and advanced practitioners, pharmacists, dieticians, psychologists, and IBD patient advocates.

@MondayNightIBD educational activities include the following: #Back2Basics Tweetorials that review the basics and current guidelines of diagnosis and management of IBD, clinical vignettes and polls addressing complex IBD management questions, followed by a peer discussion, and journal clubs and expert roundtables on current and emerging topics in IBD. Most #Back2Basics tweetorials review current knowledge, epidemiological data, or guidelines of a specific IBD topic, in preparation for the more complex IBD management poll activities that occur the following week. We have previously shown that the @MondayNightIBD activities engage gastroenterologists of all career stages, from fellows to well-established practitioners and experts in the field, including those in both private practice and academia (8).

Given the novelty of Twitter use for the provision of CME-certified activities, few studies have examined whether this social media platform is appealing to learners, covers educational needs in gastroenterology, and leads to objective knowledge acquisition by its users. Thus, our goal was to study the effect @MondayNightIBD has on IBD education by looking at the following: the participants' acceptability of the platform as a source of IBD and CME education, the effectiveness of the educational activities in improving participants' medical knowledge, and the capacity of the platform to meet the educational objectives or entrustable professional activities (EPA) in IBD as set forth by GI societies and leaders in IBD education.



@MondayNightIBD educational activities were analyzed from inception in April 2019 until May 2021. These activities included the following: (i) “#Back2Basics Tweetorials,” which are a series of tweets focusing on a specific topic in IBD, reviewing basic diagnostic and management principles in IBD including societies guidelines and recommendations (e.g., Crohn's disease Montreal classification or IBD health maintenance), (ii) @MondayNightIBD interactive conversations that stem from a clinical case vignette and management poll question, exploring complex and comprehensive IBD management situations (e.g., treatment of acute severe ulcerative after failure of steroids or management of postoperative Crohn's disease), (iii) @MondayNightIBD review of key points by the lead authors of recently published high-impact articles (e.g., update on epidemiology of IBD), and (iv) @MondayNightIBD experts roundtable focused on an emerging topic (e.g., COVID-19 and IBD).

Knowledge acquisition analysis

Before every activity, a demographic poll is posted asking participants where they are in their career, with the following 4 options: IBD specialist, general gastroenterologist or colorectal surgeon, fellow or trainee, and “other” clinician. This demographic poll is followed by 2 CME questions that precede the educational activity. The same 2 CME questions are posted after each educational activity is completed, and the key educational points are summarized. One question is case based and the other question is knowledge based, and each question includes 1 correct answer out of a choice of 4 answers. Pre-CME and post-CME questions were analyzed between February 2020 (date when @MondayNightIBD was accredited to provide CME) and May 2021. The average of correct answers to the CME questions before and after the educational activity were compared to measure objective knowledge acquisition and to understand current gaps in knowledge and assess unmet educational needs.

Acceptability and practice changing analysis

Each @MondayNightIBD educational activity is preceded by an announcement outlining the format, the conversation leaders, the topic, and the learning objectives. Posteducational activities surveys were presented to participants to assess for acceptability of @MondayNightIBD as a CME activity. Participants were asked about their agreement level to 5 statements, with options on a standard Likert scale of strongly agree, agree, neutral, disagree, and not applicable. The statements addressed the following: whether learning objectives were met, whether sessions enhanced learners' knowledge base, whether learners' most pressing questions were addressed, whether activities promoted improvements or quality in health care, and whether sessions were rigorous and evidence based. In addition, a question was asked regarding how committed providers were to changing their practice based on their participation in the educational activity, with the following answer choices: very committed, committed, neutral, not committed, and do not plan to make changes. Barriers to practice change were also assessed in the post-CME survey.

EPA analysis

IBD EPA were compiled from the Multisociety Gastroenterology Core Curriculum and the American College of Gastroenterology/Crohn's and Colitis Foundation Advanced IBD Fellowship Training group (ACG/CCF) (12,13). EPA are defined as essential and practical competencies physicians should master to practice independently in their specialty (14). Each #Back2Basics and @MondayNightIBD activity between April 2019 (date of @MondayNightIBD inception) and May 2021 was analyzed and assessed for the EPA it addressed and covered.

Primary end point

The primary end point of the study was objective knowledge acquisition, measured by the improvement in the percentage of correct answers to CME test questions before and after an educational activity.

Secondary end points

The secondary endpoints analyzed included @MondayNightIBD acceptability as a CME platform, commitment to practice change because of @MondayNightIBD activities, barriers to changing practice, and percentage of IBD EPA addressed by @MondayNightIBD educational activities.

Statistical Analysis

The primary end point was assessed using the Student t test and Cohen d effect size to estimate the degree of effect the intervention had. To detect a difference of 10 percentage points between preactivity and postactivity CME questions with an SD of 15 percentage points, a total of 48 participants completing both preactivity and postactivity CME questions was calculated at a power of 90%. The secondary endpoints were assessed using descriptive percentages. All statistical analyses were performed using SPSS software, version 27.0 (15).



A total of 45 CME activities with a management poll were developed between February 2020 and May 2021. The number of participants in each educational activity poll ranged from 115 to 410 per activity, with a total of 11,613 responses gathered in 45 activities, an average of 258 responses (or participants) per activity. The total number of responses for the demographic poll that preceded the CME questions was 5,409 during that same period. Given the anonymity of Twitter poll voting during the educational activity, we do not have the ability to determine whether those who voted in the clinical vignette poll also completed the CME questionnaire certificates. Hence, we calculated the percentage of participants who completed the CME questionnaire based on the total number of participants who completed the demographic polls that precede the CME questions. Of this group of 5,409, a total of 483 participants (8.9%) completed the preactivity and postactivity CME questions. Up to 77% of these CME learners identified as practicing gastroenterologists (MD or DO), 13% as advanced practitioner and nurses, and 10% as residents, fellows, and others not listing their professional degree. For professional specialty, 82% of CME participants identified as gastroenterologists, 4% as colorectal surgeons, 5% as internal medicine/family medicine/general practitioner, and 9% as other (including pharmacists and other non-GI MD/DO) (Table 1).

Table 1.:
CME pretest and posttest participant characteristics, as identified by terminal degree and practicing specialty

Objective knowledge acquisition

On average, 58% of participants answered the preactivity CME questions correctly (SD 16%). After completion of a @MondayNightIBD activity, 79% of participants answered the postactivity CME questions (SD 15%) correctly, with a P value <0.001 (Figure 1). Cohen d effect size over this period on the intervention was 1.37, with a large effect size considered to be >0.8. Based on this effect size, the overall knowledge improvement before and after a @MondayNightIBD activity by CME participants was calculated to be 27%.

Figure 1.:
Continuing medical education pretest and posttest percentage of correct answers from July 2020 through February 2021.

Acceptability of @MondayNightIBD

A total of 145 learners completed a postactivity survey assessing their opinions on @MondayNightIBD educational activities. When learners were asked whether @MondayNightIBD met the learning objectives set out at the beginning of individual sessions, 96% strongly agreed or agreed that any given learning objective was met. Up to 95% of participants strongly agreed or agreed that the educational activities enhanced their current knowledge base, 90% strongly agreed or agreed that their most pressing questions were addressed, 93% strongly agreed or agreed that the activities promoted improvements in medical care or quality care, and 94% strongly agreed or agreed that the activities were scientifically rigorous and evidence based. When participants were asked how committed they were to making changes in their practice based on participation in learning activities, 92% rated themselves as very committed or committed to making changes to their practice. The most common barriers to implementing practice change initiatives included lack of time and resources (30%), insurance/reimbursement issues (25%), and patient compliance/patient resource barriers (22%) (Table 2).

Table 2.:
Responses when participants asked about barriers to implementing practice change

Entrustable professional activities

A total of 111 unique EPA across 10 categories were set forth by the ACG/CCFn group (13). Of them, 87 have been covered by @MondayNightIBD (78.4% of total EPA) from April 2019 through May 2021. Individual categories with the highest percentage of EPA covered included the management of complications of IBD and IBD therapies (100%), management of IBD in special populations (100%), and classification of IBD phenotype, IBD manifestations, and extraintestinal manifestations of IBD (100%). The category with the lowest percentage of EPA covered was management of the hospitalized patients with IBD (50%) (Table 3). A total of 19 unique EPA were set forth by the multisociety group (12). Of these, 16 have been covered by @MondayNightIBD (84% of total EPA).

Table 3.:
Percentage of EPA covered by @MondayNightIBD sessions from inception in 2019-May 2021 divided by EPA category, as established by the ACG/CCFn Advanced IBD Fellowship Training group


During the evaluable period, we were able to demonstrate that @MondayNightIBD, an innovative Twitter-based IBD-focused educational handle, led to significant objective knowledge acquisition in the form of postactivity knowledge improvement. Moreover, @MondayNightIBD is effective in addressing the educational needs of clinicians with self-reported improvement in knowledge and quality of care provided. In addition, we were able to show that social media–based CME activities in the format provided by @MondayNightIBD are widely acceptable to the gastroenterology community. Finally, the topics addressed during @MondayNightIBD activities largely cover the IBD EPA set forth by national GI societies and IBD experts. Of interest, while most learners were committed to making changes in their practice based on their participation in the educational activities, there remain significant barriers to implementing these changes in practice.

To date, our study is one of the most robust and includes one of the largest numbers of learners assessed when examining social media as an educational CME platform. While most CME learners were practicing gastroenterologists, participants of the @MondayNightIBD conversation include an equal proportion of IBD specialists, general gastroenterologists and colorectal surgeons, GI fellows and medical trainees, and a smaller proportion of other clinicians, as assessed by the demographics Twitter poll set at the beginning of each activity.

Two elements that are intrinsic and vital to the purpose and success of a CME activity are knowledge improvement and practice changing learning (1,16). Data on the effectiveness of CME at improving knowledge acquisition remains mixed, although several reports suggest that it leads to significant knowledge improvement (17,18). In a large meta-analysis, 79% of studies on CME with adequate control groups show improvement in knowledge of participants. These include studies in the fields of adult primary care, cardiology, and pulmonology (19–21). This knowledge acquisition was durable over longer periods of time in 69% of studies analyzed (17). In the field of gastroenterology, traditional in-person CME courses yield significant improvement in knowledge, independent of precourse experience and confidence in skills (22,23). To the best of our knowledge, our study is the first to objectively evaluate knowledge improvement in the field of gastroenterology and to assess self-reported change in practice, when Twitter is used as the delivery vehicle for CME-certified programming. While learners in the @MondayNightIBD community exhibit improvement in knowledge and a commitment to practice change, there remain significant barriers to implementing these changes. These barriers have been described in prior studies examining educational interventions and require wider interventions at the institutional and health policy levels, which are beyond the scope of a CME activity (24,25).

Numerous studies in the medical education literature highlight the importance of active learner engagement to optimize the effectiveness of an educational activity and knowledge uptake (26–28). This type of active engagement is a distinct strength of @MondayNightIBD conversations (8). By using in-the-moment polling and active management questions to clinical scenarios in IBD, @MondayNightIBD activities stimulate discussions that engage a diverse group of clinicians involved in IBD care, including gastroenterologists, surgeons, pharmacists, psychologists, and nutritionists, leading to a multidisciplinary exchange of knowledge, expertise, and medical literature. This dynamic and inclusive format, in addition to the quality of the engagement, explains, at least partly, the significant knowledge acquisition obtained from @MondayNightIBD activities.

Similar to other studies looking at the recent use of social media to provide educational activities, our study shows broad acceptability among learners of a Twitter handle, @MondayNightIBD, at providing CME activities. The benefits of using Twitter as an educational platform include the ability to engage in asynchronous continuous learning, with highly diverse participants and without the limitations of time and physical location that an in-person activity or even a scheduled on-line webinar have, or the requirements of preregistration or fees associated with a course (29).

There are limitations to our study. Clinicians participating in our survey represent a group who is already engaged in seeking medical education on social media. Only a small percentage (9%) of the learners participating in @MondayNightIBD activities completed the requirements to obtain their CME credits. Given that up to a third of learners have a focus in IBD, this may affect the magnitude of knowledge acquisition found in the activities. However, fellows and trainees who are not seeking CME credits may have even greater knowledge gaps, which may make our effect size an underestimation if we were to include all activity participants. While a significant number of learners reported commitment to practice change, there is no data on how @MondayNightIBD activities effectively affect gastroenterologists' medical practice; however, this is a common limitation when assessing the effect of any CME activity outside of quality improvement–focused offerings.

Despite an increasing presence of the gastroenterology community on Twitter, social media remains a novel platform for CME-certified activities. This study illustrates learners' acceptability of CME activities on Twitter and the efficacy of @MondayNightIBD in improving knowledge acquisition among clinicians at different stages in their careers. Overall, this study highlights the feasibility for CME content creators to host impactful medical education activities on Twitter. As the world of CME continues to diversify and evolve, it is important that new platforms and innovative and appealing formats be evaluated to ensure they fulfill the ultimate mission of educational activities, which is improving the quality of patient care.


Guarantor of the article: Aline Charabaty, MD.

Specific author contributions: A.G. was responsible for planning the study, interpreting data, and drafting the manuscript; and he has approved the final draft submitted. W.B. was responsible for interpreting data and drafting the manuscript; and he has approved the final draft submitted. A.K. was responsible for data collection and drafting the manuscript; and she has approved the final draft submitted. A.C. was responsible for planning the study, data collection, interpreting data, and drafting the manuscript; and she has approved the final draft submitted.

Financial support: There was no funding for this original publication. During the study period, @MondayNightIBD programming was supported by educational grants from AbbVie, Janssen Biotech, administered by Janssen Scientific Affairs, LLC, and Takeda Pharmaceuticals USA, Inc.

Potential competing interests: A.C. is the founder of @MondayNightIBD. A.K. is the President of Bonum Continuing Education, LLC, providing continuing medical education to @MondayNightIBD.

Study Highlights


  • ✓ Continuing medical education (CME) is evolving with social media–based endeavors now being included.
  • ✓ @MondayNightIBD has the most extensive suite of CME-certified activities on Twitter for gastroenterologists.
  • ✓ Little is known about the effectiveness of Twitter-based CME in knowledge acquisition.
  • ✓ Little is known about whether Twitter-based CME is acceptable to learners.


  • ✓ @MondayNightIBD leads to objective knowledge acquisition by learners to a significant degree.
  • ✓ @MondayNightIBD as a form of social media CME is acceptable to learners and meets learning objectives.
  • ✓ Learners are motivated by @MondayNightIBD to change their clinical practice.
  • ✓ Learning goals for @MondayNightIBD are in alignment with gastroenterology professional society learning objectives.


1. van Nieuwenborg L, Goossens M, de Lepeleire J, et al. Continuing medical education for general practitioners: A practice format. Postgrad Med J 2016;92(1086):217–22.
2. Wang AT, Sandhu NP, Wittich CM, et al. Using social media to improve continuing medical education: A survey of course participants. Mayo Clin Proc 2012;87(12):1162–70.
3. Flynn S, Hebert P, Korenstein D, et al. Leveraging social media to promote evidence-based continuing medical education. PLoS One 2017;12(1):e0168962.
4. Bilal M, Aby ES, Mahmood S, et al. Standardized reporting of gastroenterology-related social media scholarship for career advancement. Nat Rev Gastroenterol Hepatol 2021;18(8):519–20.
5. Pershad Y, Hangge PT, Albadawi H, et al. Social medicine: Twitter in healthcare. J Clin Med 2018;7(6):121.
6. Forgie SE, Duff JP, Ross S. Twelve tips for using Twitter as a learning tool in medical education. Med Teach 2013;35(1):8–14.
7. Elfanagely Y, Atsawarungruangkit A, Moss SF. Understanding GI Twitter and its major contributors. Gastroenterology 2021;160(6):1917–21.
8. Charabaty A, Bilal M, Kickel A, et al. Sa651 Twitter based educational activities #MondayNightIBD and #ScopingSundays enhance engagement in learning, improve clinical practice, and facilitate networking and collaboration among members of the gastroenterology community. Gastroenterology 2021;160(6):S582.
9. Thamman R, Desai T, Wiener DH, et al. #ASEchoJC Twitter journal club to CME: A paradigm shift in cardiology education. J Am Soc Echocardiogr 2020;33(3):A29–A35.
10. Bergl PA, Narang A, Arora VM. Maintaining a Twitter feed to advance an internal medicine residency Program's educational mission. JMIR Med Educ 2015;1(2):e5.
11. Diug B, Kendal E, Ilic D. Evaluating the use of twitter as a tool to increase engagement in medical education. Educ Health Change Learn Pract 2016;29(3):223–30.
12. American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal. The gastroenterology core curriculum, third edition. Gastroenterology 2007;132:2012–8.
13. Cohen BL, Gallinger ZR, Ha C, et al. Development of entrustable professional activities for advanced inflammatory bowel disease fellowship training in the United States. Inflamm Bowel Dis 2020;26(9):1291–305.
14. Cate Ot. A primer on entrustable professional activities. Korean J Med Educ 2018;30(1):1–10.
15. IBM. IBM SPSS Statistics for Windows, Version 27.0. IBM: Armonk, NY, 2020.
16. Cahapay M. Kirkpatrick model: Its limitations as used in higher education evaluation. Int J Assess Tool Educ 2021;8(1):135–44.
17. Marchionni L, Wilson RF, Marinopoulos SS, et al. Effectiveness of continuing medical education. Evid Rep Technol Assess 2007;149:1–69.
18. Cervero RM, Gaines JK. Effectiveness of Continuing Medical Education: Updated Synthesis of Systematic Reviews. Accreditation Council for Continuing Medical Education: Chicago, IL, 2014.
19. Kiang KM, Kieke BA, Como-Sabetti K, et al. Clinician knowledge and beliefs after statewide program to promote appropriate antimicrobial drug use. Emerg Infect Dis 2005;11(6):904–11.
20. White CW, Albanese MA, Brown DD, et al. The effectiveness of continuing medical education in changing the behavior of physicians caring for patients with acute myocardial infarction. A controlled randomized trial. Ann Intern Med 1985;102(5):686–92.
21. Terry PB, Wang VL, Flynn BS, et al. A continuing medical education program in chronic obstructive pulmonary diseases: Design and outcome. Am Rev Respir Dis 1981;123(1):42–6.
22. Kim HC, Pandolfino JE, Komanduri S, et al. Use of a continuing medical education course to improve fellows' knowledge and skills in esophageal disorders. Dis Esophagus 2011;24(6):388–94.
23. Regueiro MD, Greer JB, Binion DG, et al. The inflammatory bowel disease Live Interinstitutional and Interdisciplinary Videoconference Education (IBD LIVE) series. Inflamm Bowel Dis 2014;20(10):1687–95.
24. Simpson F, Doig GS. The relative effectiveness of practice change interventions in overcoming common barriers to change: A survey of 14 hospitals with experience implementing evidence-based guidelines. J Eval Clin Pract 2007;13(5):709–15.
25. Arnold Rehring SM, Steiner JF, Reifler LM, et al. Commitment to change statements and actual practice change after a continuing medical education intervention. J Contin Educ Health Prof 2021;41(2):145–52.
26. Cullen MW, Geske JB, Anavekar NS, et al. Reinvigorating continuing medical education: Meeting the challenges of the digital age. Mayo Clin Proc 2019;94(12):2501–9.
27. Stephenson CR, Bonnes SL, Sawatsky AP, et al. The relationship between learner engagement and teaching effectiveness: A novel assessment of student engagement in continuing medical education. BMC Med Educ 2020;20(1):403.
28. Bucklin BA, Asdigian NL, Hawkins JL, et al. Making it stick: Use of active learning strategies in continuing medical education. BMC Med Educ 2021;21(1):44.
29. Thamman R, Gulati M, Narang A, et al. Twitter-based learning for continuing medical education?. Eur Heart J 2020;41(46):4376–9.
© 2022 by The American College of Gastroenterology