The history of digital networking in medicine started with the development of the Internet and its resulting websites. Suddenly, medical information was available online, and for the most part, it was free of charge. Relevant content, however, would need to be searched for; hence, search engines arose. The most famous example is the birth of Google. Content would need to be collected and managed, and thus, searchable databases were created. Many processes that we know from the “real world” have been transferred to the “digital world” or are waiting to be programmed. Our communication, the way we search for information and our teaching/learning behavior have been changed. Personal learning and social media groups have thus been created, paving the way for extremely effective networking for learning and sharing ideas. LinkedIn, a networking website for the business community, allows users to create professional profiles, post resumes, and communicate with other professionals and jobseekers.
A major disadvantage is that all interactions, such as making a change to one’s profile, following companies, or writing recommendations, are broadcast on the activity feed. To protect one’s own privacy, it is recommended that users turn off the broadcasting of activity and refrain from completely filling out social media profiles, giving instead only info relevant to the (applied) business position. Detailed curriculum vitae (CV) and application letters can be sent on request. The easiest way to control privacy without totally getting rid of social media apps is to separate private and business accounts. Private accounts can provide the possibility of keeping in touch with friends and family, especially across great physical distances. The audience of private profiles and friend requests can be restricted to share updates with only a select group of people, and accounts can also be switched to “protected” so that their contents will not be indexed by search engines. Additionally, requiring “tag request approval” prevents the possibility of others attaching one’s name to content without consent.
Several other negative effects, such as information overload and Internet fraud, are also attributable to social media, which consequently receives criticism. The Internet is pervasive and eternal. When information is shared through social media, that information is no longer private. Practice recommendations touch on a number of areas that are potentially problematic, including confidentiality, financial conflicts, collegial support, and general social responsibility. Business medical postings within the United States should be Health Insurance Portability and Accountability Act (HIPAA) compliant; preferably, this compliance would be consistent with regulations implemented in countries all over the world as well as, of course, with the Terms and Conditions of Services of each social media platform. The future of social media apps depends partly on how well they keep their users safe and protect their privacy. Their future also requires some kind of universal policy or “Netiquette” (network etiquette): a set of social conventions that facilitate interactions over networks ranging from mailing lists to blogs and forums in addition to other techniques used to minimize the effort required to read a post or a thread.1
The impact of false information and fake news is very relevant in the present day. Considering the motivations of the author can help to recognize fake news produced, for example, for comic effect. If all information comes from the same unknown source, its veracity is likely to be highly dubious. Referred websites should carry a disclaimer containing authors’ names and should contain no odd domain names. Critical reflection is a key skill in media and information literacy, and everything suspicious, especially supporting sources should be questioned. Social media has enormous potential for propaganda as well. Propaganda itself is an ethically neutral idea; it is the content that varies. There is no doubt that social media has been used for deceptive and manipulative patterns to negatively influence behavior in the past, and it continues to do so in the present, especially in politics. Furthermore, branding and advertising have become major aspects of business via social media through personalization intended to match the needs of consumers. By promoting brands, we are engaging in issuing propaganda on their behalf. However, propaganda can also be used for good, as in the sharing of public health messaging. This is a chance for governments, researchers, and medical associations to share authorized information promoting health behavior.
Although social media users skew toward those of younger age, more than one-third of US adults ≥65 years of age also use social media.2 The public sharing of information over social media has created a vast wealth of information while leaving some of us lost in this endless digital space. It has simply become increasingly confusing and time-consuming. We can process only limited amounts of information; accordingly, how can we incorporate this technology in a useful and intelligent manner that improves our ability to connect via social networks regarding extracorporeal technology and its community? What is available to us?
Facebook is an online social network that allows users to create personal profiles, share photos and videos, and communicate with other users. American Society for Artificial Internal Organs (ASAIO), Extracorporeal Life Support Organization (ELSO), and its branches, such as the European one (EuroELSO), have sites that have been created and administered by ELSO-designated administrators (@ASAIOJournal, @ELSOOrg, and @EuroELSO). Separate congress and conference sites are also provided (e.g., as an “Event”). Twitter, an Internet service that allows users to post “tweets” for their followers, allows these followers to see updates in real time. ASAIO (@asaiojournal), ELSO (@ELSOOrg), and EuroELSO (@EuroELSO) followers can tweet, make online comments, and send messages to administrators. Facebook and Twitter provide specific functionalities to help users to share content, for example, Twitter’s “retweet” button and Facebook’s and LinkedIn’s “share” option. User-generated content, such as text posts or comments, digital photos or videos, and data generated through all online interactions, is the lifeblood of social media. It makes it possible to use blogs (e.g., ctsnet.org), YouTube, Twitter, and Facebook to spread relevant information and to use social media for education and research.3–5 Placing a hashtag (#) symbol before an item being described allows every Twitter user rapid access to anything associated with it, such as #extracorporeal life support (ECLS), #ASAIO, or #ELSO. The use of hashtags has become a rapid way of filtering relevant cohorts and information. A closely related idea is free open access medical education (#FOAM), where online resources (e.g., articles, videos, and podcasts) are shared freely and openly to a wider audience. They can also be downloaded for listening or watching at a later date.4–7
The limitation of FOAM is related to the reliability and accuracy of the information provided. The importance of quality indicators for emergency medicine blogs and podcasts has been determined, e.g., by HONcode, a quality label for online medical content, provided by the Health on the Net Foundation (hon.ch/en).7 Another negative concern is reductive information: at the level of the textbook at first, then just the chapter, then just the paper, then just the abstract, and eventually we read only the tweet. Online resources providing timely peer-reviewed summaries of relevant publications have steadily gained readership through retweets by readers.2,8 Such resources have also been used to interview the authors of trials, allowing a wide audience to engage in critical discussion of their results merely days (and in some case hours) after publication. This phenomenon has provoked earlier changes in practice than we have previously seen with more traditional methods of information dissemination.2–6,8
In the era of social media, there are now many ways for scientists to build their public profiles, and the publication of high-quality scientific research is just one such way. Although social media is a valuable tool for outreach and for the sharing of ideas, there is a danger that this form of communication is becoming overvalued and that we may lose sight of the key metrics of scientific value, such as citation indices9 (Table 1). Twitter attracts a high number of “followers” and retweets that are difficult to compare with traditional impact factors. To help quantify this, the “Kardashian Index,” a measure of the discrepancy between a scientist’s social media profile and publication record based on a direct comparison of the number of citations and Twitter followers, has been proposed.9,10 Tweets can predict highly cited articles within the first 3 days of article publication. The proposed “twimpact factor” may be a useful and timely metric to measure the uptake of research findings and to filter research findings resonating with the public in real time.11,12 Social media activity either increases citations or reflects the underlying qualities of the article that arise from its citations, but the best use of these metrics is to measure the distinct concept of the social media index (SMi).13–15 The SMi enables an assessment of the impact and quality of #FOAM resources, enables educators to receive scholarly credit, and permits learners to identify respected resources. The question therefore arises regarding whether #FOAM could possibly replace peer review. The answer is “perhaps.” #FOAM ignores a traditional hierarchy because it is free and has equitable access 24/7, crosses professional boundaries, and is multinational, transparent, robust, and apolitical.2–7,9,11 Tweetorial16,17 and Twitter Journal Club (e.g., @EASTjournalclub18) are special forms of interactive discussion boards allowing real-time interactions between users for an immediate exchange of information (Table 1).
ASAIO, ELSO, and EuroELSO contents on social media enjoy great popularity, providing scientific information and announcing conferences and educational events for an audience of between 1,000 and 8,000 followers on various platforms (Figure 1; Table 2). Back to the roots, one of the most popular posts, which reached 5,700 people, was Dr. Bartlett’s published case report on the first application of extracorporeale membran oxygenation (ECMO) in the newborn on Facebook—all without boosting the post (Figure 2).
2. Ranard BL, Merchant RM. Harnessing digital media to promote health and research. Circulation 2018.137: 2197–2199.
6. Cadogan M, Thoma B, Chan TM, Lin M. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J 2014.31: e76–e77.
7. Thoma B, Chan TM, Paterson QS, Milne WK, Sanders JL, Lin M. Emergency medicine and critical care blogs and podcasts: Establishing an international consensus on quality. Ann Emerg Med 2015.66: 396.e4–402.e4.
9. Hall N. The Kardashian index: A measure of discrepant social media profile for scientists. Genome Biol 2014.15: 424.
11. Eysenbach G. Can tweets predict citations? Metrics of social impact based on Twitter and correlation with traditional metrics of scientific impact. J Med Internet Res 2011.13: e123.
14. Thoma B, Chan TM, Kapur P, et al. The Social Media Index as an Indicator of Quality for Emergency Medicine Blogs: A METRIQ Study. Ann Emerg Med 2018 Jul 3. S01960644(18)304128. doi: 10.1016/j.annemergmed.2018.05.003. [Epub ahead of print]
15. Thoma B, Sanders JL, Lin M, Paterson QS, Steeg J, Chan TM. The social media index: Measuring the impact of emergency medicine and critical care websites. West J Emerg Med 2015.16: 242–249.
16. Combes A, Hajage D, Capellier G, et al; EOLIA Trial Group, REVA, and ECMONet: Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018.378: 1965–1975.
18. Swol J, Brodie D, Napolitano L, et al; Extracorporeal Life Support Organization (ELSO): Indications and outcomes of extracorporeal life support in trauma patients. J Trauma Acute Care Surg 2018.84: 831–837.