Hi, this is Christopher Graffio. I'm one of the chief residents at Mayo Clinic Rochester and I'm going to be speaking today on Twitter 101, Getting Started with Neurosurgery Social Media as a part of the Building a Social Media Impact Platform and Online Branding in Neurosurgery series for the AANS. In terms of an overview of the presentation today, I'm going to start by telling you a little bit about myself and how I got so involved with social media in general and for neurosurgery in particular, and then I'm going to kind of get into the nitty-gritty of what is Twitter, why do I think it's something you should care about in terms of your professional presence online, and a step-by-step guide on how to get started on Twitter and how to take advantage of a lot of the features that make it easier to use and get a lot out of for people in neurosurgery. Then we'll close with a handful of pro tips for future power users, as well as what I like to refer to as my 10 commandments for being a good steward on Twitter as a neurosurgeon. So as I mentioned, I'm a Chief Resident in Neurosurgery, just finishing up my PGY-6 year at Mayo Clinic in Rochester. Next year, I'll be the Infolded Skull Base Fellow with Dr. Mike Link, and for a year after that, I'm heading to BNI to be Dr. Lawton's Fellow in Skull Base and Open Cerebrovascular. And in terms of my non-neurosurgical publishing experience related to social media, I worked for several years before going to medical school for a variety of arts publications, including Ins and Outs Magazine out of New York, Arts Editor out of Boston, and in college, the Declaration at the University of Virginia. Much more relevant to the audience of this talk, of course, is my experience at the intersection of social media and medicine in general, or neurosurgery in particular. And in that capacity, I've served the Journal of Neurosurgery for several years as one of their editors of social media. The Young Neurosurgeons Committee is the IT social media director and the leader of the NREF social media campaign. And in the somewhat more recent past, I've helped out with the Neurosurgery Survival Guide, app development for the CNS Resident Fellows Group. And I've been on Twitter as a sort of individual person for many years, but I've really geared my Twitter account to have a particular focus on neurosurgery since about 2014. At the moment, I've got about 3,500 followers, which I think is the most for certainly any resident in most individual accounts in neurosurgery. So something I get asked a lot is, how do you pick which social media networks you're going to focus on? A lot of my friends and my family are on Facebook, and my coworkers are on LinkedIn. My kids are on Snapchat, and I've heard Instagram is really good for business. And the case I'm going to try and make today is that really Twitter is where you want to be focused for the purposes of academic medicine or academic neurosurgery. And why is that? Well, let's start with, what is Twitter? So Twitter is a micro-blogging and social media service, in the network's own words. It's a big site. There's more than 300 million active users on any given day. It's the 12th most trafficked website in the entire world, and the second biggest of all the social media sites after Facebook. And interestingly, it's the fastest growing, which is to say the most new and engaged accounts on a daily basis. And about a third of people between the ages of 15 and 35, which is to say the sort of up-and-coming generations of neurosurgery, have accounts that they use relatively actively on Twitter. And there's a particular interest, a very large medical community, and the sort of hashtag MedTwitter comes up quite a bit, that there's a lot of doctors in a wide variety of specialties, including but not limited to neurosurgery, all over Twitter. And sort of the signature of Twitter is that it's all about short posts. So in the current format, there's a lot of short posts in the current format. That means 240 characters to which you can add up to four images or videos, and that results in an awful lot of content. There's just 300 million active users are actually posting about 10,000 tweets per second, so it's a real firehose of content. Now, that's all well and good, but it still doesn't answer the question, why choose Twitter if you're going to develop your online presence in neurosurgery in a particular platform? And to that, I would say that most professional social media is static and promotional, and it's essentially an exercise in branding yourself, branding your practice, and trying to generate referrals. And that has a role, and some of my colleagues are giving associated presentations on Facebook or LinkedIn, Doximity even, and those each have a value that's more akin to sort of internet age yellow pages, whereas Twitter, it's a very high-paced, more informal, dynamic blend of a news outlet and a chat room, and so it's not just a place to say, hey, here I am, and here's what I do, but it's actually a way for people with shared interests to have active discussions, whether that's between colleagues, between educators and trainees, between patients and surgeons, and there's a very real-time element of engagement with others, and it's made a much more interesting and exciting format for online discussions when compared to other social media networks that have medical personalities involved in them. I'd add to that a few more specific points, including the fact that there's a lot of academic opportunities tied to Twitter activity. For example, all of the journals and a lot of the authors who are active in our community post their articles regularly on Twitter. It's a great way to be a better, more up-to-date reader, and in fact, to lead discussions in your individual area of expertise by commenting on new publications or sharing your own work, and in part helping disseminate and promote or dissect the work of others that you really respect. It helps also to improve what you'd call your name recognition, so my own role in even this series of talks is almost certainly a consequence of the fact that I've gotten to know a lot of my academic colleagues at other institutions simply by participating in discussions with them on Twitter, and it's helped me meet a lot of people and make a lot of friends and really broaden my horizons in the sort of social paraneurosurgical world. Some institutions, Mayo Clinic included among them, have started to count some aspects of scholarly pursuit on social media as credit towards formal advancement within a variety of promotional structures, so that's really a footnote but something worth keeping in mind, perhaps, depending on how your institution structures those sorts of decisions. As a final point in terms of why Twitter should matter to you, I'll also add that it's a really great way to improve your outreach and to stay engaged, whether that's in the academic sense with, you know, residence fellows, students, other trainees, with your own patients and their families or advocacy groups looking to, you know, push for the needs of future patients, or with the journals and societies who really do drive a lot of the sort of core content on Neurosurgery Twitter, and, you know, as a small point, particularly relevant to people who are earlier in their career, maintaining a public-facing Twitter page that you control is one more, you know, high traffic, Google-friendly landing site that's, you know, it's independent of your employer, you can control the content on it, and you can make sure that you're getting the message out there and that your name is coming up as much as possible and in formats that you have some say in when someone, you know, searches your name on Google for the first time. So with that prologue in mind, this is a 101 lecture, of course, and it's time to dive into the real meat of things. What's our goal today? Well, let's just say I want to help you get from here to here without ending up over here. So the first thing you need to think about as you set up your Twitter account is what's in a name, and by that I actually mean there's two different unique identifiers that you need to be somewhat thoughtful about arranging. Now, your username is a unique string. It can be changed over time, but it's preferable to keep it relatively stable, and when I say it's unique, I mean that only one Twitter user can have a particular username because that will follow the at symbol in tweets that incorporate you either as a tag or someone sending you a message. It's also where your account will be most easily located if you go to twitter.com slash, and then you type in the username, that'll bring you straight to your landing page. So it's good to have something that's relatively stable over time, relatively recognizable. The name, as compared to the username, is non-unique. It's an easy way, if you have a common name or a name that someone else has already claimed the account for in the unique username string, that you can still use your actual name somewhere in the, you know, the title and the landing page for your Twitter account. People do change these periodically for a variety of reasons, but again, there's certainly some value and stability, and so for this example that we've shown over here on the right, the at Y social media lab, that's the unique username, whereas YNC underscore social media lab is the non-unique name that is, you know, identifying and labeling the account but not functionally tied to it. Now fortunately, both the username and the name can be changed relatively easily. If you go into the settings function and pull up the account tab, you'll see a box right at the top where it says username, and that can be altered, and it'll prompt you immediately with an error message. You know, if you were to go in there and type in Graphio, it'd say, hey, that name's already taken, you gotta think of something else. But if you can come up with a new unique string, then it'll let you change that. And then to change the informal non-unique name, you actually go to your profile, you hit the edit profile button, and then over on the left side below the profile picture space, the name field will open up, and you can edit that to say whatever you want up to a certain limit in terms of character length. And so here, you know, if your at username is, say, Graphio, because you set up your account before you were a doctor and you wanted to single to people that you, you know, are now a practicing physician, then you could change the name portion of things to say Dr. Christopher Graphio and keep the add Graphio tag for simplicity and continuity purposes. So once you've got your username and your name sorted out, the next two decisions you need to make are two key images have to be selected to sort of complete the visual aspects of your profile. The first is a profile photo, and that's the round image that appears on the left side of both your landing page and any tweet that you post either on your own account or someone else's as a reply or a comment. And, you know, whenever possible, this is a good place to put a professional headshot, and if not, you know, make sure it's at least a clean, smiling, friendly selfie. The header photo is the large rectangular box at the top of the Twitter landing page for your account, and this is a place where, you know, you've got a little bit more room for fun and self-expression. Some people will put, say, anatomic pictures that they really like or, you know, photographs of locations that are important to them, but as with everything else in your Twitter presence, it should certainly be professional. And so once you've got your profile picture selected and your header selected, you're ready to go. And here's what an actual profile page would look like with those two profile and header photos put into place, sort of give you a an example of things. And here's my own personal page shot from a few months ago. You can see there's sort of my headshot over on the left and then a somewhat more light-hearted picture up at the top for the header. Now once you've got your own account set up, the next step is to figure out who you're going to follow so you can actually start taking in some content. And, you know, we'd certainly recommend starting off with the basics. Look up the accounts for the AANS, the CNS, the Young Neurosurgeons Committee, the NREF. Pick the journals that you like, JNS and Neurosurgery, any of the other subspecialty journals, and obviously the panelists for this social media series via the AANS. And what I would make my next stop, and we'll look at this in a little bit more detail in a moment here, is if you go to the Young Neurosurgeons Twitter account, we put together a lot of lists that are going to sort of help curate groups of people who might be of interest to follow either on a subspecialty basis, a sort of socio-demographic basis, and then look at who your colleagues follow. And you can go to my account or the account of any of the other panelists here and take a look through their followers list to see if maybe there's anyone on there who you think their, you know, thoughts and opinions and shared content would also be interesting to you. And Twitter has a nice algorithm that will occasionally prompt you to say like, hey, here are some people you might want to follow, and that you can see in the screenshot on the right, or the two screenshots on the right, both of those have who to follow panels that are suggesting a variety of other neurosurgery-specific accounts that would, for this hypothetical user, certainly be worth looking into a little bit more. So here are the Young Neurosurgeons lists I mentioned. Once you go to the Twitter slash Young Neurosurgeons account page up on the top right, you see there's lists 13. So if you were to click on that, you'd then be able to scroll through lists that we put together of people who subspecialize in spine or pediatrics, neuro-oncology, etc. And this will help you parse neurosurgery accounts by a variety of parameters. There's also lists that are not seen in this screenshot that include the journals and societies, groups of staff and residents, medical students, patient advocacy groups, etc. So lists are a very helpful way to get started in terms of populating your own list of followed accounts. Now, once you've got some accounts you're following, your homepage will look a lot busier, and you'll see the content from all those different accounts that you've started to follow will show up in a sort of series list. And there's a few different ways to view this. You can set it up so that it sort of shows the highest impact content first, most engagements, or you can just have it present in a sort of standard timeline, you know, sequential format. That's obviously a matter of personal preference in terms of how you browse content on social media. And, you know, from this point on, if all you're following are other neurosurgery accounts and you're having a, you know, small list of followers that you've curated, the homepage may be perfect. You know, by contrast, if you end up following hundreds or even thousands of accounts, you may be very interested in making your own lists, or if you're managing multiple accounts, or if you have several different interests that you're maintaining at once, you know, say you're looking at some neurosurgery accounts, but also you have a basic science interest and you're following a bunch of immunology accounts, you may want to kind of keep those separate. And that's, again, it's a matter of sort of how do you want to take in the content and keep it organized for yourself. Now, engagement can be broken down into three basic core interactions that really define a lot of the, you know, user-to-user engagement on Twitter. So retweeting means that you send another user's post to your followers, and that can be either a simple retweet where you just say, hey everyone, look at this post, and it just automatically gets posted to your followers and they'll just see that you retweeted it or you can generate a Unique post where you would say something in that like hey guys check out this really great journal article I just read that I think is interesting because and then you know you'd fill in the blank there And it would have sort of nested within your commentary the original tweet The second way that you can engage with people is replying and this is someone else posts something say an article again And you can comment directly on their post and say like hey great work. Did you guys? Think about this and when you're doing the study design Or do you have a chance to this kind of analysis etc? and it's a way to sort of keep a discussion within a particular thread that's tied to the original post and then the sort of Lowest impact that you can do is you can like someone's post and that does two things one it You know gives that post a little bit of a boost by having another person say hey, I like this I think this is great, and it's also your profile page has a list of all the posts that you've liked on it So if someone wanted to go through and see everything that you liked It's a little bit sort of lower impact lower stakes kind of engagement than retweeting or replying, but still certainly important And so to walk you through what each of these engagements look like in practice The second button on any tweet that you would see in your home feed is the retweet button It's the one that looks like two arrows pointing towards each other in sort of a cyclical fashion Now if you just click on this You'll get prompted with a dialogue and one of the options will say just retweet to your followers And then each of them will see this exact tweet replicated in their home feed much like the one just below the one That's highlighted here where you see the use of Methodist MD post and at the top of that It says young neurosurgeons retweeted, so that's just a simple version the complicated version complicated version is If you were to click on you know add comment or add quote then this will send to your followers The Terry Burns tweet with whatever commentary you put on and you know great work love the article etc The second engagement we talked about is the reply functionality and that's the quote button the left side of the tweets in here in here and Again, that brings up a dialogue box where you can put in some sort of You know sentence or question or statement that will stay within the thread of the original tweet and anyone who's able to see that Because they follow Terry Burns would then also be able to see Your comment on it or your thoughts that you share there. They're there And finally sort of the simplest and you know most easy to understand Functionality is the like buttons when it looks like a heart, and you can see three other people who liked this tweet Once you've mastered retweeting replying and liking the next big step is to really start generating your own primary content and This can take a lot of different forms So you know one of the most common examples is you want to share a new publication you've written and maybe put a little Commentary or highlight together with that Maybe you've got a great case either You know some images in an e-case discussion Or there's an operative video that you want to share highlighting interesting patient or operation obviously in a HIPAA compliant fashion A tweetorial is a chain of posts that explains a more sophisticated concept and generally It's something that is a little bit too much information to pack into a single tweet But that wouldn't necessarily warrant an article or a longer format Exposition and then there's obviously promotional content Which is when you say hey check out this awesome thing that you know my colleague is doing that I really wanted to draw your attention to The next step in terms of going beyond is generating basic content is to really optimize your content and I wrote these four anecdotal truths of achieving Twitter Zen recently and So the first is that if you write interesting posts focused on your area of expertise The audience will find you and by that I mean you really shouldn't be dedicating time energy resources etc into garnering followers That's the wrong goal You know the point of being a neurosurgeon on Twitter is to try and put out more ideas Commentary content etc in the niche that you know better than anyone else and you know the Internet's a big place There's a lot of neurosurgeons out there if you're doing a great job generating excellent content You will accumulate followers very quickly, and you'll learn them The second is Twitter is a visual medium and by that I mean you never should put a post on Twitter And by that I mean you never should put a post up if you can avoid it Without involving either a photograph or a video or a diagram something that catches the eye And you know you'll note in your own home feed that you know If you can see 10 or 20 posts at a time and you're scrolling past them pretty quickly the ones that don't have visual content in them are Harder to notice you you know have to really make a directed effort to read them and you know you don't want something really interesting that you've worked hard on to get lost in the fray because You know our attention is is pretty easily grabbed by You know a nice looking picture and another post that's right next door The third is engagement begets engagement and by this I mean the more time you spend being a good steward a good colleague reading other people's content Retweeting it replying liking etc. The more likely those people are either you know because of both how the algorithm Will put your post in their feeds and also just the you know, basic human nature of you know feeling Positively towards, you know the content of someone who's been positive towards you You know all that pays dividends long term And then the last one number four is timing count and this is really sort of two concepts in one Um, the first is that you know if you're putting content out that is relevant to either a particular event like a meeting or Say a particular article coming online that you know You want to be a part of the discussion? When that event is the most salient, you know putting a bunch of posts up from a meeting a couple weeks later It's less likely to generate a lot of attention than if you're live tweeting from the event The second is that if you're putting together your own, you know Unique independent content and you want as many people as possible to see it You want to try and time your posts for you know The times of day when people are the most likely to be on twitter checking their phones, you know Early in the morning before the or gets started Or you know late afternoon early evening. Those are sort of the two big hot times and um There's some articles out there you can look into for some more details on how to you know Time your posts and schedule them in advance and so on So that covers the basics and now we're going to get into a quick handful of pro tips for the budding power user so The second is upgrading your interface. So there are a number of either Official or third-party platforms such as tweet deck hootsuite and twitter ethic That will let you either visualize multiple streams in parallel such as you know Your home feed or a list that you use or a particular hashtag that you follow as well as your mentions or your notifications and this is a Really important for people who are managing multiple accounts say a personal one a professional one or who are participating in the team Like we do for the jnss And so this is a tweet deck, which is one of the official twitter platforms And here you can see each of these columns pertains to a particular stream for my personal account at graphia So the one all the way on the left is the the list to neurosurgery, etc Then there are two different columns for notifications and mentions. So those are sort of different lower and higher profile Notifications that I want to you know hear about and then I help manage the accounts for the skull base society the young neurosurgeons group and so I keep those home feeds sort of at the ready as well and uh You know There's another probably 10 or so streams if you were to scroll over to the right here that i've found useful capacities The next pro tip is about hashtags which are a way to label content and include meta commentary Now in twitter more broadly. There's a lot of ways that hashtags have interesting uses that are worth investigating in your own time Within the scope of a neurosurgery account These are essentially ways to keep your posts organized to put tags in them that are going to help your followers and readers understand okay, this is a post that belongs to you know the general area of cerebrovascular neurosurgery or pediatrics or that This is a tweet that is part into a particular meeting i'm attending like, you know at the last cns meeting hashtag 2019 cns was the tag or The young neurosurgeons and ref group have a hashtag. Where's harvey that we use to signal the social media lab activities It's okay to be creative with these you can come up with your own in your own time. They're a great fun part of using twitter But it is also worth being aware that there are certain very high profile hashtags that are used and monitored by Groups that are Have a vested stake in certain controversies like the hashtag anti-vax tag for the anti-vaccine movement That may draw unwanted attention to your account. So user beware And here's a couple lists of some hashtags that I found very Useful both in my professional life and my you know, sort of personal life uh Multimedia integration is a very important prototype. This is the last one we'll cover in any detail today And like I said before, you know a post without an image a video or some other visually striking element will almost never attract attention So whenever possible think like a navy seal two is one One is none Um, it can be any kind of visual content obviously anatomy radiology pathology operative videos Those are the highest impact most likely to get engaged with options um they you know On both objective and subjective metrics score really well, but you know even just putting in a graphic Or something funny will get a lot more attention and a lot more engagement than just a wall of text So that really covers it for our pro tips other than to say there's a number of other great resources out there including the article I mentioned earlier in broker's area that the jns social media team put together. There's an nref educational video That's very similar to the content of this talk that you might find useful uh, the at young neuros twitter lists are a great place to start for finding followers and You know other great accounts that might share your interests and there's a handful of uh, older young neurosurgeon committee newsletter features that Really go in deep on various aspects of social media that you might find interesting and useful So i'm going to close by going through what I call the 10 commandments for twitter stewardship with a particular eye to people in Neurosurgery or medicine and these are ways to keep thyself out of trouble. So The first commandment is thou shalt not violate hippa And as in fight club, the second commandment is thou shalt not violate hippa I cannot overemphasize enough how much trouble people have gotten themselves in if you put patient Protected health information on the internet. It will have dire consequences for you Professionally, and it's obviously an ethical violation So please be very very careful to remove anything potentially identifying And if you're concerned that a case might be too unique to properly identify then just don't share it Number three thou shalt not tweet about political religious or other non-medical controversies Number four thou shalt imagine all posts being read aloud by thy colleagues partners patients chairs and mothers And keep you out of trouble Number five thou shalt consider all possible interpretations of thy words Though something that scans to you is very educational or innocent could taken out of context Could taken out of context Potentially offend someone you really wouldn't want to you know, read something the wrong way Number six thou shalt not fear taking a stand receiving criticism or engaging in debate but number seven Thou also shalt not wrestle with pigs. So it's okay to have some lively debate But if someone's just looking to pick a fight, you know, don't get down on the butt and wrestle with them Number eight thou shalt be considerate regarding the privacy of colleagues friends and families So, please don't share posts of people pictures of people information about people and their whereabouts if you don't have their permission number nine Thou shalt always consider the source before retweeting or replying and you know We've all been guilty of this once or twice You see something that at face value you think you agree with you quickly retweet it And then you realize that the account you are retweeting is actually tied to a particular Controversy that you might not want someone who's paying attention to your account to think that you are also tied to And number 10 thou shalt always be kind and really that's sort of the golden rule of all of these but Just a little bit of uh, you know Sort of summative advice to try and help you stay on the up and up in your twitter wanderings. Thanks So that wraps up things for the talk today. What do you do next? We'll set up your account asap Take a look at the mobile browser and desktop versions of the apps that are very helpful to start cruising content Check out the tags and lists that we've mentioned today And then start optimizing your username your photos the accounts you follow just like I mentioned earlier Um, go ahead and follow the double ans account the young neurosurgeons account, um, you know Follow me if you want and then I would start setting yourself some realistic posting goals a good way to to get your you know Twitter account off the ground is to say i'm going to make at least one post a week I'm going to make at least three posts a week something like that and then You know every day I want to find at least you know Two or three things that I think are going to be worth sharing with people following my account Or i'm going to reply to discussions on at least three different articles And again, don't forget as you go through and start making these posts visual content is key timing is key And you know if you're finding it hard to build this into your schedule It may be worth putting a you know, a one hour catch-up session somewhere in your week when you know You're going to have downtime although eventually, you know the walking down the hall the elevator ride the you know waiting for You know anesthesia to do their thing at the beginning of the case This is sort of a found time that makes twitter such an appealing and accessible way to Get involved with social media for a busy neurosurgeon And so hopefully we've gotten you from here to here And I just want to say thank you to the Young neurosurgeons double ans and session leadership that gave me the opportunity to present this as well as to acknowledge the excellent contributions of all the other co-presenters To thank all the organized neurosurgery bodies that have you know Allowed me to be so involved in their social media presences and empowered my own success in this space And of course my mentors and collaborators back home at Mayo Clinic. So I think that's it for today Hashtag where's harvey and thanks for listening. Bye

Twitter 101

Neurosurgery Social Media

Professional Presence Online

Academic Medicine

Real-time Engagement

Outreach and Communication

Power User on Twitter