My name is Joey Lindsey. I'm a neurosurgery resident at the University of Michigan. And first off, I wanted to thank the AANS and the Young Neurosurgeons Committee for giving me the opportunity to speak today about social media. The title of my talk is Twitter Tenets, a Step-by-Step Guide for Establishing a Neurosurgical Twitter Presence. This talk is meant to be the very basics, helping someone actually set up a Twitter account and then how they could begin to ramp up their Twitter presence to ultimately have a substantial Twitter following and interaction with the neurosurgical community. After that, I'll talk a little bit about some of the important reasons for setting up a neurosurgical Twitter account. As everyone knows, social media has continued and will continue to play a large role in both the public and academic medicine. Almost three quarters of the public use some form of social media. And social media has been increasingly popular among neurosurgeons, neurosurgery departments and societies like the AANS and the Young Neurosurgeons Committee, and journals like the Journal of Neurosurgery. Over the past at least three years, the studies were done looking at the last three years, but it's been going and increasingly popular. So ultimately, why should a neurosurgeon invest time, which is valuable, and effort into establishing and maintaining an active Twitter account? This is something that I was very skeptical of when I was a medical student and early residency. However, I think that it really is very important. For me, there are four main reasons to get on Twitter. The first is to be able to create and strengthen connections, which is particularly important if you are a medical student looking to go into neurosurgery or a resident hoping to build a career in academic neurosurgery. And for junior faculty who are again trying to establish themselves in a specific area within neurosurgery. Second, being able to establish a narrative and actively take control of your online presence. Third, the ability to educate both neurosurgical education, being able to talk to residents, medical students, other neurosurgery faculty, and the ability to educate patients about your area of expertise within neurosurgery. And then the dissemination of research, again, both your research and others that you're working with. So now to get started, again, we're going to start with the very basics, we're going to set up a Twitter account. The first thing you do is you go to Twitter.com, you're going to see this, and you're going to click sign up. So once you click on the sign up, you'll see this. This is where you put your name, which is what other users will see. You can add a phone number, date of birth. So I created a fake account, double A-N-S social media is what people would see. I used a fake email address, that's my real birthday. You can click next then. And from there, you'll then see this. You can click sign up. Pick a profile picture. This is something that is quite important, actually, especially if you're going to be setting up multiple accounts, whether it's a Twitter account, a LinkedIn account, other social media platforms. You want to be able to have a professional picture that's easily recognizable, something that you would find on a neurosurgical department website. You want it to also be the same picture across all of your social media accounts, so that people are able to easily link you with your different accounts, and you begin to set up your own personal brand and recognizability within the neurosurgical community. So making sure you have a good, clean, professional profile picture is imperative. The next screen that will come up is your bio, and different neurosurgeons have taken a wide range of interpretations on this. Some people keep the bio very professional and short. Some people add more personal details about themselves, and that will be completely up to your own preferences. So here we have a few examples of bios. We'll start with mine, and then go on to a few more well-known neurosurgeons on Twitter. So mine, very simple. I try to be professional. I'm a neurosurgery resident, so I wanted to keep it like that. Neurosurgery resident at the University of Michigan, social media editor for the J&S, alumnus of University of Michigan Medical School and Brigham Young. It's not very personal. It's just professional and simple. Dr. Lawton, neurosurgeon, innovator, author, teacher, president Baroneuro, co-founder of Mission Brain. He very succinctly pinpoints important things about who he is as, again, as a neurosurgeon, author, innovator. Dr. Jabbour, he adds some personal details. He has that he has a dog, certified level three sommelier. A number of examples kind of from the full gambit. Dr. Grafeo, so he has his 10 commandments for hashtag neurosurgery Twitter. The fact that he's been editor of social media for the J&S and the North American Skull Base organization. Again, one that has the full gambit for the fact that she's a skull base neurosurgeon and a residency program director for Vanderbilt, to the fact that she's a mom, a skier, a diver, an adrenaline junkie, the full gambit. So now that your Twitter profile is set up, you want to start following people. So you're going to come to a screen that looks like this. And in this search bar, you can begin searching for people to follow. So I began typing in AANS. You see the AANS main page pops up. You can click on that and go to their page. So this is the AANS homepage. You can see the description that they used. The American Association of Neurological Surgeons is dedicated to advancing neurological surgery and promoting the highest quality of patient care. You can decide to follow them by clicking this. So once you're following people, you start developing that network. You want to be in tweeting and participating in the conversation. So you're going to see this at the top of your screen. You can click in this area with the arrow. You have 280 characters to describe whatever it is that you're trying to communicate. You have a number of abilities to supplement and enrich just the text that you would be sending. The first one is with pictures or videos. You can click this icon and add those. You can add GIFs. You can add surveys, which can be helpful both in research or just getting a public opinion on a procedure or a research article or a thought that's prevalent within neurosurgery. So for tweeting, you can put an at sign and someone's handle. So for example, the handle for the JNS is at the JNS. When you put a person's handle into a tweet, it calls them into the conversation. You can also, in the body of a tweet, use a hashtag, which is the pound sign. And that is a link which will link you in to the larger conversation happening on Twitter. So anyone who uses the hashtag, for example, Neurosurgical Atlas, if you click on Neurosurgical Atlas, all tweets that were recently sent out with the hashtag Neurosurgical Atlas will be displayed. And you're able to then look through those and interact with that content. So within the neurosurgical sphere, again, there are a lot of disease specific hashtags, hashtag AVM, hashtag complex cranial, hashtag spinal. Those are all ways to bring your tweet into a larger conversation and also to be able to read what else is going on in those content areas. Again, when possible, include pictures, include videos, and that will increase those posts popularity and ability to get disseminated. So this is an example of a tweet from the JNS. So they're using a hashtag free article and they have a picture. They have a link. Towards the journal article and you can interact with it. So the first thing you can do is you notice a few things, a few bubbles at the bottom of the screen. The first one allows you to reply to a post. The second one allows you to retweet it. So this is, in a sense, sharing the tweet and you can either just share it without any comments. And it will appear on all the people who are following you on their Twitter feeds, or you can decide to retweet a post with. A comment and that will put a comment on top of the initial tweet that you can then describe your thoughts or feelings or reactions to the current tweet, and then that will go out to your followers. And then probably the least committal is to just like something and you're able to like it with by pressing on that. So for this tweet, I both retweeted and liked it. You can see the retweet icon has turned green and the like the heart icon has turned red. Now, you can also send people direct messages. So this this bar will be on the left hand of your screen. You can send someone a message that only they see. So some tips and tricks, again, we talked about this a little bit earlier, using the same professional photograph across all social media platforms. It helps, I think, especially if you're new to Twitter and social media, to begin by following large governing organizations or journals. You're following the AANS, the JNS, Young Neuros is the Young Neurosurgeon Committee Twitter feed. And this allows you to not only begin getting general information, but you can look at who those people are following and who is following them. And it's a great directory for all the people that you likely will want to be following because of the shared interests. Once you have set up your account, I think it's really important to have some habit of daily interaction with Twitter. So you want to begin interacting with a piece of content daily. So liking something, looking through your feed and retweeting something. Your ultimate goal, though, is to be generating, I would say three to four original posts per week. Some people are gonna be more prolific, some people will be less, but having three or four original posts per week where you are able to discuss, send out an article that you recently had published, being able to send out an article that someone that you're mentoring recently published or an interesting case that is de-identified. Typically, you can do all that within just spending 10 or 15 minutes per day. It doesn't have to be a 10 or 15 minute block, it can be something that is interrupted as you're walking down the hall, spending a minute here, a minute there. But typically if someone spends 10 or 15 minutes a day on Twitter, you're able to develop that daily habit of interaction that allows you to be present on Twitter. Going back to these four reasons to get Twitter, connections, narrative, education, dissemination of research. I wanted to go into each of these individually. So especially for residents and junior faculty, the ability to follow and learn from any neurosurgeon, you're able to break through any kind of geographic barrier and ultimately neurosurgery is very hierarchical and it's sometimes difficult for a resident to be asking direct questions to a chair or a program director, especially at a institution outside of their own. But Twitter allows you to follow anyone, they're under no obligation to follow you back and so you can hear their daily thoughts, the research that they're doing and Twitter at its base flattens that hierarchy and allows you to begin interacting with people, expanding your set of connections outside of just your institution. You're able to, as a resident, begin interacting with people that you wouldn't be able to interact with until fellowship or much later on in your career, with masters in the field in very low stress environments. And even as a resident, you're able to begin mentoring younger residents, upcoming medical students who are interested in neurosurgery and begin giving back as many people will do for you within Twitter. And I think something that can be very beneficial is using these online connections to kind of establish some connections outside of your institution that can then be strengthened during the in-person annual meetings in the future. Again, using those easily recognizable profile pictures, you're able to have people recognize you and it's very easy to start up a conversation. Hey, I follow you on Twitter and it's an easy icebreaker and something that you can begin using to start expanding your network. Establishing a narrative. So especially in this era where the average patient is going to Google their surgeon and your name is just gonna go into a Google search engine, it's really important that the first few things that pop up are establishing your expertise and dominance in your field of expertise. And having a strong social media presence with, again, these curated professional pictures allows patients to immediately see that you are an expert in your given field. So I think it's really important to be able to begin to develop both individually and as departments, your unique and professional narrative. Be able to find a niche within neurosurgical social media, whether it's posting really high quality, de-identified educational cases or intraoperative videos, high quality studies from important journals. These are all things that you can do to not only build your brand as an expert, again, within a specific area within neurosurgery, but begin to develop a following of medical students, residents who begin relying on your posts for education and for extracurricular knowledge about neurosurgery. It turns it into a much more fun learning environment. Neurosurgical education. So in our world, so much is turning into digital education and the ability to easily produce digital lectures, setting up online journal clubs through Twitter is something that is very common, especially among journals. Podcasts, again, these interesting case series where you're able to talk someone through maybe the radiology of an AVM and how to do a Spetzler-Martin grading. And then the next day to be able to walk them through some intraoperative decision-making, then the next day to be able to show them some research that you've found or that you've published about AVM resection and the ARUBA trial and all of these, this can be something that is day-by-day built to educate those around us. Video repositories like the Neurosurgical Atlas, the Surgeon's Armamentarium, Nexus, these are all opportunities to not only just disseminate work that's already done, but to continue to contribute to it. Patient education. Again, patients are turning to Google, to social media, to not only learn about diseases and who better to learn about the diseases from then neurosurgery faculty and residents who live and breathe those pathologies, but they also turn to social media to obtain a community. There's been a number of studies looking at how patients use social media to find a community of people who have suffered from a stroke or a subarachnoid hemorrhage or who have a brain tumor. And those are also great ways to advocate for those patients, to show them support, and to find different channels for continuing to help patients even outside of the hospital. And last, research dissemination. So this allows you to be able to highlight your own and others' research efforts. You're able to use social media and Twitter specifically to get your message, your results, out to the neurosurgical community in a timely, effective manner. You're able to begin to control the conversation that happens around your research. You're able to push past the boundaries of print publications, which are stagnant, and begin actually communicating with individuals about your research. You're able to use the retweets and the replies to answer questions directly about your research, to be able to promote different areas, different graphs, or different figures from your research in a very, again, timely manner that doesn't need to wait for the research to be published in print. And ultimately, this will lead to increased visibility and thus impact for your research. When you publish an article, the actual dissemination of it is confounded by a few things, that particular journal's visibility, its impact factor, the journal's accessibility to other people in your field. However, when you are taking control of that with social media, you're able to promote your research and your articles however you see fit. You're able to create a social media buzz which causes public attention, and ultimately can cause public change and ideally change within the scientific community. That change, in theory, will elicit increased citations because as that social media buzz surrounds your article, it's on people's minds and thus will be cited more frequently. As a way to measure that social media buzz, a new scoring system called Altmetrics was developed in 2010. Now this is in contrast to traditional bibliometric factors, but this particular metric measures a research article's impact by the article views, article downloads, bookmarks or shares, mentions in blogs, Wikipedia articles, and even shares on social media platforms like LinkedIn, Twitter, Facebook, Instagram. And this is an increasingly popular way of measuring an article's impact, a real-world impact that is being seen by a large community. Social media can be a wonderful tool. As with all good things, there are cautions. First and foremost, as physicians and as surgeons, we have to protect our patients' confidentiality. At all times, HIPAA must be strictly observed. It's important, it's imperative to always de-identify pictures or videos that involve patient care, in addition, the text, the companies, the pictures and videos should never be able to be linked back to a person. So HIPAA is always important. It's important to maintain professionalism, both with how we interact with patients and how we interact with each other as colleagues. It's important to also remember that anything posted online is there forever, even if a tweet is deleted, it's possible for people to screenshot it. Just assume that anything that you write on Twitter or any social media platform is there forever. Christopher Graffeo in his 10 Commandments of Hashtag Neurosurgery Social Media said that one of his commandments is to make sure that anything you post, you'd be comfortable rereading, you'd be comfortable rereading with your mom standing over your shoulder. And I think that's a great tenet to live by. Additionally, I personally try to avoid political or overly divisive or contentious topics. That's something that is more up to the user, but that's how I've tried to maintain a professional account. And it's also important to always carefully read articles or posts before commenting or interacting with them. I've made the mistake personally of quickly reading through an article and missing a point, but commenting on it and getting called out by some colleagues, letting me know that what I had said was inaccurate with the results of the study. So again, it's important not to be sloppy with your social media use, but always carefully read everything that you're posting and putting forward, because again, going back to the third thing in this list, anything posted online is there forever. So be careful. So in conclusion, social media is increasingly popular, both in the public and the neurosurgical community. And ultimately, if it's used properly and responsibly and professionally, I truly believe that it can help a neurosurgeon strengthen connections, establish connections, create a strong personal and departmental narrative on who they are and where their expertise lies, educate both neurosurgery residents and the public, and then disseminate research to increase the impact of it and to help support those that perform the research with you. Thank you so much to the AANS for this opportunity to give this lecture, to talk about Twitter.

Joey Lindsey

neurosurgery

Twitter

social media

connections

professionalism