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AANS Neurosurgeon | Volume 28, Number 4, 2019

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Podium, Pedagogy, Portal: Social Media and the Shrinking World of Neurosurgery

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Since the advent of “The Facebook” (as it was then known) in 2004, human communication has undergone a dramatic and rapid anthropological shift with worldwide impact. As of 2019, at least 69% of American adults reported using Facebook with 37% and 22% owning active accounts on the related platforms Instagram and Twitter.4 With the increasing gravity demonstrated by general and personal communications on social media-based platforms, a wide range of more niche sectors have developed robust social media spheres, including the academic, scientific and medical communities. This has resulted in twinned changes to the size and scope of our professional worlds: At once, the number of accessible colleagues has expanded exponentially, while the barriers to discourse have been lowered and the spaces for public discourse enlarged, ultimately resulting in perhaps a smaller yet more full “world” of neurosurgery online. As more institutions and individuals within neurosurgery join the conversation on social media — ranging from journals to departments, societies, practicing staff and trainees of all levels — the need for a shorthand understanding of what the platform provides in value to users has increased. With this in mind, neurosurgery social media serves three major functions for most users: podium, pedagogy and portal.

Podium

For individual users, the ability to widely distribute publications, ideas and other accomplishments on social media enhances visibility and elevates professional relevance. This has both soft benefits in terms of increasing readership and engagement, as well as hard benefits, such as increased citations.2 Using social media as a “podium” for disseminating work also helps by:

  • Potentially broadening one’s audience;
  • Identifying other leaders or stakeholders invested in similar areas-of-interest; and
  • Keeping abreast of pertinent news and discussions.

In their most elevated expression, these conversations translate into future collaborations as well as opportunities for personal involvement with related academic activities.

For neurosurgical departments and other larger organizations, social media provides the opportunity for promotion and professional development. However, rather than directing followers toward direct engagement, the targets shift to participation in society meetings, attendance at grand rounds or research symposia, promotion of training programs, simulators or courses and highlighting visiting professor events. Still other, more patient-centric goals include collaboration with advocacy groups, recruitment of patients to key institutional centers or practices and dissemination of information regarding clinical trials or other associated opportunities for advanced care.

Pedagogy

In its ideal expression, social media engagement is not only an opportunity to speak at the metaphorical podium and present one’s own ideas, it is an on-going discourse between experts, trainees and other interested parties, allowing unique opportunities for multidirectional collaborative learning and partnership. As most neurosurgical journals now promote their new content on social media, following such feeds will empower students and residents to:

  • Screen a larger volume of articles;
  • Note which are trending; and
  • Stay as up-to-date on the literature as possible — particularly given their typically limited time resources.

Similarly, expert clinicians and scientists with robust social media presences frequently host “Tweetorials,” or multi-post threads that highlight key lessons or teachings pertinent to their particular specialty that educate a wide swath of readers in a relatively short time. Still, other accounts emphasize high-yield content, focusing on such topics as neuroanatomy figures, operative videos, difficult patient cases or oral boards review, while institutional accounts frequently curate content emphasizing important aspects of patient education.

Of particular note, one of the many ways in which these features of social media have helped shrink the world of neurosurgery is related to their near-universal accessibility. With only access to a browser or mobile app, trainees, patients and the general public have immediate access to academic discussions that would otherwise be limited to the academy. This change is particularly emphasized in the context of providers practicing in low-resource environments empowered by social media participation to draw on resources and colleagues from around the world to improve care locally. Notwithstanding, even the relatively low barriers to participation in social media may prove insurmountable in the most strained of environments. Further, although access to educational resources is helpful, it does not immediately translate to the capacity to safely perform related procedures. While the rise of social media has decreased the distance between the highest-need global neurosurgery environments and the resources of the first world, work remains to be done to improve neurosurgical care and training worldwide.

Portal

While “pedagogy” speaks to the ways in which social media has enhanced education and associated resources for neurosurgeons and trainees, the “portal” it provides refers to the improved access and understanding of neurosurgery that social media provides for patients, families, advocacy groups, volunteers, philanthropists, interested students and other key stakeholders. In practice, this portal takes on a range of forms, largely dictated by the needs of the parties involved.

Perhaps the most important groups accessing neurosurgery via the social media portal are patients and their families who often rely on social media as the primary source of information regarding their conditions – often to an even greater degree than their surgeons. This practice is anecdotally widespread, with recent studies providing supportive evidence, as in a recent survey of caregivers of children with hydrocephalus, the majority of whom regularly use social media for hydrocephalus-related content.3 Similarly, patient advocacy and support groups are among the most prominent users of neurosurgery social media. Their role is particularly critical and well-served by the nature of social media, given their dual purposes of serving participants in the patient-physician dialogue. In this way, social media has markedly enhanced the ability of advocacy groups to bring together disparate individuals with uncommon diagnoses, limited means or disabilities in a way that promotes a sense of belonging, the formation of therapeutic peer relationships and a more unified voice to raise significant issues to the attention of the neurosurgical community.

By contrast, while patients are looking in, some neurosurgeons are also using social media to look outward, with a particular eye towards recruiting patients. A 2016 review of social media utilization in neurosurgery indicated somewhat surprisingly that private practices were responsible for the majority of institutional accounts in the U.S., rather than academic departments or other organizations.1 Although the nature of patient recruitment as more of an agenda in advertising than one of education or advocacy, this trend nevertheless highlights the influence of social media in the lives of our patients, and emphasizes the need to be thoughtful and open-minded as a specialty in determining how social media can best be leveraged to benefit patients.

Other groups benefiting from the portal into our world provided by social media include medical students, undergraduates, foreign research fellows and any other individuals exploring a possible interest in furthering their neurosurgical training, but not yet equipped to make a definitive decision. By observing and perhaps even participating in online discourse, exposing themselves to thoughtful leaders in the field and familiarizing themselves with cases, journals, and other academic resources, social media provides a much more rich landscape for understanding the terrain of neurosurgery than any other sphere, apart from a dedicated hospital rotation. Perhaps unsurprisingly, a wide range of interest groups have sprung up in association with the AANS and other neurosurgical societies or institutions; these act in parallel to patient advocacy groups in helping interested individuals connect with one another and with available resources before moving forward with a major life decision.

Conclusion

At its core, social media is human connection mediated by curated content. By providing wider access to that content and empowering broader connection of more disparate humans, including neurosurgeons, trainees, patients and innumerable others, social media has remarkably shrunk the world of neurosurgery and continues to reshape on a daily basis what it means to participate in the community of neurosurgery. The podium, pedagogy and portal it provides are core elements of its successful expression in neurosurgery; however, we are still in the relative infancy of the medium. We anticipate that the opportunities for enhancing education, collaboration and advocacy will expand exponentially in the future, potentially bringing the full breadth of the world’s neurosurgical diversity into your phone, your clinic, your lab or your OR. 

References

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1. Alotaibi, N. M., Badhiwala, J. H., Nassiri, F., Guha, D., Ibrahim, G. M., Shamji, M. F., & Lozano, A. M. (2016). The Current Use of Social Media in Neurosurgery. World Neurosurgery88. doi: 10.1016/j.wneu.2015.11.011

2. Eysenbach, G. (2011). Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact. Journal of Medical Internet Research13(4). doi: 10.2196/jmir.2012

3. Naftel, R. P., Safiano, N. A., Falola, M. I., Shannon, C. N., Wellons, J. C., & Johnston, J. M. (2013). Technology preferences among caregivers of children with hydrocephalus. Journal of Neurosurgery: Pediatrics11(1), 26–36. doi: 10.3171/2012.9.peds12208

4. Perrin, A., & Anderson, M. (2019, April 10). Share of U.S. adults using social media, including Facebook, is mostly unchanged since 2018. Retrieved from https://www.pewresearch.org/fact-tank/2019/04/10/share-of-u-s-adults-using-social-media-including-facebook-is-mostly-unchanged-since-2018/

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