How Twitter has connected the colorectal community

Social media has revolutionized contemporary communication allowing billions of people to rapidly interact and share experiences and knowledge. It has been stated that social media is an increasingly “necessary component of surgery practice” [1]. While the adoption and utility of Twitter in various medical and surgical specialties have recently been realized, studies among colorectal surgeons in the UK report adoption rates which lag behind those described in other specialties [1–10]. This underutilization represents a potentially missed opportunity for colorectal surgeons to engage, debate, and dialog with one another, their patients, and the general public in real time, on a global scale. This article serves to outline ways in which colorectal surgeons can use Twitter to learn from and engage with fellow colorectal surgeons, patients, and other key health stakeholders worldwide. It also introduces the goals of the journal’s Twitter account, @TechColoproctol.

While Facebook and LinkedIn are useful for established personal and professional networks, Twitter, given the unique functionality of its platform, is particularly useful in academia, specifically for expanding one’s network as well as conducting and disseminating research (“Using Twitter in academia - Emerald Group Publishing.” 2015. 10 Jul. 2016 http://www.emeraldgrouppublishing.com/about/pdf/twitter_academics.pdf) [11, 12]. Referred to as a form of “microblogging,” Twitter allows users to send and read short 140-character messages (i.e., Tweets). Tweets can include links to online resources, images/pictures, short videos/multimedia, and interactive polls. Users subscribe to others’ tweets by “following” their user accounts; all Twitter accounts are unique, starting with the “@”character. In addition to posting original content, users can retweet others’ tweets, “like” them, and reply to them.

Hashtags (#) serve as keywords and phrases, making them easily searchable and thus more likely viewed by a larger audience than one’s followers. It is important to note these hashtags commonly generate international participation. The ubiquity of the Internet allows hashtag communities to transcend geographical and temporal boundaries. Using Twitter and particularly with the aid of hashtags such as #colorectalsurgery, #colorectalcancer, and focused conference hashtags, colorectal surgeons worldwide can readily interact, disseminate research, and educate the general public (Table 1).

Table 1 Relevant hashtags in colorectal surgery

Medical conferences, through specific event hashtags and live tweeting [13], have increasingly adopted Twitter to amplify the content of scientific meetings [14]. For example, live congress tweeting at the American College of Surgeons 2015 Clinical Congress reached over 55 million impressions on Twitter from 15 thousand tweets, with nearly 3 thousand participants tweeting its hashtag #ACSCC15. These numbers in themselves are noteworthy, but their significance is further highlighted when compared with the 2013 Congress, when the hashtag #ACSCC13 obtained 5 million impressions from 3000 tweets of only 200 participants [15].

The social media movement, #ILookLikeASurgeon [16], illustrated that Twitter engagement could mobilize a critical mass of surgeons on an international issue. Recently, a group of Twitter-active colorectal surgeons put forth the #colorectalsurgery hashtag to collate tweets related to colorectal surgery [13]. Launched on April 24, 2016, this campaign has united diverse international population and has been successful in gaining rapid adoption and consistently high levels of engagement. By using the hashtag, users share scientific ideas, research, concepts, and publications in colorectal surgery with a global audience. In the 16-week period since launch, #colorectalsurgery has linked tweets from more than 1200 individual accounts, who have tweeted more than 8200 tweets, resulting in more than 25 million impressions.

Other hashtags serve to unite key online communities of relevance to colorectal surgeons. Hashtags such as #StrongArmSelfie, promoted during Colorectal Cancer Awareness Month, allow surgeons to engage the public, connect with patients, and promote public health. Other campaigns provide a locus for carers and patients to find support or information about chronic colorectal diseases, such as the #getyourbellyout campaign to destigmatize inflammatory bowel disease and stomas. Following and actively engaging with charitable organizations relevant to #colorectalsurgery such as @Bowel_Cancer_UK and @CrohnsColitisUK among others provides users with a platform to dynamically interact with patients and the public. This also serves to ensure the information being disseminated is accurate and contributes to patient education.

Twitter is increasingly being utilized to recruit participation in clinical research in colorectal surgery. For example, Twitter has proved to be an indispensable tool in the development of the student- and trainee-led EuroSurg (@EuroSurg) collaborative, which includes more than 100 European Universities. The collaborative, supported by European Society of Coloproctology (ESCP) and the Italian Society of Colorectal Surgery (SICCR), is running its first study on patients with colorectal diseases (EuroSurg-1) [17], which has enrolled more than 3500 patients from a wide range of European countries. The ESCP also has a specific Twitter account (@ESCP_studies) dedicated to publicizing and informing followers of the various pan-European studies promoted by the Society.

Most colorectal journals now have Twitter accounts (see Table 2). The impact of social media in publishing is demonstrated through “Altmetrics.” Altmetrics are a measure of how many people have been exposed to and engaged with an article as well as a measure of dissemination, and it provides an indication of the impact and influence of the article. These are based on discussions on online blogs, mainstream media coverage, bookmarks on reference managers like Mendeley, and mentions on social networks such as Twitter (“What are altmetrics? – Altmetric.” 2016. 10 Jul. 2016 https://www.altmetric.com/about-altmetrics/what-are-altmetrics/). In this way, Twitter is becoming key to expanding and measuring the reach of research by the modern academic surgeon.

Table 2 Essential Twitter accounts in colorectal surgery

Moving beyond predictable tweets with links to recent journal articles, many journals have published social media strategies and social media editors [18–21]. Techniques in Coloproctology started its Twitter account in June 2015 and accrued more than 400 followers in the first year. To date, tweets have consisted mainly of journal content, with no retweets or engagement through “replies.” The account is managed by a social media coordinator, who receives approval from the editor in chief prior to all tweets. In coming weeks, the journal plans to increase its tweet frequency and broaden the content of its tweeting follow more colorectal surgeons and other colorectal-focused Twitter accounts and increase engagement with its followers.

Additionally, the account aims to increase the journal’s visibility through three main goals:

• 1. Disseminate content, expanding the reach, and impact of individual articles beyond the journal’s traditional readership.

• 2. Encourage interactions between current authors and readers in real time.

• 3. Share opportunities from the surgical societies represented by Techniques in Coloproctology (Table 3). These include courses, congresses, campaigns, and clinical trials.

Table 3 Surgical societies represented by Techniques in Coloproctology

Social media offers many benefits to surgical education and practice. The key qualities of this technology include content that is constantly updated, ubiquitous accessibility, and a diverse user population. Harnessing knowledge and expertise on a portable device with a dynamic platform such as Twitter enables colorectal surgeons global access and the ability to interact with experts, peers, and patients. This enables discussion and debate about the science of the profession and the art of surgery. It allows for collaboration among surgeons who are able to bridge distances and learn about developments and surgical news in real time (see Table 4 for tips for effective tweeting). #Colorectalsurgery has established itself as a collaborative, dynamic, and global network of colorectal surgeons further enriched by every participant that joins the conversation.

Table 4 Tips for effective tweeting