Social Media Best Practices

5. GOALS AND BENEFITS OF USING SoMe IN UROLOGY

5.1. Increasing public awareness

Health campaigns on SoMe platforms can help disseminate information about health issues and promote support for action. SoMe platforms can serve as powerful communication vehicles that can be used to expand visibility and increase knowledge among the public from a local to a global community [36]. “The Ice Bucket Challenge”, a campaign that went viral in 2014, raised an estimated USD $220 million worldwide for amyotrophic lateral sclerosis. This campaign consisted of sharing videos and photos on SoMe of a bucket of ice water being poured over a participant’s head, either by another person or the participants themselves, and encouraging donations to an ALS foundation, while nominating other people to repeat these actions [37]. On the other hand, SoMe engagement with health campaigns may not always progress in the direction one may want. Taking the example of Movember – an annual event involving men growing moustaches during the month of November to raise awareness of men's health issues – it was observed that a large amount of SoMe posts focussed on non-health-related topics such as moustaches and grooming [36, 38-42]. Another example is the concept of ‘Cancer Awareness Month’, which has been popularised over the past several decades. A study evaluating internet traffic during a ten-year period (2010-2020) revealed that public interest for a number of cancers was significantly higher during their designated awareness month compared to the rest of the year [43]. One unique characteristic of SoMe is that information can be targeted towards a specific group or audience. A Facebook SoMe campaign in Australia, for example, increased recruitment of unvaccinated women for a study into HPV vaccine effectiveness from 19.3 to 50.4% when targeted advertisements directed at non-vaccinated females were used instead of generic women’s health advertisements [44]. Similar strategies have been used to increase attendance at informative sessions on various urological topics and campaigns have been used to call for living donors or to improve cancer screening engagement [45-52].

5.2. Public education

In recent years, SoMe has been one of the fastest growing means of interpersonal communication. The use of SoMe for educational purposes is not reserved just for medical professionals but is also used by the public to share and obtain urological information in an easily accessible and understandable format. SoMe has become an integral part of medical education for patients [19, 53-55]. The role of SoMe in urologic medical education has been amplified by the COVID-19 pandemic. Its utilisation has been expanding, making it very valuable for patient education [54]. In this context, when clinical rotations were paused, SoMe became an important means to continue resident and student education [56]. Multiple lecture platforms are available across a wide range of media that facilitate both general urology education and discussion of more specialised topics [57-59]. Patients who are better educated about their medical condition are expected to have better compliance with treatment and therefore better outcomes [60-62]. In this way, SoMe can therefore facilitate this doctor-patient relationship [63].

In the field of urology, an analysis of online discussion forums on erectile dysfunction found that only 28% of people who participate in anonymous forums end up seeking professional medical advice; and young men often begin their search for answers to medical questions in online chat rooms [64]. Previous studies demonstrated that the use of SoMe and the availability of adequate and truthful information to patients can make a difference in patients’ engagement with medical care [65, 66].

In summary, although the use of SoMe in education entails risks, the opportunities it offers to the field of medicine are incredibly valuable and have already been demonstrated in the field of urology. Future research should focus on ways to maximise these medical education efforts, minimise risks and increase guideline awareness among users.

5.3. Telemedicine

Telemedicine is defined as the use of medical information exchanged from one site to another via electronic communication to improve a patient’s clinical health status [67]. Telehealth, in comparison, refers to any health care activity performed via telecommunication and is a combination of both telemedicine and remote nonclinical services such as provider training, meetings and medical education [53, 68]. Prior to the COVID-19 pandemic, the main motivation for telemedicine was to increase access to health care for certain groups of patients (e.g. military personnel and people in rural areas) [69]. The COVID-19 pandemic has triggered the use of telemedicine with the aim of offering health care services without the need to expose patients and physicians to the unnecessary risk of infection [70, 71]. A German study of 400 patients showed that approximately 95% of the patients were at increased risk of a severe COVID-19 outcome and that 85% of them favoured telemedicine consultation during the pandemic [72]. The availability of social networking platforms and the broad use of electronic devices has made telemedicine feasible for most patients. Telemedicine has been successfully applied to the management of various urological conditions [73-82]. The practice of telehealth has now expanded to include a wide range of activities, such as live videoconferencing, asynchronous transmission of recorded data, remote patient monitoring and mobile health [70].

The European Association of Urology has provided recommendations for professional use of telemedicine [53]. Physicians should learn how to manage telemedicine platforms and tools that allow communication with patients, communication with other team members, and safe data sharing. Patients should be provided with convenient methods for scheduling visits and easy access to urgent consultations. A quiet and private environment should be ensured during video consultations, and physicians must maintain professionalism throughout the consultation. Even when video consultations are not available, simple phone calls may be considered during a pandemic emergency. Hospital phones should be used for formal phone consultations. Triage of patients should be performed according to the patient’s clinical conditions. Constant communication must be ensured with the team during a televisit. Physicians should also check local regulations prior to adopting telemedicine. Regulations on privacy and billing issues should be complied in accordance with local regulations. Self-discipline is important when working from home, and an undistracted environment should be ensured to allow good working efficiency. Beyond the COVID-19 pandemic, the use of telemedicine is likely to continue, and physicians have the obligation to ensure delivery of high-quality and proper healthcare services through telemedicine platforms.

5.4. Virtual and hybrid conferences

Congresses have been and continue to be crucial to education in urology, and SoMe has created an effective medium for active and live participation in conference-related discussions. Urologists use this convenient tool to participate in, and share information related to, the congress with people who are or are not in attendance. Using the congress hashtags on X, all discussions related to a congress can be saved, which enables data collection and further analysis [14, 83, 84].

Online platforms have also opened the door to virtual conferences. During the COVID-19 pandemic, many in-person conferences suspended and were conducted entirely virtually [54]. For this reason, it was crucial to continue learning and sharing knowledge through virtual platforms [85], including social networks such as X, Facebook and Instagram, as well as urological webinars organised by the various associations [2, 15, 20]. After the COVID-19 pandemic, a hybrid conference (i.e. combining physical and virtual aspects) can be considered to maximise international networking and improve conference access globally. Additional costs, however, must be considered when adopting such an approach.

For large meetings, a formal organisation through professional companies is encouraged. For smaller-scale meetings, multiple platforms are available for creating webinars and conferences. These include GoToMeeting, GoToWebinar and GoToTraining, which enable users to organise webinars, meetings and virtual conferences in a relatively simple way. However, live broadcasting can also be done through other simple online applications and platforms such as Facebook, Instagram or Zoom, which are also potential options for broadcasting a video conference.

5.5. International networking and enhancing collaborative research

SoMe offers tremendous potential for information dissemination and professional exchange among urology stakeholders [86]. Wilkinson et al. reported that 4,663 tweets were sent during the peri-conference period of the annual American Urological Association conference, totalling more than 8.6 million impressions [87]. The past few years has also seen a significant increase in the use of X at these gatherings, with a tenfold increase in usage at the European Association of Urology conference from 2012 to 2014 [87]. X is a very powerful tool for amplifying the content of scientific meetings, and its use has been widely embraced by the urological community, enabling “augmented” experiences for attendees and remote participation for those unable to physically attend a particular meeting [87].

SoMe platforms can also facilitate collaborative research work globally. The British Urology Researchers in Surgical Training Research Collaborative (BURST) is an excellent example of using the SoMe platforms to improve global visibility, recruit new potential collaborative study sites, improve site engagement, and disseminate research findings [88]. Within an enrolment period of 13 months [89, 90], the investigators were able to recruit more 10,000 patients from 110 hospitals across 26 countries. Recognition, regular feedback, as well as raising the profile of individuals / institutions contributing to such projects are ways to incentivise further collaboration [89, 90].

The use of surveys specifically has also increased during the COVID-19 pandemic [91, 92]. While surveys were conventionally disseminated via email, SoMe platforms are increasingly used for this purpose. The major advantages of SoMe-based surveys are convenience, flexibility of survey design, relatively low cost, anonymity of responders, and the ability to reach a broader population of responders across geographical borders [91, 92]. Special precautions must be taken, however, to avoid potential problems such as consent incompliance, data disruption and response duplication [91, 92].

The use of SoMe platforms may also offer reputational improvement at a departmental level. A study showed that U.S. News and World Report (USNWR) reputation scores for urology departments significantly correlated with increased X impact and activity. With the main objective of enhancing exposure and reputation within the urologic community, many tweets related to conferences, publications and other academic activities [93].

5.6. Dissemination of research findings

SoMe offers a very convenient and user-friendly way to share and to follow the latest research findings, tailored to your own particular interests [94]. SoMe platforms gathers all relevant parties in one place, such as healthcare professionals from various disciplines, scientists, patients and public stakeholders [95]. The use of SoMe enables more rapid dissemination of data, increases visibility and positively affects the impact of research findings.

With the advent of SoMe, the historical methods of disseminating research findings through journals or congresses has undergone a drastic change. In the past, one had to physically attend a conference or read the literature in detail to stay up to date. Nowadays, novel use of SoMe platforms allows dissemination of key research findings in a snapshot. The same trend is seen in academic urology journals as well, where X is used to share the latest publications or updates about the journal itself [96]. Visual abstracts on X appear to generate more attention than non-visual abstracts, as was reported by Koo et al., [97]. They found that, prior to the introduction of visual abstracts, tweets about research articles averaged 1,672 impressions, 25 engagements and 13 website visits to the full article, while after the advent of visual abstracts, tweets reached 2,197 impressions (a 31% increase), 63 engagements (a 152% increase) and 21 full article visits (a 62% increase). Previous studies investigated the influence of SoMe usage on subsequent publication and citation status. Koo et al. found that content with greater SoMe activity resulted in publication in journals with a higher impact factor and more citations [95, 98-101]. Darling et al., investigated the scientific publication cycle, highlighting the benefits of early-stage professional networking and rapid dissemination through SoMe. The results of their study showed that researchers active on SoMe were followed on X by an average of seven times more people than the number of members of their academic departments. Articles that are widely tweeted in the first several days after publication have been shown to be 11 times more likely to be traditionally cited up to two years after publication [102]. SoMe platforms have also changed the way researchers discussed and critically appraised research papers. Online journal clubs using X have increasingly been utilised to overcome the limitations of traditional journal clubs in the urological field. Examples include ‘#urojc’ and ‘#prostatejc’ on X [95, 103]. These journal clubs select recently published relevant papers and organise a 48-hour online debate on the subject to allow global participation by various parties related to the topic. In this way, the limitations in space and time of a classic journal club are overcome and a more inclusive debate on the most recent research findings can take place.

A systematic review investigated the impact of SoMe on clinical practice guideline dissemination and implementation [104]. The study found a significant improvement in knowledge, awareness, compliance and positive behaviour towards clinical practice guideline with the use of SoMe dissemination compared with traditional methods [104]. A pragmatic approach to a successful SoMe campaign include four main steps: 1) formation of a SoMe panel or recruitment of professional marketing consultancy, 2) pre-intervention planning to set key objectives and identify target population, 3) multi-level and phased SoMe campaigns, and 4) post-intervention feedback and assessment [104]. Such an approach would guide physicians to disseminate clinical practice guideline in a more effective manner.

5.7. Professional training and career advancement

SoMe represents a convenient, accessible, low cost and immediate tool for surgical training, teaching and knowledge dissemination. SoMe allows connection in real time with colleagues, residents and fellows, with the aim of sharing knowledge and improving patient outcomes. As surgical practice is changing rapidly and facing new challenges, SoMe is a valuable tool to create opportunities for training and career advancement [105].

A virtual, web-based approach is an option for continued medical education (CME) and even for the education of urology trainees, where virtual urology training programmes have been set up to cope with the reduced exposure users may experience in times of pandemics (less face-to-face contact with patients, less surgery, the need to rotate on disciplines beside urology due to understaffing, etc) [106, 107]. A study conducted by the European Society of Residents in Urology (ESRU) [15] analysed all SoMe platforms used by urology residents for educational purposes with a 20-item online survey. The study, conducted in 23 European countries with 316 respondents, showed that SoMe was the third most important educational source (after academic journals and websites) for urology residents, with YouTube being the preferred tool for surgical technique videos. Prior to the development of the internet, acquisition of new surgical skills was often based on lectures or live surgeries with a “master-apprentice” model [15]. Nowadays, surgical videos are widely available on SoMe platforms and are readily accessible by urologists in training. It is important to investigate the educational value of surgical videos on the YouTube platform. A previous study showed that YouTube videos on laparoscopic and robotic/robot-assisted radical prostatectomy can be of high quality [108]. Crisostomo-Wynne et al. [109] compare the quality of robotic prostatectomy surgical videos on YouTube with more curated, professional sources using the Global Evaluative Assessment of Robotic Skills (GEARS) criteria. According to the results of the study, the authors found no significant difference between overall GEARS scores between the YouTube videos (mean 24.8, SDEV 1.85) and the AUA Surgical Video Library (mean 24.3, SDEV 6.18) (P= 0.78) [109]. However, quality of surgical videos on YouTube varies, and we must be aware of the potential pitfalls. The study by Haslam et al. [110] characterised the available paediatric robotic pyeloplasty videos on YouTube and assessed for conformity to LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS). According to the results, the most viewed videos were not associated with higher conformity to LAP-VEGaS. Although young surgeons prefer YouTube videos as educational tools, very few high-quality educational movies are available currently on YouTube, because videos are frequently missing crucial procedural domains and show little adherence to LAP-VEGaS standards [110]. Similar concerns were raised concerning other surgical videos on Thulium Laser Enucleation of the Prostate (ThuLEP) [111], Tension-free Vaginal Tape Obturator (TVT-O) and Trans-Obturator Vaginal Tape insertion (TOT) [112]. YouTube videos may be deficient in the explanation of critical steps, the key points of patients’ perioperative management and the application of auxiliary teaching tools [112].

COVID-19 had a huge impact on urology residency programs, and the recruitment of new urology residents suffered from pandemic restrictions. Clinical rotations were cancelled, interaction among medical students and urology trainees or faculty was affected, and little to no opportunities were available to demonstrate interest in the field or in a certain urology training programme [113-115]. Subsequently, we noted an increasing utility of SoMe in urology training programmes [113, 114] and among urology applicants [113], again reflecting the value of novel technology and SoMe. This was nicely illustrated by Ho et al., who carried out a survey study on the use of SoMe among applicants for their urology training programme and compared the pre-pandemic results to the results during the COVID-19 pandemic [113]. They results of the survey study showed that the use of SoMe for professional purposes increased significantly in the pandemic cohort compared with the pre-pandemic cohort (80% and 44% respectively, p < 0.001) and that half of the pre-pandemic applicants did not have an X account, whereas in 2021, 45% reported using X at least once a day [113]. Additionally, online connections with residents more than doubled in 2021 compared to 2018/2019 (respectively 69% and 34%, p < 0.001), while connections with faculty members increased by more than fourfold (respectively 65% and 15%, p < 0.001) and connections with program coordinators increased by more than ninefold (respectively 37% and 4%, p < 0.001) [113]. Of the 80 survey respondents in 2021 who reported using SoMe, 74% reported that application changes due to the COVID-19 pandemic directly caused them to increase their SoMe use [113]. On the other end, the median percentage of programmes reporting having SoMe resources available increased from 26-50% in 2018/2019 to 51-75% in 2021 (p < 0.001) [113]. The proportion of applicants who found SoMe to be useful when deciding whether to apply to, whether to interview at and how to rank a particular programme were also significantly higher in 2021 than in the pre-pandemic cohort [113].

Regarding surgeon’s reputation among the public, it was well noted that health care consumers are able to identify surgeons by watching videos of their operative technique [116]. Urologists are also able to increase the exposure of their professional practices using SoMe platforms [117]. Houman et al., [117] showed that the number of prostatectomy procedures is linked to urologists’ usage of SoMe, particularly YouTube. Patients might be more likely to recommend and select subspecialist urologists who publish videos of their surgical procedure, even though the majority of urologists are not currently active on SoMe.

5.8. Providing a common platform to address urological topics

SoMe is a multidirectional communication tool on which users from various backgrounds can instantly engage in conversations and raise concerns about a topic of interest and that has changed the health communication paradigm. The introduction of hashtags, a short word of phrase preceded by a hash (#) symbol, has been very useful for categorising and filtering posts related to a specific subject. Hashtags have been used by both health professionals and patients to find a communal place in which to interact [45]. In December 2018, the hashtag #UroSoMe was inaugurated, and people were encouraged to use it when posting urology-related content. The hashtag was well received by the urological community, with more than 1,000 original mentions and 17,000 retweets within the first month of its implementation [118, 119].

The online fora hold on SoMe facilitate interaction at numerous levels. An analysis by Grabbert et al. of six functional-urology hashtags on X (#Incontinence, #InterstitialCystitis, #OAB, #FPMRS, #BPH, and #UroBPH) found that the hashtags were used mainly by health professionals (44.6%) and health care organisations (36.5%) to debate and share experiences about these conditions [120]. SoMe is also a useful platform where both health professionals and patients can meet to exchange views, identify needs and provide quality information. In 2018, the journal Kidney International Reports, in observance of World Kidney Day, organised and moderated an event on X consisting of a one-hour online discussion in which physicians, patients, editors and medical societies discussed kidney disease and related conditions in women [121]. The hashtag #Bedwetting is officially used to discuss this condition, its diagnosis and treatment on X. Balasubramanian et al. conducted X analytics for this hashtag and found that 35% of stakeholders were advocacy health organisations utilising SoMe to build quality awareness about bedwetting, and 93% of posts were linked to internet websites providing further information [122]. Gonzalez et al. provided a new point of view by analysis patient’s SoMe posts about overactive bladder to identify patient knowledge and potential barriers to patient-centred care that might be helpful to improve patient outreach [123]. SoMe can be a meeting point for patients and companions to share experiences and create an online support network. Online platforms such a as Facebook group pages or Reddit communities are used by patients and carers as a place to share their experiences and concerns or offer advice about a certain health condition [65, 124, 125]. A survey involving 1,615 patients with bladder cancer from 39 different countries revealed that the most popular forms of support for coping with bladder cancer for both patients and carers were friends and family (69.7 %), followed by online support groups (58.3%) [126]. Interestingly, Huber et al. compared outcomes from 955 patients joining a face-to-face support group versus 686 patients using an online support group. In the face-to-face groups, patient ratings were better for information exchange, gaining recognition and caring for others. However, both modalities of peer support received very positive ratings from their users and have significant impact on treatment decision-making [127]. Certainly, SoMe can serve as an excellent platform for SoMe interventions for patients and the public [128].

5.9. Combatting professional inequities

Historically, women and black men have been under-represented in medicine and have faced harassment, as well as discrimination in recruitment, pay and career advancement opportunities [129, 130]. According to the 2018 American Urological Association census, 90.8% of practicing urologists are male and 84% are Caucasian [55]. The lack of diversity among medical leaders is not only problematic for the medical profession but can have adverse effects on the health and well-being of patients [131, 132]. To raise awareness on this issue in academia and in health care in general, medical organisations have developed diversity and inclusion policies and initiatives that focus on improving opportunities for women and other minority physicians [133-135].

The use of hashtags has been shown to increase participation in SoMe discussions, as has the use of images and links [136]. #womeninmedicine, for example, is a weekly X chat room created in 2010 where problems facing women in medicine are discussed [135]. The hashtag #ILookLikeASurgeon was created in 2013 by women surgeons concerned with equity and equality for women in the field of surgery [137]. In 2017, this hashtag had 11,582 tweets from 2,181 contributors [138]. SoMe has also been used to promote racial diversity in medicine, including hashtags such as #Black-MenInMedicine, which was first used in 2013 but did not gain traction until a presentation on the number of AfricanAmerican men in medical school in 2017. This hashtag addresses the racial diversity of black men [135]. Regarding urology, the hashtag #ILookLikeAUrologist was launched in August 2015 to promote gender representation in urology and has been widely used by a large global audience in urology over the past years [139]. The use of this hashtag relative to the total number of tweets was higher than many other urological hashtags that started around the same time in 2015 [34].

With all these measures and the creation of a virtual community, through SoMe, the social isolation of urologists from underrepresented gender and/or racial groups can be diminished, and a more diverse community of practice can be provided.