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Journal clubs are an essential tool in promoting clinical evidence-based medical education to all medical and allied health professionals. Twitter represents a public, microblogging forum that can facilitate traditional journal club requirements, while also reaching a global audience, and participation for discussion with study authors and colleagues.
The aim of the current study was to evaluate the current state of social media–facilitated journal clubs, specifically Twitter, as an example of continuing professional development.
A systematic review of literature databases (Medline, Embase, CINAHL, Web of Science, ERIC via ProQuest) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of Twitter, the followers of identified journal clubs, and Symplur was also performed. Demographic and monthly tweet data were extracted from Twitter and Symplur. All manuscripts related to Twitter-based journal clubs were included. Statistical analyses were performed in MS Excel and STATA.
From a total of 469 citations, 11 manuscripts were included and referred to five Twitter-based journal clubs (#ALiEMJC, #BlueJC, #ebnjc, #urojc, #meded). A Twitter-based journal club search yielded 34 potential hashtags/accounts, of which 24 were included in the final analysis. The median duration of activity was 11.75 (interquartile range [IQR] 19.9, SD 10.9) months, with 7 now inactive. The median number of followers and participants was 374 (IQR 574) and 157 (IQR 272), respectively. An overall increasing establishment of active Twitter-based journal clubs was observed, resulting in an exponential increase in total cumulative tweets (
Twitter-based journal clubs are free, time-efficient, and publicly accessible means to facilitate international discussions regarding clinically important evidence-based research.
Journal clubs are a well-established method to facilitate interactive peer review and critical thinking in clinical evidence-based medical education [
An unprecedented expansion in the medical use of social media, such as Twitter, Facebook, LinkedIn, and YouTube, has followed the uptake seen with the general public. Twitter is a public, microblogging forum where users (each with a unique handle, eg @username) upload short messages comprising a maximum of 140 characters, with/or attached photos, documents, and links to other media such as videos, presentations, or journal articles. In most cases, these “tweets” are linked to a theme, often centralized using a “#” (hashtag, eg #twitter) for easy view and discovery by other users. Users are also able to “follow” the tweets of other users. Specific events (eg, medical conferences, public sporting events) often promote an official hashtag to allow users to follow all discussion relating to the event [
When combined with Twitter, journal clubs are able to function in a similar way to traditional journal clubs, with the advantage of a global audience and participation for discussion. Twitter-based journal clubs are able to be easily linked using a hashtag (eg, #...jc), allowing anyone to follow and contribute with a unique identifiable username. A central moderator is able to inform followers of the article to be discussed well ahead of time for perusal. Furthermore, authors of discussed articles are often invited as participants, enabling real-time interaction. Online journal clubs allow for international and increased participation, even when used with other less mainstream platforms [
The aim of the current study was to evaluate the current state of journal clubs facilitated by social media, specifically Twitter, as an example of continuing professional development and through a systematic review process.
A systematic review was undertaken based on guidelines outlined by the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [
A systematic literature search was performed using literature databases (Medline via OVID, Embase, CINAHL, Web of Science, ERIC via ProQuest) using synonyms relating to “social media” and “journal club” in November 2014 (see
Following review of published reports, Twitter was by far the most popular and commonly used social media outlet for journal clubs. A systematic search of Twitter was performed to identify all relevant hashtags to be included in the current study, including using the search box and the terms “journal club” and “jc”, as well as reviewing the users who were following all identified journal clubs, initially using those identified in the literature search. Journal club selection was performed by 2 independent evaluators (MR, MP), and any discrepancies were resolved.
Inclusion criteria for hashtag analysis included journal clubs related to health care. Hashtags were excluded from analysis if they were not Twitter-based journal clubs, English-speaking, if the hashtag was not used completely for the purpose of a journal club, or if the hashtag represented institutional or private journal clubs. A final search was performed on the Symplur website, which tracks social media related to health care.
Basic Twitter-based data was extracted from the relevant journal club Twitter-based websites. If available, such information included speciality, location, journal club tweets, and Twitter followers. Journal club tweets refer to the number of posts generated by a single journal club account. Data extraction from Symplur was achieved by searching each relevant hashtag (#). Data extracted from Symplur included hashtag commencement date, hashtag inactivation date, total tweet count, tweet count per month, number of tweeters, and total impressions. “Hashtag activation date” was defined as first month with greater than 5 tweets with the relevant hashtag. “Hashtag inactivation date” was defined as the starting point of 3 consecutive months with <6 tweets per month. Tweet count refers to the total number of posts containing the relevant hashtag. Number of tweeters was defined as the number of unique individual Twitter accounts that generated a post containing the relevant hashtag. Impressions, or reach, refer to the number of Twitter users using a particular hashtag and the sum of their respective followers—thus a surrogate for the number of users exposed to a particular hashtag. Detailed statistics of the top five journal clubs (@NephJC, @igsjc, @EBNursingBMJ, @iurojc, and @ADC_JC), as determined by rate of increase in cumulative tweets, were retrieved for each month from Symplur.
Data from published manuscripts were insufficient for compilation, so a descriptive analysis was performed. Twitter hashtag data were collated and analyzed using a Microsoft Excel 2003 database. Figures were created using STATA v.12.0 SE.
The final search strategy resulted in retrieval of 469 citations, including 47 duplicates, 381 irrelevant citations, 18 conference abstracts, 9 citations unrelated to journal clubs, and 9 based on blogs or other resources (
Three manuscripts referred to #ALiEMJC/@AnnalsofEM [
Of the manuscripts reviewed, three journal clubs were officially affiliated with peer-reviewed journals (#ALiEMJC/@AnnalsofEM to
Flowchart of study selection as per the PRISMA statement.
Following the hashtag and Twitter-based journal club search, 34 potential hashtags/accounts were collated. Following review, 10 hashtags and associated journal clubs were excluded: three due to multiple uses for particular hashtag, two hashtags were related to private or institutional journal clubs, four were excluded due to complete inactivity or commenced within 1 month of assessment, and one was excluded due to non-English language. Of the 24 included hashtag accounts, the median months active was 11.75 (interquartile range [IQR] 19.9, SD 10.9;
Demographic information for Twitter-based journal clubs, including specialty, frequency, commencement, inactive status, and associated peer-reviewed publications.
Hashtag, citation | Associated Twitter user | Speciality | Frequency | Commencement | Inactive datea |
#1carejcb | @amcunningham | Primary care | NR | 15/04/2013 | 5/6/2014 |
#ACCJournalclubb | @ACCinTouch | Cardiology | NR | 29/3/2014 | 29/3/14 |
#ADC_JC | @ADC_JC | Pediatrics | NR | 28/5/2014 | Current |
#ALiEMJC [ |
@AnnalsofEM | Emergency medicine | NR | 15/11/2013 | Current |
#ambjcb | @ambjournalclub | Emergency medicine | Bimonthly | 1/7/2011 | 11/11/13 |
#bluejcb [ |
@bluejchost | Women’s health | NR | 30/3/2013 | Current |
#cpjcb | @clinpsyJC | Psychology | NR | 1/7/11 | 1/10/13 |
#ebnjc [ |
@EBNursingBMJ | Nursing | Bimonthly | 5/1/2010 | Current |
#GeriMedJC | @gerimedJC | Geriatric medicine | Monthly | 1/7/2014 | Current |
#HEJC | twubs/HEJC | Health economics | NR | 1/9/2012 | Current |
#hpmJC | @hpmjc | Hospice, palliative medicine/care | NR | 1/03/14 | Current |
#IGSJC | @igsjc | General surgery | Monthly | 5/2/2014 | Current |
#jamapedsjc | @jamapeds | NR | 21/10/2014 | 8/8/14 | Current |
#JC_StEb | @JC_StE | Emergency medicine | Bimonthly | 1/10/2012 | 1/10/13 |
#MedEdc [ |
@JournalGIM | General medicine | NR | NR |
|
#microtwjc | @microtwjc | Microbiology | NR | 11/9/2013 | Current |
#NephJC | @Nephjc | Nephrology | NR | 20/4/2014 | Current |
#PGHANJC | @BSPGHAN | Pediatric gastroenterology | NR | 2/6/2014 |
|
#PHTwitJC | @PHTwitJC | Public health | Monthly | 1/7/2011 | 1/8/13 |
#psychjc | @psychiatryjc | Psychiatry | Monthly | 28/9/2014 | Current |
#rsjc | @respandsleepjc | Respiratory | Monthly | 26/6/2014 | Current |
#swjcchatb | @swjcchat | Social work | Bimonthly | 7/7/2013 | 1/12/13 |
#twitjcb | @twitjournalclub | General medicine | Bimonthly | 1/5/2011 | 1/12/13 |
#urojc [ |
@iurojc | Urology | Monthly | 1/10/2012 | Current |
aIf applicable, defined as 3 consecutive months of fewer than 5 tweets per month.
bInactive journal clubs.
c#MedEd is not a unique hashtag for this journal club—it is also used for discussion among other medical educators.
Of the 24 included journal club–related hashtags, the median number of followers was 374 (IQR 574) with a median number of active participants of 157 (IQR 272). Monthly activity was calculated with a median “tweets per month” of 203 (IQR 317) and median “impressions per month” of 165,538 (IQR 504,654). Following inception, and as of October 30, 2014, seven of the included journal clubs had become inactive (#1carejc, #ambjc, #cpjc, #JC_StE, #PHTwitJC, #swjcchat, #twitjc).
Overall, after exclusion of inactive journal clubs, an increasing establishment of Twitter-based journal clubs (
For specific journal clubs, a continual increase in cumulative tweets in the early (<24 months) stages was observed. Specifically, the linearly modeled (all
Twitter-based journal club performance, incorporating standard metrics such as tweets and followers, as well as overall tweets, participants and impressions, with calculated monthly mean tweets and impressions relating to each journal club as defined by Symplur
Hashtag | Associated Twitter user | Tweets | Followers | Total tweets | Mean tweet/moa | Participants | Impressions/moa |
#1carejcb | @amcunningham | NA | NA | 564 | 41 | 171 | 191,161 |
#ACCJournalclubb | @ACCinTouch | NA | NA | NA | NA | NA | NA |
#ADC_JC | @ADC_JC | 1452 | 459 | 2785 | 546 | 142 | 378,763 |
#ALiEMJC | @AnnalsofEM | NA | NA | 924 | 80 | 234 | 136,145 |
#ambjcb | @ambjournalclub | 57 | 87 | 93 | 3 | 42 | 1380 |
#bluejc | @bluejchost | 516 | 202 | 3705 | 194 | 290 | 126,455 |
#cpjcb | @clinpsy |
67 | 201 | 216 | 5.4 | 61 | 18,039 |
#ebnjc | @EBNursingBMJ | 2117 | 1399 | 3901 | 395 | 456 | 719,241 |
#GeriMedJC | @gerimedJC | 130 | 158 | 318 | 80 | 52 | 36,044 |
#HEJC | twubs/HEJC | NR | NR | 986 | 38 | 103 | 18,176 |
#hpmjc | @hpmjc | 588 | 129 | 1694 | 212 | 176 | 223,686 |
#IGSJC | @igsjc | 624 | 750 | 5199 | 586 | 430 | 843,358 |
#jamapedsjc | @jamapeds | NR | NR | 387 | 140 | 76 | 535,852 |
#JC_StEb | @JC_StE | 615 | 374 | 1008 | 84 | 73 | 58,346 |
#MedEdc | @JournalGIM | NA | NA | NA | NA | NA | NA |
#microtwjc | @microtwjc | 525 | 155 | NA | NA | NA | NA |
#NephJC | @Nephjc | 1436 | 584 | 5295 | 832 | 478 | 1,184,105 |
#PGHANJC | @BSPGHAN | NA | NA | NA | NA | NA | NA |
#PHTwit |
@PHTwit |
1817 | 1057 | 4245 | 170 | 320 | 139,916 |
#psychjc | @psychiatryjc | 92 | 72 | 240 | 218 | 44 | 288,109 |
#rsjc | @respandsleepjc | 929 | 176 | 1669 | 401 | 115 | 86,730 |
#swjcchatb | @swjcchat | 758 | 481 | 1199 | 138 | 138 | 6144 |
#twitjcb | @twitjournalclub | 1498 | 3446 | 12,628 | 407 | 1,954 | 883,543 |
#urojc | @iurojc | 1832 | 2401 | 9040 | 362 | 1,567 | 622,139 |
aDuring active period only.
bInactive journal clubs.
c#MedEd is not a unique hashtag for this journal club—it is also used for discussion among other medical educators.
Establishment of journal clubs per year, comparing all journal clubs (blue) with currently active journal clubs (red). 2014 included journal clubs started prior to October 2014.
Tweets and impressions for each of the top five journal clubs as determined by tweets/impressions per month (ie, @ADC_JC, @EBNursingBMJ, @igsjc, @iurojc and @NephJC) were analyzed. Subgroups were created based on the “Top 10” participants for each month (as determined by Symplur) versus the remaining participants. An average of two tweets per month, was estimated for participants outside of the “Top 10” tweet contributors for each month (
In an attempt to measure “reach” for each journal club, while considering large tweet traffic from these accounts in moderating and advertising, an impression:tweet ratio was calculated for each journal club user account. This impression:tweet ratio was shown to be linearly increasing for all journal clubs (
Average tweets per participant for the top 5 journal clubs (#ebnjc, #iurojc, #Nephjc, #ADC_JC, #igsjc). The overall calculated average for each journal club is represented by solid lines, while the average for participants outside of the Top 10 is represented by dashed lines.
Journal club user account impressions:tweets ratio as a measure of reach, represented as absolute ratio change per month.
There were an estimated 200 million users per month actively tweeting an average of 500 million times per day in 2013, depicting Twitter as a contemporary, ever-changing social media environment. While recent reports in media outlets suggest that the rate of Twitter use overall may be declining, the findings of this systematic review of published literature and Twitter suggest that Twitter-based journal clubs are an expanding method of continuing professional development and a platform for global interaction. Published reports describe positive initial uptake and support from their respective medical communities [
Overall, we have observed an increasing participation in Twitter by the medical and allied health community, evidenced by an increasing year-to-year establishment of new journal clubs (
Similar increases in Twitter participation have been observed for medical conferences [
While this relationship between social media and traditional academic media continues to grow, the use of Twitter for continuing professional development is an attractive venture. However, the freedom of voluntary participation complicates the establishment of an accurate and efficient record of participation for appropriate ethical acknowledgement for continuing professional development requirements by credentialing authorities. To date, no objective evaluation assessing the knowledge uptake and retention resulting from microblogging journal club is available [
FOAM encapsulates a collection of resources and tools for learning in medicine that are transforming medical education [
When individual journal club performance was considered, we observed a clear increase in overall tweets and impressions for established journal clubs, with some increasing at a rate as high as 722 tweets/month. However, month-to-month tweeting was observed to be highly variable. This variability could relate to diversity in interest among followers regarding the topics discussed or reduced participation of influential or high-volume tweeters for various reasons. There may also be limitations in access to articles discussed, particularly for individuals without institutional or individual journal access for those articles that are not open access. Where possible, some journal clubs, such as #urojc, provide open access to the discussed articles in order to remove this limitation [
In considering the determinants of journal club performance, subgroup analysis suggested that a large proportion of tweets each month were from those in the “Top 10”, with the remaining participants expected to contribute two tweets per journal club discussion (
This study is an analysis of social media at a point in time, when social media is known to be ever evolving. Much of the Twitter-based analytics relied on third-party services, such as Symplur, which was intended to focus on social media related to health care. Further, there are inherent limitations with the use of Twitter-based outcome measures, such as impressions, as a surrogate for reach. We were unable to measure the pattern of growth in followers or participants through data acquisition restrictions. There is also no current way to measure the passive value of journal clubs, specifically relating to users who are following the journal club discussion, and thus acquiring educational value, but not actively participating. We acknowledge that the number of included manuscripts is small, reflecting the current state of published literature relating to Twitter-based journal clubs. This review will serve as a check point and reference for the development of enhanced Twitter-based journal clubs by other medical craft groups internationally or loco-regionally.
This systematic review provides an illustration of early trends in the development of journal clubs using Twitter as a communication medium. Twitter-based journal clubs provide access to free, time-efficient, and high-level discussions on clinically important issues and equal participation opportunity for users. Twitter provides an unprecedented method of networking and formation of friendships with colleagues, which can be harnessed to educate, initiate research collaborations, and even canvass opinions with difficult cases in the time between conferences. Hence, the role of social media in continuing professional development will continue to evolve with increasing engagement by journals, conferences, and FOAM sources. Furthermore, in the midst of busy clinical duties, microblogging using Twitter provides a unique pathway to access and engage in discussions with peers and professional leaders.
Terms used for search of literature databases.
Free Online Access Medical Education
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
MJR is supported by a Doctor in Training Research Scholarship from Avant Mutual Group Ltd., Cancer Council Queensland PhD Scholarship, and Professor William Burnett Research Fellowship from the Discipline of Surgery, School of Medicine, University of Queensland.
None declared.