Tejas Desai

Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011

In recent years, the American Society of Nephrology (ASN) has increased its efforts to use its annual conference to inform and educate the public about kidney disease. Social media, including Twitter, has been one method used by the Society to accomplish this goal. Twitter is a popular microblogging service that serves as a potent tool for disseminating information. It allows for short messages (140 characters) to be composed by any author and distributes those messages globally and quickly. The dissemination of information is necessary if Twitter is to be considered a tool that can increase public awareness of kidney disease. We hypothesized that content, citation, and sentiment analyses of tweets generated from Kidney Week 2011 would reveal a large number of educational tweets that were disseminated to the public. An ideal tweet for accomplishing this goal would include three key features: 1) informative content, 2) internal citations, and 3) positive sentiment score. Informative content was found in 29% of messages, greater than that found in a similarly sized medical conference (2011 ADA Conference, 16%). Informative tweets were more likely to be internally, rather than externally, cited (38% versus 22%, p<0.0001), thereby amplifying the original information to an even larger audience. Informative tweets had more negative sentiment scores than uninformative tweets (means −0.162 versus 0.199 respectively, p<0.0001), therefore amplifying a tweet whose content had a negative tone. Our investigation highlights significant areas of promise and improvement in using Twitter to disseminate medical information in nephrology from a scientific conference. This goal is pertinent to many nephrology-focused conferences that wish to increase public awareness of kidney disease.

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

BACKGROUND There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology. METHODS A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors. RESULTS 714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology. CONCLUSIONS Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community.

Is Content Really King? An Objective Analysis of the Public's Response to Medical Videos on YouTube

Medical educators and patients are turning to YouTube to teach and learn about medical conditions. These videos are from authors whose credibility cannot be verified & are not peer reviewed. As a result, studies that have analyzed the educational content of YouTube have reported dismal results. These studies have been unable to exclude videos created by questionable sources and for non-educational purposes. We hypothesize that medical education YouTube videos, authored by credible sources, are of high educational value and appropriately suited to educate the public. Credible videos about cardiovascular diseases were identified using the Mayo Clinics Center for Social Media Health network. Content in each video was assessed by the presence/absence of 7 factors. Each video was also evaluated for understandability using the Suitability Assessment of Materials (SAM). User engagement measurements were obtained for each video. A total of 607 videos (35 hours) were analyzed. Half of all videos contained 3 educational factors: treatment, screening, or prevention. There was no difference between the number of educational factors present & any user engagement measurement (p NS). SAM scores were higher in videos whose content discussed more educational factors (p<0.0001). However, none of the user engagement measurements correlated with higher SAM scores. Videos with greater educational content are more suitable for patient education but unable to engage users more than lower quality videos. It is unclear if the notion “content is king” applies to medical videos authored by credible organizations for the purposes of patient education on YouTube.

Predicting the Number of US Medical Graduates Entering Adult Nephrology Fellowships Using Search Term Analysis

To the Editor: There has been a worrisome decrease in the number of applicants to nephrology fellowship training programs. First identified in 2008, the number of nephrology applications has been decreasing annually since 2002. Given the annual increase in kidney disease and projected shortage of nephrologists, this downward trend is concerning. Various studies have suggested that a lack of interest in nephrology is a key factor in this decrease. Parker et al have used the percentage of adult nephrology positions filled by US medical graduates as a surrogate marker of nephrology interest, but this measurement is a late indicator. Investigations have suggested that the frequency of internet search term use can serve as a leading and accurate indicator of future events. We hypothesize that the frequency of nephrology-specific search term queries can predict the percentage of US medical graduates entering nephrology fellowships. The frequency of queries using the search term “nephrology” was analyzed from 2004 to mid-September 2011 using Google Insights for Search. The terms “gastroenterology,” “oncology,” “endocrinology,” and “cardiology” were analyzed as controls. The frequency of each search term was restricted to results in the Health Education and Medical Training category. Frequencies were converted into yearly search term interest levels (STILs) by Google Insights for Search. STILs ranged from 0-100, with the latter indicating the greatest interest for the search term. A linear regression model was used to investigate the relationship between average yearly STILs and annual percentage of US medical graduates entering each fellowship listed in the Graduate Medical Education Track Database. We observed a decrease in yearly STILs for “nephrology,” from 51 in 2004 to 31 in 2011, with the greatest monthly STIL occurring in June 2004. The linear regression model showed the following relationship between the STIL for “nephrology” at year t and fraction of fellowship positions filled by US medical graduates at year t 1: Fraction of positions filled by USMGs(t 1) 0.00904 STIL(t) 0.08167, where USMG is US medical graduate. This relationship showed a strong correlation during the study period (r 0.94; P 0.01). The regression model also showed a significant relationship for the control specialties (gastroenterology: r 0.89; P 0.05; oncology: r 0.84; P 0.05; endocrinology: r 0.81; P 0.05; and cardiology: r 0.83; P 0.05). Table 1 lists the predicted values of US medical graduates filling fellowships in 2011-2012 and 2012-2013. The model anticipates a continued decrease in US medical graduates entering adult nephrology fellowships. We find that interest levels for the search term “nephrology” accurately predict the percentage of US medical graduates entering nephrology fellowship programs. The percentage of fellowships filled by US medical graduates is a meaningful but late measure of nephrology interest. An educator would have to wait until 2013 to learn the percentage of adult nephrology fellowship positions filled by US medical graduates who graduated in 2011. Our forecasting model can predict the percentage of fellowship positions filled by US medical graduates 2 years earlier by allowing educators to use STILs from the same calendar year. This reduction would allow more efficient resource allocation for recruitment, quicker assessments of interventions, and timely modifications to efforts designed to increase interest.

Online blogging during conferences: an innovative way of e-learning

Sidharth Kumar Sethi1, Tejas P. Desai2 and Kenar D. Jhaveri3 1Division of Pediatric Nephrology, Postgraduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital, New Delhi, India; 2Division of Nephrology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA; and 3Division of Kidney Disease and Hypertension, Hofstra North Shore–Long Island Jewish School of Medicine, Great Neck, New York, USA Correspondence: Kenar D. Jhaveri, Division of Kidney Diseases and Hypertension, North Shore–LIJ, Hofstra School of Medicine, 100 Community Drive, Great Neck, New York 11021, USA. E-mail: kdj200@gmail.com Need for e-learning New tools such as blogs, social media networks, and audio and video podcasts in Web 2.0 have allowed better exchange of information among physicians across distances. The medical world has started embracing this new technology as it emerges. Many top-rated medical journals have a blogging section of their website. As nephro logists, there is a growing need for us to adapt to these tools for e-learning, because nephrology is a constantly changing field. Blogs are interactive websites that consist of regular diary-like entries. Unlike traditional Web pages, blogs are dynamic and permit the writers (bloggers) to engage in ‘one-to-many’ conversations with readers.1 Because blogs engage people in knowledge sharing, reflection, and debate, they often attract a large and dedicated readership. They can also engender small virtual groupings of individuals interested in co-constructing knowledge around a common topic within a community of practice. One study showed that more than 90% of medical students in the United Kingdom were using social networking sites and blogs as part of their daily lives.1 Medical educators have begun to recognize the potential of social media at the undergraduate, graduate, and fellowship levels of training.1 Moreover, the currently available 3G generation of mobile phones equipped with megapixel cameras can instantly post high-resolution clinical photos to a worldwide audience.1,2 The nephrology community has embraced blogging, as is evident by the number of blogs that have been created in the past five years (Table 1). Nowhere is blogging more useful than at mainstream nephrology, dialysis, and transplantation scientific meetings.3 Physician-bloggers share important points of each meeting with their audience and help disseminate the most recent concepts and paradigms in nephrology to the larger community. The few blogs that did this in the year 2010 were Nephrology On-Demand (http://www.nephrologyondemand.org), Nephron Power (http://www.nephronpower.com), and the Online Transplant Center (http://www. onlinetransplantcenter.blogspot.com).

Assessing a nephrology-focused YouTube channel's potential to educate health care providers

INTRODUCTION YouTube has emerged as a potential teaching tool. Studies of the teaching potential of YouTube videos have not addressed health care provider (HCP) satisfaction; a necessary prerequisite for any teaching tool. We conducted a 4-month investigation to determine HCP satisfaction with a nephrology-specific YouTube channel. METHODS The Nephrology On-Demand YouTube channel was analyzed from January 1 through April 30, 2011. Sixty-minute nephrology lectures at East Carolina University were compressed into 10-minute videos and uploaded to the channel. HCPs were asked to answer a 5-point Likert questionnaire regarding the accuracy, currency, objectivity and usefulness of the digital format of the teaching videos. Means, standard deviations and 2-sided chi-square testing were performed to analyze responses. RESULTS Over 80% of HCPs considered the YouTube channel to be accurate, current and objective. A similar percentage considered the digital format useful despite the compression of videos and lack of audio. CONCLUSIONS The nephrology-specific YouTube channel has the potential to educate HCPs of various training backgrounds. Additional studies are required to determine if such specialty-specific channels can improve knowledge acquisition and retention.

Factors that contribute to social media influence within an Internal Medicine Twitter learning community

Medical societies, faculty, and trainees use Twitter to learn from and educate other social media users. These social media communities bring together individuals with various levels of experience. It is not known if experienced individuals are also the most influential members. We hypothesize that participants with the greatest experience would be the most influential members of a Twitter community. We analyzed the 2013 Association of Program Directors in Internal Medicine Twitter community. We measured the number of tweets authored by each participant and the number of amplified tweets (re-tweets). We developed a multivariate linear regression model to identify any relationship to social media influence, measured by the PageRank. Faculty (from academic institutions) comprised 19% of the 132 participants in the learning community (p < 0.0001). Faculty authored 49% of all 867 tweets (p < 0.0001). Their tweets were the most likely to be amplified (52%, p < 0.01). Faculty had the greatest influence amongst all participants (mean 1.99, p < 0.0001). Being a faculty member had no predictive effect on influence (β = 0.068, p = 0.6). The only factors that predicted influence (higher PageRank) were the number of tweets authored (p < 0.0001) and number of tweets amplified (p < 0.0001) The status of “faculty member” did not confer a greater influence. Any participant who was able to author the greatest number of tweets or have more of his/her tweets amplified could wield a greater influence on the participants, regardless of his/her authority.

Dermatological diseases in patients with chronic kidney disease.

CONTEXT There are a variety of dermatological diseases that are more commonly seen in patients with chronic kidney disease (CKD) and renal transplants than the general population. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science has been searched. RESULTS Some cutaneous diseases are clearly unique to this population. Of them, Lindsays Nails, xerosis cutis, dryness of the skin, nephrogenic systemic fibrosis and acquired perforating dermatosis have been described in chronic kidney disease patients. The most common malignancy found in all transplant recipients is non-melanoma skin cancer. CONCLUSIONS It is important for patients and physicians to recognize the manifestations of skin disease in patients suffering from chronic kidney disease to mitigate the morbidity associated with these conditions.

Using Social Media to Create a Professional Network Between Physician-Trainees and the American Society of Nephrology

Twitter is the fastest growing social media network. It offers participants the ability to network with other individuals. Medical societies are interested in helping individuals network to boost recruitment, encourage collaboration, and assist in job placement. We hypothesized that the American Society of Nephrology (ASN) successfully used Twitter to create a network between participants and itself to stay connected with its members. Tweets from 3 Twitter networking sessions during Kidney Week 2011 were analyzed for content. These messages were used to create a network between all participants of the networking sessions. The network was analyzed for strength and influence by calculating clustering coefficients (CC) and eigenvector centrality (EC) scores, respectively. Eight moderators and 9 trainees authored 376 Twitter messages. Most tweets by trainees (64%) and moderators (61%) discussed 1 of 3 themes: networking, education, or navigating Kidney Week 2011. A total of 25 online network connections were established during the 3 sessions; 20% were bidirectional. The CC for the network was 0.300. All moderators formed at least 1 connection, but 7 of the 9 trainees failed to make any connections. ASN made 5 unidirectional and 0 bidirectional connections with a low EC of 0.108. ASN was unable to form powerful connections with trainees through Twitter, but medical societies should not be discouraged by the results reported in this investigation. As societies become more familiar with Twitter and understand the mechanisms to develop connections, these societies will have a greater influence within increasingly stronger networks.

Web-Based Nephropathology Teaching Modules and User Satisfaction: The Nephrology On-Demand Experience

Nephropathology is an integral component of nephrology education. Online teaching sites provide valuable educational materials to learners, but learner satisfaction has not been measured. We developed a nephropathology website and measured learners’ satisfaction. The Nephrology On-Demand Histopathology website (http://blog.ecu.edu/sites/nephrologyondemand/?page_id=4502) provided nephropathologic specimens with explanations. Users were asked to complete a Likert-based survey (1—strongly agree . . . 5—strongly disagree) regarding four key areas of content quality: accuracy, currency, objectivity, and usefulness. Learners of all training levels perceived the content quality favorably. The mean (±SD) for accuracy was 1.70 (0.89), currency 1.62 (0.90), objectivity 1.80 (1.01), and usefulness 1.72 (0.95). Nephrology On-Demand Histopathology is a well-received teaching tool to learners of all training levels. Educators may consider using it, as well as other online nephropathology sites, as adjunctive teaching tools.