Neurosurgery and the rise of academic social media : what neurosurgeons should know

Social media has evolved to take on a major role in the personal and professional lives of people across the world. As of 2016, Pew Research Center data es­ timates that 86% of US adults used the Internet, of whom 79%, 24%, 32%, and 29% used Facebook, Twitter, Insta­ gram, and LinkedIn, respectively.12 In parallel, social media use among clinicians, including neurosurgeons, neurosurgical departments, and neurosurgical journals, has increased exponentially over the past 3 years.2,4,6,10,11,19 Given this dramatic rise and the increasing emphasis be­ ing placed on social media in professional networking, pa­ tient recruitment and education, and the dissemination or discussion of new scientific knowledge, our objective was to highlight the potential benefits and risks of developing a social media presence for members of the neurosurgical community in particular, as well as offer a preliminary guide for the novice social media user.


Getting Started
Many social media platforms exist, and each serves a distinct purpose (Table 1).However, all social media plat forms share the same, unique goal of disseminating in formation and allowing for the cultivation of connections and relationships that transcend the bounds of traditional geographic boundaries.Facebook and Twitter remain the most commonly used among academics.Both allow us ers to post original content, including text, images, and video.While Facebook allows the text of a given post to be of any length, Twitter currently limits the text to 280 characters per "tweet."Facebook utilizes a "friend" sys tem, which typically requires mutual agreement between users to allow shared viewing of posted content.Twitter, on the other hand, has a "follow" system, which allows a user to observe the activity of any other public Twitter account voluntarily, with no reciprocal follow or approval action required.In the academic context, this feature al lows Twitter users to more readily expand their network by following and interacting with faculty and departments outside of their home institution.
Developing a professional social media presence on Twitter can be daunting; however, a few simple tips can smooth the process, even for technological neophytes (Fig. 1), for example, 1) using the same professional, easily rec ognizable picture across all social media sites; 2) begin ning by following and interacting with large governing bodies like the AANS (@AANSNeuro) or publications like the Journal of Neuro-Oncology (@JNeurooncol); and 3) making a daily habit of interacting with at least one interesting piece of content as you review your feed.From there, building to the goal of generating 3-4 original posts per week while making sure to engage with the platform on a regular basis further establishes one's social media presence.While engagement can vary across users, an ac tive account typically requires 10 or 15 minutes of atten tion per day, although this can be broken up throughout the day.

Establishing a Narrative
One of the greatest advantages of social media is the venue it provides for individual neurosurgeons or depart ments to develop and broadcast their unique professional narrative.By selecting the content that they share or inter act with, each social media user may promote particular themes that are then relayed and reinforced to the academ ic community and public at large.In an era when the pub lic is turning to the Internet and sites like HealthGrades.com for medical advice before selecting a physician, the ability to solidify and directly influence an online pres ence and narrative is imperative.
An important aspect of this concept is applicable to residents or junior faculty, who can utilize social media to emphasize their specific interests within neurosurgery, and establish themselves prominently in the online discus sion of key topics among their colleagues or thought lead ers in the field.This may be of particular interest to techsavvy younger trainees, as the academic use of social me dia is still in its relative infancy, and therefore becoming a reliable and highly utilized information source within a specific niche of neurosurgery is accessible and powerful.By posting de-identified, intraoperative images and vid eos, or highquality imaging studies, or interesting learn ing cases, young faculty and residents can quickly amass a significant social media following of eager learners, rang ing from interested medical students and residents, to fac ulty colleagues at other institutions, or even the lay public and disease advocacy groups.The Young Neurosurgeons Committee (YNC; @youngneuros) has been exemplar in its efforts to utilize social media to facilitate networking opportunities between junior and senior faculty members and ease the difficult transition from resident to attending status.
The tactic of targeted development can be further en hanced by tailoring posts to the interests of the intended audience or creating content to interact with a specific group of patients, colleagues, or organizations.Such an approach is readily optimized using a wide range of data analytics, such as user demographics or clickthrough rates on various posts or content categories.For example, the neurosurgical department at the University of Toronto published the results of their early social media engage ment efforts, which demonstrated a base of predominantly male followers, aged 18-34 years, who were most likely to interact with posts containing images, videos, or mentions of senior faculty.These analytics may be similarly used to increase reach to a specific audience to expand one's target demographic. 4

Education
Residents have long been the educational center of most neurosurgical departments, journals, and academic mentors, all of whom are increasingly mobilizing digital resources for teaching.As an example of adopting a key component of neurosurgical training into the digital world, online journal clubs are being carried out over social me dia platforms.These events generally begin with a social media announcement heralding the anticipated date, time, and articles to be discussed.Interested students, residents, and faculty members can then log in from anywhere in the world to go over the papers, discuss salient clinical issues, or simply network with one another.These interactions foster an environment of collaboration between institu tions, fostering the free exchange of ideas, and emphasiz ing the value of an open, collaborative enterprise between residents and programs.In fact, in an effort to continually improve resident education, the Congress of Neurological Surgeons (@CNS_Update) has recently introduced month ly journal club podcasts through their journal Neurosurgery (@NeurosurgeryCNS).
One idiosyncratic but useful feature of social media pertinent to online journals and journal clubs is the use of hashtags: a keyword preceded by the pound sign (e.g., #neurosurgery), as a way of marking or categorizing con tent.These may signal a topic of interest (e.g., #cerebrovas cular, #spine), or a case for review (#ecase), while others may generally identify resources geared toward students and/or residents (#FOAM or #FOAMedEd, short for Free Open Access Medicine/Medical Education).Of particular interest, #FOAM resources like The Neurosurgical Atlas-a copartner of the JNSPG and AANS-have become popular among trainees and have utility throughout resi dency, as preliminary training resources to new interns, as refreshers for individuals preparing for cases, and/or as study material for the board exams.
As hashtags gain prominence and become more stan dardized, they have begun to prove useful both in re search-identifying key articles for review, or providing rapid content indices-and in continuing medical educa

TABLE 1 . Examples of some of the most common social media platforms with a brief platform overview and example post for that platform
InstagramPost images and videos with text captions.Here is a picture of a basilar apex aneurysm after Y-stent assisted coiling.YouTubeRepository of videos that users can upload and share.This is a video demonstrating the ideal technique for clipping a middle cerebral artery aneurysm.Snapchat Short, transient video clips, for public or private transmission, that are deleted after 24 hours or once viewed.Having a great time at the #AANS2017 opening reception with all my trail buddies!Blogger Website used to write longer, more thoughtful posts or blogs.Below is a step-by-step description of the operative techniques I used for this bypass.