Keys to a Successful International Journal Club on Twitter

The concept of an international twitter journal club in urology arose subsequent to urologist Dr Mike Leveridge tweeting from his local real time Journal Club meeting at Queen’s University in Canada catching the attention of international colleagues who wanted to join in on the discussion.  The twitter discussion that followed, came to realization that we were actually participating in a journal club discussion on twitter and agreed that this idea was worth pursuing.  Given that the ‘uro-twitterati’ were a truly global community, we were challenged with the logistical problems of a fixed time twitter chat.  The logical solution was to use an asynchronous chat model and it was agreed that we would hold journal club meetings over a 48 hour period of time to foster international engagement.

The account @iurojc was created with the agreed hashtag #urojc and history made as the first truly global surgical journal club on twitter.   From the outset, our team of supporters were eager to see that this project was not a ‘fly by night’ operation and several measures were put in place as follows:-

• 1.     Asynchronous chat over 48 hours to enable global involvement without the constraints of time zones.  Whilst ‘international’ engagement could potentially be achieved with fixed time twitter journal club chats, it could only be achieved across a relative narrow band of time zones (eg transatlantic) 
• 2.     Cutting edge publications are selected for discussion.  Papers that are within 4 weeks of publication on line ahead of print in the major urology journals provide incentive for participants who wish to be at the forefront of latest findings and opinion.
• 3.     Engage journals to provide open access of the selected articles on line for easy access for participants.  This has been a huge benefit to participants who do not have ready access to manuscripts hidden behind a journal paywall.
• 4.     Invitation of authors to participate in the twitter discussion.  This has been an essential part of the #urojc since its inception and provides insights that conventional and SoMe journal clubs could not otherwise achieve.  What if the author does not have a twitter account or does not wish to create one?  For one author, the invitation provided the incentive to join twitter and for another, we created a guest account which was actively used for one of the discussions.
• 5.     A Best Tweet Prize is offered subsequent to each month’s discussion. We specifically do not offer donated prizes from companies offering products directly associated with the patient doctor interaction.  Our supporters are primarily entities associated with medical education, particularly the major journals in urology.  Prizes are generally valuable and include annual on-line subscriptions, fee exempt open access publication fees or free major conference registration as examples. Journal article and Best Tweet Prize winners selection are made independent of prize donors.  If a journal is supporting the Best Tweet Prize, the manuscript for discussion is intentionally selected from a different journal.
• 6.     Routine follow-back of urology followers on Twitter and following of any urologists that we become aware of.  This policy maintains an open door for feedback and suggestions without users having to request a follow for direct messaging.  Our experience with direct messaging makes clear that not all followers wish to make public their questions or suggestions.

The #urojc has now been in operation since November 2012 on a monthly basis and typically we would have 35-40 active participants with each discussion and many more watching the discussion.  The @iurojc account currently has over 600 followers.  At the recent BJU International SoMe Awards held during the American Urological Association Annual Meeting in San Diego in May 2013, the #urojc was awarded the prize for “Innovation in Social Media”.  The #urojc continues to go from strength to strength and we welcome support and collaboration from the twitter community.

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Henry Woo is the coordinator of the International Urology Journal Club on Twitter which can be followed @iurojc and his personal account can be followed @DrHWoo.  He is a urological surgeon and Associate Professor of Surgery at the Sydney Adventist Hospital Clinical School of the University of Sydney

Maintaining Composure During A Consultation

Doctors are human.  Some things we see will make us laugh when for the circumstances it is totally inappropriate.  I was recently reminded of an episode when I came close to losing all sense of professionalism during a patient consultation but survived.

A number of years ago, I saw a young man aged in his late twenties with lower urinary tract symptoms.  Although he was young, he looked much older and could easily have passed as a man aged in his mid-40s.  He had immigrated to Australia from a dispute ravaged country and probably had good reason for looking hostile and as if carrying concrete blocks of anger and despair on his shoulders.  He spoke no English and interpreter was at hand.  I think you get the scene – it was serious and we had better get on with the job of sorting him out.  Having asked a number of questions, I then asked as to whether he had any stage seen blood in his urine.  The interpreter then turned to him and spoke in his native language a question to which he gave a moderately long reply and to which followed alternating dialogue that went on for approximately five to ten minutes.  I was sat patiently expecting to hear a complex history of how he had indeed seen blood and the circumstances in which it had been observed and so forth.  The interpreter then turned to me and said “No”.  I dug the heel of my boot onto the top of toes of my other foot as hard as I could as I politely excused myself to go into the next office.  I think it took about 10 minutes to regain my composure before going back into my consulting room to complete the interview.  I think my eye contact with the young man was subsequently kept to an absolutely as needed basis.

At the end of the consultation, I did ask the interpreter about the nature of the discussion following my question about blood in the urine.  He told me that he had essentially given him an earful for not looking after himself since being in the country.  Okay.  Next patient. 

Creating One's Own Luck

I’ve been inspired to write this blog piece after seeing the wonderful Prezi presentation constructed by Dr Marni Basto on Urology Social Media 101.  It really is a fantastic presentation that has gone viral throughout the international urological community.  Although she is yet to commence formal urological training (she deferred commencement by a year to work on her Masters of Surgery), she now has an international reputation for her skill and understanding in the area of social media and associated technology.  When you look at her presentation, it is obvious that she is an individual who has great clarity of thought and able to develop depth of understanding of a given topic – these types of skills are easily translated to any area of medicine.  One can only sense that she has a bright future ahead of her. 

I’ll now move onto what her Prezi has got me thinking about.  Over the years, I have observed a number of young urologists returning to Australia after completing post FRACS (surgical qualification) training.  I commonly see this expression of despair that they cannot find a coveted public teaching hospital position, which is always the best way to kick-start a new practice in surgery.  Here you have access to multidisciplinary care, senior collegial mentorship, teaching of surgical trainees and medical students as well as research opportunities.  These positions are in limited supply and only come about when they are to replace a surgeon who has either resigned or retired or if the waters have parted to create a new position. 

Some of these young surgeons feel a sense of entitlement that they should be able to just walk into such a position.  I recall one surgeon who complained that he was a subspecialized surgeon who had done his special post fellowship training and could not understand why no teaching hospital was making any particular effort to find space for him within their units.  Another said to me that he was technically a much better surgeon than some others who had received teaching hospital appointments. When I thought about their achievements, they had not made a single presentation at a major urological meeting, had not published a single paper whilst away and since returning home, had contributed little to the profession (eg could do volunteer work or perform committee work with the Royal Australasian College of Surgeons or Urological Society of Australian and New Zealand).   

And here lies the point that people can create their own luck.  I can usually make a prediction before one of our trainees goes overseas or interstate for post FRACS training, as to who will literally walk back into a teaching hospital position. When I look at trainees who have done research with me, the ones who reliably kept to deadlines and completed their assignments were the same who did such when abroad and the same ones who eventually found positions in teaching hospitals.  These were individuals prepared to go the extra mile and create their own luck.  The trainees where I had to repeatedly provide gentle reminders to complete tasks to help their own careers have more often struggled.   The ability to create luck had already been defined early in their careers.

Back to Marni.  She has already passed the hurdles to be selected for urological training and is yet to commence whilst she does her Masters of Surgery.  You know that Marni has already begun to create her own luck and I am excited that we will have a future urologist who will be more than just ordinary.