Characteristics of General Surgery Social Media Influencers on Twitter

Abstract

Background

The influence of social media and Twitter in general surgery research, mentorship, networking, and education is growing. Limited data exist regarding individuals who control the dialogue. Our goal was to characterize influencers leading the discussion in general surgery.

Methods

Right Relevance Insight API was searched for “general surgery,” and individual influencers were ranked by a comprehensive assessment of connections (followers/following) and engagement (likes, retweets, and comments). Profession, specialty, gender, and location were collected utilizing Twitter, Doximity, LinkedIn, ResearchGate, and institutional websites. American Board of Surgery and Royal College of Physicians and Surgeons of Canada were queried for board certification and academic h-index scores were acquired from Scopus.

Results

Eighty-eight individual influencers in general surgery were identified, with 73 holding positions in general surgery. Attending level general surgeons comprised 50%, of which 91% are board certified, and 94% completed a fellowship (surgical oncology, laparoscopic surgery, critical care/trauma, and colorectal surgery). Residents comprised 31%; 11% were nonsurgeons and 3% were not physicians. The majority of residents and fellow influencers were female (72%). Many general surgery influencers were international (51%), particularly Canadian (28% overall). The academic h-indices for these influencers (n = 73) ranged from 0 to 73 (mean 14.5 ± 8.2; median 9.5).

Discussion

Our data describe the positions, backgrounds, and research contributions of the top Twitter influencers in general surgery. Those engaged in social media should consider the background, expertise, and motivation of these influencers as the utilization and impact of this platform grows.

Keywords

social and electronic media general surgery surgical education resident education

Introduction

The pervasiveness of social media, in its various platforms, has drastically increased in recent years and has influenced a large audience in medicine. Particularly for the field of general surgery, social media is a modality that allows for network creation through this dissemination and discussion of information online and in real time. The use of social media by general surgeons varies widely from promotional content and distribution of current research topics to networking and mentoring. Previous authors have recently recommended social media as a necessary part of a surgeon’s practice in order to actively participate in a rapidly changing field that relies on current research and guidelines.¹ Among the social media platforms available, Twitter is reported to be the most popular among members of the medical community.² In 2018, over 2000 health care providers were reported to tweet over twice per day and to have at least 300 followers.³ Twitter allows for these conversations among colleagues to be promoted, viewed, and joined by learners and experts alike.

A social media influencer is an individual who creates impact through interactions and posts, usually regarding a specific topic. An influencer may disseminate content targeted toward those involved in their respective field. The influencer can also encourage dialog and discussion regarding the content.^4,5 Additionally, influencers are important for those outside their respective fields and even the medical community, as social media is a common source of information for clinicians, nonmedical participants, and patients.^2,6 An influencer’s impact can be measured through connectedness (number of users following and users followed) and the effect the posts create in the topic community (likes, retweets, visibility). This resembles an academic researcher’s h-index, which was designed to measure not only publication productivity but also the impact of the research in the community.^4,7,8

Twitter is a versatile tool for disseminating information within a community and has recently become a platform for sharing current research in medicine.^4,5 In fact, social media has been reported as a tool to encourage one’s research transmission by increasing views and engagement in the community.^9,10 This has been referred to as “altmetrics,” or alternative metrics and may be considered as an adjunct to a researcher’s h-index.^4,7 Several surgical fields have shown a correlation between the use of social media and research output.^7,11,12 While the role of groups or organizations on Twitter has been discussed by academic departments of general surgery,^4,13 the influence of individuals and their productivity within the general surgery community has not been established. As the role of social media and general surgery is in early development, our goal was to characterize the influencers in general surgery on Twitter and determine who is leading the discussions.

Methods

This study was reviewed by the University of Cincinnati Institutional Review Board and given the determination of “Not Human Research.” Adapted from prior work,^7,11 Right Relevance (www.rightrelevance.com, San Francisco, CA, USA) Insight API was used to perform a search for “general surgery” to generate Twitter influence scores for this topic. Right Relevance calculates social media influence based on numerous factors, including connections (follower/following) and engagement (views, likes, re-tweets) in the topic community. The Right Relevance API was queried on February 7, 2020, and data were stored in Microsoft Excel (Seattle, WA, USA). Accounts were ranked by influence scores and excluded if they represented a group or organization. The resultant list included the most influential individuals on Twitter in general surgery.

Utilizing Twitter and additional social media accounts such as Doximity (San Francisco, CA, USA), LinkedIn (Sunnyvale, CA, USA), ResearchGate (Berlin, Germany), and respective personal and institutional websites, additional data were collected for each influencer. Data collected included profession, specialty, subspecialty, gender, board certification, and practice. Gender was collected from preferred pronouns or listed gender on websites. Board certification data were pulled on February 25, 2020, using the American Board of Surgery (ABS) and Royal College of Physicians and Surgeons of Canada, respectively. Academic h-index scores were queried from Scopus (Reed Elsevier, London, UK) on February 22, 2020. Statistics and figures were constructed using Microsoft Excel.

Results

The top individual social media influencers on Twitter in general surgery are represented in Table 1, with the complete list of social media influencers in the. Of these influencers, 50% are general surgeons, 3% are general surgery fellows, and 31% are general surgery residents (Figure 1). Of general surgery attendings (n = 44), 34% had an academic rank of full professor, 16% were associate professors, 16% were assistant professors, 7% were clinical lecturers, 2% visiting professors, 5% in nonacademic roles, 2% unknown, and 18% international without traditional academic positions correlating with the American academic rank. Of the attending general surgeons, 93% have completed a surgical fellowship. Influencers trained most frequently in surgical oncology (18%), laparoscopic surgery (16%), critical care/trauma (14%), and colorectal surgery (12%), while 6% were not specialized. Interestingly, 11% of the influencers in general surgery were physicians in other fields, specifically emergency medicine, orthopedic surgery, anesthesiology, urology, or plastic surgery integrated track. A minority of influencers (3%) were not physicians but were instead physician assistants, researchers, or professors. Excluding fellows and residents in training, of influencers listed as general surgeons in the United States and Canada, 91% are currently board certified in their respective country’s surgery association. Of the American influencers, 94% were board certified, with 1 physician with expired board certification. Of the Canadian influencers, 89% were board certified, with 1 provider not listed as certified, and 1 listed as retired.

Table 1

Top 25 Individual Influencers in General Surgery.^a

Overall rank	Twitter handle	Twitter name	Influencer score	Occupation in general surgery
4	logghemd	Heather Logghe, MD	92	General Surgery Resident
10	jbmatthews	Jeff Matthews MD	85	General Surgeon
11	docmartin22	Matthew Martin	85	General Surgeon
12	enenbee	Nancy Baxter MD PhD	84	General Surgeon
16	injurydr	Avery Nathens	82	General Surgeon
18	ewakeam	Elliot Wakeam	81	General Surgeon
20	tgrantcharovmd	Teodor Grantcharov	79	General Surgeon
21	drhasanalam	Hasan Alam	78	General Surgeon
25	ramosdelamedina	Antonio Ramos, MD, FACS	77	General Surgeon
26	doctorandysmith	Andy Smith	76	General Surgeon
27	allanokrainec	Allan Okrainec	76	General Surgeon
28	annajdare	Anna Dare	76	General Surgery Resident
30	jpmeizoso	Jonathan Meizoso, MD, MSPH	76	General Surgery Fellow
31	najmadoc	Najma Ahmed	76	General Surgeon
32	pmartinezmd	Patricia Martinez Quinones, MD PhD	76	General Surgery Resident
33	dbischof1	Danielle Bischof	75	General Surgeon
34	paulkaranicolas	Paul Karanicolas	75	General Surgeon
35	laurenbnosanov	Lauren Nosanov	75	General Surgery Resident
36	karimbrohi	Karim Brohi	74	General Surgeon
38	rg_oncodoc	Ralph George	74	General Surgeon
39	dorry_segev	Dorry Segev	74	General Surgeon
41	specialkdmd	Karen Devon	73	General Surgeon
42	tdcil	Tulin Cil MD	73	General Surgeon
43	uwo_gen_sx_pd	Dr. Michael Ott	73	General Surgeon
44	dhirparamd	Dhruvin H. Hirpara	73	General Surgery Resident

^aRight Relevance Insight API Data (www.rightrelevance.com, San Francisco, CA, USA) Topic Search for “General Surgery” Queried on February 7, 2020.

Figure 1

Occupational distribution of general surgery twitter influencers.

With respect to general surgery attendings, fellows, and residents, 41% were female, 58% were male, and 1% unknown. However, when divided into attending-level general surgery influencers, 80% were male, while only 20% were female. Interestingly, in assessing the influencers currently in general surgery residencies and fellowships, only 27% were male, while 70% were female, and 1 with unknown gender (Figure 2). Additionally, the majority of general surgery influencers were international (51%) with a large percentage based in Canada (28% overall). Influencers from the United States (48%) were distributed widely across the country (Table 2).

Figure 2

Gender distribution of general surgery twitter influencers.

Table 2

Geographical Distribution of General Surgery Twitter Influencers.

	n	%
International	45	51
Canada	25	28
Spain	7	8
United Kingdom	5	6
Australia	1	1
Colombia	1	1
Ireland	1	1
Kyrgystan	1	1
Malaysia	1	1
Mexico	1	1
Oman	1	1
Saudi Arabia	1	1
Unknown	1	1
United States	42	48
California	6	7
New York	5	6
Illinois	3	3
Massachusetts	3	3
Michigan	3	3
North Carolina	3	3
Ohio	3	3
Pennsylvania	3	3
District of Columbia	2	2
Georgia	2	2
Maryland	2	2
Texas	2	2
Colorado	1	1
Florida	1	1
Kansas	1	1
Virginia	1	1
Unknown	1	1

The academic h-indices for the social media influencers in general surgery or in general surgery training (n = 73) ranged from 0 to 73 (mean, 14.5 ± 8.2; median, 9.5; Figure 3). There was a significant correlation between Right Relevance general surgery twitter influencer score and both h-index (0.478, P < .05) and number of publications (0.397, P < .05).

Figure 3

Research output/productivity of general surgery twitter influencers. (A) General surgery twitter influencer score and h-index. (B) General surgery twitter influencer score and number of publications.

Discussion

Social media, and more specifically Twitter, has become a modern venue for information and idea sharing as well as networking for the general surgery community.^1-5 Educators, students, and patients collaborate to contribute and obtain information while being able to interact through “favorites” and “retweets” which can be tracked to find data valuable to the community. Previous studies have evaluated the relevance of the Twitter community, particularly the impact of societies and associations^4,13; however, in this study, we assessed the characteristics of individual influencers in general surgery. Most, but not all, were general surgery attendings and general surgeons in training. The majority of those at the attending level were board certified, fellowship trained, and held academic positions. The influencers as a whole were actively involved in the research. The majority of attending level general surgeon influencers were male. By contrast, training-level general surgeon influencers were predominantly female. Lastly, most influencers were located in the United States and Canada.

One of the unique aspects of social media is the broad reach of a discussion platform. Any member with an account worldwide can join the dialog on Twitter. Thus, nongeneral surgeons, including orthopedic surgeons, emergency medicine physicians, anesthesiologists, physician assistants, and researchers, were also influencers of the general surgery conversations. An awareness of the diverse backgrounds of those guiding these discussions in the field is crucial for interpreting information as well as continuing an open, universal discussion with a variety of perspectives. While an analysis of the content and the resultant impact of the tweets was beyond the scope of our study, we noted that posts from many of these influencers include topics ranging from surgical management and professional development to current events and social issues. Each influencer likely had biases and interests affecting their scope of engagement.

A significant portion of the influencers in general surgery were residents or fellows in training. While the distribution of general surgeon influencers was largely male, interestingly, the gender distribution for general surgeon influencers in training when both residents and fellows were combined was largely female. Social media has had a significant influence on increasing the diversity of those in fields with a traditional hierarchical structure, such as surgery, by offering a unique setting in which to gain recognition and encourage those beginning their careers to find mentors.^14-16 Our findings highlight the relevance of the Twitter platform for those at the beginning of their career. Additionally, our data suggest a potential shift in the dialog from largely male predominate (80% practicing general surgeons) to female predominate (72% residents and fellows) with equivalent involvement overall. Opportunities such as the 2015 viral image campaign #ILookLikeASurgeon pioneered by Heather Logghe (@LoggheMD), the top individual Twitter influencer in general surgery, allowed for the dissemination of images portraying the teamwork and diversity in the operating room.¹⁶ This has developed into worldwide movements celebrating the many faces of the individuals contributing to the field of general surgery.

In an earlier study, the mean h-index of 3712 general surgeons employed by academic surgery programs, with 79% of these reported as male, has been previously reported as 14.9 ± 14.8 with a median of 10, range 0-131.¹⁷ The h-index data reported from our general surgeon influencers (n = 73; range 0-73; mean 14.5 ± 8.2; median 9.5) was similar to the previously reported h-indices of academic, attending-level general surgeons across the country. While these data sets are similar, it is important to consider that the populations compared include general surgeons with careers based in high-ranking academic institutions as opposed to the open-access Twitter influencers with a large distribution still in general surgery training. Previous studies evaluating influencers in surgical subspecialties, plastic surgery, orthopedic surgery, and urology support that involvement in research of those on social media is higher than those not involved in social media.^7,11,12 However, these relationships are likely correlative and do not imply causation. The expansion of research dissemination with the evolution of social media is of continuing interest to those measuring research output and contribution to the field.^4,7 Inclusion of social media influence alongside a physician’s h-index through “altmetrics” as a measure of academic productivity requires additional study and consideration.¹⁸ While social media may reach additional members of the research community and enhance the impact of a particular project or publication, each potential user must perform an individual cost-benefit analysis of creating and maintaining a strong social media presence.¹⁹

The limitations of this study include the dependence on the Right Relevance API algorithm. This algorithm provides unique advantages by evaluating influencers by utilizing a more comprehensive appraisal that integrates interaction among peers as well as post interactions with peers involved in the specific topic. This has been more advantageous than evaluating social media involvement by top posts or the number of followers alone. However, while the Right Relevance API provides this technology to evaluate the community, we utilized only 1 algorithm to evaluate the general surgery community. Results from alternate algorithms may vary; however, we are confident that our list represents top general surgery influencers through the evaluation of Twitter profiles and supplemental social media sources such as LinkedIn, Doximity, ResearchGate, and Scopus. Lastly, social media has advantages in information distribution because of its dynamic profile, which leads to variability in the leaders in the field over time. Additional studies are needed to evaluate changes over time in top influencers as well as on alternative social media platforms. While Twitter has been determined to be the most influential in the medical community,^1-3 additional social media platforms should be explored.

In conclusion, the rise of social media and its central role in education and dissemination of information emphasizes the importance of characterizing those at the forefront of adoption. General surgery as a social media discussion topic on Twitter comprises a wide variety of participants at varying points of their careers, with a broad geographic distribution, and for many purposes. We have further characterized these participants providing insight regarding those currently leading the conversation on Twitter and directing the virtual discussions in general surgery.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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