- Email: [email protected]
Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery, and Opportunity for Improvement
Author's Accepted Manuscript Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery and Opportunity for Improvement Bradley C. Gill, JJ Haijing Zhang, Margaret A. Knoedler, Daniel A. Shoskes, Sandip P. Vasavada
PII: DOI: Reference:
S2352-0779(16)30206-0 10.1016/j.urpr.2016.09.004 URPR 224
To appear in: Urology Practice Accepted Date: 9 September 2016 Please cite this article as: Gill BC, Zhang JH, Knoedler MA, Shoskes DA, Vasavada SP, Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery and Opportunity for Improvement, Urology Practice (2016), doi: 10.1016/j.urpr.2016.09.004. DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain. All press releases and the articles they feature are under strict embargo until uncorrected proof of the article becomes available online. We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date.
ACCEPTED MANUSCRIPT
Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery and Opportunity for Improvement Bradley C Gill1,2, JJ Haijing Zhang1, Margaret A Knoedler3, Daniel A Shoskes1,2, Sandip P Vasavada1,2 1
246 / 250 words
Manuscript:
2,046 / 2,500 words
References:
22 / 25 references
Running Head: Digital Identity in FPMRS
Bradley C Gill, MD, MS
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Corresponding Author:
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Abstract:
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Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic 2 Lerner College of Medicine, Education Institute, Cleveland Clinic 3 Department of Urology, University of Wisconsin
Department of Urology, Glickman Urological and Kidney Institute
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Cleveland Clinic
9500 Euclid Ave | Cleveland, OH 44195
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Tel: (216) 445-7242 Fax: (216) 445-2267
E-Mail: [email protected]
Twitter: @BradGillMD
Key Words:
Social Media; Urology; Professionalism; Female Pelvic Medicine and Reconstructive Surgery; Education
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ABSTRACT Aims
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To describe the digital identity of academic urologists in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) by assessing their visible online information. Methods
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A GoogleTM search of Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) board members, past presidents, and fellowship directors was completed. Hits on the first page of results were categorized as: Institutional Page, Group/Society Page, Rating Site, Interview/Multimedia, Journal Article or Book, Social Media, Professional Profile, or Another Person. Sites were sub-classified as physician-controllable content or not. Descriptive statistics, comparisons between SUFU roles, and site-type associations were calculated.
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Results
Conclusions
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First page results contained a median 11[Q1-Q3: 10-11] hits with 2[2-3] institutional pages and 1[1-2] group/society. Ratings sites were frequent, with 4[3-5] hits in 98% (N=60) of searches. Only 1[1-1] social media, 1[1-2] professional profile, and 1[1-2] interview/multimedia hits occurred. Overall, 6[5-7] sites were physician-controllable content, with all but 1 physician having at least 1 such result. Institutional (correlation coefficient: -0.38, p 0.001) or group/society (-0.34, p 0.023) pages were associated with fewer rating sites. Group/society pages were 3.41(mean 11.7% vs 3.44%, p 0.009) times more prevalent among SUFU board members, while past presidents had 3.03(6.8% vs 2.3%, p 0.046) times more journal articles or books, and fellowship directors 1.43(25.6% vs 18.6% p 0.021) times more institutional pages.
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Active SUFU members have rating sites comprise a substantial portion of their search results. More online engagement or social media use could increase the visibility of physician-controllable content in their digital identities.
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Introduction:
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The professional reputation of physicians is increasingly dependent upon the Internet’s evergrowing catalogue of digital content. Whether or not by choice, every doctor has a “digital footprint” pervasively embedded in society(1). It is now this digital identity that makes the initial impression, before a true first impression may be formed in person. This poses a problem, in that many web sites returned when searching for physicians are content they have no control over - information that may not be most helpful for patients, colleagues, or employers.
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One response by the physician community has been the adoption of social media as a tool for sourcing self-controlled content into the digital realm. The term “social media” historically carried a negative connotation in healthcare due to widespread examples of unprofessionalism during its infancy(2, 3). However, when used appropriately, a strong social media presence can serve as a source of information, education, and networking. Additionally, the proprietary search engine algorithms of sites like GoogleTM and Microsoft Bing® preferentially return major social media and networking toward the top of in internet search results.
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Social media differs from traditional websites that passively present information in that it facilitates dynamic interaction with real-time content. This not only shifts learning into an interactive experience but enables a greater networking capability, which carries a number of other benefits. The popularity and accessibility of social media allows the contemporary physician to have substantially greater reach with their influence. The significance of this is clear, in that over 80% of people seek medical information on the internet, while there are over 600 million Facebook users(4, 5).
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The urologic community is actively engaging in web-based interaction. Issues in urology, most visibly the debate surrounding prostate cancer screening, have been addressed through venues like Twitter(6). Likewise, a recent multicenter study found growing numbers of health care professionals are generating useful information on “incontinence” across the internet(7). Clearly, the utilization of internet-based content is growing in urology and its subspecialty focuses. This study characterized the digital identity of academic urologists practicing Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and involved in Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) governance. Materials and Methods
This study is Institutional Review Board exempt and was completed using publically-available data gathered from internet searches. All results are presented in aggregate to provide anonymity to the individuals who had information collected. Using Microsoft Internet Explorer® (Microsoft Corporation, Redmond, Washington), a GoogleTM (Google, Mountain View, California) search using “First Name Last Name” of all Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) board members, past presidents, and fellowship directors was completed. The listing of physicians was collected from the SUFU website. Each hit on the first page of results was categorized (Table 1) as one of the following: Institutional Page, Group or Society Page, Rating Site, Online Interview or Multimedia, Journal Article or Book, Social Media, professional profile, or another person.
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No data was collected for physicians who are deceased or no longer practicing clinically. Descriptive statistics, comparisons between SUFU roles, and correlations between result types were calculated using JMP Pro 10 (SAS Institute, Cary, North Carolina). Data are presented as median [interquartile range] based upon non-parametric data distribution. All comparisons utilized p < 0.05 to indicate significance. Any type of hit lacking for an individual was excluded from analyses, except as described otherwise. Results
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A total 61 physicians were identified via the SUFU website and searched. First page results (Table 2) contained a median 11[Q1-Q3: 10-11] hits with 2[2-3] being institutional pages and 1[1-2] being a group/society site. Across all urologists, 97% (N=59) had at least one institutional page while only 38% (N=23) had a group/society page return. Results frequently contained rating sites, comprising 4[3-5] or 36.6% (range 29.3%-45.5%) of hits, with nearly all (98%, N=60) physicians having at least 1 return. Information about another person occurred in 18% (N=11) of searches, with such results comprising 6[3-7] hits if present. In the group analyzed, only 3.23% (N=2) of urologists had 1[1-1] social media site appear in results. However, 72% (N=44) had 1[1-2] professional profile visible, while 84% (N=51) had 1[1-2] interview or multimedia hit return. Journal articles and books comprised 1[1-2] result in 18% (N=11) of searches. Overall, 98% (N=60) of academic urologists assessed had at least 1 site with physiciancontrollable content, with such sites comprising 6[5-7] or 63.6% (range 54.4%-70.7%) of results if so.
Discussion
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Fewer numbers of rating sites were noted if institutional pages (correlation coefficient: -0.38, p 0.001) or group/society sites (-0.34, p 0.023) were present. Group/society sites were 3.41 (mean 11.7% vs 3.44% of hits, p 0.009) times more prevalent among SUFU board members, while past SUFU presidents had 3.03 (mean 6.8% vs 2.25% of hits, p 0.046) times more journal articles or books return. Searches for SUFU fellowship directors returned 1.43 (mean 26.6% vs 18.63 of hits, p 0.021) times more institutional pages.
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This study found that of first-page hits from internet searches of 61 academic urologists in FMPRS, over 36% of results were not physician-controllable content. These results were mostly ratings sites and information returned about other individuals. This has significant implications for a physician’s digital identity, as 90% of internet search activity is limited to the first page of results(8). Therefore, the top results of a search for a physician are crucial in defining the physician’s visibility and projected identity. As many patients rely on internet searches to identify physicians before arranging care, this may influence their decisions. Ratings sites vary in their structure, content, and function. Some, including HealthGrades® and ZocDocTM, are built upon small samples of anonymous patient ratings. With limited data points, the information presented in such reviews is subject to be skewed by disgruntled patients or similarly exuberant ones. Likewise, accurate portrayal of the physician in such venues is subject factors like
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parking, clerical staff, or commute that may otherwise impact the patient experience. With that, across the 10 most frequently visited ratings sites, the average user-generated physician rating was 77 out of 100 (SD 11, range 33-100)(9). This warrants consideration, as over 65% of patients utilize such ratings when choosing which physicians to see(10). To increase objectivity and decrease potential bias in a physician’s digital presence, populating first-page search results with self-controlled content may help offset some of the ratings sites and displace them to a subsequent page via search engine algorithms that preferentially return social media sites.
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In the data analyzed, social media was underrepresented in first-page results of academic urologists active in SUFU. Only 1 social media result returned for those with such sites visible. This is consistent with findings in a recent a study of the digital footprints of urologists at 10 prominent urology residency programs noting a median 0 [0-1] social media sites visible in first-page search results(1). While the data presented herein, such as the significantly higher number of institutional sites appearing for fellowship directors, shows academic involvement may result in more useful content early in search results, it does not capitalize upon the observation that internet search engines preferentially return social media hits early in search result lists(11-13). In the context of a growing social media presence in academic urology, this lack of social media visibility represents an area for improvement.
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As a field, part of the social media growth in urology has been driven by its specialty journals. At present, at least 25% of high profile Urology journals use TwitterTM and 40% use FacebookTM to interact with their readership and the general public(14). Of these journals, 3 prominent ones have achieved increased impact factors in the time period after initiating TwitterTM utilization(14). With that, other work has shown that compared to going without, TwitterTM utilization by urology journals is associated with significantly higher impact factors (3.588 vs 1.78, P=0.013)(14). The sub-specialty journal of SUFU, Neurourology and Urodynamics, has been on Twitter since 2011, but only with only intermittent activity and none since December 2015. Of the academic urologists assessed in this study, no reduction in ratings sites was observed for having journal articles return in search result. However, more journal articles were noted to return for SUFU presidents than those with other SUFU roles, suggesting they may command higher visibility in existing literature.
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The data in this study showed SUFU board members were significantly more likely to have pages for professional groups or societies return in their search results. In addition to publications, professional organizations and scientific meetings have also benefitted from social media use. TwitterTM participation at AUA annual meetings increased drastically from 2012 to 2013 with 811 tweets from 134 accounts to 4590 tweets from 540 accounts(15). At the 2016 annual SUFU meeting, Twitter use was promoted by the organization and its leadership, with active online discussion occurring during the conference. This has provided a venue for real-time dialogue regarding breakthrough presentations, as well as a means of sharing such information with a broader audience that may not be in attendance. The underpinning of the benefit of social media to both publications and meetings, however, is the individual user – the source of content sharing and forging connections with others. With the emphasis on Twitter use at SUFU this past year, it may be interesting how the findings in this study differ in a year or two.
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A wealth of information exists on the internet, some valid, some superficial, and some detrimental. Taking control of one’s digital identity help ensures the information readily discoverable about that individual is content they control and wish for others to see. This study found that over 63% of the sites returned contained physician-controllable content, which is in agreement with findings in prior work analyzing academic urologists at prominent institutions(1). Furthermore, having control over such content can help advance knowledge in one’s field, as well as aid patients in their care. One study of social media content on “incontinence” found only 13% of FacebookTM results were “informative” while, at most, 40% of content across 3 social media platforms was medically useful(16). Similarly, only 29% of the first 150 GoogleTM search results for “urinary incontinence” were from physicians, professional societies, or scientific journals(17). Taken together, and with more recent information showing a continued paucity of helpful content heavy with advertising, it is clear there is room for more online involvement by the clinicians treating these conditions(7, 18)
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The ideal framework for developing a useful and robust digital identity can be simplified into 3 components supplementing an existing institutional profile: Networking (eg LinkedInTM, DoximityTM), Commentary (eg TwitterTM, blog, YouTubeTM), and Academics (eg PubMed)(19). By making connections, sharing information, and spreading knowledge, maintaining a useful and accurate digital identity becomes straight forward. Additional guidance in doing so can also be found in any of the social media best practices or guidelines materials available from professional organizations(20, 21). Furthermore, many medical schools are now including education on digital content as part of their professionalism curriculum and some residency programs are considering such additions(2, 22).
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The strengths of this study include a standardized search methodology, which utilized a single individual on a single computer. Approaching the search in this fashion limits the influence of proprietary search algorithms on results returned by eliminating the introduction of other computers with variable browsing histories that could alter results. Another strength of the study is the use of publically available information, which eliminates the likelihood of observer bias that could influence the behavior of the academic urologists being studied. Drawbacks of the study include the unknown impact of the proprietary search algorithm on results, however, whatever effects this has would be replicated across each individual studied. The use of a single browser and single search engine could also be considered a limitation of this study, however, in prior work the results returned using different software and search engines suggested Google provided the least repeated first page search results(1).
Conclusions
The digital and professional identities of physicians are closely intertwined, whether or not the choice to actively engage in managing online content has been made. High-stakes SUFU members, like other academic urologists, have large numbers of ratings sites and non-controllable content in their primary internet search results with relatively less social media visibility. Increased engagement online may help improve the visibility of SUFU members and the amount of physician-controllable online content in their digital identities.
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References
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1. Gill BC, Ericson KJ, Hemal S, Babbar P, Shoskes D. The digital footprint of academic urologists: where do we stand? Urology. 2016; 90: 27-31. 2. Walton JM, White J, Ross S. What's on YOUR Facebook profile? Evaluation of an educational intervention to promote appropriate use of privacy settings by medical students on social networking sites. Med Educ Online. 2015; July 20. Accessed December, 2015.
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3. Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med. 2008; 23(7): 954-7.
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4. Menon AM, Deshpande AD, Perri M3, Zinkhan GM. Trust in online prescription drug information among internet users: the impact on information search behavior after exposure to direct-to-consumer advertising. Health Mark Q. 2002; 20(1): 17-35. 5. Digital differences [Internet]. 2012. Accessed December, 2015. Available from: http://www.pewinternet.org/2012/04/13/digital-differences/. 6. Loeb S, Bayne CE, Frey C, Davies BJ, Averch TD, Woo HH, et al. Use of social media in urology: data from the American Urological Association (AUA). BJI Int. 2014; 113(6): 993-8.
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7. Alas A, Sajadi K, Goldman H, Anger J. The rapidly increasing usefulness of social media in urogynecology. Female Pelvic Med Reconstr Surg. 2013; 19(4): 210-3. 8. Brin S, Page L. The anatomy of a large-scale hypertextual web search engine. Computer Networks and ISDN Systems. 1998; 30(1-7): 107-17.
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9. Kadry B, Chu LF, Kadry B, Gammas D, Macario A. Analysis of 4999 online physician ratings indicates that most patients given physicians a favorable rating. J Med Internet Res. 2011; 13(4): e95.
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10. Emmert M, Meier F, Pisch F, Sander U. Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study. J Med Internet Res. 2013; 15(8): e187. 11. A visual history of Google Algorithm Updates [Internet]. 2015. Accessed December, 2015. Available from: http://blog.hubspot.com/marketing/google-algorithm-visual-history-infographic. 12. How to dominate the first page of branded search results [Internet]. 2014. Accessed December, 2015. Available from: http://www.riverbedmarketing.com/dominate-first-page-branded-searchresults/. 13. 10 ways to rank for your name in search results [Internet]. 2015. Accessed December, 2015. Available from: http://www.thesaleslion.com/10-ways-to-rank-for-your-name-in-search-engineresults/.
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14. Nason GJ, O'Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, et al. The emerging use of Twitter by urological journals. BJU Int. 2015; 115(3): 486-90. 15. Matta R, Doiron C, Leveridge MJ. The dramatic increase in social media in urology. J Urol. 2014; 192(2): 494-8.
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16. Sajadi KP, Goldman HB. Social networks lack useful content for incontinence. Urology. 2011; 78(4): 764-7. 17. Sajadi KP, Goldman HB, Firoozi G. Assessing internet health information on female pelvic floor disorders. J Urol. 2011; 186(2): 594-6.
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18. Saraswat I, Abouassaly R, Dwyer P, Bolton DM, Lawrentschuk N. Female urinary incontinence health information quality on the internet: a multilingual evaluation. Int Urogynecol J. 2016; 27(1): 69-75.
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19. Gill BC, Zampini AM, Mehta NB. Digital identity: develop one before you're given one. Urology. 2015; 85(6): 1219-23. 20. American Urological Association Social Media Best Practices [Internet]. 2015. Accessed December, 2015. Available from: https://www.auanet.org/press-media/social-media-bp.cfm. 21. Roupret M, Morgan TM, Bostrom PJ, Cooperberg MR, Kutikov A, Linton KD, et al. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media. Eur Urol. 2014; 66(4): 628-32.
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22. Galiatsatos P, Porto-Carreiro F, Hayashi J, Zakaria S, Christmas C. The use of social media to supplement resident medical education - the SMART-ME initiative. Med Educ Online [Internet]. 2016; January 8. Accessed December, 2015.
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Table 1 Web Search Result Categorization Examples Academic Institution, Hospital, Health System, … Specialty Organization, Subspecialty Society, Group or Society Page Community Volunteer Group, Social Club, … Rating Site HealthGrades®, VitalsTM, ZocDocTM, RateMDsTM, … Online Interview or Multimedia YouTubeTM, PodCastTM, News Site, … Journal Article or Book Journal Website, Indexing Website, AmazonTM, … Social Media TwitterTM, Google+TM, FacebookTM, Blog, … Professional Profile LinkedInTM, DoximityTM, Maps, … Another Person Another Person
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Category Institutional Page
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Table 1: Typical categories and examples of websites returned on web searches for physicians.
Table 2
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Category
Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) Physician Leadership First Page Web Search Results Number of Urologists Interquartile Range Median with Site Type (%) [Q1-Q3] 11 10-11 11 (18%) 6 5-7 60 (98.4%) 4 3-5 59 (96.7%) 2 2-3 23 (37.7%) 1 1-2 44 (72.1%) 1 1-2 51 (83.6%) 1 1-2 11 (18.0%) 1 1-2 2 (3.3%) 1 1-1
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Total Results Another Person Rating Site Institutional Page Group or Society Page Professional Profile Online Interview or Multimedia Journal Article or Book Social Media
Table 2: First page web search results for Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) physician leadership. Results listed in gray boxes signify content that is not physician-controllable. If a type of site was lacking for an individual, it was excluded from analyses.
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Key of Definitions for Abbreviations SUFU: Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction
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FPMRS: Female Pelvic Medicine and Reconstructive Surgery
PII: DOI: Reference:
S2352-0779(16)30206-0 10.1016/j.urpr.2016.09.004 URPR 224
To appear in: Urology Practice Accepted Date: 9 September 2016 Please cite this article as: Gill BC, Zhang JH, Knoedler MA, Shoskes DA, Vasavada SP, Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery and Opportunity for Improvement, Urology Practice (2016), doi: 10.1016/j.urpr.2016.09.004. DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain. All press releases and the articles they feature are under strict embargo until uncorrected proof of the article becomes available online. We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date.
ACCEPTED MANUSCRIPT
Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery and Opportunity for Improvement Bradley C Gill1,2, JJ Haijing Zhang1, Margaret A Knoedler3, Daniel A Shoskes1,2, Sandip P Vasavada1,2 1
246 / 250 words
Manuscript:
2,046 / 2,500 words
References:
22 / 25 references
Running Head: Digital Identity in FPMRS
Bradley C Gill, MD, MS
TE D
Corresponding Author:
M AN U
Abstract:
SC
RI PT
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic 2 Lerner College of Medicine, Education Institute, Cleveland Clinic 3 Department of Urology, University of Wisconsin
Department of Urology, Glickman Urological and Kidney Institute
EP
Cleveland Clinic
9500 Euclid Ave | Cleveland, OH 44195
AC C
Tel: (216) 445-7242 Fax: (216) 445-2267
E-Mail: [email protected]
Twitter: @BradGillMD
Key Words:
Social Media; Urology; Professionalism; Female Pelvic Medicine and Reconstructive Surgery; Education
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ABSTRACT Aims
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To describe the digital identity of academic urologists in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) by assessing their visible online information. Methods
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A GoogleTM search of Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) board members, past presidents, and fellowship directors was completed. Hits on the first page of results were categorized as: Institutional Page, Group/Society Page, Rating Site, Interview/Multimedia, Journal Article or Book, Social Media, Professional Profile, or Another Person. Sites were sub-classified as physician-controllable content or not. Descriptive statistics, comparisons between SUFU roles, and site-type associations were calculated.
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Results
Conclusions
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First page results contained a median 11[Q1-Q3: 10-11] hits with 2[2-3] institutional pages and 1[1-2] group/society. Ratings sites were frequent, with 4[3-5] hits in 98% (N=60) of searches. Only 1[1-1] social media, 1[1-2] professional profile, and 1[1-2] interview/multimedia hits occurred. Overall, 6[5-7] sites were physician-controllable content, with all but 1 physician having at least 1 such result. Institutional (correlation coefficient: -0.38, p 0.001) or group/society (-0.34, p 0.023) pages were associated with fewer rating sites. Group/society pages were 3.41(mean 11.7% vs 3.44%, p 0.009) times more prevalent among SUFU board members, while past presidents had 3.03(6.8% vs 2.3%, p 0.046) times more journal articles or books, and fellowship directors 1.43(25.6% vs 18.6% p 0.021) times more institutional pages.
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Active SUFU members have rating sites comprise a substantial portion of their search results. More online engagement or social media use could increase the visibility of physician-controllable content in their digital identities.
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Introduction:
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The professional reputation of physicians is increasingly dependent upon the Internet’s evergrowing catalogue of digital content. Whether or not by choice, every doctor has a “digital footprint” pervasively embedded in society(1). It is now this digital identity that makes the initial impression, before a true first impression may be formed in person. This poses a problem, in that many web sites returned when searching for physicians are content they have no control over - information that may not be most helpful for patients, colleagues, or employers.
M AN U
SC
One response by the physician community has been the adoption of social media as a tool for sourcing self-controlled content into the digital realm. The term “social media” historically carried a negative connotation in healthcare due to widespread examples of unprofessionalism during its infancy(2, 3). However, when used appropriately, a strong social media presence can serve as a source of information, education, and networking. Additionally, the proprietary search engine algorithms of sites like GoogleTM and Microsoft Bing® preferentially return major social media and networking toward the top of in internet search results.
TE D
Social media differs from traditional websites that passively present information in that it facilitates dynamic interaction with real-time content. This not only shifts learning into an interactive experience but enables a greater networking capability, which carries a number of other benefits. The popularity and accessibility of social media allows the contemporary physician to have substantially greater reach with their influence. The significance of this is clear, in that over 80% of people seek medical information on the internet, while there are over 600 million Facebook users(4, 5).
AC C
EP
The urologic community is actively engaging in web-based interaction. Issues in urology, most visibly the debate surrounding prostate cancer screening, have been addressed through venues like Twitter(6). Likewise, a recent multicenter study found growing numbers of health care professionals are generating useful information on “incontinence” across the internet(7). Clearly, the utilization of internet-based content is growing in urology and its subspecialty focuses. This study characterized the digital identity of academic urologists practicing Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and involved in Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) governance. Materials and Methods
This study is Institutional Review Board exempt and was completed using publically-available data gathered from internet searches. All results are presented in aggregate to provide anonymity to the individuals who had information collected. Using Microsoft Internet Explorer® (Microsoft Corporation, Redmond, Washington), a GoogleTM (Google, Mountain View, California) search using “First Name Last Name” of all Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) board members, past presidents, and fellowship directors was completed. The listing of physicians was collected from the SUFU website. Each hit on the first page of results was categorized (Table 1) as one of the following: Institutional Page, Group or Society Page, Rating Site, Online Interview or Multimedia, Journal Article or Book, Social Media, professional profile, or another person.
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No data was collected for physicians who are deceased or no longer practicing clinically. Descriptive statistics, comparisons between SUFU roles, and correlations between result types were calculated using JMP Pro 10 (SAS Institute, Cary, North Carolina). Data are presented as median [interquartile range] based upon non-parametric data distribution. All comparisons utilized p < 0.05 to indicate significance. Any type of hit lacking for an individual was excluded from analyses, except as described otherwise. Results
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A total 61 physicians were identified via the SUFU website and searched. First page results (Table 2) contained a median 11[Q1-Q3: 10-11] hits with 2[2-3] being institutional pages and 1[1-2] being a group/society site. Across all urologists, 97% (N=59) had at least one institutional page while only 38% (N=23) had a group/society page return. Results frequently contained rating sites, comprising 4[3-5] or 36.6% (range 29.3%-45.5%) of hits, with nearly all (98%, N=60) physicians having at least 1 return. Information about another person occurred in 18% (N=11) of searches, with such results comprising 6[3-7] hits if present. In the group analyzed, only 3.23% (N=2) of urologists had 1[1-1] social media site appear in results. However, 72% (N=44) had 1[1-2] professional profile visible, while 84% (N=51) had 1[1-2] interview or multimedia hit return. Journal articles and books comprised 1[1-2] result in 18% (N=11) of searches. Overall, 98% (N=60) of academic urologists assessed had at least 1 site with physiciancontrollable content, with such sites comprising 6[5-7] or 63.6% (range 54.4%-70.7%) of results if so.
Discussion
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Fewer numbers of rating sites were noted if institutional pages (correlation coefficient: -0.38, p 0.001) or group/society sites (-0.34, p 0.023) were present. Group/society sites were 3.41 (mean 11.7% vs 3.44% of hits, p 0.009) times more prevalent among SUFU board members, while past SUFU presidents had 3.03 (mean 6.8% vs 2.25% of hits, p 0.046) times more journal articles or books return. Searches for SUFU fellowship directors returned 1.43 (mean 26.6% vs 18.63 of hits, p 0.021) times more institutional pages.
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This study found that of first-page hits from internet searches of 61 academic urologists in FMPRS, over 36% of results were not physician-controllable content. These results were mostly ratings sites and information returned about other individuals. This has significant implications for a physician’s digital identity, as 90% of internet search activity is limited to the first page of results(8). Therefore, the top results of a search for a physician are crucial in defining the physician’s visibility and projected identity. As many patients rely on internet searches to identify physicians before arranging care, this may influence their decisions. Ratings sites vary in their structure, content, and function. Some, including HealthGrades® and ZocDocTM, are built upon small samples of anonymous patient ratings. With limited data points, the information presented in such reviews is subject to be skewed by disgruntled patients or similarly exuberant ones. Likewise, accurate portrayal of the physician in such venues is subject factors like
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parking, clerical staff, or commute that may otherwise impact the patient experience. With that, across the 10 most frequently visited ratings sites, the average user-generated physician rating was 77 out of 100 (SD 11, range 33-100)(9). This warrants consideration, as over 65% of patients utilize such ratings when choosing which physicians to see(10). To increase objectivity and decrease potential bias in a physician’s digital presence, populating first-page search results with self-controlled content may help offset some of the ratings sites and displace them to a subsequent page via search engine algorithms that preferentially return social media sites.
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In the data analyzed, social media was underrepresented in first-page results of academic urologists active in SUFU. Only 1 social media result returned for those with such sites visible. This is consistent with findings in a recent a study of the digital footprints of urologists at 10 prominent urology residency programs noting a median 0 [0-1] social media sites visible in first-page search results(1). While the data presented herein, such as the significantly higher number of institutional sites appearing for fellowship directors, shows academic involvement may result in more useful content early in search results, it does not capitalize upon the observation that internet search engines preferentially return social media hits early in search result lists(11-13). In the context of a growing social media presence in academic urology, this lack of social media visibility represents an area for improvement.
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As a field, part of the social media growth in urology has been driven by its specialty journals. At present, at least 25% of high profile Urology journals use TwitterTM and 40% use FacebookTM to interact with their readership and the general public(14). Of these journals, 3 prominent ones have achieved increased impact factors in the time period after initiating TwitterTM utilization(14). With that, other work has shown that compared to going without, TwitterTM utilization by urology journals is associated with significantly higher impact factors (3.588 vs 1.78, P=0.013)(14). The sub-specialty journal of SUFU, Neurourology and Urodynamics, has been on Twitter since 2011, but only with only intermittent activity and none since December 2015. Of the academic urologists assessed in this study, no reduction in ratings sites was observed for having journal articles return in search result. However, more journal articles were noted to return for SUFU presidents than those with other SUFU roles, suggesting they may command higher visibility in existing literature.
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The data in this study showed SUFU board members were significantly more likely to have pages for professional groups or societies return in their search results. In addition to publications, professional organizations and scientific meetings have also benefitted from social media use. TwitterTM participation at AUA annual meetings increased drastically from 2012 to 2013 with 811 tweets from 134 accounts to 4590 tweets from 540 accounts(15). At the 2016 annual SUFU meeting, Twitter use was promoted by the organization and its leadership, with active online discussion occurring during the conference. This has provided a venue for real-time dialogue regarding breakthrough presentations, as well as a means of sharing such information with a broader audience that may not be in attendance. The underpinning of the benefit of social media to both publications and meetings, however, is the individual user – the source of content sharing and forging connections with others. With the emphasis on Twitter use at SUFU this past year, it may be interesting how the findings in this study differ in a year or two.
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A wealth of information exists on the internet, some valid, some superficial, and some detrimental. Taking control of one’s digital identity help ensures the information readily discoverable about that individual is content they control and wish for others to see. This study found that over 63% of the sites returned contained physician-controllable content, which is in agreement with findings in prior work analyzing academic urologists at prominent institutions(1). Furthermore, having control over such content can help advance knowledge in one’s field, as well as aid patients in their care. One study of social media content on “incontinence” found only 13% of FacebookTM results were “informative” while, at most, 40% of content across 3 social media platforms was medically useful(16). Similarly, only 29% of the first 150 GoogleTM search results for “urinary incontinence” were from physicians, professional societies, or scientific journals(17). Taken together, and with more recent information showing a continued paucity of helpful content heavy with advertising, it is clear there is room for more online involvement by the clinicians treating these conditions(7, 18)
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The ideal framework for developing a useful and robust digital identity can be simplified into 3 components supplementing an existing institutional profile: Networking (eg LinkedInTM, DoximityTM), Commentary (eg TwitterTM, blog, YouTubeTM), and Academics (eg PubMed)(19). By making connections, sharing information, and spreading knowledge, maintaining a useful and accurate digital identity becomes straight forward. Additional guidance in doing so can also be found in any of the social media best practices or guidelines materials available from professional organizations(20, 21). Furthermore, many medical schools are now including education on digital content as part of their professionalism curriculum and some residency programs are considering such additions(2, 22).
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The strengths of this study include a standardized search methodology, which utilized a single individual on a single computer. Approaching the search in this fashion limits the influence of proprietary search algorithms on results returned by eliminating the introduction of other computers with variable browsing histories that could alter results. Another strength of the study is the use of publically available information, which eliminates the likelihood of observer bias that could influence the behavior of the academic urologists being studied. Drawbacks of the study include the unknown impact of the proprietary search algorithm on results, however, whatever effects this has would be replicated across each individual studied. The use of a single browser and single search engine could also be considered a limitation of this study, however, in prior work the results returned using different software and search engines suggested Google provided the least repeated first page search results(1).
Conclusions
The digital and professional identities of physicians are closely intertwined, whether or not the choice to actively engage in managing online content has been made. High-stakes SUFU members, like other academic urologists, have large numbers of ratings sites and non-controllable content in their primary internet search results with relatively less social media visibility. Increased engagement online may help improve the visibility of SUFU members and the amount of physician-controllable online content in their digital identities.
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References
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Table 1 Web Search Result Categorization Examples Academic Institution, Hospital, Health System, … Specialty Organization, Subspecialty Society, Group or Society Page Community Volunteer Group, Social Club, … Rating Site HealthGrades®, VitalsTM, ZocDocTM, RateMDsTM, … Online Interview or Multimedia YouTubeTM, PodCastTM, News Site, … Journal Article or Book Journal Website, Indexing Website, AmazonTM, … Social Media TwitterTM, Google+TM, FacebookTM, Blog, … Professional Profile LinkedInTM, DoximityTM, Maps, … Another Person Another Person
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Category Institutional Page
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Table 1: Typical categories and examples of websites returned on web searches for physicians.
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Category
Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) Physician Leadership First Page Web Search Results Number of Urologists Interquartile Range Median with Site Type (%) [Q1-Q3] 11 10-11 11 (18%) 6 5-7 60 (98.4%) 4 3-5 59 (96.7%) 2 2-3 23 (37.7%) 1 1-2 44 (72.1%) 1 1-2 51 (83.6%) 1 1-2 11 (18.0%) 1 1-2 2 (3.3%) 1 1-1
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Total Results Another Person Rating Site Institutional Page Group or Society Page Professional Profile Online Interview or Multimedia Journal Article or Book Social Media
Table 2: First page web search results for Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) physician leadership. Results listed in gray boxes signify content that is not physician-controllable. If a type of site was lacking for an individual, it was excluded from analyses.
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Key of Definitions for Abbreviations SUFU: Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction
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FPMRS: Female Pelvic Medicine and Reconstructive Surgery