Twitter Use among Academic Urology Programs

Author's Accepted Manuscript Twitter Use Among Academic Urology Programs Nicholas J. Farber, Christopher J. Koprowski, Parth K. Modi, Wei Wang, Justin M. Dubin, Young Suk Kwon, Sammy E. Elsamra

PII: DOI: Reference:

S2352-0779(16)30204-7 10.1016/j.urpr.2016.07.009 URPR 222

To appear in: Urology Practice Accepted Date: 14 July 2016 Please cite this article as: Farber NJ, Koprowski CJ, Modi PK, Wang W, Dubin JM, Kwon YS, Elsamra SE, Twitter Use Among Academic Urology Programs, Urology Practice (2016), doi: 10.1016/ j.urpr.2016.07.009. 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

Twitter Use Among Academic Urology Programs Nicholas J Farber1, Christopher J Koprowski2, Parth K Modi1, Wei Wang3, Justin M Dubin2, Young Suk Kwon3,4, Sammy E Elsamra1 1

Correspondence:

TE D

M AN U

SC

RI PT

Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 2 Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 3 Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NJ 4 Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

AC C

EP

Nicholas J. Farber, MD Rutgers Robert Wood Johnson Medical School Division of Urology 125 Paterson Street New Brunswick, NJ 08901 Tel: 732-235-6813 Fax: 732-235-6596 [email protected]

Runninghead: Twitter use among academic urology programs

Key Words: Twitter, social media, urology programs, residency programs 1

ACCEPTED MANUSCRIPT

Abstract

RI PT

Purpose: Twitter is a popular social media platform that plays an important role in the urologic community. Benefits include dissemination of knowledge, cross-institutional communication, amplification of conference content, and greater engagement of the public, with increased departmental exposure. To date, however, the use of Twitter by academic urology programs has yet to be examined.

SC

Materials and Methods: The existence and profile of institutional Twitter accounts of each United States urology residency program was recorded and reassessed in six months. Geographic stratification of Twitter presence was evaluated with chi-square analysis. The relationship between Twitter variables and USNWR ranking was evaluated using Pearson’s correlation coefficient. Detailed account data was collected for the top five accounts by tweet volume. Conference hashtag activity for the 2013-2015 AUA meetings was compared.

M AN U

Results: The total number of residency programs with a Twitter account is 38 (30%). Median number of tweets, followers, following, and age of account was 58, 154, 107.5, and 20 months, respectively. Geographic stratification failed to show significant difference (p=0.73). Of the 38 accounts, 11 were inactive over 6 months. The 27 active accounts had an average percent increase of 161% in tweets and 148% in followers. Twitter presence showed no difference in USNWR ranking (p=0.51). Conference hashtags #AUA13-#AUA15 increased in activity each year.

AC C

EP

TE D

Conclusions: A minority of academic urology programs use Twitter. Account activity grew significantly over time. The role of Twitter is still being defined, but is rapidly gaining traction as a new powerful communication tool amongst urologists and with the public.

2

ACCEPTED MANUSCRIPT

Introduction

Twitter (Twitter Inc, San Francisco, CA, USA) is a popular social media platform that

RI PT

facilitates user-generated content. With approximately 320 million monthly active users, Twitter offers a highly visible public platform for widespread information exchange. The benefits of this massive forum are multi-fold and include opportunities for teaching,

SC

advocacy, learning, and networking. In the past several years, the urologic community has recognized the potential benefits of engaging with this social media platform and

M AN U

consequently Twitter use in urology is on the rise.

One of the largest characterizations of social media use among urologists includes an email survey distributed by the American Urologic Association in 2012-2013 to 2000

TE D

randomly selected urologists and 2047 resident/fellow members. This survey indicated that 36% of urologists and urology residents use Twitter.1 Twitter also plays a prominent role amongst academic journals, as approximately 25% of all urologic journals have an

EP

associated Twitter account to feature articles of significant interest.2 In addition, Twitter has been used to feature content from many notable urologic conferences, including the

AC C

World Congress of Endourology, European Association of Urology, American Urological Association and Canadian Urological Association annual meetings.3, 4 Twitter can even be used as valuable research tool. Dal Moro performed the first online survey in urology back in 2013 when he asked AUA congress participants to describe their approach to prostatectomy using the hashtag #AUA13. This novel methodology quickly received 326 responses.5 Finally, academic urologists from around the world have

3

ACCEPTED MANUSCRIPT

utilized Twitter to engage in an international urology journal club, which featured participation by 189 unique users from 19 countries over a twelve-month span.6

RI PT

While academic urology has widely embraced Twitter in various capacities, to date no

study has investigated the Twitter presence of United States academic urology programs. Moreover, a prominent benefit of Twitter is that it allows urology programs to directly

SC

engage the public, thereby increasing exposure of the department. This study is an

exploratory analysis and description of the current state of Twitter use among academic

Materials and Methods

M AN U

urology programs in the United States.

TE D

Academic urology programs included in our study were identified by the listing on the “Accredited U.S. Urology Programs” section of the AUA website.7 Academic urology departments/divisions without a residency program were not included. Geographic

EP

stratification of urology residency programs was done using the four “regions” (Northeast, Midwest, West, South) established in the Geographic Areas Reference

AC C

Manual by the United States Census Bureau.8

A manual search using the Google search engine and of the Twitter.com website was performed between the dates of October 16-19, 2015 to identify Twitter accounts. The search was repeated on April 10, 2016 to trend account parameters over time and to discover any new accounts. Urology department/division webpages were also assessed

4

ACCEPTED MANUSCRIPT

for the presence of a Twitter account. Two separate reviewers performed independent searches and a third reviewer verified the search results of the two reviewers and settled

RI PT

any discrepancies.

The presence or absence of each institutional Twitter account was recorded, along with

the total number of followers, following, favorites, tweets, and age of account in October

SC

2015 and again in April of 2016. The age of the account was based on the date of creation as explicitly listed on the Twitter account; if the date of account creation was unavailable

M AN U

then the date of the first tweet was used as a surrogate for the date of creation.

Detailed demographics including gender, age and city of Twitter account followers were obtained for the top five Twitter accounts by Tweet number identified in the initial search

this analysis.

TE D

in October 2015. The Klear website (twtrland Inc.; www.klear.com) was used to perform

EP

Twitter activity during the 2013-2015 American Urologic Association (AUA) meetings was compared by analyzing the activity of the following hashtags: #AUA13, #AUA14

AC C

and #AUA15. To facilitate this analysis, the Symplur website was employed (Symplur LLC; www.symplur.com), which indexed the conference hashtags and provided information about Twitter activity over the course of each respective conference.

The 2015 U.S. News and World Report (USNWR) Urology hospital ranking was recorded for each residency program’s associated hospitals. The chi-square (X2) test was

5

ACCEPTED MANUSCRIPT

employed to assess for differences in Twitter prevalence among different geographic regions. The relationship between twitter variables and USNWR ranking was evaluated using Pearson’s correlation coefficient (PCC). All statistical analyses were performed

RI PT

using SAS 9.4 (SAS Institute, Cary, NC) and R 3.2.1 (CRAN: The Comprehensive R

Archive Network at http://cran.r-project.org). Statistical significance was defined as two-

SC

sided p<0.05.

M AN U

Results

The total number of urology residency programs with Twitter accounts as of October 2015 was 38 (30% of all programs). Median (range) number of tweets, followers, following, and age of account in October 2015 was 58 (1–1646), 154 (0–1697), 107.5 (0-

TE D

655), and 20 months (1-78), respectively. With geographic stratification, the prevalence of Twitter accounts in urology residency programs was 26.3% in the Northeast (n=38), 21.4% in the Midwest (n=28), 33.3% in the South (n=42), and 40.0% in the West (n=20).

EP

Chi-square analysis comparing geographic regions failed to show a statistically

AC C

significant difference (Χ2= 1.3, p=0.7291) (Table 1).

The accounts were reassessed six months after the initial data collection was performed. After six months, 11/38 accounts (28.9%) were deemed inactive. Inactive accounts were defined as those with fewer than 5 new Tweets over that six-month period. Of the remaining 27 accounts, there was an average percent increase in number of Tweets of 161.0%, with a range of 14%-1838% and median increase of 47%. In terms of followers,

6

ACCEPTED MANUSCRIPT

one account lost 13% of its followers, another lost 3% and a third account was unchanged. The other 34 accounts all gained followers, with an average percent gain of 115.3%, a range of 1%-1271% and a median gain of 54%. Among the 11 relatively

RI PT

inactive accounts, the change in followers ranged from -13% to 17%, with an average

change of 4.1%. Excluding these accounts from the initial analysis yields an average and median increase of 148.4% and 70%, respectively. From October 2015 to April 2016, one

SC

new urology department Twitter account was created. (Table 2)

M AN U

Compared to urology programs without Twitter accounts, those with accounts showed no statistically significant difference in ranking on USNWR (p=0.51). Having a higher number of followers was associated with higher rank, but the result was not statistically

TE D

significant (PCC: -0.34, p=0.17) on bivariate analysis.

A group of particular interest – the most active accounts by Tweet number – was separately studied. The programs, in decreasing order, were: University of North Carolina

EP

(UNC), Johns Hopkins University (JHU), New York University (NYU), Oregon Health & Science University (OHSU) and the University of California, San Francisco (UCSF).

AC C

From October 2015 to April 2016, the number of followers for each account increased, and the number of Tweets increased for four out of five accounts. See Figure 1. In terms of followers over this six-month period, UNC grew by 29.0%, JHU grew by 23.2%, NYU grew by 23.3%, OHSU grew by 4.6% and UCSF grew by 22.9%.

7

ACCEPTED MANUSCRIPT

Detailed demographics for Twitter account followers were tabulated. The majority of followers of these accounts were male, except for OHSU (78% female) and UCSF (62% female). Followers were stratified by age, with most followers falling into the range of

RI PT

18-49. The home city of each program housed the highest percentage of followers, with the exception of JHU, where New York City had the most. (Table 3)

SC

The activity of AUA conference hashtags #AUA13, #AUA14 and #AUA15 were

compared. From 2013 to 2015, there was increasing activity of these hashtags around

M AN U

their time of peak usage. #AUA13 had a maximum peak number of Tweets of 1033 in one day, whereas #AUA14 had a peak of 2330 Tweets and #AUA15 had a peak of 3715 Tweets. Figure 2 represents a detailed comparison of conference hashtags.

TE D

Discussion

Twitter has experienced a meteoric rise in utilization in the urology community. Once a

EP

social media platform employed only by the most tech-savvy urologists, it is now a ubiquitous presence at academic conferences and engages urologists from around the

AC C

world in daily discussions. For instance, in just a three-year period from 2012 to 2014, the number of Twitter users at the European Association of Urology Annual Congress increased by nearly a factor of ten, with the number of Tweets skyrocketing from 347 to about 6000.3 In our study, AUA conference hashtags (#AUA13, #AUA14, #AUA15) showed a marked increase in activity from year to year as well, with #AUA15 having consistently over 3 times as many Tweets per day as #AUA13 during periods of peak

8

ACCEPTED MANUSCRIPT

activity. Twitter has a unique ability at academic conferences to facilitate real-time discussion and can amplify the conference experience to a wider, even international

RI PT

audience.

Given that academic urologists are at the forefront of the Twitter expansion into urology, we sought to describe for the first time the state of Twitter use in academic urology

SC

programs. Previous reports have characterized Twitter usage metrics by members of the AUA, by urologic journals, and by attendees at a variety of different conferences.1, 2, 9

M AN U

Just recently, the Twitter accounts of individual faculty members from the top 10 ranked urology programs were analyzed.10 However, no data is available on Twitter use by specific academic urology institutions, despite the fact that academic programs stand to

TE D

gain a substantial public presence by expanding into the social media realm.

Our results showed that an institutional Twitter account was available for a minority (30%) of all academic urology programs. This suggests that although Twitter use is

EP

prevalent in various academic urologic settings, Twitter utilization is still underemployed by academic urology departments/divisions. However, the median age of Twitter

AC C

accounts as of October 2015 is only 20 months, indicating that Twitter use amongst urology programs is a recent phenomenon. The accounts remained relatively active over time, with just less than one third having fewer than 5 Tweets over a six-month period. Of the accounts that remained active, their average percent increase in total Tweets was 161.0%, which indicates that on average accounts more than doubled their total number of Tweets over this relatively short amount of time. The increase in followers was also

9

ACCEPTED MANUSCRIPT

impressive, with an average increase of 148.4% among active accounts. Overall, it is clear that the majority of departmental Twitter accounts have grown significantly over

RI PT

this six-month time period.

The top five urology department Twitter accounts by Tweet number were studied further. Among these accounts, four grew by 20% or more in total number of followers over a

SC

six-month period. The percent growth increases here are small relative to the average and median discussed before. This likely represents the fact that these accounts are

M AN U

established and already have a large number of followers. While most of the accounts had the largest percentage of followers in the home city of the program, all accounts had 25% or less of their followers located there, indicating the far geographic reach of Twitter.

TE D

The urology departments studied in our report all used Twitter in different ways. Accounts commonly tweeted about new faculty additions to the department, recent research developments, as well as information related to urology conferences and new

EP

services being offered at their respective facilities. It is clear that there is high professional engagement between urology departments, individual urologists and urology

AC C

journals.

The U.S. News and World Report (USNWR) Urology hospital score is the most widely available and cited hospital ranking. Of note, the subcomponents that comprise the overall score include a section on “Reputation with specialists.” This reputation score is a survey-based score of the hospital’s reputation for taking care of challenging patients

10

ACCEPTED MANUSCRIPT

amongst other urologists. Reputation, presumably, is a factor of not only overall expertise but also visibility and exposure. Many excellent clinicians have a strong local reputation but may not be widely recognized on a national or international scale. An institutional

RI PT

Twitter account affords institutions the ability to expand their digital footprint and possibly enhance their overall reputation.

SC

From a ranking perspective, the mere presence of a Twitter account did not correlate with USNWR ranking. This finding is not surprising. However, in an era of increasing

M AN U

interest in patient satisfaction and hospital rankings, Twitter is a unique avenue for bidirectional communication between patients and hospitals and may help improve hospital rankings. In fact, this perceived benefit was recently recognized in a 2015 survey of Twitter users in the urology community. Of 312 respondents, 97% cited "networking"

TE D

as the single most important benefit of Twitter use.11 While this survey was aimed at individual urologists, the same capacity for networking certainly applies to hospitals

EP

networking with their patients and the medical community.

Some may question what value these Twitter accounts offer to the public. A recent report

AC C

by Salem et al. emphasized how urologists might learn from social media use among other specialties.12 For instance, the Breast Cancer Social Media tweet chat (#BCSM) was created in July 2011 by breast cancer survivors with the goal of providing support and information to patients with breast cancer. Weekly chats covered screening, diagnosis, treatment, survivorship, and refrained from giving individualized medical advice. When the participants in the #BCSM chat were later surveyed, they reported

11

ACCEPTED MANUSCRIPT

increased knowledge in a plethora of areas related to breast cancer and also reported lower anxiety levels after these discussions.12, 13 This example illustrates how Twitter can

patient support, by decreasing anxiety.

RI PT

be used in patient education, by increasing patients’ knowledge of their disease, and in

There are several limitations to this study. First, many Twitter account names were not

SC

readily identifiable. In several instances, the twitter account name was an abbreviation of the institute or a specific name that was not easily identified by Google to be associated

M AN U

with the program. The “search-ability” of a program’s twitter account is something that should be considered important; if an interested party cannot find the account, then perhaps that diminishes the value of the account to the public. Additionally, many institutions may have prominent urologists with their own twitter presence without a

TE D

distinct account for the department/division. Regarding USNWR rankings, our findings are correlative and likely represent the fact that more highly ranked institutions are more likely to use Twitter and be followed on Twitter, rather than any direct influence on

EP

academic rank. Nonetheless, the public undoubtedly actively engages with social media and this is certainly an opportunity to increase institutional visibility both now and in the

AC C

future as social media use continues to increase.

Conclusion

Twitter is utilized by a minority (30%) of academic urology programs, but a majority of these accounts have seen significant growth over a six-month period. The role of urology

12

ACCEPTED MANUSCRIPT

department Twitter accounts is still being defined. There is significant interest in using Twitter at academic urology conferences, and Twitter utilization has increased significantly in this setting. Twitter offers a means to publicize and facilitate discussion

RI PT

of new research, and to act as a valuable tool for survey research, health education,

patient support, and study participant recruitment. Greater social media presence may

AC C

EP

TE D

M AN U

SC

allow greater engagement of the public and other clinicians.

13

ACCEPTED MANUSCRIPT

References

AC C

EP

TE D

M AN U

SC

RI PT

1. Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: data from the American Urological Association (AUA). BJU Int. 2014;113(6):993-8. 2. Nason GJ, O'Kelly F, Kelly ME, et al. The emerging use of Twitter by urological journals. BJU international. 2015;115(3):486-90. 3. Wilkinson SE, Basto MY, Perovic G, Lawrentschuk N, Murphy DG. The social media revolution is changing the conference experience: analytics and trends from eight international meetings. BJU international. 2015;115(5):839-46. 4. Canvasser NE, Ramo C, Morgan TM, Zheng K, Hollenbeck BK, Ghani KR. The use of social media in endourology: an analysis of the 2013 World Congress of Endourology meeting. J Endourol. 2015;29(5):615-20. 5. Dal Moro F. Online survey on twitter: a urological experience. J Med Internet Res. 2013;15(10):e238. 6. Thangasamy IA, Leveridge M, Davies BJ, Finelli A, Stork B, Woo HH. International Urology Journal Club via Twitter: 12-month experience. Eur Urol. 2014;66(1):112-7. 7. Accredited U.S. Urology Programs: American Urological Association; 2015 [October 19, 2015]. Available from: https://www.auanet.org/education/accredited-usurology-programs.cfm. 8. United States. Bureau of the Census. Geographic areas reference manual. Washington, D.C.: U.S. Dept. of Commerce, Economics and Statistics Administration, Bureau of the Census; 1994. 9. Chung A, Woo H. Twitter in urology and other surgical specialties at global conferences. ANZ J Surg. 2015. 10. Gill BC, Ericson KJ, Hemal S, Babbar P, Shoskes D. The Digital Footprint of Academic Urologists: Where Do We Stand? Urology. 2016. 11. Borgmann H, DeWitt S, Tsaur I, Haferkamp A, Loeb S. Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals. Can Urol Assoc J. 2015;9(910):E713-7. 12. Salem J, Borgmann H, Murphy DG. Integrating Social Media into Urologic Health care: What Can We Learn from Other Disciplines? Current urology reports. 2016;17(2):13. 13. Attai DJ, Cowher MS, Al-Hamadani M, Schoger JM, Staley AC, Landercasper J. Twitter Social Media is an Effective Tool for Breast Cancer Patient Education and Support: Patient-Reported Outcomes by Survey. J Med Internet Res. 2015;17(7):e188.

14

ACCEPTED MANUSCRIPT

Table 1. Geographic prevalence of Twitter accounts among academic urology programs. Number of programs

Number with Twitter account

%

38 28 42 20

10 6 14 8

26.3% 21.4% 33.3% 40.0%

38

29.7%

Northeast Midwest South West

128

AC C

EP

TE D

M AN U

SC

Total

RI PT

Region

ACCEPTED MANUSCRIPT

38 11 (28.9%) 27 (71.1%)

<1 follower gained >1 follower gained

3 (7.9%) 35(92.1%)

Average increase (%) Range (%) Median (%)

161.0% 14%-1838% 47%

Average increase (%) Range (%) Median (%)

148.4% 20%-1271% 70%

Account TweetsϮ

M AN U

Account followersϮ

SC

Number of accounts <5 new Tweets (inactive) >5 new Tweets (active)

RI PT

Table 2. Change in Twitter Account Activity Over Six Months.

AC C

EP

TE D

Ϯ Excludes inactive accounts

ACCEPTED MANUSCRIPT

Table 3. Twitter Account Follower Demographics for Top Five Accounts Ranked by Tweet Number 12-17 <5% <5% <5% <1% 7%

18-24 32% 22% 19% 20% 33%

Age (%) 25-34 32% 33% 41% 40% 20%

City with Most Followers (%) 35-49 26% 33% 29% 40% 27%

50-64 5% <5% 7% <1% 7%

AC C

EP

TE D

M AN U

SC

Gender (%) Male Female Univ. of North Carolina 57% 43% Johns Hopkins 52% 48% New York Univ. 58% 42% Oregon Health Science Univ. 22% 78% Univ. of California, San Francisco 38% 62%

Chapel Hill (7%) New York City (8%) New York City (15%) Portland (25%) San Francisco (14%)

RI PT

Urology Program Account

ACCEPTED MANUSCRIPT

Figure 1. Number of Twitter followers and tweets over time for selected accounts. Number of Twitter Followers of Selected Accounts

RI PT

2000 1500 1000 500 0 UNC

Johns Hopkins

NYU

OHSU

UCSF

M AN U

Urology Program

SC

Number of Followers

2500

Oct-15

Apr-16

Number of Tweets of Selected Accounts

2000 1500 1000 500 0

TE D

Number of Tweets

2500

UNC

Johns Hopkins

NYU

AC C

EP

Urology Program

Oct-15

Apr-16

OHSU

UCSF

ACCEPTED MANUSCRIPT

Figure 2. AUA conference hashtag usage from 2013-2015.

Comparison of Twitter Activity of #AUA13-15 Around Peaks

RI PT

4000 3500

SC

2500 2000

M AN U

1500 1000 500 0 Day 1

Day 2

Day 3

Day 4

Day 5

Day of Respective Activity Peaks #AUA14

EP

TE D

#AUA15

AC C

Number of Tweets

3000

#AUA13

Day 6

Day 7

ACCEPTED MANUSCRIPT

Key of Abbreviations: AUA: American Urologic Association

AC C

EP

TE D

M AN U

SC

RI PT

USNWR: U.S. News and World Report