Twitter as a Medical Media Among French Young Oncologists: Results from a National Survey

For the last two decades, Internet has deeply modified our way to practice and learn medicine. Social networks have become ubiquitous, and with them, the conventional education means have been overturned. More and more students now use digital media for their formation, including medical education [1].

Twitter is a microblogging network that was created in 2006, where users can share contents within a 140-character limit. It has quickly grown into one of the most used social networks, with around 330 million users in 2019, around half of which declare a daily use [2]. In the medical field, Twitter is recognized as a useful platform for scientific discussion, literature monitoring (through dedicated accounts), or press releases [3]. It is a meeting point for medical doctors, scientists, and patients’ associations that allows an increase in the visibility of shared articles [4]. Because clinical research is central in oncology, it is probably one of the fields where Twitter is the most useful.

Recently, COVID-19 pandemic has pushed the international medical community to attend online congresses, and medical content has increased on the platform [5]. It is therefore relevant to ask whether COVID-19 has had an influence on Twitter use by the medical community.

Twitter has also become a customary tool for medical students: it seems complementary to academic courses [6, 7], and a few studies even suggest its educational benefit [8, 9]. However, the impact on their formation has not been well studied so far [10]. Similarly, despite an increasing literature on this subject [11], there is little evidence on how Twitter is used by young oncologists for their continuous education, and what advantage they find in it.

Moreover, even if the proportion of medical practitioners using this network seems rising, only a few express themselves, whereas a large majority retweet medical influencers’ content [12]. Younger doctors seem overrepresented on Twitter [13], and as in social media in general, representativeness is therefore in question [14].

We conducted a national survey in France to help better understand the role of Twitter in the continuous medical education of young oncologists and its possible evolution due to COVID-19 pandemic and congress digitalization.

To our knowledge, this work is the first to describe the characteristics of Twitter users but also non-users among young oncologists and the influence of COVID-19 pandemic on their Twitter activity. Our survey shows a very heterogeneous use of Twitter despite the large sample and its representativity of French young oncologist population. Nevertheless, these results are consistent with other studies [13].

On one hand, the majority of the survey participants do not have a Twitter account, mainly because of a defiance against overuse of social media in general and estimated insufficient benefits of the time spent on this platform. Indeed, time management is one of the major pitfalls when talking about social media (SoMe) [15].

On the other hand, close to a third of them use Twitter as a medical education tool and are clearly active: more than 40% connect every day. Twitter is for them a full part of their training, completing (and in some cases replacing) academic teaching. They prefer following expert accounts rather than journals or pharmaceutical companies. An explanation would be that they are willing to fully understand medical actuality through key opinion leaders, rather than just being informed. This need became stronger with the global pandemic and suspension of physical congresses. Students watching online talks alone are seeking for experts’ comments. In our study, more than 80% of them considered Twitter an essential complement to meetings, which is consistent with the rising use of Twitter during international congresses [16]. However, despite their intense presence on this media, only a few of French young oncologists express themselves otherwise than by retweeting experts’ posts. To remain feasible and maximize the number of responders, we did not explore in depth the reasons why they refrain from sharing their own views but we imagine that they might not feel qualified enough to express their opinion.

In our study, more than 40% of Twitter users increased their use of this social media since the beginning of COVID-19 pandemic. This underlines the challenge of digitalization of medical information, due to social distancing. Twitter plays an important role in such a process and can help users follow medical actuality when they cannot physically attend courses or congresses.

In this survey, we failed to identify significant differences between these two profiles that determine their use of medical Twitter. First, it should be noted that the goal of our questionnaire was to focus on Twitter use, more than on the characteristics of users. Moreover, reasons for using or not using Twitter seemed unrelated to medical specialty or hospital status as they are mainly related to personal beliefs. We can therefore assume such a difference does not exist. In both cases, residents lack guidance for a wise use of Twitter as a professional tool, some of them thus deciding to avoid it, the others to abstain posting original content. An American study already demonstrated that only few physicians, known as “superusers,” mastering the codes of their specialty and social media, are responsible for the majority of tweets in oncology [17].

Like Attai et al. [15] showed, SoMe can be tricky for physicians, especially young ones, having to manage simultaneously patient privacy, their own privacy, and building an e-reputation, without wasting valuable time. However, Twitter can provide many benefits to oncologists’ continuous education. Besides real-time and commented information, young oncologists could enlarge their network and access to virtual mentorship [18]. By contrast with our non-user responders’ opinion, Twitter can also help young oncologists to sort key papers. Indeed, tweets can predict most cited articles, leading to the development of altmetrics (non-traditional bibliometrics proposed as an alternative or complement to traditional citation impact metrics) [19]. For example in radiation oncology, it has been demonstrated that tweeting the link of a research article was correlated with the number of academic citations of this article [20]. Thanks to Twitter, young oncologists can also highlight their own work and participate in patient advocacy. Some institutions have even decided to include SoMe activities in academic advancement [21].

COVID-19 pandemic has underlined the importance of medical media in the medical education of French residents, which contrasts with the lack of formation they receive on their use. To help residents optimize their time on social media, some societies have written recommendations [22, 23]. These have multiple goals: protect physicians in training from blurred lines between personal and professional identities as well as organize their bibliographic monitoring, increase the altmetric of their articles, facilitate communication and mentorship. We believe such recommendations should be taught early in the medical education of young oncologists, in order to help them better understand this tool and to overcome their fears.

In conclusion, close to a third of young French oncologists are using Twitter as a tool in order to learn mostly from key opinion leaders. This phenomenon increased with COVID-19 pandemic and the access to many online talks without experts’ live commentaries. However, guidance is needed to make the most from the time spent on this platform and provide a clearer perspective to a majority of physicians regarding the value of Twitter and potentially encourage its use in order to avoid the “superusers” bias.