Month: March 2020

Twitter journal clubs: Sharing knowledge from a social distance

When I was an academic researcher, I attended many journal clubs — convening with my group in a conference room to discuss the methods and findings of a selected paper. These meetings are common in academic and medical education, allowing students to develop their presentation skills and helping everyone keep up with the flood of scientific literature.

In the era of social media, such in-person journal clubs are being replaced by Twitter journal clubs — now more than ever — and it’s led me to wonder, are 280 characters really enough?

I spoke with Roxana Daneshjou, MD, PhD, a dermatology resident at Stanford, to find out. She co-authored a recent editorial in JAMA that describes the advantages of using Twitter compared to the traditional format.

How do Twitter journal clubs work?

The journal club picks a paper to discuss, often using crowdsourcing to select something people are interested in. Everyone logs into Twitter at a specific time and has an online conversation with people from around the globe. Someone may facilitate and use pre-selected questions, but there’s also time for open discussion. You can string many tweets together, so you can basically write as much as you want.

Most journal clubs meet once a month for an hour, but the nice thing about Twitter is that the conversation is saved. So, if someone wants to comment the next day, the participants will see those responses whenever they log into Twitter. That’s important because participants are from different time zones. Having the conversation publicly recorded could be an issue for some people, but I think scientists and clinicians aren’t shy about asking questions and critiquing papers, even publicly.

Why did you start the first dermatology Twitter journal club?

I lurked in other journal clubs and participated in a dermatopathology one that was really interesting. But I wanted to have the same experience with medical dermatology, discussing disease management and new clinical discoveries.

I think Twitter journal clubs are particularly useful for small specialties like dermatology. They allow dermatologists to share knowledge across institutions. They also help promote the field of dermatology to a wider, cross-specialty audience, demonstrating the role that dermatologists can play for their patients. These interactions among specialists are easier with Twitter, compared to traditional journal clubs, because anyone can comment or ask a question about the topic, using the free Twitter website or app without advanced coordination.

Who participates?

We have over 1,700 people following our dermatology journal club, but we typically only have about 15 to 20 people actively participating in a meeting — with more people lurking. Our participants are a diverse group of residents, medical students, faculty and community physicians from across the country.

However, we’ve gotten a much larger group when we’ve done joint meetings with other specialties. For example, we did a joint journal club with nephrology — one of the largest Twitter journal clubs —  to discuss the role of dermatologists in helping manage immunosuppressed kidney transplant patients who are at higher risk of skin cancer. These cross-specialty Twitter interactions are great, because I’ve become friends with residents and faculty at other institutions and now feel comfortable sending them private messages if I have a question. For example, I met dermatologist Adewole Adamson, MD, MPP, through the journal club, and he provided me with a high level of mentorship to co-write the JAMA editorial.

How has the pandemic affected Twitter journal clubs?

Multiple Twitter journal clubs have discussed issues related to COVID-19 and their particular specialty. Our most recent dermatology journal club discussed how dermatologists were transitioning to virtual visits to help with social distancing and how resident training was continuing in dermatology with COVID-19. On April 6, infectious disease’s Twitter journal club will be discussing a paper entitled, “A Trial of Lopinavir-Ritonavir in Adults with Severe COVID-19.”

With social distancing, in-person journal clubs will be more difficult to have. Twitter is the perfect medium for having multiple conversations at once with many people. This is a really difficult time for many, and I hope Twitter journal clubs can help physicians and trainees continue to engage in academic conversations.

Image by Mohamed Mahmoud Hassan

This is a reposting of my Scope story, courtesy of Stanford School of Medicine.

Identifying and addressing gender bias in healthcare: A Q&A

International Women’s Day offered a reminder t0 “celebrate women’s achievement, raise awareness against bias and take action for equality.” Stanford-trained surgeon Arghavan Salles, MD, PhD, is up for the challenge.

As a scholar in residence with Stanford Medicine’s educational programs, Salles researches gender equity, implicit bias, inclusion and physician well-being. Beyond Stanford, she is an activist against sexual harassment in medicine, and she’s written on these topics from a personal perspective for the popular press, including Scientific Americanand TIMEmagazine.

I recently spoke with her to learn more.

What inspired your research focus?

As an engineering undergraduate, I never really thought about gender or diversity issues.

Then during the first year of my PhD at Stanford, I learned about stereotype threat. The basic idea is that facing a negative stereotype about part of your identity can affect your performance during tests. For example, randomized controlled studies show that if minority students are asked for their race or ethnicity at the beginning of a test of intellectual ability, like the GRE (Graduate Record Examination), this question can impair their performance. A lot of decisions are based on these kinds of test scores, and this really changed how I think about merit.

At the time, I was also in the middle of my residency to become a surgeon. I started thinking about whether stereotype threat affects women who are training to be surgeons, so that’s what I studied for my dissertation.

I have continued to think about these types of issues, studying things like: Who gets the opportunity to speak at conferences? Does gender affect how supervisors write performance evaluations for residents and medical students?  And how extensive is gender bias in health care?

How does gender bias impact women surgeons?

We all have biases. Growing up in the U.S., we generally expect men to be decisive and in control and women to be warm and nurturing. So when women physicians make decisions quickly and take charge in order to provide the best care to their patients, they’re going against expectations.

I hear the same struggles from women all over. For women surgeons in particular, for example, the operating room staff often don’t hear when they ask for instruments. The staff may not have all the devices and equipment in the room because their requests aren’t taken as seriously as those of men. And they are often labeled as being demanding or difficult if they act like their male colleagues, which has significant consequences on opportunities like promotions.

Related to gender bias, women surgeons also deal all the time with microaggressions from patients and health care professionals. For instance, patients report to the nursing staff they haven’t seen a surgeon yet, when their female surgeon saw them that morning. Or they say, ‘Oh, a woman surgeon. I’ve never heard of that.’ So you have to strategically decide what to confront.

How can we address these issues?

It’s really important to have allies to give emotional support and advice, but also to speak up when these things are happening. For example, an ally can speak up if a committee member brings up something irrelevant during a promotion review.  

In the bigger scheme, we need to change how we hire people, to make it more difficult to act on our biases. We should use a blinded review so we don’t know the gender or race of the applicant. We should have applicants do relevant work sample tests to select the most qualified candidate. And we should use standardized interview questions. Changing how we hire and promote people would make a big difference.

We also need to create a culture of inclusion, in addition to hiring more women, underrepresented minorities and transgender and nonbinary gender people to bring new ideas. Diversity without inclusion is essentially exclusion. We’ve talked about gender today, but a lot of the same challenges are faced by other underrepresented groups.

Why do you write about these topics from a very personal viewpoint?

In some ways, I’m a naive person. I don’t have the same degree of professional self-preservation that some people have. There may be unintended negative consequences, but I’m just honest to a fault.

The piece about anger came out of seeing time and time again women being misunderstood — having their anger attributed to some personality flaw rather than a reasonable consequence of what they were experiencing. I figured if I wrote about it, I could raise awareness and maybe a few people would react differently next time they saw a woman express anger.

I wrote the fertility piece because I wanted to share my experience to educate people, so fewer people would end up involuntarily childless. In general, I just feel that it’s important to share my experiences to help others not make the same mistakes that I have.

Photo courtesy of Arghavan Salles

This is a reposting of my Scope story, courtesy of Stanford School of Medicine.