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.

Eponym debate: The case for naming diseases after people

Is it better to name a genetic disorder Potocki-Lupski syndrome or the 17p11.2 duplication syndrome? What about Addison’s disease as opposed to adrenal insufficiency? Or Tay-Sachs disease versus hexosaminidase alpha-subunit deficiency (variant B)?

If you have a strong opinion about which is preferable, you aren’t alone: there is an ongoing controversy on how to name diseases. In Western science and medicine, a long-standing tradition is to name a disease after a person. However, many physicians now argue that these eponyms should be abandoned for biologically-descriptive names.

First, a bit about how eponyms are created.

Although the media sometimes comes up with a catchy name that sticks, like swine flu, diseases are typically named by scientists when they first report them in scientific publications.

Oftentimes, diseases are named after prominent scientists who played a major role in identifying the disease. The example that leaps to my mind is Hodgkin’s disease — a type of cancer associated with enlarged lymph nodes — because I was diagnosed and treated for Hodgkin’s at Stanford years ago. Hodgkin’s disease was named after Thomas Hodgkin, an English physician and pathologist who described the disease in a paper in 1832.

Less frequently, diseases are named after a famous patient. For example, amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease, was named after the famous New York Yankee baseball player who was forced to retire after developing the disease in 1939.

As these examples show, one of the reasons to keep eponyms is that they are embedded with medical traditions and history. They include some kind of story. And, oftentimes, they honor key people associated with the disease.

“I think the people who discover these conditions deserve recognition,” explains Angela Primbas, MD, a resident physician at Stanford. “I don’t think the medical community would know their names otherwise.”

Some physicians also feel eponyms bring color to medicine. “The use of eponyms in medicine, as in other areas, is often random, inconsistent, idiosyncratic, confused, and heavily influenced by local geography and culture. That is part of their beauty,” writes Australian medical researcher Judith Whitworth, MD, in an editorial in BMJ.

Other proponents of eponyms are more practical. They argue that eponymous disease names provide a convenient shorthand for doctors and patients.

Medical eponyms are also widely used by patients, physicians, textbooks and websites. According to a dictionary of medical eponyms, thousands of eponyms are used throughout the world particularly in the United States and Europe. They are even prominent in the World Health Organization’s international classification of diseases.

So is a massive effort to purge these eponyms worth it, or even realistic?

“There are certainly examples where eponymous disease names are so inculcated in medical vernacular that changing them to a pathology-based name might not be worth the effort,” says Vishesh Khanna, MD, a resident physician at Stanford. He gives the examples of Alzheimer’s disease and Crohn’s disease.

Jimmy Zheng, a medical student at Stanford, agrees that eponyms are here to stay. “At the level of medical school, eponyms are broadly dispensed in class, in USMLE study resources and in our clinical training,” Zheng says. “While some clinicians have called for the complete erasure of eponyms, this is unlikely to happen.”

Zheng and Stanford neurologist Carl Gold, MD, recently assessed the historical trends of medical eponym use in neurology literature. They also surveyed neurology residents on their knowledge and attitude towards eponyms. Their study’s findings were published in Neurology.

“Regardless of ‘should,’ our analyses demonstrate that eponyms are increasingly prevalent in the scientific literature and that new eponyms like the Potocki-Lupski syndrome continue to be coined,” Gold says. “Despite awareness of both the pros and cons of eponyms, the majority of Stanford neurology trainees in our study reported that historical precedent, pervasiveness and ease of use would drive the continued use of eponyms in neurology.”

So the debate rages on. According to my informal and small survey, some Stanford physicians favor eliminating eponymous disease names — stay tuned to find out why.

This is the beginning of a two-part series on naming diseases. The conclusion will appear this week.

Photo via Good Free Photos

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

FemInEM blog facilitates conversations about women in emergency medicine

Photo by LIOsa

As a female PhD physicist, I was often the only woman in the room as an undergraduate and graduate student and as a research scientist. I faced sexism, unwanted attention and personal criticism — particularly early in my career. So I can relate to the gender equity issues that prompted Dara Kass, MD, an emergency medicine physician at New York University, to found FemInEM.

FemInEM is a blog that explores a variety of issues centered on the development and advancement of women in emergency medicine. Kass said their overarching goal is to make it easier for women in medicine to stay at work, despite conflicting priorities like family commitments, career objectives and personal health issues.

“I started FemInEM because I wanted to build a community amongst the women in emergency medicine,” Kass told me. “I had seen so many women solve their own problems around the expected life changes — like maternity leave, lactation and promotion — but they weren’t talking to each other. FemInEM seemed like a way to solve that problem. I didn’t want others to have to figure it out on their own, like I did.”

In addition to the blog, Kass said they use the power of social media — Facebook, Twitter, Instagram, and Snapchat — to amplify the conversation. “There are about 12 to 15 thousand women practicing in emergency medicine in our country, and we probably reach about half of them on a regular basis. The coolest part is that we reach all levels of learners from all over the world,” Kass said.

Kass explained that the online medium is important because it is “extraordinarily accessible and inclusive.” She emphasized that when discussing something like gender equity and the careers of women in medicine, it can never be only about the women. The conversation has to include men and allow them to reflect on their careers as well.

“We do this in a very inclusive way, so it’s really never about ‘us verses them,’” said Kass. “We’re talking about things like parental leave or salary equity. We base our discussions on data, but more importantly we focus on needing to all work together towards real solutions. Men are cool with it.”

Given the goal of inclusion, the blog uses an open-access submission process. “We take submissions from men, from people not in emergency medicine and from people around the world who have very different issues,” Kass said. “Anyone that wants to write for us just needs to submit an interesting piece that somehow speaks to the issue around gender equity in medicine.”

Kass particularly enjoys writing and reading posts on the struggles of having “multiple personalities.” One of her favorite posts is titled, “They call me #badassdoctormom.” “The #badassdoctormom post was written by a woman physician who talked about her daughter,” she told me. “This woman saved a guy at a train accident by cutting off his leg in the field, which is extraordinary. Her friend called her a bad ass. That night, during a bedtime story, her daughter asked whether she should call her doctor or Mommy. In her mind, she thought ‘How about bad ass doctor mom?’ In reality, her 5-year-old daughter now calls her a real-life superhero — that’s a really cool story.”

However, Kass told me that this blog post and others have gotten backlash from the female spouses of male physicians. This may be because the wives feel like they are being judged if they don’t work outside the home. Kass hopes this will change. Her advice to all women: “Just be who you are. Be happy. Our goal is to make people feel centered about the life they have in front of them and the choices they’ve made.”

Today Kass is spreading her message on how to support women in medicine when she gives grand rounds to Stanford’s emergency medicine residents. She is also expanding beyond online conversations to an in-real life event called the FemInEm Idea Exchange. Kass said this conference, being held in October in NYC, will make in-person conference networking more accessible to help develop women’s careers quickly and provide motivation.

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

Health journalists focus on initial studies that are often refuted, a new study finds

Photo by geralt

Will people read about null research findings? And are such findings news? These are critical questions facing health reporters, because news coverage often influences how people make their health-care decisions.

The problem is that positive research findings make more alluring stories, particularly if the new study suggests a potential cure for a horrible disease. But many of these initially positive findings are refuted by larger, more rigorous follow-up studies that journalists rarely cover. This biased news coverage can mislead the public with important consequences — such as helping to perpetuate the discredited link between autism and vaccines.

Health News Review recently tackled this topic, using the example of statins. Initial observational studies showed that statins may help boost survival from cancer. But later, more rigorous trials showed that statins don’t improve cancer outcomes. Nonetheless, the media heavily covered the initial findings, but barely picked up on the more reliable negative findings.

Researchers at the University of Bordeaux, France investigated the extent of this problem by analyzing the news coverage of 156 primary medical studies, as outlined in a paper recently published in PLOS One. They focused on studies that looked for associations between risk factors and diseases in six areas: psychiatry, neurology, breast cancer, rheumatoid arthritis, glaucoma and psoriasis.

The study found that “journalists preferentially cover initial findings although they are often contradicted by meta-analyses and rarely inform the public when they are disconfirmed.”

Using a database of thousands of stories published in the general press, the research team discovered all 53 initial research studies that generated news coverage reported positive findings — even though two thirds of these initial findings were refuted by subsequent research. In contrast, journalists covered none of the 174 initial studies reporting a null effect and rarely covered null findings in subsequent studies.

They also found that journalists more often covered lifestyle research, which investigates factors like diet and smoking. Lifestyle associations received larger newspaper coverage, even if the initial studies were published in less prestigious scientific journals. The authors stated, “This preferential coverage further supports the view that the first journalists’ aim is to attract readers’ attention.”

Finally, the researchers offered some advice on how to remedy this problem. They suggested that “journalists should always ask scientists whether it is an initial finding and, if so, they should inform the public that this discovery is still tentative and must be validated by subsequent studies.” They also recognized that it can be difficult for journalists to find objective sources to put a new study into the appropriate context, so they called on scientists to assist journalists. The authors concluded by saying that scientists have a moral duty to make sure press releases covering their work are accurate.

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

Too few woman scientists are invited to review academic journal manuscripts

Photo by Slawek Borewicz
Photo by Slawek Borewicz

As a researcher at Lawrence Berkeley National Laboratory, I reviewed manuscripts for several academic science journals and acted as an editor for an engineering journal.

This makes me an exception, according to a commentary recently published in Nature that reveals a gender bias in the review of scholarly publications. Journals invite too few women to referee, write commentary authors Jory Lerback, a graduate student at the University of Utah, and Brooks Hanson, PhD, director of publications at the American Geophysical Union (AGU).

The peer review process plays a critical role in the validation of research by allowing experts to scrutinize the work of their peers before research results are published. Participating in this review process is also critical to a scientist’s career. The commentary explains:

“Participation as a reviewer for papers and grants has many benefits, particularly for early-career scientists. It is a chance to develop a relationship and make a positive impression with an editor, review-panel member or programme manager, who are typically senior scientists and are in turn likely to be involved in evaluating the reviewer’s future papers and grants.”

Unfortunately, Lerback and Hanson found that women of all ages have fewer opportunities to act as a reviewer for AGU journals.

Using membership and editorial databases, they identified the age and gender of authors, reviewers and editors for AGU manuscripts from 2012 to 2015 — creating a dataset that included more than 24,000 authors, nearly 15,000 reviewers, nearly 100,00 reviewer suggestions by authors and 119,000 reviewer requests by editors.

Analysis of this dataset showed that only 20 percent of reviewers were women, proportionally less than expected as 28 percent of AGU members were female and 27 percent of first authors were female. This difference was observed across all ages, so it was not due to editors seeking more senior reviewers who are predominantly male.

The problem, they found, was due to a gender bias in reviewer selection. At AGU, authors suggest reviewers at submission and editors prepare a final list. However, both authors and editors nominated fewer women to review. Female first authors suggested female reviewers 21 percent of the time, whereas male first authors suggested women just 15 percent of the time. Similarly, female editors recommended female reviewers 22 percent of the time compared to 17 percent for male editors.

Is this just a problem for AGU journals? The authors don’t think so. As the largest Earth and space science society and publisher, they argue that AGU is a good proxy for STEM demographics in the United States. In addition, they suggest that similar problems exist for funding agencies.

The researchers recommend that publishers hire more female editors and train their staff to combat this gender bias.

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

Discussing cancer: Online course offers tips to tackling tough conversations

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Photo by Serena Wong

Have you tried to talk to a friend or family member about cancer? It’s not easy. You might have blurted out something offensive, offered advice you weren’t quite sure about, or tried to minimize cancer’s severity or prevalence. Or maybe you just avoided the conversation entirely.

Even those with medical training struggle with cancer discussions. In response, a London-based nonprofit has created a free online course called “Talking About Cancer,” which offers strategies for discussing cancer risks, preventing and screening.

The three-hour course — which is designed for health-care workers, counselors, volunteers and others — is organized into short, self-paced modules made up of videos, quizzes, online discussions and role-playing with actors. I recently spoke with one of the course organizers, former journalist and Stanford alumni David Risser.

What is the course like?

“The course quickly reviews cancer myths and facts, and then concentrates on how to have confident conversations about cancer prevention. It’s an important area, because more than four in ten cancer cases could be prevented by lifestyle changes. Another goal is to boost early diagnosis, by training people to encourage others to see a doctor.

We wanted to present an engaging course with varied activities, including a ‘real-life’ narrative that runs through the course. We hired improv actors to play two characters, Anita and Brian. Anita has health difficulties but is reluctant to see a doctor. Brian feels invincible, but has multiple habits — smoking, drinking too much, a poor diet, and even refusing to use sunscreen — that put him at higher risk… We were amazed at how strongly participants identified with the experiences of these characters, leading to passionate discussions about effective ways to talk about cancer.

The course is led by our cancer awareness trainers — two nurses with experience in engaging doctors, nurses and people without medical training. It’s open now, but you must sign up by October 31. Otherwise, we plan to offer another free, public run of the course early next year.”

What inspired you to get involved?

 “I am a Stanford graduate with a B.A. in history, and a past managing editor of The Stanford Daily. I joined Cancer Research UK after a 28-year career in journalism, in part because of my own experience with several family members who have had cancer. I struggled to talk to one family member who didn’t seem to want to talk about her cancer. That made it easy for me to avoid talking about it, which wasn’t the ideal outcome.

It was also difficult to talk to another family member about being more proactive about her medical care, which was inadequate at the start. It’s still difficult to know whether or how to talk to friends about prevention.”

What have you learned while working on this project?

“I learned that there are widespread gaps in knowledge about cancer, from causes to treatments to chances of survival. For example, many people don’t know that obesity is the second most-preventable cause of cancer or that alcohol is linked to a range of cancers.

I think the most common mistake when talking about cancer is feeling you have to know everything. It’s more effective to say ‘I don’t know, how do you think we can find out?’ or `What have you thought about doing?’ than to avoid the subject, make pronouncements or communicate incorrect information. Another common mistake is failing to listen, listen, listen, rather than fix everything. Sometimes it’s better to guide the person through what they are feeling and what they are concerned about, keeping it about them and not about you or your solutions. The bigger issue in both cases is to gently help people see what they can do that works for them.

While the course focuses on cancer information, prevention and early diagnosis, most of it is about how to have conversations about difficult subjects. The greatest lesson in the course is how to talk to people in ways that encourage behavior change. And that can save lives.”

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

Not just an image: Radiologists boost communication skills

Dr. Marcus Maydew, radiologist from Creighton University, reviews an x-ray (Offutt Air Force Base).
Dr. Marcus Maydew, radiologist from Creighton University, reviews an x-ray (Offutt Air Force Base).

As a Hodgkin’s lymphoma survivor, I’ve had plenty of CT scans, mammograms, chest X-rays and MRIs during my diagnosis, therapy and 20 years of follow-up care. So I’ve interacted with radiologists at many Bay Area clinics, including Stanford where I was treated — that is, if you count getting summary reports in the mail as “interactions.”

This type of interaction may be changing with the growing movement toward patient-centered care, which is a critical component of the new American College of Radiology’s Imaging 3.0 initiative. Some radiologists are now going beyond image interpretation by discussing test results directly with their patients.

“Many interventional radiologists are now creating their own clinics, seeing patients and following them like any other surgeon,” Sandip Biswal, MD, a Stanford associate professor of radiology, told me. “Patient interactions are also quite heavy in mammography, particularly if the radiologist sees something suspicious.”

As radiologists come out of their reading rooms, many need to improve their communication skills, and a new training program at UMass Memorial Medical Center, called “Coming Out of the Dark,” teaches first and fourth-year radiology residents effective communication skills through role-playing. The program is led by Carolynn DeBenedectis, MD, an assistant professor of radiology there.

The participants practice six scenarios, such as delivering bad news from breast imaging tests, with trained actors performing as the patients. They are evaluated by both the patient actors and attending radiologists with prior communication skills training. The sessions are also videotaped and reviewed with the residents. The same participants return two weeks later to role-play six similar scenarios in order to evaluate their improvement.

At the Radiological Society of North America 2015 meeting, DeBenedectis reported on last year’s pilot program results. Participants were graded using a standard communications assessment scale and their scores on average improved about 5 percent between the two sessions — from 74 percent to 79 percent for first-year residents. More importantly, participants found the training useful, as reported in a recent online story.

We could probably all benefit from improved communication skills. However, there is some controversy over whether diagnostic radiologists should discuss imaging results directly with their patients after their scans. Biswal explained to me:

In the patient’s best interest, we really need to take a team approach. The primary care physician or referring specialist has the best understanding of what the patient is going through, so they can better convey the news. For radiologists to sit down with a patient and give them imaging results without knowing their full story can be potentially dangerous. There is an art to conveying this type of information that takes years of practice. I think of it like this: if it was my mother, how would I want her to be treated?

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