The #TwitJC Twitter Journal Club, a New Initiative on Twitter. Some Initial Thoughts.

10 06 2011

There is a new initiative on Twitter: The Twitter Journal Club. It is initiated by Fi Douglas (@fidouglas) a medical student at Cambridge,  and Natalie Silvey (@silv24)  a junior doctor in the West Midlands.

Fi and Natalie have set up a blog for this event: http://twitjc.wordpress.com/

A Twitter Journal Club operates in the same way as any other journal club, except that the forum is Twitter.

The organizers choose a paper, which they announce at their website (you can make suggestions here or via a tweet). Ideally, people should read the entire paper before the Twitter session. A short summary with key points (i.e. see here) is posted on the website.

The first topic was:  Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock [PDF]

It started last Sunday 8 pm (Dutch time) and took almost 2 hours to complete.

@twitjournalclub (the twitter account of the organizers) started with a short introduction. People introduced themselves as they entered the discussion. Each tweet in the discussion was tagged with #TwitJC (a so called hashtag), otherwise it won’t get picked up by people following the hashtag. (Tweetchat automatically provides the hashtag you type in).

Although it was the first session, many people (perhaps almost 100?!) joined the Journal Club, both actively and more passively. That is a terrific achievement. Afterwards it got a very positive Twitter “press”. If you know to engage people like @nothern_doctor, @doctorblogs, @amcunningham and @drgrumble and people like @bengoldacre, @cebmblog and @david_colquhoun find it a terrific concept, then you know that it is a great idea that meets a need. As such, enough reason to continue.

There were also not purely positive voices. @DrVes sees it as a great effort, but added that “we need to go beyond this 1950s model rather than adapt it to social media.” Apparently this tweet was not well received, but I think he made a very sensible statement.

We can (and should) asks ourselves if Twitter is the right medium for such an event.

@DrVes has experience with Twitter Journal Clubs. He participated in the first medical journal club on Twitter at the Allergy and Immunology program of Creighton University back in 2008 and presented a poster at an allergy meeting in 2009.

BUT, as far as I can tell, that Twitter Journal Club was both much more small-scale (7 fellows?) and different in design. It seems that Tweets summarized what was being said at a real journal club teaching session. Ves Dimov:

“The updates were followed in real time by the Allergy and Immunology fellows at the Louisiana State University (Shreveport) and some interested residents at Cleveland Clinic, along with the 309 subscribers of my Twitter account named AllergyNotes“.

So that is the same as tweeting during a conference or a lecture to inform others about the most interesting facts/statements. It is one-way-tweeting (overall there were just 24 updates with links).

I think the present  Twitter Journal Club was more like a medical Twitter chat (also the words of Ves).

Is chatting on Twitter effective?

Well that depends on what one wants to achieve.

Apparently for all people participating, it was fun to do and educative.

I joined too late to tell, thus I awaited the transcript. But boy, who wants to read 31 pages of “chaotic tweets”? Because that is what a Twitter chat is if many people join.  All tweets are ordered chronologically. Good for the archive, but if the intention is to make the transcribed chat available to people who couldn’t attend, it needs deleting, cutting, pasting and sorting. But that is a lot of work if done manually.

I tried it for part of the transcript. Compare the original transcript here with this Google Doc.

The “remix of tweets” also illustrates that people have their own “mini-chats”, and “off-topic” (but often very relevant) questions.

In addition, the audience is very mixed. Some people seem to have little experience with critical appraisal or concepts like “intention to treat” (ITT) and would perhaps benefit from supplementary information beforehand (i.e. documents at the TwitJC website). Others are experienced doctors with a lot of clinical expertise, who always put theoretical things in perspective. Very valuable, but often they are far ahead in the discussion.

The name of the event is Twitter  Journal Club. Journal Club is a somewhat ambiguous term. According to Wikipedia “A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature”. It can deal with any piece which looks interesting to share, including hypotheses and preclinical papers about mechanisms of actions.

Thus, to me Journal club is not per definition EBM (Evidence Based Medicine).

Other initiatives are a critical appraisal of a study and a CAT,  a critical appraisal of a topic (sometimes wrongly called PICO, PICO is only part of it).

The structure of the present journal club was more that of a critical appraisal. It followed the normal checklist for an RCT: What is being studied? Is the paper valid (appropriately allocated, blinded etc ), what are the results (NNT etc) and are the results valid outside of the context of the paper?

Imo, official critical appraisal of the paper costs a lot of time and is not the most interesting. Looking at my edited transcript you see that half of the people are answering the question and they all say the same: “Clearly focused question” is answer to first question (but even in the edited transcript this takes 3 pages), “clear interventions (helpful flowcharts) is the answer to the second question.

Half of the people have their own questions. Very legitimate and good questions, but not in line with the questions of @twitjournalclub. Talking about the NNT and about whether the results are really revolutionary, is VERY relevant, but should be left till the end.

A twitter chat with appr. 100 people needs a tight structure.

However, I wonder whether this  approach of critical appraisal is the most interesting. Even more so, because this part didn’t evoke much discussion.

Plus it has already been done!!

I searched the TRIP database and with the title of the paper, to find critical appraisals or synopses of the paper. I found 3 synopses, 2 of which follow more or less the structure of this journal club here, here (and this older one). They answer all the questions about validity.

Wouldn’t it have better with this older key paper (2001) to just use the existing critical appraisals as background information and discuss the implications? Or discuss new supporting or contradictory findings?

The very limited search in TRIP (title of paper only) showed some new interesting papers on the topic (external validation, cost effectiveness, implementation, antibiotics) and I am sure there are many more.

A CAT may also be more interesting than a synopsis, because “other pieces of evidence” are also taken into consideration and one discusses a topic not one single paper. But perhaps this is too difficult to do, because one has to do a thorough search as well and has too much to discuss. Alternatively one could choose a recent systematic review, which summarizes the existing RCT’s.

Anyway, I think the journal club could improve by not following the entire checklist (boring! done!), but use this as a background. Furthermore I think there should be 3-5 questions that are very relevant to discuss. Like in the #HSCMEU discussions, people could pose those questions beforehand. In this way it is easier to adhere to the structure.

As to the medium Twitter for this journal club. I am not fond of  long Twitter chats, because it tends to be chaotic, there is a lot of reiteration, people tend to tweet not to “listen” and there is a constriction of 140 characters. Personally I would prefer a webinar, where people discuss the topic and you can pose questions via Twitter or otherwise.
Other alternatives wouldn’t work for me either. A Facebook journal club (described by of Neil Mehta) looks more static (commenting to a short summary of a paper), and Skyping is difficult with more than 10 people and not easy to transcribe.

But as said there is a lot of enthusiasm for this Twitter Journal Club. Even outside the medical world. This “convincing effort” inspired others to start a Astronomy Twitter Journal Club.

Perhaps a little modification of goals and structure could make it even more interesting. I will try to attend the next event, which is about Geoffrey Rose’s ‘Prevention Paradox’ paper, officially titled ”Strategy of prevention: lessons from cardiovascular disease”, available here.

Notes added:

[1] A summary of the first Twitter journal club is just posted. This is really valuable and takes away the disadvantages of reading an entire transcript (but one misses a lot of interesting aspects too)!

[2] This is the immediate response of one of the organizers at Twitter. I’m very pleased to notice that they will put more emphasis on implications of the Journal. That would take away much of my critic.

(Read tweets from bottom to top).

References

  1. Welcome (twitjc.wordpress.com)
  2. An important topic for the first Twitter Journal Club (twitjc.wordpress.com)
  3. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77. PubMed PMID: 11794169. (PDF).
  4. The First Journal Club on Twitter – Then and Now (casesblog.blogspot.com)
  5. Allergy and Immunologyclub on Twitter (allergynotes.blogspot.com)
  6. The Utility of a Real-time Microblogging Service for Journal Club in Allergy and Immunology. Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Ann Allergy Asthma Immunol., Vol 103:5, Suppl. 3, A126, Nov 2009.
  7. https://docs.google.com/document/pub?id=1qzk1WzjNO5fbWd0PAax6cIDdUGGg1sDn86FPT1li-sQ (short remix of the transcript)
  8. Model for a Journal Club using Google Reader and Facebook OR if the prophet does not go to the Mountain…. bring the journal club to FB! (blogedutech.blogspot.com)
  9. Astronomy Twitter Journal Club/ (sarahaskew.net)
  10. A summary of week one: Rivers et al (twitjc.wordpress.com)
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17 responses

10 06 2011
nsilvey

Thanks for the post and feedback. As Fi says, last week was our first week and very much an experiment – the whole thing was organised in a week and both of us have very busy day jobs!! We will be changing things over the weeks as the journal club evolves. This is a huge learning curve for us both but a challenge we both relish to make this as useful a tool as possible

@silv24

11 06 2011
laikaspoetnik

@nsilvey, Dear Natalie. I hope that I didn’t give the wrong impression. I think that you both did a great job in little time. I only wished to address some aspects that could be improved, imho. But, apparently, given Fi’s answer, you we’re already planning a different structure. As said, the response was enormous (both in quantity & quality). That is a great start. Looking forward to the next session. All the best.
Jacqueline

10 06 2011
Anne Marie Cunningham

Generally tweetchats… and I think this is what this is… are events which need to be participated in. Although most try and archive the tweets, it certainly is hard to make sense of them afterwards. But here the chat is also supported by a blog and there has been some good sharing of ideas and questions there.

I think that as well as focus on how things can be changed it’s also important to think about what worked well in this. Why were people so engaged? Why were they giving up their Sunday night? Why do other groups want to try and follow the model? I think this is because many people are using Twitter and they are excited to see that it can be used for sensible, engaging, critical discussion. It helps them find others who are interested in the same things as them. It shows that Twitter can be put to good use.

In the UK we are developing a healthy community of health professionals and students who are looking for opportunities to see how they can use Twitter to learn and to share.

Thanks for your help. Let the learning continue!

12 06 2011
laikaspoetnik

Hi Anne Marie.

Of course it is best to participate. But I was simply too late. The transcript was useful though to get an idea of the Twitter Chat. And I don’t think the transcript differs a lot from what happened in “real life”: many sub-questions, and questions taking too long for getting answered (and already answered in existing synopses). This is in line with my previous experience with twitter chats. People tend to tweet, not listen. Also “in real life” it is difficult to follow all that is being said. The more people, the more difficult it becomes.

I know the advantages of Twitter, I’m a (relatively) early fan, and have blogged about Twitter numerous times. Perhaps I tend to forget that the power of Twitter (interactivity, scale, speed, viral nature) is not self-evident and that I should highlight that too. Might have been more balanced. I agree, that Twitter can be very enganging.

My main issue with last session was that a critical appraisal of the paper was not the most interesting to do. It would have been better to use existing critical appraisals (see below) and concentrate on the implications. If done, there would probably have been less privat chats or it wouldn’t have mattered as much (now people started to talk about more important things first).

But apparantly people were very satisfied with this journal club. And at the end that is all that matters.

p.s. Agreed, the summary at the blog is very helpful.

Previous appraisals (would have been very helpful)

http://pedsccm.org/view.php?id=128

http://icu-10.med.usyd.edu.au/ebdm/journal/therapy46.shtml

http://www.sicsebm.org.uk/Sepsis/rivers_nejm.htm

10 06 2011
Euan Lawson

Thanks for this. Sadly I couldn’t join in with the first journal club but will look forward to future events. I really enjoyed this post as it fleshed out some detail around the concept and highlighted some of the pitfalls. All very useful.

And thanks for the mention but I should point out that I have retired @northerndoctor and gone over to using my own name. Cheers!

@euan_lawson

12 06 2011
laikaspoetnik

Hi Euan,

Nice to see you at my blog and thanks for the comment.

Sorry, there seems to be a @northern_doctor as well. Of course there is only ONE @northerndoctor for me. I assumed he was you.

12 06 2011
David Little

A really interesting and well thought out summary of the #twitJC idea.

I agree with you that it would be nice to focus more on the impact of the paper rather than the design. As you rightly said, most people agreed on the answers to the questions. I did however feel that the structure worked quite well in moving people along.

I disagree that twitter may not be a suitable medium. I’ve never been to a journal club with more than 10-15 people, mostly within the same specialty and all within the same hospital. Twitter allows for inclusivity on a global scale with students – consultants able to contribute evenly. I agree that 100+ people can make it difficult to follow and you do need to pay attention to get properly involved, but twitter’s ability to make this happen outweighs the negatives in my opinion. There are indeed often sub-discussions ongoing. I don’t think this is a bad thing, in-fact I consider this to be another positive of using Twitter

As a first attempt I felt it worked surprisingly well and look for to more. Importantly, posts like this allow for constructive criticism which will hopefully improve things rather than dismissing it as @DrVes was so quick to do.

@drdlittle

13 06 2011
Clinical Cases and Images: CasesBlog

Hi David,

A comment is not a dismissal of a great idea. On the contrary, please have a look at the excerpts from my recent blog post:

“In June 2011, a medical student and a junior doctor in the UK launched the idea of a journal club exclusively on Twitter. I wish them best of success in this new educational endeavor. I think it is a great effort and it should be strongly encouraged. In conclusion, from personal experience, I would say that you can only learn when people criticize your project – it is the most helpful kind of feedback that you typically get for free. Please consider visiting the website and Twitter account of this new Twitter Journal Club (http://twitjc.wordpress.com), follow the hashtag #TwitJC and enjoy the new editions.”

http://casesblog.blogspot.com/2011/06/first-journal-club-on-twitter-then-and.html

Note by Jacqueline: Sorry for the late approval. Comment was in my spambox…

14 06 2011
drdlittle

Thanks for the reply, my comments related to some of your initial tweets about the idea which seemed overly negative.

On reflection, and having read your post, I am pleased to see that you have considered your arguments and present a more constructive kind of criticism. See my comments on your post for more on this.

12 06 2011
laikaspoetnik

Hi David,

Thanks for your well-founded response.

I fear that reality has proved me wrong. ;)
Seen from the glass half full (instead of the half empty), it is indeed amazing that that many people engaged on a global scale. The enthusiasm of 100 people speaks volumes.

In retrospect, I think, everyone agrees that it is better to concentrate on the implications of a paper, not on the appraisal* (that had already been done 10 years ago). Then it is easier to pose just a few central questions (I don’t mind sub-chats as long as they are related to the main question, otherwise it is very difficult to follow it all).

I also think that a CAT (critical appraised topic) and/or aggregate evidence may be more interesting than discussing one key paper, because (as said) “other pieces of evidence” are also taken into consideration and one discusses a topic not one single paper.

This is in agreement with the suggestion of Victor Montori at the Twitjic Blog. He explains it better than I did at:

http://twitjc.wordpress.com/2011/06/06/transcript-number-one/#comments

Here was another good suggestion from Dan Harvey
“Perhaps ask along an expert in the field to help guide the discussion, answer technical questions etc? Real life journal clubs benefit from having someone to facilitate and ensure “facts” are correct to allow interpretation….just a thought.”

Yes, all these constructive forms of criticism can only help to make it better.

Jacqueline

* Although this would still be interesting to do with more recent papers.

13 06 2011
David Little

I don’t know much about the CAT idea but it certainly sounds sensible and interesting. As you say, people refer to other evidence during the discussion so it might be wise to focus on a topic rather than a paper.

Also, I would love to see someone present their own work. Inviting someone along to get involved would be much easier on twitter than it would in real life.

14 06 2011
Fi Douglas

I’ve replied to your comment on our blog, David, but just to add – Natalie and I were discussing getting people to present their own papers this weekend. I’ve got a particular one in mind, but it might take a little while to organise.

14 06 2011
Health Business Blog » Blog Archive » Grand Rounds Vol. 7 No. 38

[...] Clinical Cases describes the first journal club on Twitter (going way back to 2008) while Laika’s MedLibLog informs us of a newer [...]

14 06 2011
The Second #TwitJC Twitter Journal Club « Laika's MedLibLog

[...] the previous post I wrote about  a new initiative on Twitter, the Twitter Journal Club (hashtag #TwitJC). Here, I shared some [...]

15 06 2011
Debbie King

I have to agree with Anne Marie and some of the others. Twitter has really come into its own as a medium and can definitely be taken seriously. The Mayo Clinic is even using Twitter now for updates.

15 06 2011
laikaspoetnik

Oh but Debbie, I’am NOT discussing the seriousness nor the usefulness of Twitter as a medium on its own. I was among the first bloggers writing about the Mayo Clinic Tweetcamps and I have given numerous (positive) examples of medical use of Social Media, including Twitter.

http://laikaspoetnik.wordpress.com/2009/04/24/hospitals-on-twitter-mayo-clinic-and-tweetcamp2/

But my point here was, is Twitter a suitable tool for a critical appraisal, where 100 people are joining the discussion (knowing that at least 3 critical appraisals have already been published on the very same topic). A critical appraisal is very structured, whereas the medium Twitter is not. The second journal club was not a critical appraisal, but more a journal club, as done in Science (discussing the findings in the paper). It was more of a debate and I enjoyed it. Twitter is more suitable for Twitter chats like these, although it is still not easy to follow it all. But perhaps that is something you should not strive for….

http://laikaspoetnik.wordpress.com/2011/06/14/the-second-twitjc-twitter-journal-club/

8 09 2011
FUTON Bias. Or Why Limiting to Free Full Text Might not Always be a Good Idea. « Laika's MedLibLog

[...] Club  (Hashtag #TwitJC), a succesful initiative on Twitter, that I have discussed previously here and [...]

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