Peer Reviews

Shariff A, Fang X, Desai T. Using Social Media to Create a Professional Network between Physician-trainees and the American Society of Nephrology. Advances in Chronic Kidney Disease 2013. Vol. 20, No. 4, pp. 357-363.

Comments from Guest Editors: Major revision This is an interesting article about the effectiveness of social media in the hands of ASN. It appears that it was not very successful, despite the successes of other medical groups. I would like the authors to expand the discussion to include more details about the successful experiences with twitter and compare them to the ASN experiencewhat was different in these successful experiences? What could be done better? Why does it work for Ortho? What do the authors think should be done differently? How would would the authors use Twitter at the next ASN meeting? For the twitter-naive, it might be helpful to describe the structure of the twitter networking sessions. Are the trainees tiring of twitter? As noted in the results section, only 8.1% of registered trainees participated in the networking sessions. Maybe they have twitter fatigue? Lastly, Figure 1 and 2 need to be labeled as such. Reviewer #1: Abstract: -In the introduction, the authors say that Twitter offers the ability to network with other individuals; however, its functionality could be more precisely articulated. Specifically, it is a 'microblog' that enables the construction of vast networks. The 'microblogging' aspect is what differentiates it from other social networks that perform the same basic function of 'connecting people'. The authors should be more specific in identifying the core purpose of the tool. -The authors have worded their hypothesis in a problematic way. They should say that they hypothesized that "the ASN 'would' successfully use Twitter." Additionally, the authors should specify why they chose the ASN and Kidney Week. This is a relatively small conference compared to a more general medical meeting, such as the ACP or AMA. The authors could hypothesize that Twitter could be useful even in a smaller venue, which I believe is the main thrust of the article. The authors could either generalize the results to any clinical subspecialty, or explain reasons why this is particularly useful for nephrology. -The authors should use past tense in summarizing their methods. Nephrology On-Demand ! http://www.myNOD.org

Peer Reviews

Shariff A, Fang X, Desai T. Using Social Media to Create a Professional Network between Physician-trainees and the American Society of Nephrology. Advances in Chronic Kidney Disease 2013. Vol. 20, No. 4, pp. 357-363.

Further, it is neither clear here nor in the body of the text how they analyzed tweets for content. Also, they should not assume the reader knows what Kidney Week is. Is this a conference? Is it a week devoted to raising awareness? When does it occur? How many participants are involved? What is the ratio of students, residents, and attendings? These metrics are important. Regarding the #kidwkstu hashtag, it would be useful to define what a hashtag is and what it means in the context of a professional conference. How was the chosen hashtag decided upon? Why not just "kidwk11" or something more generic? -In the results subsection, the phrase "navigating Kidney Week 2011" is confusing, as the phrase "navigate" could take on a multitude of meanings, from physically making one's way through a conference to acquiring information online, etc. It is suggested that the authors be more rigorous in their terminology here to reduce the interpretive element of one of their main themes. Introduction -It would be helpful if the authors could define social media in the first paragraph to differentiate this technology from existing approaches (i.e. mailings, phone, etc). They should also describe precisely what Twitter is and does, as alluded to above. Currently, this discussion is underdeveloped and buried in the text, and yet it is much more useful to the reader in the introduction. Further, because the authors are choosing to focus on Twitter, they should elaborate on why this social network is different from other commonly used media, including email, blogs, and Facebook. Why does Twitter have more potential for networking at a conference than, for example, a Facebook group? Ease of use, rapid exchanges, and other themes could be explored. Lastly, this article reports on a use of Twitter in 2011; however, the site rapidly changes and is decidedly different in 2013. The authors should address changes in functionality, and how this potentially affects the professional usage of Twitter. -The authors would also do well to reference the usage rates of social media/Twitter not only in the lay public but also amongst doctors and trainees. There are several recent studies that have published these data, and citing them would help build a larger framework for the experiment the authors performed at the ASN conference. -Have other studies on social networks used the type of network analysis employed by the authors of this manuscript? What value has been demonstrated through this form of analysis (as opposed to looking at a Nephrology On-Demand ! http://www.myNOD.org

Peer Reviews

Shariff A, Fang X, Desai T. Using Social Media to Create a Professional Network between Physician-trainees and the American Society of Nephrology. Advances in Chronic Kidney Disease 2013. Vol. 20, No. 4, pp. 357-363.

simple metric like "number of followers")? This would be useful if summarized in the introduction. -I have read over the second paragraph several times and still am not sure how three sessions were held in October and November in conjunction with what appears to be a week-long conference. Methods: -How were participants notified about this opportunity? Was the option offered to all who registered for the conference? Did participants provide informed consent? To this point, the authors do not report whether an IRB was used for this research. Even if an exemption was granted, this must be stated in the methods. - Please elaborate on how exactly the searches were conducted. For someone nave to Twitter, it is not apparent. -It isn't clear what the authors mean by "moderators were self-identified through their tweets". Perhaps citing an example would help clarify. Also, specifically how were moderators contacted? And was there any sort of compensation/incentive offered for their participation? -Why did the authors fold medical students and residents into a "trainees" category? Even given the paucity of data from trainees, it might be useful to drill deeper and see which of these two populations most engaged on Twitter. -With regards to the definition of a 'participant' as a user generating at least one tweet, I wonder if this is problematic. For instance, did any users follow a moderator without tweeting? If so, they would still have benefited from access to that person's tweets/expertise even though they did not contribute to the discussion and were thus excluded as formal participants given the inclusion criteria used by the authors. This is a major flaw in the study. A major dimension of Twitter is "following," as opposed to actively tweeting. This is especially true for students, who may follow an established, prestigious physician only to make contact in the future, mentioning meeting at the conference. A critical analysis missing from the paper is that of new followers for the ASN following the conference, or even individual networking sessions. Further, establishing the new follows between moderators and participants could be incredibly informative and interesting. Active tweets are, in many cases, only the tip of the iceberg.

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Peer Reviews

Shariff A, Fang X, Desai T. Using Social Media to Create a Professional Network between Physician-trainees and the American Society of Nephrology. Advances in Chronic Kidney Disease 2013. Vol. 20, No. 4, pp. 357-363.

-It is not clear how the authors determined the 4 thematic categories. Did they use grounded theory? Did all authors participate equally? Were there disagreements in determining themes? If so, how were they resolved? -What is the "Twitter database"? Did the authors create this? Or is this open source data available from Twitter? Results -"Twitter" should be capitalized throughout this section. -It isn't clear what the duration of the 3 separate Twitter chats was. Did moderators devote and advertise a specific hour/day to them, or did they simply happen randomly over the interval of a week? This needs to be better fleshed out in the intro and methods section. Discussion: -The authors say that moderator activity is a "prerequisite for a successful Twitter networking session". Can they cite previous studies that have established this as fact? It seems somewhat ironic that for a democratizing technology such as Twitter a strong central moderator would be so central to the creation of a successful network. -The authors should remove the sentence about their "surprise," as this editorial element detracts from the presentation of their data. -When the authors say that trainees "did not receive enough valuable information from @ASNKidney to establish a connection with ASN" how do they know this? --Were participants formally asked why they did not establish a stronger connection? It does not appear so, and that the authors are simply making an assumption here. A more structured inquiry and analysis may have found that their lack of connection had nothing to do with receiving inadequate information. This seems a significant weakness in the study. -The authors do not need to capitalize "nephrology" throughout. -In their discussion of organizations using social media, it is unclear if the authors are arguing that social media is more cost-effective than other approaches. They need to add "than" to make this a proper comparison. This section also raises the question of who organizations can task with ongoing communication via social media platforms such as Nephrology On-Demand ! http://www.myNOD.org

Peer Reviews

Shariff A, Fang X, Desai T. Using Social Media to Create a Professional Network between Physician-trainees and the American Society of Nephrology. Advances in Chronic Kidney Disease 2013. Vol. 20, No. 4, pp. 357-363.

Twitter. It is unlikely that healthcare professionals can provide consistent leadership (unless their time is compensated), so how does an organization ensure quality messaging/communication with its followers? -The penultimate paragraph - which looks at other ways healthcare professionals have integrated social media into their professional lives would be better served in the introduction. However, when the authors cite specific usages of Twitter (for instance, the plastic surgeons) they need to provide references to the literature. -The discussion would benefit from an elaborated reflection on possible approaches that others might take to more efficiently build a sustainable network. Perhaps even a figure summarizing effective procedures and best practices would be a valuable contribution. The third paragraph in the discussion currently contains some of this information, and I would encourage the authors to repurpose this as a figure. Tables: -I'm not sure that Table 1 is necessary as the examples are so few/succinct that they could be easily folded into the text of the results section. -In Table 2, one wonders whether the high relative number of "other" tweets suggests that users would value a less tightly-managed and more organic network in which they corresponded not only about nephrologyrelated issues but more peripheral issues of their choosing. In the absence of examples of "other" tweets, it is difficult to determine whether their content was substantive or frivolous (or both). Figures: -Figures 1 and 2 could easily be combined into a single figure

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