A welcoming guide to social media for cytopathologists: Tips, tricks, and the best practices of social cytopathology.

This guide provides an overview of social media (SoMe) use with the recent updates for the "cytopathologists and the ones interested in". Our aim was to introduce the basic terms and rules, the potential benefits and risks, and some tips and tricks for using SoMe. The two most popular SoMe platforms, Facebook and Twitter, were the focus of this article. Thus far, many pathologists have already proved how efficiently the SoMe services could be utilized; the same applies specifically to the community of cytopathology. In our opinion, the more CPs are involved in SoMe, the more connected, productive, and stronger the community will become.

***“All knowledge is connected to all other knowledge. The fun is in making the connections.”

(1922–2013, palaeopathologist and expert on dissecting mummies)[1] ***

INTRODUCTION

What is social media

Social media (SoMe) is defined as a worldwide platform using various web-based applications, wherein individual users or groups create their profiles to connect and share their contents with other individuals or groups.[2] The estimated number of global SoMe users has reached 1.96 billion and expected to increase some 2.5 billion by 2018.[3] As of 2017, daily usage of SoMe by overall internet users amounted to 135 minutes.[4] What distinguishes SoMe from the other media platforms is the way its content is generated. The ability to share easily, instantly, freely, and without borders has made SoMe a major player in communication with the world.

***“Knowledge is like money: to be of value it must circulate, and in circulating it can increase in quantity and hopefully, in value.”

(1908–1988, American author)[1] ***

A brief manual and some basic terms for the new social media users

There are various SoMe platforms with a potential utility for “cytopathologists and the ones interested in”, such as Twitter, Facebook, Instagram, Snapchat, Pinterest, LinkedIn, and YouTube.[5] Above all, Twitter and Facebook are the most feasible hosts that have already gained the largest number of pathologists. In these two social networking platforms, there are thousands of active members including many experts around the world. It is very easy to sign up on these services (www.twitter.com and www.facebook.com) with an e-mail address and a unique username.

“Hashtag (#)” and “@” signs are typically used on both Facebook and Twitter. Hashtags are words or phrases preceded by a hash sign (#) and are used to identify messages on a specific topic. For example, #CytoPath is one of the key hashtags for the CPs. Hashtags are more frequently used on Twitter. The other commonly used cytopathology-related hashtags are #Cytopathology, #Cytology, #FNAFriday, and #PAPtest.[6] The users can also use a certain hashtag to search a relevant topic by simply writing it into the search box. Later, the results could be listed separately as photographs, videos, or to see people who state an interest for that hashtag in their profile. To mention or tag a user in a post, “@” is prefaced by the name of a user of interest. An example of how to use a hashtag and “@” signs in a post (tweet) is depicted in Figure 1. A concise Twitter glossary for pathologists is listed in a recently published article.[7]

Figure 1

A “tweet” by Anne Mills, M.D., exemplifies the use of “at (@)” and “hashtag (#)” signs. (1) The name of a user or a page is represented by “@(username).” (2) Hashtags are used to refer to a general topic using “#(topic),” under which the relevant tweets are collected. (3) Another user(s) can be mentioned using “@(username)” within a tweet

Some of the prominent cytopathology journals and societies have already taken part in Twitter such as Diagnostic Cytopathology (@DiagnosticCyto), Cancer Cytopathology (@CancerCytopath), Cytojournal (@CytoJ), the American Society of Cytopathology (@cytopathology) and, its previous president, the Papanicolaou Society of Cytopathology (@PapSociety), the European Federation of Cytology Societies (@EFCytology), the British Association for Cytopathology (@CytopathologyJ), and the College of American Pathologists (@Pathologists) broadcasting new head-and-neck guideline recommendations for fine-needle aspirations.[8910111213141516] The publisher Karger's journal Acta Cytologica is affiliated with over fifty cytology societies worldwide on Twitter.[17]

Currently, on Facebook, the “Cytopathology” group is in the forefront with over 17,000 members. In this page, the members mainly discuss unknown cases.

There is no character limit for Facebook posts, while Twitter presently allows up to 280 characters for each post. One can post up to four photographs in a single tweet, but Facebook allows up to thirty photographs in a post. Nevertheless, Twitter seems to be used more efficiently by CPs, since its design is simpler and more organized, posts are more pathology focused, and the pathologists leading the SoMe prefer to use Twitter more than Facebook.[18] The major differences between Facebook and Twitter are listed in Table 1.[19]

Table 1

Remarkable differences between the two most popular social media websites

Features	Facebook	Twitter
Special features	Friends, fans, wall, news feed, fan pages, groups, apps, live chat, likes, videos, text, polls, status, pokes, gifts, games, messaging	Tweet, retweet, direct messaging, follow people and trending topics, videos
Active users (2017)	2.07 billion/month	330 million/month
User expressions for contents	Like, share	“Retweet” or “Favorite”
Postlength	Unlimited	280 characters (since November 7, 2017)
Editing posts	Yes	No
Adding friends	Yes	No

*** “Often, we are too slow to recognize how much and in what ways we can assist each other through sharing expertise and knowledge.”

(1949-, Barbadian politician)[1] ***

Basic rules and potential risks for social media users

There are a few rules that anyone should be aware of before sharing contents in SoMe. The most important concern is the protection of patient privacy. Deidentification of patient characteristics by applying principal ethical rules is essential.[20]

It would be reasonable to keep personal and professional contents separate since any personal sharing may be misinterpreted by the followers and an unprofessional content would damage an individual's professional image. The users may obtain two different profiles: one for personal and one for professional use. However, managing two different accounts would be challenging. Thankfully, most SoMe websites allow users to customize settings so as to determine who to see or not see any particular post.[5]

One should also not give medical advice based on the limited and potentially misleading information. All the recommendations should be considered rather as “curbside” opinions.[21]

The users should take precautions for several inherent risks that every SoMe platform carry. Hacking and scam activities have been reported occasionally on Twitter and Facebook, so every user should conform to each platform's security and privacy policies to protect accounts and personal data. Using SoMe unduly would be time-consuming and prevent performance and productivity with a potential of causing addiction. Excessive use also bears health risks due to physical inactivity.

*** “Share your knowledge. It's a way to achieve immortality.”

(1357–1419, high lama of Tibetan Buddhism)[1] ***

The benefits of using social media

Cytopathologists and the others who are interested in cytopathology can benefit from SoMe in many ways.[22] There are already plenty of well-organized pathology groups and pages, in which many users actively engage every day. In these platforms, sharing tough cases with the cytopathology community will most of the time initiate instant case discussions. The more well prepared the case – supported with high-quality images and sufficient clinical information, the more it will elicit attention and response from the other users.

The posts shared in these groups are not only “unknown cases” but also may be some interesting aspects or educational points, such as a typical example of a cytological finding. Some members gather interrelated inputs from multiple users, reorganize them, and present as easy-to-glance notes [Figure 2]. For those who may not attend a major conference, many key points from the lectures are shared in these platforms. For this purpose, “live-tweeting” is often organized by Twitter users during an event where you post comments while the event is taking place. In a live-tweeting activity during the United States and Canadian Academy of Pathology meeting in 2015, a total of 16,524 tweets had been generated by 662 users on Twitter.[23] PathCast, an Internet-based video conferencing website on pathology, has started featuring educational videos in 2016, also broadcasting on cytopathology, such as “The Atypical Thyroid FNA: What's Atypical and What Isn’t” by Edmund Cibas.[24] Real-time discussions provide enormous information and update to the followers. For the ones who miss to join these activities, they can easily retrieve what had been shared by searching the relevant keyword or hashtag.

Figure 2

A growing number of useful compilations are made by the social media pathologists. Special “bodies” in pathology compiled by Vijay Shankar, M.D.

E-learning platforms, for example, Eurocytology (#eurocytology), have been developed to serve as a means of cytopathology teaching and assessing. Eurocytology is a multilingual platform with the aims of harmonizing and increasing access to training in clinical cytology since 2008. In 2013, it received on an average 50,000 visits among which 49.1% used Eurocytology as part of their training, with 75,000 pages downloaded per month. After being online on Twitter, the web traffic, which refers to the number of users visiting a particular website, displayed 534,681 users in 2016.[25]

There are other promises that SoMe offers to the CPs. Virtual journal clubs serve as article discussion platforms typically including the authors and experts on the topic from various fields at a scheduled time, for example, @path_JC.[26] Posting a link of one's own publication would be purposed in self-promoting and increasing citations.[27] Strengthening the interactions between the patients and CPs, as well as with the other disciplines, has been more feasible.[28] Live educational videos by attaching special equipment on microscopes or using applications on a smartphone have made pathology education more accessible and effective. Periscope is a live video-streaming application which has been used by some university-based pathologists, such as Jerad M. Gardner, MD (University of Arkansas) and Sanjay Mukhopadhyay, MD (Cleveland Clinic), to present their educational pathology videos or seminars.[29] Participants in these online teaching activities are also allowed to interact with the instructor during the sessions. A “Tweetup” may be organized to bring Twitter users together to meet up in person, especially in pathology courses and conferences.[30]

*** “The only thing to do with good advice is to pass it on. It is never of any use to oneself.”

(1854–1900, Irish playwright, poet, and writer)[1]***

Tips and tricks for a better social media experience

Newcomers in Tweeter

You may start practicing with following the leading SoMe members and pages in pathology and cytopathology. A comprehensive list of “who to follow” by Dr. Rose Wu from the University of Pennsylvania would be helpful which is mentioned below:

(https://twitter.com/smlungpathguy/status/848575088811282436; accessed November 30, 2017).

Sharing images

One does not have to buy special equipment to take pretty microscopic images. Smartphones are not only able to capture high-quality images but also allow users for creative editing. Photographing through an ocular of a microscope could be achieved using Dr. Morrison's free-hand technique described by Montana-based pathologist Dr. Annie Morrison (https://youtu.be/cfd9ViHBlR4; accessed November 30, 2017).[31] Optimizing and watermarking images are easy using appropriate apps on smartphones. Suggested apps for both purposes are “Enlight” for iPhone users and “Snapseed” for Android users. For iPhone users, to magnify a particular finding in a picture, Dr. Pembe Oltulu (@pembeoltulu), a pathologist in Turkey, described a technique which is called “to pembify (#pembify)” using the Markup tool.

What is more, sharing images is also within the scope of telecytopathology, which aims to provide an easy approach for diagnosis (rapid-on-site evaluation, intraoperative diagnosis, consultation, ancillary tests, etc.), teaching, testing, archiving, and quality assessment.[32] Nowadays, some institutions offer comprehensive subspecialty consultations for diagnosis and treatment through their digital portals.[33]

An innovative e-learning platform, developed as a European Project and focused on cytological training at European standard through telepathology, CyTest, has the feature of deep integration between virtual microscopy and the training system allowing quantitative measurement of image comprehension and testing. The software is distributed as open source and available on GitHub (a software repository hosting service). The platform is also being considered, in collaboration with the European Federation of Cytology Societies, as a basis of an eQUATE (Quality Assurance, Training and Examinations Committee) test at European level.[34]

Following strategies

To follow discussions in a post on Facebook, there is an option “Turn on notifications for this post” in the top right corner of the post [Figure 3]. After activating this option, you will get notifications for each new response to that post. You may choose to deactivate anytime you want by simply turning it off. Currently, Twitter does not provide an option to follow a tweet. However, you may save a tweet of your interest to review it anytime using “Add to Moment” option in the top right corner of that particular tweet.

Figure 3

Here, we depict an example of how to follow a topic of interest easily on Facebook activating the option “Turn on notifications for this post”

*** “Principles for the Development of a Complete Mind: Study the science of art. Study the art of science. Develop your senses-especially learn how to see. Realize that everything connects to everything else.”

(1452–1519, an eminent artist and intellectual of the Italian Renaissance)***[35]

CONCLUSION

SoMe has revolutionized our capabilities of communication worldwide by providing an easily accessible, dynamic, fast-paced, and limitless platform. Knowledge and experience have never been transferred in such a rapid and powerful way to people around the world before. According to Karl Popper's philosophy of science, a theory should not only be verified but should also be tested and even refused to be considered as scientific.[36] Humanity and the advance of science throughout history may be likened to a baby crawling in a huge labyrinth through a range of obstacles, including testability, verifiability, and objective evaluation. Once the enlightenment of this labyrinth has been reached, road maps, flowcharts, and algorithms will be created so that others will be able to use the knowledge without getting lost.[37] Today's dynamic and limitless interactions provided by SoMe platforms seem to enable and facilitate to remain within the bounds of scientific and critical thinking required by falsifiability.

Cytopathologists should be well educated about the potential benefits and pitfalls of SoMe mentioned in this article. With the ever-growing professional network, the community of cytopathology is becoming increasingly more productive, much stronger with synergy, and endeavoring to contribute to the scientific development for a greater patient care.

*** “Two there are who are never satisfied — the lover of the world and the lover of knowledge.”

(1207–1273, poet, jurist, theologian, and Sufi mystic)[35] ***

COMPETING INTERESTS STATEMENT BY ALL AUTHORS

The authors declare that they have no competing interests.

AUTHORSHIP STATEMENT BY ALL AUTHORS

All authors of this article declare that we qualify for authorship as defined by ICMJE http://www.icmje.org/#author.

Each author has participated sufficiently in the work and take public responsibility for appropriate portions of the content of this article.

FD participated in the design of the study and has drafted the manuscript. BO participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

Each author acknowledges that this final version was read and approved.

ETHICS STATEMENT BY ALL AUTHORS

This study was conducted within the terms of ethical standards stipulated in the declaration of Helsinki. Authors take responsibility to maintain relevant documentation in this respect.

LIST OF ABBREVIATIONS (In alphabetic order)

CPs – Cytopathologists and the ones interested in cytopathology SoMe – Social media.

EDITORIAL/PEER-REVIEW STATEMENT

To ensure the integrity and highest quality of CytoJournal publications, the review process of this manuscript was conducted under a double-blind model (authors are blinded for reviewers and vice versa) through automatic online system.