Journal clubs have been a mainstay of medical education in the last fifty years, serving both to disseminate recent advances in medicine, as well as to discuss and critically appraise the published literature.38 This kind of activity fits perfectly into the SoMe background, where conversation and discussion are highly facilitated. Twitter has become the most common platform for hosting online journal clubs, and they are growing steadily in the last few years.

The Nephrology Journal Club (NephJC) is a Twitter-based online journal club that was started in April 2014 and is conducted twice a month. Articles are selected by a committee of 15 nephrologists from 5 countries, and highlight high-impact or controversial articles, primarily in clinical nephrology.39 A few days before the journal club, a summary of the article is posted on the NephJC website. In addition to the summary, these posts detail the background of the study and raise possible topics for discussion. The actual journal club is a Twitter chat, and the hashtag #NephJC allows everyone to participate and follow the discussion. A moderator “hosts” the chat, and guides the conversation, usually with a prepared script.

Each edition of the NephJC has three sessions at different schedules (US Chat, EU Chat and India Chat), to allow individuals in different time zones to participate actively. Authors often join the chat and provide additional insight or answer questions from the participants directly. For example, the CREDENCE trial, one of the most important Nephrology articles published this year,40 was discussed by 639 participants, and the lead author actively engaged in the three sessions of the journal club.41 The presence of an author contributes to the flattening of the educational hierarchy and makes the journal club a richer learning experience.

The webinar, the contraction of the words “web seminar”, is an interactive seminar conducted through the web, usually with live video transmission, and users can participate through text-based chat, voice or video.42 The ISN organizes monthly freely accessed 60-min webinars held by renowned experts in various Nephrology topics, followed by a live “questions and answers” session. They are also available for offline view in the ISN Academy website.

Another good example of free webinar-based education is the one provided by the Glomerular Disease Study and Trial Consortium (GlomCon). GlomCon has a biweekly web-based nephropathology educational conference, where a case is presented by a nephrologist, followed by a review of the pathology slides and case discussion.43 Participants are allowed to ask questions and to give their opinions regarding the case. It is also possible to review the webinars later, as they are recorded and upload into the GlomCon website.

NephMadness is an online educational game modeled after a yearly college basketball tournament known as March Madness, that started in 2013.44 Thirty-two topics are chosen each year to “compete” head-to-head in a single-elimination tournament with winners chosen by a panel of nephrology experts (“Blue Ribbon Panel”) (Fig. 4). This panel judges the matchups based on a particular topic's relevance or potential ability to affect the lives of patients with kidney disease.

Fig. 4.

An example of a tweetorial on volume assessment in end-stage kidney disease. A tweetorial is a series of posts with high educational content regarding a, usually presented in a dynamic way with question pools, multimedia content, and opportunities to interact.

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Each of the 32 concepts is described in a short, but fully referenced, entry written by guest authors who are experts in the field and published in the AJKD blog.45 People play NephMadness by predicting the outcomes of all matchups (Fig. 5). Players accrue points when their predictions match the results determined by the Blue Ribbon Panel. Participants are encouraged to tweet, blog, and promote their picks using the hashtag #NephMadness.46 The prolonged nature of the game also enforces spaced education, a concept defined by presenting information repeatedly over time instead of in isolated binges, which increases the uptake and durability of knowledge.47

Fig. 5.

NephMadness 2019 brackets. NephMadness is an online initiative that leverages the tools of social media to teach about the latest and greatest breakthroughs in the field of nephrology based on the premise of the “March Madness” basketball tournament. 32 nephrology concepts are divided into eight main topics (regions) with four subtopics (teams), where the participant decides which topic is more relevant in each direct matchup.70

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The 2018 Nephrology World Cup was created by the ISN Education SoMe team to promote nephrology-focused scholarly work from around the world.48 A representative paper, published in each nation's leading domestic nephrology journal, was selected to compete in the Nephrology World Cup, using the same 32-country roster as the 2018 FIFA World Cup.49 This included an article published by Nefrología.50

Each article was summarized and/or converted into a single-page infographic, forming the “scouting report”. These reports summarized the methodology, findings, and implications of each work and included editorial commentary from a member of the organizing team. Scouting reports were divided into eight groups that paralleled the FIFA World Cup structure, and participants voted for the winner of each group and the top 3 competitors. Gamification seems to be a valid strategy to increase the interest and dissemination of locally published scientific work.

Medical centers and academic institutions have begun considering SoMe and digital activities as part of their criteria when considering academic appointments and promotions, not only in nephrology but in other fields as well.51–53 As the scope and reach of SoMe have increased exponentially, the use of these new technologies for multiple applications such as dissemination, branding, advertisement, advocacy, research, and education is being adopted. The Mayo Clinic became one of the first academic institutions to formally include social media scholarship as part of their metrics for promotion.54 One method for objectively measuring one's digital impact is the Altmetric score.

Altmetrics is the term that was coined to describe the method of measuring dissemination and impact of specific articles, or other academic activities.55 Unlike traditional journal-based metrics, such as the impact factor and the h-index, altmetrics can rapidly quantify the dissemination, generated discussion, and potential impact of any academic product, whether it is a journal article, a blog post or a podcast.56 This metric includes weighted measures of tweets, shares, links from blog posts, as well as traditional media mentions.52 The use of such metrics allows the quantification of the dissemination of information to a broader group of people, such as students or non-academic clinicians, and demonstrate general public engagement, which may also be relevant to the success of a project.

Through its platforms and tools, SoMe has the potential to reduce the time lag between publication of evidence and its translation to the bedside, by allowing for quicker and broader sharing of relevant information due to user posting and amplification.57 Multiple trials show that articles promoted on SoMe are more widely accessed compared to those without some promotion.20,58,59

Both academic and non-academic nephrologists should consider developing a SoMe portfolio that documents their digital activities, demonstrating evidence of their quality, and the impact of their digital work. SoMe presence and expertise may lead to other opportunities including leadership chances, recognition in medical journals (e.g., VA editor, journal blog editor) and medical societies (e.g., social media teams, education awards).

Scientific societies and communities, especially nephrology-related ones, are extending their presence in SoMe platforms, as there are many benefits to be gained from it. Beyond the obvious utility of recruiting members more easily, SoMe is the best channel to spread useful information, such as future events, scientific groups associated with the society itself, the existence of grants, etc. Ultimately, this makes societies more transparent and closer to its members and to the rest of the nephrology community.

ISN, ASN, and ERA-EDTA are the most important scientific societies of nephrology on Twitter, and their accounts sum more than 30 thousand followers. All of them use English as their official language. National societies of nephrologists are also present on SoMe. Among them, the Sociedad Española de Nefrología (@SENefrologia) is the prime example of the importance to have a presence on SoMe for a National Scientific Society. With more than 8 thousand followers on Twitter @SENefrologia reaches a huge number of nephrologists, not only in Spain but also in Latin America, since it uses Spanish as its official language.60 The success of @SENefrologia ultimately led to the birth of regional Spanish nephology societies on Twitter such as the Sociedad Valenciana de Nefrología (@SVNefro), Sociedad Madrileña de Nefrología (@SOMANEorg), and the Societat Catalana de Nefrologia (@nefrocat). This heavily contributed to the expansion and diffusion of projects and ideas, papers published on small national journals, local medical protocols, etc. from a local context to potentially everywhere. The key to success for @SENefrologia and other regional societies on SoMe is probably due to the fact that nephrologists themselves (especially younger ones) are managing these accounts. Other National Societies tried to use external marketing companies with not very brilliant results. For example, the official account of Italian Nephrologist Society (@SinReni), is actually inactive since 2018. Other societies such as the Portuguese or the German have no international SoMe presence whatsoever.

Before the advent of SoMe, live sharing of congresses and conferences was difficult, and those who were not attending were left in the dark. Nowadays, academic societies encourage the sharing of information at conferences by providing an official hashtag, Wi-Fi, and by updating their photography and sharing policies to endorse SoMe activity. Live-tweeting at academic conferences has become the new norm.

International nephrology societies such as the ISN and the ERA-EDTA formed their own dedicated SoMe teams, with one of the duties being the coverage of their associated meetings and conferences.36 These groups of “tweet warriors” divide themselves through the parallel sessions to bring highly educational content, such as lecture summaries, selected posters pictures, and video interviews with faculty speakers or award winners. SoMe coverage not only increases the dissemination of the current nephrology hot topics but also the reach of the conference for the scientific community, expanding the opportunities for debate and potentiating participation in future editions.61,62

Promotion of scientific events in SoMe is already an established approach to increase the chance of success of a particular event. Virtually every major institution or organization share their events in one or more SoMe platforms. Recently, a strategy involving the use of “giveaways” in Facebook was successfully used to promote the “Encontro Renal 2017”, the Portuguese nephrology congress, making it the edition with the highest number of participants until that date.63