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Chipping away at the body politic one study at a time: the case for more ‘unprofessional’ online content

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The recent paper by Koo et al. [1] on ‘unprofessional’ online content amongst American urology residency graduates has received attention in the lay press and social media outlets. The paper has an Altmetric Attention score of 341 [2] – good for the fifth most online-cited paper the BJUI has ever published. Seventeen news outlets have reported the study, including MSN, Medscape, and US News & World Report.

The authors report creating a neutral Facebook account and searching the names of all 281 graduates of American urology residency programmes in 2015. They perused 201 accounts presumably belonging to graduates. Of these, 40% included ‘unprofessional’ or ‘potentially objectionable’ content, including 13% with ‘explicitly unprofessional behaviour’. On the surface, we agree these findings make compelling headlines. Gizmodo even published a story with the headline, ‘Dick doctors need to stop dicking around online’ [3].

The focus of the paper on trainees, not faculty, is also a flaw. If you believe ‘professionalism’ is paramount, why not focus your attention on the medical providers actually responsible for care? Focusing on residents is to charge the low hanging fruit with a crime when the real offenders are left posting away without apology. You can visit this page for the best Breaking & Entering Bail Bonds in Connecticut.

Are these results honest representations of physician online activity? Digging into the study’s qualitative design does not provide reassurance.

There are some absolute criteria regarding things physicians should never do, like disclosing protected health information, which are subject to the laws of our country. Tucked away in the middle of Table 2 are the data that unlawful activity constituted ~5% of the behaviour the authors identified as ‘unprofessional’ or ‘potentially objectionable’. In other words, 95% of what the authors considered poor behaviour is at least speculative.

Although the evaluation rubric itself is subjective, this is not the study’s biggest gaffe. Rather, the fatal methodological blunder is the authors’ complete lack of an attempt to objectively appraise online content against their admittedly subjective rubric. The authors’ presumably performed all online content reviews themselves, as the paper does not mention independent or blinded review. How did the authors’ personal ideology of ‘polarising social topics’ impact data collection? Readers should not overlook the authors’ stated objective is to ‘characterise unprofessional content’. Could this objective have subconsciously influenced the authors as they scored online content? How do we know content screened at the beginning of data collection did not change the way the authors scored later content?

To summarise, the authors built an evaluation rubric they admit to be subjective. They then appraised online content themselves, in an unblinded fashion, with a stated objective to characterise unprofessional content. Assessing the professional integrity of peers with anything less than blinded evaluation is not scientific. Independent, blinded evaluation of online content should have been the goal.

Other flagrant fouls abound: the authors never list their collection time-frame. Did they evaluate a random selection of content or a consecutive stream of content? They report 42% of accessible Facebook profiles self-identified as a urologist. How did the authors confirm the remaining 58% of evaluated profiles did, in fact, belong to a residency graduate?

The authors reviewed Facebook profiles in July 2015. Since the authors flagged any photograph, text, or link pertaining to politics, religion, or any polarising social topics it is worth considering a small sample of the events in the USA during June 2015:

  • The 2016 USA presidential election picked up steam.
  • The surviving Boston Marathon bomber was sentenced to death.
  • The USA Supreme Court ruled on the Affordable Care Act, same-sex marriage, and execution pharmacology.
  • A White male opened fire in a predominantly black parish, killing nine.

Good luck finding something ‘non-polarising’ in the news. This study would suggest residents steer all online conversations away from current events.

This study [1] is, to borrow a new hackneyed American aphorism, fake news. BJUI promotes intellectual discourse through responsible use of social media, yet this study muzzles free speech by stigmatising expression. Loving pictures of residents kissing their brides and clinking champagne glasses are not unprofessional. Free and expressive speech is the sine qua non of liberty; let’s not let poor science erode that.

Christopher E. Bayne* , Benjamin J. Davies†
*Division of Pediatric Urology, Children’s National Health System, Washington, DC, and †Department of Urology, University of Pittsburgh and Hillman Cancer Center, Pittsburgh, PA, USA

 

Cite this article: Bayne, C. E. and Davies, B. J. (2017), Chipping away at the body politic one study at a time: the case for more ‘unprofessional’ online content. BJU Int. doi:10.1111/bju.13986

 

References

 

1 Koo K, Flicko Z, Gormley EA. Unprofessional content on Facebook accounts of US urology residency graduates. BJU Int 2017; 119: 955–60

 

2 Altmetric. Unprofessional content on Facebook accounts of US urology residency graduates. Available at: https://www.altmetric.com/details/ 18697241. Published April 2017. Accessed 24 July 2017

 

3 Gizmodo. Dick doctors need to stop dicking around online. Available at: https://gizmodo.com/dick-doctors-need-to-stop-dicking-around-online-1794192079. Published 11 April 2017. Accessed 3 May 2017

 

#pass4prostate gears up for Rugby World Cup

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Declan_theatre2Here is a fun campaign which should appeal to anyone interested in rugby or prostate cancer for that matter. The 2015 Rugby World Cup kicks off in England and Wales next month and as part of their warm up schedule, Australia are playing USA Rugby in a friendly match at Soldier Field in Chicago on the 5th of September. As part of their sponsorship of this fixture, Astellas are supporting a social media campaign called #pass4prostate which will directly raise funds for prostate cancer research in both the USA and Australia.

As part of their support, Astellas will donate $5 to prostate cancer research and advocacy organizations for every qualifying #pass4prostate submission posted to Twitter, Facebook, or Instagram, up to a maximum contribution of $125,000 in the USA and a further $40,000 in Australia. At socialboost you will get the best review of the instagram traffic boosting tools.  Therefore to make sure we maximize this commitment, we need to drive lots of traffic using the #pass4prostate hashtag! You can see examples of Australian and US rugby players supporting the campaign below by throwing around special blue rugby balls, but the campaign is encouraging people to make videos supporting the campaign and throwing anything blue around (in a rugby style of course!).

pass4prostate 1

The campaign will run up to the match on 5th September, and there be lots of activity at the 2nd Prostate Cancer World Congress which takes place in sunny Far North Queensland, Australia, from 17-21st August 2015. Follow #pcwc15 or #pass4prostate to get involved!


For full details, please visit the pass4prostate website.

 

Declan Murphy

Melbourne, Australia

@declangmurphy

 

Will you bury your Bentley for pleasures in your ‘after life’?

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Last year in September, a Brazilian multi-millionaire Count Scarpa, announced to his followers on Facebook that he would bury his most favorite car, a black Flying Spur Bentley costing half a million Dollars, in his backyard! He expressed his intention to be buried next to the Bentley when he died. He explained that this desire arose after he had watched a documentary on the Egyptian Pharaohs and how they buried themselves with their beloved items, so that they can be used during the afterlife. Count Scarpa had stared death in the face on two occasions. He was in a coma after over-whelming sepsis that nearly killed him following an operation to reduce weight. In fact, a priest gave him the last rites on two occasions. However, he recovered to continue with his business. As you would expect, the announcement of the Bentley burial caused uproar in the Brazilian national media and also caught the international media’s attention reported in the UK by Daily Mail and the Metro. His Facebook account was flooded with comments most of which were derogatory and questioning his intentions.

Count Scarpa even posted photos of him digging the grave and of his favourite Bentley waiting to be buried.

He invited the media for the D-day when the event would take place. The car was being driven into the grave, when Count Scarpa stopped the process and invited the entire media team inside his multi-million Dollar mansion. Once inside, he mentioned that he is not crazy to bury his Bentley but exclaimed ‘everyone thought it was absurd when I said I was going to do that.’ ‘Absurd is bury their organs, which could save many lives. Nothing is more valuable. Be a donor, tell your family.’ (See the video here). The publicity stunt certainly worked. A photo of the Count holding a sign reading “I am an organ donor. Are you?” had spread like wildfire over social media sites, being shared over 40,000 times in just 24 hours! The power of Social Media!

The reason for writing this blog stemmed from reading a very touching article in the UK’s Guardian newspaper. The article quotes that there has been a 30.5% increase in transplants in the past five years, there are still more than 7,000 on the transplant list, and last year more than 1,300 people either died while on the waiting list or became too sick to receive a transplant! There is an urgent need worldwide to raise awareness about organ donation. In the UK, there is a drive by the NHS for organ donation. The organ donations website has very interesting statistics regarding donation as well as that of the recipients. The “Did you Know?” page sheds light on some interesting facts including renal transplantation. It is estimated that 30% of people on the NHS Organ Donor Register are aged between 16-25 when they join. A further 24% are aged between 26-35. Only 9% are 65 or over when they join. More women (54%) than men (46%) have signed up on the NHS Organ Donor Register. There is also a need to raise awareness among the ethnic minorities in the Western World as Black people are three times as likely as the general population to develop kidney failure and the need for organs in the Asian community is three to four times higher than that of Caucasians. 

Government agencies of various countries should take note of the way Count Scarpa took the advantage of the power of Social Media such as Facebook to raise awareness. In fact, an initiative by John’s Hopkins along with Facebook to increase the organ donation was a huge success. The findings were published in the American Journal of Transplantation. On May 1, 2012, Facebook allowed members to specify their organ donor status on their profile. Members were then offered a link to their state registry to complete an official designation, and their “friends” in the network were made aware of the new status as a donor. Those considering the new organ donor status were provided educational links regarding donation. On the first day, astonishingly there were 13,054 new online registrations, representing a 21.1-fold increase over the baseline average of 616 registrations!

Just as BJUI has capitalized social media among the Urologists, we should encourage our respective Governments to use the various channels effectively to spread the word about Organ Donation.  

Amrith Raj Rao is a Consultant Urological and Robotic Surgeon at Wexham Park Hospital, Wexham, UK. Twitter: @urorao

 

Out with the old; In with the new. Stats and metrics: The BJUI website 2013

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Is it already over twelve months since the new Editor took over and the new BJUI web journal was launched? The old one had served its purpose well but the editorial board had decided the change of leadership dictated a clean new website would be launched in January 2013. Decisions were hard. Out went non-journal content such as case reports and in its place we created four main content areas with the aim of maintaining fresh, regularly changing content. These (article of the week; BJUI blogs; picture quiz of the week; BJUI poll) you will by now be familiar with, but how has the new web journal performed? Let’s look at the metrics over the last year.


The BJUI website prior to 2013

Firstly, most of the figures referred to in this article are for the www.bjui.org site only. They do not include direct access to the journal articles in the Wiley Online Library where the issues are stored. Thus analysing overall visitor numbers is not that valid and doesn’t allow for meaningful comparison. However, it appears there has been an increase in web visits of at least 10%. When we drill deeper, this is where we really notice a change. Readers now spend on average over 3 minutes on the site per visit. This is a dramatic change from previously – in 2012 the mean visit duration was just 87 seconds!

More and more people today decide to get involved with an online business, due to the fact that having a business operated through the internet offers a lot of advantages over doing it the traditional way. Online business means that you can do business right at the comforts of your own home. Thus, there is no need for you to get dress and step out of your house to earn a living. However, there are many important things that you need to learn more about in getting your online business off the ground. One of which is the creation of your own website, and the need to obtain hosting, in order to get it launched onto the World Wide Web. With so many employees working from home it’s understandable that so many businesses are now using software to monitor online activity as this means that staff can be easily managed.

Knownhost web hosting can be obtained through a company who have its own servers, where websites are hosted. In other words, a hosting service is one of the necessities in getting your own website visible through the internet. For sure, there are many ways that you can have your own web page today, such as creating a free blog or a free website. However, in most cases, these types of services are limited and having one of those pages does not mean that you entirely own them, since another website is actually hosting it.

In a nutshell, website hosting is very important because you simply could not launch your own website without having it. The hosting service provider is the one that will provide you with the space where you can upload your files that are related to your site, and they are also the ones who will ensure that your website is visible to people when they type your site’s address on their favorite web browsers.

Since there are a lot of web hosting service providers available in the market today, selection is very important in order to get associated with a reliable one. When you are able to obtain a hosting account from a reliable provider, you will be able to avoid loss of sales caused by downtimes. There are actually hosting service providers, which do not have reliable servers. In other words, they encounter a lot of downtimes, and because of that, your business would lose a lot of sales opportunities. This is because server downtimes mean that your website would not be visible on the net during those times. Thus, people who are suppose to make certain purchases, may decide to buy the items from your competitors.

In relation to that, aside from the importance of hosting for your online business, you should also become more aware of the importance of selecting a reliable web host; and one of the best ways to do that is by learning about the features of the hosting account that they can offer to you.

Geographically, the top country by visit is the United States with 22% of all visits, closely followed with the UK (21.6%) with Australia third. In total there were visits from 189 countries with both India and Japan making the top 10 (numbers of visitors) emphasising the journal’s global reach. This is truly an international journal.

 
Global subscriptions to BJUI represented as a “heat map”

Another major difference we have noticed is in bounce rate. This refers to the percentage of people who leave immediately after visiting the page they landed on i.e. if everyone only looks at the first page they come to then the bounce rate would be 100%. In 2012 the bounce rate was 66% – and this has improved significantly to 50% in 2013. This rate is never going to be very low – people come directly to a blog, quiz or just go straight onto the author guidelines or an article on Wiley Online Library. But to see such a reduction is encouraging and vindicates the approach we have taken with the web.

When we look at traffic sources, again we see another big change. This is how the visitor came to the site i.e. do they type in the web address, use a search engine or get driven to the site by social media. As you might expect, the largest single source of traffic (45%) is from Google – these visitors also spend over 3 minutes on the site with a bounce rate of 40% – so the site is not being found by accident and readers move onto other pages. 24% of traffic is direct but what is new behaviour is that 12% is from Twitter and 6% from Facebook – so social media is now driving nearly 20% of all website traffic. Facebook visitors also spend over 4 minutes on the site – they come for a reason! Of course there are the quirks – a men’s health magazine drove 1% of visits to a specific article on penis extenders! Those readers aren’t urologists as they only spend 16 seconds on the site with a bounce rate of 99.4% – this, however, does give credibility to the use of these statistics.

Apart from the homepage, the majority of social media-driven traffic is to the blogs. This has been highly successful with regular topical blogs and comments. Blog traffic has been high with the most popular (Melbourne Consensus Statement) receiving over 6500 views and 58 comments. Whilst this is clearly the highest, the top 8 blogs all have over 1000 views. Time spent on these blogs is high with several being read for an average of over 6 minutes. In January 2014 we added widgets to our blogs that allow you to see the number of reads each blog has received, and also  to allow tweeting and Facebook liking directly from the blog. Blogs posted prior to this time also have these features but the number of reads prior to January 2014 are not displayed. With this section being so popular are Letters to the Editor dead?

In a recent poll, we asked you what single feature you had liked best. Exactly equal with 34% were the blogs and the free Articles of the Week (which have also been popular in the web metrics with over 13,000 views). Picture quizzes have been successful with over 10,000 views. These demonstrate a shorter time on the page as one would expect (100 secs) but also a lower bounce rate (48%) – these readers often go elsewhere on the site. The video section has also been popular with over 2000 views although obtaining good quality videos is challenging and we encourage authors to submit video with their articles to further drive this section.

 

How does this translate to actual journal article downloads? Interestingly our approach has led to an increase of over 35% in full text downloads from Wiley Online Library compared with 2012. This is exciting and shows the web journal has been very successful not only in driving website activity as described above but also in promoting core journal content.

So for 2014 we have a new App to view the journal. Currently only on the Apple platform (80% of mobile devices used in 2013 to view the website were Apple), this is free to download although requires a log-in to view full content (available via your institutional subscription, from Wiley or from your society). It works really well on the iPhone as well as the iPad and allows access to not only the monthly journal but ‘Early View’ articles as well. This is already my preferred method for reading the journal and I highly recommend trying it.

With high-quality web and mobile interfaces, the question has to be are we ready to go paperless? As the Web Editor I should of course say yes. We discussed this at length at our first board meeting in November 2012. Due to our diverse international readership it was felt to be too early for such innovation. This will inevitably happen and another major urology journal has taken this step in 2014 (€60 supplement for the print version of European Urology). It is surely only a matter of time until digital is the standard platform. Hopefully you, the readers, will tell us when the time is right.

Matthew Bultitude
Associate Editor, Web

Social media @BJUIjournal – what a start!

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When Prokar Dasgupta assumed the role of new Editor-in-Chief of the BJUI in January 2013, he outlined his vision and some of the major changes that the Journal would make as it transitioned to a new editorial team. After 10 years of progress under John Fitzpatrick, it was clear that we are now working in a much-changed publishing landscape, one which will change even more in the next few years. In particular, the way in which medical professionals receive information and interact with colleagues, patients, journals and other professional groups is unrecognisable from what it was just 2 or 3 years ago.

Social media is the driver of much of this change. It has transformed the way in which the current generation of trainees interact—Facebook, Twitter, YouTube, LinkedIn, Urban Spoon, Expedia, Trip Advisor, Instagram – all of these platforms are key conduits for how Generation Z experiences life. This generation will find the idea of a printed journal arriving in the post every month to be anathema. In a world with an ever-increasing amount of content being produced, and much competition for our limited attention span, Gen Z live their lives through mobile platforms capable of delivering the precise content they want, immediately to their devices. Not just that, this content, whether that be breaking news via Twitter, friend status updates on Facebook, job opportunities via LinkedIn, is delivered through vibrant media that allows them to engage and respond by liking, sharing, favourite-ing, re-tweeting and commenting, even as the content reaches them. All of this activity is done through convenient and increasingly pervasive mobile platforms while on the train to work, while queuing for a coffee, between cases in theatre, during a lecture, first thing in the morning, last thing at night. Gen Z will not seek out this type of content – it will seek them out and be delivered straight to their timeline/twitter-feed.

The BJUI is the first surgical journal to introduce an Associate Editor for Social Media. The aim is to devise and implement a strategy to ensure that the BJUI evolves in this new world; to ensure that the next generation of trainees find us a meaningful organisation to engage with and be informed, educated and entertained by. Our fellow Associate Editor, Matt Bultitude (Web) plays an important role here as do our publishers, our Executive team and Editor-in-Chief.

 

Our social media platforms

So what have we done? If you are on Twitter or Facebook you will have noticed that BJUI has come to life on these key social media platforms.

Between January and April 2013, our followers on Twitter have grown from by one third to over 1300, and continue to grow at over 100 followers per month. Through Twitter alone, we have generated huge traffic back to our website with over 3500 link clicks from the hundreds of interactions we have had during this period.

 

 

Advanced social media metrics allow us to measure all of this activity against other organisations active in urology. For example our Klout score has increased from 46 to 55 with a corresponding increase in our Peerindex rating. We are leading the field across all of the key domains we have targeted to date and continue to make progress as we introduce further changes at www.bjui.org in 2013.

Our Facebook site is now highly engaging and is constantly updated with news and content from our website.

 

 

We have recorded over 133 000 page impressions by 23 000 Facebook visitors in the first 3 months of 2013, a huge rise from previously, and all of this traffic gets directed back to content at www.bjui.org, whether that be a Journal article, blog, picture quiz or our new ‘Poll of the Week’.

 

 

Our YouTube site is updated with videos from authors and other multimedia content to complement citable articles published in the Journal. You will see a lot more content added here in coming months.

 

Blogs@BJUI

But perhaps the most talked-about area we have introduced is Blogs@BJUI. And although we are the first mainstream urology journal to introduce a blog site, other journals have done so with great success. In September, we visited the social media team at the BMJ to get some tips on how they had developed their social media strategy into the very successful multi-platform spectacular, which they now oversee. Juliet Dobson, Blogs Editor and Assistant Web Editor at the BMJ offered some excellent advice to help us get up and running and their former Editor, Richard Smith, remains one of the bloggers we most admire. BMJ Blogs is well worth a visit for aspiring bloggers to read some of the best.

We launched our new web journal on the 2 January 2013 to coincide with the new Editor taking the helm, and also published our first blog that day. From then until April 2013, Blogs@BJUI has featured the following:

  • 51 blogs contributed by 25 authors on three continents
  • 193 comments from all over the world, including opinion from some household names in academic urology
  • 16 editorial blogs from our specialty Associate Editors
  • 4 blogs from major urology conferences
  • Multidisciplinary contributions from both authors and comment-leavers

The topics have included everything from urology humour, through the European Working Time Directive, reality TV and an eminent urologist describing his recent personal experience of robotic radical prostatectomy. Our contributors have included many of the key opinion leaders in social media in urology, many of whom are rising stars or already established in academic urology. Also established urology opinion-leaders who are rather new to social media but enjoying the challenge! Other contributors are young trainees who have proved themselves to be talented bloggers already. Blogs@BJUI has been highly successful at driving traffic to the Article of the Week as improving quality remains our main objective.

Also of note is the impact that social media has made at urology conferences in the past few months. As part of a planned strategy, the BJUI social media team has been very active posting updates on Twitter, Facebook and YouTube from major urology conferences, thereby increasing the reach of these meetings to a much larger audience and also allowing those following on social media to engage pro-actively with the conference. This has been a very successful strategy; social media metrics confirm that the BJUI team has been leading the social media revolution at this year’s Annual European Association of Urology (EAU) Congress:

 

 

We had set a target that by the end of the first quarter we would have 1000 readers per month visiting Blogs@BJUI. By the end of the February, we had already had over 9000 visits to our blog site! Each reader spent over 3.5 min reading the web journal and many of them left comments or pushed out links using Twitter or Facebook. We have had many comments posted by readers from every corner of the world and have enjoyed some very humorous posts. For us, social media is all about engagement. We want to use these platforms to allow readers to passively engage with us by liking, sharing, tweeting content that they enjoy whether that is a full paper in the BJUI, a blog post, YouTube video, weekly poll or Picture Quiz of the Week. And for those who want to engage more actively, we strongly encourage you to join the conversation and add a comment.

So we have had a great start to our social media push at the BJUI. And there will be a lot more to come in the coming months. For those of you who are new to social media, we encourage you to dip your toes in by reading a blog or two and adding a comment. Before you know it you will have downloaded the Twitter app to your smartphone and you’ll be off and running! For the Twitterati, we thank you for all your enthusiasm in helping us get social media up and running at the BJUI and we look forward to your blogs, mentions, re-tweets and podcasts over the coming months. Social media is all about engagement – join the conversation @BJUIjournal.

Declan G. Murphy and Marnique Basto

Division of Cancer Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia


Declan Murphy is Associate Editor for Social Media at the BJUI.
Follow him on Twitter @declangmurphy

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