With the rapid pace of advances in oncology care ever-quickening; with the paradigm of oncology care evolving from short-term treatment and palliation to long-term chronic disease management; and with the constant need to integrate these changes into practices ranging from the small, rural, two-physician group practice up to the largest inner-city academic medical center — traditional forms of information management and knowledge sharing are being pushed to their breaking point. Enter social media. The problem? How to use it effectively.

At a meeting of 30,000 healthcare professionals, in the back corner of a room that could easily hold 15,000 standing at arm's length, amid a cluster of upwards of a hundred 60-inch round tables, I found myself among a motley group of 15 to 20 folks gathered at the 2010 American Society of Clinical Oncology Tweetup, held during the ASCO Annual Meeting in Chicago in June. Our mission: to tackle the ins and outs of Twitter, a microblogging tool that's rapidly gaining a dominant foothold in the world of social media — and medical education. And, of course, to actually meet face to face after knowing each other mainly through Twitter.

Among those who gathered at the 2010 ASCO Tweetup were several oncologists (including one ASCO board member), employees from medical education companies, publishers/journalists, ASCO staff members, and industry professionals from around the world. Each of the “partwicipants” — Twitter aficionados tend to use words that play off of the Twitter name, sometimes to the point of terminal cuteness — wore a name tag bearing both a birth name and an @twitter name (e.g., Brian; @CMEAdvocate). (See the Twitter Glossary at left for more about Twitter and some common terms.)

Several attendees introduced themselves as being Twitter novices, others were known as leaders in integrating oncology with social media. The perspectives were broad and experiences were diverse — and this would prove invaluable to the discussions that progressed over the approximately hour-long meeting. Before going into what we discussed, I would like to disclose that I currently work for Pfizer, that the opinions shared here are my own and not those of my employer, and that this article was written as a volunteer effort to help medical organizations understand the value of social media technologies.

ASCO Takes the Lead

Shortly after ASCO staff and the board member in “attwendance” began their opening remarks, it became abundantly clear that the society had embraced the potential of social media to improve the overall experience, reach, and value of the 2010 ASCO Annual Meeting. Here's a short list of social media strategies they mentioned ASCO was using for its meeting:

  • The www.asco.org/twitter URL was designed serve as a depot for social media strategies.

  • An ASCO staffer tweeted on behalf of the organization throughout the meeting on the @ASCO account.

  • A series of hashtags were created to simplify communications and knowledge sharing: #ASCO for general ASCO information, #ASCO10 as the official 2010 ASCO Annual Meeting hashtag, and the #ASCOehr hashtag was created just for electronic health record-related discussions.

Then we moved into a free-form discussion about general experiences with Twitter and other forms of social media by medical societies and associations. Our goal was to develop a list of topics that ASCO could consider or act upon to improve the services and the education it provides to its members. What we walked away with was far from a definitive road map for using social media, but just capturing and organizing the discussion into workable themes should help ASCO — and all medical societies and associations — develop plans to make the most of social media platforms.

One practical take-away to consider is to hold a tweetup of your own at your next meeting. Those engaged in social media are very open to sharing best practices, and this is a relatively easy and cost-neutral action item. If you do decide to try it, though, find a quiet place to hold it.Though the cavernous space in the back of the professional's hall at the ASCO Tweetup provided ample elbow room, the meeting lacked the intimacy and ambience suitable for easy listening.

The group also thought it would be a good idea to develop working committees to address each of the following work streams: policy, education/information sharing, and logistics/operations. After much discussion, here are some ideas — and answers — we came up with for each of these areas.

Developing a Policy

While we quickly concluded that organizations should develop a social media policy, there was little consensus on what constitute best practices. However, we did come up with some points to consider.

Societies/associations should think carefully about who they “follow.” In Twitter, as with other forms of social media, there is an important distinction between whom you elect to follow and who elects to follow you: The first process is active, the second passive. Once you establish an account, your primary goal is to develop a social network. This won't happen overnight, but your sphere of influence will grow as you interact with other twitterers.

The general consensus of those gathered at the ASCO 2010 Tweetup was that when you choose to follow an account, you are tacitly endorsing that account, which could a have significant impact on how others perceive your organization. This doesn't mean you shouldn't participate in social media — in fact, social media participation provides a significant opportunity to build a brand and advance your mission. Just do it carefully. Policy consultant and social media expert John Michael O'Brien, PharmD, MPH, offered these three options:

  1. Societies/associations may choose not to follow any other accounts, because their leadership fears being perceived as endorsing those they follow — or slighting those they don't. However, they risk missing important communications about their organization or issues affecting their membership.

  2. They may also create an official account that follows verified members, staff, partners, opinion leaders in their field, and meeting attendees. This approach keeps the organization aware of meeting and membership issues while still granting “exclusivity” to those who support their mission.

  3. Organizations that elect to follow anyone who follows them (the “followback” strategy) have the greatest potential to monitor communications of interest and communicate with the largest possible audience. However, they may struggle with filtering incoming tweets and follow “controversial” or less-reputable accounts.

Another thing to consider is the idea of establishing a “technomentor” program. This is a spin on former GE chairman and CEO Jack Welch's theory that you can ensure progress by establishing a youth mentor — someone who is in touch with existing technologies and possibilities. Though the technomentor role doesn't have to be age-dependent, it is key to ensure that organizations remain open to new technologies. Welch would suggest that this should be formalized, not left to chance.

We just so happened to have such a person in our midst: an oncology fellow from New Mexico who was recognized for the work and advice he had provided leading up to the ASCO 2010 Annual Meeting — he was unofficially nominated, seconded, and approved unanimously as the founding ASCO Technomentor … though I am not sure the vote was binding.

Additional policy considerations included how ownership and copyright matters should be managed and enforced. The general consensus was that it would be nearly impossible to police attendees sending out “twitpics” of slides or content. As one participant said, “I stopped carrying a notebook years ago. Now I take pictures and write my notes on my smartphone.”

Also, the group agreed that it is important to point out that the presentations and slides at the ASCO meeting are ASCO's intellectual property, although ASCO has permitted attendees to photograph slides during sessions (as long as flash photography is not used) for personal use. All of the presentations at the ASCO Annual Meeting are available for purchase at the ASCO “Virtual Meeting” (www.asco.org/virtualmeeting).

We discussed the approach a recent congress took: Obligating each presenter to set his or her own policy on copyright, ownership, and social media. As one person recalled, “at the meeting, each faculty member had to have an opening slide that gave a thumbs-up or a thumbs-down on photography and twittering during their session … but if you walked into the session a few minutes late, you had no idea what the rules were.”

Similarly, there are several examples of social media and embargo crashing headlong into one another (See Embargowatch post: http://bit.ly/cFJNXL.)

Next Page: Education/Information Sharing

Sidebar #1: Education/Information Sharing

The group agreed that social media is wonderfully suited to facilitating information-sharing and education. There was no shortage of opinions or suggestions when the discussion turned to recent experiences with social media at conferences. Admittedly, I was left wondering if people were just more passionate about sharing what needs improving, because bad experiences seemed to outnumber positive experiences by about five to one.

  • Intrasession tweeting: Several conferences have experimented with the use of broadcasting on a series of flat-screen televisions the real-time “tweetstream” so that participants in the room can share a “learners' dialogue” during presentations. Several participants at the ASCO Tweetup recalled a recent patient advocacy conference in Philadelphia. The room, packed with patient advocate and social media experts, was largely lit by the glow of the panel televisions and laptops. While this is not quite what you'd usually find at a large medical conferences like ASCO, there were clearly lessons to be learned.

    Though the experience was generally positive, there were several instances where the tweetstream seemed to become polluted with comments made about the speaker's slides, appearance, or topics totally unrelated to the learning. As one person recalled, “There was a prolonged discussion about chocolate.” For now it seems that caution is advised when using social media for intrasession purposes, but with new software being produced every day, it is likely that the learning experience will evolve along with the technologies.

  • Intersession tweeting: The most positive experiences reported by the group come from not how the technology is being used inside the learning setting, but from the fact that social media can redefine the learning setting. Throughout the ASCO annual meeting, learners were moving between lecture rooms of the McCormick Place Convention Center in search of better content and speakers — and this was facilitated by feedback on Twitter.

  • Extrasession tweeting: Beyond just helping fellow local learners find the best available on-site learning, there was a promising discussion about how learners were using Twitter to be in more than one place at a time, or “multi-twasking.” For example, while in Chicago for ASCO, I was able to participate simultaneously in the Global Alliance for Medical Education meeting in Montréal by following the hashtag #GAME2010. Add to this the possibility for learners around the world to access the #ASCO10 archive through software such as www.twapperkeeper.com and the lessons from Chicago have a broad reach both spatially and temporally.

  • Learning assessment and evaluation: Organizers can use the social media conversations arising from medical conferences and congresses to perform novel assessments and evaluations. Organizers who monitor the official hashtag have access to a near real-time pulse check of what is working for learners and what they need. And organizers can use the hashtag in the days and weeks that follow the meeting to encourage a broader conversation to continue, which could give rise to new educational opportunities.

However, said ASCO 2010 participant Martin Fenner, MD, Hannover Medical School Cancer Center (@mfenner), “The main problem with using Twitter at conferences is that it is difficult to connect all tweets talking about a particular session. General hashtags like #ASCO10 are not a solution for conferences with several thousand tweets. The ASCO conference organizers asked us to use two special hashtags for some sessions, but it seemed as if almost nobody was using them. I would not be surprised if someone invents (or has already done so) a nice service that connects tweets to conference sessions.”

In a post-Tweetup conversation, Lawrence Sherman, FACME, CCMEP, senior vice president, educational strategy, Provo Education, Fort Washington, Pa., (@meducate) said there were a variety of examples of organizations using social media networks as a resource for gap analyses and needs assessments. “By engaging healthcare professionals through social media, we have re-engineered our access to learners, and this has proven very successful to date,” he said.

Edward Winstead, a journalist with the NCI Bulletin (@NCIBulletin), also noted that Twitter and other forms of social media may be quite valuable in helping traditional media and journalists gain access to data, researchers, and potentially board members in more timely and convenient ways. There was general agreement that this seems like a viable means of translating clinical and scientific information out to the broadest audience through traditional media outlets.

Sidebar #2: Social Media for Operations/Logistics

There was a general recognition that social media is wonderfully suited to manage operational and logistical issues that arise at a medical conference, but that an association/society should carefully consider how they monitor the official hashtag — and who's doing the monitoring.

For example, the group offered countless examples of Twitter being used to report issues such as lecture rooms that were too warm, too cold, or too loud, as well as when in-session audio or video needed to be corrected. One example straight from the floor of ASCO was that the initial setup of the ASCO poster session had the posters so close together that there was little room for learners to gather around for conversations with authors. This was reported to the @asco account and the #asco10 hashtag. By the next morning the poster spacing was improved. Kudos to ASCO for getting this right!

There is, however, an obvious downside to establishing an official hashtag, and that is that learners will expect that the account and hashtag are being monitored closely and that the organizers will be responsive to questions and complaints. Among the group's questions: “Must societies monitor their official hashtags?” and, “For this to be done right, does the staff monitoring the hashtag have to be senior enough to act independently and quickly on behalf of the society?” At this Tweetup there were no clear answers, but as societies and associations move forward with social media plans, it is likely the best practices will evolve — and hopefully be shared.

All of this is admittedly new to many of us. Several early adopters of Twitter and other social media noted that the number of tweets posted for the entire 2009 ASCO Annual Meeting was less than the average per-day tweet count for the 2010 ASCO Annual Meeting. So use is growing, at least at ASCO. It may take a few more years before we can truly integrate these new technologies into our working practices and daily lives — at one point during the Tweetup one person shared a comprehensive but lengthy opinion of what social media policies should look like and how social media can support learning. About five minutes into his comments he was interrupted and reminded that he had exceeded his 140 Twitter character limit. We laughed, but it was clear that change will not happen overnight.

If you have already begun heading down the road of adopting social media technologies to meet the needs of your organization, join the dialogue by using and monitoring the hashtags #hcsm and #hcsmeu (healthcare and social media) — there are thousands of patients, advocates, healthcare professionals, and educators already participating in these discussions. Or, reach out to me directly at @CMEadvocate, and I would love to continue the discussion.

If you have questions or are interested in learning more about how to get started in social media but don't quite feel as if you have found your voice, surf over to the resources provided on page 22 and try to absorb as much as you can.


Brian S. McGowan, PhD, earned his doctorate in cardiovascular physiology and completed fellowships in cardiothoracic surgery research and translational medicine. He has dedicated the past 12 years to medical education as a faculty member, mentor, accredited provider, and commercial supporter and is a staunch advocate for transforming the CME profession. The opinions expressed are McGowan's and do not reflect those of his employer, Pfizer Inc. He can be reached at via Twitter at @CMEAdvocate.

Editor's Note

If you aren't quite ready to join the “twitterati” and, at least for now, are sticking with the more traditional modes of learning, you are not alone. Medical Meetings has asked the author of this article to share some of the valuable lessons he's learned from his experiences at the intersection of social media and medical education in a new column premiering in the September/October issue.

Next Page: Twitter Glossary

Sidebar #3: Twitter Glossary:

TWEET: A 140-character message posted on Twitter

@USERNAME: The @symbol establishes a reference to a user's account (e.g., @asco, @CMEAdvocate, @spelletier).

FOLLOWING: Accounts you have elected to view; their tweets appear in your “feed”

FOLLOWERS: Accounts that have opted to view your tweets

DIRECT MESSAGE (DM): A tweet sent privately to a follower, used to have a private conversation

HASHTAG (#): The # symbol establishes a topic and allows accounts that are not following one another to search for tweets related to a topic (e.g., #ASCO10, #learning).

LISTS: A relatively new feature that allows any user to create a list of accounts that can be followed to simplify monitoring

REPLY: A tweet sent in response to one account, but visible to all followers, used to have a public conversation

RETWEET (RT): The act of taking a tweet from someone you follow and a sharing it with everyone who follows you

Web Resources

HealthCare & Social Media:

http://meetingsnet.com/social-media/
Social media's impact on medical meetings

http://social-media-university-global.org/curriculum/twitter/
The ultimate resource for anyone or any organization looking to participate in or learn more about social media

http://ebennett.org/
A comprehensive list of hospitals and healthcare systems using social media; also includes resources for social media policies

http://bit.ly/9aYRjf
Includes one author's opinions of the steps in a physician's acceptance of Twitter

http://bit.ly/vYYrf
140 healthcare uses for Twitter — a phenomenal resource

http://bit.ly/cHZIOG
A compilation and brief overview of social media sites used by healthcare professionals

http://bit.ly/4vpcn8
Short case studies addressing how oncologists use Twitter

http://bit.ly/a3tTWd
How to keep social media policies short, simple, encouraging, educational, and transparent

For more tips, case studies, applications, and other information on using social media for meetings and educational activities, visit our http://meetingsnet.com/social-media/ social media special report.