Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Surge or Scourge

27 May 2019

In 1797, Edward Jenner submitted a paper to the Royal Society of London summarising his observations after inoculating an eight-year-old with vaccinia virus (cowpox) to demonstrate subsequent immunity to smallpox. Throughout his research, Jenner was criticised by scientists who dismissed his work, opposing the idea of deliberately introducing material from a diseased animal into a healthy individual. Religious, political and ethical arguments culminated in vaccination bans in some nations, aiding the rapid spread of smallpox. After decades of mass vaccination campaigns, in 1980, the World Health Organization (WHO) officially declared global eradication of smallpox - one of the deadliest infections faced by mankind.

Despite this, many members of public still fail to acknowledge the important public health role of vaccinations, their views mostly stemming from fear and poor comprehension of the associated benefits.

Today, our negative perception of social media's professional use in surgery may have a parallel with what happened back in 1797. The positive use of social media to improve understanding of important medical information is often under-appreciated by 21st-century medical professionals. We may be turning our backs on the potential benefits that social media provides, particularly in relation to improving access to quality continued medical education (CME).

This closed mindset clouds forward thinking and reason. We need to break the stereotypical image of social media's use and broadcast its significance for the surgeon of the future.

Impact, reach and speed - social media ticks all these boxes. Information conveyed through this format can include education and research. More importantly, the information can be shared in a manner tailor-made to the target audience - not just to healthcare professionals but also to patients and
the wider public.

Strategic use of social media platforms has been adopted by world renowned institutes. Take, for example, the Johns Hopkins Center for Bariatric Surgery whose Facebook page is regularly updated and monitored to ensure patients receive accurate real-time information to help them on their weightloss journey. With obesity being labelled as a chronic progressive disease that poses infinite health risks, Johns Hopkins' bariatric surgeons can communicate important messages promoting a healthier lifestyle to a wide audience, thus playing an integral role in reducing the prevalence of obesity. Additionally, support groups that encourage sharing of post-operative patient testimonials and long-term weight loss success stories on social media, establish trust between patients and healthcare providers.

Another example of the effectiveness of this is Tufts Medical Center's Facebook page, "liked" by 13,736 people. Tufts holds interactive sessions to raise awareness in relation to newly available surgical technology. The "Meet our Joint Surgeons, Learn about Mako Robotic-Assist Surgery" was a public event hosted by Tufts where, via Facebook, they invited all relevant stakeholders - patients, their families and professionals. Tufts' ENT surgeons host annual free head/neck and nasopharyngeal cancer screening programmes via Facebook, with the aim of early detection, thus reducing the need for major surgery. In addition, live healthcasts via social platforms are another robust means of disseminating reliable information and discussing different surgical options. Such healthcasts also conveniently address frequently asked questions. Most hospital websites provide at least one social media page link for interested patients to engage at a more societal level. Worldwide, incorporation of social media in similar contexts is effective at relaying vital surgical information which may be too jargonised on a simple Google search.

Mastering the complexities of surgery can take many years depending on where training takes place and on the level of specialisation. The timeline of a surgical career can be compared to a logarithmic curve whereby maintaining competence amongst a competitive cohort of colleagues is key to not only providing optimal patient-centred care but also avoiding litigation. Keeping up to date with the latest research and contributing to same is another challenging facet of the profession that should not be underestimated. Is it economically feasible for developing countries to fund such extensive training programmes that require expert faculty alongside a proper educational structure? The answer is not that straightforward. The demand for surgical training and research has undoubtedly been on a steep upslope and social media is playing a crucial role in providing the supply that meets this demand.

In an interview, Dr Devi Shetty, a renowned Indian cardiac surgeon and pioneer of affordable surgery, mentioned his plans for building health institutions in Africa to train doctors. He detailed the consequences of the acute shortage of surgeons in developing countries. Sub-Saharan Africa has a dire ratio of 1.8 surgical specialists for every 100,000 people as per the World Bank Indicator. The challenge is to retain health workers in low-income countries as themajority migrate for education and work, resulting in "brain drain". In a move to help mitigate the effects of this, The Royal College of Surgeons in Ireland (RCSI) in collaboration with the College of Surgeons of East, Central and Southern Africa (COSECSA) has designed and provided an online Basic Surgical Training (BST) programme to those training in Africa. Social media is a crucial resource for providing coverage to help impact surgical training.

Moreover, it can be used to encourage other international organisations to partner with institutions such as COSECSA to help establish successful global surgical programs, leading to long-term improvement in surgical outcomes in low-income countries. Additionally, scholarship opportunities are made widely available via social media, providing doctors with supports to help them engage effectively and yield high-quality work.

Research in healthcare is accelerating exponentially. Today, valuable archive articles are retrieved with a simple search command. With sparse free time, a click of a button gives surgeons access to new research publications enabling incorporation of evidence-based guidelines like never before. Professionals around the globe use platforms such as Twitter to share information and collectively build a stronger base of knowledge. To measure dissemination of research articles, tools such as Altmetric have been developed. Altmetric uses social media to analyse the impact and influence of articles.

Forbes has declared YouTube America's most popular social media platform. With a few keywords, trainees can access surgical skill tutorials and procedures alike. Not only does this form of learning save time, cut costs and reduce patient risk, it importantly allows trainees to replay videos at their leisure. GIBLIB, popularly known as the "Netflix of medical education" is the world's largest library of surgical videos dedicated to providing an education ecosystem. By uploading trailers of narrated surgeries on different forms of social media, it successfully advertises its services in a "try-it-before-you-buy-it" subscription model. Furthermore, social media draws attention to business providers such as Surgical Science (LapSim®) that provide virtual reality simulators for a safe yet realistic surgical practice to training centres worldwide. Expensive surgical equipment is a big investment for most institutes. Social media reviews prove handy before making a large-scale purchase.

The New Yorker's #NYerORCoverChallenge was an impactful, ongoing social media movement that began in 2017 and reached female surgeons in more than 53 countries, bringing visibility to the women working in the traditionally male-dominated field of surgery. The power of social media is most evident when it helps increase awareness and promote positive changes in society - gender equality in surgical training being just one of them.

On a different note, global networking helps amalgamation of learnings from unique case presentations. Surgeons commonly join Facebook groups
to exchange anonymised details of surgeries and subsequent management plans. This form of education is unparalleled. The "International Hernia Collaboration" Facebook group is a well-known example. In this way, social media helps reduce the impact of professional isolation for surgeons working in rural locations.

A multi-institutional study published in the Journal of Surgical Education concluded that 70 per cent of surgeons believe that social media benefits professional development. The prime reasons for neglecting social media were lack of time and concerns surrounding privacy and confidentiality. However, by adhering to ethical best practice guidelines, these concerns can be addressed effectively. Undeniably, the authenticity of information on social media platforms is often of a questionable nature. With the possibility of false and outdated information constantly being recycled on the internet, validating information and sources can be time-consuming. Without policing to ensure accuracy, the abundance of unreliable information can understandably put one off from using it. This is contrasted with the extreme accessibility of information provided by social media platforms when used correctly.

In conclusion, surgical education is an ongoing process that takes decades of practice and experience. As humanity continually evolves, so too does the nature of disease and healthcare. By accepting and embracing new opportunities, we pave a path which consequently allows us to upgrade ourselves. As Bruce Lee stated, "I think of myself as a human being. Because under the sky, we are but one family." Humans have the power to come up with a solution to most problems - collectively. Having explored the different roles of social media platforms in this article, it is evident that expeditious communication of this form has provided this vital collectivity factor that has the power to quench the thirst for knowledge and research.

Bharti Kewlani is the recipient of the Arthur Stephen ffrench O'Carroll Medal, awarded at the annual Biological Society meeting for best surgical undergraduate essay. The medal is supported by Mr Paul ffrench O'Carroll in honour of his late grandfather, Dr Arthur Stephen ffrench O'Carroll (1896-1952), a former President of the Biological Society who received his licentiate from RCSI in 1924.