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Expanding journal clubs beyond single institutions using Twitter

What problems were addressed? Journal clubs are traditionally used to critically appraise current literature and discuss medical advances. However, participation is often limited to one institution, unless significant investment in technology and planning is made to engage multiple institutions. Twitter is a widely available social media platform that has been used for the discussion of academic literature. The online venue overcomes the barriers of traditional journal clubs, offering opportunity to engage providers from various institutions. Few Twitter journal clubs are led by trainees; none existed for paediatric hospital medicine (PHM), a young subspecialty in which a growing number of fellows are positioned to advance medical knowledge through social media. We sought to create a fellowdriven PHM Twitter journal club to foster interinstitution idea exchange through the discussion of recent literature. What was tried? We launched a monthly Twitter journal club (#PHMFellowJC), moderated by PHM fellows. Each hour-long chat featured an article, along with learning objectives and discussion questions posted at set intervals to facilitateconversation, and active moderator participation. Discussants could continue to respond after the allotted hour. Engagement metrics were obtained 24 hours after the session concluded using the Healthcare Hashtag Project, and included numbers of participants, tweets and impressions (number of times tweets were viewed). To increase participation, we e-mailed national PHM listservs, released poll questions to engage participants in advance, and invited article authors and journal social media editors to participate. Over the first 7 months, #PHMFellowJC engaged an average of 21 participants with a mean of 281 tweets and nearly 205 000 impressions per chat. Approximately half of participants were PHM fellows from multiple institutions; others included PHM faculty members, residents, nurses, article authors, topic experts, patients and caregivers. Providers in various subspecialties, including paediatric critical care, emergency medicine, surgery and primary care, also contributed. What lessons were learned? The creation of a PHM fellow-led Twitter journal club was a novel way to engage the PHM community in the discussion of recent literature. It generated inter-institution conversations amongst PHM fellows, faculty members and other subspecialists. The most successful efforts to increase participation included inviting and publicising the participation of article authors and engaging journal social media editors. One strength of #PHMFellowJC is its emphasis on personal and institutional practices related to each article’s topic. Participant feedback revealed that the most frequently perceived benefit of the journal club was the opportunity to learn about practice variation. Some participants reported making changes in clinical practice based on chats. In addition, ideas for future multi-site studies expanding on the articles were generated during the chats. An important lesson from this experience is that engagement with the conversation cannot be immediately ascertained by surveying a room of participants as in traditional journal clubs. Based on participant feedback, we know many individuals followed conversations without posting any tweets. Other similar journal clubs should focus on facilitating conversations and providing content in the knowledge that individuals may read the material even if they do not actively participate. As preparation for Twitter journal clubs does not take significantly more effort than that for traditional journal clubs, they could be adopted easily by educators in other fields.