Live tweeting from #ACSCC15

As many of you know, I have not been a fan of live tweeting conferences. I blogged about the issue last year (here and here) and received a lot of feedback about the posts, most of it strongly opposing my views.

Vigorous live tweeting from the American College of Surgeons Clinical Congress (#ACSCC15) in Chicago is underway. Here are a couple of examples of tweets from that meeting. Twitter handles are blocked to protect the innocent (or guilty).

First, the good. Here is a nice montage showing what surgical program directors are looking for in residency applicants.

The photos are in focus and well-positioned. Anyone not in the audience for the talk can get something useful from this tweet. My one complaint -- we do not know who the speaker is. That information may have been provided in an earlier tweet, but this retweet is the only one I saw.

More about why live tweeting conferences is bad

Yesterday, I blogged about why live tweeting from conferences is not worth it. (Link here.)

Such tweets are difficult to comprehend, lack context without a detailed explanation, and might be detrimental to the persons who are tweeting because they aren't paying attention to the lecture.

I have never had such a response to a blog post before. Live tweeters were highly indignant that I should question what they are certain is the greatest marvel in medical education since the invention of PowerPoint.

I said it took a minute to compose and type a tweet, and many claimed they can do it much faster. Others also said that they use their tweets as notes for later reference.

A twitter colleague, Dr. John Mandrola (@drjohnm), unknowingly stepped into the conversation by posting a link to an article [link fixed 6/8/14] in The New Yorker about college teachers proposing to ban laptops in their classrooms.

It referenced a 2003 study from Cornell "wherein half of a class was allowed unfettered access to their computers during a lecture while the other half was asked to keep their laptops closed."

"The experiment showed that, regardless of the kind or duration of the computer use, the disconnected students performed better on a post-lecture quiz. The message of the study aligns pretty well with the evidence that multitasking degrades task performance across the board."

A New York Times piece about handwriting said, "For adults, typing may be a fast and efficient alternative to longhand, but that very efficiency may diminish our ability to process new information."

It cited a study showing "that in both laboratory settings and real-world classrooms, students learn better when they take notes by hand than when they type on a keyboard. Contrary to earlier studies attributing the difference to the distracting effects of computers, the new research suggests that writing by hand allows the student to process a lecture’s contents and reframe it—a process of reflection and manipulation that can lead to better understanding and memory encoding."

The New Yorker article concluded, "Institutions should certainly enable faculty to experiment with new technology, but should also approach all potential classroom intruders with a healthy dose of skepticism, and resist the impulse to always implement the new, trendy thing out of our fear of being left behind." [Emphasis mine.]

The elephant in the room—Live tweeting conferences

Live tweeting from conferences has become very popular, but I'm not sure why. The biggest problem is this—lucid communication of a point made by a speaker using more than 140 characters at a time is difficult to capture in a tweet.

The tweets tend to be filled with obscure abbreviations and references to previous tweets that may seem quite clear to the tweeter but not the tweetee. Some also post out-of-focus photos of the dreaded PowerPoint bullet slides taken from acute angles. Lacking context or explanation, they tend to be useless.

What about the one doing the live tweeting? How can you fire off 15 or 20 tweets in an hour and continue to pay attention to what the speaker is saying?

Please don't tell me what Symplur or some other data disgorging company says a meeting's impressions were. Here's an example from the recently concluded meeting of the American Society of Clinical Oncology. (#ASCO14) for May 30 through June 4.

There were 38,896 tweets generated by 7,284 participants. Let's very conservatively estimate that it took each tweeter 1 minute to compose a tweet, type it into a mobile device, and send it. That is 648 hours worth of tweets. The leading tweeter at ASCO produced 975 tweets or 16 hours worth of tweets.

You might say, "Hey, there were 134,569,479 impressions. That number represents over 40% of the population of the US." But hold on. Impressions are the number of tweets delivered to a follower's Twitter feed and potentially available to be viewed. There is no way to determine if anyone has actually read a specific tweet.

Other than counting retweets or replies, which apparently is not done by Symplur, there is no way to measure engagement. And even a retweet does not guarantee that a tweet was read. [See my previous post on this subject.] Favoriting (yes, that's a Twitter verb) is not a countable Twitter metric and even if it was, it's not a surrogate for reading.

Most of the time, I solve the problem by temporarily unfollowing someone who is live tweeting a conference.

What do you think about live tweeting of conferences?

6/7/14 ADDENDUM: 


More about why live tweeting conferences is bad. Link here.

What goes on at a real morbidity and mortality conference?

f you’ve read my reviews of the new medical TV show “Monday Mornings” [here, here and here], you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes—the morbidity and mortality (M&M) conference.

I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training programs and are rather specific to surgical disciplines.

It is possible that they may be held in large non-teaching hospitals, but time constraints and the fact that direct attending surgeon to attending surgeon criticism in an open forum is difficult to do.

Unlike the TV version, real M&M conferences feature presentations by residents, not the attending staff. The resident who performed the operation prepares a summary of the case which these days is usually on PowerPoint. Pertinent history, physical exam findings, lab results and images are shown. A radiologist or pathologist may be on hand to help educate the attendees. The conduct of the surgical procedure and the patient's hospital course are described.

The resident is asked questions about the way the case was managed and what she knows about the disease process and the surgical literature. The resident may have prepared a brief review of recent papers on the subject.

The attending surgeon who was involved with the case might add some more details. At least one person asks a question that was already addressed in the presentation. An attending surgeon or two will describe a similar case they had 10 years ago that went wrong and state that now he does things a different way, never mind the evidence to the contrary.

Comments from other surgeons and the chairman are made. Often a consensus may be reached about whether or not the complication or death was preventable. The idea is that the discussion informs the whole department, and everyone does not have to make the same mistake. In theory, the complication might be averted the next time.

However, not all complications or deaths are due to errors. Sometimes despite everything being done correctly, outcomes are bad.

In the old days, residents were blamed for everything that went wrong. Public humiliation was common. A famous chairman allegedly once said to a resident who presented a case that resulted in a patient's death, “Why didn’t you just take a gun and shoot him?”

Although this is said to still happen in some hospitals, the conference is much more civil in most places.

Unlike the “Monday Mornings” version, M&M conference is not where attending surgeons are browbeaten, tricked or fired. Of course, the real conference is far less dramatic (most of the time).

There can be raised voices and sometimes arguments occur, but the focus of the conference is usually more on education and quality improvement.

It's too bad about the show. It could have done a lot of good if it tried to realistically portray how self-critical we are. Unfortunately, it went all Hollywood on us, like every other medical TV show.