Pathologists have shown an increasing acceptance of professional social media use in recent years. There are currently more than 4700 pathologists and pathology-related accounts on Twitter per an online list maintained by one of the authors (J.M.G.).1 Many pathology organizations and journals have social media accounts.2 Facebook, Twitter, and other social media platforms provide numerous potential benefits to the global pathology community.2–21 Despite this growing popularity and acceptance, some pathologists are still reticent to use social media professionally.22,23 One of the authors (J.M.G.) has given more than 60 invited lectures related to professional social media use. In discussions with many pathologists, he has often heard some variation of “but I'm too old” as a reason that many pathologists from the Baby Boomer generation or beyond choose not to use social media. To the contrary, the authors know pathologists of all ages, generations, and experience levels who effectively use social media. We suspect that many pathologists, particularly those from older generations, are still unaware of the many potential benefits of social media regardless of age or career stage.
The authors of the present work are both dermatopathologists who use social media professionally but are from different ends of the generational and career stage spectrum. J.M.G. has been in academic practice for 6 years at the University of Arkansas for Medical Sciences. P.H.M. is currently retired after having an academic career at Brigham and Women's Hospital, The Institute of Dermatology, and other centers that spanned more than 30 years. The authors became acquainted with one another via social media in 2016. They interact often online but have yet to meet face to face “in real life.” Both authors have experienced significant benefits from using social media, and they sought to share some of those experiences here to represent different perspectives across the age/generation/career stage spectrum.
WHICH SOCIAL MEDIA PLATFORMS DO YOU USE AND HOW?
J.M.G.: “Twitter, Facebook, Instagram (parent company: Facebook), Snapchat, YouTube (parent company: Google). I use Twitter and my public Facebook page as my main platforms for publicly sharing pathology educational content (eg, images of interesting cases, teaching pearls, links to articles or useful resources, etc).4,8,16 I use Twitter for live tweeting content from pathology meetings such that pathologists who could not attend the meeting, both back home and around the world, can keep up with the cutting-edge information arising from the meeting (as well as the excitement of the social interactions at the meeting).7 I use Twitter for pathology journal clubs (#pathJC and #dermpathJC) where colleagues from around the world can come together and discuss a preselected article from the published literature in real time.17 I participate in Facebook groups for more in-depth discussion of cases with other pathologists.8 Examples include my own dermatopathology (www.facebook.com/groups/dermatopathology/) and bone and soft tissue pathology (www.facebook.com/groups/softtissue/) Facebook groups as well as many other Facebook groups that I am a member of (including McKee Derm; www.facebook.com/groups/mckeederm/). I volunteer in a variety of sarcoma and other rare cancer patient Facebook support groups, where I educate patients and also learn from them about their diseases.9,15,24 I also share pathology content on Instagram and Snapchat, but I post less frequently and tend to filter content to some extent on those platforms, posting images and topics that may appeal to a broader audience that includes many nonpathologists.25 I create pathology teaching videos and share them on my YouTube channel (https://www.youtube.com/user/JeradMGardnerMD). I have found YouTube to be a robust teaching tool that has also made me more efficient as an educator. Instead of teaching every new rotating resident all of the basic features of basal cell carcinoma, for example, I created a video about it and have all new rotating residents watch it.26 This way my fellow does not have to hear the same basic diagnostic teaching points about basal cell carcinoma every day. It frees up my time so that I can focus on teaching more advanced and nuanced topics. In addition, it allows me to freely share educational content with learners in medically underserved areas around the world just as though they were sitting next to me at the microscope. I have begun to incorporate my YouTube videos into the official curricula for my own medical students, residents, and fellows. My basic approach is to take all of the traditional educational activities I already do ‘in real life’ and then think of ways to convert those into online content that can be shared via social media. This expands the size and impact of one's classroom/multiheaded microscope greatly, from dozens up to thousands.”
P.H.M.: “Facebook. I tried Instagram and Twitter for a short while but found that they did not work for my needs. However, Facebook has completely altered my approach to sharing interesting cases, reviewing problematical cases on a worldwide basis, and teaching residents and fellows. During my career, the part that I enjoyed most was teaching and mentoring. This included personal and group teaching at the microscope, formal lecturing and workshops, and through a number of textbooks. I use Facebook for a number of purposes. Firstly, it is as a teaching aid, whereby I post good examples of challenging entities for members to study and enjoy. Sometimes this is as a difficult case for folk to give their diagnosis. On other occasions I give the diagnosis and describe the lesion as individual comments for each image. Secondly, I have a private group (McKee Derm; www.facebook.com/groups/mckeederm/) for people to post their problematical cases for curbside opinions. I qualify the information as being a curbside rather than a full consultation.12 This is for a number of reasons. Most obvious is medicolegal and an inability to charge a fee as would be required by federal law. In the same vein, if these were actual consultations, one would need to have appropriate insurance, which I don't think would be possible. An additional problem is that with many cases, staining and focus is suboptimal, which makes interpretation very difficult.12 Another very important issue is that one can only comment on the images that the pathologist has posted, and so we are at a disadvantage in that different features not shown might provoke a different reaction and diagnosis. This last concern is sometimes alleviated when one is given access to a whole scanned slide, but this does not happen very often (I think that in the short term this will become much more common). I try to ensure (not always successfully) that the pathologist provides good clinical information. I also work hard to persuade people not to be shy about giving their opinion, reminding all that ‘everyone can be wrong!!' One of the most exciting developments has been the use of smartphones for photography. Although I was brought up in the traditional school of 35-mm photography and later “digital” photomicroscopy, many pathologists do not have the funding for expensive cameras. This has been overcome with the use of smartphone cameras for photomicroscopy, either with a low-cost extension or by freehand techniques. With a little bit of practice, highly professional images can be taken.”27
WHY SHOULD PATHOLOGISTS OF YOUR GENERATION/CAREER LEVEL USE SOCIAL MEDIA?
J.M.G.: “As an early career pathologist (I have been in practice 6 years posttraining), social media has been a robust tool for building my career. It has allowed me to network and develop professional relationships with pathologists on a global level in a fraction of the time that was possible in the pre–social media era. Professional connections made via social media can lead to traditional academic collaborations, such as publishing and research opportunities, as well as invitations to speak at meetings, join editorial boards, or serve on committees.4,16 All of these things are very beneficial to junior pathologists trying to establish their careers. Social media platforms can be used as robust tools for conducting formal research on a variety of topics.15 Professional social media activities can be included in one's curriculum vitae and even have the potential to be used as additional evidence supporting an application for academic promotion and tenure.28,29 Social media is an incredibly powerful tool that can be leveraged to accomplish traditionally recognized academic achievements with greater efficiency and reach than has been possible in the past. It does not replace traditional activities, but it amplifies and augments them dramatically.”
P.H.M.: “Firstly, because it is the way the younger generation communicate most comfortably and as a result it is very easy to reach out to a very large population. I believe that it is really a duty for established pathologists (physicians) to pass on their knowledge and experience to those who are at an early stage in their careers.23 Mind you, we all still learn every day of our lives. Equally well, sometimes the situation is reversed and a case might be posted for discussion and the pathologist who posted the case learns much from the opinions offered. There is a tendency for older pathologists to regard the use of social media as being beneath their status and just something that young folk use for purely social reasons. This should be countered as much as possible. I don't know how one persuades the older generation to use Facebook and Twitter other than by word of mouth. It is such a valuable tool because it is often the beginning of a study of a new entity for the student. In addition, the past has been strictly ruled by the need to publish in peer-reviewed journals. I believe that with time this will be to some extent superseded by the use of social media. It may well be replaced by a format whereby data can be disseminated through closely supervised platforms rather than be published in a journal.3 This will take some time, as the establishment is very set in its way and loathe to make changes.”
DOES SOCIAL MEDIA HELP YOU KEEP IN TOUCH WITH PEERS AND COLLEAGUES?
J.M.G.: “Absolutely. Like most pathologists, I have gained many colleagues and friends from around the world via attending pathology meetings over the years (the traditional way of meeting colleagues). Unfortunately, I would only get to see them a few times per year at most, when we were present at the same meeting or conference. Social media has changed all of that. I now interact with many of these people multiple times per week, if not daily, via Facebook and Twitter. I have friends and colleagues on the other side of the world who I converse with more often than colleagues just down the hall within my own department! Social media does not replace the joy of traditional ‘real life' face-to-face interactions, but it does allow one to spend more time with friends and colleagues in between those face-to-face interactions, which is something that was much harder to accomplish in the past.”
P.H.M.: “It most definitely does. One of the best aspects of using social media is not just keeping in contact, but it is the facility of meeting new like-minded people on a daily basis. Social, cultural, geographical, and religious barriers are broken down, and this is such a great aspect of the medium. In the space of just more than a year, my own dermatopathology Facebook group has grown from just a few folk to more than 9000 members. The daily interactions are so useful both from an academic and a social standpoint. To be honest, becoming involved in Facebook has literally changed my life, and very much for the better.”
WHAT IS YOUR FAVORITE THING ABOUT USING SOCIAL MEDIA?
J.M.G.: “Meeting and getting to know other pathologists through social media and then encountering them in real life and feeling like you have been friends forever…this is a sublime experience. It is especially poignant when that pathologist lives in another country and we may never have met at all were it not for social media. Sanjay Mukhopadhyay, MD, coined a phrase to summarize this unique experience: ‘met on Twitter, then in real life.' Coincidentally, Dr Mukhopadhyay is one of the many pathologists who I first met on Twitter and then later in real life. Those who have experienced this know exactly what it means and all of the joy and excitement that comes along with it. It has even been turned into an acronym and converted into a widely used Twitter hashtag (#mottirl), which often accompanies the obligatory selfie pictures taken and tweeted by pathologists who know each other online and then finally meet in real life.16 There is a wonderful and palpable sense of camaraderie in the online global pathology community thanks largely to social media, and in my experience, this usually translates into the real-world pathology community in a positive way. I think pathologists who do not use social media are really missing out on something special.”
P.H.M.: “Probably the ability to ‘talk' with so many people from such diverse backgrounds and the idea that in our own small way, we are promoting harmony.”
CAN YOU GIVE AN EXAMPLE OF SOMETHING INTERESTING YOU HAVE SEEN OR LEARNED VIA SOCIAL MEDIA?
J.M.G.: “I have encountered so many different diagnostic pearls, novel entities, new immunostains, and new articles on social media before I ever heard of them anywhere else. Yet the most amazing and meaningful things that I have seen and learned on social media have been taught to me not by other physicians, but by patients. Just more than 4 years ago, I first starting volunteering with sarcoma and other rare tumor Facebook patient support groups. I joined these groups to help teach the patients, but I have learned so much more than I have taught.24 Many patients have shared with me high-quality photographs of their own tumors. I have more clinical images of angiosarcoma, epithelioid hemangioendothelioma, and dermatofibrosarcoma protuberans (DFSP) than most physicians could acquire in an entire career of practicing. I have learned that DFSP (and many other rare tumors) are so often clinically misdiagnosed as ‘cyst,' leading to delayed diagnosis and treatment. I have seen unusual symptoms and presentations of rare tumors that to my knowledge have not yet been recognized or well publicized in the medical literature. I have heard many patient stories and have even met patients and their family members face to face in real life. I have seen a small glimpse of what it means to be a patient with a rare and terrible cancer, and it has made me a more invested, conscientious, and compassionate physician. It has changed not only my career but my life.”9
P.H.M.: “Oh yes, I learn every day. ‘ALKoma' and ‘BAPoma' spring to mind as particularly good examples (Figures 1 through 6).30,31 I also discover the host of new immunohistochemical antibodies that weren't around when I was practicing in Brigham and Women's Hospital.”
Example of a teaching case posted in the McKee Derm Facebook group. This case of a BAP1-deficient melanocytic neoplasm (colloquially referred to as “BAPoma”) received 29 comments and more than 80 “likes” from group members.
Example of a teaching case posted in the McKee Derm Facebook group. This case of a BAP1-deficient melanocytic neoplasm (colloquially referred to as “BAPoma”) received 29 comments and more than 80 “likes” from group members.
BAPoma. This is a pedunculated lesion with a nodular intradermal proliferation of melanocytes (hematoxylin-eosin, original magnification ×40). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 3 BAPoma. Large epithelioid melanocytes with spitzoid nuclear features (left) are combined with smaller melanocytes similar to those of a conventional intradermal nevus (right) (hematoxylin-eosin, original magnification ×200). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 4 BAPoma. The cytologic features may lead to confusion with melanoma. The epithelioid/spitzoid melanocytes are individually surrounded by collagen, creating sharp cellular borders; this is a useful clue for the diagnosis (hematoxylin-eosin, original magnification ×400). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 5 BAPoma. BAP1 immunostain shows retained nuclear expression (normal) in epidermal keratinocytes and in the conventional nevus component (upper left) but loss of nuclear expression (abnormal) in the large epithelioid/spitzoid melanocytes (lower right) (BAP1 immunostain, original magnification ×100). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
BAPoma. This is a pedunculated lesion with a nodular intradermal proliferation of melanocytes (hematoxylin-eosin, original magnification ×40). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 3 BAPoma. Large epithelioid melanocytes with spitzoid nuclear features (left) are combined with smaller melanocytes similar to those of a conventional intradermal nevus (right) (hematoxylin-eosin, original magnification ×200). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 4 BAPoma. The cytologic features may lead to confusion with melanoma. The epithelioid/spitzoid melanocytes are individually surrounded by collagen, creating sharp cellular borders; this is a useful clue for the diagnosis (hematoxylin-eosin, original magnification ×400). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
Figure 5 BAPoma. BAP1 immunostain shows retained nuclear expression (normal) in epidermal keratinocytes and in the conventional nevus component (upper left) but loss of nuclear expression (abnormal) in the large epithelioid/spitzoid melanocytes (lower right) (BAP1 immunostain, original magnification ×100). Image courtesy of Carlos A. Cerruto, MD, Cape Coral, Florida.
BAPoma. In the past, these lesions were sometimes confused with nevoid melanoma. Facebook groups and other social media provide a space where pathology experts can easily share their experiences and lessons learned during many years of practice with the next generation of pathologists. This comment received 24 likes, which is a sign of strong approval. Pathologists value open and honest online commentary from leading pathology experts.
BAPoma. In the past, these lesions were sometimes confused with nevoid melanoma. Facebook groups and other social media provide a space where pathology experts can easily share their experiences and lessons learned during many years of practice with the next generation of pathologists. This comment received 24 likes, which is a sign of strong approval. Pathologists value open and honest online commentary from leading pathology experts.
DISCUSSION
Both of the authors derive significant benefits from using social media professionally, despite being from different generations and at different career stages. They believe that their use of social media allows them to help, teach, and learn from other pathologists more effectively. They propose that it is particularly important for the older generations of pathologists to use Twitter and Facebook professionally. Social media can facilitate greater interaction and enhanced mentoring between the older generations, who make up most of the current leaders of our specialty, and the younger generations, from which the pathology leaders of tomorrow will come.2 It is another tool for passing on diagnostic pearls, personal experience, and general wisdom that the older generation has collected during decades of practicing pathology (Figure 6). Although textbooks are still the mainstay in medical education, social media provides an alternative, free, and less time-consuming method for pathologists to share their knowledge and experience with the next generation. The younger generations are greatly in need of this kind of information, and posterity will benefit from it too.
Social media allows retired pathologists to stay connected to the rest of the pathology community and to continue learning, teaching, and contributing. As a retired pathologist, P.H.M. has found this aspect of social media to be useful and even life-changing. As a junior pathologist, J.M.G. is very grateful to have P.H.M. and other pathologists of his generation actively involved and accessible via social media; countless other pathologists around the world have expressed similar feelings of gratitude.
CONCLUSIONS
We hope that our stories and experiences with social media use will help convince pathologists of all ages and generations to sign up for Twitter and Facebook. One of the authors (J.M.G.) published an online introductory guide that teaches pathologists how to get started with using social media (http://pathinfo.wikia.com/wiki/Social_Media_Guide_for_Pathologists). The authors are hopeful that more of their colleagues, particularly senior pathology leaders, will join social media and engage with the robust and exciting global community of pathologists online.
