So, Elliot, thank you for inviting me to come speak. So again, my name's Nneka Ufure. I'm a GI fellow in my last year of fellowship at MGH, and I will be the transplant hepatology fellow there. And I'm here to talk with you all about how to engage in Twitter as a trainee, specifically liver Twitter. So I have nothing to disclose. So Elliot has given a really great overview of how you set up your profile, how you define and label yourself to the world, and now you're at this point where you've created your first tweet. So the question is, what should you be doing next? So I'm gonna go through an overview of how you can engage in hashtag liver Twitter as a trainee. First, how you can start as a passive consumer of content, aka a lurker, then how you can progress to becoming an active creator of content, a few points of caution for trainees, and then I'll share with you some unexpected benefits that I have found from my experience on Twitter over the past year and a half. So let's first start with you being a passive consumer of content. So I have three tips that I'll go into in a little bit more depth, but it's important to start local and then go global, start passive and then go active, and then find ways to amplify your message using the at sign. So when you initially start on Twitter and you start following individuals or organizations, you may initially start by following ASLD or following other hepatologists locally within your walls. And I think that when you're looking at your timeline, this may look like what your timeline looks like. So a lot of tweets that are based solely in hepatology, and I think for a lot of us this is great. We're all here because we love hepatology, but what I'd like to encourage you all to do is as you progress and become more comfortable on Twitter, expanding outside of the walls of your institution and importantly the walls of sort of the content that you're looking at and to go global with the content that you become invested in. So I would say the most unexpected benefit that I have gotten from my experience on Twitter has come from following individuals who have nothing to do with hepatology. So as Elliot has told you guys, I'm very interested in palliative and supportive care for patients with liver disease and their caregivers. And if you were to look at who I follow on Twitter, it may be hard to see that I'm a hepatologist. So I follow a lot of palliative care clinicians. I follow a lot of palliative care journals. Last week before the liver meeting, if you looked at my timeline, you would think that I was a dementia specialist because I've been following dementia Twitter, seeing the sort of parallels that we have between dementia as well as hepatic encephalopathy to think about how we can develop interventions to help our patients and their caregivers. And so if you are someone who's interested in NASH or NAFLD, you should be following cardio Twitter. If you are someone who's interested in the intersection of alcohol-related liver disease as well as viral hepatitis and substance use disorders, you should be following harm reduction Twitter as well as addiction Twitter. If you're someone who's invested in frailty, following geriatrics Twitter can be really inspirational in terms of thinking about nutritional interventions and exercise interventions to help our patients as well as their caregivers. And then I think everyone should be following epi Twitter and stats Twitter because that's how you can learn some new methodologies so that we can start to think about how we can better analyze the studies that we're creating. So after you've started local and gone global, I'd recommend that you start passive and go active and start to amplify your messaging. So these are the four action buttons that you'll have in front of you when you're starting on Twitter. The first one is private and so this is the bookmark tool. So if you are a lurker, you can follow content and if that content is something that you like, you can click on this button, it will save it to your bookmarks and no one will know that you've saved that. However, it's important to note that these three buttons, the liking button, the retweet button, and the comment button and posting button are public buttons and we'll come back to some cautions about how to use these buttons later, but these are public buttons that allow you to more actively engage with the content that you're seeing. And so you can go from passive engagement with just bookmarking and progressively step up towards more active engagement to the point at which for those individuals that you're following who are posting comments or posting content, you can like that content, you can retweet it, and you can even post about that content. And it's surprising how if you move from the passive to active modes of engagement how sometimes that can have individuals start to follow you back. And then you can start to amplify your messaging, especially when you're on the more active side of engaging with content by tagging individuals, places, journals, and organizations. So now we've gone through how to be a passive consumer of content and so how do you progress to becoming a more active creator of content? And so I think that there are three different ways you can do this. You can share what you've learned, you can share what you or others have made, usually in the forms of manuscripts or other projects that you've done, and then you can share what you know through the form of tutorials. And I will completely defer to Dr. Breaux on this since he is the master at this. So let's start with sharing what you've learned. So my single most favorite tweet this year was a tweet from Ted James. He's at UNC and he does a lot of tweets on board reviews on mnemonics. And so I'm in the context right now studying for my boards. I have no idea, like motility is a black box still for me. And when Ted came out with this tweet, he completely summarized the way to think about achalasia in a way that is very witty and using a mnemonic that's very clear. And so these are very easy ways that you as a trainee can share what you've learned through the mnemonics that you may be using as you're studying through materials. You can do this for not just GI board review, but for newly published guidelines, noon lecture and grand rounds, intern and resident reports, and journal clubs as well. And so I'm going to shout out the cardiology trainees community a little bit so that I can provide some hopeful inspiration for our community as we move forward. So the American College of Cardiology Fellows in Training group, the FIT group, has created this hashtag called the FIT Survival Guide, the Fellows in Training Survival Guide. That is a way for trainees to be actively involved in creating tutorials for their community that are on basic cardiology topics. And so an example of how this is used in their community, this is a tutorial by a fellow on syncope. One on the diagnosis of heart failure and one on the diagnosis of mitral regurgitation. And so I think that Elliot has been pulling a lot of the weight for us on Liver Twitter on creating educational content that's related to hepatology and it would be really wonderful if we as trainees could find our own way to start to contribute some education back to the Twitter community as well. And so maybe after this talk we can start to determine whether there are forums that we can create and thinking about our own hashtag to give back. So I thought that this tweet was a great example involving two of our speakers about how you can share what you have or what others have made, specifically how you can break down a manuscript on Twitter. So this is a manuscript that was written by Dr. Garcia Sal that Elliot wrote a tweet about. And so he went through a few key steps. One, he showed what the research question was for the manuscript. He used a hashtag to show indexing. He tagged the author of the study. He described the approach of the study. He summarized the results and the outcomes from the study. He discussed the implications of the study and the next steps. He provided an open access link if that's available. He highlighted through attaching a key paragraph which could have also been a key figure in the paper. And then he tagged appropriate journals, professional clubs, the GI division, and others. And this is a way for him to not only highlight the high points of this paper but also to amplify the messaging that came from this manuscript and could be a great template for all of us to follow. So I wanted to move on now to a few points of caution. So it's important to mind your P's on Twitter. And first I'll start with patience. And so remember that when you're thinking about whether you should present a patient case on Twitter, which I basically have decided not to do, but a few points of caution. That patient is a person to you, but once you present that patient on Twitter they become a case. And we cannot always control the responses of other people to what we have posted on Twitter. And so when a patient becomes a case on Twitter that can lead to language that may be less empathetic and less professional when discussing what's going on with that patient. And so just be very cognizant and careful when you're posting about a patient on Twitter. And then if there are any members of these groups for whom you would be worried about a potential tweet going out and worried about their response to that tweet, you should take a step back and wonder whether that's something that you should be posting. And I'll make a very quick note about politics. We're going into an election year, so I would just recommend that you tread lightly, if at all, when it comes to political topics next year. And so mind your Qs, your Ps and Qs. If your post gives you pause, you should quit while you're ahead. So lastly, think before you tweet. So again, I think all of us know that when you're on the more proactive side of this phase, so when you're about to post, there are many things that you should think about not posting, but I actually think the more dangerous buttons here are the ones that you can post on or that you can press on passively. So the like button and the retweet button are things that you can press without really thinking. And so if you see a headline for a news article and you're thinking about retweeting it, you should go and read that news article before you retweet it or like it. So pause before you post, read before you retweet, and look before you like. So lastly, I wanted to go through some unexpected benefits that I found from being on liver Twitter. So a few key shout outs. So I wanted to first start with Lizzie Abbey. So I think most of us in this room know who Lizzie Abbey is. And one of the key things I'm going to state when I start with this is that I have not met half of these people up until this meeting, but I am able to give a one-liner on these individuals based on how they present themselves on Twitter. And so if I can do that as a trainee, think about what a division chief can do. Think about what a professional society can do. Think about what a leader in hepatology can do. So back to Lizzie. So Lizzie was a UCLA chief resident. She ran, I think, the JAMA Teachable Series, the JAMA IAM Teachable Series, and was a great GI ambassador for us. And now she is at the University of Minnesota doing amazing work on quality improvement for our patients with cirrhosis and is actually going to be giving an oral presentation today at 5 p.m. So we should all go to celebrate Lizzie because she's done a lot to celebrate all of us. Mary Thompson is a current transplant hepatology fellow at Michigan. She's been doing incredible work on deprescribing and cirrhosis and I think is really changing the way that we think more critically about the medications that we're prescribing to our patients. She gave a great oral presentation this morning. You guys should follow her. I feel like when Russell Rosenblatt puts out any material, I just stop what I'm doing and I read it. He's been doing such great work on fragmentation of care for patients with cirrhosis, looking at readmission rates, and also the intersection of hepatology and ID. And he just came out with a red journal paper looking at the importance of doing early paracenteses for our patients that should probably be a part of every single presentation that we do on how to improve the inpatient care of our patients. Tracy Khalili is going to be a world leader in preventative hepatology, and I'm not just saying that because she's a close friend of mine. So she is a current MGH faculty member. And at the post-grad courts, you guys probably saw her work frequently quoted on the use of statins in chemoprevention for HCC. If you want to have your hand on the pulse of preventative hepatology, you guys should follow her. Andrew Moon, if you want to learn how to use large-scale databases to do epi work, Andrew Moon is the man to follow. And his work looking at the trends of different types of liver disease over time, both in the U.S. and abroad, has really been formative and I think is work that a lot of us will be citing moving forward. Patty Bloom is someone who is going to change the way that we treat and manage HE for our patients moving forward. Her work using the gut microbiome as well as innovative work using technology to see how we can improve the care of our patients suffering from HE is going to make her be the future of our field. And Nicole Rich is doing such awesome work on HCC and cirrhosis and how we can prevent the progression of cancer in that population. Her work at UT Southwestern coming out with looking at the impact of DAA therapies on cirrhosis has also been formative. And then last but not least, Arpan Patel, who's been my brother on this palliative hepatology journey, who has really come out with the foundational work in this field, is a wonderful human being and he deserves a follow as well. So I can do that and I think everyone who's following these individuals would be able to do that as well just by how forward facing and how proactive these individuals have been on Twitter. So I'm going to share 30 seconds of a last story that I think shows the importance of Twitter and how it's been for me and something that was unexpected that came out. So I was looking through my timeline over a year ago and I saw rolling through my timeline a nephrologist who posted this paper on the use of or how palliative care consultations have helped with inpatients with severe renal disease. So I ended up sending her a DM to figure out how she got access to that database. And from that DM went to us emailing each other. She ended up connecting me with the owners of that palliative care database. I ended up emailing them. I ended up pitching to them so that I could use that database and a year later that ended up being a paper. So there is a DM to CV pathway that can happen through the use of Twitter. So to summarize, start local and go global. Start passive and go active. Share what you've learned. Share what you and others have made and share what you know. Mind your P's and Q's and think before you tweet. And remember the DM to CV pathway. Thank you.

liver Twitter

trainees

content creation

professional connections

networking