Wednesday, February 3, 2016

#SurgTweeting: Understanding Data Visualizations of Twitter Communities Using #ACSCC15

2015 was an exciting year for Twitter at the Clinical Congress of the American College of Surgeons. The #ACSCC15 selfie contest catapulted off the #ILookLikeASurgeon movement with vigor. The contest drew in a plethora of Twitter neophytes who posted their first tweets at the Congress, leaping into #SurgTweeting.
According to Twitter data analytics from Symplur, #ACSCC15 had record Twitter participation with over 50 million impressions, 14,000 tweets and over 2,500 participants. Statistics, however, only tell part of the story; they do not reveal the interactions and interconnections of those who tweeted. In other words, they reveal little about the network. To illustrate these connections, Twitter data can be organized graphically into interactive network visualizations.
Using Twitter’s API, I (Mookie Thayer, of @PresentServices) built interactive data visualizations for #ACSCC14 and #ACSCC15. These visualizations were created using the mentions, favorites and retweets of all tweets that included the conference hashtags. The #ACSCC14 network visualization of mentions and retweets can be viewed below.
The dots or “nodes” represent Twitter users such as @AmCollSurgeons and @WomenSurgeons. Hovering over a node reveals the username. Connecting lines represent interactions such as a mention, favorite, or retweet. The colors highlight “communities” or “conversations” revealing sub-networks within the overall conference dialogue. Clicking on a node highlights the network of the selected user, allowing you to view the individual user’s impact and participation in the overall network. Being able to visualize the network of an individual user serves as a proxy for their influence within the Twitter community. For example, click on the pink node in the bottom right; you will see the sub-community of @heatherevansmd. Notice the multiple nodes connected only to her. Those are her colleagues back at home, participating in #ACSCC14 through Dr. Evans.
#ACSCC15 – Massive growth of conversations and users

To establish the data set, I imported all the tweets that contained a “mention” (i.e. @name), those that had been favorited or “liked”, and all retweets. The initial visualization of this much larger group of tweets from #ACSCC14 looks like an explosion of connected points. To make it more legible, I then limited the data points to nodes of users with 10 or more mentions/favorites/retweets.
10_degree_nodesMultiple algorithms were used to determine data points of interest. For example, the “Degree Distribution Average” (i.e., the average number of connections to each node) was a bit over 4 Twitter users per community, but only the top 10 communities are color-coded.
The “communities” were determined by calculating the modularity of the tweets and colorizing those users whose tweets demonstrated intense modularity. Modularity is a measure of the strength of division of a network into modules (also called groups, clusters or communities); in this case the modularity increases with increased strength of interactions as measured by retweets, replies, and favorites.
Once the nodes were colorized based on their communities, the nodes (i.e. users) were weighted based on volume of mentions, retweets, and favorites.
Finally the visualization was manipulated for clarity by expanding the spacing, adding and removing gravity from the weighted objects, adjusting alignment, and labeling.
This non-interactive version is 1080p with a black background. Download it to zoom in to see all those users and connections!
1080p – High-res version of #ACSCC15 Twitter user network.
Zoomed in Screenshot
The last step is to take the data and make it more interactive, enabling the user to view the network as a whole as well as to break down each user’s network. (The programming involved in this is beyond the scope of this blog.)
#ACSCC15 – Twitter User Network Data Visualization
Click here for the interactive version of #ACSCC15
What changes do you see between 2014 and 2015? Look at the number of followers many of the users picked up over time. Who were the major Twitter influencers at the conference each year? What surprises came out of the visualizations?
Similar visualizations will be created for the 2016 Academic Surgical Congress. Follow @presentservices for future visualizations of the #ASC2016 Twitter communities.  You can discuss and ask questions in our comments section, or you can always tweet me.
I’d also like to thank Heather Logghe and Christian Jones for helping me co-author and explain the data for this project.
– Matt “Mookie” Thayer – @presentservices

Tuesday, February 2, 2016

#ILookLikeASurgeon: Unraveling the myths and stereotypes of the "surgeon personality"

Since #ILookLikeASurgeon went viral last August, I have had the opportunity to talk with surgeons the world over as to why they think the hashtag struck a collective nerve of passion and positivity. One of the most insightful conversations was with Drs. Michael Conlin and Dan Parrish. Their perspective was that #ILookLikeASurgeon was the first time surgeons were empowered to shape their public persona. Rather than being powerless victims of their portrayal in the media and popular press, surgeons themselves have an opportunity to say, “This is who we are; this is what we look like.” As Dan put it, “We [surgeons] are being seen as social media savvy, fun, diverse, accepting, hard-working, and most of all, as human.”

Public perceptions of surgeons matter; fear of an intimidating surgical persona can prevent patients from seeking needed care, undergoing potentially beneficial surgery, and complying with treatment plans. Biases rooted in negative perceptions can influence patients’ hospital experiences and consequently physician ratings. These perceptions also influence those who choose to enter the profession; sadly the world may be missing out on caring and perceptive surgeons due to inaccurate stereotypes of the “surgical personality.”

A recent opinion article titled, “There is no place for the surgeon myth in modern medicine,” by Alexis Sobel Fitts provoked ire within the surgical Twitter community for its “misguided opinion” and being “uneducated and poorly researched.” Despite being an aspiring surgeon, I was not offended by the article as I felt Ms. Fitts was writing sincerely from her own personal perceptions and delving into surgical history in an attempt to make sense of them. Ms. Fitts describes being motivated to write the article after hearing her sister’s generalizations of lack of diagnostic skill among surgeons that were inculcated during her first year of medical school. I believe Ms. Fitts was struck by the discordance of her sister’s observations with the heroism, glamour, and grandeur she had seen portrayed by surgeons in the media.

In an attempt to explain this discordance, Ms. Fitts’ article details the history and evolution of modern surgery--from the Middle Ages’ ‘barber-surgeons’ when surgeons were at the bottom of the medical hierarchy to the implementation of modern anesthesia and antiseptics, culminating in the image of an “outsize personality required to carve into a human body.” She goes on to state, “An operation is performed within a distinctly macho context: a showdown between disease and individual doctor, leading a team through authoritative decision-making. Surgeons are valued for their ability to execute, not analyse.” I suspect many surgeons would disagree strongly with these statements. Still, it’s important to remember that with the evidence available to her, these are the conclusions the author made.

In fact directly contrary to the stereotype of the decisive and authoritative surgeon, a study on surgical leadership styles by Hu et al. showed that transactional (task-focused) leaders achieve “minimum standards” compared to transformational (team-oriented) leaders who “inspire performance beyond expectation.” Sadly I could find no blog post and only one lay press article conveying these results to the general public. This is unfortunate as the results of the study likely have implications and applications to settings far beyond the operating room. Fortunately the numerous team photos of #ILookLikeASurgeon actively counter this stereotype.

Indeed images are among the most powerful tools to change perceptions. A 1987 image of one of the world’s first heart transplant surgeons, Dr. Zbigniew Religa has literally been dubbed a picture that “changed the world.” Similarly, the images of #ILookLikeASurgeon showing surgeons having fun, with family, exercising, cooking, and living a life outside of the operating room have served to--as blogger Terri Coutee put it--“humanize the profession.” Ms. Coutee further writes,

I have a suspicion, unfounded and non-evidence based though it might be, and I will own it. My suspicion is this; the surgeons who have posted on this Twitter trend have high ratings with their patients. These are the surgeons who respect you as a team member in your health decisions, sometimes tagged as #SDM (shared decision making) on Twitter. These are surgeons who go the extra distance not only as team members with their colleagues but spend the extra time it takes to research evidence based medicine (#EBM) to hone their practice and skill achieving the best in patient outcomes.

Surgeon authors Drs.
Atul Gawande and Pauline Chen as well as surgeon bloggers such as Dr. Nikki Stamp and guest posts on KevinMD such as this one on teamwork by Dr. Starla Fitch provide insight to the general public on the experience of both becoming and living life as a surgeon, bridging what sometimes feels an uncrossable chasm between the often contrasting lives of surgeons and their patients. Given surgery is one of the most intimate forms of healing, it should come as no surprise that patients seek a connection and understanding with those they grant this intimate invasion.

In the end, I feel the lack of congruity between the title and the content of Ms. Fitts’ article is most revealing; by stating, “There is no place for the surgeon myth in modern medicine,” Ms. Fitts suggests she does not believe the existing stereotypes and media portrayal of modern surgery are true. Yet, at the close of the article, it seems she is left yearning for a more realistic definition and image of “surgeon,” one that is both human and a team player. I believe her vision is today’s reality. Follow #ILookLikeASurgeon for surgeons who are living that reality!