Twelve Tips for ‘Clinical Tweeting’ – Teaching and learning a concise way of presenting clinical information

Background : Tweeting is a social media concept familiar to most surgical trainees; succinct communication through limited characters. Most clinicians ﬁnd presenting clinical information this way diﬃcult however it helps develop prioritisation of information and key viva skills for examinations. Aims : We aim to teach trainees to use the tweet model to ﬂourish in clinical communication and to aid in exam success. Methods : Our article highlights our experience of this method. Results : Our 12 tips help the clinician to prioritise, summate and eﬃciently verbally communicate key information in the context of discussing a referral or presenting examination ﬁndings. The ﬁrst six steps explain how to ‘tweet’ and the last six steps outline how to teach the skill. Conclusions : By using the tips provided clinicians will develop good communication skills. Furthermore these tips can be used as a good teaching tool for the development of undergraduate and postgraduate skills.


Introduction
In the current modern climate of medical education using technological adjuncts has been successful in teaching clinical skills from complex simulation learning for surgical procedures to the simple use of Apple mac laptops or Patel L, Jaffe W MedEdPublish https://doi.org/10. 15694/mep.2016.000088 Page | 2 applications to teach examination skills.
Most clinicians have day to day access to smart phones which now seem to be a necessity for efficient clinical functioning via downloadable intranet or general applications for prescribing, clinically assessing patients and even being able to manage conditions. Therefore most clinicians are becoming technologically sound and appreciate new ways of communication like tweeting.
Tweeting is a method of communication most frequently used in social arenas however it now features as live feed communication at medical conferences as well as allows communication via the media for the medical profession. The basic concept of a tweet is a method of communication using only 140 characters therefore it limits content expressed and enforces a succinct, abbreviated way of communication.
We've developed this concept into a training aid to help trainees present clinical information succinctly and in an exam like format. Clinical communication is essential to safe practice and therefore of paramount importance. Furthermore it is a skill that is appraised yearly for UK trainees as part of their ongoing review of progress as well as vitally important for higher marks in professional examinations such as the FRCS (Fellow of the Royal College of Surgeons). Here are our tips on how to 'clinically tweet' and how to teach the skill using a worked example;

1) Start with basic patient demographic information
This is a good way of focusing the clinical information and setting a relevant background for other clinicians which could influence management. 'This is a 60 year old gentleman who used to work as a builder' can be effectively tweeted into 'retired 60 year old male builder'.

2) Summarise the clinical issue in a sentence
This is how the tweet concept enforces prioritisation of what is presented as clinical information. Attempt to present a diagnosis and communicate only relevant positive history and examination findings. For example 'presents today with a possible SCC on examination which changed in size, shape and character in the last 6 months. Past medically he is a renal transplant patient on tacrolimus' can be effectively tweeted into 'presents with a squamous cell carcinoma on dermatoscope examination with recent changes on the background of long term immunosuppression for a renal transplant'. The tweet process not only highlights the key information succinctly but also demonstrates a superior knowledge and assessment of the SCC's risk factors.

3) Include your management plan in brief
This helps the person you are presenting to understand what the conclusion of your assessment is and helps end the tweet well with an action plan. For example 'I think he needs to be considered for biopsy and I will need to explain what this process involves' can be effectively tweeted into 'listed for excision biopsy and direct closure as a local anaesthetic day case procedure'.

4) Practice fluent delivery
To enhance this communication skill it's important to practice clear, concise, confident and well-paced verbal delivery which can be done in practice before calling the consultant or attending for exams. Attempt to use the clinical tweet at work as much as possible to hone in on summarisation and prioritisation of clinical information skills such as in clinics when presenting your findings to the consultant or when calling colleagues for referrals.

6) Get feedback on your clinical tweet from seniors
Getting feedback is essential as this will allow you to understand if you are using the technique well and will improve your performance for exams. Ask as many people as possible and implement the feedback changes suggested to continue personal development.

7) Encourage it's use in your department
Develop the clinical tweet into a departmental concept of clinically communicating and ensure all trainees and clinicians are aware this. This fosters a positive environment for good tweeting to flourish.

8) Explain its importance for good and efficient communication
Allow clinicians to understand how and why the concept works so they are aware of the benefits of its use. It's best to demonstrate its benefits for example in mock exam scenarios whereby clinicians will be able to objectively see they will score marks on keeping to time when communicating, clarity, being able to prioritise clinical information and inspire confidence in the examiner of their capabilities.

9) Direct clinicians on how to prioritise clinical information
It's important to explain the format of the tweet. Patient demographics at the beginning has relevance for issues such as risk factors and appropriate management for that patient. Summarising the clinical scenario allows prioritisation of the key and most essential relevant information such that this is not lost in reams of irrelevant findings. This is particularly important when communicating over the phone for ensuring clarity. Giving a management plan allows the examiner to understand the end point of the consultantion and helps examiners see you are able to formulate a diagnosis and treatment plan. Be strict with enforcing the tweet idea of only a few characters to communicate. 10) Allow opportunity for face to face feedback Direct and instant feedback helps clinicians immediately learn how to improve their tweet from experience and this helps improve their technique in the future. It also allows for discussion of why certain information presented was irrelevant or hindered the clarity of the tweet.

11) Be fair and constructive with feedback
Allow clinicians to reflect on what they felt went well and what they felt could be improved. Furthermore, give achievable action points to improve the technique by using the example you may be discussing. Ensure you empower tweeters to not only use the technique but utilise the above points to teach it in order to improve other clinician's clinical communication skills.

Discussion
In our experience this technique has helped trainees develop sharper communication skills and has given them the confidence for a good performance in viva examinations. A series of informal qualitative interviews highlighted the trainees that found this technique beneficial used this concept in their professional FRCS Plastic Surgery exams and felt confident of their ability to score highly due to 'inspiring confidence' -an exam quality that, if can be demonstrated, can result in the highest marks awarded. Furthermore some trainees reported they had ingrained the concept of the clinical tweet to help guide their day to day clinical history taking and presentation of information in the clinical arena. There was some feedback to suggest the technique should be applied to more junior trainees or students however we have demonstrated its applicability to all levels of clinical practice. In conclusion we hope this technique enhances the learning experience of all that apply it and we look forward to how well it is received via feedback.

Take Home Messages
Clinical tweeting helps improve communication skills Practing and teaching this skill is achievable in the steps highlighted Our experience of utilising this method is a positive one

Notes On Contributors
Mrs Lopa Patel is a Plastic Surgery Trainee Registrar (ST4) working at the Uniersity Hospital of Coventry and Warwickshire with an interest in Medical Education.
Mr Wayne Jaffe is a Plastic Surgery Consultant with interests in Surgical Education working at the Royal Stoke Hospital, Staffordshire.