So Much for “Antisocial”

For most students starting medical school, pathology is an unknown; their M1 year is their first-ever exposure to the field. They get an introduction to H&E stains, normal histology, and maybe learn about a few basic pathologic entities and their appearance under the microscope. Students quickly learn that pathologists are not typically out and about on the wards; rather, they are the “behind the scenes” making diagnoses on specimens and performing the occasional fine needle aspiration or autopsy. As they progress through medical school, the beauty of pathology as a field of medicine is not well-communicated. Even if medical students happen to cross paths with a passionate, education-oriented pathologist in their preclinical years, the extreme stress of studying for Step 1 exams (and the resulting intellectual and emotional fatigue) often eliminates any good memories of pathology. During clerkships, students frequently see pathologists used as the punchline of jokes about “antisocial” personalities. These experiences conjure visions of a dark, dingy hospital basement and solitary practitioners wearing tweed coats adorned with elbow patches, sitting at their microscopes and reviewing slides with nothing but their thoughts for company. This small glimpse paints a horrible picture of the stereotypical pathologist – quiet, introverted… and lonely. The pathologist has come to be known as the antisocial doctor.

Of course, this misconception could not be further from the truth. Pathologists are some of the most social doctors around! Communication is at the core of our entire professional existence. Pathologists are in constant contact with one another, doctors from other specialties, medical laboratory professionals, pathologists’ assistants, histotechnologists, cytotechnologists, and students of all kinds. Not only is the stereotype untrue, it could be potentially harmful to our profession; these impressions influence medical students who are still “undifferentiated” and considering different specialties. In the 2020 National Residency Match Program, there were 603 pathology residency positions available across 164 programs in the United States – and only 502 US medical student seniors and 1,277 international candidates applying for those positions (1). More worrying still is the fact that these numbers are trending downward. US candidates peaked at 597 in 2016, whereas international medical students and graduates peaked at 1,903 in 2017 (2). Could negative stereotypes be playing a role in this trend? It seems highly likely.

But despite our “antisocial” reputation, pathologists keep up with each other in technologically savvy ways while working from their desks and microscopes – which brings us to Twitter.

Getting involved
The community of pathologists and laboratory professionals on Twitter, aka #PathTwitter, has been active for years and is referenced in pathology journals and literature as far back as 2010 (3). The popularity and continued growth of #PathTwitter is at least in part due to how well the platform lends itself to sharing and captioning images from interesting educational cases – a staple for active users. The discussions that stem from shared cases are instructive and overwhelmingly friendly, giving medical students and trainees exposure to exciting cases in a fun and engaging format. #PathTwitter also has many other ways to get involved, including Twitter-based journal clubs such as #DermpathJC (4) and live-tweeted conferences so that social media users who can’t attend in person can participate virtually. Large multi-institution research studies have been brought to fruition through #PathTwitter (5,6), and social media has been incorporated into elective pathology rotations in the form of #TwitterHomework (7). Thanks to enthusiastic pathologists who have created a welcoming and energizing environment, the community is constantly growing.

But for medical students who aspire to become pathologists, #PathTwitter offers much more than just “cool cases.” The #Path2Path initiative was created to engage medical students interested in pathology on social media and has had great success leading discussions and Q&A sessions on a variety of topics. Brett Kurpiel, a recently matched M4, says, “I had been on Twitter for about a year before residency applications started, so I was plugged in fairly well with the community. When I started seeing the #Path2Path hashtag used, I knew I had to jump on it and join my co-applicants. Everyone was so supportive and amazing; I never felt uncomfortable going to a program [for an interview] because I knew I would find at least one other #SoMe friend.” It’s clear that #PathTwitter is a vibrant, supportive, and interactive community that has something to offer not just pathologists, but also the students who hope to follow in their footsteps.

Unsurprisingly, there seems to be a positive trend in the number of pathology-bound medical students who are looking to social media to get involved, stay connected, and access the growing number of online resources available to applicants. To highlight the benefits of social media, a group of pathology residency applicants from the 2019–20 cycle created their own online forums on which they could discuss anything concerning the interview season (for instance, programs they liked, housing during interviews, or organizing shared trips to and from airports). The groups were relatively small compared with the overall number of applicants; a Twitter direct messaging group acquired about 50 members and a Slack messaging workspace about 70. It seems probable, though, that the number of applicants seeking such online forums will continue to rise – especially given that the 2020–21 residency application season will be virtual due to the COVID-19 pandemic.

All in the numbers

To understand how important social media is to applicants, a survey about social media usage was sent to a group of pathology residency applicants who matched in March 2020. Of the 15 total respondents, the majority (60 percent) were 26 to 30 years old, with a nearly even split between US MD students, US DO students, and international medical graduates. Interestingly, nearly half (46.7 percent) had joined a social media platform during the 2019–20 interview cycle. Two-thirds found the online pathology community (specifically #Path2Path) through social media itself, whereas 26.7 percent were informed about it by a fellow residency applicant. The most exciting element to these survey responses was the fact that 60 percent thought being on social media had helped their interview process for a variety of reasons:

• meeting new people
• being able to talk to other applicants and exchange interview information
• being able to interact with and learn from faculty members from different institutions
• building camaraderie

Nearly all (86.7 percent) of respondents stated that they would recommend that upcoming applicants get involved in social media. Of all the benefits named, the most appreciated and valued aspect of participating in the pathology online community was the ability to interact with faculty and residents from distant institutions. Notably, 60 percent of respondents said they matched to a program with a Twitter account, but 57.1 percent said that a program’s social media presence had no influence on their final rank list decision. Only 7.1 percent of respondents felt that a program’s Twitter presence influenced their choice of rank – but, nevertheless, 100 percent of applicants wanted to see their programs develop an online presence through social media.

To understand how residency program leadership felt about social media in relation to recruitment, a survey was sent to pathology faculty via the Association of Pathology Chairs (APC) listserv. Of the 30 respondents, 57 percent were program directors, 33 percent were associate or assistant program directors, 7 percent were residency selection committee members, and 3 percent were not formally involved in resident recruitment. The majority (60 percent) of respondents reported using social media professionally (with two-thirds on social media for four or more years); another 10 percent reported plans to join social media. Of respondents with a social media presence, 61 percent reported engaging medical students on social media and 55 percent had heard of #Path2Path, although only 39 percent had participated in a #Path2Path event. There may be an opportunity to get more faculty to engage applicants by simply increasing promotion of #Path2Path events and letting them know about the opportunities.

With respect to recruitment, half of survey respondents reported searching applicants or interviewees online or on social media, with Facebook and Twitter being the most common sites searched (see Figure 1). Of the 26 respondents who answered supplemental questions, 31 percent indicated that their observations of an applicant on social media had positively impacted their decision on interview invitations or on the final rank order list at least once, whereas 19 percent indicated that such observations had negatively impacted their decisions at least once. People’s positive impressions came from demonstrating interest in the field, passion, professionalism, and collegiality on social media; negative impressions came from “inappropriate content” and unprofessional behavior, such as swearing or inappropriate jokes.

But what of people’s thoughts on social media as a whole? Nearly three-quarters (73 percent) of all survey respondents viewed professional social media use at any career stage favorably or somewhat favorably, 20 percent viewed it neutrally, and 7 percent viewed it unfavorably or somewhat unfavorably – with one respondent expressing concerns about HIPAA and institutional representation. Overall, it appears that making a dedicated professional social media profile can be beneficial for residency applicants inclined to do so – but it is good to remember that program directors can likely view any public social media profiles, whether professional or personal.

Making a match

Now to address the positive-sense, single-stranded RNA elephant in the room: SARS-CoV-2. The COVID-19 pandemic completely changed the medical landscape this spring. Everything from patient care and workflow to trainee education to celebrations for graduating medical students changed overnight. Fortunately, #PathTwitter was in the perfect position to provide support for the pathology community when COVID-19 hit – and immediately rose to the occasion. Pathology organizations and groups, such as PathCast, took to social media to promote free lecture series (with many of the talks given by familiar #PathTwitter faces) to assist with disruptions in trainee education. The Virtual Pathology Grand Rounds (@VirtualPathGR) series was formed. Residency programs at institutions like Massachusetts General Hospital used Twitter to promote their publicly available learning resources. In a touching and supportive move, #PathTwitter also rallied for graduating medical students who had matched in pathology.

Unbeknownst to everyone involved, this year’s Match Day would be unlike any before. Under normal circumstances, most medical schools have joyous celebrations in which students receive envelopes containing the name of their new residency program. Many of these events involve themes, dressing up, or being surrounded by family and friends. Regardless of each individual school’s traditions, what they all have in common is that the day is a large, in-person event commemorating students’ achievements. Unfortunately, due to the COVID-19 pandemic, nonessential events and gatherings were cancelled – and the much-anticipated Match Day 2020, set to take place on March 20, was no exception. Without a way to celebrate, many students felt dejected and deprived of the Match Day they had been looking forward to for their entire medical school careers. Seeing this, members of the #PathTwitter community asked what they could do for their medical students going into Match Week – and thus, #VirtualPathMatch was born.

Building on the popularity of the #Path2Path hashtag and the #PathTwitter community, #VirtualPathMatch sought to create its own version of Match Day on Twitter. Event information was distributed ahead of time and, on Match Day, people tweeted their match results using the hashtag #VirtualPathMatch. Anyone could follow this hashtag to join the celebration and congratulate future pathologists on their accomplishments. In just a few weeks, #VirtualPathMatch had 482 participants, 1,470 tweets, and over 4.4 million impressions (8). Although students across the US were unable to celebrate Match Day 2020 in person at their home institutions, they had the opportunity to experience it virtually with friends and future colleagues from around the world. As the pandemic changed the meaning of “socializing,” the need for social interaction and human connection skyrocketed – and #PathTwitter was there to deliver.

Even now, the #PathTwitter community continues to grow and find new ways to support its members. This is especially true as we continue adapting to the realities of an ongoing pandemic in which social media has become an important tool for staying connected and sharing resources. Although social media is not for everyone, it can be an overwhelmingly positive experience for users at every stage of their careers. Don’t let false “antisocial” stereotypes weigh you down; join #PathTwitter and be part of this vibrant community!