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Where Science Meets Instructional Design

How Digital Opinion Leaders are Changing the Medical Landscape


How Digital Opinion Leaders in Clinical Care are Changing the Medical Landscape

Posted By Lori Salamida, Instructional Designer & Elizabeth Samander PhD, Medical Director

Are you overlooking the influence of DOLs?

This is the first in a 2-part series interviewing digital opinion leaders (DOLs) in clinical care about their evolving influence on the medical landscape. We start the series with an interview with Dr. Khoi Than (@KhoiThanMD on Twitter).

Dr. Khoi Than is an Associate Professor of Neurosurgery at Duke University Hospital. He is also a digital opinion leader with a great deal of influence on clinical care and decision making within the field of minimally invasive spine surgery. He sat down with us recently to share his thoughts on the value of continuous learning through social media and discuss his role as the Media Chair for the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves.

Before we delve into our interview with Dr. Khoi Than, scroll down to take a look at who DOLs are, how they are helping to shape a more scientifically skilled salesforce, and why that matters.

A Digital Opinion Leader Interview with Dr. Khoi Than

Dr. Than’s interview has been edited for clarity and length

Interview Begins

“My name’s Khoi Than. I work at Duke University Hospital. I’m an Associate Professor of Neurosurgery and I specialize in the field of spine surgery with a specific focus on minimally invasive spine surgery.”

“On the digital platform, I have a couple of different roles. I think my main role is, as the Chair of the media section for the Joint Spine Section, which is the governing body of spine surgery in neurosurgery, with the parent organizations being the Congress of Neurological Surgeons and the American Association of Neurological Surgeons.

And with that responsibility, me and my team do both content creation, as well as curation. So on some days of the week, we try to disseminate articles that have been published in our different parent journals, which include Journal of Neurosurgery and Neurosurgery. And other days of the week, we post original cases in order to generate discussion amongst our different followers on best ways to treat a specific problem. And still other days, we use the platform to promote each other. We’ve got a large membership of several hundred, if not, more than a thousand members, and it’s really good to highlight not only our leadership, but also our rank and file members.”

“I was inspired to start sharing things with my peers in the digital arena because it’s a much more efficient way to share things with others than the typical ways we’ve been doing in the past, like textbooks and journal articles. I honestly can’t even tell you the last time I opened a textbook to read it. It’s literally been years or even picked up a journal article to scroll through things. It’s so much easier to go to PubMed or to Google and type in what it is that you’re interested in and find the information you’re looking for, and through different digital and social media platforms, it’s even much more efficient because you tend to follow and be followed by people, who have similar interests as you. And so generally things that are directly relevant to you, pop up in your feeds and you’re able to go through a lot more information much more quickly than you could in the past.”

“I was actually very hesitant to start professionally posting on social media, but then I really started to see the value in what others were doing, it really is a tremendous way to share information with others. And this includes not only other providers, but also our trainees, which includes fellows, residents, medical students, and also, potentially, patients.

I know many of my peers who are very prominent on social media and similar visual platforms who have patients seeking them far and wide because of what they post on their profiles. And whether it’s research studies, discussing challenging cases, even showing straightforward educational things for students and trainees, I think there’s a lot of value in adopting these different platforms.

As neurosurgeons and spine surgeons, we’re not only operating, but we’re also doing studies to further the field. And also, it’s a field where there’s a lot of controversies and a lot of different ways of doing things. Many people post videos of their operations so that others can learn how to do certain techniques, obviously, it won’t be the course of the full operation, which can be anywhere between an hour to 12 hours. But certainly, the highlights of the case, curated and welded into a more digestible video can educate others into how to do certain cases.

I think more important than doing surgeries, is the decision-making behind doing them. There’s a saying in spine surgery, where if you asked 10 surgeons their opinion on a case, you would get 11 different answers. Why is there all that variability? Using these platforms as a means to discuss why you would offer someone a certain intervention and why that intervention might be better than others or not, is certainly valuable and I think we see that in the different polls that we post.

Sometimes we’ll post a picture and say, ‘How would you manage this?’”

Shared with permission from Dr. Than’s Twitter account @KhoiThanMD

“And you’ll see that all sorts of different answers get all sorts of different votes, right? Very rarely is it one surgical answer gets all the votes, there tends to be a lot of votes for one, a lot of votes for another, maybe less for the less desirable choices. But certainly, it shows that there’s many ways of doing things and a long way to go before we achieve consensus on how to best treat patients.”

“In terms of research, I think it’s extremely important that if you are heavily involved in academics, that you are involved in social media platforms. At least within the realm of spine surgery, there’s pretty good evidence to suggest now that, if you advertise your work on social media, it’s going to get cited more.”

“Polls and questions are really a great way to engage your audience. We’ve polled people on different things, best way to treat a specific type of pathology. We even delved into socioeconomic details like costs of spinal surgery and the different implants we use. Pictures are really valuable too. They say a picture’s worth a thousand words, so anytime we post an imaging study or a video, it tends to generate a lot of discussion. So I think, certainly, the more visually appealing that you can make a post and the more interactive you can make it, the more successful that post is going to be. Success is defined by engagements or comments or retweets or what have you.

If you posted a link to an article and say, ‘Hey, this article is about how to best manage this pathology. What are your thoughts?’ Chances are that that will get a fair amount of interaction on these platforms.”

Shared with permission from Dr. Than’s Twitter account @KhoiThanMD
Shared with permission from Dr. Than’s Twitter account @KhoiThanMD

“Being involved in digital platforms, certainly I feel, makes research much more accessible for everyone and this includes not only people in the United States, but people internationally, as well. I think they have done counts of, for example, how many people are on Facebook and it’s, basically, every adult in the world where Facebook is not illegal. Similarly, we’re seeing increased international engagement in things like Twitter and LinkedIn and certainly, Instagram. Although I find Instagram a little bit harder just because it’s purely picture-based.”

“If I write something and I want to share it, I can share it literally with the click of a button and anyone who follows me can have instant access to it, and if they like it or they reshare it, then that expands the audience that’s seeing my study. 20 years ago, research was only found in journals. And so if you were lucky enough to live in this country or more developed countries, then you could have access to those because they would be shipped to your mailbox. But think about all the people in very populated, but less fortunate countries who weren’t receiving that information.”

“And I can actually think of an example I’ve seen with that. About six years ago, I had the opportunity to teach a course in India, which is obviously a very populated country with a lot of neurosurgeons and a lot of spine surgeons. But when we asked the audience, “Who here has ever placed cervical lateral mass instrumentation?” a very, very common type of procedure that we do in the United States, no-one raised their hand. When we asked, ‘Who’s put in Lumbar pedicle screw instrumentation?’ Again, a room full of practicing neurosurgeons and spine surgeons, no-one raised their hand. And that’s, I think, simply because they’d never been taught, obviously.”

“Now, because you can share things at the click of a button and you can share it widely and instantly and across the globe, people have access to, not only operative techniques, but research findings, instantaneously. And I think the real value is, not only can everyone see research, but it really, I think, generates a lot of discussion to do even more research. And so we’re seeing that a lot now with questions being asked in these different posts, and then someone asks, “Hey, who wants to do a multi-institutional study on this?” People volunteer and then things get off the ground. So I think, absolutely, these digital platforms certainly allow the rapid, wide dissemination of research and of other things. I think patients will substantially benefit from it, and really at an exponential rate compared to maybe how things were done 20 years ago.

I think part of the learning curve of being involved in digital and social media is just learning through trial and error. And I think quickly, you learn what sort of posts are popular and engage others and which ones don’t. Videos tend to be very successful. Generally, for Instagram, those videos have to be shorter than a minute and even on other platforms, studies have shown that if content is really longer than a couple of minutes, people lose interest.  Pictures, particularly ones that demonstrate challenging cases or controversial topics, tend to generate a lot of discussion. Polls as well, can accomplish the same.

My involvement in social media spans four different platforms, which are Facebook, Instagram, Twitter, and LinkedIn. Now, my favorites professionally, are probably Twitter and LinkedIn. LinkedIn tends to be much more professional, so to speak. The posts do not have a 144-character limit and so you can put in as much or as little attention to the post as you like. It tends to be very well-received by more domestic surgeons, as well as folks in industry. Twitter, because it tends to be shorter posts, you have to be sometimes more creative in creating that content because you’re limited by space, but I feel like Twitter has much greater engagement with trainees. I feel like every young person I know is on Twitter, more so than LinkedIn. But also an international audience where we really reach out to people beyond America.”

“Even within the realm of spine surgery, I keep saying that, with time, these virtual conferences are going to become less and less popular, but they really haven’t been. The Virtual Global Spine Conference still gets multiple dozens of people attending each week, with hundreds more watching those videos on YouTube.

And we have people staying up every night in the Middle East and in Europe up to 12:00 AM and 1:00 AM. It’s every Thursday at 6:00 PM Eastern. So you can imagine, or you can calculate, how late it is over in Europe or in the Middle East, but they’re attending live. They’re presenting, they’re chatting in the chat box because people out there who are passionate about their field, just like, I’m sure, most people watching this, want to learn, want to get better. And I think we’ve seen that virtual conferences are here to stay.”

“Social media has been a really wonderful way to interact with companies. Obviously, in spine surgery, a lot of what we do is instrumentation and there are literally hundreds of spine companies out there. And particularly if you looked at LinkedIn, you’ll frequently see a company posting cases being done by a prominent surgeon who’s using their particular device.”

“I think that if you do a specific technique with a specific company that prominence on digital and social media can be an avenue for working more closely with that company, because obviously they want to show off amazing physicians using their products to the benefit of patients. So absolutely, that is a realm that I don’t think existed before.”

“Before the digital age, these companies would hold in-person courses, however, often times a year and you fly in to teach the course and you’re able to spend a day or two with 15 or 30 students. But now, because of digital social media, you can really show what you can do, educate others, hundreds, thousands at a time with a lot less effort and time away from home and work.

I think it’s very important to be very conscientious as you post. And this is something I’ve learned on my own. There are things that really will upset people and, don’t forget, most of the people following you on these platforms, you don’t know them, and they don’t know you, aside from what you’re posting. So it’s really important to think twice, and you can sometimes be caught off guard.

I think one important thing to absolutely do before getting involved in social media is, to check with your institutional policies. So for example, I mentioned before that Duke does not allow posting any sort of patient image, even if it’s de-identified. You could put a picture of someone’s hand and would have no names or any sort of identifiers and that’s not allowed. Many of them will also have you comment in your comment blog, on Twitter or Instagram, for example that, Views expressed are my own and do not reflect my institution. So, that’s definitely something very important to look at too.”

“What defined someone as a KOL previously? It was someone who worked at a prestigious institution, wrote a lot of papers and at bi- or at most tri-annual meetings gave the most dynamic talks. Well, I really think that era is declining because now, as a DOL, you are able to touch thousands of people, tens of thousands of people, whenever you want. It doesn’t have to be at your annual meeting or at your two or three meetings that you go to each year, it could be every day.

As a DOL, you’re able to show your results, whether it’s clips from your surgery or your pre- and postoperative images. That’s your work, you’re able to show it, stand by it. Similarly, whenever you come up with a great idea or publish something of value, you’re able to share it right away. You don’t need to really wait for the study to come out in journal, which is usually many months after you’ve actually submitted it and had it accepted. You’re able to share it right away.”

“I think that the new era of KOLs will be the DOLs, if that makes sense? I think people who are really, really successful on digital platforms, showing the cases they do, demonstrating their ability to educate, really good at engaging with others, those are going to be the KOLs who are sought after to speak at these annual or semi-annual conferences. Because I think these digital platforms allow a way for you to really show what you’re doing.”

End of Interview

Thanks to Dr. Khoi Than for participating in this interview and sharing his expert insights into the impact of digital opinion leaders on the medical landscape.

Get in touch if you would like to discuss opportunities to incorporate DOLs into your training solutions.

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