SDN Radiation Oncology - how do you describe it?

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subatomicdoc

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Happy New Year everyone!

I'm collaborating on a peer-reviewed review article summarizing online social networks in radiation oncology. I can describe it to a point as an episodic participant, but I'd rather hear about SDN's positive/negatives and what value it adds from you.

I will not be quoting anyone, identifying anyone. If you feel comfortable sharing I'd appreciate it. Feel free to message me here or my email is mskatzmd
at Gmail.

Best, Matt

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I think it adds value in a number of ways.

It provides a forum for anonymous feedback on the most contentious topics of our specialty. Members, included residents and med students, can contribute on topics such as residency expansion, job market, etc. without fear of retaliation.

The anonymity is a double-edged sword in that some may not be who they say they are and we sometimes get "trolling" from random people. The moderators do a great job of mitigating this.

It also provides an opportunity for quick input from others on challenging cases that arise. Other forums do this, but it takes awhile to gather input (not as much traffic from members of our specialty). If I post a challenging case, I can get valuable feedback within hours.

I would also mention that there is a Facebook group for ARRO which posts important publications and topics. That one is nice because it comes in through my facebook newsfeed.

Nice idea for a publication. I look forward to reading it!
 
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I'd be happy to collaborate on the article if you're interested in having me. I've been an SDN administrator/senior moderator/advisor for going on 15 years now.

My opinion is that broadly there are two models for forums geared towards radiation oncology professionals or aspirants. These are anonymity optional (e.g. SDN) and identity enforced sites (e.g. themednet).

As thesauce points out, the principal advantage to anonymity optional sites is that people generally feel more open to share whatever they truly think. The problem is that is that you generally don't know the source of the information. Fortunately, there is a fairly high volume of people on SDN who quickly respond to things that are wrong or outlandish. Therefore, the culture is such that things that are controversial become obviously controversial and things that are correct or consensus opinion tend to be repeated and supported. SDN does require verification (which is protected by contract not to be shared) for verified statuses (such as "verified physician") which helps with this somewhat. If a user who clearly has no idea what they're talking about claims to be an attending physician or similar in their status (unverified) and is reported, we do investigate these claims and we have taken action for this in the past. Certainly, the information is more "rough around the edges". The writing is less polished and people are not being political when they post.

The principal advantage to identity enforced sites is that you know the source of the information. On themednet you often see big names in the field posting answers to questions such as clinical cases. For some this is a good thing. I sometimes hear my peers commenting that "so and so does X, so therefore maybe I should." I can't just say that "some guy does X on SDN", but rather more critically evaluate what is being said and stand behind it myself. From a personal standpoint, I'm much less inclined to post answers to radiation oncology questions when my identity is public. I do not have the status to challenge more senior people. But, on SDN nobody really knows who is more senior or who is a big name. I feel that my ideas are evaluated anonymously by my peers and based on my supporting evidence. With such scrutiny, I am more inclined to believe and follow the ideas promoted by others. With more public identities, people tend to be more political and less challenging of the ideas of others. I certainly have read some things on public sites that I find objectionable, but again I don't feel the status to actually object. It's not something that's really done in a public, professional setting unless you are also a big name person.

As an SDN administrator, I do get a lot of information about who is posting what. Again, that information is protected by contract, so it is not shared. I find it interesting that many of the "big names" only come here to defend their or their institutions reputation or promote things like residency positions, fellowship programs, research opportunities, talks that they're giving, etc... Therefore, some users do not post here except if there is some sort of benefit to them. I am not a fan of this type of behavior. That said I often feel as if I am in a minority. I have frequently been asked by my peers who know my online identity why I continue to post and help with the site if I "don't get anything out of it." I find it to be the most rewarding volunteer experience that I can have. Most of my time has been served in the physician-scientist forums, but here as well I take great pride in both contributing to patient care and helping others make decisions about entering the field. I have assisted hundreds on SDN in this way, a small fraction of whom eventually figure out who I am in person one way or another.

Conversely, themednet showcases the IDs of posters right next to their posts, which seems to make those same users post much more often and more thoroughly in response to questions. My hypothesis is that this is due to the inherent self-promotion that this provides. That is a good thing in some ways, as more case based material comes out from those specialist academic physicians. I suspect that they find the potential for personal rewards much higher in that setting versus the anonymous posting on SDN that will likely have little or no personal reward.
 
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The one thing I like about SDN is that I can post questions or discuss differences in opinion in management without having to be all hoity-toity respectful if a big-name responds to my question. I'd feel extremely uncomfortable answering a question on MedNet, especially as a resident. Seems like the most frequent posters are new attendings trying to make a name for themselves (who frequently write a response similar to a response for a journal, including citations) or bigger names who already have the name and confidence to just post what they think without having to have oodles of citations to back their point. Not saying that there's anything wrong with that, but to jump in with any frequency, as a resident, and answer questions that other residents (and even ATTENDINGS) have isn't something I feel comfortable with.

I wish that, as a forum, we posted more about interesting cases that we're in the process of seeing, especially those that any of the active members on this forum had a question in terms of management. Outside of my attendings and tumor board, I routinely bring cases from real life to this forum for what is essentially an anonymous free-text survey of people within the field. You can tell who is truly within the field (either as resident or attending) just based off the language one uses and general understanding of the process, so while the labels are nice, I'm rarely thrown for a loop in terms of whether someone is truly an attending or not (although @Damn_Daniel definitely had me on the ropes for quite a bit when he first started posting).

I'm active in this forum because this is where the most interesting, practice changing (or not changing, depending on your opinion on the article) stuff gets posted on a regular basis. I don't want another re-hash about MA-20 or Z11. I saw stuff like the QUARTZ trial first on here. SDN was a close second to CRITICS prelim results. People referencing stuff like ASCEND-RT or ProTECT made me go figure out what people are discussing.

As much as I learn from the big books (Perez-Brady/Gunderson-Tepper) as a resident, those are only good as the fundamental and to teach you the past. That's critically important for sure, but it gets boring to review history from the big book without being able to see where the disease site is trending. That's where SDN comes in. I have half a mind to revive threads from 1 to 3 years ago that asked interesting clinical questions or questions about trials that faded away.
 
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once i went through and looked at the SDN residency subsites and manually determined the number of posts that were actual case related/study related. Rad Onc was by far, by far (2+ SDs) the highest % of posts that were about actual medicine and patient treatment, not just getting into residency/interviewing/lifestyle etc.. The lowest? Derm. You might find it interesting to replicate this idea for the study. Cite me if you do :)
 
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For the folks who have been moderating this site for a long time - do you have a sense for the web traffic trends on the site? It seems that there is much less activity on this forum in recent years, but I'm not sure thats reality. I feel like the applicant chatter has decreased considerably, but maybe thats because a lot of that (i.e. interview dates) got moved to google docs, etc. Thoughts?
 
I agree that there seems to be less traffic and I would agree for the reasons that you cited. However, you can only ask the questions "what are my chances" and "what is the future of Rad Onc" so many times until you get answers that run together. We have a huge repository of threads which I think users are more diligent in searching.


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Taking a look at the interview spreadsheet it does seem like all the impressions are being posted there.


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For the folks who have been moderating this site for a long time - do you have a sense for the web traffic trends on the site? It seems that there is much less activity on this forum in recent years, but I'm not sure thats reality. I feel like the applicant chatter has decreased considerably, but maybe thats because a lot of that (i.e. interview dates) got moved to google docs, etc. Thoughts?

The traffic continues to increase year over year. See the traffic stats here: https://www.quantcast.com/p-3LRGstxyA8BCR (stretch the bar at the bottom to see traffic since 2012 - ignore the current holiday period of Nov-Dec, as traffic always dips during this timeframe)

In 2013 we upgraded the forums platform which introduced 'likes' and a dramatically improved search function. That led to a few changes which impact discussions:
  1. A clear decrease in posts with a corresponding increase in use of 'likes.' In our old platform there was no 'like' feature which meant we had a lot of posts which were just 'thanks for the post' messages.
  2. The search function in the old platform cannot hold a candle to our current system. Now members and visitors can find exactly the information they need without creating a new thread. In the past we always saw the same questions asked over and over.
  3. Our forums are much faster than the old site, which means Google is able to spider every one of the millions of pages on the site. This allows individuals to arrive directly to the page they need.
Lastly, I think we may be seeing a long-term trend since 2008 of both increasing use of facebook for basic social interactions and use of mobile devices which I believe naturally decreases the amount of interaction. Over 50% of the site traffic is now delivered to mobile devices.
 
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Thank you everyone! Sorry for the delayed reply but just getting over a nasty cold. I'll take a look over some of the comments in more detail and see what I can summarize. Neuronix, thank you and I may take you up on the offer!
 
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