The 2020 American College of Surgeons Clinical Congress (ACS-CC) was 100% virtual because of the COVID-19 pandemic. Social media (eg, Twitter, Facebook, YouTube) is increasingly prevalent and provides a tool for information dissemination, defined as “conscious efforts to spread new knowledge, ideas, policies, and practices to specific target audiences or to a public at large.” 1 Twitter allows users to share content with short 280-character posts and link common tweets through hashtags. This study aims to examine the impact of the 100% virtual format for the 2020 ACS-CC on conference participation and information dissemination through the Twitter platform measured by both passive and active Twitter activities. We hypothesize that Twitter hashtags will facilitate and increase information distribution, enhance online active participation, and the overall event attendance rate.
This is a cross sectional study comparing the utilization of Twitter at the ACS-CC between the in-person 2019 and virtual 2020 conferences. We used Symplur Signal software (Upland, CA) to analyze the #ACSCC19 and #ACSCC20 Twitter hashtags activities, including impressions, tweets, Twitter users, tweets/hour, and tweets/user. “Impression” was defined as the number of times conference related tweets were viewed and represented passive engagement. “Engagement” was defined as the number of tweets posted with a conference hashtag and represented active interaction. Only publicly available data and Twitter metrics were collected. This study was conducted in compliance with ethical standards and reviewed by our Institutional Review Board and deemed exempt.
Conference attendance increased from 8596 to 32 542 following transition to the 2020 virtual platform (P < .05). Between 2019 and 2020, conference related tweets decreased from 17.4k to 9.7k and Twitter users decreased from 4.9k to 2.7k. The total number of Twitter impressions decreased from 84.4 m to 80.7 m. The average tweets/h decreased from 51/h to 34/h, but the average tweets per user remained constant at 4/user (Table 1; Figure 1).
Table 1.
Twitter Metrics and Total Conference Attendance for ACSCC 2019 and 2020.
| ACSCC 2019 | ACSCC 2020 | |
|---|---|---|
| Tweets | 17.4k | 9.7k |
| Average tweets/hour | 51 | 34 |
| Average tweets/participant | 4 | 4 |
| Twitter users | 4.9 k | 2.7 k |
| Impressions | 84.4 m | 80.7 m |
| Conference attendance | 8596 | 32 542 |
Abbreviations: ACSCC, American College of Surgeons Clinical Congress; k, thousands; m, millions.
Figure 1.
(A) Total number of conference participants, twitter users, and tweets for ACSCC 2019 and 2020 (B) average tweets per participant and average tweets per hour for ACSCC 2019 and 2020 (C) twitter impressions in millions for ACSCC 2019 and 2020.
The switch to a virtual format significantly increased event participation at the ACS-CC by 279%. The switch was also associated with a decrease in engagement and impressions for the conference Twitter hashtag. These findings highlight the ease of access and participation provided by the virtual format, but also exposes the disadvantage of decreased information dissemination through decreased Twitter interaction and engagement.
National conferences are time consuming and expensive to attend. Time off from work and travel expenses presents hurdles to attend in-person conferences. The ability to attend a virtual conference from anywhere in the world removes many of these barriers.
Twitter engagement measures active participation among users around conference-related conversations, including tweets, retweets, and replies to others’ tweets. Active participation provides the opportunity for information dissemination and formation of professional relationships. 2 The large decrease in conference related tweets and participating Twitter users from 2019 to 2020 indicates there has been a decrease in engagement following the switch to a virtual platform. ACS-CC Twitter engagement has fluctuated the past 6 years. 3 While the number of conference-related tweets has decreased in the past 2 years, it is unlikely that this trend alone explains the decrease seen in 2020. It is important to note there has been no associated decrease in tweets/user. This may indicate that the decrease in overall Twitter engagement is a consequence of less people using Twitter to communicate about the conference rather than a decrease in engagement/user. A possible explanation for this finding is that the online conference format provided participants with alternative methods of communication, decreasing the need for Twitter. Another possible explanation is social media fatigue. 3 A reality of online formats is attendees remain in-front of their electronic devices for hours which may amplify social media fatigue. 4
Twitter impressions are passive engagements among users, and represent the number of times conference related content was viewed. Similar to Twitter engagement, impressions are an important metric for the dissemination of information and give insight into how often posts are viewed. While there was a decrease in impressions from 84.4 m to 80.7 m for the 2020 ACS-CC, the reduction was not nearly as large as expected considering the drastic decrease in engagement. Other studies have found that Twitter impressions for medical conferences have remained approximately the same 3 or increased 5 despite recent decreases in engagement, indicating that this disparity may be related to factors other than the switch to a virtual format. Social media fatigue provides a possible explanation. 4
A major benefit of the virtual format identified from this study was the significant increase in event participation. This change opened the conference to a larger cohort increasing the collective pool of knowledge and ideas. The increase in participation was likely due to the time effectiveness and flexibility provided by a virtual format. An additional major benefit is the increased ability to build and enrich mentorship regionally, nationally, and even internationally. Social media facilitates communication across physical borders and reduces barriers. Another benefit of the all-online conference is the increased cost-effectiveness. 6 The ACSCC 2020 virtual meeting registration was free of charge. This likely opens conferences to participants from diverse socioeconomic backgrounds, including those that are unable to attend in-person meetings.
The major disadvantage of the 100% virtual format identified by this study was the decrease in Twitter engagement and impressions. Tweeting and retweeting indicate actual interaction with conference information, providing the opportunity to spread information among presenters, participants, and the public. 7 Thus, decreased Twitter engagement and impressions may negatively impact dissemination of conference information through the Twitter platform.
Moving forward the compromise of a hybrid may combine the benefits and minimize the disadvantages. Individuals will be capable of participating from anywhere in the world regardless of socioeconomic status or time constraints, while in-person sessions will provide the benefits of face-to-face interactions. Strategies aimed at encouraging Twitter use among attendees could be implemented to spread conference related information. 8
Our study has limitations. Our analysis only captured Twitter hashtag activities during meeting timeframes. Therefore, the long-term interaction and dissemination of information after the conference concluded was not measured. Additionally, Symplur did not identify the details on the specific contents of every tweet and exactly what information was shared. Twitter allows any individual to interact with hashtags. It is therefore difficult to determine what proportion of twitter activity was from medical professionals. Our study also did not collect data on cost effectiveness or time efficiency of the 100% virtual format.
The switch to a 100% virtual format for the 2020 ACS-CC was associated with a significant increase in event participation. Conversely, the virtual format decreased the dissemination of information through social media evidenced by a decrease in both active and passive Twitter participation for the conference hashtag. Transition to a hybrid setup for future conferences may leverage the increase in online attendance while also providing in-person sessions. Efforts may be made to encourage Twitter use among conference attendees to increase the dissemination of information through social media.
Footnotes
Author Contributions: Study design and conception: A.E.
Data collection, interpretation and analysis: K.N., A.E., M.M.
Manuscript preparation: K.N., A.E., M.M.
Critical revision of manuscript: A.E., K.N., M.M.
All authors read and approved the final manuscript
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
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