Social media generally, and in particular platforms like Twitter, have been variously described as a bin fire, a sewer and a place for trolls. So why choose it as a platform for education?

Who bet­ter to ask than Dr Tris­tan Rut­land, NSW Health Pathol­o­gy anatom­i­cal pathol­o­gist, and the recent recip­i­ent of a pres­ti­gious US award for his self­less ded­i­ca­tion to pathol­o­gy education.

Dr Rut­land is also very pop­u­lar on Twit­ter. He’s no Elon Musk, but Tris­tan Rut­land (@TristanRutland7) has over 12,000 fol­low­ers and his use of the social net­work­ing plat­form to share and dis­cuss images of pathol­o­gy slides has attract­ed a devot­ed world­wide following.

The win­ner of the 2022 Col­lege of Amer­i­can Pathol­o­gists Res­i­dent Advo­cate Award and the 2020 Kon­rad Muller RCPA Out­stand­ing Teach­ing Award explained how the COVID pan­dem­ic fired his inter­est in what’s known as #PathTwit­ter – an inter­na­tion­al com­mu­ni­ty of pathol­o­gists shar­ing cas­es and edu­cat­ing each oth­er on how to avoid diag­nos­tic pitfalls.

“When the pan­dem­ic kicked off I end­ed up teach­ing our reg­is­trars via dig­i­tal, and that expand­ed to the point where I was teach­ing pret­ty much all the reg­is­trars in Aus­trala­sia in the RCP train­ing pro­gram every Sat­ur­day for four hours for six months,” Dr Rut­land explained.

“Then I had a cou­ple of them say­ing, ‘You should get involved in Twitter’.

“Now, social media has always been a bit of a bin fire, or a dump­ster fire, for me. It was always frus­trat­ing and peo­ple get­ting angry very quick­ly, so I just stayed clear of it. But then some­body intro­duced me to #PathTwit­ter and it’s just com­plete­ly the oppo­site of all that.

“Mar­ket­ing peo­ple would say, ‘it’s where the peo­ple are at’ – and it turns out Twit­ter is actu­al­ly one of the most per­fect plat­forms for pathology.

“You have to be suc­cinct, and you can show images, and that’s what peo­ple want.

“We’re busy peo­ple. Peo­ple can read what I post for two, three min­utes, and in a busy world it just seems to work.”

Dr Rut­land has a the­o­ry about why the med­ical com­mu­ni­ty, and pathol­o­gists in par­tic­u­lar, seem to have avoid­ed the nas­ti­ness that has come to be syn­ony­mous with social media.

“We’re all doc­tors who already have a cer­tain lev­el of eth­i­cal behav­iour,” he said.

“Peo­ple who choose to engage on Twit­ter in this edu­ca­tion­al capac­i­ty tend to be sort of more dynam­ic, for­ward-think­ing and will prob­a­bly not want to engage in (nasty behav­iour), that’s not their forum.

“Peo­ple tend to be quite pro­fes­sion­al and very sup­port­ive. I also have patients and oth­er pro­fes­sion­als fol­low­ing me so I’m always very aware of my behaviour.”

Dr Rut­land is also very keen to empha­sise that the shar­ing of infor­ma­tion is done with­out any iden­ti­fi­ca­tion of patients.

He only shares images of cas­es that are years, if not decades old, to avoid any con­nec­tion to patients and it’s all de-identified.

“The whole idea is not to talk about the patient. It’s about dis­cussing the pit­falls and the things that are impor­tant for some­one to learn and make a diagnosis.

“What do you think this pos­si­bly could be? What are the pit­falls and how do you get around it, a bit of a dis­cus­sion about how you could avoid mak­ing this mis­take and poten­tial­ly do a dis­ser­vice for your patients.

“Par­tic­u­lar­ly with unique cas­es, then there’s a big, big, time lag. If some­thing is super rare, you would­n’t put it up the next day, you’d wait a year.”

As much as he enjoys pass­ing on his knowl­edge, Dr Rut­land says he’s also learned from oth­er peo­ple shar­ing their cases.

“I do it because I enjoy teach­ing and I also get some­thing out of review­ing my old­er cas­es, but I have to admit I have been saved and peo­ple in our depart­ment have been saved by stuff that peo­ple have put up on Twitter.

“I’ve actu­al­ly been like, ‘Yes, I’ve seen some­thing like this’, and it’s changed a diagnosis.”

More than that, the plat­form has changed the way he col­lab­o­rates with col­leagues around the world, open­ing up new oppor­tu­ni­ties for learn­ing and research.

“Absolute­ly. I’ve just got an abstract accept­ed for USCAP (Unit­ed States and Cana­di­an Acad­e­my of Pathol­o­gy), which is over in the US next year, and I’m one of about 60 pathol­o­gists that have nev­er met in per­son, haven’t had a zoom call – it was all through Twit­ter,” he said.

“There are peo­ple putting out calls for papers and col­lab­o­ra­tion on Twit­ter, for peo­ple to get involved in research arti­cles, to be involved in new projects and new ini­tia­tives. It’s com­plete­ly changed the way peo­ple collaborate.

“I had no idea this would actu­al­ly be such a pow­er­ful tool.”

He hopes the vis­i­bil­i­ty of the #PathTwit­ter com­mu­ni­ty will attract more peo­ple to pathol­o­gy, a spe­cial­ty strug­gling for num­bers worldwide.

“The irony is we are one of the most active med­ical com­mu­ni­ties on social media, yet it’s still very dif­fi­cult to attract peo­ple. We have trou­ble get­ting peo­ple into our train­ing cours­es and that’s a real shame.

“It’s fig­ur­ing out how to trans­late what we do here into, not nec­es­sar­i­ly engag­ing the gen­er­al pub­lic, but increased recog­ni­tion in the med­ical world.”

He acknowl­edges pathol­o­gy is not often viewed as a “sexy option” for med­ical stu­dents but insists that rep­u­ta­tion is not deserved.

“If I had my time again, I’d do pathol­o­gy again. It’s such a great spe­cial­ty because it’s super inter­est­ing. Peo­ple go, ‘You’re just look­ing at lit­tle glass slides’, but once you know what you’re look­ing at, it’s actu­al­ly real­ly engag­ing, one of the most engag­ing things I’ve done in my life.”

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