Online academic community in the Asia‐Pacific countries: The paragon of a metamorphic world

There has been a remarkable shift in the ways and means of knowledge exchange in recent times, with an exponential increase in sharing information online while braving widespread lockdowns amid a raging pandemic.1 The widespread use of social media (SoMe) among the youth (up to 70% in some surveys) opens the case for building an online community for collaborative learning with a global outreach.2 Digitalization of medicine has ushered in an era of e-meetings, online mentoring, and e-collaborations, lending a unique enthusiasm and dynamics to an entire generation of scholars.3-5 Trending scientific information on #MedTwitter and #AcademicTwitter have made the conventional learning models less impactful, especially during the pandemic, which made physical presence an exception to the norm. However, these adaptive measures may be here to stay after the situation returns to normal.6 The use of SoMe for learning is notably slower among scholars in the Asia-Pacific region, albeit gaining momentum in recent times.7, 8 Central agencies like APLAR (Asia Pacific League of Associations for Rheumatology) have recorded a total number of 1127 followers on Twitter and 3835 followers on Facebook with a maximum engagement of 1708 people, while BSR (British Society of Rheumatology) has 13.1 k followers on Twitter (as seen in the first quarter of the year 2021). These numbers highlight the importance of increasing awareness about the scholarly use of SoMe among the youth of the Asia-Pacific region.9 The number of followers may be improved by a charismatic presence; however, the quality and credibility of the content plays a larger role. Central agencies like APLAR, American College of Rheumatology (ACR), European League Against Rheumatism (EULAR), and so on, hold the potential to be the torchbearers in leading education on SoMe platforms while dispersing information for the lay public. They also may act as the credible sources for reliable engagement with other scholars, practitioners, researchers, allied specialists, allied health professionals, nurse practitioners, and most importantly, patients with chronic diseases. Moreover, an increased presence of academics on such platforms will improve the representation of Asia-Pacific regional experts on a global platform, thus ensuring a holistic approach to shaping global communication and furthering scientific exchange.10 However, the scholars from the Asia-Pacific countries may potentially face specific limitations in using SoMe. In this brief, the authors discuss the current landscape of SoMe in the Asia-Pacific and explore solutions to enhance academic engagement on social media platforms (SMPs) for career advancement. The scholarly use of SMPs includes the collection, dissemination, and promotion of scientific literature and real-time events like conferences and scientific events.11, 12 Facebook is widely used for scientific communications in the Asia-Pacific region while Twitter is seen to have a better hold on the global level.13-15 This may be due to the open nature of the platform, and the diverse and wide userbase of Twitter which is designed to further professional communications, discussions, and relationships.16 Therefore, they help enhance the experience of large conferences such as those of ACR and EULAR, enabling quick sifting through content, amplification of breaking news, and highlighting “obscure” sessions that attendees may not be able to get to given the wealth of available content. Dissemination of information using audiovisual aids also helps to get across a large amount of information in a concise manner, allowing for intake of large chunks of information without fatiguing. The pandemic times saw a massive increase in the presence of academic journals on SMPs to reconnect with their reader base and enhance webometrics.17, 18 SMPs may help to connect with experienced mentors, all over the world, who help to upgrade learning, improve intercommunication and analytical skills of peers in the same field irrespective of their geographical location.19, 20 The EULAR regularly offers e-peer mentoring sessions which are open to rheumatology fellows from all regions. SMPs of central agencies such as APLAR can bust myths to tackle misinformation in brittle times such as now,21 by deploying their wide reach (Figure 1). A geographically diverse node and hub network of rheumatologists can take the lead in educating young trainees, practitioners, and academics, helping them turn into knowledgeable and skilled practitioners, researchers, and potentially, administrators (Figure 2). Several online tools for research have emerged in recent times, and SMPs assume the central role in reaching out to patients, and colleagues for opinion-based studies.22, 23 Information about open access datasets such as TrinetX were circulated online, as were invitations to join hands for a common rheumatology global alliance for expedited research on the coronavirus disease 2019 (COVID-19) and rheumatic diseases. Movements such as the Plan S and the Open Access Initiative make scientific literature freely available throughout the world.24 This makes scientific literature accessible to young scholars at no cost and also provides the opportunity to participate in related scientific discussions on SoMe platforms. However, the fee acts a barrier to publish in Open Access Journals and therefore is a mixed blessing. Citation rates of COVID-19-related papers increased during the COVID-19 pandemic due to the large volume of literature accrued in a short period of time on the subject.25 However, Altmetric scores assumed a larger role in projecting article visibility, and potential utility for practice, guidelines, and public advice.26 Infographics used for summarizing research assume a central role in conveying key points in an attempt to communicate better with a wider audience.27 SMPs house a large amount of academic information which acts as a haven for the lay public on the lookout for credible sources while dealing with widespread misinformation. However, the potential downside of scientific integrity and authenticity needs to be guarded.28 The availability of all information at the click of a button points to the possibility of an infodemic, which the medical fraternity should be wary about. Robust screening systems to allow for calling out misinformation and helping younger professionals identify genuine sources help in the case of an infodemic. Physicians take to SMPs for patient information, and at times even practice. In India, WhatsApp, due to its wide reach and penetrance, plays an important role in facilitating patient communication with doctors.29 Further, analysis by researchers of geo-sensed and time-stamped posts helps to identify public discussions on COVID-19 and predict outbreaks in a timely fashion, offering unique insights into the untapped potential of the apparently disorganized information on these platforms. Technology enthusiasts are exploring the possibility of digital transformation of practice, with an emerging online data bank, and deploying this for artificial intelligence (AI)-based approaches to further medical practice.30 This may address the gap in physician-patient ratios in developing countries in Asia. The Asia-Pacific region includes all the countries situated near the western Pacific Ocean, encompassing Central Asia, East Asia, North Asia-Russian Far East, South Asia, Southeast Asia, Central Asia Australasia, Melanesia, Micronesia, and Polynesia. North-East Asia possesses a higher range of internet penetration rate, a stark contrast from South-West Asia.31 The countries in the Asia-Pacific region are highly populous and have shown a sharp increase in SoMe presence, especially in China, Indonesia, India, and Japan.32 Facebook is widely used in this region followed by regional SoMe platforms like WeChat, Sina Weibo, Line, and TikTok.32 Trend shifts in the use of different SoMe platforms do occur as seen by the sudden boom in the use of TikTok in South-East Asia. These trends must be followed to stay relevant among the constantly changing SoMe dynamics. Twitter has very few users from this region as compared to the rest of the world, even though it is a common platform for scientific discussions.33 Some countries in this region practice strict regulations and have temporary restrictions on SoMe use which act as an impediment to sustained access to SoMe.34, 35 China constitutes a large percentage of the rheumatology workforce in Asia. SoMe platforms like QQ, WeChat and Sina Weibo are more popular in China.34 Therefore, platforms like Twitter where scholarly conversations take place on a global platform, perceive the absence of the participation of physicians from China. Additionally, scholars from the Asia-Pacific region have fewer international publications and presence as compared to the developed nations, although these numbers are consistently increasing.36, 37 Moreover, South-Asian journals have a poor social media presence on a global scale, reducing the visibility of their content causing poor publication standards and indexing.38 This puts the students of the Asia-Pacific region at an inherent disadvantage due to their under-representation on a global scale. English being the most common medium of conversation on SMPs, students with English as their second language face communication difficulties as they mostly use English secondarily to their native languages.39 The availability of the translate tool on Twitter has furthered interaction on the platform for non-English speaking (or those with English as a second language) scholars. Available machine translators like Google translator, Yandex, and Bing Translator also facilitate the participation of scholars with poor English fluency. Google translator has the widest range of interpretation, enclosing 107 languages, followed by Yandex and Bing Translator.40 Cultural influences may be inhibitive to a free opinion or freedom of expression, and a potential deterrent to the habit of free will and voicing one's thoughts on an open platform.41 There is a potential risk of miscommunications highlighting the need for a moderator and set of rules to maintain harmony. Moreover, professional avatars may differ from personal handlers, and it is imperative to keep professional accounts clean, follow cyber laws and follow the unsaid rules of the SoMe game. Places like Twitter may have a rapidly flammable environment, making it important to deal with sensitive issues professionally. Misinformation, incivility, cyberbullying, are unwelcome. Moreover, young scholars interacting with professional handlers of organizations or journals may need to be aware of professional ethics and the repercussions of controversial and non-evidence-based opinions. Thus, it is imperative to train scholars and practitioners to diligently use SMPs for the best professional growth and healthy networking. Lastly, the vast sea of social media offers innumerable possibilities, including entertainment, catharsis via art forms, and non-academic writing like poems, cartoons, and viewpoints.42, 43 The Asia-Pacific region nurtures enthusiastic youth, that has the potential to add to the global academic community by their novel ideas. Enhanced participation of the youth in global scientific exchange may also further individual careers, as well as scientific developments, in respective countries.44 Engagement of the youth in the research community under the supervision of experienced allies can help them attain full potential.45 Central agencies or professional societies encourage medical professionals and individual members by sponsoring their scientific studies and provide avenues for networking and enhancing scientific knowledge. Events held by the agencies act as opportunities to exhibit leadership skills and contribute to the scientific literature already available. This eventually benefits society at large.46 Various central societies like ILAR (International League of Associations for Rheumatology), EULAR, PANLAR (Panamerican League of Associations for Rheumatology), AFLAR (African League of Associations for Rheumatology), ACR, and BSR provide a wide array of opportunities for their members. APLAR is a central agency started in 1963 by 4 nations, Australia, India, Japan, and New Zealand, and is affiliated with ILAR with currently 34 members.47 APLAR helps to consolidate and propagate rheumatology endeavors in the Asia-Pacific region by providing state-of-the-art care to patients with arthritis and other rheumatic diseases and helping APLAR members with professional development, increasing the understanding and awareness of rheumatic diseases, and promulgating scientific research in the field of rheumatology.48 It has also helped nurture young scholars with education grants, rewarding ideas, and interest groups under the guidance of experienced mentors. This facilitates the building of an efficient and capable academic community. The online courses, educational projects, and training modules with supportive materials have helped members to build a much-needed medical academic community.49 APLAR has SoMe profiles on Twitter and Facebook. The Facebook profile showed an increase in followers by almost 3000 in 3 years. The age of their audience ranges between 25-34 years with 61% males and 38% females. Their largest audience is in Dhaka, Bangladesh, followed by Kathmandu, Nepal with a large majority of them accessing the information in English. The information shared on their profile reaches vast audiences residing in Taiwan, Bangkok, Singapore, Iraq, and South Korea. They also have a COVID updates page with 479 followers. To improve its outreach APLAR should expand its presence to other SMPs like Instagram and YouTube to connect with a diverse audience. Publishing newsletters, conducting certification courses on social media conduct, like the EULAR Twitter course, and having mentorship programs, allows for building of a vast online community. Young medical students can be involved by allowing them to send in small write-ups, poems, or animations for publishing. Images, including infographics or access to articles, videos with post-publication scientific discussions, and podcasts with mentor-mentee discussions, or young rheumatologist opinions, may help cater to the needs of the vast audience. Virtual congresses and online learning platforms are not only financially feasible but also have a wider impact showing a huge shift from yesteryear's physical forums. Extracting from the success of specialist trainings held by EULAR, APLAR too can provide for such curricula to improve the practice of rheumatology in the countries of the Asia-Pacific region. However, the impact of such curricula will be seen if there are no bottlenecks in joining central agencies. Intermediate agencies like member national organizations (MNO) play an important role in this sphere. An independent researcher should be allowed to obtain an APLAR membership online without the interference of a MNO, if they fulfill the requirements. This calls for a robust screening process to eliminate false personas and negative elements. Central agencies can pave the way for the increased participation of young scholars in the medical fraternity and provide them early exposure to the vast global medical community. The concept of intelligent tutoring systems and personalized learning platforms will capture a large component of the Asia-Pacific academic community. This will help ensure that young entrants in the field are updated and have a broad understanding of the rheumatology community. The use of SoMe in scholarly communication is the need of the hour with enriching global discussions taking place. Participation of the Asia-Pacific countries in such discussions will enhance the available scientific knowledge and allow for globally uniform healthcare. They will also lead to the formation of strong and sustaining social relationships and eventually help with improving healthcare practice throughout the world. This brief calls to action young scholars to join academic discussions on SMPs, especially Twitter, and identify the need for scientific representation and contribution on a global scale. The improved global scientific contribution will lead to the betterment of rheumatology in particular, but also medicine and humanity in general. PSG, SS and LG: preparation of the first draft. HA, IL, GH, PW, CYK, BS, DD and AUH: revision of manuscript and critical and intellectual inputs.

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