What is the largest audience you have ever taught? Until recently, my answer was in the double digits. However, the world is changing.

Asynchronous medical education using social media is a powerful tool with growing popularity. In the COVID-19 era, the decline of in-person didactics has been met with a robust rise of digital education in the form of social media, podcasts, webinars and more. Tweetorials are an increasingly popular and, when done right, effective medium for education. So, what is a Tweetorial and how do you create one?

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What is a Tweetorial?

Tweetorials are a thread of multiple individual tweets linked together to tell a story. While the 280-character limit constrains individual tweets to focused morsels, these can be threaded together as Tweetorials to express complex ideas. Tweetorials democratize education from the learners’ perspective by disseminating to a large audience, and from the educators’ perspective by empowering even our most junior colleagues to teach. This is balanced by the wonderful discussions that ensue, often involving content experts and serving as an organic and engaging form of peer review.

How do you create a Tweetorial?

Many terrific educators have never used Twitter to teach, which is to the detriment to millions of potential learners. Imagine the impact you could have using Tweetorials! Perhaps all you need is a gentle nudge. So here it is!

Here is a straightforward approach to teaching via Tweetorials using five steps plus five tips, or "click tweet" for short.

Five Steps

1. Choose a topic.

You are ready to become a Twitter educator! But first, you need something to teach. Begin by choosing the main topic for your Tweetorial. For greatest impact, I suggest three categories:

1. A question from patient care: Starting with a clinical question will benefit your learners and your own practice! For example, after seeing a patient with classic angina and a negative coronary angiogram, I wondered about the next step. This led me to create a Tweetorial about coronary microvascular disease. But first, do no harm; protect your patient's privacy by omitting identifying information.
2. A common knowledge gap: This is a great way to bridge a gap among colleagues and possibly even impact their practice. For example, after reading about widespread undertesting for primary aldosteronism, I created a Tweetorial about  testing for primary aldosteronism.
3. A physiologic curiosity: Anthony Breu, MD, wrote beautifully in his New England Journal of Medicine perspective on Tweetorials about the power of asking "Why?" He has crafted several fascinating Tweetorials for a variety of questions like why myocardial ischemia causes dyspnea.

2. Learn the topic.

Here comes the fun part! Choose your topic. Now dive in and become the expert. Read as much as you can to fully grasp what you want to teach. I prefer beginning with high-quality reviews, but other starting places include UpToDate, Google and (depending on your topic) news outlets. From there, dig deeper into the literature. Keep track of high-yield concepts, relevant data, illustrative figures and authors with a Twitter presence. Build your bibliography as you go so you can cite your work in your tweets. If you found the article interesting, chances are that your learners will also!

3. Identify learning objectives.

As with any lecture, an impactful Tweetorial needs well-defined learning objectives. What should your learners take away from your Tweetorial? These should be clear, specific and sequential such that one flows into another. Craft them as questions that can draw in their interest. For example: How do you interpret the aldosterone-to-renin ratio (ARR)? Such learning objectives will form the backbone organization and help formulate polls. Identify about three to five learning objectives. Consider an early tweet outlining the learning objectives and a later tweet summarizing the key takeaways.

4. Create teaching points.

Populate key teaching points for each objective; these build your individual tweets. For example, in which circumstances would an ARR yield a false positive or false negative result? Create about two to four teaching points per objective for a total Tweetorial length of 10 – 15 tweets. Use the data and figures you collected in step #2 to support your teaching points and make them more engaging.

5. Knit it all into a Tweetorial.

Congratulations! By now, you have all the ingredients for a deliciously educational and captivating Tweetorial. Use your preferred application – OneNote, Microsoft Word, Evernote, etc. – to draft your Tweetorial. Include the text, references, polls, images, videos and colleagues you want to tag. Craft each tweet on Twitter to ensure you are within the 280-character limit and then copy into your draft. Once you Tweet, you cannot edit (I learned this the hard way), so proofread! Finally, create your Tweetorial and (drumroll) click the "Tweet" button to teach the world!

Five Tips

1. Tempt your audience.

Your first tweet is key to drawing in learners. You can tempt them with different tools like a question, poll, media or case – experiment with different methods!

2. Wrap it up within 10-15 tweets.

Based on a survey by Anthony Breu, MD , learners may stop reading your Tweetorial if it is too long; the optimal length is probably 10 – 15 tweets. However, do not let this limit you; your topic may be better suited by a shorter or longer Tweetorial.

3. Evaluate their knowledge.

Use poll(s) to evaluate your learners. If everyone gets the right answer, you might reconsider our learning objectives next time. Some repeat the key poll(s) at the end to see if the learners' learned from the Tweetorial. Polls also help make the learner an active participant which brings us to the next tip.

4. Engage your learners.

Hold onto your learners' attention by maximally engaging their interest and curiosity. The same survey found figures, linked references and polls to be valuable components in Tweetorials. Many among the #MedTweetorial audience are clinicians; bring it back to the bedside to keep it relevant. One way to do so is interweaving a case throughout your Tweetorial. Consider using questions to transition between tweets to keep them at the edge of their seats!

5. Tag colleagues to amplify your teaching.

Tag colleagues who would want to amplify your teaching by retweeting. But do not just follow followers. Your tags will be more welcomed and effective if you match the content to the interests of those you tag. Tagging authors who wrote the articles you cite are a great way to both engage an interested audience and get feedback from content experts. Consider using images to add tags without using valuable characters.

Most importantly, this is just a guide. See what works for you as you discover your own Twitter voice! As you get started, I recommend this review about social media with tips and cautions by Purvi Parwani, MD, FACC, Martha Gulati, MD, MS, FACC, et al. For more on Tweetorials, follow Anthony Breu, MD. His influential work truly advanced and popularized Tweetorials as effective vehicles for education.

You are now ready to teach the world! I encourage you…no…rather, I challenge you to submit your teachings to #MedTwitter in the form of a Tweetorial. The next time someone asks you about the largest audience you have ever taught, the answer will not be in the double or even triple digits, but rather in the six to seven digits. All you have to do is "click tweet!"

This article was authored by Amit Goyal, MD, Fellow in Training (FIT) at Cleveland Clinic in Cleveland, OH. Twitter: @AmitGoyalMD