Feature

Monday Night IBD offers GIs, experts a new way to discuss cases

Aline Charabaty
Aline Charabaty

The phrase “Monday night” often instills images of professional football played under the lights in front of national audiences.

However, the phrase “Monday night” has a different meaning for some experts in inflammatory bowel disease. Instead of scrambling for their remotes or a TV to watch the game, many are dashing for their phones or computers to buckle down and participate in a conversation.

Several months ago, Aline Charabaty, MD, director of the IBD Center at Johns Hopkins School of Medicine at Sibley Memorial Hospital threw a case discussion up on her Twitter page, and that Hail Mary has turned into a weekly event where hundreds of individuals, including IBD specialists, gastroenterologists, other clinicians and patients with IBD, interact about any given topic related to the treatment and management of IBD.

Charabaty (@DCharabaty) spoke with Healio Gastroenterology and Liver Disease about the weekly Twitter discussion that is #MondayNightIBD, how it got started and how she hopes it will help educate everyone. – by Ryan McDonald

Healio: How did the premise of Monday Night IBD come about?

Charabaty: I posted an IBD case on a Monday at the end of March, followed by a “what would you do poll” with several answer options, and tagged a few of my IBD colleagues. More than 200 clinicians took the poll, and this clinical question generated a great discussion, with seasoned and emerging IBD experts as well as general gastroenterologists, sharing their opinion, tweeting links to articles, and trying to come to a consensus. People really got excited by this type of forum, and suggested that we should have this kind of conversation more often, and we came up with the #MondayNightIBD. I then assigned someone to post a case for the next Monday and another expert for the following week, and it snowballed very quickly from there. Originally, I was hosting these convos on my Twitter page, but the interest was growing so fast that it needed its own page and the @MondayNightIBD handle was created.

It was a very spontaneous project, but it was all about recognizing that there was a need to have a platform where clinicians with different expertise, from different parts of the country and the world, could come together and discuss cases without the constraints of time and space, something that only social media can offer.

There are many clinical questions we ask ourselves on a daily basis when caring for patients with IBD and not every clinical situation has an answer in clinical trials, studies or professional guidelines. Sometimes there’s conflicting data from different studies, new studies results contradict older guidelines, and often guidelines are not uniform between different professional societies within or outside the U.S. There are also several areas of gaps in our knowledge, and that’s where physicians struggle and have to rely on clinical experience, instinct, a colleague’s expertise, personal interpretation of scientific data and new research findings to individualize the care of our patients.

Healio: How far in advance do you schedule the weekly discussions, and how does the process work?

Charabaty: I understand that we are all very busy juggling our professional and personal lives, so I ask clinicians to commit to a date many weeks to months ahead of time. A few weeks before a discussion, we decide on a topic that aligns with the moderator’s expertise or particular area of research. My goal is to highlight the expertise and the passion of each clinician, and to give this opportunity to everyone: you will see topics led by renowned experts in the field, but also by emerging IBD leaders and researchers, GI fellows, colorectal surgeons, dieticians, psychologists and other experts. We often invite other medical specialties to participate in the conversation when needed. For example, Natalia Queiroz, MD, PhD, [@QueirozNataliaF] discussed how to best approach a patient with Crohn’s disease who tests positive for tuberculosis. The moderator and I put together the clinical vignette and poll, to fit in the Twitter word count limits but also to make sure it will generate interest, and we later co-lead the conversation to ensure a good discussion flow.

Healio: What are some of the goals of Monday Night IBD?

Charabaty: The main goal of @MondayNightIBD is to be an open platform that brings clinicians from academic and private practice, from different areas in the U.S. and the world together to engage with each other and to share their knowledge, expertise, scientific data and their interpretation of the data to best approach complex or controversial IBD situations. You can consider it as the modern portable social media version of a multidisciplinary case conference, at your (smart phone or laptop) fingertips, in the comfort of your home with quick access to worldwide experts in the field. In addition, the platform is a very effective way to promote clinicians with a focus in IBD, amplify their research and network with various other clinicians. Often now, gastroenterologists tweeting an interesting study or an IBD question, will tag @MondayNightIBD to gather other’s opinions. The results of the clinical vignette polls and the discussions also highlight areas where there is conflict in data interpretation. For example:

  • What does treat to target mean in Crohn’s disease, led by Edward Loftus, MD, [@EdwardLoftus2];
  • Does proactive therapeutic drug monitoring change disease course, led by Waqqas Afif, MD, [@waqqasafif];
  • Do we treat asymptomatic ileitis, led by Alan Moss, MD, [@moss_md];
  • Approach to refractory pouchitis, led by Florian Rieder, MD, [@IBD_FloMD], and
  • Pre-op nutrition optimization led by Kelly Issokson, MS, RD, [@GIdietitian].

My educational goal with @MondayNightIBD is to bring these issues, and so many more, to light and identify areas where more research is needed, disseminate the scientific data and the guidelines when available, share the insights of IBD experts on a worldwide forum, and subsequently improve the care of patients.

But there is one more goal that makes @MondayNightIBD special – giving a voice to patients with IBD to educate and improve a clinician’s understanding of the patient experience. Our patients often turn to social media to find answers to their questions, and unfortunately there is a lot of pseudo-science or blunt snake oil advice out there. It is our duty as physicians to reach out to patients where they are (which is on social media) and share with them evidence-based scientific information. Every Wednesday, Alison Rothbaum, an IBD patient advocate [@Empoweringpts9] and I put together a poll for patients with a question related to the topic discussed earlier that week with clinicians. The poll gives patients the opportunity to share their experience. For example, when we polled patients on whether or not their physicians reviewed their vaccination history, less than half responded with the affirmative.

By raising awareness on this topic, now patients can go back to their doctor and say, “I heard that vaccines are important for patients with IBD, what should I do?”

This kind of conversation has two main goals – to use @MondayNightIBD platform to educate patients, but also identify areas where we need to do better in educating our GI colleagues and optimizing the care of those patients. Some #PatientExperience polls aim at fostering a better understanding from clinicians of our patients’ needs and perspectives. After our conversation on GI fellowship training in IBD led by Manasi Agrawal, MD, [@ManasiAgrawalMD] and Mohammad Bilal, MD, [@BilalMohammadMD], we asked patients what they valued most in their treating physicians. What we learned is that while physicians are focused on accumulating medical knowledge, patients want someone who takes the time to listen and explain. Our priorities as physicians are sometimes not aligned with the patients’ needs, and I hope that @MondayNightIBD can help with closing this gap.

Disclosure: Charabaty reports no relevant financial disclosures.

Aline Charabaty
Aline Charabaty

The phrase “Monday night” often instills images of professional football played under the lights in front of national audiences.

However, the phrase “Monday night” has a different meaning for some experts in inflammatory bowel disease. Instead of scrambling for their remotes or a TV to watch the game, many are dashing for their phones or computers to buckle down and participate in a conversation.

Several months ago, Aline Charabaty, MD, director of the IBD Center at Johns Hopkins School of Medicine at Sibley Memorial Hospital threw a case discussion up on her Twitter page, and that Hail Mary has turned into a weekly event where hundreds of individuals, including IBD specialists, gastroenterologists, other clinicians and patients with IBD, interact about any given topic related to the treatment and management of IBD.

Charabaty (@DCharabaty) spoke with Healio Gastroenterology and Liver Disease about the weekly Twitter discussion that is #MondayNightIBD, how it got started and how she hopes it will help educate everyone. – by Ryan McDonald

Healio: How did the premise of Monday Night IBD come about?

Charabaty: I posted an IBD case on a Monday at the end of March, followed by a “what would you do poll” with several answer options, and tagged a few of my IBD colleagues. More than 200 clinicians took the poll, and this clinical question generated a great discussion, with seasoned and emerging IBD experts as well as general gastroenterologists, sharing their opinion, tweeting links to articles, and trying to come to a consensus. People really got excited by this type of forum, and suggested that we should have this kind of conversation more often, and we came up with the #MondayNightIBD. I then assigned someone to post a case for the next Monday and another expert for the following week, and it snowballed very quickly from there. Originally, I was hosting these convos on my Twitter page, but the interest was growing so fast that it needed its own page and the @MondayNightIBD handle was created.

It was a very spontaneous project, but it was all about recognizing that there was a need to have a platform where clinicians with different expertise, from different parts of the country and the world, could come together and discuss cases without the constraints of time and space, something that only social media can offer.

There are many clinical questions we ask ourselves on a daily basis when caring for patients with IBD and not every clinical situation has an answer in clinical trials, studies or professional guidelines. Sometimes there’s conflicting data from different studies, new studies results contradict older guidelines, and often guidelines are not uniform between different professional societies within or outside the U.S. There are also several areas of gaps in our knowledge, and that’s where physicians struggle and have to rely on clinical experience, instinct, a colleague’s expertise, personal interpretation of scientific data and new research findings to individualize the care of our patients.

Healio: How far in advance do you schedule the weekly discussions, and how does the process work?

Charabaty: I understand that we are all very busy juggling our professional and personal lives, so I ask clinicians to commit to a date many weeks to months ahead of time. A few weeks before a discussion, we decide on a topic that aligns with the moderator’s expertise or particular area of research. My goal is to highlight the expertise and the passion of each clinician, and to give this opportunity to everyone: you will see topics led by renowned experts in the field, but also by emerging IBD leaders and researchers, GI fellows, colorectal surgeons, dieticians, psychologists and other experts. We often invite other medical specialties to participate in the conversation when needed. For example, Natalia Queiroz, MD, PhD, [@QueirozNataliaF] discussed how to best approach a patient with Crohn’s disease who tests positive for tuberculosis. The moderator and I put together the clinical vignette and poll, to fit in the Twitter word count limits but also to make sure it will generate interest, and we later co-lead the conversation to ensure a good discussion flow.

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Healio: What are some of the goals of Monday Night IBD?

Charabaty: The main goal of @MondayNightIBD is to be an open platform that brings clinicians from academic and private practice, from different areas in the U.S. and the world together to engage with each other and to share their knowledge, expertise, scientific data and their interpretation of the data to best approach complex or controversial IBD situations. You can consider it as the modern portable social media version of a multidisciplinary case conference, at your (smart phone or laptop) fingertips, in the comfort of your home with quick access to worldwide experts in the field. In addition, the platform is a very effective way to promote clinicians with a focus in IBD, amplify their research and network with various other clinicians. Often now, gastroenterologists tweeting an interesting study or an IBD question, will tag @MondayNightIBD to gather other’s opinions. The results of the clinical vignette polls and the discussions also highlight areas where there is conflict in data interpretation. For example:

  • What does treat to target mean in Crohn’s disease, led by Edward Loftus, MD, [@EdwardLoftus2];
  • Does proactive therapeutic drug monitoring change disease course, led by Waqqas Afif, MD, [@waqqasafif];
  • Do we treat asymptomatic ileitis, led by Alan Moss, MD, [@moss_md];
  • Approach to refractory pouchitis, led by Florian Rieder, MD, [@IBD_FloMD], and
  • Pre-op nutrition optimization led by Kelly Issokson, MS, RD, [@GIdietitian].

My educational goal with @MondayNightIBD is to bring these issues, and so many more, to light and identify areas where more research is needed, disseminate the scientific data and the guidelines when available, share the insights of IBD experts on a worldwide forum, and subsequently improve the care of patients.

But there is one more goal that makes @MondayNightIBD special – giving a voice to patients with IBD to educate and improve a clinician’s understanding of the patient experience. Our patients often turn to social media to find answers to their questions, and unfortunately there is a lot of pseudo-science or blunt snake oil advice out there. It is our duty as physicians to reach out to patients where they are (which is on social media) and share with them evidence-based scientific information. Every Wednesday, Alison Rothbaum, an IBD patient advocate [@Empoweringpts9] and I put together a poll for patients with a question related to the topic discussed earlier that week with clinicians. The poll gives patients the opportunity to share their experience. For example, when we polled patients on whether or not their physicians reviewed their vaccination history, less than half responded with the affirmative.

By raising awareness on this topic, now patients can go back to their doctor and say, “I heard that vaccines are important for patients with IBD, what should I do?”

This kind of conversation has two main goals – to use @MondayNightIBD platform to educate patients, but also identify areas where we need to do better in educating our GI colleagues and optimizing the care of those patients. Some #PatientExperience polls aim at fostering a better understanding from clinicians of our patients’ needs and perspectives. After our conversation on GI fellowship training in IBD led by Manasi Agrawal, MD, [@ManasiAgrawalMD] and Mohammad Bilal, MD, [@BilalMohammadMD], we asked patients what they valued most in their treating physicians. What we learned is that while physicians are focused on accumulating medical knowledge, patients want someone who takes the time to listen and explain. Our priorities as physicians are sometimes not aligned with the patients’ needs, and I hope that @MondayNightIBD can help with closing this gap.

Disclosure: Charabaty reports no relevant financial disclosures.