To tweet or not to tweet, that is the question: A randomized trial of Twitter effects in medical education.

INTRODUCTION:Many medical education journals use Twitter to garner attention for their articles. The purpose of this study was to test the effects of tweeting on article page views and downloads. METHODS:The authors conducted a randomized trial using Academic Medicine articles published in 2015. Beginning in February through May 2018, one article per day was randomly assigned to a Twitter (case) or control group. Daily, an individual tweet was generated for each article in the Twitter group that included the title, #MedEd, and a link to the article. The link delivered users to the article's landing page, which included immediate access to the HTML full text and a PDF link. The authors extracted HTML page views and PDF downloads from the publisher. To assess differences in page views and downloads between cases and controls, a time-centered approach was used, with outcomes measured at 1, 7, and 30 days. RESULTS:In total, 189 articles (94 cases, 95 controls) were analyzed. After days 1 and 7, there were no statistically significant differences between cases and controls on any metric. On day 30, HTML page views exhibited a 63% increase for cases (M = 14.72, SD = 63.68) when compared to controls (M = 9.01, SD = 14.34; incident rate ratio = 1.63, p = 0.01). There were no differences between cases and controls for PDF downloads on day 30. DISCUSSION:Contrary to the authors' hypothesis, only one statistically significant difference in page views between the Twitter and control groups was found. These findings provide preliminary evidence that after 30 days a tweet can have a small positive effect on article page views