Only the Bluesky is the limit: ten tips for a trending #Skytorial Open Access

ABSTRACT

Threaded online medical education first emerged on X (formerly Twitter) in early 2018 following the introduction of a threading feature in December 2017, with nephrologists quickly becoming enthusiastic adopters. However, changes like paid features and weakened content moderation have led many nephrologists and allied professionals to migrate to other platforms, which offer the potential for a more suitable environment for learning and discussion. The 2024 US presidential election and growing disillusionment with X has accelerated this shift. By late November 2024, Bluesky appears to have reached critical mass, and we propose that it will become a major social media platform in nephrology. To this end, we provide 10 tips to compose educational material for use on Bluesky. We suggest a clean break with regards to terminology and propose the term ‘skytorial’. Starter packs can help rebuild networks on Bluesky. Skytorials need to be planned with thought given to audience and scope. The first post is important: like a hook in fishing, it needs to interest the audience and establish contact. Emojis and visual content can be used to generate interest. Skytorials need to be concise and less is often more. Tagging and the use of hashtags is important, as is a good take-home message. Finally, it is important to check the entire skytorial before posting it. The arena of social media is constantly evolving and the future is difficult to predict. However, given the rapidly growing popularity of Bluesky, we believe nephrologists should now explore the opportunities of the new platform.

INTRODUCTION

The term tweetorial arose as a portmanteau combining tweet and tutorial with the aim of overcoming Twitter's character limit [1]. Tweetorials became increasingly popular during the COVID-19 pandemic [2] and X was for years the main social media platform in nephrology [3]. Educational initiatives, such as online journal clubs, also became very popular [4].

However, more recently, the use of X has been marred by controversies, mainly around disinformation [5] and advertisements and also in relation to influencing elections [6]. The migration of scientists from X to its competitor, Bluesky, is now well under way. As part of this development, nephrologists and the wider renal community have arrived on Bluesky in large numbers. The success of the growing renal community on the new platform will be critically dependent on the educational material provided there. There are various reasons why people read such material—mostly to learn, to discuss and share insights with others or out of curiosity [9]. Online educational material has already begun to substitute traditional pathways for education [7] and constitutes a new form of scientific writing [8]. It is therefore key that high-quality threaded educational material be provided on the new platform.

We acknowledge the uncertainty in trying to predict the future of social media. However, based on our own experiences, we feel that there is significant momentum with Bluesky and that it is now time to explore its use for online educational activities. The challenge we feel is to build on the amount of scientific discussion, dialogue and debate that we enjoyed in the early days of X/Twitter and improve our online presence further on the new platform. Here, we provide a practical guide on how to create, compose and use threaded educational material on Bluesky, and we suggest the term ‘skytorial’ for this form of information on the new platform.

TIP 1: GOODBYE TWEETORIAL—HELLO SKYTORIAL!

The migration of nephrologists from X to Bluesky occurred for several reasons, including the increasing number of advertisements, paid content and unsolicited direct messages. The increasing amount of disinformation also played a major role [5, 10]. However, there is no doubt that most of the ‘digital migrants’ finalized their decision to abandon X shortly after the 2024 US presidential election, where there was objection to the use of X for political purposes, leaving users feeling that their values no longer aligned with those supported by the platform. On that basis, we feel that a complete change in terminology is required and that continued use of terms used on X would not be appropriate on Bluesky. The term ‘#Nephsky’ has been coined already to replace ‘#Nephrotwitter’. The term ‘skeet’ has been suggested to describe a post on Bluesky, but the discussion is still under way on the use of this term, and ‘post’ is also used on a regular basis. We propose the term ‘skytorial’ as an alternative to replace tweetorial.

TIP 2: USE STARTER PACKS TO REBUILD YOUR AUDIENCE ON BLUESKY

Rebuilding an online community in a relatively short period of time is not easy given that many nephrologists had hundreds and in some cases thousands of followers on X. The challenge of recreating networks that took years to grow on X also applies to institutions and their followers and to the journals and educational initiatives in our specialty. Therefore, the number of followers of an account posting a skytorial is key to success.

Importantly, Bluesky features ‘starter packs’ that allow new arrivals to follow many accounts within nephrology all at once to grow the number of accounts followed much more quickly than would have been the case on X. We speculate that the rapid development and adoption of starter packs has been a crucial factor in enabling the rapid growth of the Bluesky renal community ahead of other medical specialties to date. Six starter packs for nephrology exist already as of 30 November 2024, with thousands of accounts owned by nephrologists and their teams, by renal institutions and by journals. Uncritical use of these starter packs may not necessarily be the appropriate approach for the official account of a renal journal, as it would be difficult to be sure about the nature of all the accounts followed. However, this approach may be considered by newly arriving social media teams or editors, as it will allow them to follow a large percentage of the Bluesky renal community within seconds of their arrival on the platform. Many of the accounts followed will follow back shortly, leading to an instant and rapid growth in followers. This will guarantee a significant audience even for relatively new Bluesky accounts from which a skytorial is posted.

Transfer of previous content, i.e. older posts from X to Bluesky, is also worth considering. It is of course possible to simply copy and repost old posts from X on Bluesky, but this is very cumbersome. Several apps, such as SkyFollowerBridge, are now available to facilitate the transition and transfer posts and followers. There are also commercial providers that will take care of the entire migration process for a fee. Such an approach may be worth considering for journals and their social media teams, e.g. if they want to transfer complex or valuable educational content from X to Bluesky.

TIP 3: LEARN ABOUT OTHER DIFFERENCES BETWEEN X AND BLUESKY AND PROMOTE REPOSTS

A full review of all technical differences between X and Bluesky is beyond the scope of this article, but there are some salient points to consider: previously invitation only, Bluesky became open to the public in February 2024. On Bluesky, the current word limit stands at 300 characters per post, so skytorials need to be relatively short (see Tip 7). Polls are not currently available on Bluesky and there is a 1-minute limit on embedded videos, with links to YouTube preferred for longer videos. Another important point to consider is the differential between likes and reposts in reaching a large audience: due to the difference in algorithms, on Bluesky liking is not very effective in reaching a large audience, whereas reposting is. It is therefore worth asking the audience to repost a skytorial and not just like it. Table 1 provides an overview of key technical differences between the two platforms.

TIP 4: DEFINE SCOPE/LENGTH AND CONSIDER THE INTENDED AUDIENCE

Before starting the skytorial it is important to be clear about its scope and intended audience. The latter will dictate the level of depth of the discussion but will also influence whom to ‘tag’. During the planning process, it is advisable to seek input from colleagues in the target audience regarding their preferences for content, scope and level of detail. In addition to reading some of the existing scientific literature on the topic, it may be useful to find the most recent editorial comment or pro/con debate as well to get a feel for current controversies and areas of uncertainty. Next, one should have a brief think on the length of the skytorial and which software platform to use when composing it (word processor, shared online document, etc.). It is also worth bearing in mind that, unlike X, Bluesky does not currently feature a draft option on the platform itself. In general, most successful skytorials will comprise up to 10 individual posts in a thread.

TIP 5: START WITH A BANG AND INVEST IN A GOOD ‘HOOK’

Traditionally, the first post of a thread has been referred to as the ‘hook’ [11], although perhaps for Bluesky a different term could be invented. As in fishing, the hook is intended to fascinate the target audience, spark curiosity and establish permanent contact, in this case until the entire skytorial has been read. The first post also typically receives the most engagement and the highest number of reposts, which can push the initial post to a wider audience, potentially making it the only one people see. Despite your best efforts, some readers will stop reading after the first or second post of the thread. A successful skytorial is therefore one that keeps readers engaged from the beginning to the end. There are several ways to create a good ‘hook’ and most of them use a relatable everyday experience [1]. For example, in a skytorial on bedside ultrasound to determine dry weight for nephrology trainees one could use the common scenario of a dialysis patient with a fractured hip who is bed bound and where determination of dry weight is notoriously difficult. Many trainees, but also experienced nephrologists, will have experienced this scenario, and the challenge will likely resonate with them. One can also start by sparking the reader's curiosity (e.g. Have you ever heard of cosmic kidney disease and wondered how living in space affects the kidney?). Another way is to share a surprising fact (e.g. What if I told you that proteinuria in nephrotic syndrome was earlier treated by immersing patients in hot tubs and inserting needles). Lastly, sharing breaking news about a recent discovery can pique your audience's interest (e.g. Have you found yourself thinking that antinephrin antibodies may revolutionize our understanding of focal segmental glomerulosclerosis?). The first post should not only capture attention but should also appear in search results when people search keywords. Research the terms related to your topic and identify the keywords that are frequently used and the discussions around them. This helps tailor the first post to reach its target audience. The first post should also briefly describe the scope of the skytorial and may also name the intended audience (e.g. mid-level nephrology trainees, nephrologists with an interest in renovascular disease, etc).

TIP 6: USE EMOJIS AND VISUALS TO ENGAGE THE AUDIENCE

Some skytorials are narrative and limited to text that may be perfectly appropriate in, for example, a reflective post around ethics. For most topics though, this approach struggles to keep readers interested and engaged. Emojis can help to overcome this challenge: they can be used to generate interest or accentuate statements. Emojis can also add personality where that is intended [12] and help to establish a ‘brand’, i.e. where a defined set of emojis are recognizable in all skytorials authored by an individual or group. There is reason to believe that overall the use of emojis is increasing [13], although excessive use of emojis is likely to distract readers [1].

Use of visual content is equally important, and it may be useful to employ a clinical image, graph or diagram as part of the ‘hook’ to interest readers. During the main body of the skytorial it is best to use visual content sparingly, e.g. to emphasize key points or to summarize. Visual media significantly improves engagement, with some studies reporting 150% more retweets for visual content compared with text [14]. As a result, most posts now include visuals to help substantiate claims, arguments or overarching points. There are many different visual formats that can be used. Static images like graphs, screenshots and clinical photos are commonly used to display results and for educational purposes. Most nephrology journals now include visual abstracts to summarize articles, and these can be used for a skytorial. It is crucial that images are clear and high-resolution, and any accompanying text should be concise, allowing the visuals to convey the message. GIFs or videos add dynamic elements and are useful for punctuating points or summarizing processes. Memes with reference to popular culture can boost reader engagement with humour and additional tools such as picture generators can be helpful to create and design specific infographics. Visual citations, such as images of manuscripts, can be used to reference data or literature and services like Bitly or tinyURL can provide concise citations. Inserting media is easy, but videos are limited to 60 seconds. Longer videos can be embedded through YouTube (Table 1).

TIP 7: LESS IS OFTEN MORE

Concise skytorials will ensure that readers remain focused and do not become overwhelmed by information. It is often useful to tell the audience how many posts there will be in a skytorial and how long it will take to read. Previous surveys on X [9] suggested that most people prefer a thread that is 10–15 posts in length, and similar perceptions are likely on Bluesky. We would suggest 6–8 posts for a skytorial on a focused topic or if providing an overview and approximately 8–12 posts for larger or more complex topics. Summaries, figures or take-home points should be saved for the final posts.

TIP 8: USE TAGS AND HASHTAGS AND CLARIFY ROLES

Tagging and hashtags are invaluable and strengthen the scope, visibility and content of the post. Tagging boosts engagement, as research authors and tagged users are more likely to respond, repost or take part in discussions. This allows firsthand insights from those involved, answers to readers’ questions and expert opinions to enrich the conversation. Tagging and hashtags also enhance visibility, as followers of tagged users will be notified about the post, and using trending hashtags means the post may be seen by those not already following you or your tagged users directly. Hashtags make a post searchable, boosting visibility and connecting it to others discussing the same topic. Tagging and hashtags therefore improve networking by widening your audience and highlighting you and your content to those who may be interested in collaborating.

Importantly, tagging authors of original work also gives much deserved recognition to those involved in the research. In the future it is likely that social media metrics, or altimetrics, will be used to measure research outputs rather than solely the traditional methods. Finally, by clarifying roles, such as the role in posting a skytorial or how tagged users are involved, provides users with essential context on the perspectives shared. This helps readers understand the source of views and enables authors to highlight if the views are their own or represent those of organizations they may be affiliated with. This creates transparency and improves the credibility of the post if readers can easily identify where information is coming from and with what aim.

TIP 9: END WITH A SUMMARY, DO A FINAL CHECK BEFORE YOU POST AND CHECK STATISTICS AFTERWARDS

Finishing your skytorial with a summary or conclusion holds numerous benefits. First, concisely summarizing key points helps reinforce important content and key ideas and aids retention. It is also a chance to signpost to other related resources that users might find beneficial but are outside the scope of your skytorial. An inspiring conclusion can leave a lasting impression on readers and highlight unanswered questions or areas for further discovery. Further reading and links can be added for readers who wish to learn more about the topic. Fig.1 summarizes the suggested structure of a skytorial.

We all tend to make mistakes while writing, especially when we are in a hurry, but proofreading the entire skytorial is a ‘must’. Tagging accounts related to your posts is a good way to increase engagement, but checking if correct accounts are tagged would be wise. Notably, reviewing the visuals is essential to avoid posting in the wrong post. Links to further information should be double-checked as well, as they can change or move. If a URL and a visual are simultaneously used in a post, the focus might be on the first one you copy. Therefore, we suggest inserting the visual first to ensure its visibility since it is generally more attractive. Finally, autocorrect issues are important. It might be a good idea to turn this setting off if you frequently post from your phone.

Although metrics do not mean everything, they are still significant. Statistics of your skytorial will show numbers of reposts and likes, whereas the number of impressions is not currently available on Bluesky. We speculate that such information will soon be available, too. Tagging relevant accounts may increase quote posts, reposts and engagement rate thereof. Notably, posting during prime time is important. We have observed that academic users of X are usually online in the evenings of workdays. In addition, pinning the first post of your most recent skytorial to your profile might result in an increase in engagement.

TIP 10: LEARN FROM PREVIOUS EXPERIENCE, EMBRACE THE OPPORTUNITIES OF BLUESKY AND MAKE IT A BETTER PLACE

Incivility and anger have been key issues on X, and we would suggest that they have also served as key factors to drive the migration to Bluesky. For many years, X has been the home to social media in nephrology, with all its educational initiatives [4]. Bluesky is a new and exciting avenue to meet, learn and interact, but we should learn from the experience on X. This is particularly true for the way debate, discourse and disagreements occur on the new platform. Institutions, educational initiatives as well as journals and their social media teams will have a key role in this process. Unfortunately, hostility is quite common in the digital world and across many platforms [15], with research describing a pattern of polarized interactions [16]. It has also been suggested that people with negative sentiments are more susceptible to addictive use of social media [17]. Discussions often become more acerbic after working hours, but posting educational material at this time also tends to reach a larger audience and generate more interactions. In our own experience, Bluesky is currently a relatively friendly digital ecosystem, which might be partially related to the fact that it is new, and we suspect that the enhanced blocking functions on Bluesky play a role in this. It is highly likely that users block earlier and more widely after their negative experiences on X. On the new platform it will be crucial to remain kind, polite and professional, even when social media ‘trolls’ demonstrate confrontational behaviour. This is particularly relevant with controversial topics where the existence of opposed views can become an opportunity for stimulating discussion and for a skytorial that is organized as a pro/con debate. Alternatively, one could consider two separate skytorials with different opinions expressed by two groups.

CONCLUSION

Until late autumn 2024, tweetorials were the most widely used vehicle for online educational content in nephrology [1, 18]. Key advantages of this format included its ease of use and the ability to reach a large, diverse and worldwide audience. Our ten tips (Table 2) provide practical tips to use Bluesky in a similar way. What nobody had anticipated was the rapid and significant change that has led to large-scale migration of academia from X to one of its competitors [19]. Bluesky is similar in layout to X but features different algorithms, improved blocking functions and a decentralized approach [20]. What both platforms have in common is the ability to overcome barriers and trigger discussion and debate among people who would otherwise never meet. In hindsight, significant concern around X had been voiced previously [21, 22], and many nephrologists had left or migrated to other platforms before autumn 2024 or made little use of their X profile.

However, important questions around Bluesky also exist: Is the trend seen in November 2024 just a blip or will it be permanent? Also, with just under 24 million users, it is still quite a bit smaller than X. And will the scientific community come together on one platform or will it simply become more fragmented? [23] Also, in comparison (Fig. 2), X has features that Bluesky is currently lacking. Journals may soon ask for a corresponding skytorial for many articles in the same way that they have so far wanted authors to compose a tweetorial after publication [24]. Another interesting question is that of how Bluesky will finance itself. It is very likely that at some stage Bluesky may offer some form of subscription or enhanced features for a fee, although it has for now committed not to allow advertisements.

It is also highly likely that threaded educational material will undergo further evolution, as a trend towards shorter messages has been noticeable for some time on X. Another important factor in this arena is whether and how online educational material can count for academic portfolios. We encourage institutions and the wider renal community to consider how authorship of online educational material can be made to count in this regard [25]. Going forward, it will be fascinating to observe how Bluesky evolves and whether our predictions prove correct. The experience of autumn 2024 also includes the ease with which the scientific community migrated to a new platform. Based on this experience, we can be sure that we could also take our digital presence to yet another platform in the future if that is required. In that sense, we could see the transition between X and Bluesky, concurrent presence on and competition between platforms and constant change not as a disruption, but as a necessity of digital life. The renal community should embrace the change in the arena of social media and go beyond a replica of our previous digital home. Instead, we should now harness the opportunity, encourage ‘Bluesky thinking’ and build a much-improved digital landscape on this nascent platform.

FUNDING

None.

AUTHORS’ CONTRIBUTIONS

A.W. came up with the initial idea for this manuscript which described ten tips for a successful tweetorial. All authors contributed to the original submission. A.W. rewrote the manuscript for use on Bluesky during the revision process with input from all authors. All authors have seen and approved the final version of the manuscript.

DATA AVAILABILITY STATEMENT

No new data were generated or analysed in support of this research.

CONFLICT OF INTEREST STATEMENT

J.S., M.S. and L.F. are all part of the Clinical Kidney Journal social media team. S.M. received support for meeting registration and travel from Amgen and Sanofi Genzyme outside the submitted work, is on the editorial board of Nephrology Dialysis Transplantation and serves as a social media editor. A.W. is on the editorial board of Clinical Kidney Journal and serves as social media editor.

REFERENCES