Instructions: 
This week we looked at how groups (West Indian teens, Migrant Italians, and Artists/Migrants at the US southern border) actively use media. Thinking about “active” rather than passive use of media, suggests that the media they consumed is purposeful, not the end goal, and part of a broader social practice. We also talked about “active” through the theory of Use and Gratification.
For each group we looked at this week (West Indian teens, Migrant Italians, and Artists/Migrants at the US southern border), describe the purposeful use of a particular media and and the specific need from Use and Gratification Theory that was fulfilled. How might the ideas of “active” and “need” help to form questions about the participants in your project?
In Dr. Dominguez presentation and the readings about the Transborder Immigrant Tool this week, the idea that media practices are or can be “tactical” or “interventions” was an important theme. Briefly describe what you think it means for media practices to be “interventions”, and how might this lens/idea be used to think about your project?
Revision for project topics: 
1a good
1b good
2a. Way too general! This covers just about everyone on SM. Try to be more specific. What specific community?
2b. Similarly too general. What type of professional or profession? Try to be specific.
one way to do this is to think about your own network. Who do you know, have access to, or can easily connect with?
A Digital Ethnography of Medical Students who Use Twitter
for Professional Development
Katherine C. Chretien, MD1,2, Matthew G. Tuck, MD1,2, Michael Simon, BA2, Lisa O. Singh, PhD3,
and Terry Kind, MD, MPH2,4
1
Washington DC Veterans Affairs Medical Center, Washington, DC, USA; 2School of Medicine and Health Sciences, George Washington University,
Washington, DC, USA; 3Georgetown University, Washington, DC, USA; 4Children’s National Health System, Washington, DC, USA.
BACKGROUND: While researchers have studied negative
professional consequences of medical trainee social media use, little is known about how medical students informally use social media for education and career development. This knowledge may help future and current physicians succeed in the digital age.
OBJECTIVE: We aimed to explore how and why medical
students use Twitter for professional development.
DESIGN: This was a digital ethnography.
PARTICIPANTS: Medical student Bsuperusers^ of Twitter
participated in the study
APPROACH: The postings (Btweets^) of 31 medical student
superusers were observed for 8 months (May–December
2013), and structured field notes recorded. Through purposive sampling, individual key informant interviews were
conducted to explore Twitter use and values until thematic
saturation was reached (ten students). Three faculty key
informant interviews were also conducted. Ego network
and subnetwork analysis of student key informants was
performed. Qualitative analysis included inductive coding
of field notes and interviews, triangulation of data, and
analytic memos in an iterative process.
KEY RESULTS: Twitter served as a professional tool that
supplemented the traditional medical school experience.
Superusers approached their use of Twitter with purpose
and were mindful of online professionalism as well as of
being good Twitter citizens. Their tweets reflected a mix of
personal and professional content. Student key informants had a high number of followers. The subnetwork
of key informants was well-connected, showing evidence
of a social network versus information network. Twitter
provided value in two major domains: access and voice.
Students gained access to information, to experts, to a
variety of perspectives including patient and public perspectives, and to communities of support. They also
gained a platform for advocacy, control of their digital
footprint, and a sense of equalization within the medical
hierarchy.
CONCLUSIONS: Twitter can serve as a professional tool
that supplements traditional education. Students’ practices and guiding principles can serve as best practices for
other students as well as faculty.
KEY WORDS: social media; undergraduate medical education; internet;
twitter; professional development.
Electronic supplementary material The online version of this article
(doi:10.1007/s11606-015-3345-z) contains supplementary material,
which is available to authorized users.
Published online May 8, 2015
J Gen Intern Med 30(11):1673–80
DOI: 10.1007/s11606-015-3345-z
© Society of General Internal Medicine 2015
BACKGROUND
Social media has transformed the way we communicate as a
society. Medical students, who have grown up using these
technologies, are adept at using social media for personal
purposes. Ample attention has been paid to health professionals’ unprofessional use of social media, including privacy
violations, conflicts of interest, and inappropriate relationships
with patients;1–4 egregious lapses of professionalism have
even resulted in medical school dismissal and state medical
board sanctions.2,3 However, social media has power that
could be harnessed for positive professional purpose. Sharing
credible health content, advocacy, career networking, and
staying up to date with one’s field can all be achieved through
use of social media.5,6
Twitter is a social media platform with characteristics that
can make it useful for professional networking. Its mission is,
BTo give everyone the power to create and share ideas and
information instantly, without barriers.^7 Twitter has 271 million active users monthly, and 500 million tweets are sent each
day.7 Among US online adults ages 18–29 years, 37 % use
Twitter, and the majority of users have public accounts.8 Users
write 140 character-limited messages called Btweets^ that can
contain links to webpages or other content. Users can interact
with other users by following their accounts, and replying to,
or mentioning other users in their tweets, thereby creating a
network of connections. Many medical organizations and
medical journals have Twitter accounts and share relevant
information and news.9 Physicians on Twitter often post medical or health-related tweets and share information.10 Twitter
has been identified as a potential learning tool in medical
education.11,12 Medical education faculty can regularly participate in Bchats^ on Twitter, and others host Twitter journal
clubs to discuss medical articles of interest. Hashtags help
categorize tweets for indexing. There are currently active
hashtags for medical education (#meded, #GME, #CME)
and medical students (#medstudent).
Medical educators are challenged with guiding medical
students along their professional development and giving
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Chretien et al.: Students on Twitter
them the tools to succeed in their future careers. Little research
has addressed how to leverage social media use for educational and career development.1 The goal of this research was to
describe how and why medical students are using Twitter for
their professional development.
METHODS
We conducted a digital ethnography with the research question,
BWhat is the culture of medical students who use Twitter for
education?^ Sub-questions were, BHow do they use Twitter?^,
BWith whom do they interact?^, and BWhat do they value?^
An ethnography is a qualitative research framework that
seeks to provide a description and interpretation of a cultural
group or system.13,14 This typically involves prolonged observation of the group, interviews with key informants who can
provide insights into the group, and examination of cultural
artifacts and documents. Digital ethnography (also called Internet, virtual, or online ethnography) is a research method
used to examine the culture of online groups, modifying
traditional ethnographic approaches and theory and applying
them to the online space.15,16
Our target group was medical student Bsuperusers^ who
used Twitter for educational or professional purposes. We
sought to describe this cultural group—their online behavior,
their digital networks, and their values.
Identification of Target Group
We identified potential subjects by: 1) searching key words
Bmedical student^ and Bmed student^ on Twitter.com; 2)
searching existing public lists of medical students on Twitter
collated by individual users; 3) searching relevant hashtags
(#medstudent, #meded); 4) soliciting referrals by current subjects (chain sampling); and 5) hosting a medical education
Btweetchat.^ A Btweetchat^ is a public real-time discussion on
Twitter run by a moderator. For this study, two authors (KC
and TK) hosted a 1 h tweetchat in April 2013 on how medical
students use Twitter for educational or professional purposes,
using the established #meded tweetchat. This helped to identify students in our target group, and also helped structure our
interview guides.
All identified students were added to a general medical
student Twitter list shared among the investigators. The number of students on this list was fluid, as students were continually added or removed (if not actually a student, for example),
with a total of 293 at study closure. From the general medical
student list, students were added to a superuser list if they were
observed to post professional content (for instance, sharing a
journal article or live-tweeting a medical conference), interact
with other medical students and faculty, and/or participate in
professional Twitter Bchats.^ The research team met weekly to
establish consensus on who should be added to the superuser
list. To be included, users had to be current medical students in
the US. Current students at our medical schools were
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excluded. The final superuser list as of May 2013 included
31 subjects.
Structured Observations
Four investigators, including two expert Twitter users (KC and
TK) and two novice users (MS and MT), observed tweets of
the 31 superusers and of the general list of medical students for
8 months (May–December 2013), taking structured field
notes, guided by key dimensions of descriptive observations
(Space, Actors, Activities, Objects, Acts, Events, Time, Goals,
Feelings).17,18
Semi-Structured Interviews with Key Informants
Using purposive sampling, key informant superusers were
identified for interviews. We used a semi-structured interview
guide designed to explore their use of Twitter, the nature of
their interactions with other users, and what they valued from
their use (Appendix). Subjects were invited for interview via
email and provided an institutional reviwe board (IRB)-approved information sheet on study procedures. Their agreement to participate served as consent. Interviews were digitally
audio-recorded, and with the exception of personal identifiers,
transcribed by an external service. At the conclusion of each
interview, major themes were reviewed with the participant for
member-checking. Interviews continued until saturation of
themes was reached (n=10). For data triangulation, three faculty key informants, identified through student key informant
interviews, were also interviewed. Faculty informants were
asked to describe their interactions with students on Twitter,
how they felt students used Twitter for educational purposes,
and student best practices. All subjects interviewed were offered $25 for their participation. Interviews lasted between 30
and 60 min.
Network Analysis
In order to understand students’ use of Twitter, we extracted
total number of tweets, number of followers, number followed, and for a subset of tweets, analyzed content for URLs, retweets, and hashtags for each key informant. Further, to understand and describe the virtual community in which students
Blive^ and Binteract,^ we conducted two forms of network
analysis: 1) an ego network (local network of an individual)
analysis of key informants, and 2) a subnetwork analysis of
key informants who were connected to each other. For the ego
network analysis, we computed the centrality (ego behavior
metrics) degree and clustering coefficient. The degree is the
number of connections the individual (node) has, or the size of
the local neighborhood. Clustering coefficient (value range 0–
1) is a measure of the connectivity a local neighborhood.
Higher clustering coefficients indicate a well-connected neighborhood and potential for rapid information dissemination.
Subnetwork analysis focuses on the characteristics of the
network itself. The metrics we computed were subnetwork
density, number of triangles, and subnetwork diameter. These
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Chretien et al.: Students on Twitter
metrics help describe the connections between the key informants and the ability to transmit information within this group.
We used R, Node XL (an Excel-based tool) and Gephi (network analysis and visualization software) for the network
analysis.
Qualitative Analysis and Trustworthiness
The team met monthly to discuss observations and review
interview transcripts. Memos captured emerging themes and
analytic insights from comparing and contrasting the various
forms of data (triangulation). We compiled a list of codes that
emerged inductively from the data and applied these to all field
notes and interview transcripts. Each transcript was coded
independently by two investigators; in addition, to add consistency, a single investigator (KC) coded all transcripts.
Codes were compared and any discrepancies were resolved
through discussion; subsequent modification of codes resulted. Representative and exemplary quotes were highlighted for
each code. Following principles of inductive analysis19 and
incorporating network analysis results, we constructed a description of the target group.
We bolstered trustworthiness in several ways: 1) triangulation of data sources and methods; 2) inclusion of expert and
novice Twitter users and a medical student on the researcher
team; 3) member checking of main themes at the end of the
interviews; 4) creation of an audit trail to document team
decisions and discussion; 5) peer-review of transcripts with
feedback given to interviewers; and 6) use of multiple interviewers. Qualitative data was managed with NVivo10 (Cambridge, MA). The Washington DC Veterans Affairs Medical
Center Institutional Review Board approved the study.
RESULTS
Of the 31 superusers, 17 were female, 13 male, and for one,
gender was not specified. Thirteen (41 %) linked to their
blogs. The majority (25, 81 %) appeared to include their real
name on their Twitter prolife. They represented all regions of
the US and all years of medical school. For the ten student key
informants, seven were female and three were male. They
were in their first year (2), third year (2) and fourth year (6)
of medical school. They lived in large cities on the East Coast,
West Coast, Midwest, and Southern regions of the US.
Results are organized around how students use Twitter
(practices), their interactions (network analysis), and why they
use it (value).
Twitter Practices of Superusers
Overall, students were active Twitter users who were often
early adopters of Twitter use among their medical school
classmates. Many also had a personal blog. They followed
other medical students, medical faculty, medical journals,
medical and news organizations, and other health professionals, among others.
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Medical student superusers used Twitter thoughtfully and
were guided by the purpose of their use. They were mindful of
their professionalism online and were careful not to mention
specific patients to protect patient privacy. Many mentioned
thinking twice before tweeting to avoid potential misinterpretation of what they meant to say. In general, they avoided
venting and possible inflammatory statements and were aware
of their public image. Their tweets included both professional
and personal content.
BI’m a real-life person. I’m not a made-up person. I
don’t think that that detracts from my professional
interaction—that’s just me.^ (Key informant 8)
BI try to go about my social media as if I was actually
interacting with a patient. So if I were to see a patient in
the office …you do share a little bit about your personality so that’s where I post things about myself and my
personal life.^ (Key informant 9)
Superusers also practiced Bgood Twitter citizenship^ by
contributing to conversations, sharing helpful information
with others, and being cognizant of posting etiquette.
Students identified faculty role models on Twitter who
helped guide their own use in terms of how to share information and how to respond to challenging situations with other
users. We did not observe any unprofessional content posted.
See Box 1 for a summary of superusers’ Twitter practices.
Box 1. Twitter Practices of Medical Student Superusers
Know purpose for use
Mindful of online professionalism
Avoid mentioning specific patients
Think twice, tweet once
Avoid venting
Avoid inflammatory statements
Aware of public image
Not strictly medical content, show “personality”
Practice “good Twitter citizenship”
Contribute to conversations
Share information
Aware of posting etiquette
Identify faculty role models for use
Network Analysis of Key Informants
As of July 2014, the student key informants followed a median
of 489 (range 56–6425) Twitter users. They, in turn, were
followed by a median of 1770 (range 403–11169) users. The
key informants posted a median 7371 tweets (range 4172–
21057) since their Twitter debuts (which predated our study in
all cases). Analysis of a subset of 2074 tweets (Twitter imposes restrictions on how much data can be imported) revealed
that 553 contained URLs, 423 were re-tweets, and 647
contained one or more hashtags (Table 1).
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Chretien et al.: Students on Twitter
Table 1 Hashtags Used by Medical Student Key Informants in a
Subset of 2074 Tweets
Hashtag
Frequency
count
Comment
#socaphealth
69
#meded
63
#hcsm
31
#fmrevolution
26
#ase2013
25
#sdoh
#fitstats
23
20
#disruptinginequality
16
#medschool
#medstudent
#residency
#usavsbel
16
15
11
11
#commdev
#obgyn
10
10
Socap Health conference; goal
is to examine the roles of
entrepreneurs, investors, and
funding bodies in the larger
public health ecosystem.
Medical education; weekly
Twitter chat.
Healthcare communications
and social media; weekly
Twitter chat.
Family medicine revolution;
Re-branding campaign started
by family med residents to
promote family medicine
careers.
Association for Science
Education 2013 conference
Social determinants of health
Fitness statistics derived from
popular fitness app
Disrupting inequality;
advocacy for social change
Medical school
Medical student
Residency
USA versus Belgium World
Cup game
Community development
Obstetrics/Gynecology
*Tweets occurred between January 2013 and July 2014. No hashtags
were excluded
Figure 1 shows the full followers network on the key
informants. The ten key informants connect to 40,091 other
individuals on Twitter. Based on the average directed degree
(2) and the low clustering coefficients (0.054 directed, 0.102
undirected), key informant networks have limited overlap.
JGIM
They are not the center of a broader community structure,
although they may participate with multiple separate overlapping communities. This suggests an opportunity for extensive
information dissemination (access to different groups to share
information with).
Figure 2 visually highlights the connectivity between key
informants from the ego and subnetwork analysis. Overall, the
informant network is well connected (clustering coefficient of
0.851, average directed degree 9). None of the males are connected to each other, but the majority of females follow each
other. The overall subnetwork density is 0.46, high for a Twitter
subnetwork. Subnetwork analyses support that students maintain large, diverse networks that have other key informants in
them, but otherwise interact with different subgroups of people.
Value for Medical Students
Twitter served as a professional tool, something that supplemented their medical school education.
BI just think it’s helped me grow as a professional
because…there is more to who you become as a physician that can enable better patient care that doesn’t
happen just with textbooks.^ (Key informant 4)
Students derived value from Twitter in two main domains of
Access and Voice (Fig. 3).
Access. Medical student superusers gained access to
information, to experts, to a variety of perspectives including
patient/public perspectives, and to communities.
Twitter is a way that these students accessed information.
They used it to stay up to date with general news and their
fields of interest.
Figure 1 Full followers network of the key informants. The size and color of the node correspond to the degree (number of connections) of the
node. (Average degree =2; clustering coefficient, directed=0.054; clustering coefficient, not directed=0.102; number of nodes=40,101; number of
edges=61,602).
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Chretien et al.: Students on Twitter
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Figure 2 Key Informant Network. The size of the node corresponds to the number of key informant followers the node has. A large node
indicates that many key informants follow that node. The color of each node maps to the clustering coefficient. A red node indicates a low
clustering coefficient a green node indicates a mid-range clustering coefficient, and a blue node indicates a high clustering coefficient. It is not
surprising that nodes with a higher degree have a lower clustering coefficient. Finally, a white dot in the middle of a node indicates that the key
informant represented by that node is male. (Average degree=9; clustering coefficient=0.851; number of triangles, no direction=42; number of
triangles, with direction=69; network diameter=3).
BIt helps keep me up to date on what’s going on in the
world, in the world of medicine in this country, with
healthcare reform, and everything.^ (Key informant 3)
BI definitely know about various articles that tend to be
of importance in my field before other people.^ (Key
informant 7)
has worked for them, and that’s really not something
that we get [in training].^ (Key informant 1)
B[I] ask them a lot of questions about how they’ve been
treated by their doctors…It’s kind of like an opportunity to just interview a lot of patients without having to
wait until third year.^ (Key informant 6)
Students on Twitter find value in the ability to access
content experts in medicine with whom they otherwise
would not be able to connect. One key informant asked a
question on Twitter during a lecture and had an international expert respond with the answer within 2 min—before
the class instructor could look up the answer. Other key
informants described having access to medical content
experts during Twitter chats or following experts who
tweeted clinical pearls.
Twitter provided some students with opportunities for professional collaborations, allowing them to connect with other
medical students with similar interests.
Access to individuals with different perspectives was of
particular value for students, including others’ opinions about
health policy, medical education, and the medical profession
in general. For many key informants, being able to gain the
patient perspective was invaluable to their professional development.
Beyond the patient perspective, Twitter also allowed them a
broader context by which to understand medicine, outside of
the patient–physician dynamic.
Through Twitter, students gained access to communities of
learning and support. One key informant shared, BThe most
valuable thing for me is a sense of community, because as an
older medical student there’s just not a lot of community.^
Students described having a community of medical students
that congratulate each other when milestones are reached, help
each other study for exams and experience medical school
together.
B…looking at their feeds and hearing them talk about
their experiences has really changed the way that I see
the personal side of patients– how the medical system
BWe all kind of support each other and…are there to
cheer each other on as we go through medical school.^
(Key informant 10)
BWe share information all the time. We share articles,
we share study techniques.^ (Key informant 8)
Students interacted with faculty on Twitter who provided
advice, encouragement and virtual mentorships.
BWe had basically a public discussion where I just
asked her questions about what is the right way to talk
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Chretien et al.: Students on Twitter
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Figure 3 Value for medical students.
to patients about this, and what is the right word choice
that won’t be offensive?^ (Key informant 6)
B…phenomenal advice from people who are very accomplished…I got to shadow one of them.^ (Key
informant 5)
B…being able to follow older physicians [is] the most
valuable, just getting a glimpse into what my life could
be like when I’m a doctor.^ (Key informant 3)
Students also connected with communities of likeminded others, such as communities centered on personal
interests and hobbies or those who carried similar views.
For some, these communities served as sources of
inspiration.
For instance, one student commented on the impact of a
Twitter community on her decision to pursue a primary care
specialty.
^ …coming from my institution… the attendings
weren’t always the most supportive in trying to
persuade people to go into primary care so having that
online group of people that was really supportive and
giving advice to each other and patting each other on
the back— I think that was super inspiring.^ (Key
informant 9)
These communities of like-minded others have helped students maintain their ideals.
BI want to make a difference …Twitter gave me a
community where I could like not like feel alone in
doing that. How Twitter has influenced me is that it
really connected me to other people that believe that we
can make things better. B(Key informant 8)
Voice. Twitter also provided students value by giving them a
voice in the domains of advocacy and an enduring digital
footprint, and was an equalizer of power.
Some students used Twitter as a platform to support political issues and to share their health policy opinions. It helped
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Chretien et al.: Students on Twitter
them develop their own voice and engage with others outside
of their comfort zones.
BI think it’s important for everyone to have a voice and
honestly I think a lot of times medical students really
need to have the loudest voice of all, because they’re
the people in the transition zone between being a
patient and a receiver of healthcare to being a
healthcare provider.^ (Key informant 8)
Twitter allowed medical students a way to craft their digital
footprint in a positive way.
BI want them to search for me and find a consistent
presence that is positive.^ (Key informant 7)
Finally, Twitter served as an equalizer and a Bleveling force
in terms of power hierarchy^ (Key informant 5).
BA lot of times I don’t even know if … the person that
I’ve talked to is faculty or student or resident… it’s
often just a conversation… the great equalizer.^ (Key
informant 7)
BIt kind of disrupts who gets a voice, like who gets to
talk about what.^ (Key informant 4)
DISCUSSION
For this group of students, Twitter served as a professional
tool, giving them access and voice. It provided added value
from the traditional medical school curricula; they gained
support, networking opportunities, mentorship, and learning.
These students do not represent the majority of medical students on Twitter, but a subculture who were often pioneers in
their use of Twitter for professional purpose.
We were particularly moved by students’ interactions with
patients. Note that these were not patients the students had
cared for clinically, but people on Twitter who self-identified
as patients with certain disease conditions. Students seemed to
greatly value hearing patient perspectives, gaining greater
cultural sensitivity and understanding of what it is like for
patients living with their conditions. Social media, with its
many virtual patient communities, could be a resource for
medical students to better understand the patient experience.
The posting practices of these superusers align with guiding
principles of online professionalism derived from national
consensus statements and guidelines,20,21 research on stakeholders’ perspectives of what is appropriate and what is inappropriate to post,22–25 and expert opinion.6,26 These include
safeguarding patient privacy, Bpause before posting,^ avoiding
inflammatory material, and carefully considering material that
is to be posted for public consumption. The one area where
superusers deviated from published guidance is the advice to
maintain separate personas or accounts for personal and
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professional purposes. Superusers included parts of their personal lives on their accounts and felt this added to their
authenticity. Of note, others have disagreed with recommendations to separate professional and personal online identities,
arguing that this is simply not possible on the Internet, is
inconsistent with the concept of professional identity, and
could be potentially harmful.27
In comparison to the average Twitter user, the key informants in this study had more followers. The majority of
Twitter users have fewer than 50 followers whereas the median number of followers for student key informants was
1770.28 In Twitter, the amount of community structure is
correlated with the number followers a person has.30 Network
analysis metrics of the key informant subnetwork reflect a
social network community as opposed to an information network community.29 In other words, the students we studied
tend to have social, reciprocal relationships on Twitter more so
than simple information retrieval, and this may account for
some of its added value.
In a systematic review of social media use in medical
education that included 14 studies incorporating social media
in formal curricula, Cheston et al. cited opportunities of promoting learner engagement, feedback, collaboration and professional development.30 Some medical educators have advocated for the use of Twitter, specifically, as a professional
tool.11,12 In their pilot studies, George and Dellasega noted
that Twitter, as one of several social media platforms incorporated into two humanities courses for fourth-year students,
augmented learning and collaboration and allowed real-time
communication between learners and instructors outside the
classroom.31 Little research exists about how medical trainees
or physicians actually use social media for informal learning
and professional development. The present study thus fills a
gap in the literature.
Connectivism is a learning theory that supports the use of
Twitter for learning.32 Connectivism relates learning as a
process of connecting information sources; nurturing these
connections is needed for continual learning. A diversity of
perspectives and opinions fuel learning and knowledge, and
the capacity to increase one’s knowledge is more important
than what one currently knows.32 Managing and filtering the
information on Twitter and other social media platforms in
order to obtain the most current information in students’ fields
of interest may be a key competency for today’s learners that is
not regularly addressed in undergraduate medical curricula.33
Future research could explore how students critically appraise
information on Twitter or other social media sites, as well as
the quality of students’ learning.
The ability and desire to use Twitter as a professional tool
may be specific to certain students. In one study of osteopathic
medical students, students with learning styles self-assessed as
active, global, intuitive and/or visual were more likely to
access online educational materials than those whose learning
styles were reflective, sensing, sequential, and/or verbal.34 In
addition, individual student preferences and characteristics
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Chretien et al.: Students on Twitter
may dictate whether students choose to use Twitter for professional development. Many in our sample also had a blog; this
could indicate particular comfort in sharing ideas publicly?
This study has potential limitations. Digital ethnography is
a newer research method; diverse approaches have been used
to study the Internet with an ethnographic perspective.16 Key
informants may not have disclosed fully in interviews if concerned about anonymity, though efforts were made to reduce
this possibility. Expert Twitter user faculty investigators may
have carried pre-existing assumptions about student use; to
test these assumptions, the team also included n