I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky.  

[1] Set up your account & profile

• This is essentially the same as Twitter.
• There is no entry for your location.
• I'd encourage folks to enter their real names, locations, and job descriptions. Knowing who you're talking to facilitates having better conversations.

[2] Add labels to your profile

• Labels will show up under your name whenever you post anything.
• This is optional but might help people understand your perspective.

[3] Use started packs to find people

• Starter packs are collections of people/accounts who often post on various topics.
• You can find starter packs using the search function.
• Within a starter pack, you can follow every person, or scroll through and follow people selectively.
• You will recognize lots of people in these starter packs. Try to start following >50 accounts within a few minutes.

[4] Find and follow feeds that cover your interests

• Feeds are streams of posts that pertain to various topics.
• Search for feeds about your interests and subscribe to them.
• Feeds vary dramatically in quality and design.
  • Some feeds contain tweets by a group of selected authors.
  • Some feeds contain tweets marked with a specific hashtag(s).
• More on this later on. To start with, just add some feeds to your profile and try using them.
• Some feeds that I'd recommend:
  • Acute Medicine (EM, IM, CC)
  • PulmSky
  • IDSky
  • Neurocritical care

[5] Understand the Bluesky algorithms

• I've heard many people say that “Bluesky doesn't have an algorithm.”  That's incorrect.
• Bluesky has two built-in algorithms: the “Discover” feed and the “Popular with friends” feed.
  • Discover feed: more broad-ranging, maybe most analogous to Twitter's algorithm.
  • Popular-with friends feed: this is more focused on your interests (judged based on who you're following). I've found this feed to be more helpful in picking up relevant medical stuff.

[6] Contribute to feeds

• Some feeds are designed to collect posts containing one or more hashtags (e.g., #EMIMCC, #PulmSky, etc.). If you post on these topics, add the appropriate hashtag to place your post within the feed.
• If you find a terrific post that wasn't labeled with a hashtag, you might want to add that post to a feed.  There are two ways to do this:
  • [1] Quote-post the original post, including the appropriate hashtag.
  • [2] Reply to the original post with a hashtag (this will only work with user-curated hashtag feeds, as discussed in the next section).

[7] Create your own user-curated hashtag feed (UCHF)

• UCHF have a feature where if you see a post that you want to add to the feed, you can reply with your own post that includes the feed's hashtag. This will add the original (root) post to the feed.
• UCHF allows everyone to add posts of interest to the feed (without needing to quote-post the original post). This will enable folks to quietly file away great content within various feeds without blasting it out to everyone who follows them.
• If your field of interest doesn't have a couple of good UCHF feeds, then you should create one. Creating feeds is easy using SkyFeed (discussed on this YouTube video). A UCHF feed will look like this on SkyFeed when you're done:

[8] Bookmarks

• Currently, Bluesky cannot bookmark posts. My guess is they will add this function eventually. For now, there are a few ways around this.
• You can export posts to the notes program in your phone. If you click on “share” and select the notes app on your phone, it will generate a small note with the post in it. This may work if you just want to bookmark a couple posts.
• You can get a 3rd party Bluesky app that includes a bookmark function. I'm using the Skeets app for iPhone and it includes bookmarking.

[9] Lists

• Bluesky contains the ability to create lists. You can stick the list on your main screen to follow it (essentially functioning similarly to a feed).
• I find it helpful to create a list of accounts who solely post about medicine and little else (primarily journals and professional organizations).  You can follow my list, but I'd also encourage you to create your own.

That's it for now.  If you have more useful suggestions or questions, add them below.

⚠️ Editorial policy for this post: The last time I posted about BlueSky, I received some borderline abusive posts accusing me of being overly political. I mostly left them up because they were somewhat relevant to the topic. If I receive any abusive comments on this post, I will delete them. The purpose of this post is to explore the technical aspects of using BlueSky.

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Josh Farkas

Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.

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