Keywords
social media - ophthalmology - residency
As a pillar of communication in contemporary society, social media has found a strong
footing in medicine. From networking with colleagues and disseminating knowledge,
to building professional recognition and communicating with patients, an individual's
online presence may greatly affect her/his career trajectory.[1]
[2]
[3]
[4]
[5] Especially on Twitter (Twitter, Inc., San Francisco, CA), the medical community
is burgeoning with students, trainees, educators, and healthcare workers participating
through the use of the hashtag “#medtwitter.” This community has surged during the
COVID-19 pandemic, as education and networking were shifted primarily online.[6]
While social media may benefit medical professionals and trainees, there are also
concerns regarding patient confidentiality, repercussions for subjective “unprofessional”
behavior, as well as a risk for Social Media Disorder (SMD).[7] SMD is characterized by social media addiction and may be associated with resident
stress and burnout.[8] Recently, a scale was developed to help identify adolescents at risk of SMD.[9] Further, few formalized curricula regarding the professional use of social media
exist within training programs.
The present study aims to assess ophthalmology trainee attitudes toward and use of
social media. We characterize if, why, and how ophthalmology trainees are incorporating
social media in their training and identify the prevalence of SMD in this population.
Methods
Institutional review board approval was obtained from the University of Miami and
this study adhered to the Declarations of Helsinki. A survey assessing role and attitudes
toward social media and prevalence of SMD based on the validated 9-item Social Media
Disorder Scale was distributed to a listserv of ophthalmology residency applicants
to the Bascom Palmer Eye Institute between September 2016 and January 2020.[9] The survey included consent prior to being filled, and responses were collected
between October 25, 2020, and November 8, 2020.
Demographic information collected included age, gender, and level of training. Participants
were asked if they used social media for personal and professional purposes. Personal
use was defined as interacting with friends and family for non–work-related reasons.
Professional use was defined as the use of social media in a work-related capacity
such as to interact with patients, increase practice visibility, and communicate with
colleagues regarding work or other ophthalmology matters. A diagnosis of SMD was made
when five or more out of the nine criteria on the SMD scale were met in accordance
with the accepted definition (preoccupation, tolerance, withdrawal, persistence, escape,
problems, deception, displacement, and conflict).[9] Chi-square analyses were used for the analysis of social media use in ophthalmology
trainees compared with that in practicing ophthalmologists, which was previously examined
in a study by one of the authors (HA).[10]
Results
Of the 1,688 email recipients, 208 (12.3%) ophthalmology trainees replied to the survey
through the email link. Eighty-eight (42.3%) respondents were identified as female,
119 (57.2%) identified as male, and 1 (0.5%) respondent selected “other” for gender
identity. The average age of all respondents was 29.7 (SD: 3.4; range: 24–58) years.
Of all respondents, 54 (25.9%) were in post-graduate year (PGY) one, 43 (20.7%) were
in PGY-2, 51 (24.5%) were in PGY-3, 56 (26.9%) were in PGY-4, 3 (1.4%) were in PGY-5,
and 1 (0.5%) was in PGY-6.
Of the 208 respondents, 192 (92.3%) trainees use social media for personal purposes.
The top three platforms used for personal use were Facebook (166, 86.4%), Instagram
(157, 81.8%), and YouTube (87, 45.3%). There were 90 (43.4%) trainees who used social
media for professional reasons. The top three platforms for professional use were
LinkedIn (47, 52.2%), Instagram (31, 34.4%), and Twitter (24, 26.7%) ([Fig. 1]).
Fig. 1 The percentage of trainees using different social media platforms for professional
and personal reasons.
Comparison of the proportion of ophthalmology trainees on social media to that of
practicing ophthalmologists (from a study by Al-Khersan et al[10]) revealed that the proportion of trainees on social media for personal purposes
(92.3%) was significantly higher than the proportion of attending physicians using
social media for personal purposes (68.3%, p < 0.001). In contrast, the proportion of trainees using social media for professional
purposes (43.4%) was not significantly different from the proportion of attending
physicians using social media for professional purposes (45.2%, p = 0.73).
Survey responses are presented in [Table 1]. Two respondents met full criteria (met at least 5 criteria) for SMD, and 12 were
at risk (met at least 3 criteria) for SMD according to the SMD scale ([Table 2]).
Table 1
Survey questions
|
Yes
|
|
Have separate professional and personal social media accounts. (n = 208)
|
27 (13%)
|
|
Feel it is important to have a professional social media presence. (n = 207)
|
81 (39.1%)
|
|
Are aware of professional social media guidelines. (n = 208)
|
98 (47.1%)
|
|
Have reviewed professional social media guidelines. (n = 208)
|
53 (25.5%)
|
|
Have received instructions from their institution/department regarding social media
use. (n = 208)
|
98 (47.1%)
|
|
Are encouraged by their institution to use social media. (n = 206)
|
68 (33.0%)
|
|
Believe social media may challenge a physician's authority. (n = 194)
|
107 (55.2%)
|
|
Believe social media empowers the patient. (n = 193)
|
111 (57.5%)
|
|
Believe that social media encourages shared care. (n = 193)
|
90 (92.8%)
|
|
Rate the quality of medical information on social media as “poor” (n = 192)
|
117 (60.9%)
|
|
Rate the quality of medical information on social media as “acceptable” (n = 192)
|
68 (35.4%)
|
|
Rate the quality of medical information on social media as “good” (n = 192)
|
7 (3.6%)
|
|
Have looked up a patient on social media. (n = 195)
|
27 (13.8%)
|
|
Have provided their social media account to a patient. (n = 195)
|
3 (1.5%)
|
|
Have responded to patient messages on social media. (n = 195)
|
5 (2.6%)
|
|
Have followed a patient on social media. (n = 195)
|
5 (2.6%)
|
|
Have had a patient follow them on social media. (n = 195)
|
20 (10.3%)
|
|
Social media has positively impacted their training. (n =191)
|
101 (52.9%)
|
|
Social media has allowed networking with other health professionals. (n = 194)
|
124 (63.9%)
|
|
Social media has helped find research projects. (n = 194)
|
14 (7.2%)
|
Table 2
Criteria for social media disorder[9] during the past year, have you…
|
Yes (n = 194)
|
|
regularly found that you can't think of anything else but the moment that you will
be able to use social media again?
|
7 (3.6%)
|
|
regularly felt dissatisfied because you wanted to spend more time on social media?
|
3 (1.5%)
|
|
often felt bad when you could not use social media?
|
7 (3.6%)
|
|
tried to spend less time on social media, but failed?
|
73 (37.6%)
|
|
regularly neglected other activities (e.g., hobbies, sports) because you wanted to
use social media?
|
16 (8.2%)
|
|
regularly had arguments with others because of your social media use?
|
6 (3.1%)
|
|
regularly lied to your parents or friends about the amount of time you spend on social
media?
|
2 (1.0%)
|
|
often used social media to escape from negative feelings?
|
42 (21.6%)
|
|
had serious conflict with your parents, brother(s) or sister(s) because of your social
media use?
|
1 (0.5%)
|
Discussion
The present study is the first to assess the use of social media among ophthalmology
trainees and demonstrates its widespread use in both personal and professional capacities.
Our finding that trainees are utilizing social media personal accounts more often
than attendings is in line with previous trends. A prior study of ophthalmologists'
tweets at annual meetings of the American Academy of Ophthalmology found that the
majority were still in-training or in practice for less than 10 years.[11] In contrast, there was no significant difference in the rates of professional social
media use between trainees and attending ophthalmologists.[10] Many professional accounts are often run by social media managers or by the institutions
employing ophthalmologists, which may influence this finding.[10] Additionally, the perceived incentives for maintaining a strictly professional page
as a trainee may not be as compelling as for practicing ophthalmologists who may benefit
in building their practices and reputation. Lastly, an interesting question for future
research is whether current trainees believe in separating their “personal” and “professional”
pages or whether they prefer to blend the two. The strong personal social media use
by trainees may be suggestive of increased professional use as they graduate and begin
practicing. Another avenue for the study is if the preferred platforms for personal
and professional pages change with time and/or professional development.
Social media may offer benefits to trainees, as it reportedly has positively impacted
their training, provided avenues for networking, and helped them find research opportunities.
There are also risks to consider in the sphere of patient privacy and professionalism.
In this study, there were low rates of professional social media guideline awareness
and knowledge, as well as sparse education and encouragement by institutions regarding
social media use. A clear understanding of social media rules is imperative, given
the potential negative consequences, namely patient privacy breaches and subjective
“unprofessional” behavior. We encourage training programs to address this discrepancy
between social media use by trainees and guideline awareness by developing social
media policy and educating trainees on social media guidelines set forth by professional
associations, including the American Academy of Ophthalmology (AAO).[12]
[13] In short, the AAO's guidelines are as follows: identify yourself and your qualifications;
identify why you are offering information and how it is substantiated; be trustworthy,
honest, and reliable; provide knowledge and information that is useful and desirable;
and share appropriately.[13]
We also explored the attitudes of trainees toward the role of social media in patient–physician
interactions and found a mixed sentiment. The majority agreed that social media encourages
shared care between healthcare providers. Previous studies have reported the use of
social media to increase patient referrals and professional visibility.[10]
[14]
[15]
[16]
[17] Additionally, more than half of trainees believed that social media empowers the
patient. While this does allow patients to be more engaged in their healthcare experience,
a concern shared by many trainees was that social media may challenge a physician's
authority. These ethical implications have been previously reported, and further research
is needed to understand the role of social media in patient–physician relationships.[18]
The rate of actual social media interaction between patients and ophthalmology trainees
was minimal, with only a minority of trainees looking up, being followed by, providing
account information, responding to patient messages, or following their patients.
Potential reasons for this low rate of interaction may be greater adherence by trainees
to traditional patient–physician boundaries compared to practicing physicians who
have formed lifelong relationships with their patients, some of which may go beyond
a strictly professional relationship and brush ethical boundaries. Another reason
could be that trainees are generally not actively involved in patient recruitment,
which is a common motive for practicing physicians to utilize social media.[10]
[15]
[16]
[17] These results suggest that ophthalmology trainees prefer using social media as a
networking and educational tool over using it as a medium for current and prospective
patient interaction.
Although previous studies have evaluated the prevalence of SMD in other specialties,
this is the first study to evaluate its prevalence in ophthalmology.[8] Given that most ophthalmology trainees utilize social media, it may be concerning
that 1 in 15 ophthalmologists in-training are at risk for or have SMD. In comparison,
a survey of urology trainees found that 1 in 10 urologists in-training was at risk
for SMD.[8] SMD has been suggested to be prominent in individuals as a coping mechanism for
loneliness and depression, and it is possible that SMD may contribute to resident
stress levels.[8]
[19]
[20]
[21] With social media becoming increasingly integrated within ophthalmology, SMD may
represent an area where further research is needed to mitigate its risk. We recommend
training programs to include information regarding healthy social media practices
in their professional development curricula.
Our study shares the general limitations of surveys. First, the data may be influenced
by a sampling bias. The survey was distributed electronically, and respondents may
have been more likely to use social media than those that did not respond. Furthermore,
surveys were emailed only to trainees who had applied for residency at a single academic
institution. Additionally, applicants may have applied for residency with their medical
school's institutional email address, which may no longer be in use if in residency
at a different institution. Finally, the SMD scale was developed on adolescents aged
10 to 17 years and may not be psychometrically valid when applied to adults in their
late 20s or early 30s. Despite these limitations, the survey provides interesting
insights regarding the use of social media by ophthalmology trainees.
Ultimately, the present work demonstrates the widespread use of social media by ophthalmology
trainees, both personally and professionally. As these trainees graduate and begin
their careers, social media may be more integral to ophthalmology practices and patient–physician
interactions in the future. Benefits of social media for trainees include networking,
educational, and research opportunities. Training programs should work to increase
guideline awareness, promote professionalism and hygiene, institute social media policy,
and develop social media curricula to educate trainees regarding their policy.
