OPINION: Social Media in Medicine: A Force for Good

Shelby Wood, MPH, EMT-P, MS IV
St. George’s University School of Medicine
EMRA MSC International Representation 2020-2021

Social media has become a pervasive force within the medical education (#MedEd) community, and emergency medicine is leading the charge. When it comes to free open access medical education (FOAMed), there is no other specialty that has more wholeheartedly embraced the power of social media to supplement training for students, residents, and attendings on hot topics within the field. Additionally, social media-based learning encourages interactions between educators and learners. It is more learner-generated, collaborative, and engaging to younger audiences. By sharing FOAMed through platforms such as Twitter, Facebook, Instagram, YouTube, etc., emergency physicians and trainees have been able to breach the barriers imposed by physical location in order to reach an ever-growing audience of online followers.

In addition to using social media as an educational tool, many physicians and trainees also maintain social media profiles for personal use, especially sites dedicated to social networking (Facebook, Twitter, Instagram, etc.), and the line between personal and professional use of social media is not always clear-cut. A survey of 4,000 physicians showed that >90% of those surveyed use social media, but only 65% do so for strictly professional reasons. Even medical schools and residency programs use social media to advertise to applicants and connect with current trainees - in a 2014 survey of 132 U.S. medical schools by Harrison et al., 95% had Facebook presence and 10% had Twitter accounts. The influence of social media in modern medical education is undeniable - so why isn’t everyone on board?

Despite all of the advantages offered by social media, there are important concerns to consider when using these platforms to interact both personally and professionally. The most commonly encountered issues include violations of patient privacy, misrepresentation of information due to lack of peer review, and unprofessional behavior. While HIPAA violations and misinformation are overt examples of the potential harms of social media in medicine, it is especially important for medical students to consider social media professionalism beyond these examples. “Social media misconduct” is quite subjective - a post or photo that may seem innocuous to someone may be considered offensive to another, and if that offended person happens to be a residency program director, the consequences could be severe, and possibly even career-threatening.

A study of Facebook and Twitter profiles of 501 medical students showed 70% of profiles depicting drunkenness and foul language, and other themes of misconduct including sexually-related content, violations of patient confidentiality, and defamation of institutions have been known to occur. It is unclear whether students continue to post these types of content because they truly don’t understand the consequences, or because they simply don’t see this type of behavior as unprofessional. Medical students are generally young, and may engage in youthful activities, such as drinking alcohol, going out to parties and clubs, and having a good time outside of work - nothing wrong with that! However, choosing how much of this “private life” to display on social media can be a tenuous balance when one considers the possible professional repercussions. Another prevalent type of “social media misconduct” is venting. Airing of frustrations about a patient, coworker, or situation in the workplace that may be seen by the student as harmless and cathartic, but to a perusing residency program director, it may imply a lack of empathy or even a genuine disdain for patients and the profession of medicine. A common concern among medical students entering the Match is that residency program directors are becoming increasingly engaged in the practice of vetting applicants based on their social media feeds to get a sense of the applicant’s personality and professionalism, and this fear can (and should) be at the forefront of any student’s mind when deciding what to post.
So, given the gravity of the potential consequences for lack of online professionalism, how does a medical student navigate the world of social media and use it to their advantage? Here are 5 tips to turn social media into your secret weapon during this residency application season:

1. Highlight your successes. Instead of hiding your social networking profiles by changing your name, choosing the maximum security settings or simply deleting them altogether, use them as a platform to showcase your best self to potential residency programs! Share the news of your honor society nomination on Facebook, post a (HIPAA-compliant) Instagram photo of yourself smiling in your white coat on your first day outside your new hospital, and tweet about how relieved you are to have just passed Step 2 CK with your goal score. Programs love to see students who are passionate and excited about medicine, and a little humble brag on yourself from time to time shows that you take pride in your work. You have the power to curate a social media feed that portrays you as an engaged and enthusiastic medical student who would make an excellent resident.
2. Be yourself. Don’t be afraid to show your true personality and don’t feel pressured to create the persona you think that programs want to see. Speak freely about your hobbies, interests, and whatever else you are passionate about. You don’t have to keep things strictly professional (unless you want to). Making connections with others who share similar interests is one of the best parts of social media, and you never know where these interactions may lead.
3. Network. It’s called social networking for a reason! Social media sites like Twitter have made it much easier to access physicians that we would otherwise never come in contact with. If you’re a fan of someone’s work, find them and tell them so! Follow residency programs you’re interested in and interact with their faculty and residents by liking, commenting and reposting. They may remember your engagement when it comes time for interviews! Many emergency physicians are also willing to provide mentorship and advice to students who reach out on social media, so don’t be shy!
4. Learn. The world of #FOAMed is bursting with knowledge for you to discover. Follow all of your favorite EM journals, podcasters, and physician authors on social media for updates on their work and discussion on hot topics in the field. EM docs love to post clinical pearls learned from their ED shifts, and you may learn an interesting tidbit that will come in handy on rotations. Also, keep your eyes peeled for opportunities for away rotations, conferences, events, workshops, talks, leadership positions, you name it! Most organizations are becoming savvy with social media advertising and you may be the first of your classmates to find out about these amazing opportunities.
5. Be mindful. Don’t forget that you are the curator of your own social media feed, and as medical students, we are ultimately responsible for the self-image that we project to the larger world of medicine. Think twice before you post, especially if it has to do with a patient, provider, classmate or institution, and consider how that post might appear to your wider “invisible audience.” Try to refrain from using profanity and posting overtly sexual content. While it may sound a bit Orwellian, you truly never know who might be watching. Simply use common sense!

References:

1. Cheston, C., Flickinger, T., & Chisolm, M. (2013). Social media use in medical education. Academic Medicine: 88(6), 893-901. doi:10.1097/ACM.0b013e31828ffc23
2. Harrison, B., Gill, J., & Jalali, A. (2014). Social media etiquette for the modern medical student: A narrative review. International Journal of Medical Students: 2(2), 64-67. doi:10.5195/ijms.2014.86
3. Greysen, S.R., Kind, T., & Chretien, K.C. (2010). Online professionalism and the mirror of social media. Journal of General Internal Medicine: 25(11), 1227–1229. doi:/10.1007/s11606-010-1447-1
4. Prensky M. (2001). Digital natives, digital immigrants. On the Horizon, 9(5), 1-6.
5. Ventola C.L. (2014). Social media and health care professionals: benefits, risks, and best practices. P&T: A Peer-Reviewed Journal for Formulary Management: 39(7), 491–520.