ORIGINAL REPORTS

Professional Use of Social Media

Among Surgeons: Results of
a Multi-Institutional Study
Justin P. Wagner, MD,⁎ Amalia L. Cochran, MD, FACS,† Christian Jones, MD, MS, FACS,‡
Niraj J. Gusani, MD, MS, FACS,§ Thomas K. Varghese Jr., MD, MS, FACS,║ and
Deanna J. Attai, MD, FACS¶

⁎
Department of Pediatric Surgery, University of Nebraska Medical Center, Omaha, Nebraska; †Department
of Surgery, University of Utah, Salt Lake City, Utah; ‡Division of Acute Care Surgery, Johns Hopkins University
School of Medicine, Baltimore, Maryland; §Department of Surgery, Program for Liver, Pancreas, and Foregut
Tumors, Penn State College of Medicine, Hershey, Pennsylvania; ║Division of Cardiothoracic Surgery,
University of Utah, Salt Lake City, Utah; and ¶Department of Surgery, David Geffen School of Medicine at
UCLA, UCLA Health Burbank Breast Care, Burbank, California

OBJECTIVE: Among surgeons, professional use of social
media (SM) is varied, and attitudes are ambiguous. We
sought to characterize surgeons' professional use and per-
ceptions of SM.
DESIGN: Surgical faculty and trainees received institutional
review board-approved e-mail surveys assessing SM usage
and attitudes. Regression analyses identified predictors of
SM attitudes and preference for professional contact.
SETTING: Surveys were administered to surgical faculty,
fellows, and residents at 4 academic medical centers between
January and April 2016.
PARTICIPANTS: Of 1037 surgeons, clinical fellows, and
residents e-mailed, 208 (20%) responded, including 132
faculty and 76 trainees.
RESULTS: Among 208 respondents, 46 (22%) indicated
they preferred some form of SM as their preferred network-
ing and communication modality. A total of 145 (70%)
indicated they believe SM benefits professional develop-
ment. The position of clinical resident predicted preference
to maintain professional contact via SM (p ¼ 0.03). Age
o55 predicted positive attitude (p ¼ 0.02) and rank of
associate professor predicted negative attitude toward SM
(p ¼ 0.03). Lack of time as well as personal and patient
privacy concerns were cited most commonly as reasons for
not using SM.
Correspondence: Inquiries to Deanna J. Attai, MD, FACS, Department of Surgery,
David Geffen School of Medicine at UCLA, UCLA Health Burbank Breast Care, 191
S. Buena Vista, #415, Burbank, CA 91505; E-mail address: dattai@mednet.ucla.edu
CONCLUSIONS: Most of surgeons responding to our
survey used some form of SM for professional purposes.
Perceived barriers include lack of value, time constraints,
and personal and patient privacy concerns. Generational
differences in surgeon attitudes suggest usage of SM among
surgeons will expand over time. ( J Surg Ed ]:]]]-]]]. J
C 2017
Association of Program Directors in Surgery. Published by
Elsevier Inc. All rights reserved.)
KEY WORDS: social media, professional development,
generational trends, surgical education, patient privacy
COMPETENCIES: Medical Knowledge, Professionalism
INTRODUCTION
In spite of the near-ubiquitous nature of social media (SM)
in modern life,1 use of these tools among surgeons in
professional environments is poorly characterized. Previ-
ously documented barriers to SM adoption by physicians
include a lack of available time and a lack of perceived value,
as well as concerns about personal and patient privacy.2,3 In
addition to the practical barriers to adoption of SM in the
professional realm, a generation gap exists, with millennials
using SM for contact and information far more frequently
than members of generation X and baby boomers.4,5 Digital
natives seem to be more comfortable working in the virtual
space provided by SM, although they are no less likely to
commit personal or patient privacy violations.6
With the exception of a recent study profiling the use of
SM by oncology physicians and trainees,2 little is reported
regarding the use of SM by physicians for professional

Journal of Surgical Education  & 2017 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 1
Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2017.09.008
purposes within a particular specialty. Our study was
designed to assess usage of and attitudes about SM by
surgical faculty and trainees at 4 academic centers.
METHODS
An electronic survey using SurveyMonkey was designed to
query participants′ attitudes, interest, and involvement with
common SM outlets in professional practice (Appendix A).
The institutional review boards of the University of California
Los Angeles, the University of Utah, Johns Hopkins
University, and Pennsylvania State University approved this
study. The survey was pilot tested on a convenience sample
before distribution to the study group. The survey invita-
tion was distributed via e-mail between January and April
2016 to all surgical faculty, fellows, and residents at the 4
participating institutions. At each institution, the survey
invitation was sent twice, 2 weeks apart. Participation was
voluntary and survey participants were not compensated.
Descriptive data were used to characterize respondent
demographics. Stepwise regression was performed for multi-
ple independent participant characteristics, and multiple
linear regression was performed for binary categories of
independent participant characteristics to identify predictors
of SM as a preferred means of professional contact, as well
as characterizing attitudes toward SM. In stepwise regression
analyses, independent variables included sex, age, practice
setting, academic rank, and year of medical school gradu-
ation. In multiple linear regression analyses, binary category
thresholds included participant sex; age of 45 years; age of
55 years; years of medical school graduation before 1990,
1995, 2000, and 2005; academic vs community practice
setting; and faculty vs trainee position.
RESULTS
Over the study period, 1037 e-mail surveys were sent to 645
faculty members, 330 residents, and 62 fellows. There were
208 respondents from all 4 institutions, including 132
faculty, 74 residents, and 2 fellows, for an overall survey
response rate of 20%.
Among the 208 respondents, 79 (38%) were females. Age
ranges and years of graduation from medical school are
shown in Table 1. Professional practice settings of respond-
ents included 191 in academic practices (92%) and 17 in
community-based practices (8%).
Table 2 summarizes respondents' preferred means of
maintaining professional contact. Respondents were permit-
ted to select more than 1 option. In total, 205 respondents
indicated their preferred means of keeping in touch was an
electronic medium (i.e., computer-based, excluding tele-
phone calls), whereas 46 respondents indicated they pre-
ferred a SM outlet above all other means to keep in touch
with professional contacts.
2 Journal of Surgical Education  Volume ]/Number ]  ] 2017
Most of respondents (80%) indicated they were aware of
at least 1 online journal club, private case discussion, or
other surgical forum, whereas 42 respondents (20%)
indicated they were not aware of any. A total of 128
respondents (62%) indicated they have been prompted to
read a journal article from another individual's posting on a
SM site. Only 25 respondents (12%) indicated they have
collaborated professionally with a colleague known to them
only from SM. Excluding e-mail, 83 respondents (40%)
indicated they have participated in online discussion forums
about surgery; however, only 26 respondents (13%) indi-
cated they have participated as a physician in online patient-
care discussion forums.
Respondents perceived the overall effect of SM on pro-
fessional development as very beneficial (15.6%), somewhat
beneficial (54.0%), neutral or irrelevant (21%), somewhat
detrimental (4.5%), very detrimental (1.0%), or other (4.0%,
including more complex descriptions). Among those who do
not use SM for professional purposes, respondents most
commonly cited their preference for more traditional methods
of communication, education, and collaboration. A total of
36% of respondents cited concerns for personal privacy, and
33% cited concerns for patient privacy, and 31% cited lack of
time as reasons for not using SM. Table 3 summarizes this
and other reasons respondents cited against SM use for
professional purposes. Results of regression analyses are shown
in Tables 4 and 5. Stepwise regression analyses (Table 4)
showed that clinical residents were independently more likely
to prefer SM as a method of keeping in touch professionally.
Sex, age, and practice setting were not independent predictors
of preferences or attitudes regarding SM in stepwise regression
analyses. Multiple linear regression (Table 5) demonstrated
that respondent age o55 years independently predicted
positive opinion of SM. Sex, medical school graduation year,
and practice setting were not independent predictors of
preferences or attitudes regarding SM in multiple linear
regression analyses.
DISCUSSION
Most of surgical faculty, fellows, and residents responding to
our survey used some form of SM for professional purposes.
However, many stated that they preferred traditional means
of communication, education, and collaboration and approx-
imately 1 in 8 were unfamiliar with the use of SM in the
professional setting. A recent study by Langenfeld et al.7
noted that 68% of program directors in general surgery use
Facebook, and that it is common practice among them to
amend rank order lists of applicants based uniquely on SM
content. Given that members of our educational leadership
include SM in their selection process for trainees, ensuring
SM awareness and literacy among our ranks is imperative.
Almost 70% of respondents noted that SM use could
have a “very” or “somewhat” beneficial effect on
Journal of Surgical Education  Volume ]/Number ]  ] 2017

TABLE 1. Survey Response Rates and Respondent Demographic Characteristics

Response Rates
Position Surveyed, Responded, (%)
N N

Faculty 645 132 20

Fellow 62 2 3
Resident 330 74 22
Demographics
Sex Female Male
Respondents, N (%) 79 (38) 129 (62)

Age (y) 25-34 35-44 45-54 55-64 65-74

Respondents, N (%) 77 (37) 62 (30) 36 (17) 26 (13) 7 (3)

Practice setting Academic Academic Community Community
(private hospital) (public hospital) (private hospital) (teaching hospital)
Respondents, N (%) 71 (34) 120 (58) 7 (3) 10 (5)

Rank Professor Associate Assistant Fellow Resident Resident

professor professor (clinical) (research)

Respondents, N (%) 38 (18) 39 (19) 55 (26) 2 (1) 55 (26) 19 (9)

Medical school 1966-1970 1971-975 1976-1980 1981-1985 1986-1990 1991-1995 1996-2000 2001-2005 2006-2010 2011-2015
graduation (y)
Respondents, N (%) 3 (1.4) 4 (1.9) 5 (2.4) 18 (8.7) 9 (4.3) 20 (9.6) 19 (9.1) 33 (15.9) 36 (17.3) 61 (29.3)
3
TABLE 2. Proportions of Respondents Indicating Preferred
Methods of Maintaining Professional Contact
E-mail 96%
Direct contact 74%
Telephone 60%
SMS or text message 57%
Facebook 11%
Twitter 9%
Doximity 4%
LinkedIn 3%
Whatsapp 1%
Other 1%
professional development. There are several examples of
how physician use of SM can provide value to the medical
community including continuing education, research col-
laboration, and research promotion. All major medical
journals and institutions have a presence on Twitter and
Facebook, and most journals disseminate articles online
ahead of print. By following physicians, journals, and
institutions of interest, medical professionals can use SM
as an efficient mechanism to receive relevant, high-yield
content.8 Ibrahim et al.9 recently demonstrated that the use
of “visual abstracts” associated with article tweets by a
surgical journal led to higher levels of article dissemination.
Twitter journal clubs and specialty-specific Facebook groups
have demonstrated opportunities for professional education
and collaboration among surgeons.10-14 Twitter has addi-
tionally shown promise as an effective medium to dissem-
inate information at surgical conferences, and many feel this
practice enhances the experience of meeting attendance.15-17
A recent review of the use of SM in medical education
determined that interventions using SM were associated
with improved knowledge, attitudes, and skills among
students and residents, and that the use of SM provided
opportunities to promote engagement, feedback, collabo-
ration, and professional development. 18,19,20 These studies
also indicate the challenges of data privacy, security con-
cerns, time demands, and technology issues in implement-
ing SM-based curricula. In the present study, we show an
age-dependent trend of positive attitude toward SM favor-
ing surgeons younger than 55 years. In contrast to the
moderate participation rates among surgical residents and
faculty we report, another study found that 80% of medical
students in the surgery clerkship are familiar with Twitter.21
TABLE 3. Proportions of Respondents Citing Reasons Against Using SM for Professional Purposes
Prefer more traditional methods of communication, education, and collaboration
Concern about personal privacy
Concern about patient privacy and HIPAA violations
Lack of time
Lack of perceived value
Unsure how to use
I do use SM for professional purposes
HIPAA, Health Insurance Portability and Accountability Act.
4 Journal of Surgical Education  Volume ]/Number ]  ] 2017
In evaluating the use of SM in continuing medical
education, Wang et al.22 advised that “…course directors
may want to direct SM strategies toward more youthful,
technology-savvy physicians and that the usage of SM in
continuing medical education will become increasingly
worthwhile as junior physicians enter the profession.” As
surgical residents express greater preferences to interact
professionally via SM, and as more SM-conversant surgeons
enter the workforce, we anticipate professional use of SM
among surgeons will expand.
One of the primary roles physicians play is that of patient
educator. An increasing number of patients search the
internet for health information.23,24 Accordingly, there are
a growing number of opportunities for physicians to provide
patients with credible and evidence-based information by
posting on institutional websites and professional blogs and
by participating in online patient communities. On Twitter,
disease-specific hashtags (a word or phrase preceded by the
# sign) facilitate open discussion threads focusing on a
particular medical condition, thereby remotely connecting
patients and healthcare professionals in real time.25 A
Twitter-based breast cancer support group, comoderated by
one of the authors (D.J.A.), was shown to improve knowl-
edge and decrease anxiety among participants.26 Sedrak
et al.27 have shown the potential value of SM in recruitment
for clinical trials. As only 13% of respondents to our survey
noted that they used SM to interact with patients in a
professional capacity, tremendous opportunities exist for
surgeons to improve the quality and timeliness of patient
education.
Barriers cited to professional SM use in our survey included
patient and personal privacy, and there are many examples of
privacy violations and unprofessional online behavior among
both faculty and trainees.6,28,29 Specific privacy settings
within SM platforms may protect some content from public
view, but careful attention to one's online posting is advisable.
The American Medical Association suggests, “…to maintain
appropriate professional boundaries physicians should con-
sider separating personal and professional content online.”30
However, this is not always practical, and physicians should
be aware that even with a small number of followers, most
online content is public, archived, and searchable.31
Perceived lack of value of professional SM use was
reported as a barrier by 24% of our respondents. The
48%
36%
33%
31%
24%
13%
40%
TABLE 4. Stepwise Forward Linear Regression Analysis
Dependent Variable Predictor Coefficient p Value
SM as a preferred means of keeping in touch Position: clinical resident þ0.14 0.03
Positive attitude toward SM Position: professor −0.24 o0.01
Neutral attitude toward SM GY: 2006-2010 −0.20 o0.01
Position: associate professor −0.16 0.04
Negative attitude toward SM Position: clinical fellow þ0.98 o0.01
GY: 1971-1975 þ0.23 0.03
Position: associate professor þ0.08 0.03
GY, Medical school graduation year.

question has been raised regarding whether professional SM
use should “count” toward academic faculty advancement,
and a prominent online blogger has noted that opinions
shared on SM may in fact be more important than the
number of published articles, given that many articles are
never read or cited.32,33 In 2016, the Mayo Clinic
announced that it will take scholarly SM activity into
account when considering academic promotion.34 As pro-
fessors and associate professors are less likely to view
professional SM positively, it remains to be seen whether
current residents and assistant professors will succeed in
promotion based upon SM engagement and productivity.
Our study has several limitations. First, though our
response rate is comparable to other e-mail survey studies,
it does reflect a low proportion of our intended participant
population. Respondents may have been subject to selection
bias toward those with preconceived notions (either positive
or negative) regarding SM. Furthermore, nearly all partic-
ipants in this study work at academic medical centers, which
may tend toward more traditional communications infra-
structure or may have policies limiting faculty engagement
on SM. We did not clearly define “professional use,” and our
survey did not inquire about personal SM use or how it may
overlap with the professional activities of users. Potential
benefits to more isolated surgeons, particularly those in
nonacademic practices, were not discussed or assessed. Our
survey was performed in 2016, so our results may under-
estimate current SM use due to the exceptionally rapid
growth of SM activity. Finally, our survey did not use a
validated instrument because one is not available in this area.
CONCLUSIONS
Most of academic surgical faculty and trainees who responded
to our survey use some form of SM for professional purposes
and consider SM participation potentially beneficial to pro-
fessional development. Personal and patient privacy concerns
as well as uncertainty regarding potential uses remain barriers
to more widespread use. Clinical resident propensity to keep in
touch via SM and positive attitude regarding SM among
younger surgeons may reflect a generational trend in profes-
sional collaborative behaviors and leads us to believe that SM
use will organically expand in the future. Many SM outlets
have demonstrated value to the surgical community. However,
additional research is necessary to determine how to optimally
integrate the use of SM into the surgeon's daily workflow, to
develop guidelines for assessing professional SM activity for
academic advancement, and to clarify best practices for the
surgeon operating in the public online space.

TABLE 5. Multiple Linear Regression Analysis

Independent SM as a Preferred Positive Attitude Neutral Attitude Negative Attitude
Variable Means of Keeping About SM About SM About SM
in Touch

Coefficient p Value Coefficient p Value Coefficient p Value Coefficient p Value

Female −0.03 0.63 þ0.05 0.50 −0.04 0.56 þ0.01 0.75
Faculty −0.28 0.37 þ0.40 0.22 þ0.12 0.70 −1.00 o0.01
Resident −0.23 0.45 þ0.28 0.37 þ0.26 0.40 −0.99 o0.01
Academic þ0.09 0.39 þ0.05 0.64 −0.01 0.95 −0.03 0.62
Age o45 þ0.24 0.09 þ0.04 0.79 þ0.00 0.97 −0.01 0.84
Age o55 þ0.00 0.98 þ0.39 0.02 −0.29 0.08 −0.04 0.62
GY after 1990 þ0.10 0.57 −0.23 0.22 þ0.14 0.44 þ0.08 0.33
GY after 1995 −0.19 0.24 þ0.02 0.90 −0.05 0.75 þ0.01 0.85
GY after 2000 −0.05 0.69 þ0.10 0.46 þ0.03 0.79 −0.05 0.45
GY after 2005 −0.02 0.86 þ0.04 0.75 −0.06 0.57 −0.05 0.30
GY, Medical school graduation year.

Journal of Surgical Education  Volume ]/Number ]  ] 2017 5

ACKNOWLEDGMENTS
The authors would like to acknowledge Marcia Morrissey
(UCLA), Lisa Marley (University of Utah), and Angela Lehman
(Pennsylvania State University) for their administrative assistance.
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