The use of social media for marketing, education, and connecting with colleagues has grown substantially among orthopaedic surgeons.1–3 This is due in part to the COVID-19 pandemic, which encouraged the evolution of social media as a way to provide educational content for both trainees and patients and also created an avenue for networking within orthopaedic surgery when in-person events could not occur.4 Social media provides a quick, easy way to disseminate information and network with others across geographic borders.1 In addition to networking among colleagues, social media allows trainees to network with mentors in their field of interest. Social media has played a role in supporting women physicians and trainees because it allows female medical students to connect with female physicians at different stages of training outside of their home institution.5–7 Stevens et al7 found that Instagram and Twitter are regularly used platforms by women surgeons, allowing students and physicians to connect through personal and outcome-based content. This is particularly important within orthopaedic surgery because women make up only 6.5% of practicing orthopaedic surgeons and 16% of orthopaedic surgery residents.8

However, the use of social media can be complicated for medical students, residents, and fellows seeking employment opportunities, especially when they are trying to maintain a separation of personal and professional information.9,10 This is supported by a study by Irwin et al,10 which evaluated how plastic surgery residency applicants use social media in the application process. The respondents reported behaviors such as deleting or altering profiles ‘out of fear’ and not following a residency program of interest to prevent ‘unwanted attention to their own account.’

To our knowledge, no previous studies have investigated the usage and perceptions of social media among female orthopaedic surgeons, fellows, residents, and medical students interested in orthopaedic surgery. The purpose of this study was to determine the perceptions of female orthopaedic surgeons, fellows, residents, and medical students interested in orthopaedic surgery regarding personal and professional usage of social media. We hypothesized that social media usage would be prevalent among women in orthopaedic surgery across all stages of training, with concerns about professionalism being more prevalent among trainees.

Methods

An anonymous, online 22-question survey was generated using Qualtrics and sent via e-mail to 1,189 female members of the Ruth Jackson Orthopaedic Society (RJOS). The survey included questions regarding the individual participants' level of training, social media usage, perceptions regarding social media, home orthopaedic surgery department, and demographic information. Data collection lasted a total of 4 weeks from July 2022 to August 2022. Each participant was asked to complete one survey anonymously. Responses were analyzed using descriptive statistics.

Results

Of the 1,189 female members to whom the survey was sent, 207 responded (response rate of 17%). The respondents comprised 90 practicing orthopaedic surgeons (43%), 60 medical students (29%), 49 residents (24%), and eight fellows (4%). Fifty-two respondents (26%) were in the Northeast, 56 (28%) in the Midwest, 62 (30%) in the South, and 33 respondents (16%) in the West. Demographic information regarding distribution of year of training in medical school and residency, years in practice, race, and age are further described in Supplemental Table 1 (https://links.lww.com/JG9/A305).

A total of 189 of 207 respondents (91%) reported having a social media profile. This included 74 of 90 practicing orthopaedic surgeons (82%), 48 of 49 residents (98%), 59 of 60 medical students (98%), and all eight fellows (100%). When asked why they used social media, the most common reason was personal use (182 of 189; 97%), followed by educational (84 of 189; 44%), networking (79 of 189; 42%), news source (44 of 189; 23%), and business/marketing (36 of 189; 19%). Based on the participants' responses, the most frequently used social media platform was Instagram (166 of 189; 88%), followed by Facebook (163 of 189; 86%). When the participants were categorized by stage of training, it was found that practicing orthopaedic surgeons were more likely to use Facebook (66 of 74; 89%), followed by Instagram (57 of 74; 77%). Conversely, medical students and residents were more likely to use Instagram (58 of 59 medical students; 98% and 44 of 49 residents; 92%), followed by Facebook (50 of 59 medical students; 85% and 40 of 49 residents; 83%). Twitter was also commonly used among respondents, with 32 of 59 (54%) medical students, 24 of 48 (50%) residents, two of eight fellows (25%), and 29 of 74 (39%) practicing orthopaedic surgeons. Both TikTok and SnapChat were more popular among participants who were in earlier stages of training, with the highest usage among medical students (33 of 59, 56% for SnapChat; 16 of 59, 27% for TikTok) and the lowest among practicing surgeons (6 of 74, 8% for SnapChat; three of 74, 4% for TikTok). Usage of other social media platforms is described in Table 1.

Table 1 - Individual Social Media Profile Usage by Level of Training Across Different Platforms Individual Social Media Profile Usage Level of Training Instagram Facebook Twitter YouTube SnapChat Linked In TikTok Medical student (of 59) 58 (98%) 50 (85%) 32 (54%) 19 (32%) 33 (56%) 31 (52%) 16 (27%) Resident (of 48) 44 (92%) 40 (83%) 24 (50%) 22 (46%) 25 (52%) 18 (38%) 7 (15%) Fellow (of 8) 7 (88%) 7 (88%) 2 (25%) 0 (0%) 2 (25%) 4 (50%) 1 (13%) Practicing surgeon (of 74) 57 (77%) 66 (89%) 29 (39%) 21 (28%) 6 (8%) 29 (39%) 3 (4%) Total (of 189) 166 (88%) 163 (86%) 87 (46%) 62 (33%) 66 (35%) 82 (43%) 27 (14%)

When participants were asked who they connected with on social media, 185 of 189 (98%) reported friends, 174 of 189 (92%) reported family, and 153 of 189 (81%) reported coworkers or colleagues. In addition, most respondents reported connecting with professional orthopaedic organizations, such as residency programs or university orthopaedic departments (141 of 189; 75%) and medical or surgical organizations (123 of 189; 65%).

Most respondents (122 of 189; 65%) reported keeping accounts private across all platforms while 47 of 189 (25%) reported private accounts only on some platforms, and 20 of 189 respondents (10%) reported public profiles across all platforms (Supplemental Table 2: https://links.lww.com/JG9/A306). Forty-three of the 189 respondents (23%) reported having separate ‘personal’ and ‘professional’ social media accounts while 146 (77%) reported having only one account. Among the 43 respondents who reported having separate ‘personal’ and ‘professional’ social media accounts, the most common platform to have a separate ‘professional’ social media account was Twitter (21 of 43; 49%), followed by Instagram (18 of 43; 42%), Facebook (11 of 43; 26%), LinkedIn (3 of 43; 7%), and TikTok (1 of 43; 2%).

When asked about the use of social media by the participant's home orthopaedic surgery departments, 142 of 207 (69%) respondents reported that their department has a social media profile, with Instagram being the most used platform (112 of 142; 79%). Data regarding the other platforms are described in Table 2.

Table 2 - Respondents of Home Orthopaedic Surgery Department Social Media Usage Orthopaedic Surgery Department Social Media Platforms Used n=142 Facebook 23 (16%) Instagram 112 (79%) Twitter 37 (26%) Linked In 1 (<1%) Do not know 3 (2%) YouTube 1 (<1%)

Although most respondents reported that they connect with professional orthopaedic organizations through social media (141 of 189; 75%), only 73 of 189 (39%) reported allowing such organizations to follow their personal accounts. Thirty of 189 respondents (21%) reported allowing professional organizations to follow their professional account, 16 (8%) allowed professional organizations to follow both accounts, and 60 (32%) reported not allowing professional organizations to follow any of their accounts.

When respondents were asked about altering their social media profiles in preparation for an interview, 51 of 189 (27%) respondents reported changing their name on social media profiles to deidentify themselves and 20 (11%) reported deleting their profiles. Other reported changes to their accounts included changing accounts to private (4 of 189 respondents, 2%), removing or untagging pictures (10 of 189 respondents, 5%), or deactivating accounts (11 of 207 respondents, 5%). Fifty-eight of the 189 respondents (31%) endorsed changing or deleting profiles for the purpose of interviews, including for medical school (10 of 58 respondents; 17%), residency (36 of 58 respondents; 62%), fellowship (4 of 58 respondents; 7%), or a faculty position (3 of 58 respondents; 5%).

When respondents were asked for their opinions on social media usage, 109 of 207 (53%) ‘agreed’ that being active on social media is a good way to network within orthopaedic surgery. In addition, 20 of 207 (10%) strongly agreed, 62 (30%) agreed, 59 (29%) were neutral, 48 (23%) disagreed, and 18 (9%) strongly disagreed that personal life events posted on social media can be considered unprofessional and should be kept on a separate, private profile. Conversely, 71 of 207 respondents (35%) disagreed and 13 (6%) strongly disagreed with having a fear of gaining attention to their social media profile while engaging with professional social media accounts, whereas 64 of 207 (31%) respondents reported neutral feelings, 45 (22%) agreed, and 13 (6%) strongly agreed. Responses by level of training are described in supplemental Table 3 (https://links.lww.com/JG9/A307).

Discussion

The purpose of this study was to determine the perceptions of female orthopaedic surgeons, fellows, residents, and medical students interested in orthopaedic surgery regarding personal and professional usage of social media. Our study findings demonstrated that many female orthopaedic surgeons have a favorable view of social media as a means for networking professionally and endorse connection with professional organizations, such as residency programs or medical/surgical organizations, through social media platforms. Yet, our findings also indicated that trainees are concerned about professionalism and are endorsing behaviors such as altering social media profiles in preparation for interviews, as well as not allowing professional accounts to follow their own profiles for fear of gaining attention.

Trainees had the highest rates of social media usage, with 59 of 60 medical students (98%), 48 of 49 residents (98%), and eight of eight fellows (100%) reporting having a social media profile. Social media usage was the lowest among practicing orthopaedic surgeons, with 74 of 90 (82%) reporting usage. Across all groups, Instagram and Facebook were the most used social media platforms, both of which allowed for engagement through the sharing of photograph and video media. Although Instagram was the most widely used platform among all respondents of our survey, Twitter was the most common platform where respondents reported having a separate, professional account. Twitter allows for short text posts accompanied by photograph or video media and has been widely used among surgeons and surgery journals with high impact factors.11,12 In 2020, Wang et al investigated orthopaedic surgery-related content posted on Twitter and Instagram.13 By evaluating the use of the hashtags #Orthopedics, #OrthopedicSurgery, and #OrthopedicSurgeons, they found that Twitter had more advertisements from companies, whereas Instagram had ‘markedly more personal content, medical imaging, and medical procedures’. The authors concluded that Instagram is preferable to Twitter for engaging students with an interest in orthopaedic surgery because of higher rates of user engagement and visual-based content.13 Stevens et al7 had similar findings, with Instagram being preferred for connecting women surgeons and students because there was higher engagement when compared with Twitter. Although Instagram may be more beneficial for trainees to connect with other women in orthopaedic surgery, it may be more challenging for trainees to have a separate, professional Instagram account because of a lack of photograph or video content related to orthopaedic surgery. Being active on a professional Twitter account may be easier as a trainee, given the ability to respond to tweets posted by other physicians or journals.

Our study also found that SnapChat was used by more than 50% of medical students (33 of 59) and residents (25 of 48) who use social media, but rarely by practicing surgeons (6 of 74, 8%). This is consistent with findings by the Pew Research Center in 2021, which found that 65% of adults age 18 to 29 years use Snapchat but only 2% of adults 65 or older use this platform.14 Although being the overall least used platform, TikTok use was most common among the youngest trainees, with 16 of 59 (27%) medical students using this platform. As a relatively new platform, TikTok has recently grown in popularity in its ability to share short, video media. Most participants in our study (74%) who had social media accounts endorsed connecting with professional organizations, such as orthopaedic surgery residency program and national medical or surgical organizations on social media. Orthopaedic residency programs have been increasingly using Instagram as a platform to connect with potential applicants, providing both educational content and general information about their program.15 However, 32% of participants (60 of 189) reported that they did not allow these professional organizations to follow their own account and more than 25% of respondents (68 of 207) agreed or strongly agreed with the behavior of not engaging with professional organizations for fear of drawing attention to a social media profile. Similarly, Irwin et al10 found that 39% of plastic surgery residency applicants deleted or altered their social media profiles ‘out of fear,’ and 15% of respondents did not follow a residency program of interest to prevent ‘unwanted attention to their own account’. Although social media can be used by residency programs to engage with potential applicants, medical students may not feel comfortable engaging back, particularly with private, personal accounts. Using a separate professional account may be beneficial in these scenarios because potential applicants could maintain a separation between their personal life and professional interests.

Although participants endorsed the benefits of social media, only 20 of 189 respondents (11%) reported all their social media profiles were public, and 122 of 189 (65%) reported all accounts as private. Public profiles were more common among practicing orthopaedic surgeons (14 of 74, 19%) than respondents who were still in training. Most medical students (38 of 59, 64%), residents (35 of 48, 73%), and fellows (7 of 8, 88%) endorsed having all of their accounts as private. The ability to balance professionalism while being active on social media and connecting with other users can be challenging. The definition of professionalism on social media has been under scrutiny for being subjective and often biased minority groups including women, racial minorities, and those identifying as LGBTQ+.16 A study by Hardouin et al in 2020 addressing the prevalence of unprofessional social media content among young vascular surgeons was retracted because of using a scoring system that was biased against women, classifying social media content of women in swimwear as potentially unprofessional.17 In response to this article, female physicians and trainees were active on social media with the hashtags #MedBikini and #ILookLikeASurgeon, to bring recognition to female surgeons and demonstrate the bias in this definition of professionalism.18 Drudi et al called for redefining professionalism at the individual, organizational, and societal level, to focus on inclusivity, transparency, and quality patient-centered care from physicians.

Despite concerns for professionalism, only 43 of 189 participants (23%) reported having separate professional and private social media accounts. This was most common among practicing orthopaedic surgeons, with 27 of 74 (36%) with two accounts. In addition, 82 of 207 respondents (40%) agreed or strongly agreed with sharing personal life events on a nonprivate account as unprofessional. Hamilton et al published guidelines for developing a professional social media voice and presence among plastic surgery residents and surgeons beginning their careers.19 They recommended maintaining separate personal and professional social media accounts. Individuals at earlier stages of training may not feel comfortable establishing professional accounts before becoming a practicing physician because of lack of ‘professional’ content, less confidence in their knowledge base, or lack of time to dedicate to posting on a separate account. Yet, separate accounts may present a means for trainees to continue to be involved within the field of orthopaedic surgery and connect with professional accounts while maintaining boundaries between personal and professional life.

There are several limitations to this study. First, the survey results are captured from one professional organization at a single time point, with a response rate of 17% and may not be generalizable to all women within orthopaedic surgery. Although individuals from each demographic region were captured, the lowest percentage was in the West with only 16% (33 of 207 respondents) being from this region. In addition, our respondent population was predominantly White individuals (167 of 207 respondents, 75%). There also may be selection bias in the responses from the survey because individuals who do not use or are unfamiliar with social media may have not responded to the survey. The majority of respondents (189 of 207; 91%) to the survey used social media, so the perceptions of those that are not on social media may be different and were not captured by the survey. Future studies should aim to collect data from a larger and more diverse population or even follow respondents over time to see how perceptions and usage of social media change through a prospective study.

Conclusion

Social media can be used to network professionally within orthopaedic surgery, connecting women at different levels of training. Although concerns about professionalism of social media accounts exist, this may be mitigated by maintaining a separate private account from a public, professional profile. Future guidelines regarding social media usage and how to maintain professionalism while being active on social media may be beneficial.

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