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. 2024 Jan 16;9(1):e23.00098. doi: 10.2106/JBJS.OA.23.00098

Use of Social Media in Orthopaedic Surgery Training and Practice

A Systematic Review

Aliya G Feroe 1, Arthur J Only 2, Jerome C Murray 2, Lynsey R Malin 2, Nizar Mikhael 2, Ryan S Selley 3, Ryan R Fader 4, Mahad M Hassan 2,5,a
PMCID: PMC10786589  PMID: 38229872

Abstract

Background:

Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time.

Methods:

We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results:

Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube).

Conclusions:

Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice.

Level of Evidence:

Level IV.

Introduction

Over the past decade, social media use has grown across healthcare delivery and practice1-3. The variety of social media platforms, such as Twitter/X, Instagram, and Facebook, provide individual healthcare professionals and institutions with a means to disseminate health information, advocate for issues in healthcare policy, and foster communication with patients, families, trainees, and colleagues3,4.

There is a variety of literature examining the benefits of social media use in healthcare. When used by hospitals and individual physicians, social media activity has been associated with improvements in patient satisfaction5,6, patient-physician relationships7, healthcare utilization5,8, research collaboration, and productivity8. Among medical training programs, social media use has benefited resident and fellow education and recruitment9,10. The COVID-19 pandemic accelerated this recent expansion in the use of social media by individuals and institutions alike as digital platforms became the central means of communication amid lockdowns and physical distancing11. In March 2020, 30% of US social media users used social media platforms for 1 to 2 hours daily and 38% for more than 2 hours daily12. More than 80% of US State health departments today have social media accounts13. This trend is similarly observed across residency and fellowship programs for trainee recruitment14.

Orthopaedic surgery is a technologically progressive field with patients, trainees, faculty, and institutions using digital platforms to acquire knowledge, seek information, and establish connections15. Given the rapid adaptation of social media across healthcare, it is important to improve our understanding of its effect on surgical practice, education, and recruitment. The purpose of this systematic review was to (1) identify trends in the use of social media by orthopaedic surgeons and institutions and (2) determine how social media can be effectively used by surgeons and training programs to improve the acquisition and circulation of information, alongside optimization of recruitment.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines16.

Study Eligibility

The following inclusion criteria were used for article selection: English language, original research, and investigation of social media use by (1) US orthopaedic surgery residency and fellowship programs or (2) by individual orthopaedic surgeons. Exclusion criteria included abstracts, conference proceedings, errata, editorials, and commentaries.

Literature Search

An electronic search of all published literature in PubMed, Embase, and MEDLINE databases from January 1, 2000, to April 17, 2022 was conducted (search strategy detailed in Appendix, http://links.lww.com/JBJSOA/A594). A total of 659 studies were identified.

Study Selection and Data Extraction

After the removal of duplicate (n = 282) and nonoriginal research articles (n = 84), the remaining 298 articles were screened based on their titles and abstracts (Fig. 1). The resulting 36 studies underwent full-text review. Ultimately, 28 studies were included in the analysis. All screening was conducted by 2 independent reviewers (L.R.M. and N.M.), and disagreements were resolved after discussion and consensus with A.G.F. and the senior author (M.M.H.).

Fig. 1.

Fig. 1

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Study selection PRISMA flow diagram. *Excluded article types include abstracts, conference proceedings, errata, editorials, and commentaries.15 PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Quality Assessment of Included Studies

Quality appraisal was conducted for primary outcomes using the Agency for Healthcare Research and Quality17 (AHQR) checklist to assess the methodology of the included cross-sectional studies. No eligible observational or randomized clinical studies were published at the time of the literature search. Minimum scores of 14 (of 22) on the AHQR checklist were deemed sufficient for inclusion a priori. All 28 of the included studies exceeded the minimum scores required for final inclusion.

Characteristics of Included Studies

Study characteristics are summarized in Tables I and II. Publication years ranged from 2017 to 2022.

Table I.

Data Regarding Social Media Use in Residency and Fellowship Programs

Authors (Year) Study Design (Level of Evidence) No. of Residency Programs Evaluated Social Media Platforms Used and Assessed Purpose for Social Media Use
J. X. Checketts et al. (2021) Survey (level IV) 192 Twitter, Instagram, and Facebook Gain information and recruitment tool
T. M. Yong et al. (2021) Cross-sectional analysis (level IV) 164 Twitter, Instagram, and Facebook N/a
K. Y. Wang et al. (2021) Survey (level IV) 78 Twitter, Instagram, Facebook, and LinkedIn Recruitment tool
J. T. Bram et al. (2021) Cross-sectional analysis (level IV) 192 Twitter, Instagram, and Facebook Distribute information and recruitment tool
C. K. Cantrell et al. (2022) Cross-sectional analysis (level IV) 197 Twitter, Instagram, and Facebook N/a
M. J. Abbas et al. (2021) Comprehensive search strategy; cross-sectional analysis (level IV) 158 Twitter, Instagram, and Facebook Distribute information and recruitment tool
R. LeDuc et al. (2021) Cross-sectional analysis (level IV) 187 Twitter and Instagram Distribute information and recruitment tool
B. M. Holderread et al. (2021) Cross-sectional analysis (level IV) 202 Twitter, Instagram, and Facebook Gain information and recruitment tool
A. Malyavko et al. (2021) Cross-sectional analysis (level IV) 192 Twitter, Instagram, and Facebook Gain information and recruitment tool
C. D. Wilson et al. (2022) Cross-sectional analysis (level IV) 89 Twitter, Instagram, and Facebook Distribute information and recruitment tool
D. L. Rodkey et al. (2021) Cross-sectional analysis (level IV) 190 Instagram Distribute information and recruitment tool
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Table II.

Data Regarding Social Media Use with Orthopaedic Surgeons Practices

Authors (Year) Study Design (Level of Evidence) No. of Surgeons Surveyed Social Media Platforms Assessed Study Population (Location)
D. Thorne et al. (2020) Cross-sectional analysis (level IV) 1,039 Twitter, Instagram, Facebook, LinkedIn, ResearchGate, and YouTube Orthopaedic surgeons (Australia)
M. J. Abbas et al. (2021) Retrospective content analysis (level III) 25 Instagram Orthopaedic surgeons (global)
D. N. Bernstein et al. (2021) Observational study (level IV) 221 Twitter, Instagram, Facebook, LinkedIn, YouTube, and professional website Spine surgeons (USA)
B. LaGrant et al. (2021) Cross-sectional analysis (level IV) 505 Twitter, Facebook, Instagram, LinkedIn, and ResearchGate Sports medicine physicians (USA)
D. Damodar et al. (2019) Retrospective study (level III) 145 Twitter, Facebook, Instagram, and YouTube Joint replacement surgeons (USA)
T. Call; R. Hillock (2017) Cross-sectional analysis (level IV) 1,021 Twitter, Facebook, LinkedIn, YouTube, professional website, and professional blog Orthopaedic surgeons (USA)
T. M. Duymus et al. (2017) Survey (level IV) 321 Twitter, Facebook, and Instagram Orthopaedic surgeons (Turkey)
T. Justinia et al. (2019) Cross-sectional survey (level IV) 165 Twitter, Facebook, Instagram, Snapchat, LinkedIn, and YouTube Orthopaedic surgeons (Saudi Arabia)
A. J. Hodakowski et al. (2022) Cross-sectional analysis (level IV) 555 Twitter, Facebook, and Instagram Hip arthroscopists
S. T. Lander et al. (2017) Cross-sectional analysis (level IV) 987 Twitter, Facebook, LinkedIn, YouTube, ResearchGate, and PubMed Pediatric orthopaedic surgeons
N. Reddy et al. (2021) Cross-sectional analysis (level IV) 469 Twitter, Facebook, and Instagram Hand surgeons
G. Garofolo-Gonzalez et al. (2021) Cross-sectional analysis (level IV) 123 Twitter, Instagram, Facebook, LinkedIn, YouTube, professional website, and group website Foot and ankle orthopaedic surgeons
J. R. McCormick et al. (2021) Cross-sectional analysis (level IV) 646 Twitter, Facebook, and Instagram Shoulder and elbow surgeons
A. S. Narain et al. (2021) Cross-sectional analysis (level IV) 676 Twitter, Facebook, Instagram, LinkedIn, ResearchGate, and professional website Shoulder and elbow surgeons
R. G. Samtani et al. (2021) Cross-sectional observational (level IV) 325 Twitter, Facebook, Instagram, LinkedIn, YouTube, and professional website Spine surgeons
B. J. Chiang et al. (2022) Cross-sectional observational (level IV) 1,231 Twitter, Facebook, Instagram, LinkedIn, YouTube, TikTok, ResearchGate, and professional website Pediatric orthopaedic surgeons
G. Garofolo et al. (2020) Cross-sectional observational (level IV) 116 Twitter, Facebook, LinkedIn, YouTube, professional website, and group website Hand surgeons
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Statistical Analysis

Descriptive statistics, such as mean, SD, and ranges, are presented. Because of significant heterogeneity between studies, studies were manually grouped by similar outcome measures and social media platforms analyzed. Because of the low sample size, p values were not calculated.

Results

Of the 28 articles included studies, 11 focused on residency/fellowship programs18-28, whereas the remaining 17 examined the utilization of social media by individual orthopaedic surgeons and surgical practices29-45.

Part I. Residency/Fellowship Programs

All 11 studies examining the use of social media by residency and fellowship training programs explored at least one social media platform (Table I). Of these, Instagram was the most commonly investigated social media platform (11/11), followed by Twitter/X (10/11), and Facebook (9/11). Across these studies, Instagram was identified as the most common platform used by residency programs, with 42% to 88% reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%) (Fig. 2). Social media was documented as a recruitment tool by residency programs (9/11 studies) and as a means to provide information to prospective residency applicants (8/11).

Fig. 2.

Fig. 2

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Orthopaedic residency social media presence by platform across included articles (N = 11).

All 8 articles that examined social media use trends by training programs demonstrated an increase in use, as indicated by the rate of social media account creation (Fig. 3). From May 2019 to November 2020—over 9 months into the COVID-19 pandemic—the number of residency and fellowship Instagram accounts increased by 620%, whereas there was a 177% and 69% increase of Twitter/X and Facebook accounts, respectively28. LeDuc et al. (2021) revealed that the number of posts on Instagram by programs with existing accounts increased 96% (from 3.76 to 7.36 posts per month) after the onset of the COVID-19 pandemic23.

Fig. 3.

Fig. 3

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Growth in orthopaedic surgery residency program social media presence with the COVID-19 pandemic. Numerical values represent the individual number of programs with a noted social media account before and after March 2020 (the initial wave of the COVID-19 pandemic). For each article, the bar on the left represents prepandemic, and the bar on the right represents after the start of the COVID-19 pandemic.

Part II. Individual Orthopaedic Surgeons

Seventeen studies analyzed trends in social media use among individual orthopaedic surgeons spanning a variety of subspecialty fields (Table II). Eight of the 17 studies assessed the percentage of surgeons who reported the use of any public social media page as a primary endpoint, whereas nearly all (15/16) studies reported the breakdown of social media usage by social media platform (Fig. 4). Social media use by individual orthopaedic surgeons ranged from 37% to 74%. Range of utilization by platform across studies was distributed in descending order as follows (mean; range): Twitter/X (1.7%-76%), Facebook (10%-73%), Instagram (0%-61%), LinkedIn (22%-61%), and YouTube (6.5%-56%).

Fig. 4.

Fig. 4

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Distribution of social media platforms used by individual orthopaedic surgeons. The 5 most common platforms reported are portrayed (N = 17).

Three studies looked at physician review websites (including, Google, Healthgrades, and Vitals) to examine the relationship between social media use and the number of surgeon ratings33,37,41. All 3 studies revealed a positive relationship between social media presence and the number of ratings and comments on these sites. Three studies found no relationship between social media presence on surgeon ratings30,33,37, whereas one study reported significantly higher surgeon ratings among those with a social media presence41.

Two studies found no difference in social media use by gender25,45. One study, of US hand surgeons, identified higher use of LinkedIn among male surgeons; the gender distribution was equal among other platforms43. Among shoulder and elbow surgeons, one study identified a higher use of Instagram by female surgeons compared with male surgeons, with no differences in use across other social media platforms42.

Eight studies analyzed the association between social media use and practice settings. One study of members of the Cervical Spine Research Society44 and one study of sports medicine surgeons39 found no difference in social media use by practice type (academic vs. private) for any platform. Four studies identified differences in social media use between academic and private practice surgeons34,40,42,46. One study identified an overall higher use of social media among private practice surgeons40, whereas another study identified higher use of ResearchGate by academic surgeons42.

Four studies examined the ethics and professionalism of social media use among orthopaedic surgeons29,31,32,38. One study determined that 3.5% of social media content produced by orthopaedic surgeons was “unprofessional”31. Another study reported that 89.7% of orthopaedic surgeons surveyed had not read any guidelines for the professional use of social media38. When considering specific content, one study of Pediatric Orthopaedic Society of North America members identified considerable disagreement with the use of promotional posts on TikTok (65%) and Facebook (35%)32. Another study determined that certain social media content was associated with greater social media following, such as posts that elicit emotions, solicit viewer engagement, or use a combination of these approaches29.

Discussion

Social media is engrained in modern life, and this is reflected across healthcare professions47,48. This systematic review demonstrates the rapid adoption of social media in the field of orthopaedic surgery because individuals and institutions seek to acquire and distribute information, recruit, and network. The COVID-19 pandemic accelerated this uptake. Within orthopaedic surgery, the role of social media depends on the user and their goal.

Part I. Residency/Fellowship Programs

Orthopaedic surgery residency applicants seem to value social media as a source of information. Wang et al. (2021) found that 67% of programs used social media for recruiting applicants in the 2020 to 2021 application cycle compared with 15% from the previous application cycle26. Moreover, more programs reported social media to be “extremely helpful” or “very helpful” for recruiting applicants in the 2020 to 2021 cycle (39% vs. 10%, p < 0.001)26. Checketts et al. (2021) surveyed 127 applicants from the 2020 to 2021 application cycle and found that 78% perceived that orthopaedic surgery residency programs should have social media accounts and 54% of applicants indicated that an orthopaedic surgery residency program's social media content increased their interest in the program21. In addition, 50% of surveyed applicants stated that they attended an open house, educational session, or information session hosted by a residency after learning about the opportunity through social media21.

Findings would suggest that residency programs are expanding their use of social media as a recruitment tool and as an avenue to promote their program. Among residency programs, Instagram was consistently the most popular platform, used by 88% of programs26. This is followed by Twitter/X and Facebook26. The number of residency and fellowship programs with social media accounts before and after 2020 has increased substantially, with an average increase of 620%, 177%, and 69% for Instagram, Twitter/X, and Facebook, respectively28. The disproportionately larger increase in Instagram accounts compared with other platforms adds to the growing body of evidence, suggesting that Instagram is the primary social media platform among applicants and residency programs. According to applicants, Instagram provides the most benefit during the orthopaedic surgery residency application process21.

The marked increase in social media use by orthopaedic training programs during 2020 coincides with the transition from audition externships to virtual away rotations at the onset of the COVID-19 pandemic. Although programs already realized the wide-reaching capabilities of social media, the pandemic seems to have hastened the integration of social media into the residency application process. These findings are in line with literature from other surgical specialties14. In otorhinolaryngology (ENT), 61% of programs had at least 1 social media account as of June 202049. Similar to the rapid growth seen across orthopaedic surgery residency programs, 67% of Instagram accounts among ENT residency programs were created after March 2020—the beginning of the COVID-19 pandemic in the United States50.

Part II. Individual Orthopaedic Surgeons

In assessing social media use among individual orthopaedic surgeons, a wide variety of social media platforms surveyed did not fit within the conventional perception of social media. In particular, professional websites and ResearchGate profiles are not as commonly considered social media outlets compared with more dominant platforms such as Instagram, Facebook, and Twitter/X. As such, these authors assumed the definition of social media as any platform in which users can create and share content or participate in social networking. The more expansive definition allowed additional analysis into the use of these less common platforms that are vital to individual orthopaedic surgeon practice and professional promotion. Several studies found that a professional website was the most common platform, with use as high as 98% among surveyed orthopaedic surgeons30.

A wide variety of social media practices existed among orthopaedic surgeons across the published studies. Although the studies were relatively consistent in their findings regarding the percentage of surgeons reporting use of any social media platform, the breakdowns by platforms vary. The largest discrepancy was in the use of Twitter/X, with values ranging from 1.7% to 76% of orthopaedic surgeons35,38. The former statistic stems from a study of US hand surgeons35, whereas the latter statistic came from a study of all orthopaedic subspecialists in Saudi Arabia38. Similarly, most studies examined particular subspecialty groups, such as hand surgeons35,43, foot and ankle surgeons36, or shoulder and elbow surgeons42. More research is warranted to understand the impact of regional and cultural beliefs, as well as subspecialty, on social media use and platform preference.

The importance of social media presence differs between academic and private practice-based orthopaedic surgeons in certain settings. Private practice pediatric orthopaedic surgeons were twice as active on social media than their hospital-based counterparts40. Social media use could be more critical for patient recruitment and visibility for the private practice surgeon. Conversely, academic-based hip arthroscopy surgeons were more likely to use Twitter/X than their private practice-based colleagues, possibly as a means to promote their research37. Future studies are needed to delineate the difference in social media utilization between academic and private practice-based surgeons.

Future Directions for Social Media Use in Orthopaedic Surgery

It is likely that the variety of social media platforms will continue to diversify, with platforms such as TikTok already becoming popularized among healthcare professionals. Further study into the psychological aspect of social media utilization within healthcare is necessary. The authors are not clinical psychiatrists or psychologists and thus are unable to expound on the designs of various social media platforms and how they can be optimized for specific purposes. Instagram is a platform built on visual stimulation, whereas Twitter/X is designed based on the dissimilation of written thought. In a continuously competitive market, additional studies would be of benefit to determine which platforms are best suited to a particular task within healthcare.

Despite the broad utilization of social media throughout society, there are concerns regarding its use among physicians. Ethical and professional conduct concerns permeate throughout institutional leadership and medical licensure governing bodies. In a study evaluating the social media accounts of orthopaedic surgeons within the American Academy of Orthopaedic Surgeons directory, unprofessional content was documented in 2.8% of surgeons sampled31. Concern regarding professional infractions also exist within the clinician ranks. Approximately 37.9% of surveyed foot and ankle surgeons reported apprehension pertaining to social media use secondary to professional conduct concerns51. Social media posts containing misinformation and/or content deemed unprofessional can quickly damage the reputation of an orthopaedic surgeon or institution. A need for clearer guidelines for surgeons regarding appropriate use of professional social media accounts31. There is an opportunity for subspecialty organizations to develop guidelines for their members to create a shared understanding of appropriate usage. Care must be taken to ensure that the rapid adoption of social media across the field of orthopaedic surgery is an overall positive change that serves to increase accessibility to orthopaedic care and training.

Limitations

This systematic review has several limitations. Primarily, all articles analyzed in this study were Level III evidence or lower. However, a strength was the breadth of the literature search, having queried 3 large literary search engines for all articles meeting the inclusion criteria. This strategy ensured a high confidence that all relevant articles evaluating the use of social media within the field of orthopaedic surgery were captured, and that no higher-level studies were omitted from the review. This review demonstrates a need for higher-level studies to investigate the evolving presence of social media in orthopaedic surgery training and practice. Second, our results are those of the data reported at the moment of each specific articles publication. Unfortunately, this does not allow for the evaluation of real-time assessment of evolving social media trends or the adoption of newer platforms. This does represent a limitation and an opportunity for future survey and follow-up studies analyzing alterations in trends over time. Society's increasing reliance on technology is likely to prompt new and innovative uses of social media.

Conclusion

Social media has become instrumental to orthopaedic surgery training and practice as a means of information acquisition and dissemination, recruitment, and networking. Because of physical distancing restrictions, the COVID-19 pandemic further catalyzed the adoption of social media by orthopaedic institutions and surgeons alike. Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent, but additional platforms are proving valuable to research promotion and information distribution. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice.

Appendix

Supporting material provided by the authors is posted with the online version of this article as a data supplement at jbjs.org (http://links.lww.com/JBJSOA/A594). This content was not copyedited or verified by JBJS.

Footnotes

Investigation performed at the University of Minnesota Medical School, Minneapolis, MN

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A585).

Contributor Information

Aliya G. Feroe, Email: feroe.aliya@mayo.edu.

Arthur J. Only, Email: only0001@umn.edu.

Jerome C. Murray, Email: jeromecolinmurray@gmail.com.

Lynsey R. Malin, Email: malin085@umn.edu.

Nizar Mikhael, Email: mikha032@umn.edu.

Ryan S. Selley, Email: rsselley@gmail.com.

Ryan R. Fader, Email: Ryan.Fader@allina.com.

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