Development, Implementation, and Evaluation of a Virtual MedTwitter Curriculum for Medical Students

Abstract

Introduction

Social media has numerous academic and professional benefits and is increasingly valued within healthcare. MedTwitter is an online community of medical professionals on the X platform (formerly Twitter). Despite MedTwitter’s numerous benefits and far-reaching users, few medical schools teach students about this resource. We addressed this educational gap by implementing a MedTwitter curriculum designed for medical students.

Materials and Methods

Utilizing the principles of Adult Learning Theory (ALT), we developed a 10-h, virtual, self-paced curriculum introducing medical students to MedTwitter and its applications within medicine and education. The curriculum included primary literature, expert commentary, select MedTwitter content, original slideshows, and hands-on MedTwitter activities. Surveys collected qualitative and quantitative data regarding interest, knowledge, perceptions, and comfort with MedTwitter before and after course completion.

Results

Forty-three pre-clinical students voluntarily registered; only 26% had used MedTwitter previously. Pre- and post-course surveys showed significantly increased perception of MedTwitter as a valuable resource, intent to increase MedTwitter utilization, and significantly higher comfort with MedTwitter skills. Learning objectives were achieved, determined by survey results, group discussion responses, and products of course activities. Networking and learning were frequently cited benefits. Most responded positively to the self-paced, virtual design.

Discussion

A short, virtual, self-paced MedTwitter curriculum for medical students addressed an important educational gap regarding a valuable resource for medical students. It was well-received and achieved learning objectives, supporting our use of ALT.

Conclusions

Our MedTwitter curriculum, designed using ALT, was well-received, effective, and potentially adaptable for other platforms and healthcare professions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02122-9.

Introduction

Social media (SoMe) has numerous academic and professional benefits [1]. For a variety of reasons, X (formerly known as Twitter) has become a popular platform in the medical community, with over 26,000 individual physician accounts in 2020 [2, 3]. A boom of physician and institutional accounts followed the COVID-19 pandemic [4–6]. MedTwitter is the online, open-source community of medical professionals and students covering all niches of healthcare that interact on the X platform. The community uses the hashtag #MedTwitter to denote relevant posts, even after the platform rebranded to X. Users, from pre-med students to distinguished professors, utilize the same arena of idea-sharing, allowing open and direct communication between individuals who may never interact in person due to time or space constraints.

As a learning tool, MedTwitter aligns with the principles of Adult Learning Theory (ALT), which posits that concise bites of information; visual and audio inputs, asynchronous and self-directed learning, peer interaction, hands-on practice, question-based learning, and real-world applications all enhance adult learning efficiency [7, 8]. The increasingly recognized value of ALT and digital medical education resources suggests MedTwitter warrants continued exploration [8–12].

MedTwitter has been studied in numerous ways [1]. Studies have explored learner attitudes towards MedTwitter [11, 12], its use as a learning tool in undergraduate [13], graduate [14], and continuing [15] medical education; its effect on research dissemination [16], online medical practice reviews [17], patient education [18], professional development [19–21], and even residency match success [22]. Despite MedTwitter’s numerous benefits and highly active, far-reaching users, little formal education exists on the topic. Medical students, at the brink of their career, are not taught about this valuable tool that can enhance both their education and professional development. Our home institution, Ohio State University College of Medicine (OSUCOM), currently offers a “Healthcare Social Media” elective for medical students and “Social Media for the Internist” for internal medicine residents; each of these covers SoMe in a broad fashion without diving deeply into any one platform. No in-depth, dedicated MedTwitter curriculum exists at our institution or, to our knowledge, at any other institution. Nor are we aware of any studies addressing the impact of a curriculum designed to teach the uses of MedTwitter.

To address this education and literature gap, we utilized ALT principles to develop a short, virtual, self-paced curriculum that teaches learners about the many benefits and uses of MedTwitter for medical education and a medical career.

Materials and Methods

IRB Review

This project was deemed exempt after IRB review.

Implementation

At OSUCOM, “Selectives” are 10-h enrichment electives taken during pre-clinical years of medical school offering enhanced content exposure and didactics beyond core competency requirements. We designed our curriculum “MedTwitter for Medical Students” to be implemented in this context. The curriculum was listed in the course catalog alongside other Selectives; interested students enrolled voluntarily. While no explicit pre-requisite knowledge was required, it was assumed interested students of this generation would have at least a rudimentary understanding of the Twitter (now X) platform, even if they had never used it.

The curriculum was designed to be virtual and completed at a self-directed pace. While 2 days were earmarked as their “Selective” time, students were emailed with all course materials 2 weeks in advance, giving them ample time for self-directed completion. The only time requirement was a scheduled virtual group discussion at the end of their earmarked time.

A logic model diagram for our curriculum design can be seen in Supplemental Material 1. Curriculum learning objectives are shown in Fig. 1A. The curriculum comprised 10 h of didactics. The course outline can be seen in Fig. 1B (abbreviated) and Supplementary Material 2 (comprehensive). Education materials were curated and selected by JAG and CC based on literature search and personal/professional experience with MedTwitter; materials included primary research literature, commentary pieces, select MedTwitter content from recognized MedTwitter experts, a podcast audio clip, and original slideshows covering a range of topics.

Fig. 1.

Three learning objectives (A) and abbreviated hour-by-hour breakdown of our curriculum. (B). Abbreviations: MedEd, medical education

We used principles of ALT to inform our curriculum design. We tapped into learner motivations by emphasizing how MedTwitter can be leveraged to their advantage as students and professionals [7]. Self-pacing allowed students to spend their learning time as they chose, focusing more on what each student found difficult to grasp. The course materials were designed to take 30 min or less each, knowing attention and knowledge retention may suffer with longer sessions [23]. Content was presented in a variety of formats and media to prevent monotony and ensure different learner types were represented. Experiential learning and deliberate practice via hands-on activities allowed students to immediately apply what they learned while utilizing their own creativity and interests to solidify the concept. Group discussion allowed for collaborative learning, deeper reflection, posing of questions, and socialization and contextualization of the content with their peers [7, 24, 25].

Evaluation and Statistical Analysis

We administered pre-course and post-course surveys similar to those used in the other SoMe curricula at our institution. Surveys were distributed via Google Forms (Google LLC, Mountain View, CA, USA). The pre-course survey assessed demographics, background characteristics, and prior SoMe use. Both surveys utilized five-point Likert scales to evaluate MedTwitter perceptions, comfort with MedTwitter skills, intended changes to MedTwitter use, and course satisfaction. The post-course survey also incorporated open-ended response questions to elicit course feedback and reflective thoughts on MedTwitter.

Quantitative analysis was performed utilizing R (version 4.2.0, R Core Team, 2022). Descriptive statistics were used for baseline demographics, characteristics, and SoMe use. For MedTwitter perceptions and comfort, student’s pre-course and post-course values on 5-point Likert scales were compared. Median differences were calculated; statistical significance was determined using Wilcoxon signed-rank test.

Inductive thematic analysis of open-ended responses utilized a six-phased method for trustworthiness[26, 27]: (1) familiarize yourself with your data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) define and name themes, and (6) produce the report. JAG and JBV met to initially code a short set of student comments. After establishing a coding framework, independent iterative coding (Supplemental Material 3) was performed using the qualitative analysis software NVivo 14 (Lumivero, Denver, CO, USA). The two reviewers maintained reflexive notes during the coding process. They completed four debriefing check-ins, comparing notes, to reach a consensus regarding themes. Reflexive notes allowed examination of the data with sensitivity to prior assumptions and experiences, while also functioning as an audit trail, contributing to trustworthiness. Inter-rater reliability, calculated as outlined in McAlister et al. [28], indicated high agreement (94.3% and 96.1%). Common themes were extracted for more detailed understanding of MedTwitter perceptions.

Learning objective achievement was formatively evaluated via instructor review of activities, survey responses, and group discussion with the aid of validated surveys [29, 30]. Objective 1 was evaluated via successful completion of the first course activity. Objective 2 was evaluated via instructor review of student Twitter activity along with utilization of a rubric adapted from the Written Communication VALUE rubric [31] to assess the original MedTwitter content students created as part of a course activity. Objective 3 was evaluated via instructor utilization of a rubric adapted from the Critical Thinking VALUE rubric [32] to assess student responses to open-ended survey questions and group discussion (Supplementary Material 4).

Results

Forty-seven students enrolled, and 43 consented to study participation. Twenty-three (53%) were female, and 22 (51%) were first year students. All had used SoMe before; 38 (88%) were active users. Most (35, 81%) had heard of MedTwitter; only 11 (26%) had ever used MedTwitter. Full student characteristics and baseline SoMe use are found in Supplementary Materials 5–7.

After course completion, there was a statistically significant increase and high level of agreement that MedTwitter is a valuable educational tool and should be incorporated into medical education. There was low agreement and no significant change regarding the sentiment that MedTwitter is preferred to traditional lectures (Fig. 2A).

Fig. 2.

Student perception of MedTwitter and comfort with MedTwitter skills. A Percent of students completing each statement with “agree” or “strongly agree” before and after course completion on a 5-point Likert scale (1, strongly disagree; 5, strongly agree). B Percent of students feeling “comfortable” or “very comfortable” for various MedTwitter skills before and after course completion on a 5-point Likert scale. Abbreviations: CI, confidence interval; MedEd, medical education

Most students, regardless of prior use, intended to start or increase MedTwitter use and content creation after course completion (Supplementary Material 8). Comfort with each of ten MedTwitter skills was low at baseline but increased significantly for all ten skills (Fig. 2B). All 43 students agreed they were satisfied with the course and learned something new. Most (36, 84%) were likely or very likely to encourage others to use MedTwitter.

Qualitative Data

Thematic analysis revealed networking and learning as the two major themes reported as MedTwitter benefits. Few participants also pointed out MedTwitter negatives. Overall, students enjoyed learning about the uses and benefits of MedTwitter. The self-paced, virtual design and content creation activity were frequently cited as positives. Examples of the MedTwitter content created by students during the course can be found on the X platform (Supplementary Material 9). The most mentioned course critique was the need for more or different content or examples. Some suggested more group discussion. Full coding results are found in Supplementary Material 10. Representative comments illustrating common identified themes are in Table 1.

Table 1.

Examples of common positive feedback and critiques identified during thematic analysis of open-ended post-course survey responses

Theme	Example
Positive feedback
Networking	“…I never realized just how useful MedTwitter can be for education, mentorship, and networking when used properly” “I have a habit of shying away from in-person networking events… Twitter takes some of the pressure off” “I already met a faculty member who recognized my tweet from MedTwitter and it made an instant connection between us” “I really want to use Med Twitter as a networking platform since I am a first gen med student with minimal connections” “[MedTwitter] lessen[s] the barrier between students and professionals”
Learning	“There are a lot of good study graphics on MedTwitter which help me as a visual learner” “MedTwitter [is] helpful for staying up to date [with] literature” “[MedTwitter is] a fast way of coming in contact with a variety of helpful content” “…allows me to take in material that I wouldn't have seen otherwise” “Tweetorials… allow information to be learned concisely and efficiently”
Self-paced, virtual design	“I thought keeping it virtual from the comfort of home… felt more creative and natural to not be discussing a virtual world in-person” “…allowed me to go at my own pace, spending time on things I wanted to know more about”
Content creation activity	“I like how we made our own accounts and had to create our own content because it pushed me outside of my comfort zone in a good way” “I enjoyed the engaging part and requiring us to make a post. I felt it was like an induction into MedTwitter and made me less shy to use it”
Group discussion	“I enjoyed the group zoom session! There were great conversations surrounding the best way to produce content; I found it helpful” “It was helpful to have the discussion at the end to connect everything”
Critiques
Course content	“Would be great to provide even more examples” “[There should be] a segment… about the negatives of Medtwitter”
Content creation activity	“…brainstorming breakout sessions [for] creating content may be useful” “Maybe having a specific prompt to tweet about would be helpful.”
Group discussion	“It could be a little more interactive.” “Talk[ing] out ideas on posts with everyone would've been beneficial”

Learning Objective Achievement

All students were successful in learning objective achievement. Successful completion of all course activities (examples in Supplementary Material 9) along with data in Fig. 2B demonstrates achievement of learning objective one. For objectives 2 and 3, all students received scores of 2–4 on the respective rubrics for MedTwitter content creation and explanation of potential MedTwitter benefits (Supplementary Material 4), indicating successful objective achievement.

Discussion

We developed a 10-h, virtual, self-paced curriculum to teach medical students about the uses and benefits of MedTwitter. Forty-three students participated. Post-course surveys show most students intend to start or increase MedTwitter utilization and have increased and positive perception of MedTwitter and an increased and high level of comfort with MedTwitter skills. Students were satisfied with the curriculum, and most would recommend colleagues use MedTwitter. All students demonstrated achievement of the learning objectives, indicating fulfillment of the educational gap we addressed.

Students reported positive feedback regarding the self-paced, virtual curriculum structure, diverse materials, real-world applications, group discussion, and hands-on activities—all aspects intentionally aligned with ALT. This feedback combined with successful learning objective achievement strongly supports our decision to use ALT in curriculum design.

While overall course feedback was positive, we recognize areas of improvement for future iterations. First, the addition of an instructor-led course introduction and group discussion during content creation brainstorming was requested by multiple students. Second, although potential negatives of MedTwitter (SoMe addiction, online bullying, controversial posts, HIPAA violations, misinformation) were covered in group discussion, multiple students felt drawbacks should be covered in more depth in the primary materials. These simple changes will strengthen the course; the next iteration will reflect this feedback.

While our curriculum was delivered to medical students, MedTwitter is comprised of members from all healthcare fields. The learning objectives and course material are not exclusive to medical students; rather, the curriculum is directly applicable to any healthcare professional, educator, or student with minimal adaptations needed. The effectiveness of our curriculum in achieving learning objectives demonstrates its potential as a solid template for other SoMe platforms. This is especially important given the constant and rapid evolution of SoMe, as demonstrated by Twitter’s rebranding to X and the platform changes that have come along with it [33]. Our future work will focus on updating the curriculum to match ongoing changes to the X platform, exploring student experiences with other SoMe platforms, and creating parallel curricula for these platforms (ex: Instagram, Facebook, podcasting, TikTok, Mastodon).

Project limitations include surveys that are not a validated measurement tool. Future work should include development of validated surveys to evaluate student perceptions and comfort with social media, course satisfaction, and intended practice changes as a result of the curriculum. Further limitations include a cohort of students from one semester at one institution. Although informed consent stated participation and de-identified survey responses would not affect grading, it is possible responses were biased by perception that pass/fail grades might be affected. Because the curriculum focused on MedTwitter benefits, not negatives, it is possible survey responses were biased in a positive direction. Finally, as we know SoMe is a rapidly evolving entity, specifics within the curriculum may become out of date, although general principles will likely remain applicable.

Conclusion

Despite these limitations, we provide evidence that a 10-h virtual curriculum designed to teach medical students about applications and benefits of MedTwitter was popular with students and effective in achieving learning objectives. This curriculum fills an educational gap and provides students with the tools and knowledge to effectively utilize MedTwitter, a free and increasingly valuable academic and professional resource, particularly in the realms of networking and learning. This curriculum can be utilized by all healthcare students and professionals or adapted for other SoMe platforms. As healthcare education evolves and the importance of SoMe grows, educators must evolve in kind to equip learners with cutting-edge knowledge and skills to succeed.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contribution

This project was developed as part of the Medical Education Advanced Competency program within the Nationwide Children’s Hospital Pediatrics Residency Program.

Data Availability

Original data from pre- and post-course surveys are available upon reasonable request from the corresponding author.

The results of this project were previously presented at the Ohio State University College of Medicine Annual Education Symposium (1/25/2023) in Columbus, OH, and at the Nationwide Children’s Hospital Annual Advanced Competency Symposium (6/6/2023) in Columbus, OH.

Declarations

Ethics Approval

This project was reviewed by the Ohio State University Institutional Review Board and deemed exempt from any required ethics approval.

Consent to Participate

Informed consent was provided to every student at the time of course enrollment. Only those who provided consent were included in the analysis. Providing consent changed nothing about course requirements; it simply granted our team permission to include survey data in analysis.

Competing Interests

The authors declare no competing interests.