Best practices from the Association of Pulmonary and Critical Care Medicine Program Directors for social media use with emphasis on virtual recruitment

Abstract

Since the COVID-19 pandemic, the need to develop innovative strategies for virtual engagement and interaction has emerged. There has been a growing emphasis on online recruitment strategies for most medical specialties. For the last several interview seasons, many national organizations have recommended that fellowship interviews be conducted virtually for all applicants. Social media represents a powerful tool for both the program and the applicants. However, there remains a paucity of data published on social media use for virtual recruitment in pulmonary and critical care medicine (PCCM). Here, we review the available data for virtual recruitment and propose best practices for PCCM programs. Our social media strategy outlines specific and practical steps that form the framework for a social media charter including defining the goal and audience, following institutional guidelines, choosing appropriate platform(s), identifying and defining an account management plan, devising a strategy for content generation and posting, and continuing to reassess and optimize the process. Our best practices provide a practice framework for PCCM programs, both novice and advanced, for social media use. They also emphasize a need for more research on social media’s impact on future recruitment cycles while providing a better understanding of current practices for applicant program selection and virtual recruitment.

Introduction

Since the COVID-19 pandemic, there has been a transition to virtual interviews and a growing emphasis on online recruitment strategies for most medical specialties. Pulmonary and critical care medicine (PCCM) fellowships have experienced a steadily rising interest from applicants nationwide based on longitudinal data from the Electronic Residency Application Service and the National Resident Matching Program.¹ The Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD) consists of program leaders from critical care medicine (CCM), pulmonary medicine, and PCCM, representing 98% of the Accreditation Council for Graduate Medical Education (ACGME)–accredited fellowships in these subspecialties. The APCCMPD is vested in all aspects of fellowship recruitment.² In response to evolving needs, the APCCMPD Social Media Committee has taken the initiative to develop innovative virtual strategies to enhance engagement and interaction.

The applicant’s first impression is often based on the program’s website, but social media is a powerful tool that can harness significant influence. Social media platforms serve as a modality to engage prospective fellows, highlight the accomplishments of fellows, faculty, and the program, and elevate the visibility of the institution and the fellowship. It also allows the fellowship to showcase efforts at wellness, social gatherings, diversity and inclusion efforts, insight into living and working in the program’s geographic region, and even community service.³ Social media represents a powerful tool for both the program and the applicants, but there remains a paucity of data published on social media use for virtual recruitment. Most of the current literature is composed of small-scale studies regarding social media use in residency ­recruitment. Our purpose is to review the current data on social media use for virtual recruitment and to propose 6 best practices for CCM, pulmonary medicine, and PCCM programs moving forward (Figure 1).

Figure 1.

Six best practices for utilizing social media for fellowship recruitment.

Define goal and audience

Social media platforms vary based on content and target demographic, so it is imperative to define your goal and audience at the outset.⁴ For this publication, prospective applicants are the primary focus; however, social media platforms impact many individuals, institutions, and professional organizations. Social media allows the display of real-time institutional identity and work culture, and prospective fellows can utilize these engagements to discern their perception of the institution. Further, they may prioritize programs suited to developing their own professional identity or those that align with their priorities.

The social media account is an adjunct to the program’s website but not a replacement. Depending on platform choice, the content and tone can vary to feature a variety of real-time or interactive content, including highlighting program faculty, celebrating clinical or scholarly accomplishments, and emphasizing research endeavors. Featuring the “intangible” aspects of the program can promote a sense of camaraderie as well as the daily routines and lifestyle among current fellows. The account can represent the division and/or focus solely on the fellowship. The latter promotes solidarity, daily routines, and lifestyle among current fellows.⁵ A hybrid model could include representing the division and the fellowship, thus incorporating aspects of fellow life and accolades of the training program and institutions themselves.^6,7

Follow institutional guidance

Institutions often have specific criteria for use of their brand on social media, as well as guidelines for employees and/or departments, and these may include the integration of branding and oversight of content, among other regulations.⁴ Many fellowship programs have circumvented institutional restrictions by creating “unofficial” accounts. In these cases, accounts should clearly state that shared content does not represent the institution’s views.^8-10

However, not all institutional involvement is restrictive. Some institutions may have resources that can benefit account management, such as access to paid social media management platforms, branding, or multimedia software. Additionally, engaging with other high-performing accounts within the institution can help to amplify the program’s account. Regardless, clear communication within institutional guidelines and with internal media departments is recommended to facilitate synergy and collaboration.

Choose platform(s)

In surveys of social media use among applicants in the postpandemic era, applicants expressed that the first stop for gathering information is the program website.^11-13 However, while websites can convey the most information about a program, they are difficult to update in real time, may require technical expertise, and lack interactivity.

Surveys of program social media presence have also demonstrated a shift toward multimedia-based accounts such as Instagram.^12,14-18 While historically X (formerly known as Twitter) was heavily used by medical educators and scholars, choosing a platform most widely used by the current target demographic is ideal.⁸ Algorithmic boosting of content and users’ preference to view multimedia-based content highlights the value of original content with pictures or videos for generating greater impressions, thus increasing visibility.¹⁰ Although the use of multimedia allows greater flexibility in transmitting information, the composition of more elaborate posts (including videos and graphics) represents an added workload. Challenges may arise with various platforms, including generational predilection, concerns for data privacy and security, and efforts at monetization. Cross-platform posting may further optimize viewership, improve efficiency, and reduce duplication of work. The pros and cons of various popular social media platforms are summarized in Table 1.

Table 1.

Pros and cons of common virtual recruitment platforms.

Platform	Pros	Cons
Website19 (institution, division, fellowship)	First stop for applicants accessing program ­information Most comprehensive reservoir for information Serve as an archive for learning resources (lectures, articles) Flexibility in design Links to social media bios or posts	Institutional oversight often required to amend Lack of interactivity Unable to update in real time May require technical proficiency
Facebook5	Large audience Interface familiar to most users Easily cross-posts to Instagram	Generational limitation Not routinely used among current ­prospective applicants
X (formerly Twitter)5  ,  9  ,  20	Widely used by medical departments and faculty Still most “public square” and venue for discourse on social media Well-defined best practices for use in medical ­education community Allows for video/image posting Scheduled posts permissible Utilize “pin” feature to keep specific posts at the top of the profile. For example, post with video introduction to program, so visitors see it first	Algorithm changes Changes to security/safety Character limit Pressure to subscribe/be verified Increasing “bot” presence and politically charged environment
Bluesky	Similar interface to X/Twitter Becoming more popular among the medical ­education and scientific community Ability to curate one’s own feed without ­algorithmic input	Lacks broader audience Unclear trainee usage
Instagram5  ,  11  ,  14-18  ,  21-23	Popular personal account with wide appeal among trainees Widely used by multiple programs Ability to store/highlight important posts Heavily moderated, can disallow comments Flexibility in content and interactivity Pin multiple Reels or posts to the top of the grid strategically to highlight program; for example, videos including program information or other attributes	Limited ability to create and schedule ­interactive posts in advance Higher-performing accounts involve highly engaged account moderators More effort is required to create ­multimedia posts
Threads	May capture audience already using Instagram Bridge between Twitter and Instagram for those not posting videos or reels	Lacks ability to schedule posts in advance Need a Meta account (Facebook, Instagram) to join No anonymity allowed Future is uncertain
TikTok	Widely used by most young adults Can be shared across other platforms	Only video content allowed Future is uncertain Limited inability to moderate/disallow comments National security and data privacy concerns
LinkedIn3  ,  9	Largely used by professionals and businesses for job search	Limited utility for daily use Limited interactivity

Identify an account management plan

Once a goal, audience, and platform have been identified, the program must decide on operationalization.

• Identify who will be responsible for generating, approving, and posting content:

  • Some programs may opt for fellow-run accounts to demonstrate an unfiltered look into the fellow experience. However, content must be discussed ahead of time so that controversial topics such as politics or world events are avoided. Ultimately, even with fellow-run accounts, vetting of posts that reflect content outside of those previously agreed upon should be approved.

  • Others may prefer that program leadership (director, key clinical faculty, or coordinator) serve as gatekeepers and approve all posts, which can be fellow generated.

  • For trainee-run accounts, the individual or team should be someone in good standing and preferably with a neutral or positive outlook on the program. Ground rules as noted in this document should be discussed at the start and revisited periodically. Ideally a team of several individuals will allow collaboration as well as consensus for posts. Selection of fellows from multiple years will also allow some degree of sustainability when the senior fellow member graduates.

  • Ultimately, if the account represents the fellowship program, a designee from program leadership should be ­appointed to monitor and provide feedback to posts, regardless of who runs the account.

• Determine the workflow for content posting: Depending on the platform, posts can be scheduled in advance, but genuinely interactive posts and videos must be posted in real time.

• Devise a plan to respond to comments: Once identified, the primary account manager should decide in advance how to handle comments, and protocols on how to direct messages and/or inquiries should be established.^8,9 Specifically, positive comments can be acknowledged, and those with inquiries can be referred to the website or program leadership. For comments that are negative or conflict-provoking, a transparent system with a thoughtful, professional, and strategic approach is needed (Table 2).

Table 2.

Recommendations for social media responses.

Recommendations	Examples
Stay professional and respectful: Maintain a calm, courteous tone. Avoid defensiveness, blame, or sarcasm. Do not respond impulsively. Take the time to evaluate the ­concern and understand the comment fully. Evaluate the nature of the response. Is it a legitimate concern or a comment or misinformation or trolling?	My dad died in this hospital We are so sorry for your loss. If you have concerns about your father’s care, please DM us and we can connect you with the right people.
Address constructive criticism: For comments that are valid with legitimate concerns, provide a clear, respectful response. This would include acknowledging the issue and thanking them for feedback. Consider a method for follow-up (direct message, email) if the conversation seems productive. For misinformation, consider correction politely with links to credible sources or evidence.	This post is unhelpful and misleading Thank you for your comments. If there is a specific concern, feel free to direct message us or email at … Vaccines don’t work. This is a scam Thanks for your comment. Evidence from multiple studies shows … Here is a helpful summary from [guidelines, trusted source] We understand the concern. Based on current guidelines …
Avoid engaging with comments meant to provoke (offensive, ­abusive, or irrelevant): Use platform tools to hide, mute, report, or block as appropriate. Document the exchange and escalate within the platform. Save exchange if needed for institutional records.	You people are idiots No response This all made up and fake science No response
Take conflict-provoking conversations offline: Some situations are best handled privately. Involve your communications or legal team if needed. For those potentially damaging, threatening or legally sensitive, escalate to your institution’s public relations or legal team.	It is clear you don’t care about patients or their families We can continue this conversation via direct message or email so we can better address your concerns. We understand that this is a sensitive topic, and we welcome respectful dialogue. We aim to share evidence-based information, and we are happy to continue our conversation via …

Devise a plan for content generation and posting

Content will vary based on the goal of the account. A prepandemic survey of social media use by PCCM programs categorized content into medical education (#MedEd), clinical, and social. Posts using hashtags and links tended to generate more engagement. At the time of this study, multimedia formats, including video, were seen less frequently.²⁴ However, since the pandemic, multimedia content, including short-form video, has become increasingly popular. Conventional content recommendations include utilizing current medical education events, faculty and fellow awards and accomplishments, and publications.^9,25

In general, since the account is centered around medical education and the fellowship program attributes, posting of politically or emotionally charged content is strongly discouraged. Views will never reflect the sentiment of all and, worse, may alienate others. Moreover, such posts can endanger the credibility of the program, impact the institution, and jeopardize the job (or funding) of those posting. Further counseling of trainees to avoid such content is also encouraged, as the content may always be discoverable.

In all instances, content should respect Health Insurance Portability and Accountability Act (HIPAA) privacy.^8-10 Pictures of patients and/or associated images should not be posted with any patient-identifying information. Take caution not to generate pictures or posts or live feeds in patient care areas. Even de-identified images should not be shared proximal to the actual patient visit or interaction, and these should be considered for sharing in another forum (case report, case conference) with patient permission.

Creating a content calendar can ensure regular posting and a regular cadence for followers. Multiple social media platforms “boost” accounts that post content regularly rather than intermittently. This “boost” increases the chance for the account to be seen by prospective applicants.²⁵ Regarding prospective applicants, content can include “Day in the Life” Or “Account Takeovers” in which current fellows share posts about their day. “Ask Me Anything” posts allow applicants to interview current faculty and fellows. Posts can also include faculty and fellow profiles, wellness initiatives, conferences, and diversity and inclusion efforts.^5,25 Some programs offer virtual “open houses” as an opportunity to interact with current fellows as well.^14,17 A survey of general surgery residency applicants revealed that posts regarding life outside the hospital were the most helpful.¹¹ Examples of suggested content are detailed in Table 3.

Table 3.

Examples of recruitment-specific content.

Type of post	Examples
“Day in the Life”	Fellow gives real-time video “play-by-play” of their day Provides view of work life Opportunity to view fellow colleagues and interactions Demonstrates value placed by program on their fellows
“Account Takeover”	Helpful for non-fellow moderated accounts Fellows take over the account for the day and can feature a “Day in the Life” or answer real-time user submitted questions Emphasizes value of program for fellow perspective
“Ask Me Anything”	Representative (faculty, fellow, program leadership) answers user submitted questions
Fellow profiles	Profile on current fellows Allows fellow background, aspects of life outside the hospital, current research projects, or testimonial about the program
Faculty profiles	Profile on current faculty Feature specialized program offerings or areas of expertise, aspects of life outside the hospital, ­current research projects, or testimonial about the program
Medical education content	Feature infographics Snapshot of lectures to represent available curricula Highlight program curriculum to both disseminate information regarding structure and content
Diversity and inclusion	Transparently showcase diverse faculty and fellows Describe mentorship or development offerings
Fellow achievements	Highlights fellow awards, conference participation, and research endeavors Can showcase various program offerings including scholarship and advocacy
Social posts	Feature fellows outside of work Fosters sense of comradery among current fellows Displays fellow lifestyle to prospective applicants
Leverage current ­“viral” trends	Utilize and adapt current viral trends to showcase various aspects of your program Capture relatability of fellowship and program

Continue to reassess and optimize

Like any successful research or quality improvement initiative, a successful social media strategy (Figure 2) comprises regular monitoring of metrics, including followers and impressions. If a particular type of content is highly performing regularly, future account content can be modified appropriately.^8,9 Various strategies and diversity in posts (Table 3) can help boost impressions and visibility of the account.

Figure 2.

Social media optimization strategies and examples.

Limitations

Given the evolving nature of social media, several limitations exist to these recommendations. First, published data from the postpandemic recruitment seasons is limited and already inherently outdated, and there may be a delay between when the current landscape is captured, processed and reflected in the medical literature.³ Thus, this work reflects timely consensus from a digitally engaged PCCM-focused group. Utilization of social media as well as preference of platform may vary from applicants to the programs themselves.

Conclusions

The APCCMPD has recommended virtual interviews for all applicants, including those who are local. As such, social media will continue to have a role in representing the identity of each program and communicating its unique qualities.²⁶ Our best practices provide a practice framework for PCCM programs, both novice and advanced, in social media. Since the pandemic, training programs have increasingly been using social media to convey program culture and “intangibles” in the era of virtual interviews. Engaging with prospective fellows online requires a consistent presence on social media platforms and content management, with a growing emphasis on multimedia or video content.

More research is needed on current practices for program selection from applications, virtual recruitment from programs, and the impact of social media in future application cycles. Our statement outlines 6 core components of a social media charter, applicable to any current or future social media platforms, so PCCM programs may navigate virtual recruitment engagements successfully.

Author contributions

All authors contributed to the drafting and critical revision of the manuscript and approved the final version.

Supplementary material

Supplementary material is available at ATS Scholar online.

Conflicts of interest

Please see the ICMJE disclosure forms, which have been provided as supplementary material. A.A.G. serves on the American Board of Internal Medicine Critical Care Medicine Board. J. R. is Executive Director of the APCCMPD. All other authors declare no conflicts of interest.

Disclaimer

Only the named authors of this manuscript contributed to the content and writing of this manuscript. None of the authors received financial compensation from an external source in return for writing or publishing this paper.

Artificial intelligence disclaimer

No artificial intelligence tools were used in writing this manuscript.