The Usage of Social Networking Sites by Medical Students for Educational Purposes: A Meta-analysis and Systematic Review

Abstract

Background:

Online social networking sites (SNSs) (e.g., Facebook, MySpace, Flickr, Twitter and YouTube) have emerged as rapidly growing mechanisms to exchange personal and professional information among university students. This research aims to determine the medical students’ extent of usage of SNSs for educational purposes.

Materials and Methods:

Educational Resources Information Centre (ERIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, and Excerpta Medica Data Base (EMBASE) were searched to retrieve articles from 2004 to 2014, applying predefined search terms and inclusion criteria. The extracted 10 articles were outlined in a narrative synthesis of Quality, Utility, Extent, Strength, Target and Setting of the evidence (QUESTS).

Results:

Majority (75%) of the respondents admitted using SNSs, whereas 20% used these sites for sharing academic and educational information. No single study explored the impact of the SNSs on the academic performance.

Conclusion:

Understanding and knowledge of the significant use of SNSs by the medical students demand inclusion of such domains in medical curricula. This will train tomorrow's doctors in fostering their skills of digital technology for educational purposes.

Introduction

The social networking sites (SNSs) are dedicated websites or applications that allow the clients to communicate with each other for sharing information, posting videos, pictures, comments, and messages.[1] A wide spectrum of telecommunication gadgets are available for networking which are broadly classified in six categories, that is, blogs and microblogs (e.g., Twitter), collaborative projects (e.g., Wikipedia), content communities (e.g., YouTube), virtual social worlds (e.g., Second Life), virtual game worlds (e.g., World of Warcraft), and SNSs such as Facebook and MySpace.[2] Google and Facebook are the most commonly used social media tools, followed by YouTube, Twitter, Flickr, and LinkedIn.[3] The usage of SNSs depends upon specific requirements of the clients. Precisely, if an academician wants to supervise trainees’ use of social media, Facebook, the most popular SNS, would be a logical choice.[4] On the other hand, if a researcher or learner wishes to follow conversations in a particular discipline or contribute by sharing novel research information, one may consider Twitter, a popular microblogging SNS used by 15% of adults.[5] Blogging is recommended for those who wish to further develop their writing skills. Engagement with social media can be personal, professional, or both, and there is ample evidence that digitally-savvy adults and youth use social media for health-related information.[6]

Social media uses mobile and web-based technologies to create highly interactive digital platforms through which individuals and communities share, co-create, discuss, and modify their interactions. It facilitates pervasive and profound means of communication organizations, communities, and individuals.[7] For this purpose, “Web 2.0” is often used interchangeably with “Social Media” or “user-generated content.”[8] There is convincing evidence that SNSs are becoming popular among university students, specifically in connection with their studies.[9] There are over 350 such SNSs in operation across the internet,[10] however, there is a paucity of data in the adult literature describing their usage for educational purposes by medical students. This meta-analysis aims to test the hypothesis that “medical students use SNSs for educational purposes.” The results of the meta-analysis are then analyzed and conclusions are drawn to capture future recommendations.

Materials and Methods

The databases Medline, Educational Resources Information Centre (ERIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, and Excerpta Medica Data Base (EMBASE) were searched for articles about the usage of SNSs by medical students and the extent of usage of SNSs for educational purpose. The search included the period from 1 January 2004 to 1 January 2014. Data was retrieved by connecting Medical Subject Heading (MeSH) terms [“social media” or “social network” or “social networking” or “medical education” or “medical students” or “Facebook” or “Twitter” or “Web 2.0”] in Endnote ×5 Software Philadelphia, PA.

Inclusion criteria were the selection of those articles where

• Respondents were medical and allied health (medicine, pharmacy, dentistry, nursing) students and/or of the undergraduate or postgraduate programs

• Usage of SNSs by students for educational purposes was explored

• Implementation of SNSs as an intervention in medical education was studied

• Studies included surveys or research-based projects.

Data were extracted, for each individual study, into a piloted, nonstandardized data-table for accuracy and completeness [Table 1]. Extraction included subheadings from the Best Evidence Medical Education (BEME) Quality, Utility, Extent, Strength, Target, Setting of evidence (QUESTS) acronym.[11] The strength of the retrieved evidence was graded using strength of evidence for BEME;[12]

Table 1.

Narrative-analysis of selected articles by QUESTS about usage of social networking sites

• Grade 1; No clear conclusions can be drawn. Not significant

• Grade 2; Results ambiguous, but there appears to be a trend

• Grade 3; Conclusions can probably be based on the results

• Grade 4; Results are clear and very likely to be true

• Grade 5; Results are unequivocal.

The meta-analysis was conducted through Forest plot that graphically represents the consistency and reliability of the results from selected studies. In this study, Forest plot was designed through Microsoft Excel 2013 by following the recommended steps by Neyeloff, Fuchs.[13] Effect size of each study was computed as an outcome, and pooled effect size was also calculated to observe the heterogeneity among studies. This search retrieved 1188 citations. Analysis of these studies was done by following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[14] After analysis of abstracts and full-text articles, 1125 studies were excluded as they did not match the inclusion criteria either because these studies did not emphasize on social media literature or did not focus on SNSs usage in different health disciplines [Figure 1].

Figure 1.

The flow diagram showing selection of articles for this systematic review and meta-analysis

Sixty three studies were found relevant as they examined the usage of SNSs in medical education. During full-text analysis of these 63 studies, 3 more relevant studies were retrieved from cited research. From the aggregate of 66 studies, 56 were excluded due to theoretical and opinion-based contents, general studies on information technology and education, and meta-analysis, and review studies. The finally selected 10 articles were analyzed in detail.

Results

Overall, 75% (70–80%) of the respondents in this meta-analysis used SNSs, whereas 20% (1.7–54%) reported that they used SNSs for academic and educational purposes. No single study has performed the scientific analysis to examine the educational impact of the SNSs on the medical and allied health sciences students. Only two studies have applied inferential statistics whereas rest of the studies have presented descriptive statistics only. Figure 2 shows the Forest plot that illustrates a series of estimates and their confidence intervals at 95% level.

Figure 2.

The Forest plot analysis illustrating the usage of social networking sites by medical students for educational purposes

Each individual study's effect size (outcome) is shown by a square box and the confidence interval is represented through a horizontal line. This plot shows that the selected studies have wider confidence intervals with inconsistent response rates, indicating heterogeneity. On the basis of greater heterogeneity, random effects model is the appropriate effect summary model of this study. Therefore, effect summary 60.06% with confidence interval (49–71%) is the relative point to compare the effect sizes of all studies. The 10 studied articles are briefed in Table 1.

Gray et al.[9] explored the productive usage of SNSs (Facebook) by Australian medical students. They applied both quantitative and qualitative methods, and empirically, found that 25.5% of 759 respondents used Facebook for educational purposes. Sandars and Schroter[15] assessed the level of awareness and usage of Web 2.0 technologies (podcasts) by qualified medical practitioners and medical students in the UK. They found that respondents had greater understanding of different Web 2.0 technologies and they were eager to apply these technologies in medical education. Unfortunately, the respondents were unable to properly utilize them without training. The authors stressed the need to train the students in getting better results. White et al.[16] investigated the usage of SNSs by medical students in Canada. The majority of respondents agreed that Facebook might be beneficial if its usage follows appropriate guidelines for maintaining privacy, legal, and social concerns. Roblyer et al.[17] conducted a comparative overview of usage and purposes of SNSs by faculty and medical students in USA. The study concluded that only 9 (4.9%) respondents used Facebook and other social media for academic purposes and communication. Sixty (33%) of the respondents agreed that Facebook was for social and personal usage but “not for education.” However, majority (69; 37.9%) of the respondents agreed that it would be very convenient to use Facebook for education. The students preferred SNSs technologies for study and class work projects whereas faculty still used traditional modes such as email. Mena et al.[18] studied the eagerness of health professionals and medical students regarding the usage of SNSs for shaping their professional behavior in Spain. They found that 65.1% health professionals searched influenza vaccination queries on internet, and joined and actively participated in technical Facebook group. They claimed that students were more willing to join and participate in informal Facebook pages.

Erfanian et al.[19] explored the knowledge and usage of SNSs of medical students from different fields including Medicine, Nursing, Health, and Paraclinic in Iran. They found that 57.5% medical students were aware about SNSs. However, more than half (55%) used SNSs for getting in touch with their old friends whereas only 11% students used SNSs for educational purposes. They suggested that there was a need to improve the cultural and educational quality of SNSs for producing optimal outcome. Cain and Policastri[20] studied the informal application of SNSs among undergraduate pharmacy students in USA. They developed a unique learning environment to provide exposure to students regarding contemporary issues and perspectives of 3 external experts in their field by creating a Facebook group page with optional participation. The majority (84%) stated that their main reason of joining the group was to gain extra credit in exam. On the other hand, 16% highlighted various learning perspectives and priorities to join the group. Majority (64%) of the group members indicated this activity as somewhat valuable, 13% very valuable, whereas 23% remained neutral. This study concluded that group members’ exam scores were significantly higher as compared to nongroup members.

DiVall and Kirwin[21] studied the usefulness of SNSs for undergraduate pharmacy course-related discussion in USA via a Facebook page. Students actively participated in online discussion on Facebook as well as in survey with a response rate of 97%. The students contributed significantly in online discussion through posts and comments, with a contribution rate of 26%. Majority (86%) of the students found Facebook usage in their course extremely beneficial for learning perspectives. Fifty seven percent strongly recommended the continuity of Facebook application in upcoming courses due to its productivity and more learning opportunities.

Hall et al.[22] investigated the application and perspective of pharmacy students regarding SNSs in the UK. Among the respondents (377/659), 98% stated that they used SNSs for their personal matters, and few (1.7%) of them used SNSs for academic purposes. Seventy five percent agreed that they frequently used SNSs for discussing academic problems. The authors suggested that students require special training to familiarize them regarding how to effectively apply codes of conduct while using SNSs. Adithya et al.[23] explored the usage of SNSs among students in India. The authors claimed that students most frequently used SNSs for information and getting in touch with friends. They found that 67 (54.92%) students suggested the usage of SNSs being beneficial to their studies and learning needs and 22% (18.03%) students stated that SNSs usage had a positive impact on their academic performance.

Discussion

Modern tools and technologies such as blogs and microblogs, folksonomies, RSS feeds, wikis, media-sharing applications, networking sites, or other social artifacts are being used with great potential in various capacities and disciplines for commercial, social, and educational purposes. As of today, the Internet has reached near ubiquity,[24] and the standard on which the Internet is now based is known as “Web 2.0”: Web applications that allow end-users to interact and collaborate as content creators, rather than -one-directional information on relatively static “Web 1.0” websites of pre-2004 era.[25] Web 2.0 technologies have been classified by their main functionalities, that is, online reflection, social spaces, online collaboration, social bookmarking, and repository.[15] When applied to medical education, social media seems to help both medical educators/doctors, physicians, librarians, and students to utilize the Web 2.0 enterprise, enhancing their teaching-learning experiences through customization and personalization in a rich environment of networking and collaboration.[26] The results of the current meta-analysis report a significant (75%) use of SNSs by the medial and allied health students. However, 20% students use SNSs for educational purposes (random effects model; 60.06%) with 95% CI of 49–71%. This report might encourage the medical educators and administrators to incorporate the usage of social media technology in various instructional and teaching/learning strategies. Embedding the state-of-the-art digital technologies in medical curricula will be at par with the medical students’ learning styles[27] that has the potential to foster learning at workplace.[28]

The advantages of using SNSs for educational purpose are far ranging. A study reported that the use of social media tools augmented students’ learning opportunities, allowed for real-time communication outside the classroom, helped students connect with medical experts, fostered collaborative opportunities, and enhanced creativity.[29] Learners can watch educationally relevant videos or exchange information about what they have watched and learned, and then join online to further discuss with tutors. Even the tutors can learn from the students during social media interactions. Likewise, a tutor can supervise students while they are learning, interacting, sharing, reflecting, and summarizing discussions. SNSs provide a forum to contact peers and teachers from wherever they are, offering the flexibility of “extended duty hours.” Some social sites’, especially Facebook, features may encourage students to engage in creative and social learning processes that extend beyond traditional educational settings and institutions.[30] This provides added benefit to access wide and diverse sources of information and opportunities for communication.[31]

Selwyn has rightly commented that the use of social media in higher education is driven by three concepts, that are, the changing learning environment of the student coming to the university as highly connected, collective, and creative subject; the changing relationship that today's university student develops in terms of knowledge consumption and knowledge construction; and de-emphasis of institutionally provided learning due to the emergence of “user-driven” education.[32] King et al. developed an interprofessional team course in the healthcare field by integrating social networking teaching strategy.[33] Investigators reported that the integration of an educationally structured social networking environment facilitated growth toward the concept of effective communication. A study has reported that almost all US medical schools have a Facebook presence, however, the majority does not know the bylaws addressing student online social networking policies and control.[34]

While the use of social media escalates, policies regarding the appropriate conduct in medical schools need to be applied. Established policies at some medical schools can provide a blueprint for other institutions. The educators and administrators of the medical schools are urged to develop policies to define the balance between the forbidden and appropriate social media behaviors that can help students navigate their online interactions.[29] Nevertheless, the application of a social media policy alone cannot prevent unprofessional networking behavior by students,[35] and there is a strong urge to enforce the fundamental principles of ethics in medical fraternity.[36]

Paul and Baker have shown that the time spent on SNSs by the medial students can negatively influence students’ academic achievement.[37] In their structural equation model, authors reported a small, but significant, negative relationship (r = −0.119, P = 0.048) between time spent on an SNS and academic performance as measured by course grades and cumulative grade point average (GPA). Others found a negative relationship between Facebook use and GPA as the quantitative analysis of their study showed that there were mean differences between the GPAs of users (M = 3.06) and nonusers (M = 3.82).[38] However, Pasek et al. could not find a negative correlation between Facebook use and GPA in a sample of students from a public research university.[39]

Social networking is not without problems. Integrity and privacy are purported to be the two major concerns regarding the use of SNSs.[40] The social communication paradigm is transforming the traditional face-to-face or telephone model to one that depends on a range of Web-based social media applications. These technologies have proliferated to the extent that can disrupt the delicate elements of our social fabric.[41] Institutions need to stay abreast with the knowledge and understanding of the evolving landscape of legal and ethical issues about the unethical use of SNSs. Ethics, privacy, and code of conduct are important issues to be considered while advocating the legal applications of SNSs.

Conclusion

In this meta-analysis, majority (70–80%) of the respondents used SNSs for social communications, however, 20% (1.7–54%) used SNSs for sharing academic and educational information. No single study has explored the impact of the SNSs on the academic performance of the students. Only two studies have applied inferential statistics whereas rest of the studies have presented descriptive statistics only. Authors have not reported the reliability and validity of their instruments, which might need to be considered in future studies. Social media are changing the face of medical field. The results of this meta-analysis emphasize the need to inculcate various modalities of SNSs in the teaching and learning strategies of the medical curricula. At the same time, students and faculty need to be more acquainted and well-trained to get the maximum benefits of SNSs.

Recommendations

• Significant usage of SNSs implies that this platform can be used for better educational impact by modifying the instructional strategies and curricula of the medical schools

• The details of how the students use SNSs for educational purpose should be explored

• The reliability and validity of the instrument applied for the collection of information must be checked prior to its analysis

• The upcoming studies might formulate the hypothesis “Do social networking sites promote medical education,” and might test this hypothesis through regression and correlation analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.