Abstract
Objective
Social media has been gaining traction among learners and educators for its ability to stimulate discussion, increase participation, and promote knowledge sharing. Despite the growing research around the benefits of social media in education, there is little evidence on how it is being incorporated into emergency ultrasound (EUS) fellowships. This study aims to determine the preference and use of social media by engaging with program directors across EUS programs in the United States to assess the current landscape of and attitudes toward social media use.
Methods
This was a cross‐sectional study. An online questionnaire was electronically sent to all EUS fellowship directors across the country. The survey consisted of questions regarding current practice patterns, policies, and perceptions regarding the use of social media in EUS fellowship programs.
Results
Ninety‐six ultrasound fellowship programs were identified for inclusion into this study. A total of 64 participants completed the survey, representing a 63% response rate. Thirty‐eight percent (95% confidence interval [CI] = 26% – 50%) of responding fellowship programs have an official social media outlet and 25% have a separate ultrasound handle for their EM residency program. Fifty‐eight percent (95% CI = 46% – 70%) of programs do not provide training to fellows and residents on the social media outlets used by their program. The top two social media outlets currently being used by programs are Twitter and YouTube to disseminate educational content and knowledge sharing. Twenty‐eight percent (95% CI = 17% – 39%) of programs create or post new ultrasound content at least once per month. Regarding barriers in the use of social media in EUS fellowships, 57% (95% CI = 45% – 69%) of program directors sited lack of time as the primary reason for decreased usage and implementation. Eighty‐four percent (95% CI = 75% – 93%) of responders felt that social media has the potential to impact patient care.
Conclusions
The results of this study indicate that there is perceived value in utilizing social media resources in EUS education; however, certain challenges need to be further evaluated.
Medical education has undergone a significant transformation in the past decade, and students now engage in discussion and learning through nontraditional channels.1 As curricula adjusts its focus toward communication and collaboration, social media networks are gaining traction in medical education.2 Social networks are becoming more widespread in delivering information and promoting knowledge transfer and discussion, with over 275 active and freely available emergency medicine (EM) or EM/critical care blogs or podcasts. There are 30,000 active participants of free online access to medical education (FOAM or #FOAMed). Twitter usage, for example, has increased significantly since 2012. Cadogan and colleagues used Symplur (a healthcare social media analytics company) to analyze the use of healthcare‐related hashtags. They compared 6 months of data from 2012 to 2016 and documented an increase in Tweet impressions from 40 million to 725 million, an increase in Tweets from 20,000 to 237,000, and an increase in active participants from 2,400 to 30,000.3, 4 The abundance of online resources and the robust online network provides a unique opportunity for practitioners of medicine to conveniently communicate and collaborate on projects, share information, access educational resources, and develop professional networks.5 Social media proponents perceive it to be beneficial to patient care when incorporated into clinical practice, and EM residency programs frequently use social media resources and networks, both formally and informally.6, 7, 8
Ultrasound education and knowledge transfer is particularly well suited to online resources and discussion as short videos demonstrating of technique and imaging findings can easily be created. Furthermore, as experts, who are dispersed across the world, develop new techniques or protocols, this knowledge can subsequently be demonstrated in a fashion suitable for education. Although social media research found that ultrasound is one of the top topics on EM blogs, it only comprises 2.4% of all EM social media posts.9 This vast popularity with ultrasound topics on EM blogs, despite a current low representation in social media posts, identifies a current void in FOAM curricula. Social media offers an excellent educational interface to support the dynamic visual demand of ultrasound education, allowing users to share educational scans in real time.
There is a lack of evidence demonstrating how social media specifically impacts the education in emergency ultrasound (EUS) fellowship programs. This study aims to determine the preference and use of social media by engaging with program directors across the United States EUS programs to assess the current landscape of and attitudes toward social media use.
Methods
Study Design and Population
This was a cross‐sectional survey study conducted electronically using a questionnaire developed by the investigators. All academic institutions with EUS fellowship programs were included in the study. The fellowship directors were identified from the Society for Academic Emergency Medicine (SAEM) residency directory and EUS fellowships website. The University of Arizona's institutional review board reviewed and approved this study.
Survey Content and Administration
A 20‐question survey was designed by the investigators based on review of existing literature, knowledge of current practices, and discussions with experts in the field (see Appendix). Prior to implementation, three EM physicians with expertise in point‐of‐care ultrasound evaluated all questions for relevance, clarity, and overall comprehensiveness. The survey consisted of questions regarding current practice patterns, policies, funding, and perceptions regarding the use of social media in EUS fellowship programs.
The questionnaire was distributed via e‐mail to EUS fellowship directors with an introduction explaining our project and goals. The survey was built and deployed using Survey Monkey. Each invitation included an opt‐out option. When the e‐mail did not result in a response from a particular program, the principal investigator e‐mailed the emergency department administrator asking for the contact information for the appropriate physician who was actively involved in EUS education. This physician was then e‐mailed a link to our questionnaire. Only EUS fellowship directors responded to this survey. If there was no response by the conclusion of our study, the program was deemed a nonresponder. Data were manually evaluated to assure one response per program and there was none found. Data were collected from July 2015 to March 2016.
Data Analysis
Descriptive statistics were used to summarize the data using SAS version 9.3 (SAS Institute Inc.). The survey responses are reported as the percentages of total respondents along with 95% confidence intervals (CIs).
Results
Ninety‐six ultrasound fellowship programs were identified for inclusion into this study. A total of 64 fellowship program directors completed the survey, representing a 63% response rate. Fifty‐six percent (95% CI = 44% to 68%) of responding EUS fellowship directors stated that they were either “very comfortable” or “relatively comfortable” with the use of social media outlets. Thirty‐eight percent (95% CI = 26% to 50%) of responding fellowship programs have an official social media outlet and 25% (95% CI = 14% to 36%) have a separate ultrasound handle for their EM residency program. Only 18% (95% CI = 9% to 27%) have a dedicated personnel in charge of updating and managing the program's social medias outlets. Fifty‐eight percent (95% CI = 46% to 70%) of programs do not provide training to fellows and residents on the social media outlets used by their program. Fifty‐five percent (95% CI = 43% to 67%) of programs do not provide training for ultrasound educators regarding the use of social media for education. Eighty‐one percent (95% CI = 71% to 91%) do not have program guidelines that outline appropriate use of social media.
The top three social media outlets currently being used by programs to disseminate educational content and knowledge sharing are Twitter, podcast/videocast, and YouTube. A summary of the most commonly used social media outlets are listed in Table 1. The top two reasons programs use social media are dissemination of educational information and knowledge sharing. A summary of the most common reasons that EUS fellowship programs use social media is found in Table 2. Twenty‐eight percent (95% CI = 17% to 39%) of programs create or post new ultrasound content at least once per month while 39% (95% CI = 87% to 99%) spend less than 1 hour per day involved with ultrasound related social media activities. When asked about what content is most important on social media, the top three were current research, imaging, and video demonstration. A summary of the most important content for social media is found in Table 3.
Table 1.
Most Commonly Used Social Media Outlets
| Social Media Outleta | % (95% CI) |
|---|---|
| 56 (44–68) | |
| Podcast | 36 (24–48) |
| Videocast | 36 (24–48) |
| YouTube | 33 (21–45) |
| Blogs | 31 (20–42) |
| 27 (16–38) | |
| Google+ | 24 (14–34) |
| 2 (0–5) |
Responses were not mutually exclusive (n = 64).
Table 2.
Most Commonly Stated Reasons to Use Social Media Outlets
| Reasona | % (95% CI) |
|---|---|
| Disseminate educational information | 70 (59–81) |
| Knowledge sharing | 68 (57–79) |
| Sharing ultrasound image | 52 (40–64) |
| Online instruction | 42 (30–54) |
| Journal article update | 36 (24–48) |
| Professional networking | 34 (22–46) |
| Interactive discussion | 24 (14–34) |
| Required learning | 22 (12–32) |
| QA related | 12 (4–20) |
| Journal club | 10 (3–17) |
| Case studies | 8 (1–15) |
Responses were not mutually exclusive (n = 64).
QA = quality assurance.
Table 3.
Most Important Content Found in Social Media Outlets
| Reasona | % (95% CI) |
|---|---|
| Current research | 80 (70–90) |
| Imaging | 57 (45–69) |
| Online journals | 55 (43–67) |
| Video demonstrations | 53 (41–65) |
| Case reviews | 37 (25–49) |
| Conference proceedings | 33 (21–45) |
| Blogs | 32 (20–42) |
| Live conferencing | 32 (20–42) |
| News articles | 20 (10–30) |
| Live chat | 12 (4–20) |
Responses were not mutually exclusive (n = 64).
Regarding barriers in the use of social media in EUS fellowships, 57% (95% CI = 45% to 69%) of program directors cited lack of time as the primary obstacle in the development and implementation of new social media content. Program directors also reported “lack of oversight on the quality of content” as a barrier to the use of social media. A summary of the most common barriers to the use of social media is found in Table 4. Eighty‐four percent (95% CI = 75% to 93%) of responders felt that social media has the potential to impact patient care. Finally, 52% (95% CI = 40% to 64%) of responders believe that social media should be part of the formal EUS curriculum.
Table 4.
Barriers to the Use Social Media Outlets
| Reasona | % (95% CI) |
|---|---|
| Lack of time to use or implement | 57 (45–69) |
| Lack of oversight on the quality of content | 45 (33–57) |
| Lack of familiarity | 42 (30–54) |
| Overreliance of social media as a medical resource | 32 (21–43) |
| Legal concerns | 25 (14–36) |
| Lack of privacy | 18 (9–27) |
| Lack of participation | 16 (7–25) |
Responses were not mutually exclusive (n = 64).
Discussion
As the use of online educational resources and networks continues to expand, it is no surprise that EM and its fellowship programs have and continue to embrace these new tools. In fact, previous literature has shown that 72% of EM residency programs across the United States have a twitter account and that 67% of EM programs have formal interactive instructional curricula that take advantage of online educational tools.9, 10 Although there is great interest in ultrasound in the FOAM community, ultrasound comprises only 2.4% of all EM social media posts.10, 11 This suggests that while only 37% of EUS fellowship programs have an institutionally endorsed social media outlet, ultrasound is a common topic of discussion, likely anchored in the online accounts of individual educators or residency programs as opposed to EUS fellowship programs.
As mentioned, ultrasound is well suited to online resources and discussion for a number of reasons. While residents overwhelmingly prefer audio podcasts as a source of asynchronous learning, video casts receive substantial support.7 Current tools—including YouTube, podcast/videocast, and Twitter, the top three outlets used by EUS programs—make it remarkably easy to share short videos demonstrating both ultrasound technique and imaging findings. Since only 53% (96/182) of EM residency programs in the United States have an EUS fellowship program, social media is a well‐suited route for delivering supplemental ultrasound education to EM residents at programs not currently supporting an EUS fellowship program. There is substantial opportunity for programs with few or no ultrasound faculty to benefit from offsite, asynchronous expertise.
Our needs assessment investigation sought to evaluate different components that may affect the quantity and quality of social media content and usage. Our data demonstrate that there is variation in EUS fellowship program participation in social media outlets. A vast majority (84%) of responders felt that social media education has the potential to benefit patient care, which is consistent with a recent study by Purdy et al.12 where 82% of EM program directors used online educational resources for patient care questions. Likewise, only a minority (16%) of our responders felt that resident and fellow participation was a barrier to implementing a more robust social media outlet. This is consistent with a recent study that found that greater than 70% of EM residents in the United States endorsed podcasts as the most beneficial source for education.13 Unfortunately, nearly all (95%) programs do not have dedicated funding for the development of ultrasound‐specific social media content, and few (7%) have a dedicated social media facilitator helping them to prepare these materials. Our data suggest that the social media–based educational movement in EUS fellowships is being driven by individual proponents who dedicate a few hours per week toward the development and dissemination of valuable content. Overall, EUS fellowship directors feel that their greatest barrier is lack of time and departmental support.
Our study has identified that although social media can have an impact in education within ultrasound fellowship programs, only a minority of fellowship programs are officially participating in social media outlets. Improvements can be made in numerous areas. Support for faculty interested in social media educational efforts can be improved by increasing institutional support. Some institutions, like ours at the University of Arizona and Mayo Clinic, have social media guidelines to help develop a social media outlet, establish responsibilities associated with social media, and provide consultation with a social media expert when necessary.14, 15 Developing guidelines and investing support for social media is beneficial to the institution as social media following can increase the branding of a program, with programs that provide easy access to online education likely gaining favorable notoriety within their field of expertise. This increased positive brand can expand the pool of applicants to both residency and fellowship programs. Finally, future implementation of ultrasound education in social media will allow educators to pioneer new educational techniques and collaborate from distance, offering a new avenue for education in EUS fellowships across the United States.
Limitations
Although attempts were made to contact all EUS fellowship programs, not all (64 of 96) EUS fellowship directors responded. The introductory e‐mail at the beginning of our survey conveyed that our survey was specific to social media; it was not explicit in each question stem. Although the survey has not been validated in previous studies, it was pilot tested by experts in the field. Pilot testing in a select nonparticipant group of non‐social, media–savvy program directors may have allowed us to catch questions which were reliant on interpretation. In addition, our survey is reliant on the assumption that the fellowship directors have an understanding of how their fellows and resident are using social media. Finally, our survey was only distributed to academic institutions, which limits the generalizability of our findings.
Conclusions
The results of this study indicate that very few emergency ultrasound programs use social media despite their belief that it has the potential to impact patient care. Barriers to utilizing social media in emergency ultrasound education exist and are related to protected time, funding, and quality.
The authors thank Paulette Pierce for her help with the survey.
Appendix 1.
Social Media in Emergency Ultrasound Fellowship Programs Survey Questions
-
Does your fellowship program have an official Social Media outlet?
☐ Yes ☐ No
-
Does your program have a separate handle for ultrasound for your residency program?
☐ Yes ☐ No
-
What form(s) of Social Media does your fellowship program utilize?
-
(Check all that apply).
☐ Facebook
☐ Twitter
☐ Linked In
☐ Google+
☐ Instagram
☐ Youtube
☐ MY Space
☐ Skype
☐ Wiki / WikEM
☐ ResearchGate
☐ Blogs
☐ Podcasts
☐ Videocasts
☐ HumanSim
☐ Other (fill in the blank) ________________
-
-
Do you train or orient your fellows and residents in the forms of Social Media used by your program?
☐ Yes ☐ No
-
Do you train or orient your ultrasound educators in the forms of Social Media used by your program?
☐ Yes ☐ No
-
How comfortable are you with using Social Media (for ultrasound) in the workplace?
☐ Very comfortable
☐ Relatively comfortable
☐ Neutral
☐ Relatively uncomfortable
☐ Not very comfortable
-
Do you have an official policy or guideline that outlines appropriate Social Media use by your fellowship program?
☐ Yes ☐ No
-
What is the main purpose of utilizing Social Media in your Ultrasound fellowship program?
-
(Check all that apply)
☐ Disseminate educational information
☐ Knowledge Sharing
☐ Share ultrasound Images/clips
☐ Journal article updates
☐ Collaborate on research studies
☐ Professional networking
☐ Required learning
☐ Online instruction
☐ Interactive discussions
☐ Recruitment and interviews
☐ Case studies
☐ Journal clubs
☐ Clinical practice
☐ CME
☐ Q&A
☐ Personal use
☐ Other (please specify)
-
-
How often is new ultrasound content created or posted on Social Media by your fellowship program?
-
(Approximately)
☐ None
☐ Once per month
☐ Once per week
☐ Once per day
☐ Other (please specify)
-
-
How much time do you spend on ultrasound ‐related Social Media per day?
-
(Approximately)
☐ None
☐ Less than one hour
☐ One Hour
☐ Two Hours
☐ More than Two Hours
☐ Other (please specify)
-
-
How much time do your fellows spend on Fellowship‐related Social Media per day?
-
(Approximately)
☐ None
☐ Less than one hour
☐ One Hour
☐ Two Hours
☐ More than Two Hours
☐ Other (please specify)
-
-
Do you feel that information shared by Social Media is evidence based?
☐ Always
☐ Nearly Always
☐ Sometimes
☐ Nearly Never
☐ Never
-
Do you feel that Social Media is beneficial to patient care?
☐ Yes ☐ No
-
Do you feel that Social Media should be part of the formal curriculum in your fellowship program?
☐ Yes ☐ No
-
What do you feel are barriers to Social Media use in your fellowship program?
-
(Check all that apply)
☐ Do not have time to use or implement
☐ Lack of familiarity
☐ Too distracting or disruptive
☐ Overlooks important core topics
☐ Over‐reliance on social media as a medical resource
☐ Lack of evidence based content
☐ Lack of quality assurance
☐ Lack of participation
☐ Lack of professionalism
☐ Lack of privacy
☐ Lack of oversight on the quality of content posted
☐ Legal concerns
☐ None
☐ Other (please specify)
-
-
What topics and sources of information are most important to you?
☐ Current Research
☐ Online Journals
☐ News Articles
☐ Conference proceedings
☐ Blogs
☐ Case Reviews
☐ Imaging
☐ Video demonstrations
☐ Live conferencing
☐ Live chat
☐ None
☐ Other (please specify)
-
Does your fellowship program have dedicated funding and/or resources to support Social Media use?
☐ Yes ☐ No
-
Does your program have a dedicated person to maintain and update your program's Social Media accounts?
☐ Yes ☐ No
-
How valuable is the impact of Social Media use in your fellowship program? (Rephrase)
☐ Very valuable
☐ Somewhat valuable
☐ Unsure
☐ Somewhat not valuable
☐ No value
-
Would you be interested in collaborating with other fellowship programs on Social Media in EUS education?
☐ Yes ☐ No
AEM Education and Training 2017;1:27–33.
The authors have no relevant financial information or potential conflicts to disclose.
References
- 1. Davis WM, Ho K, Last J. Advancing social media in medical education. CMAJ 2015;187:549–50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Cheston CC, Flickinger TE, Chisolm MS. Social media use in medical education: a systematic review. Acad Med 2013;88:893–901. [DOI] [PubMed] [Google Scholar]
- 3. Cadogan M. The World of FOAM and EMCC [Internet]. Life in the Fast Lane. 2016. Available at: http://lifeinthefastlane.com/emcc-blog-update-2016/. Accessed October 6, 2016.
- 4. Cadogan M, Thoma B, Chan TM, Lin M. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002‐2013). Emerg Med J 2014;31:e76–7. [DOI] [PubMed] [Google Scholar]
- 5. Choo EK, Ranney ML, Chan TM, et al. Twitter as a tool for communication and knowledge exchange in academic medicine: a guide for skeptics and novices. Med Teach 2015;37:411–6. [DOI] [PubMed] [Google Scholar]
- 6. Klee D, Covey C, Zhong L. Social media beliefs and usage among family medicine residents and practicing family physicians. Fam Med 2015;47:222–6. [PubMed] [Google Scholar]
- 7. Scott KR, Hsu CH, Johnson NJ, et al. Integration of social media in emergency medicine residency curriculum. Ann Emerg Med 2014;64:396–404. [DOI] [PubMed] [Google Scholar]
- 8. Bahner DP, Adkins E, Patel N, Donley C, Nagel R, Kman NE. How we use social media to supplement a novel curriculum in medical education. Med Teach 2012;34:439–44. [DOI] [PubMed] [Google Scholar]
- 9. Residency Programs on Twitter [Internet]. Academic Life in Emergency Medicine. 2016. Available at: https://www.aliem.com/em-im-residency-on-twitter/. Accessed Jun 10, 2016.
- 10. Singelman J, Barthold M. Best Practices in Individualized Interactive Instruction [Internet]. Council of Emergency Medicine Residency Directors Individualized Interactive Instruction Task Force. Available at: https://www.cordem.org/files/DOCUMENTLIBRARY/Committee/III%20Task%20Force/Individualized%20Interactive%20Instruction%20Best%20Practices.pdf. Accessed Jun 10, 2016.
- 11. Stuntz R, Clontz R. An evaluation of emergency medicine core content covered by free open access medical education resources. Ann Emerg Med 2016;67:649–53.e642. [DOI] [PubMed] [Google Scholar]
- 12. Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine residents and program directors. CJEM 2015;17:101–6. [DOI] [PubMed] [Google Scholar]
- 13. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med 2014;89:598–601. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Timimi F. A 12‐word Social Media Policy [Internet]. The Mayo Clinic. Available from: https://socialmedia.mayoclinic.org/discussion/a-12-word-media-policy/. Accessed Oct 6, 2016.
- 15. Arizona Board of Regents . UAHS Guidelines for Official Social Media Use [Internet]. The University of Arizona; 2014. Available at: http://uahs.arizona.edu/ahsc-guidelines-official-social-media-use. Accessed Aug 25, 2016. [Google Scholar]