Social media in radiology: overview and usefulness of online professional #SoMe profiles

Abstract

Social media is a ubiquitous part of society and used by many healthcare professionals, including radiologists. This article prepared by the 2019–2020 Radiology Research Alliance Social Media Task Force presents different uses and benefits of an online professional social media profile. Physician and healthcare-specific issues along with popular platforms such as LinkedIn, Facebook, Twitter, Instagram, and YouTube are used to explore topics including education, branding, research, mentorship, promotion, and leadership.

Introduction

Many radiologists and other physicians use social media (#SoMe) for professional development, expression, and promotion of research or imaging services. Social media represents an avenue to engage radiologists, healthcare providers, researchers, and patients. Some benefits include education (of self and others), engaging with other professionals, news from professional societies, and professional networking. Prior survey data indicates use among radiologists and radiology trainees is prevalent among all stages of practice and nearly all age groups. [1] This manuscript, prepared by the Association of University Radiologists Radiology Research Alliance’s 2019–2020 Social Media Task Force, discusses a number of specific social media platforms including Twitter, Facebook, LinkedIn, Instagram, among others in the context of their utility towards a variety of factors in radiologic career development including education, branding, research/collaboration, mentorship, academic advancement/promotion, and leadership.

Definition, Use, Major Platforms and Outline

Merriam-Webster defines social media as forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos)[2]. This definition itself showcases the power, diversity, extent and reach of information across the globe instantaneously with press of a button. It is available on various platforms/operating systems and a plethora of devices. Most of the applications are free and have versions that are cross compatible with other platforms. Major selected social media platforms are summarized below and in Table 1.

Table 1.

Summary of selected major social media platforms

Platform Name	Number of Users	Supported Content in Posts	Interaction	Direct Messagin g	Stories	Viewer Trackin g	Hashtags (#)to Sort Content	Crowdsource d Data
https://www.facebook.com/	2.41 billion active monthly users as of May 2019	Text based posts with support for embedded images, videos and links	Add Friends Like Comment Share
https://twitter.com/	320 million active monthly users	Text based post with support for embedded images, videos and links	Follow Retweet Like Reply
https://www.instagram.com/	1+ billion active monthly users as of June 2018	Image based platform with support for videos and some text	Follow Like Comment Share
https://www.redditinc.com/	430+ million active monthly users as of January 2020	Digital bulletin board with primarily text-based posts with support for embed links, photos and videos where more popular items appear first	Follow Comment Share Upvote Downvote
https://www.linkedin.com/	660+ million members as ofJanuary 2020	Professional online profile for networking purposes, primarily text-based posts with support of embedded links, photos and videos	Connect Like
https://www.youtube.com/	2+ billion users as of January 2020	Primarily video-based posts with support for embedded links and text	Share View Subscribe Like Dislike Comment
https://www.doximitv.com/	1 million members as of February 2018	Primarily text-based platform for displaying a profile for medical professionals with support of?	Send HIPPA-compliant messages and faxes Search profiles
https://www.snapchat.com/	200 million (+) worldwide users	Primarily image and video-based posts with support of embedded text	View Snap
https://www.researcheate.net/	15+ million worldwide members as of April 2018	Primarily text-based posts that have either been published, been rejected, in need of revision or additional research support	Ask questions Share Research Seek Opportunities Find Collaborators
https://www.whatsapp.com/	1.6 billion active users as of July 2019	Text based mobile messaging with support of embedded	Free mobile messaging app interaction via direct messaging other users

Note: Neither the publishers nor authors of this manuscript endorse any particular platform

^*Stories are a collection of temporary images, text, and/or videos with relevant links and other interactive content that are viewable by friends/followers and disappear after a certain time interval.

^**Crowdsourced data is to obtain (information or input into a particular task or project) by enlisting the services of a large number of people, either paid or unpaid, typically via the Internet.

Facebook

As a leading platform in social media, Facebook (Menlo Park, CA) use accounts for 45.03% of all social media site visits in the United States (US) in the most recent data from May 2019 and boasts 2.41 billion active monthly users [3, 4]. Although 45–96% of health care professionals have an active Facebook profile [5], it still trails in medical professional and education use behind platforms like Twitter [6]. In one small sample study by Alsobayel targeting health care professionals in Saudi Arabia, Facebook was reported as the fourth most common platform used for professional development, at 61%, falling behind YouTube, Twitter, and Instagram [7]. In a radiology-specific survey, 110 of 186 radiology respondents used LinkedIn and Twitter most frequently for professional purposes. Facebook use was uncommon and only reported by radiologists who were “active” (posting several times a day) using Facebook as the third most common social media platform behind Twitter and LinkedIn [1].

Instagram

Instagram, a title derived from the fusion of the words “instant camera” and “telegram” is a social media platform rooted in online video and photos-sharing. Following its creation and debut as an iOS app 2010 the application rapidly gained popularity globally and was acquired by Facebook in 2012.

Twitter

Twitter (San Francisco, CA), a microblogging social media platform has over 320 million active monthly users and offers the ability to rapidly disseminate online content to a diverse audience [8, 9].

LinkedIn

LinkedIn (Sunnyvale, CA) is one such powerful professional tool that allows individuals to create a professional online profile for the purposes of networking. Founded in 2002 with over 630 million members (1), this social media platform operates as both a website and mobile app. LinkedIn’s popularity and widespread use led to LinkedIn becoming acquired by Microsoft in 2016.

Reddit

Reddit is a social news and content aggregation website. The self-named “front page of the internet,” is an online bulletin board where users submit content in the forms of links, pictures, and questions. Unlike other social media platforms such as Facebook and Twitter, which feature linear interactive discussions, Reddit provides “upvoting” and “downvoting”, in which more popular posts rise to the top of the page. In this way, the community determines which content and discussions are important and subsequently displays them at the top of the feed. Forums on the Reddit platform are called subreddits. Reddit regulates the forum name like this: “r/Forumname”. r/Radiology is a dedicated radiology-themed subreddit with content posted by self-identified radiologic technologists, radiologists, and other anonymous users without self-identification. Users may self-identify themselves in this subreddit with a “flair” that appears next to their username, identifying themselves as a technologist, radiologist, radiology resident, or other professions. One easy way to find a topic or discussion forum in Reddit is to type Reddit and what you are interested in such as MCAT, radiology or residency in google and you will be directed to those subreddits. Reddit also allows for posting Gifs, photos and videos up to 15 minutes to further illustrate educational content. For educational-themed content, users can censor a text portion of the post with a ‘spoilers’ designation where other users would have to click on the censored text to see the answer. This can lend itself well to presenting imaging unknown cases with the answer in the spoiler text. Reddit’s structure makes it suitable for obtaining a comprehensive collection of opinions in a short period of time.

Youtube

Youtube (San Bruno CA), a Google subsidiary, is the primary platform for online video hosting and viewing. It estimates over 30 million daily users and over 2 billion monthly users [10].

Doximity

Doximity, a platform specifically targeting physicians’ social networking as well as education can also be a powerful tool for honing collaborative efforts in radiology [11]. As of February 2018, Doximity reached 1 million members and supports point-of-care crowdsourcing.

Snapchat

Snapchat, a camera application that allows social media networking through images and video with text messaging functionality, has greater than 200 million users worldwide. It is also reported that Snapchat is the preferred social media platform for millennials, the primary constituent of the current radiology resident workforce [12–14].

ResearchGate

ResearchGate is a professional network that allows one to post, ask questions and seek out research related to your field of interest among peers. Using this network, one is able to post their own research, obtain insight from others in the same field or area of expertise. This global network boasts 15 million plus members from around the world and their works[15–17].

WhatsApp

WhatsApp (WhatsApp Inc, Mountain View, California) is another platform that can facilitate cooperative efforts in radiology. It is free messaging app released in 2009 that uses the Internet to share data and is free of third-party advertisements. Based on active users (1.6 billion as of July 2019), WhatsApp is currently the most popular mobile messenger app worldwide[18, 19]

Use in Healthcare

Prior literature has highlighted the importance of social media in the healthcare sector, including patient facing applications and information sharing [1, 7, 20–22]. This article will focus on the benefits of multiple social media platforms with a focus on career development. The discussion will be formulaic for each social media outlet and will be broken down into categories relevant to career planning and development. The categories broadly covered are: (1) education, (2) branding, (3) research/collaboration, (4) mentorship, (5) academic advancement and promotion, and (6) leadership.

Education

Many social media platforms can be of great value to the radiologic community for educational purposes with selected examples including LinkedIn, Facebook, Twitter, Instagram, and YouTube. Using LinkedIn, Facebook, and Twitter, Radiologists can post educational content, cases, videos, and articles on the site for rapid dissemination to a broad audience across the globe, thereby augmenting one’s professional reputation as an educator [7]. This educational content can also be “tagged”, allowing for more organization of materials as part of one’s educational portfolio. Other users can interact with this information with likes, comments, and hashtags. Radiologists can also assess the impact of various posts by tracking analytics such as number of views and likes, which is automated within the software. Users can certainly benefit from learning from other radiologist’s content, but the focus of this section will be building a social media profile as an educator for teaching purposes.

Some challenges associated with education via these online platforms cannot be overstated. Creating a meaningful professional profile requires time and effort, especially if one is inclined to post articles, cases, and videos for the purposes of education. There are also privacy and security issues associated with LinkedIn, Facebook, and Twitter in that theoretically HIPAA non-compliant information can be posted by anyone that has an active account [20]. Finally, educational posts are not peer reviewed, which limits the credibility of the content disseminated to the public.

Facebook’s, Twitter’s, and Instagram’s platforms are amenable for utilization in medical education, especially for a visual-centric field such as radiology. Instagram is rooted in image and video-based posts, while Facebook’s and Twitter’s platforms are centered on text-based “posts,” although one may incorporate images, links and video content as well [5, 23]. Visual representations of these three platforms are demonstrated in Figure 1. This not only allows for individuals to share content related to medical education, but allows dispersal of information via organizational accounts such as CTisus.com, Radiopaedia, New England Journal of Medicine (NEJM), American College of Radiology (ACR), or individuals who may share blog content via their Facebook and Twitter page, such as Robs Radiology [24]. Many organizational pages in radiology will post unknown cases with links to explanations, allowing the user to participate as they appear on their newsfeed, rather than requiring one to access the poster’s page in order to view content. This method has also been used in radiology education of medical students, with one radiology interest group in South America demonstrating how creating and posting weekly educational case material on a Facebook page could reach many more users than the initial members as users share and “like” content, leading to a large increase in page “likes” over the study period. [25]Tweet Chats is a group chat hosted on Twitter with the intent of gathering individuals to discuss a particular educational, legislative, or other topic. Often centered around national and societal meetings, a moderator promotes a topic, sets a time, then engages users participating in the Tweet Chat [8].

Figure 1.

Examples of professional social media profiles on Twitter (A), Facebook (B), and Instagram (C) with some of the advantages or logistics of each platform.

Another way in which to connect with a larger audience with educational content is through the utility of hashtags. Pre-existing or originally created hashtags can be included in comments and captions to sort images from multiple users into themed categories, aiding in dissemination of educational content to wider audiences [26]. For example, @CincyKidsRad created the hashtags #MSKMonday, #TummyTuesday, #NeuroWednesday, #ThoraxThursday, and #FridayQuizDay to meet their stated goals of educating others as well as building a global community around the hashtags by organizing content across multiple accounts [23]. @TheRadiologyGuy did something similar with the creation of a very clever hashtag #anatomyoverlays to categorize his radiographic anatomy educational series in which he shares original radiographs as well as images overlaid with color coded anatomy for side to side comparison [27].

In addition to hashtags, users of Instagram as well as Facebook have the option of publishing a “story”. The story feature is a series of temporary images or videos that contain relevant links, hashtags, and interactive features. Prominent Instagram educators, such as @TheRadiologyGuy and @thexraydoctor, use stories to post a sequence of images or short videos relating to a mystery diagnosis or general information on a particular pathology. Content-creators can edit the images quickly with the pen tool to highlight features for the untrained eye or they may narrate the videos to guide users. In addition to engaging medical trainees, many educators strive to engage the general public by posting patient-facing information on popular themes such as breast cancer screening and treatment for heart attacks. While the story feature is convenient and unique to these platforms, users are limited by the story’s short time limit and inability to post high-quality edited content.

YouTube can be a powerful didactic tool in radiology as users can publish high-quality, comprehensive educational media. For example, the Chief of Musculoskeletal Imaging at Stanford, Dr. Chris Bealieau, uses his YouTube channel as an educational tool through sharing case conferences and lectures on a wide range of musculoskeletal imaging topics with over 14,000 subscribers [28]. For disseminating educational radiology content online, it is helpful to use an inherently visual platform such as YouTube to do justice to such a highly visual field. The Yale Radiology and Biomedical Imaging channel for instance attempts to take advantage of YouTube for this purpose by featuring a playlist entitled “Introduction to Radiology” that exhibits a series of short educational videos on various imaging modalities, radiographic anatomy, and specific clinical radiology cases [29]. YouTube allows any user to upload videos that are up to fifteen minutes long by default; however, if a few steps are taken to verify an account, it is possible to lift the fifteen-minute time limit and enable the posting of longer videos [30]. As an example, Michigan State University took advantage of this to showcase a series of radiographic anatomy lectures, each about forty-five minutes long, on their channel [31]. Its compatibility with longer videos establishes YouTube as the gold standard for full length video sharing when compared to other platforms that only allow shorter video uploads, such as Instagram, Twitter, and Facebook.

Branding

Strategic usage of social media on topics which help to promote your “brand” is important for career development.An example of how a social media profile may be used to develop branding is demonstrated in Figure 2. Tweeting articles, for instance, from the Harvard Business Review on topics related to leadership or professional development are helpful in establishing your brand as an individual with a focus and interest in these areas. This branding allows others to recognize you and extends your network to individuals with similar interests and expertise. By demonstrating that you are able to add value to others by providing relevant content, you continue to develop your brand as well as extend your network to individuals who may be able to multiply your efforts. A personal brand can also be viewed as the sum of “the quality of our work, the messages we convey, the principles we espouse and those we stand against, the actions we take in particular circumstances, and more” [32]. It can include the positive or negative impression left after interacting with peers in person, on the phone, and even online [32].

Figure 2.

Examples of how a profession social media account may be used to promote educational content, research, and ultimately contribute to one’s branding.

As a platform-specific example, Instagram can be a powerful asset for radiologists or institutions looking to build their online social media presence and display aspects of their work to others. Personal branding on Instagram begins with choosing a username and writing a short biography that appears at the top of one’s page. Both of these can be creatively crafted to quickly introduce one’s purpose and tailor the audience’s expectations for content [26]. Underneath these, an archive of previous posts appears as small thumbnails that can quickly be scrolled through; simply glancing at this thumbnail collection allows viewers to formulate quick opinions about the account’s owner and decide whether they want to see more. Tapping one of the tiny thumbnails reveals the original post, which may contain up to 10 images, videos as long as 60 seconds, and up to 2200 characters of text [23]. Every post on platforms like Instagram may be tailored toward personal branding and influencing the way one is perceived online. As an example, a glance at @TheRadiologyGuy’s page reveals a breast radiologist who built his online personal brand on education, breast imaging, and family values. A deeper dive reveals advice for aspiring students, encouragement for breast cancer screening through mammography, and commentary regarding healthcare costs [27]. The @MayoClinic page provides an example of institutional branding; their nearly 200 thousand followers see posts from Mayo on a variety of educational topics, their core values as an organization, and commentary on popular issues in medicine. Once a user becomes associated with certain themes and ideas based on the content of their posts and interactions online, their brand is born.

LinkedIn (Sunnyvale, CA) is a powerful application that allows individuals to create a professional online profile for the purposes of networking. Its social media platform operates via the World Wide Web and mobile apps. LinkedIn’s easy to use interactive platform also has many benefits for the user and also offers additional benefits for radiologists, mainly centered on shaping one’s professional image and brand in an easy to use interactive platform. The primary purpose of LinkedIn revolves around the dissemination of a professional profile, highlighting one’s Curriculum Vitae (CV) to a broad audience via the internet. Radiologists can post their training information, years trained, job titles, skills, licenses, certifications, and educational background geared towards attracting job recruiters. In fact, recruiters can contact radiologists directly through the LinkedIn platform via email or the platform’s embedded chat function. The platform also allows one to apply directly for jobs and receive notifications of vacant jobs in one’s geographic area. Radiologists also have the option of following companies and organizations, thereby staying up to date on their recent developments and needs.

A potential downside of this professional networking and branding via social media is the potential to project oneself in an unprofessional manner, now known as e-professionalism, or a professional’s online appearance [33]. When evaluating the online presence of medical students by examining their Facebook profiles, many of which were public, one of the most common unprofessional components is pictures of the individuals with alcohol [21, 33]. When evaluating similar unprofessional Facebook content amongst practicing surgeons, nearly 15% were found to contain potential or definite unprofessional content [34]. It remains important that students and those entering their post-graduate medical careers be educated on this topic as it can affect their reputation as a physician as well as one’s ability to obtain a residency or job.

Many social media platforms such as Twitter, in addition to traditional websites like HealthGrades.com and Vitals.com, are often accessed by users to research the character of facilities and individual providers before becoming their patients, making this public appearance increasingly important as healthcare becomes more accessible via the internet. On an institutional or practice level, Facebook pages can be utilized for branding and increasing visibility to referring clinicians and patients, particularly important in a traditionally less patient-facing field like radiology, where two-thirds of patients could not describe the role radiologists play in patient care and only half realized that radiologists are physicians [35]. It seems that with continued advances in technology and availability of information via the internet, practices must be more than knowledgeable, and Facebook pages allow these practices to highlight educational backgrounds of individual radiologists, in addition to showcasing their patient satisfaction scores, imaging accreditations and producing content to educate both patients as well as referring clinicians [35, 36].

Private practice groups have been quicker to adopt social media as a marketing tool, perhaps in part due to increasing competition in the private arena [22]. Even so, academic groups could utilize social media like Facebook to bring educational content to the public as well as for branding their group to potential residency and faculty job seekers. Many large hospital institutions maintain Facebook pages, allowing inexpensive and broad-reaching dispersal of information, including events like health screenings, or to highlight and promote wellness, such as an educational posting during breast cancer awareness month [37].

Research and Collaboration

Focused and high yield content shared on social media can allow one to become recognized as an influencer and expert on the topic. This is vital in developing further networking opportunities and identifying collaborators. For instance, as others “like” “share”, or “retweet” your posts, your network extends to new followers or “friends”. You then have the opportunity to engage with these users and to request collaboration. It is not uncommon to be recognized at national meetings by members of your social media network whom you had never met, allowing for in person interaction and further relationship development. This is particularly notable with Twitter where collaboration may arise from these in person interactions, however, may also arise directly from tweets. For example, if you have a research idea or a topic that you would like to submit for a workshop proposal and need collaborators, simply posting on Twitter about your idea is often sufficient to gain potential collaborators and begin the conversation. By opening the topics to all who follow you, and have become familiar with your brand, you allow for flattening of the hierarchy with many prominent members of the medical community now able to see your philosophy and expertise. If there is a robust project in which they share an interest, they may choose to reach out as a potential collaborator or sponsor [7, 38–40].

Similar to Twitter, Instagram’s utility in research and collaboration lies in the ability to disseminate research through image-based posts or stories to a network of followers. As opposed to text-based outlets, Instagram allows for a visual snapshot of an individual’s journal publications, poster presentations, or new developments in evidence-based practice. Sharing to a network of followers directly combats the research isolation felt by individuals who study niche topics or who practice at community or private organizations [41]. It allows researchers to discover a network of like-minded researchers and communicate through direct messages and comments. As opposed to communicating through email, messaging through Instagram is an informal and convenient mode to connect with someone to support their research endeavors and develop new collaborations.

In addition to personal accounts, academic radiology departments and radiology professional societies use Instagram as a platform for research dissemination and collaboration. For instance, SUNY Downstate Health Sciences University maintains an account (@SUNYradiology) which posts research accomplishments from faculty and residents. In addition to lauding their peers, content on Instagram purveys the idea of a research-focused, well-funded, and cooperative department. In a larger scope, professional organizations such as American College of Radiology (@radiologyacr) and American Roentgen Ray Society (@arrs_radiology) use Instagram as a hub for recently published images. These images, linked with a DOI, direct users to novel research in real time. This effectively circumvents the conventional, brick-and-mortar dissemination of paper journals. Lastly, these organizations use Instagram to advertise for upcoming national meetings and post highlights of past meetings.

ResearchGate offers the ability to share your information with others in the research community. Benefits to using this great online source is the ability to share your information with others in the research community and easily find information relevant to you and your work. This platform serves as a place to make connections with others that could be of mutual benefit. It utilizes the same functional elements as some of the more popular social medial platforms including creating profiles, liking or following certain topics or authors, sharing, bookmarking favorites, and the ability to comment and provide feedback¹. ResearchGate also encourages its members to post, not only their accepted works, but also, those that were not accepted or incomplete. This allows one to obtain additional feedback and potentially complete works in progress.

One of the downsides of this research platform is just that: it is a research platform. Using this for things such as sharing interesting cases or for quick responses, such as polling and questions, would be better suited to one of the other platforms [15]. Another downside is the concern for copyright infringement that occurs on the site. Users should be aware however that ResearchGate may not screen for copyright compliance of the uploaded material. According to a study by Jamali, the majority of the non-compliant cases (97.5%) occurred when authors self-archived publishers’ PDF files (final product version) [16]. This indicates that authors infringe copyright most of the time not because they are not allowed to self-archive, but because they use the wrong version, which might imply their lack of understanding of copyright policies and/or text complexity and diversity of policies. There is also a proprietary quantitative score (“RG score”), similar to alternative metrics (“altmetrics”; discussed in more detail in Academic advancement and promotion section), called the RG score. Alternative metrics is a growing arena in academic medical centers to evaluate the impact of a faculty’s scholarship. The RG score is based on work appearing in the researcher profile and other ResearchGate members’ interactions with it. The RG score has attracted criticism aimed at a lack of transparency in how it is calculated and at vulnerabilities leading to the potential of intentional inflation by those seeking to abuse it [15–17].

The physician social networking platform Doximity offers the advantages of text and image-based messaging within a community intended for physicians and other healthcare providers with support of point-of-care crowdsourcing [11]. Crowdsourcing involves a large group of people solving a problem or completing a task for an individual or, more commonly, for an organization. While the field of crowdsourcing has developed more quickly in information technology, it has great promise in health applications [20, 42]. Doximity also utilizes Op-Med, an online forum for Doximity users to share information. In doing so, there is a chance that your post could be shared among the Doximity community for others to view. However, not all submitted material will be disseminated equally. The platform utilizes its members to rate and review shared information. Because of this, reviews may be more biased towards more well-known sources. As with many online social media platforms, information coming from subjectively more reputable or popular sources will be made more readily available. This creates a potential disadvantage for independent authors or smaller publications.

WhatsApp global popularity is based largely on the ability to communicate internationally with voice, video, and text for little-to-no cost compared to using standard cellular networks. This likely explains why it ranks as the #1 messaging app in many underdeveloped countries [18]. WhatsApp currently supports voice messages, group chats of up to 256 members, photo and document sharing, audio and video calls (including group calls), among other social media features. WhatsApp is not compliant with patient data protection laws such as HIPPA and the EU’s General Data Protection Regulation [43]. It is also not a tool designed for diagnostic purposes in radiology. However, its ease of use, low cost, and worldwide accessibility have made it a powerful communication tool in the personal and business world, facilitating collaboration between users living in different countries. As an example in radiology, RSNA’s International Visiting Professors use WhatsApp as an online discussion forum with their colleagues in Uganda [44, 45]. It is also commonly used to communicate, plan activities, and share resources among national and international committee members or large physician groups with shared interests. A survey of a U.S. academic radiology department showed that WhatsApp was the fifth social media platform used by faculty and trainees [46], WhatsApp can be considered as a free, easy, and accessible tool for international committee members and collaborations with colleagues across the globe.

Academic advancement and promotion

A vital component in the academic promotion process is the reputation of the individual. This reputation is gained by being recognized as an authority on a particular topic. Traditionally, this has been accomplished through the publication of peer reviewed papers, as well as invitations to speak at regional and national meetings. However, junior faculty often struggle with opportunities to present their work at the national level, and often shoulder a substantial clinical load, reducing their ability to conduct research. Strategic use of social media can shine a light on the scholarship and expertise of an individual, thus building their reputation and network. The two most important components of scholarship are recognition of impact, and dissemination of the scholarship. YouTube can be used for both of these purposes [39]. Creation of a YouTube video of a lecture or teaching innovation by a faculty member can be shared with others (or promoted via other social media outlets like Twitter) – creating a method to disseminate an individual’s scholarship [47]. The impact of this video can also be tracked and used for career development and promotion metrics, more specifically altmetrics [48]. Social media platforms like YouTube, ResearchGate, and Twitter for example can provide altmetrics and be used in a promotional dossier to make a case for impact. Unlike commonly used impact factors for peer reviewed publications (e.g. H factor), altmetric data provides information on non-traditional vehicles of scholarship dissemination, such as number of page or video views. Altmetric.com is one company that generates an altimetric score based on news mentions, number of social media mentions, citations in Wikipedia, among others. The exact method of calculating these scores is proprietary[49]. While high altmetric scores may lead to further opportunities for career advancement, their direct role in academic promotion is unclear and likely minor, if impactful at all. Specifically, metrics for peer-reviewed articles such as the impact factor of the journal, type of the article (review, retrospective scientific, prospective scientific) are more easily understood by promotion committees, number of followers on social media, news mentions, and these other alternative metrics may be less clear.

As an example of the power of YouTube for the promotion of scholarship, consider this scenario: An assistant professor records a lecture on Educational Research and Innovation and places it on her YouTube channel. She then Tweets about the lecture and provides a link to the lecture on her LinkedIn and faculty profile pages. The lecture is viewed by a Professor from another institution who is impressed by the faculty’s content and speaking ability. The Professor invites the Assistant Professor to be a Visiting Professor at their institution and asks to collaborate on some projects.

Twitter has become the defacto social media of choice for the sharing of professional identity [7, 24, 26, 38, 40, 50]. An increasing body of literature describing the mechanics of using Twitter, the benefits for professional development and branding, and professional network development supports its increasing relevance. Also, in support of the importance of Twitter in professional and career development is the increasing number of lectures and workshop sessions on the platform presented at national meetings. One may ask what the benefit of this platform is and why it has become so popular, particularly given that the amount of information which can be shared in one post (“tweet”) is limited. Its popularity stems from a number of factors, including the flattening of traditional organizational hierarchies, ability to develop a personal brand, increased opportunity to network particularly with individuals outside of one’s home institution, and the ability to develop collaborative relationships and projects with individuals of different experience levels, particularly from different institutions and specialties.

Instagram, which has more active users than Twitter, has the potential to become more impactful for creation and sharing of professional identity. This platform provides several advantages which include its inherent reliance on photo and/or video for its primary mode of communication. Additionally, Instagram captions allow for up to 2,200 characters and 30 followable hashtags to support visual content, tagging of images, and referencing other’s accounts. Like both YouTube and Twitter, Instagram is useful to disseminate information regardless of hierarchical position and geography. This social media platform provides users the ability to share the content of their post to other apps including Facebook, multiplying the impact of a single post. Users should be aware that posts shared to Twitter from Instagram will not contain the image. An expertly curated image, video snippet or posted case can be used to promote one’s professional development activities.

These matters can be critical in the academic advancement and promotion process as many view external review to be an essential component in the development and maintenance of a strong academic record. This is of particular importance as an individual’s contributions to a chosen area of academic medicine are often measured in consideration of standing amongst peers at other medical schools. Committees for promotion and advancement typically require letters of recommendation that address whether or not a candidate would be qualified for promotion on a given track by the criteria usedat the recommender’s institution [51, 52].

The ability to connect is key to the mentoring process. One of the most powerful and meaningful advantages of social media platforms, such as LinkedIn, remains the formation of a professional network with colleagues, students, and teachers across the globe [1]. Individuals are able to connect with other individuals, receive automated notifications of others’ promotions and accomplishments, and can endorse and recommend colleagues for certain skills and tasks. This networking interface allows radiologists to stay in close contact with a seamless ability to contact them for personal or professional reasons. This allows for a possible avenue for mentorship and meaningful access to radiology leaders when they are not physically present within one’s radiology department or professional group. This seamless ability to connect to various leaders in the radiologic community can prove indispensable in augmenting one’s career.

Retrouvey et al. demonstrated that Social Media created networking and collaboration is particularly vital to career development in women. It allows extension of networking reach and has been a catalyst for extended mentoring and sponsorship for female radiologists [53]. Finding mentorship (and sponsorship) can be challenging, particularly for those in their early career. Lack of access to effective mentorship, lack of recognition of the need of mentorship, and intrinsic fear of being unworthy of mentorship (imposter syndrome) can be powerful deterrents for developing mentorship relationships[54, 55].

Many Twitter posts, for example, touch on the need for mentoring and suggestions for how to develop these relationships. It opens portals to forming both peer and dyadic mentorship relationships and allows for connections between potential mentees and mentors [24].

Facebook’s platform is also ideal for professional development through mentorship by utilizing public or more focused, private group pages. While many groups are regional, or pertain to a particular specialty such as radiology, others are incredibly specialized, such as those for physician side jobs, physician mothers, financial groups tailored to physicians, business of medicine, and the list continues. These forums are often private, requiring verification of physician status prior to approval, thus providing a safe community to seek out advice from other physicians, to network or to educate oneself on topics outside the direct realm of medicine. Facebook pages have been used specifically for mentorship, such as the Future Radiology Chicks group, which allows current female radiology residents and attendings to mentor interested medical students. Recently Facebook created a mentor function within these group pages, making it easier to set up a mentorship program within a specific group [33].

Instagram’s platform leverages the impact of images for social engagement. It has been said that “a picture is worth a thousand words.” Power Instagram users understand this and carefully curate posts for the largest impact. Mentors use imagery to connect with many groups, raise awareness of causes, and to promote mentees. Examples include @radiology_chicks, a community that promotes women radiologists, @road2IR, a global health initiative dedicated to training interventional radiologists in Tanzania, and @sirrfs, the resident, fellow and student section of the Society of Interventional Radiology [9,23]. All post publicly and frequently to extend their networks, maintain engagement and build relationships. Like Twitter, Instagram posts can increase their reach by using hashtags, by mentioning other accounts and tagging others in posts.

Leadership

To be an influencer in one’s field online, it is necessary to strategically draw interest to one’s social media page through building a network of followers. A survey of faculty and trainees at Indiana University School of Medicine reported that 26% of respondents within their radiology department used Instagram, behind Facebook (67%) and YouTube (57%) [46]. In general, smaller more intimate social networks like this one tend to foster trust and the local sharing of resources [56]. Since social media allows for instantaneous travel of ideas and efficient exchange of information, it may prove to be helpful as another communication option for faculty to rapidly interact with trainees, even in a local area. However, the efficient and widescale collaboration made possible with social media really outshines other means of collaboration and leadership when larger networks are established. Networks that span vast geographic areas and contain great numbers of people provide increased opportunities to access new information and thus may foster innovation in the field [56].

Imagine a trainee meeting a mentor at a regional or national meeting and then connecting with that person via social media. Once connected, users may interact by liking posts, leaving comments, tagging other users, sharing posts, exploring hashtags, and following others to generate a personalized newsfeed. A mentorship role on Instagram for example may involve a student interacting with a mentor’s educational posts, research, and other content, or perhaps it may involve using Instagram’s direct messaging feature to communicate more privately, which may facilitate offline opportunities via invitations to interact, teach, and collaborate in real life. Though Instagram was not necessarily designed for mentorship, it is still an effective platform for maintaining instantaneous mobile communication over long distances with minimal effort.

Instagram is not only useful for individuals looking to create personal pages. Professional organizations have extended their online presence to Instagram to expand their ability to communicate and provide continued leadership in the field. The American Roentgen Ray Society (ARRS) for example, created an Instagram page that boasts nearly 19,000 followers. @Arrs_Radiology features many posts of radiographs intended for facilitating education via cases of the week and references to literature, drawing attention to new study results within the field, and advertising for their yearly meetings [57]. Instagram also allows users to post to other social media platforms like Facebook, Twitter, and Tumblr at one time, further expanding one’s online reach [32].

Twitter is an excellent venue to learn about and exchange leadership experiences and techniques. Sharing of leadership article citations and learning from comments on these articles can provide a good foundation for learning about different leadership methods and approaches. Following leaders within radiology, as well as outside of the specialty or even business leaders if important in order to learn from their wisdom. A tweeted topic can stimulate further and deeper reading on the topic outside of the “twitterverse”, providing building blocks for personal leadership development. Resources on leadership opportunities may also be shared on social media, increasing exposure to high yield programming that would not ordinarily be visible to radiologists [26, 38].

A search of “radiology” on YouTube renders a list of videos that demonstrate the utility of YouTube for accomplishing a variety of leadership objectives including the presentation of educational content, promoting professional society missions, and use as a recruitment tool. For example, The Radiological Society of North America’s channel boasts over 48,000 views and features short videos on select topics such as cardiothoracic and cancer imaging as well as longer lectures and discussions about leadership, financial advice, and the job market [23]. Professional radiology organizations also take advantage of YouTube to archive videoed highlights from yearly meetings for sustained periods of time for continued dissemination to audiences around the globe [23, 39]. YouTube can be of assistance in leadership development at all levels of training, Entering the terms “radiology residency” into the search bar for example reveals efforts to use YouTube as a recruitment tool by a variety of programs, including but not limited to, Loyola University, Johns Hopkins, Creighton University, Emory, and The University of Iowa [47]. While organizational channels such as these may be used to advertise their organization’s collective goals and ideas, individuals may choose to utilize their personal channels to display their own academic and professional interests. A notable individual YouTube channel belongs to Dr. Cellini, youtube.com/DrCellini (https://www.youtube.com/channel/UCiPW7OlzTfQjR_vLlkYPZCg), a radiology resident with over 35,000 subscribers who uses his page to provide people with a glimpse at his life both personally and professionally. He offers video commentary about the life of a resident as well as advice for aspiring radiologists regarding medical school, interviews, and exams [58].

Snapchat, popularity, preference among millennials, and popularity with the current radiology resident workforce [12–14] results in an intriguing potential for its use towards leadership development amongst our trainees. Nonetheless, Snapchat has received little attention in radiologic academic literature. In 2016, an investigator placed a link to a web-based survey, embedded on a variety of social media platforms, to gauge the impact of the various platforms on healthcare professionals’ engagement in key leadership skills necessary for professional development. Around half of survey respondents found snapchat to be a useful tool for various professional development outcome measures (clinical reasoning, problem solving, creativity, etc.). Snapchat was favored less than Twitter, YouTube, and Instagram, but more than LinkedIn and Facebook with respect to individual outcome measures [7].

Caution with Social Media

Radiologists and other physicians must be cautious and intent with the content they post, “like”, and discussions they participate in. An inappropriate compared to an appropirate social media post is demonstrated in Figure 3. In general, one should use social media with the knowledge that colleagues, mentors, current and future employers, supervised trainees, patients, and lawyers involved in litigation may view content posted on social media. Educational content using de-identified patient images and data should conform to HIPPA regulations. The de-identified level of patient information in describing a case report or figure in a peer-reviewed journal may not be sufficient and the element of when the patient was imaged should also be considered. For example, an interventional radiologist posting images from a splenic artery embolization the day after the procedure with the header “47-year-old man riding on a scooter struck by motor vehicle with a grade 4 splenic laceration successfully treated with coil embolization” may inadvertently identify the patient. Coupled with the possibility that the patient’s family and friends may be searching the internet for the name of this radiologist involved in the patient’s care and discover their social media profile, posting the specifics of the scooter, age, and in close proximity to when the event occurred may clue individuals the patient is the one associated with the images. A more ideal way to present the case may be to wait weeks to months after the event and describe it as “patient with blunt trauma with a grade 4 splenic laceration successfully treated with coil embolization.” Institutions may have policies against posting images. There are many other ways to jeopardize one’s professional image with social media including participating or voicing an opinion in controversial topics, engaging in non-healthcare-related politics, posting images of social events that may be better suited for a personal social media account (or better left off social media), or self-promoting material that does not contribute to one’s professional image. It is also important that we are mindful of the information that we disseminate on social media, ensuring that it is within our scope of expertise. Moreover, it is important that we verify this material before presenting it as factual and avoid perpetuating misinformation within the confines of our social media networks. Thorough research of topics posted to a professional social media platform for a diversity of sources is one way in which to counteract the creation of these echo chambers[59]. The full gamut of potential legal and professional consequences of social media is beyond the scope of this work.

Figure 3.

Examples of an inappropriate (A) and appropriate (B) post on social media.

Conclusion

Radiology is a visual, communication-based practice and with the diversity of social media platforms available, there is an opportunity for radiologists and radiology programs to connect with and influence a larger number of individuals than was possible with traditional methods of communication in the past. Social media can be a valuable educational and communication tool that medical professionals can use to enhance career development, specifically as it relates to the dissemination knowledge, brand development, collaboration, mentorship and recruitment.