Instagram: A platform for ultrasound education?

Abstract

Introduction

Social media has become an integral part of our daily life with 38 million users in the UK alone and the average user being logged-in for 135 minutes daily. Social media is increasingly used to disseminate learning in a variety of fields including medicine.

Objectives

The aim of this study was to assess the proportion of Instagram posts using #ultrasound for educational content and compare this with #radiology. We also aimed to assess the changes in the use of the newly introduced #UltrasoundEd for ultrasound education since its introduction in November 2018.

Methods

Instagram searches were conducted using the hashtags: #ultrasound and #radiology, and the content of the first 100 posts from each search was analysed and classified into being either social or educational. A second search using #UltrasoundEd was conducted at baseline, 3 months and 12 months. Fisher’s exact test was used to compare categorical data.

Results

The searches retrieved 461,884 #ultrasound and 243,011 #radiology posts. From the first 100 #ultrasound posts, 11 were educational and 89 were social. The social posts predominantly related to announcements of pregnancy. Of the 100 #radiology posts, 49 were educational, while 51 were classified as social. The number of posts with the hashtag #UltrasoundEd increased over the study period from 15 to 232, with the majority of posts being educational.

Conclusions

Educational ultrasound content is difficult to separate from social posts on Instagram. The use of the hashtag #UltrasoundEd makes educational ultrasound content more readily identifiable.

Introduction

Social media is the use of internet-based platforms to create and share user-generated content.¹ Some social media platforms have become widely used by healthcare professionals to disseminate their academic output, share ideas and advertise conferences and events.² Social media allows for collaborative learning and rapid access to vast amounts of information and contemporary research. The free open-access medical education movement (FOAMed) has changed the way medical education is accessed making it readily available for all.³

There are different types of social media platforms, each catering for different social networking needs. For example, YouTube is a video-sharing platform, while Facebook, Google+, Twitter and LinkedIn allow for microblogs, wikis or media sharing services. Instagram is a photo and video-sharing outlet. The nature of Instagram makes it an ideal platform for the dissemination of image-based information including diagnostic imaging. Instagram has an audience of one billion users worldwide,^4,5 with around 500 million active users per day.⁵ Currently, there are a number of Instagram accounts solely dedicated to radiology education, but it remains underutilised in ultrasound-specific education.

The hashtag symbol (#) is inserted before a keyword or phrase on social media platforms’ search engines without the use of spaces. The use of a hashtag allows users to find content and track discussions related to those keywords. Ultrasound education (UltrasoundEd) is underrepresented on social media with the hashtag #ultrasound being predominantly used socially on Instagram particularly for pregnancy announcements with these posts obscuring any educational content. In order to bridge the gap, we tried to popularise the #UltrasoundEd in November 2018, to separate ultrasound educational posts from social posts and make them easier to identify on Instagram.

Aim

To assess the current use of Instagram in disseminating ultrasound education and compare this to its use in radiology education. We also aimed to assess changes in the use of #UltrasoundEd over time on Instagram.

Materials and methods

We conducted Instagram searches using the hashtags: #ultrasound and #radiology, respectively. The results were sorted by ‘most recent’ and ‘top posts’ using Instagram’s user interface. The 100 most recent posts from each of the two searches were reviewed, and the content of each post was categorised as being either social or educational. Both images and the written content of the posts were reviewed initially by NA and where there was uncertainty regarding the content of a post, this was settled by consensus with AA. This was also repeated for the ‘top’ 100 posts from each of the searches, and the results were compared. Both photo and video posts were included. Another search was conducted using the less commonly used hashtag: #UltrasoundEd before suggesting its use at a national ultrasound imaging conference, an international conference as well as contacting some of the more popular educational ultrasound accounts asking them to adopt the use of the hashtag. The search was then repeated at 3 months and 12 months. All #UltrasoundEd posts were reviewed and categorised as being social or educational at each timepoint and the results were compared.

GraphPad Prism 6.0 for Mac OS (GraphPad Software Inc., San Diego, CA, USA) was used for statistical analysis. Fisher’s exact test was used to compare categorical data. p Values of <0.05 were considered statistically significant.

Ethics

Ethics approval was not required to conduct this analysis of publicly available anonymised data.

Results

An Instagram search of #ultrasound yielded a total of 461,884 posts. Of the 100 most recent posts, 11 were educational, while 89 were social, the majority of posts relating to pregnancy announcements. Similar results were found when the ‘top’ 100 posts were analysed (Figure 1). The #radiology search retrieved a total of 243,011 posts, with 49/100 of the most recent ones being educational and 51 being social (Figure 2). The educational radiology posts were largely of plain radiographs and computed tomography (CT).

Figure 1.

Most recent #ultrasound posts compared with top posts.

Figure 2.

Comparison of the top (a) and most recent (b) posts #radiology and #ultrasound posts showing that more #radiology posts are educational.

There were significantly more educational posts in the #radiology results compared with the #ultrasound results both in the most recent and top results (p < 0.0001) (Figure 2). There were also significantly more educational posts in the top 100 #radiology posts compared with the most recent 100 posts (65 vs. 49, p = 0.0319).

At the time of the initial search, #UltrasoundEd was used in 15 posts, with most of the posts being unrelated to ultrasound. The hashtag has since been adopted by some Instagram accounts dedicated to ultrasound education with 232 posts on the most recent search, the majority of which were educational (Figure 3).

Figure 3.

Changes in the total number of Instagram posts using #UltrasoundEd.

Discussion

Social media is an effective tool for the dissemination of information on a mass scale. It can be a space for active learning allowing individuals from across the globe to engage, contribute and learn from each other as well as experts. The material posted is constantly being updated and scrutinised by users; important information is therefore being shared and reinforced. Our study highlighted a number of dedicated educational ultrasound and radiology accounts on Instagram as well as personal accounts with regular educational posts. The widely used #ultrasound hashtag in social posts resulted in educational posts being buried in a sea of social posts. Only 11% of #ultrasound posts were educational. At the outset of the study, we contacted some of the more successful Instagram accounts that regularly post educational ultrasound content with a view to popularising the hashtag #UltrasoundEd in an attempt to make educational content more easily accessible. This has resulted in a significant increase in the number of posts using the hashtag with the majority of new #UltrasoundEd posts being educational. There is further work to be done, however, with the wider use of the hashtag in the educational ultrasound community both on Instagram and other social media platforms.

There was more educational content in the top 100 #radiology posts compared with the most recent 100 posts. This reflects that while just over half of the posts are educational, they generate more user interest compared with non-educational posts and are therefore being ranked higher. This was not replicated in the #ultrasound content, as the majority of posts were social. There is a growing number of Instagram accounts dedicated to radiology education with increasing popularity. Some of the more established educational platforms, such as Radiopaedia.org, have a significant presence on social media and are increasingly aware of the wide reach of their content on these platforms. Some of the more popular Instagram accounts dedicated to radiology education include: @TheRadiologistPage, @Radiopaedia.org and @thexraydoctor, with 228k, 192k and 58k followers, respectively. @TheRadiologistPage, for instance, has grown significantly over the past two years. Having posted 87 educational posts since it was established in 2018, @TheRadiologistPage now has nearly a quarter of a million followers. The page has a highly engaged audience with an average of 71.6 comments per post.⁶

Making medical education content widely available has clear advantages, but is not without challenges. The fact that anyone can post and that users may protect their identity raises questions of validity. It remains the responsibility of the social media user to scrutinise any content prior to using it in their practice. The use of social media for medical education also raises some ethical questions, not least, regarding confidentiality of the discussed cases and images. While images can be adequately anonymised, the information posted may make the case identifiable to the patient or their relatives and this should be carefully considered prior to posting such content. The General Medical Council (GMC) in the UK has issued guidance on the use of social media by healthcare professionals.⁷ In addition to confidentiality and professionalism concerns that the use of social media raises, posts may be accessed by patients who may use such information to self-diagnose and treat. This may have serious consequences and should also be taken into consideration prior to posting on Instagram or other social media platforms.

Our study is not without limitations. A number of educational accounts may be ‘private’ and may only be viewed if the user is granted access. Private accounts are often used by healthcare professionals to further ensure that confidentiality is maintained. Our results may therefore underestimate the number of educational ultrasound posts on Instagram. Our results are from a small sample of posts. By assessing the top 100 and the most recent 100 posts, we tried to emulate those posts likely to be viewed by the average Instagram user, but this strategy may not be completely representative. While the use of standardised hashtags may make educational ultrasound content more accessible, it would be important to evaluate the impact of such use on learner engagement and information retention.

Conclusion

The image-based nature of Instagram makes it an ideal platform for the free dissemination of ultrasound and radiology education. The use of the newly introduced hashtag #UltrasoundEd when posting educational ultrasound content will help make such posts more readily identifiable.

Key points

• Educational ultrasound content is difficult to identify on Instagram due to the widespread use of #ultrasound socially.

• Over half of #radiology posts are educational compared with just over 10% of #ultrasound posts.

• The use of the newly introduced #UltrasoundEd helps separate educational ultrasound content from social posts on Instagram.