Abstract
Background
The COVID-19 pandemic has changed the way orthopaedics programs are educating and recruiting residents and applicants. With an increased focus on online and virtual programming, there has been an uptick in social media usage by orthopaedics residencies as a means of communicating with applicants. This study investigated the growth in utilization of social media platforms by residency programs since the beginning of the COVID-19 pandemic.
Methods
Instagram and Twitter were queried for each orthopaedic surgery residency program. It was determined if each program with a corresponding social media account was created before or after March 1, 2020. The number of posts per month were tabulated for accounts that existed prior to March 1, 2020.
Results
187 orthopaedic surgery residency programs were identified using the AAMC ERAS database. Of these programs, 74 (41.6%) were found to have an Instagram profile, and 50 (26.7%) were found to have a Twitter page. Of the 74 Instagram profiles, 45 were created after March 1, 2020, representing a 155% increase. Of the 50 Twitter pages, 15 were created after March 1, 2020, representing a 43% increase. Instagram accounts that were active before the pandemic had a 96% increase in the number of posts per month, on average, after March 1, 2020.
Conclusion
Over one-third of programs are utilizing social media for recruitment purposes. There has been an 155% increase in Instagram and 43% increase in Twitter usage by residency programs since March 1, 2020. Instagram accounts created prior to the pandemic also demonstrated a near doubling of increased utilization after March. This represents a new, cost-effective way to connect with applicants in a time when in-person interactions are limited.
Level of Evidence: III
Keywords: residency recruitment, social media, covid-19
Introduction
Social media and networking platforms have been increasing in popularity amongst the medical community over the past decade. In the field of orthopaedic surgery, social media presence has become an increasingly popular tactic for marketing to patients and has been correlated with improved patient review scores.1-3
The novel coronavirus (COVID-19) global pandemic has placed residency programs and applicants in unchartered territory. Programs rely on in-person audition rotations and interviews to both assess applicants and to market their program. Students similarly rely on these face-to-face encounters to gauge the overall culture and environment of the training program as well as to demonstrate their merit. On average, students applying to orthopaedics attend 2.4 away rotations and successful applicants attend 11.5 interviews.4 With the recommendation by the American Orthopaedic Association’s (AOA) Council of Orthopaedic Residency Directors (CORD) to cancel the majority of in-person visiting rotations and interviews for the 2020-2021 application season, many residency programs have taken to social networking sites to connect with applicants.5
The purpose of this investigation is to evaluate the use of common social networking platforms by orthopaedic residency programs and determine the change in usage of these platforms since the beginning of the COVID-19 pandemic in the United States.
Materials and Methods
The Association of American Medical College’s (AAMC) Electronic Residency Application Service (ERAS) was used to identify all accredited orthopaedic surgery residency programs. Once identified, these programs were searched on the social media platforms Instagram (Instagram from Facebook; Menlo Park, CA) and Twitter (San Francisco, CA). We identified accounts using all combinations of full and abbreviated program names and “ortho”. Accounts and posts were verified to belong to the residency program, and not to an individual. Accounts were excluded if there were no posts related to the residency program or graduate medical education. Additionally, the CORD AOA public residency spreadsheet and each program’s website were referenced to identify any pages that may have been missed. Once identified, it was determined whether the account was active prior to or after March 1, 2020 to identify which accounts were created to supplement the upcoming application cycle following the declaration of the coronavirus global pandemic in the United States. The number of monthly Instagram posts for accounts that existed prior to March 1st were tabulated as a means of determining increase in utilization of social media surrounding COVID-19.
For our data analysis, the programs were divided by region – West, Midwest, Northeast, and South – to determine if there were any regional differences in the utilization of social media platforms. Social media usage, regional counts and increase in monthly posts were analyzed using descriptive statistics by the authors.
Results
187 orthopaedic surgery residency programs were identified using the AAMC ERAS database. Of these programs, 74 (41.6%) were found to have an Instagram profile, and 50 (26.7%) were found to have a Twitter page. Of the 74 Instagram profiles, 45 were created after March 1, 2020, representing a 155% increase. Of the 50 Twitter pages, 15 were created after March 1, 2020, representing a 43% increase (Figure 1).
Figure 1.
Orthopaedic Surgery Residency Programs Using Social Media. This figure demonstrates the overall number of programs utilizing the social media platforms Instagram and Twitter before and after the COVID-19 pandemic.
Regionally, West coast programs were most likely to have both Instagram and Twitter pages, with 55.5% (15/27) and 37.0% (10/27) of programs having accounts on the two platforms, respectively. Southern programs were least likely to have an Instagram page, with 26.4% (14/53) of programs using the platform; Midwestern programs were the least likely to engage in Twitter, with 13.5% (7/52) of programs having a page. However, Midwestern programs did show the largest percent increase in Instagram use, with a 275% increase after March 1, 2020. Midwest and West coast programs responded with the largest growth in Twitter utilization, with a 67% increase after March 1 (Figure 2a and 2b). Regional social media usage is outlined in Table 1.
Figure 2a.
Instagram Use by Region. Figure 2a focuses specifically on Instagram usage by program before and after COVID-19. The figure breaks down usage by region (West, Midwest, South, and Northeast).
Figure 2b.
Twitter Use by Region. Represents Twitter pages by region before and after COVID-19.
Table 1.
Programs Using Instagram and Twitter Pre-/Post-COVID
| Total # of programs | Instagram: Before COVID | Instagram: After COVID | Percent Increase | Twitter: Before COVID | Twitter: After COVID | Percent Increase | |
|---|---|---|---|---|---|---|---|
| West | 27 | 9 (33.3%) | 15 (55.5%) | 66.7% | 4 (14.8%) | 10 (37.0%) | 150% |
| Midwest | 52 | 4 (7.7%) | 15 (28.8%) | 275% | 6 (11.5%) | 7 (13.5%) | 16.7% |
| Northeast | 55 | 8 (14.5%) | 20 (36.4%) | 150% | 11 (20%) | 17 (30.1%) | 54.5% |
| South | 53 | 8 (15.1%) | 14 (26.4%) | 75% | 14 (26.4%) | 16 (30.2%) | 14.3% |
| Total | 187 | 29 (15.5%) | 74 (39.6%) | 155% | 35 (18.7%) | 50 (26.7%) | 42.9% |
Instagram and Twitter Utilization Pre- and Post- Covid (a summary).
Instagram was the most utilized platform for orthopedic surgery residency programs. It was determined that programs with an existing Instagram account (n=29) posted on average 3.76 times per month prior to the onset of the COVID pandemic in the United States. These same programs increased their frequency of posting to 7.36 times per month, on average, after the onset of the pandemic. This represents a 96% increase in frequency of posting on Instagram.
Discussion
The purpose of this study was to investigate the increase in the utilization of social media platforms for the recruitment of orthopedic surgery applications and the promotion of residency programs. In a field in which away rotations are viewed as a necessity for both applicants and programs the coronavirus pandemic brought on new challenges to how programs would advertise themselves and how applicants would learn about programs. Based on observation, social media seemed to be an excellent medium to fill this role. In this study, the authors sought to quantify this trend.
Virtual learning and conferences have become commonplace throughout the COVID pandemic and there has likewise been a drastic rise in free, accessible, online programming intended for residents and applicants.6-9 Similarly, graduate medical education recruitment efforts have transitioned online. While many programs have begun using social media in this capacity for the first time, the idea of promoting programs virtually is not new. A recent systematic review of the plastic surgery literature demonstrated an overall trend towards residency programs establishing a social media presence as a cost-effective opportunity to communicate with students.10 In 2018, 21% of plastic surgery programs were noted to have active Instagram accounts, and 30% of urology programs used Twitter in 2017.11,12 Applicants have also voiced placing an increasing importance on social media in the residency application process. A sample of radiology applicants reported that 85% of interviewees used social media platforms to learn more about individual programs.13 Similarly, in a survey of 992 medical students and trainees, 10% of respondents noted that a program’s social media presence would influence their residency decisions.14
Applicants often rely on interviews and away rotations to gauge several important factors while evaluating programs. A survey of 742 orthopaedic applicants demonstrated that the most important factors when making a rank list included perceived happiness/quality of life, resident camaraderie, and impression following an audition rotation.15 Programs have been using social media in a variety of ways to engage applicants and answer these questions. Residency programs are using these platforms to spotlight the culture of their program by highlighting social events and overall resident and faculty camaraderie. Other programs have posted videos and pictures highlighting “a day in the life” of a resident. Many programs are hosting both anonymous and live question and answer sessions. Lastly, social media is being used to feature research and academic pursuits, including recent publications, presentations, and educational conferences. It was found that as programs became more active on social media accounts after the onset of COVID, a large number of their posts were dedicated to the recruitment activities listed above.
Several publications have recently demonstrated the high costs associated with application to an orthopaedic surgery residency program. As noted previously, students complete an average of 2.4 away rotations throughout the application process, with an average cost of $2,799.16 A survey of 48 orthopaedic applicants estimated an overall cost of $7,119 throughout the interview season. Seventy-two percent of respondents to one survey reported borrowing money in order to finance interviews. Similarly, 28% of applicants reported cancelling interviews due to financial burdens.10 Social media is a free, readily available resource that programs and applicants can use to connect throughout the application season and may prove to decrease the financial burden on students.17
Limitations of this study include the pure observational nature of the study. No programs were contacted to identify their rationale for creating a social media page, so it can only be implied that this was intended to augment recruitment practices. Further, it remains to be determined whether this is an effective method of communicating with applicants. This application cycle is an anomaly in terms of the exposure which applicants have to programs and vice versa. The authors encourage future studies to investigate the success of these newly utilized recruitment methods, including applicant perception and interaction with these platforms.
Our investigation revealed that over one-third of orthopaedic residency programs are utilizing social media platforms as a means of communicating with applicants. There has been a dramatic increase in use of these programs since the beginning of the COVID-19 pandemic and the announcement limiting in-person interviews and rotations for the 2020-2021 season. The most popular platform utilized by programs is Instagram, followed by Twitter. This suggests that programs are increasingly utilizing these platforms to reach applicants in novel ways. A substantial number of programs created new accounts during the 2020 application cycle, while those that had accounts prior to the COVID pandemic also demonstrated a meaningful increase in usage. Social media and online programming may prove to be a cost-effective way for applicants and programs to connect during the often cost-prohibitive application season. Further consideration into how applicants interact with these platforms can help programs maximize their virtual reach during the recruitment and application season.
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