To the Editor: We applaud Schwartzman et al1 for studying Instagram as an effective avenue for dermatology residency program promotion during COVID-19. On May 11, 2020, the Coalition for Physician Accountability2 discouraged away rotations, while recommending virtual interviews and transparent communication in the residency selection process.3 Social media can bolster transparency while enhancing organizational accountability and audience relationships.4 To extend prior analysis,1 we examined dermatology program engagement on Instagram, Facebook, and Twitter and highlight opportunities for interaction with prospective applicants.
Social media accounts of accredited dermatology residency programs were searched in February 2021. Emulating Schwartzman,1 account creation dates were noted. To assess relative page popularity, account follower numbers (Instagram, Twitter) or profile likes (Facebook) were recorded and ranked. Total user engagement (likes, comments, and shares) for the latest 3 residency-focused posts of 2019 and 2020, excluding general patient- or department-oriented posts, were compared for each program by platform (Fig 1 ).
Fig 1.
Social media account creation dates and summary of top 10 dermatology residency programs by platform as of February 2021, showing total likes, comments, and shares from 3 comparable posts (December 2019 vs December 2020). One hundred forty-two Accreditation Council for Graduate Medical Education (ACGME)-accredited dermatology residency programs were searched for social media accounts. May 11, 2020 is the date of the announcement by the Coalition for Physician Accountability, which included Association of American Medical Colleges (AAMC) and ACGME representatives, recommending transparent residency selection communication. For Instagram, Account Creation Date (unavailable) was listed as date of first post. B-JH, Barnes-Jewish Hospital; N/A, social media account did not exist on that platform during time period; SLCH, St. Louis Children's Hospital. ∗ Post Engagement on Instagram = Likes + Comments; † Post Engagement on Facebook and Twitter = Likes + Comments + Shares.
Prior to the May 11, 2020 coalition recommendation, 63 official dermatology residency program social media accounts existed: 18 (29%) were Instagram accounts, 27 (43%) were Facebook accounts, and 18 (29%) were Twitter accounts. After that date, 64 new social media accounts were created, predominantly Instagram (55; 86%), followed by Twitter (6; 9%) and Facebook (3; 5%) (Fig 1). Instagram demonstrated the greatest popularity, reaching a maximum of 2223 followers (University of Miami). Average account followings were highest on Instagram (>1000 followers for the top 10 most-followed programs), compared to the published findings for 2019, where Facebook was most popular.5 The University of South Florida remained the most-liked (2294 likes) program on Facebook, but overall Facebook engagement largely fell (−2% to −100% for 7 of the top 10 programs) from 2019 to 2020. Program Facebook accounts were also much older than Instagram or Twitter accounts. Top Twitter account followings moderately grew (top account +66%; top 10 average, +230%) relative to 2019. Except for the University of Southern California (1075 likes plus comments and shares for 2020 Twitter posts), 2020 engagement was highest on Instagram, with the most consistent growth from 2019 (change, −14% to +186%).
Due to Instagram's notable expansion, post engagement was also assessed by content category (Table I ). Group photos, faculty spotlights, posts about residents socializing at work (gift exchanges, holiday parties), and program application cycle announcements showed the highest engagement. Posts with the least engagement were those on educational dermatology-related topics and posts highlighting the resident workday, including didactic sessions.
Table I.
Content categories of dermatology residency program Instagram posts ranked by engagement: Likes and comments from December 2019 to December 2020
| Instagram post content | No. of posts | % of total posts | Total no. of likes | Total no. of comments | Total no. of likes and comments | Engagement∗ (%) |
|---|---|---|---|---|---|---|
| Resident group photo | 22 | 8.7 | 1110 | 29 | 1139 | 51.8 |
| Faculty spotlight | 13 | 5.2 | 627 | 34 | 661 | 50.8 |
| Resident life: social at work | 47 | 18.7 | 2288 | 58 | 2346 | 49.9 |
| Announcement: program | 26 | 10.3 | 1170 | 66 | 1236 | 47.5 |
| Resident spotlight | 29 | 11.5 | 1272 | 71 | 1343 | 46.3 |
| Resident life: social outside of work | 16 | 6.3 | 670 | 24 | 694 | 43.4 |
| Announcement: social | 12 | 4.8 | 354 | 9 | 363 | 30.3 |
| Location highlight | 12 | 4.8 | 274 | 8 | 282 | 23.5 |
| Resident life: work | 67 | 26.6 | 1364 | 41 | 1405 | 21.0 |
| Educational | 8 | 3.2 | 90 | 12 | 102 | 12.8 |
| Total posts analyzed | 252 | 9219 | 352 | 9571 |
Engagement = 100 × (Likes + Comments)/(Number of Posts).
COVID-19 complicated the residency selection process, which typically allows for applicants to familiarize themselves with programs. Allowances for away rotations in the near future remain unclear and dermatology residency programs should consider emphasizing social media, such as Instagram, Facebook, and Twitter, to interact with applicants. Instagram may currently be the most promising platform, as it accumulates the highest engagement metrics and reaches the largest audience. Because most existing residency social media accounts were created after the coalition recommendation, future investigation of a wider selection of posts and platforms is necessary to determine the true impact of this potential paradigm shift in communication. Further investigation of the level of engagement of different post types could also provide helpful information to augment the social media involvement of residency programs.
Conflicts of interest
Dr Dellavalle receives editorial stipends from the Journal of the American Academy of Dermatology and the Journal of Investigative Dermatology, royalties from UpToDate, and expense reimbursement from Cochrane Skin; and is Editor-in-Chief of the Journal of Medical Internet Research (JMIR) Dermatology. Authors Harp, Szeto, Meckley, and Geist and Drs Presley, Anderson, Laughter, Rundle, and Husayn have no conflicts of interest to disclose.
Footnotes
Authors Harp and Szeto contributed equally to the article and are cofirst authors.
Funding sources: None.
IRB approval status: Not applicable.
Reprints not available from the authors.
References
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