The universally accepted system for the transmission of scientific knowledge in the field of medicine has long been grounded in scientific publications. Social networks can be a useful alternative or complementary method of transmitting this knowledge.
Social networks (e.g., Twitter, Instagram, Facebook, LinkedIn, YouTube, and TikTok) generate educational contents that enable quality training, despite their informality. Each of these networks has strengths and weaknesses that users should know about.
These platforms are free and allow for real-time discussion. They make it easy to incorporate content and to contact experts or access sources of knowledge directly. Aware of their influence, publishers have incorporated metrics to measure the impact of their articles in social networks (Altmetrics).
These networks should be incorporated into departmental training programs immediately. Nevertheless, navigating through social networks is complex, and the hashtag-based system of searching is inefficient, limiting their use in education.
Despite the informality of the knowledge generated on social networks, the importance of these networks as a source of knowledge is growing. Radiology departments must design a strategy for using social networks for education rather than for propaganda, creating well-organized focal groups that search for contents through systematic, filtered review of information, digital repositories, and review sessions and for sharing this knowledge both inside and outside the department. Departments must also implement a strategy for communicating through these networks.
El sistema universalmente aceptado para la transmisión del conocimiento científico en medicina se basa desde hace mucho en las publicaciones científicas. Las redes sociales (RRSS) son una alternativa o complemento que puede ser útil.
Las RRSS (Twitter, Instagram, Facebook, LinkedIn, YouTube, TikTok) tienen generadores de contenidos educativos que pueden proporcionar formación de calidad, a pesar de su informalidad. Cada una tiene sus puntos fuertes y sus debilidades, que conviene conocer.
Son gratuitas y permiten discutir en vivo, incorporar contenidos ágilmente y contactar directamente con expertos o fuentes de conocimiento. Las editoriales son conscientes de su influencia y han incorporado métricas que miden el impacto en ellas de los artículos (Altmetrics).
La estrategia formativa de cualquier servicio debe incorporarlas ya. Sin embargo, navegar en ellas es complejo y el sistema de búsqueda, basado en hashtags, es ineficiente, por lo que su uso en educación sigue siendo cosa de excéntricos.
El conocimiento generado en las RRSS, a pesar de su informalidad, es una fuente cada vez más importante de conocimiento. Los servicios de radiología deben definir una estrategia de RRSS, no con fines de propaganda, sino educativos, creando grupos focales bien formados que busquen contenidos mediante revisión sistemática y filtros, repositorios digitales y sesiones de revisión y los compartan dentro y fuera del servicio. Igualmente, debe ser implementada una estrategia de comunicación a través de redes.
Communication today has changed in general. Traditional media (press, radio) have been displaced on a daily basis by social media. Their impact has made them one of the most widespread means of communication. Why not also in scientific communication? In principle, because social media are not designed for sharing professional content. However, this does not imply that they cannot be adapted to these uses.
In fact, publishers are aware of the influence of social media and, in a move to adapt to the new times, they have incorporated new metrics into the evaluation of the impact of articles, including their presence in the main social media channels. Thus, altmetrics measure online citations (blogs, Twitter, Facebook) and allow us to better understand the real-world impact of an article, such as number of views of the article, downloads, or mentions in the media.1–3
The use of social media for medical education was pioneered in the world of emergency medicine, where the acronym FOAM (Free Open Access Medical Education) was coined to describe the movement that used free online resources provided by altruistic participants for medical education. Twitter was used from the beginning for this purpose and the hashtag #FOAMed was used to identify the content (for radiology #FOAMRad has been used).4 Subsequently, other social media have been used for the same purpose.
Characteristics of different social media and their potential use in medical communicationTwitterCreated in 2006, Twitter was initially designed as a news communication system. A kind of news ticker. In 2017, it had 328 million monthly active users. It allows short text messages (maximum 280 characters), called tweets, to be sent and displayed on the user’s page. Users can follow others without having to ask their permission. By default, messages are public, although this can be limited. It also allows private messages to be sent to followers.4,5
Messages can be forwarded, in their original state or with comments. For use in medical education, it has several interesting features: it allows you to embed links to web pages and up to four images or a video. In addition, it allows the creation of threads by adding successive messages to the original message (Fig. 1), which solves the problem of the limited number of characters in messages (Table 1). And these threads can be grouped together using the unroll function and saved as pdf files.
Advantages and disadvantages of the most popular social media networks for use in medical education.
| Social media network | |
|---|---|
| Advantages | |
| By allowing interaction, it facilitates discussion | |
| It allows images and videos to be included very easily | |
| It allows the construction and storage of threads (unroll) | |
| It is seen as a serious network, in general | |
| It allows you to send private messages | |
| It enables surveys to be carried out | |
| It allows you to follow issues without the need for acceptance | |
| Disadvantages | |
| Conflicts are frequent. Short sentences prevent nuance and often hurt sensitivities. Harsh exchanges of views are frequent | |
| Limit of 4 images per tweet | |
| Not widespread, except in certain professions | |
| Advantages | |
| It is intuitive and easy to use | |
| Very popular. The most widespread. Especially in Latin America | |
| Allows images and videos to be included very easily and in almost unlimited number | |
| There is no limit to the length of the text to be posted | |
| It allows you to send messages and interact | |
| Allows the creation of non-personal pages and groups | |
| Disadvantages | |
| It is informal. It is not seen as a “serious” network like Twitter is | |
| It does not allow the construction of structured threads | |
| Low penetration in the new generations. In decline | |
| Advantages | |
| Professional field. Serious | |
| It allows you to include images and videos | |
| It allows you to include relatively long texts | |
| It allows you to send messages and interact | |
| Disadvantages | |
| Exclusively professional field. Not widely used in the health sector | |
| It only allows you to include images or videos, but not both | |
| It does not allow you to create threads. Static | |
| Advantages | |
| Very visual. It allows you to include images and videos | |
| It allows you to include long texts (2200 characters) | |
| It allows you to send messages and interact | |
| Very popular with young people | |
| Specially designed for smartphones | |
| Disadvantages | |
| Informal. It is basically used for frivolous purposes | |
| Less widespread in higher age groups | |
| It does not allow threads or links | |
| YouTube | Advantages |
| The video format allows you to learn at your own pace: pause, rewind… | |
| Large capacity to store information. The only one that allows long videos | |
| It allows you to follow channels | |
| Disadvantages | |
| It allows little interaction. Unidirectional | |
| Poor search tool. It does not allow precise searches | |
It is widely used in journalism. The majority of Twitter users are older adults, and it is little used by young people. It is arguably the predominant social media platform for medical education.4,5
FacebookFacebook is the social network par excellence: the first (it appeared in 2004) and the largest, with some 3 billion monthly active users. Although penetration among the new European generations has decreased, it is still the most powerful network in Latin America.4,5
Users have a personalised profile with different data and can add other users as “friends” upon request and acceptance. In addition, users can join common interest groups. It allows you to exchange messages, post content, share photos, videos and links, use multiple applications and receive notifications about other friends. It also allows you to embed a link to another page with a comment (Table 1).
It was designed from the outset as an informal social communication system, initially among university students, and then progressively expanded. It is little used for medical education, but much used to educate and guide patients and the general public on health issues. In fact, there are studies showing the impact of Facebook on radiology education, and it is one of the few social media platforms that have demonstrated effectiveness in reaching patients on radiology-related topics.6–9
LinkedInDesigned as a means of professional communication, LinkedIn is geared towards business, personal contacts and job searching. Launched in 2002, it has had rapid success, reaching over 700 million members and 50 million companies, and is still growing. Used by both companies and individuals, its main use is to find or improve a job, in the case of professionals, and to find new clients or staff, for companies.10
But it also allows you to share professional information, join communities of interest, follow companies or professionals to keep up to date with the latest news and connect with other professionals. This makes it possible for educational use and for carrying out shared projects. In fact, in 2016, it incorporated a utility for accessing online courses: learning.10
It allows you to search for and follow other users (the latter requires their acceptance) and to form or follow groups with common interests. You can include extensive text in posts and post images or videos (never both), as well as reply to posts. And also send messages directly to contacts (Table 1).10
LinkedIn is popular among radiologists: several surveys have shown that it is the network preferred by radiologists for professional use, especially in Europe.11–20
YouTubeYouTube is the second largest social media network, with more than 2 billion monthly active users. It is not strictly speaking a social media network, but a repository of videos, although it does allow for some interaction. It is therefore an ideal platform for sharing presentations (Table 1). The COVID pandemic has increased its use for radiology education.5,13,14
The platform consists of a search bar and various sections (Home, Explore, Subscriptions, Library, Shorts) and categories. Each video on the platform is part of a YouTube channel which is, in practice, a profile of a person or institution on whose page the videos they have uploaded appear in reverse chronological order. Members of the network can subscribe to channels, so that the page will display content personalised for the user. The search bar allows you to search for videos or channels.13–15
It allows for some interaction: showing approval or disapproval, making comments or sharing the video with other users. Downloading videos is only available to Premium members (who pay a subscription fee). The platform is a huge repository of videos where you can find almost anything you are looking for. These include a large number of radiology videos, especially recorded lectures.4,5,14
InstagramLaunched later than the previous networks, in 2010, Instagram has more than 700 million monthly active users. It is designed primarily for sharing images. It allows users to upload images or videos that can be edited with filters and organised by keywords and locations. Posts can be shared publicly or with followers. Users can browse the content of other members of the network and use hashtags. And also send private messages.4,16–19
Designed for smartphones, which is its strength, images and videos are displayed vertically on the phone screen. Initially, it allowed only 640 pixel square images to be included, but this was expanded to 1080 pixels. Multiple images or videos can be included, but not links, and images can also be edited and annotated. It is the fastest growing social media network and the most popular among young people, with several hundred million users (Table 1). Because it is image-based, it is suitable for radiology education.4,17–19
TikTokThe latest addition (launched in 2016) focuses on video sharing. It is a social media network of Chinese origin for sharing short videos in vertical format, which have a duration of 1 s–10 min. When the videos end, they start again automatically.
Undoubtedly, it has functionalities that can be exploited, and it is an almost virgin terrain for the development of educational functionalities. However, it is seen as (and is) not a very serious network and currently has hardly any relevance in the educational world.20
Pluses and minuses of social media in medical educationThere are several problems in the use of social media for training and these are set out in detail in Table 2. The first is that professionals do not expect to find training on social media and use them for something else: they do not consider social media a tool for seeking knowledge. And even if they tried, no social media network offers users the possibility to search for content effectively; the transmission of knowledge is more of a day-to-day thing. In addition, users are subject to the algorithm of the social media platform, which may promote certain posts and hide others on their timeline, with no clear criteria.5
Advantages and disadvantages of using social media for medical education.
| Advantages |
| They are free of charge |
| They are widely used |
| They generally allow access to any content on the network |
| They allow for agile debate |
| They allow easy contact with the author of the content |
| They allow content to be added by several authors (collaborative work) |
| They allow other online sources to be incorporated |
| Disadvantages |
| They are not prepared for content review (e.g. peer review) |
| They have no curricular value |
| There is no recognised standard |
| They are not very formal |
| They are prone to contain unverified information |
| Their scientific value rests on the prestige of the person who publishes the content |
| They facilitate confrontation as opposed to calm scientific debate |
| They are open to anyone’s opinion, including those without knowledge of the issue at hand |
| The weight of opinion is the same for those who know what they are talking about as for those who do not |
| There is no good content search system |
| They are too immediate. Posted content is lost at the bottom of the timelines |
While the open and accessible nature is an advantage of social media, this entails the problem that anyone can access any content, with a consequent lack of privacy. Authors of publications will therefore suffer from public exposure, which can be unpleasant and lead to conflict. It is not uncommon for those who post content on medical topics to receive messages from patients asking for information or opinions. It is therefore advisable to maintain two separate profiles, one personal and one professional, on social media networks.5,12–14
Some platforms, such as Twitter, severely limit the amount of text allowed, making it impossible to convey nuance in messages, often leading to unpleasant interpersonal conflicts. In others, the limits of images or video may make it difficult to transmit the information.8
But the most important problem is that the reliability of the information is highly variable, as anyone can write on them, whether or not they are qualified to do so. There is no such thing as a content reviewer and, ultimately, the reliability of what is communicated rests on the prestige of the communicator. This has been evident in the recent pandemic, where reliable and expert information coexisted, on an equal or sometimes less impactful footing, with inaccurate content or blatant misinformation. There is also no control over the ethical aspects of the information transmitted or the intellectual property of the information.4,5,11–16,18
However, they have considerable advantages, which make them tools with immense potential (Table 1). They allow very wide access to information, including for people from many different geographic areas who would not otherwise have access to such knowledge.9 They are free and widely available; undoubtedly the most widely available sources of information today. And the knowledge generated in social media networks, despite its informality, is an increasingly important source of knowledge.
Additional advantages of social media are that they allow you to connect with other profiles, such as patients, who are excluded from traditional scientific communication. They allow for an open and informal (sometimes too harsh) debate in which any expert anywhere in the world could participate.6–9 They are not overly censored, thus allowing non-academic viewpoints that are often excluded from formal journals, where reviewers may have biases that limit the discussion of heterodox viewpoints, which are sometimes right. And most importantly, they are the media of the future and must be counted on.
The real impact of social media in professional trainingThe impact of social media, in general, is measured in the number of followers and likes received. However, this is an artificial measure that does not imply knowledge of the impact on the target audience. Theoretically, to determine the reach of a publication, one should consider the engagement rate (number of people who interacted with the publication from among the number of people who viewed the publication). It has been calculated that the average engagement rate on Instagram (this could be extrapolated to other social media) is 1.22%–4.7%. This means that a post with 100 likes would be seen by between 2200 and 8200 people.4,5
But the like can also be given out of affection for the publisher, rather than for the content’s usefulness, and more to publications with eye-catching or popular content. And in the professional world it is not to be expected that a message with educational content will go viral, so measuring the impact factor in social media by this means seems inappropriate.
Moreover, this does not measure the impact of the teaching on the observer. Looking for other methods of assessing the impact of social media as a vehicle for training, the author of this article recently evaluated the usefulness of his Twitter and Facebook profiles, both of which have a professional profile, by sharing two publications that included surveys to measure the evaluation of the account from the point of view of its training usefulness. The result was apparently discouraging (Fig. 2): on a Twitter profile with about 4000 followers, only 263 people responded, and on the Facebook profile with about 2000 followers, 225 responded. But virtually all responses indicated appreciation for the training provided. And if we apply the participation rate, the real audience of the profiles would be between 5597 and 21,557 people, a significant (and possibly exaggerated) number.
The role of networks in the training of today and tomorrow
The survey data, although limited to one account, suggests that the number of followers is not a measure of the real impact of social media in transmitting knowledge, and that it is currently limited. They are tools designed for less “serious” purposes: propaganda and aggressive discussion (Twitter), or maintaining personal contacts (Facebook).
The question that arises is whether it is worth maintaining a training initiative for which social media are not designed. The answer is complex. This is because we are not considering the role of networks in today’s radiology, but the role they will play in tomorrow’s radiology. All beginnings are hard, and the reality is that social media have quickly established themselves as a vehicle for transmitting information and acquiring knowledge, despite their obvious limitations.
Social media offer an effective, albeit imperfect, alternative to traditional means of disseminating scientific information. They are not very user-friendly for these purposes: navigating them is complex and the search system, based on hashtags, is inefficient. Although the time has not yet come for social media as a massive vehicle for training, it is getting closer: the knowledge generated in social media, despite its informality, is becoming increasingly important. Early adopters will have an advantage over latecomers.
Strategic conclusions for radiology servicesTo incorporate the knowledge generated in the networks, radiology services must already define, if they have not already done so, an implementation strategy that is not only communication outside the service (the “propaganda”), but also educational, sharing knowledge and creating well-trained focus groups that search for content through systematic review and filters and share it inside and outside the service. Radiologists must acquire training in each of the media. And the perspective of contact with patients must not be lost.
Ideally, several social media networks should be used, as each has its strengths, and they should be interconnected. Thus, Instagram can be used to post cases of the day, Twitter or Facebook can be used to link to videos uploaded to YouTube, which can be sessions or lectures recorded via Facebook’s live streaming application. And Facebook to convey messages to patients.
Right now, social media are very undeveloped in terms of knowledge transmission. But a marathon always starts with a first step. It is worth continuing to insist and open up new paths.
FundingThis article has received no funding other than the author’s own.
Conflicts of interestThe author has no conflict of interest in the subject matter.
