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Social media in the mentorship and networking of physicians: Important role for women in surgical specialties
The American Journal of Surgery 215 (2018) 752e760
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The American Journal of Surgery journal homepage: www.americanjournalofsurgery.com
Social media in the mentorship and networking of physicians: Important role for women in surgical specialties Jessica G.Y. Luc a, Nikki L. Stamp b, Mara B. Antonoff c, * a
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia c Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 12 April 2017 Received in revised form 1 December 2017 Accepted 14 February 2018
Background: Social media may be a useful supplement to physician and trainee interactions; however, its role in enhancing mentorship has not been described. Methods: A 35-item survey investigating trainee and physician social media use was distributed. Responses were analyzed using descriptive statistics. Results: 282 respondents completed the survey, among whom 136 (48.2%) reported careers in surgical specialties. Women in surgical specialties were more likely to describe the specialty as being dominated by the opposite sex (p < 0.001) and to be mentored by the opposite sex though wish to be mentored by individuals of the same sex (p < 0.001). Respondents in surgical specialties were also more likely to report using social media to build a network of same-sex mentorship (p ¼ 0.031). Conclusions: Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution. © 2018 Elsevier Inc. All rights reserved.
Taxonomy: Education in health technology, Mentorship in education, Social media, Social network Meeting Presentation: Association for Surgical Education Annual Meeting 37th Annual Meeting, April 18e22, 2017, San Diego, California, USA. Keywords: Social media Mentorship Medical education
1. Introduction It is well established that mentorship has an important influence on personal development, career selection, advancement, success and productivity.1 Dr. Chip Souba has defined mentoring as a “personal as well as a professional relationship … of liberating people to reach their full potential … [where] the mentor is invariably an important role model for the mentee. Mentors are people we look up to; they are those individuals we emulate and want to be like. They embody many of the qualities we most admire and would like to possess ourselves.”2 For more than a decade, women have constituted nearly half of the medical school student body, but remain significantly under-
* Corresponding author. University of Texas MD Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, 1400 Presslar Street, Unit 1489, Houston, TX 77030, USA. E-mail addresses: [email protected] (J.G.Y. Luc), [email protected] (N.L. Stamp), [email protected] (M.B. Antonoff). https://doi.org/10.1016/j.amjsurg.2018.02.011 0002-9610/© 2018 Elsevier Inc. All rights reserved.
represented in a number of key specialties, including most surgical specialties.3 Women in surgery often reported a lack of mentorship as significant obstacles to career progression and satisfaction in the specialty,4 and to value same-sex mentors as sharing a sense of history and understanding of both personal and professional career paths.5 As a majority of trainees choose the same career as their mentor, failing to have a mentor in surgery could diminish the likelihood of surgery being selected as a career.6 In order to deliver the best possible care, the global surgical workforce should mirror the diverse society it is entrusted to serve. Reasons cited include representation from different perspectives, social equity, improved access, and health outcomes of our diverse community.7 Globally, more than 2 billion people are engaged with social media accounts, a figure estimated to rise to nearly 3 billion people by 2020.8 Social media enables near instantaneous interactions within a global community, including physicians, patients, and trainees. This wide audience provides more opportunities for networking, learning, and disseminating knowledge. Applications
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of social media in healthcare settings include its use as an educational and peer support tool,9 and in the delivery of care and policy.10,11 The remarkable growth in users engaging with social media and the nature of borderless interactive communication and networking allows for potentially substantial advances to be made in the realm of mentorship. The #ILookLikeASurgeon movement, created and disseminated by female surgeons, is an example of a modern symbol of the ability of social media to unite surgeons across the globe, spanning continents and cultures in a call for diversity and equality in the surgical workforce.12 This spontaneous campaign has aimed to challenge stereotypes, celebrate differences, and achieve equality in the workplace. It has portrayed positive and visible female surgical role models to engage and inspire future generations of surgeons.12 Social media allows for the breaking down of barriers in the healthcare field related to communication, geography, culture, specialties, practice settings and is a potent tool for building and maintaining communities.12 Physicians and surgeons are increasingly employing social media as a form of communication to engage in discussion with others for exchange of information and fostering collaboration.12 Social media may be a useful supplement to physician and trainee interactions, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution; however, its role in enhancing mentorship has not been described. Accordingly, the first purpose of this study was to characterize the usage and role of social media in the mentorship and networking of surgeons. The second purpose of this study is to explore respondent perceptions regarding a need for same-sex mentors, current patterns of same-sex mentoring, and the role of social media in such mentorship relationships.
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3. Results 3.1. Participant demographics: medical vs surgical specialties Among the 282 respondents who completed the survey, 136 (48.2%) reported careers in surgical specialties. There were no significant differences in baseline demographics of the respondents between medical and surgical specialties in terms of sex, age, level of training, relationship status, parenting, and practice environment (Table 1). 3.2. Participant demographics: men vs women in surgical specialties There were no significant differences in baseline demographics of surgical respondents between men and women in terms of age, level of training, relationship status, parenting, and practice environment (Table 2). Women in surgical specialties were more likely to perceive themselves to be in a specialty dominated by the opposite sex compared to women in medical specialties (96% vs. 35%, p < 0.001). 3.3. Usage of social media platforms Facebook was the most frequently used form of social media among all-comers, followed by Twitter, Instagram, LinkedIn, Other, and Doximity (Fig. 1). Respondents in surgical specialties were significantly more likely to use Twitter multiple times per day (36% vs. 21%, p ¼ 0.002) than those in medical specialties (p ¼ 0.002). Compared to medical respondents, surgical respondents are significantly more likely to use social media to learn about their field of interest (61% vs. 38%, p < 0.001) and promote their professional interests (40% vs. 29%, p ¼ 0.048) (Fig. 2).
2. Methods 3.4. Modalities for mentorship communication A 35-item survey investigating trainee and physician social media use was designed using online survey software and distributed via social media and email announcements with an introductory letter explaining the purposes of the survey. Inclusion required respondents to be practicing physicians or trainees preparing for careers as physicians (including fellows, residents, medical students, and pre-med students). All responses were voluntary and anonymous. The questionnaire was designed to elicit data regarding the respondents' demographics, training/professional information, personal/family status (relationships, children), career choice decisions, perception of the specialty being dominated by the opposite sex, access to mentorship, usage of social media for personal and professional reasons, effectiveness of social media for mentorship, as well as factors perceived to be important in leading to a successful mentorship experience on social media (Supplemental Table 1). Questions addressed use of social media overall, as well as specific use of multiple popular social media sites, including Facebook, Twitter, LinkedIn, Doximity, Instagram, and others. This study was approved by the University of Texas MD Anderson Cancer Center Institutional Review Board (PA17-0021). Male versus female differences in questionnaire responses were assessed for respondents in medical compared to surgical specialties. Descriptive statistics were expressed as mean and standard deviation with comparisons between groups made with paired, 2tailed t tests for means of normally distributed continuous variables. Categorical data were expressed as counts and percentages and chi-square test was used to analyze differences between groups. Statistical analyses were performed using Stata (Stata Corp, College Station, Texas, USA) with significance at an alpha level of 0.05.
In the overall cohort, 24% percent of men respondents and 39% of women respondents stated they have no mentor (p ¼ 0.118). Not Table 1 Baseline demographics of all respondents.
Sex (Female) Age <25 years old 25e30 years old 31e35 years old 36e40 years old 41e46 years old 46e50 years old 51e55 years old >55 years old Level of Training Pre-medical Student Medical Student Resident Fellow Practicing Physician Relationship Status Single Relationship Married Divorced Children (Yes) Environment Urban Suburban Rural
Medicine (n ¼ 146)
Surgery (n ¼ 136)
P-Value
71%
76%
0.327 0.332
29% 18% 21% 17% 7% 7% 7% 7%
21% 22% 17% 15% 10% 7% 5% 2%
4% 34% 13% 6% 42%
6% 27% 17% 7% 43%
29% 20% 49% 1% 43%
35% 13% 51% 1% 46%
70% 23% 8%
76% 16% 8%
0.655
0.436
0.548 0.399
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Table 2 Demographics of respondents from surgical specialties.
Age <25 years old 25e30 years old 31e35 years old 36e40 years old 41e46 years old 46e50 years old 51e55 years old >55 years old Level of Training Pre-medical Student Medical Student Resident Fellow Physician Relationship Status Single Relationship Married Divorced Children (Yes) Environment Urban Suburban Rural ¶
Men (n ¼ 34)
Women (n ¼ 102)
29% 26% 15% 6% 15% 0% 6% 3%
20% 23% 18% 17% 8% 10% 4% 1%
6% 35% 18% 12% 29%
6% 28% 17% 6% 43%
10% 2% 12% 0% 50%
36% 16% 48% 1% 41%
88% 9% 3%
73% 18% 9%
P-Value
0.255
p ¼ 0.005), social events (15% vs. 0%, p ¼ 0.044), emails (20% vs. 0%, p ¼ 0.019), and telephone conversations (24% vs. 3%, p ¼ 0.031) compared to men in surgical fields. In contrast, compared to women in surgical fields, there was no predilection for men in surgical fields to interact with mentees/mentors of either sex differently; they were equally likely to interact by formal meetings, social events, emails, telephone conversations, and social media interactions (including viewing, posting, replying, and messaging).
3.5. Sex concordance in mentorship 0.588
0.542
0.369 0.215
Indicates significance p < 0.05.
surprisingly, the primary methods of communication between mentors/mentees remains face-to-face (89%); however, this was closely trailed by email (81%), followed by telephone (45%), social media (23%) and Internet videoconferencing technology (5%) (Table 3). Compared to medical specialties, individuals in surgical specialties were less likely to connect with mentors by email (75% vs. 87%, p ¼ 0.019) and more likely to connect with mentors via Twitter (16% vs. 7%, p ¼ 0.017). Interestingly, there were significant differences in the types of interactions women in surgical fields have with their surgical mentees/mentors compared to men in surgical fields (Fig. 3). Women in surgical fields are more likely to interact with mentees/ mentors of the opposite sex only in formal meetings (26% vs. 0%,
No significant differences were observed in number of mentors (2.1 ± 1.7 vs. 1.9 ± 1.6, p ¼ 0.789) and mentees (2.1 ± 3.3 vs. 2.0 ± 3.0, p ¼ 0.656) for respondents from surgical and medical specialties, respectively. While mentors for men in both surgical and medical specialties were more likely to be sex-matched (p < 0.001) compared to women in both specialties, women in surgical specialties were more likely to be mentored by the opposite sex (p < 0.001) compared to men in surgical specialties. Both women and men in surgical specialties appear to mentor other men and women equally whereas, in contrast, mentees for women in medical specialties were more likely to be sex-matched compared to men in medical specialties (p ¼ 0.009) (Fig. 4).
3.6. Importance of mentorship Compared to men in surgical specialties, more women in surgical specialties felt that mentorship plays an important role in their career path (37% vs. 20%, p ¼ 0.007), were less likely to have access to an institutional mentoring program (32% vs. 56%, p ¼ 0.014), and less likely to have exposure to same-sex mentors at their own institution (43% vs. 91%, p < 0.001). Compared to men in surgical specialties, women in surgical specialties were also more likely to be mentored by individuals of the opposite sex though wished to be mentored by individuals of the same sex (35% vs. 0%, p < 0.001). It is worthy to note that there are a proportion of women in surgical specialties who are mentored by the opposite sex and satisfied with the arrangement. Further, there remains a sizeable proportion of individuals, both men (31%) and women (40%), who are in need of mentorship regardless of sex (Fig. 5).
Fig. 1. Pattern of social media usage by all respondents separated by surgical as compared to medical specialties.
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Fig. 2. Reasons for usage of social media by all respondents separated by surgical as compared to medical specialties and by sex, women (red bars) and men (blue bars). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
3.9. Criteria used by respondents to select mentors/mentees on social media
3.7. Mentorship topics In terms of mentorship topics, compared to men surgical specialties, women in surgical specialties were significantly more likely to seek advice from exclusively same sex mentors on topics regarding how to achieve a balance between personal, career and family time (41% vs. 10%, p ¼ 0.010). Furthermore, women in surgical specialties were more likely to seek advice from exclusively opposite sex mentors on topics regarding leadership strategies in the workplace (16% vs. 0%, p ¼ 0.002), professionalism (18% vs. 0%, p ¼ 0.042), and career planning (20% vs. 3%, p ¼ 0.043) compared to men in surgical specialties,. No significant differences in advice seeking preferences were observed among male and female surgical respondents for topics relating to research and academic projects, surviving a career in the field, guidance in preparing for exams and dealing with politics and conflicts in the workplace (Fig. 6). 3.8. Role of social media in mentorship Compared to medical specialties, respondents in surgical specialties were more likely to report that social media allowed them to build a larger network of same-sex mentorship (21% vs. 13%, p ¼ 0.031). Furthermore, this finding permeated to sex-specific effects of social media by allowing women in surgical specialties to build a larger network of same-sex mentor/mentees who may be remote from where they live/work than they felt could have previously achieved compared to men in surgical specialties (34% vs. 13%, p ¼ 0.001). Table 3 Methods of communication between mentors/mentees.
Face to Face Email Telephone Internet Video Social Media: Facebook Social Media: Twitter Social Media: Instagram Social Media: LinkedIn Social Media: Doximity Social Media: Other ¶
Medicine (n ¼ 146)
Surgery (n ¼ 136)
P-Value
90% 87% 43% 6% 27% 7% 2% 0% 0% 2%
87% 75% 46% 4% 18% 16% 2% 2% 0% 3%
0.452 0.019¶ 0.727 0.615 0.100 0.017¶ 0.693 0.145 e 0.374
Indicates significance p < 0.05.
Given the beneficial effect of social media on the mentorship environment, especially for women in surgical specialties, we were interested in identifying criteria individuals use to choose a mentor/mentee on social media. No significant differences were observed between women and men in medical or surgical specialties; however, results revealed a common trend among all respondents (Fig. 7). Respondents uniformly ranked approachability (84%) as the most important criterion in rendering mentorship via social media successful, followed by shared specific field of interest (72%), and the availability to further connect by email or phone (71%). Also noted as important to respondents were quick response time (67%), easy access/easy to find (64%), acknowledgement of confidentiality of social media exchange (60%), opportunities to connect with leaders in the field (54%), being of the same sex (45%), and option of dysynchronous communication (40%); whereas the least valued characteristic was frequent posting (22%). We then assessed respondents' impressions regarding the content that they find important to be present on mentor/mentee social media sites. Findings indicated that highest ranked was content pertaining to daily activities (76%), followed by research (72%), family life (66%) and promotion of scholarship opportunities (57%). Though few in number, some comments received from the study suggested that a subset of individuals perceive personality and goals as more important than sex concordance in mentorship. They testify of successful mentoring relationships with mentors of both sexes who were committed to their advancement and that same-sex mentorship is not critical, but may be particularly resourceful in advice and decisions that are unique to a certain sex. Furthermore, other comments were not uniformly supportive of social media as a form of mentorship. They cautioned against seeing mentorship via social media as a final destination but rather a launchpad for preliminary relationships to develop and support groups and platforms to be established. 4. Discussion Our study demonstrates differences in social media usage by physicians in medical as compared to surgical specialties and shows that social media serves as a valuable tool to enhance the networking and mentorship of surgeons. Women in surgical
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Fig. 3. Types of mentorship interactions for respondents in surgical specialties separated by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars), either sex combinations (yellow bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
specialties are more likely to perceive themselves to be in a specialty dominated by the opposite sex, to lack exposure to same-sex mentors at their own institution, and be mentored by individuals of the opposite sex though wish to be mentored by individuals of the same sex. Our results show that social media allowed women in surgical specialties to expand their professional networks, increase their knowledge, validate positive social identities, obtain social support and information from same-sex mentors, and to find community. We also offer criteria identified by surgical respondents to render mentorship via social media successful.
4.1. Types of social media Social media may be classified in a number of ways to reflect the
diverse range of existing platforms, such as collaborative projects (eg, Wikipedia), content communities (eg, YouTube), text blogging (eg, WordPress, Twitter), social networking sites (eg, Facebook, LinkedIn), and virtual game and social worlds (eg, World of Warcraft, Second Life).13 The different social media platforms each have their advantages and disadvantages, which has previously been delineated by Humphries et al.14
4.2. Role of social media in healthcare In the field of healthcare, patients have been actively utilizing social media to establish online patient communities. PatientsLikeMe is an example of an online quantitative research platform for patients with illnesses to share their experience using patient-
Fig. 4. Number of mentors and mentees for all respondents separated by surgical as compared to medical specialties, by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Fig. 5. Mentorship needs and behaviors of respondents in surgical specialties separated by sex, women (red bars) and men (blue bars). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
reported outcomes, find other people like them matched on demographic and clinical characteristics and learn from aggregated data reports of others to improve their outcomes.15 Participation in online communities has been shown to heighten patient emotional well-being, perceived control over disease, personal empowerment, level of medical knowledge and understanding through peerto-peer support and advocacy.16 Physicians have begun to rapidly participate in social media for professional purposes to allow for professional interactions and collaboration, build an online reputation/digital presence, engage in continued education, facilitate patient education, expand research efforts, disseminate campaigns to increase disease awareness and communicate new research findings and bestpractice guidelines.17 Given its broad reach and potential for privacy and professionalism breaches, organizational bodies such as the American Medical Association have worked to provide policies on the professional use of social media by physicians to maximize responsible use.18 Social media not only offers peer-to-peer support for patients, it also offers physicians an opportunity to provide patient-centered care and support through their lived experience of illness. On Twitter , there is a growing movement of patients and physicians coming together to create virtual communities built around a disease-specific hashtag, for example, #BCSM (breast cancer community) #LCSM (lung cancer) and #MPNSM (myeloproliferative neoplasms). Through weekly Tweet chats patients and their caregivers join physicians, nurses, researchers and allied health professionals to discuss symptoms, updates in treatment and other related issues.19 These have been utilized to not only empower patients to gain control over their illness, but to also to create a social climate that allows for mutual understanding and social grounding in a trusted environment. Furthermore, social media has allowed physicians to bring surgical scholarship to Twitter, for example, #TSSMN (thoracic surgery social media network) is a collaborative effort by leading journals in thoracic surgery field to bring social media attention to key publications in the specialty.20 Journal clubs are utilized to help physicians keep abreast with the developments in their field of practice and as a means to teach trainees to critically appraise the literature
and apply it to clinical practice.21e23 Bridging of journal clubs to the virtual world by tweet chats, the #IGSJC (international general surgery journal club) and #SOCJC (surgical outcomes club) allow participants in both the medical and non-medical world to learn through mutual engagement of developments shaping future surgical practice. Social media has also been used to share and document academic surgical meetings by “tweeting the meeting” to expand the available audience and broaden the discussion venue for scholarly activity.24 4.3. Role of social media in medical education The medical education realm has also seen the potential of social media to promote learning beyond the classroom with the emergence of ‘classrooms without walls’ to create virtual learning communities.25 A recent meta-analysis of 14 studies26 evaluating medical education interventions using social media tools found that they were associated with improved knowledge (eg, examination scores), attitude (eg, empathy), and skill (eg, reflective writing) by harnessing the principles of adult learning23 through increased learner engagement, feedback and collaboration. Telementoring technology is also an emerging method to help disseminate new techniques and improve surgical skill for surgeons in remote areas, and has shown success in many fields e particularly for advanced laparoscopic techniques. 4.4. Women in medicine and surgery: importance of mentorship Although females make up 49e51% of all students in medical school, females comprise only 32e34% of all general surgical residency graduates, citing their primary deterrent to choosing surgery as a career choice as being the absence of a mentor or role model.29,30 Mentorship has long been recognized as important for both male and female students to provide personal, professional and education support.31 It has been demonstrated that new physicians who were able to identify a positive role model in the surgical specialty, irrespective of sex matching, were twice as likely to be interested in a surgical career (p < 0.001).32 Although the majority of women in surgical specialties are mentored by men, female
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Fig. 6. Mentorship characteristics for respondents in surgical specialties separated by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars), either sex combinations (yellow bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
surgical mentors may be able to offer an understanding of unique matters to the female sex. However, given that the field is dominated by the opposite sex, women are significantly less likely to encounter surgical role models of the same sex compared with men.33,34 Reasons why men have less opposite sex mentoring relationships and women have more opposite sex mentoring relationships are likely based on the availability of women mentors in
senior positions and traditional relationships based on culture of the specialty. Thus, formal mentoring relationships35 or mentorship via social media may play a larger role, particularly for women in surgical specialties. It has been previously shown that mentee with informal mentors report that their mentors provided more career development, psychosocial functions and demonstrate greater overall satisfaction
Fig. 7. Respondents ranking of important criterion to render mentorship via social media successful and respondents' impressions regarding the content that they find important to be present on mentor/mentee social media sites, as separated by specialty. Respondents in surgical specialties (blue bars) and medical specialties (red bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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with their mentors than mentees with formal mentors.35 Reasons behind this striking difference has been suggested to be in the initiation, structure and processes of these relationships.36 Mentees perceive that formal relationships rely on the overuse of checklists to track their career development, are short term, and the relationship lacks individualized mentee advice, role modeling, counseling, and friendship functions that are vital to mentorship.36 Given that social media serves as an informal platform for communication and serendipitous relationships to occur based on mutual interests and goals, it allows for the same-sex informal relationships that are not possible in person for women in surgical specialties to occur in a virtual space. Interestingly, our study revealed significant differences in the types of interactions between mentees/mentors for women in surgical fields compared to men. Women in surgical fields mostly interacted with mentees/mentors of the opposite sex by formal meetings, social events, emails and telephone conversations. Whereas, there was no predilection for men in surgical fields to interact with mentees/mentors of either sex differently; these include the above methods as well as the viewing of social media sites, reposting, replying and messaging via social media. This finding may be attributed to the lack of women in the specialty or inherent differences in choice of communication that deserves further exploration. The value of informal socialization between resident and attending surgeons has been shown to increase the satisfaction of residents in the program and to feel that they could rely on their superiors to listen to their concerns.37 Others have examined the implications of collegial interactions among medical colleagues, citing collegial relationships with colleagues as significantly associated with physician motivation and job satisfaction (p < 0.001).38,39 These collegial relationships have been suggested to act as a medium through which peer recognition, communication and support can be fostered.39 Thus, beyond the potential of attracting women to a surgical specialty, social media interactions may have potential to better retain women in surgery.
career and to provide the opportunities and experiences to reach their full potential.40
4.5. Potential of social media to create a global community
Regardless of the vehicle or means of access, surgical mentorship is essential. Social media brings a new dimension to mentorship, reinventing the way we communicate with others, such that interactions may be asynchronous and with individuals who are geographically remote. Our study shows that social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution. Longitudinal studies surrounding the effectiveness of this emerging method of mentorship are warranted.
Social media has the ability to rapidly connect and unify individuals on shared issues globally where community is no longer a function of geography but rather, may offer possibilities that local communities may not. The #ILookLikeASurgeon campaign is one such example that formed a global community of surgeons and created a space for conversation, collaboration, support, encouragement and mentorship.12 Furthermore, Kramer et al. demonstrate that emotional contagion can occur online despite the absence of non-verbal cues typical of in-person interactions.27 This finding has broad implications in the potential for emotional contagion in social media networks to magnify the intensity of global emotional synchrony and its utility in providing social support to users on the interface.28 The voluntary nature of participation within social networks and virtual communities provide flexibility for online participants to actively engage or passively observe. Importantly, observers continue to belong to and reap the benefits of the community by accessing content that can be stored and reviewed at a later date if they are unable to participate at the time. Social media can offer more than real-life interactions can by creating a shared space of like-minded individuals to foster professional growth across geographical boundaries, interact synchronously (in real time) or asynchronously and combine the expertise and energy of all to achieve goals that would have previously been unattainable by individual participants. Beyond individual mentorship, social media also has the potential to establish a community of mentors for mentees with expertise to aid multiple areas or stages of their
4.6. Limitations This study was conducted online and distributed via email and social media. Therefore, respondents represent a subpopulation of individuals who already use web-based technologies and may be more inclined to use social media. Individuals who do not use webbased technologies were by default were excluded from the study. Furthermore, we were unable to calculate the response rate secondary to the method of survey distribution. This survey is limited in that it is a single snapshot in time. Although the vast majority of respondents to the survey were female, the power of the study depends on the total number of respondents to the survey and is thus, representative of the population. This study provides important information about the role of social media in the mentorship of surgeons, it brings up many issues worthy of further study. Further investigation is required to elucidate the effectiveness of mentorship by social media compared to other forms of mentorship. Furthermore, beyond sex differences, the role of social media in the mentorship of certain populations of individuals such as those of ethnic minority and rural communities deserve exploration. Despite the pattern of mentees to seek out mentors whom they identify with, it remains unknown whether there is a difference in outcomes for sex-matched mentorship as well as individual as compared to community mentorship. Longitudinal studies are required to assess for differences in career paths, professional advancement, satisfaction and productivity. We look forward to conducting subsequent investigations to evaluate these findings in a more robust cohort consisting of respondents sought from other avenues. 5. Conclusion
Funding source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements The authors wish to acknowledge the invaluable contribution of the study participants to the surgical community by their willingness to help distribute the survey via their social media platforms and to share their perceptions and experiences for analysis and publication. Appendix A. Supplementary data Supplementary data related to this article can be found at https://doi.org/10.1016/j.amjsurg.2018.02.011.
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References 1. Sambunjak D, Straus SE, Marusi c A. Mentoring in academic medicine: a systematic review. J Am Med Assoc. 2006;296(9):1103e1115. 2. Souba WW. Mentoring young academic surgeons, our most precious asset. J Surg Res. 1999;82(2):113e120. 3. Jagsi R, Griffith KA, DeCastro RA, Ubel P. Sex, role models, and specialty choices among graduates of US medical schools in 2006-2008. J Am Coll Surg. 2014;218(3):345e352. 4. Caniano DA, Sonnino RE, Paolo AM. Keys to career satisfaction: insights from a survey of women pediatric surgeons. J Pediatr Surg. 2004;39(6):984e990. 5. Zutshi M, Hammel J, Hull T. Colorectal surgeons: gender differences in perceptions of a career. J Gastrointest Surg. 2010;14(5):830e843. 6. Shortell CK, Cook C. Importance of gender-specific role models in vascular surgery. Vascular. 2008;16(3):123e129. 7. Wong EY, Bigby J, Kleinpeter M, et al. Promoting the advancement of minority women faculty in academic medicine: the National Centers of Excellence in Women's Health. J Womens Health Gend Based Med. 2001;10(6):541e550. 8. Statistics and facts about social media usage. Available from: https://www. statista.com/topics/1164/social-networks/. Accessed April 11, 2017. 9. Price DW, Felix KG. Journal clubs and case conferences: from academic tradition to communities of practice. J Continuing Educ Health Prof. 2008;28(3): 123e130. 10. Barnett S, Jones SC, Bennett S, et al. Usefulness of a virtual community of practice and Web 2.0 tools for general practice training: experiences and expectations of general practitioner registrars and supervisors. Aust J Prim Health. 2013;19(4):292. 11. Thomas AU, Fried GP, Johnson P, Stilwell BJ. Sharing best practices through online communities of practice: a case study. Hum Resour Health. 2010;8(1):25. 12. Hughes KA. #ILookLikeASurgeon goes viral: how it happened. Bull Am Coll Surg. 2015;100(11):10e16. 13. Moorhead SA, Hazlett DE, Harrison L, et al. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res. 2013;15(4):e85. 14. Humphries LS, Curl B, Song DH. #SocialMedia for the academic plastic surgeondelevating the brand. Plast Reconstr Surg - Glob Open. 2016;4(1):e599. 15. Wicks P, Massagli M, Frost J, et al. Sharing health data for better outcomes on PatientsLikeMe. J Med Internet Res. 2010;12(2):e19. 16. Naslund JA, Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016;25(2):113e122. 17. Antonoff MB. Using social media effectively in a surgical practice. J Thorac Cardiovasc Surg. 2016;151(2):322e326. 18. American Medical Association. AMA Policy: Professionalism in the Use of Social Media. 2012. 19. Wexner SD, Petrucci AM, Brady RR, et al. Social media in colorectal surgery. Color Dis. 2017;19(2):105e114. 20. Antonoff MB. Thoracic surgery social media network: bringing thoracic surgery
scholarship to twitter. J Thorac Cardiovasc Surg. 2015;150(2):292e293. 21. Quinn EM, Cantillon P, Redmond HP, Bennett D. Surgical journal club as a community of practice: a case study. J Surg Educ. 2014;71(4):606e612. 22. Antonoff MB, Nguyen TC, Luc JGY, et al. A structured debate-style cardiothoracic surgery journal club for trainee acquisition and application of seminal literature. AAMC MedEdPORTAL Publications. 2016;12:10521. 23. Luc JGY, Antonoff MB. Active learning in medical education: application to the training of surgeons. J Med Educ Curric Dev. 2016;2016(3):51e56. 24. Cochran A, Kao LS, Gusani NJ, Suliburk JW, Nwomeh BC. Use of twitter to document the 2013 academic surgical congress. J Surg Res. 2014;190(1):36e40. 25. Cheston CC, Flickinger TE, Chisolm MS. Social media use in medical education. Acad Med. 2013;88(6):893e901. 26. Pearson D, Bond MC, Kegg J, et al. Evaluation of social media use by emergency medicine residents and faculty. West J Emerg Med. 2015;16(5):715e720. 27. Kramer ADI, Guillory JE, Hancock JT. Experimental evidence of massive-scale emotional contagion through social networks. Proc Natl Acad Sci. 2014;111(24):8788e8790. 28. Hwang KO, Ottenbacher AJ, Green AP, et al. Social support in an Internet weight loss community. Int J Med Inform. 2010;79(1):5e13. 29. Weber T, Reidel M, Graf S, et al. Careers of women in academic surgery. Chirurg. 2005;76(7):703e711. discussion 711. 30. Kass RB, Souba WW, Thorndyke LE. Challenges confronting female surgical leaders: overcoming the barriers. J Surg Res. 2006;132(2):179e187. 31. Saunders CM, Nichevich A, Ellis C, Elllis C. Frontiers in academic surgery: the five M’S. ANZ J Surg. 2008;78(5):350e355. 32. Ravindra P, Fitzgerald JEF. Defining surgical role models and their influence on career choice. World J Surg. 2011;35(4):704e709. 33. Park J, Minor S, Taylor RA, Vikis E, Poenaru D. Why are women deterred from general surgery training? Am J Surg. 2005;190(1):141e146. 34. Richardson HC, Redfern N. Why do women reject surgical careers? Ann R Coll Surg Engl. 2000;82(9 Suppl):290e293. 35. Ragins BR, Cotton JL. Mentor functions and outcomes: a comparison of men and women in formal and informal mentoring relationships. J Appl Psychol. 1999;84(4):529e550. 36. Brown JB, Thorpe C, Paquette-Warren J, et al. The mentoring needs of trainees in family practice. Educ Prim Care. 2012;23(3):196e203. 37. Sullivan MC, Bucholz EM, Yeo H, et al. “Join the club”: effect of resident and attending social interactions on overall satisfaction among 4390 general surgery residents. Arch Surg. 2012;147(5):408e414. 38. Ham I Van, Verhoeven AAH, Groenier KH, et al. Job satisfaction among general practitioners: a systematic literature review. Eur J Gen Pract. 2006;12(4): 174e180. 39. Janus K, Amelung V, LC B, et al. Job satisfaction and motivation among physicians in academic medical centers: in-sights from a cross-national study. J Heal Polit Policy Law. 2008;33(6):1133e1167. 40. Warren OJ, Carnall R. Medical leadership: why it's important, what is required, and how we develop it. Postgrad Med J. 2011;87(1023):27e32.
Contents lists available at ScienceDirect
The American Journal of Surgery journal homepage: www.americanjournalofsurgery.com
Social media in the mentorship and networking of physicians: Important role for women in surgical specialties Jessica G.Y. Luc a, Nikki L. Stamp b, Mara B. Antonoff c, * a
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia c Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 12 April 2017 Received in revised form 1 December 2017 Accepted 14 February 2018
Background: Social media may be a useful supplement to physician and trainee interactions; however, its role in enhancing mentorship has not been described. Methods: A 35-item survey investigating trainee and physician social media use was distributed. Responses were analyzed using descriptive statistics. Results: 282 respondents completed the survey, among whom 136 (48.2%) reported careers in surgical specialties. Women in surgical specialties were more likely to describe the specialty as being dominated by the opposite sex (p < 0.001) and to be mentored by the opposite sex though wish to be mentored by individuals of the same sex (p < 0.001). Respondents in surgical specialties were also more likely to report using social media to build a network of same-sex mentorship (p ¼ 0.031). Conclusions: Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution. © 2018 Elsevier Inc. All rights reserved.
Taxonomy: Education in health technology, Mentorship in education, Social media, Social network Meeting Presentation: Association for Surgical Education Annual Meeting 37th Annual Meeting, April 18e22, 2017, San Diego, California, USA. Keywords: Social media Mentorship Medical education
1. Introduction It is well established that mentorship has an important influence on personal development, career selection, advancement, success and productivity.1 Dr. Chip Souba has defined mentoring as a “personal as well as a professional relationship … of liberating people to reach their full potential … [where] the mentor is invariably an important role model for the mentee. Mentors are people we look up to; they are those individuals we emulate and want to be like. They embody many of the qualities we most admire and would like to possess ourselves.”2 For more than a decade, women have constituted nearly half of the medical school student body, but remain significantly under-
* Corresponding author. University of Texas MD Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, 1400 Presslar Street, Unit 1489, Houston, TX 77030, USA. E-mail addresses: [email protected] (J.G.Y. Luc), [email protected] (N.L. Stamp), [email protected] (M.B. Antonoff). https://doi.org/10.1016/j.amjsurg.2018.02.011 0002-9610/© 2018 Elsevier Inc. All rights reserved.
represented in a number of key specialties, including most surgical specialties.3 Women in surgery often reported a lack of mentorship as significant obstacles to career progression and satisfaction in the specialty,4 and to value same-sex mentors as sharing a sense of history and understanding of both personal and professional career paths.5 As a majority of trainees choose the same career as their mentor, failing to have a mentor in surgery could diminish the likelihood of surgery being selected as a career.6 In order to deliver the best possible care, the global surgical workforce should mirror the diverse society it is entrusted to serve. Reasons cited include representation from different perspectives, social equity, improved access, and health outcomes of our diverse community.7 Globally, more than 2 billion people are engaged with social media accounts, a figure estimated to rise to nearly 3 billion people by 2020.8 Social media enables near instantaneous interactions within a global community, including physicians, patients, and trainees. This wide audience provides more opportunities for networking, learning, and disseminating knowledge. Applications
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of social media in healthcare settings include its use as an educational and peer support tool,9 and in the delivery of care and policy.10,11 The remarkable growth in users engaging with social media and the nature of borderless interactive communication and networking allows for potentially substantial advances to be made in the realm of mentorship. The #ILookLikeASurgeon movement, created and disseminated by female surgeons, is an example of a modern symbol of the ability of social media to unite surgeons across the globe, spanning continents and cultures in a call for diversity and equality in the surgical workforce.12 This spontaneous campaign has aimed to challenge stereotypes, celebrate differences, and achieve equality in the workplace. It has portrayed positive and visible female surgical role models to engage and inspire future generations of surgeons.12 Social media allows for the breaking down of barriers in the healthcare field related to communication, geography, culture, specialties, practice settings and is a potent tool for building and maintaining communities.12 Physicians and surgeons are increasingly employing social media as a form of communication to engage in discussion with others for exchange of information and fostering collaboration.12 Social media may be a useful supplement to physician and trainee interactions, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution; however, its role in enhancing mentorship has not been described. Accordingly, the first purpose of this study was to characterize the usage and role of social media in the mentorship and networking of surgeons. The second purpose of this study is to explore respondent perceptions regarding a need for same-sex mentors, current patterns of same-sex mentoring, and the role of social media in such mentorship relationships.
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3. Results 3.1. Participant demographics: medical vs surgical specialties Among the 282 respondents who completed the survey, 136 (48.2%) reported careers in surgical specialties. There were no significant differences in baseline demographics of the respondents between medical and surgical specialties in terms of sex, age, level of training, relationship status, parenting, and practice environment (Table 1). 3.2. Participant demographics: men vs women in surgical specialties There were no significant differences in baseline demographics of surgical respondents between men and women in terms of age, level of training, relationship status, parenting, and practice environment (Table 2). Women in surgical specialties were more likely to perceive themselves to be in a specialty dominated by the opposite sex compared to women in medical specialties (96% vs. 35%, p < 0.001). 3.3. Usage of social media platforms Facebook was the most frequently used form of social media among all-comers, followed by Twitter, Instagram, LinkedIn, Other, and Doximity (Fig. 1). Respondents in surgical specialties were significantly more likely to use Twitter multiple times per day (36% vs. 21%, p ¼ 0.002) than those in medical specialties (p ¼ 0.002). Compared to medical respondents, surgical respondents are significantly more likely to use social media to learn about their field of interest (61% vs. 38%, p < 0.001) and promote their professional interests (40% vs. 29%, p ¼ 0.048) (Fig. 2).
2. Methods 3.4. Modalities for mentorship communication A 35-item survey investigating trainee and physician social media use was designed using online survey software and distributed via social media and email announcements with an introductory letter explaining the purposes of the survey. Inclusion required respondents to be practicing physicians or trainees preparing for careers as physicians (including fellows, residents, medical students, and pre-med students). All responses were voluntary and anonymous. The questionnaire was designed to elicit data regarding the respondents' demographics, training/professional information, personal/family status (relationships, children), career choice decisions, perception of the specialty being dominated by the opposite sex, access to mentorship, usage of social media for personal and professional reasons, effectiveness of social media for mentorship, as well as factors perceived to be important in leading to a successful mentorship experience on social media (Supplemental Table 1). Questions addressed use of social media overall, as well as specific use of multiple popular social media sites, including Facebook, Twitter, LinkedIn, Doximity, Instagram, and others. This study was approved by the University of Texas MD Anderson Cancer Center Institutional Review Board (PA17-0021). Male versus female differences in questionnaire responses were assessed for respondents in medical compared to surgical specialties. Descriptive statistics were expressed as mean and standard deviation with comparisons between groups made with paired, 2tailed t tests for means of normally distributed continuous variables. Categorical data were expressed as counts and percentages and chi-square test was used to analyze differences between groups. Statistical analyses were performed using Stata (Stata Corp, College Station, Texas, USA) with significance at an alpha level of 0.05.
In the overall cohort, 24% percent of men respondents and 39% of women respondents stated they have no mentor (p ¼ 0.118). Not Table 1 Baseline demographics of all respondents.
Sex (Female) Age <25 years old 25e30 years old 31e35 years old 36e40 years old 41e46 years old 46e50 years old 51e55 years old >55 years old Level of Training Pre-medical Student Medical Student Resident Fellow Practicing Physician Relationship Status Single Relationship Married Divorced Children (Yes) Environment Urban Suburban Rural
Medicine (n ¼ 146)
Surgery (n ¼ 136)
P-Value
71%
76%
0.327 0.332
29% 18% 21% 17% 7% 7% 7% 7%
21% 22% 17% 15% 10% 7% 5% 2%
4% 34% 13% 6% 42%
6% 27% 17% 7% 43%
29% 20% 49% 1% 43%
35% 13% 51% 1% 46%
70% 23% 8%
76% 16% 8%
0.655
0.436
0.548 0.399
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Table 2 Demographics of respondents from surgical specialties.
Age <25 years old 25e30 years old 31e35 years old 36e40 years old 41e46 years old 46e50 years old 51e55 years old >55 years old Level of Training Pre-medical Student Medical Student Resident Fellow Physician Relationship Status Single Relationship Married Divorced Children (Yes) Environment Urban Suburban Rural ¶
Men (n ¼ 34)
Women (n ¼ 102)
29% 26% 15% 6% 15% 0% 6% 3%
20% 23% 18% 17% 8% 10% 4% 1%
6% 35% 18% 12% 29%
6% 28% 17% 6% 43%
10% 2% 12% 0% 50%
36% 16% 48% 1% 41%
88% 9% 3%
73% 18% 9%
P-Value
0.255
p ¼ 0.005), social events (15% vs. 0%, p ¼ 0.044), emails (20% vs. 0%, p ¼ 0.019), and telephone conversations (24% vs. 3%, p ¼ 0.031) compared to men in surgical fields. In contrast, compared to women in surgical fields, there was no predilection for men in surgical fields to interact with mentees/mentors of either sex differently; they were equally likely to interact by formal meetings, social events, emails, telephone conversations, and social media interactions (including viewing, posting, replying, and messaging).
3.5. Sex concordance in mentorship 0.588
0.542
0.369 0.215
Indicates significance p < 0.05.
surprisingly, the primary methods of communication between mentors/mentees remains face-to-face (89%); however, this was closely trailed by email (81%), followed by telephone (45%), social media (23%) and Internet videoconferencing technology (5%) (Table 3). Compared to medical specialties, individuals in surgical specialties were less likely to connect with mentors by email (75% vs. 87%, p ¼ 0.019) and more likely to connect with mentors via Twitter (16% vs. 7%, p ¼ 0.017). Interestingly, there were significant differences in the types of interactions women in surgical fields have with their surgical mentees/mentors compared to men in surgical fields (Fig. 3). Women in surgical fields are more likely to interact with mentees/ mentors of the opposite sex only in formal meetings (26% vs. 0%,
No significant differences were observed in number of mentors (2.1 ± 1.7 vs. 1.9 ± 1.6, p ¼ 0.789) and mentees (2.1 ± 3.3 vs. 2.0 ± 3.0, p ¼ 0.656) for respondents from surgical and medical specialties, respectively. While mentors for men in both surgical and medical specialties were more likely to be sex-matched (p < 0.001) compared to women in both specialties, women in surgical specialties were more likely to be mentored by the opposite sex (p < 0.001) compared to men in surgical specialties. Both women and men in surgical specialties appear to mentor other men and women equally whereas, in contrast, mentees for women in medical specialties were more likely to be sex-matched compared to men in medical specialties (p ¼ 0.009) (Fig. 4).
3.6. Importance of mentorship Compared to men in surgical specialties, more women in surgical specialties felt that mentorship plays an important role in their career path (37% vs. 20%, p ¼ 0.007), were less likely to have access to an institutional mentoring program (32% vs. 56%, p ¼ 0.014), and less likely to have exposure to same-sex mentors at their own institution (43% vs. 91%, p < 0.001). Compared to men in surgical specialties, women in surgical specialties were also more likely to be mentored by individuals of the opposite sex though wished to be mentored by individuals of the same sex (35% vs. 0%, p < 0.001). It is worthy to note that there are a proportion of women in surgical specialties who are mentored by the opposite sex and satisfied with the arrangement. Further, there remains a sizeable proportion of individuals, both men (31%) and women (40%), who are in need of mentorship regardless of sex (Fig. 5).
Fig. 1. Pattern of social media usage by all respondents separated by surgical as compared to medical specialties.
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Fig. 2. Reasons for usage of social media by all respondents separated by surgical as compared to medical specialties and by sex, women (red bars) and men (blue bars). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
3.9. Criteria used by respondents to select mentors/mentees on social media
3.7. Mentorship topics In terms of mentorship topics, compared to men surgical specialties, women in surgical specialties were significantly more likely to seek advice from exclusively same sex mentors on topics regarding how to achieve a balance between personal, career and family time (41% vs. 10%, p ¼ 0.010). Furthermore, women in surgical specialties were more likely to seek advice from exclusively opposite sex mentors on topics regarding leadership strategies in the workplace (16% vs. 0%, p ¼ 0.002), professionalism (18% vs. 0%, p ¼ 0.042), and career planning (20% vs. 3%, p ¼ 0.043) compared to men in surgical specialties,. No significant differences in advice seeking preferences were observed among male and female surgical respondents for topics relating to research and academic projects, surviving a career in the field, guidance in preparing for exams and dealing with politics and conflicts in the workplace (Fig. 6). 3.8. Role of social media in mentorship Compared to medical specialties, respondents in surgical specialties were more likely to report that social media allowed them to build a larger network of same-sex mentorship (21% vs. 13%, p ¼ 0.031). Furthermore, this finding permeated to sex-specific effects of social media by allowing women in surgical specialties to build a larger network of same-sex mentor/mentees who may be remote from where they live/work than they felt could have previously achieved compared to men in surgical specialties (34% vs. 13%, p ¼ 0.001). Table 3 Methods of communication between mentors/mentees.
Face to Face Email Telephone Internet Video Social Media: Facebook Social Media: Twitter Social Media: Instagram Social Media: LinkedIn Social Media: Doximity Social Media: Other ¶
Medicine (n ¼ 146)
Surgery (n ¼ 136)
P-Value
90% 87% 43% 6% 27% 7% 2% 0% 0% 2%
87% 75% 46% 4% 18% 16% 2% 2% 0% 3%
0.452 0.019¶ 0.727 0.615 0.100 0.017¶ 0.693 0.145 e 0.374
Indicates significance p < 0.05.
Given the beneficial effect of social media on the mentorship environment, especially for women in surgical specialties, we were interested in identifying criteria individuals use to choose a mentor/mentee on social media. No significant differences were observed between women and men in medical or surgical specialties; however, results revealed a common trend among all respondents (Fig. 7). Respondents uniformly ranked approachability (84%) as the most important criterion in rendering mentorship via social media successful, followed by shared specific field of interest (72%), and the availability to further connect by email or phone (71%). Also noted as important to respondents were quick response time (67%), easy access/easy to find (64%), acknowledgement of confidentiality of social media exchange (60%), opportunities to connect with leaders in the field (54%), being of the same sex (45%), and option of dysynchronous communication (40%); whereas the least valued characteristic was frequent posting (22%). We then assessed respondents' impressions regarding the content that they find important to be present on mentor/mentee social media sites. Findings indicated that highest ranked was content pertaining to daily activities (76%), followed by research (72%), family life (66%) and promotion of scholarship opportunities (57%). Though few in number, some comments received from the study suggested that a subset of individuals perceive personality and goals as more important than sex concordance in mentorship. They testify of successful mentoring relationships with mentors of both sexes who were committed to their advancement and that same-sex mentorship is not critical, but may be particularly resourceful in advice and decisions that are unique to a certain sex. Furthermore, other comments were not uniformly supportive of social media as a form of mentorship. They cautioned against seeing mentorship via social media as a final destination but rather a launchpad for preliminary relationships to develop and support groups and platforms to be established. 4. Discussion Our study demonstrates differences in social media usage by physicians in medical as compared to surgical specialties and shows that social media serves as a valuable tool to enhance the networking and mentorship of surgeons. Women in surgical
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Fig. 3. Types of mentorship interactions for respondents in surgical specialties separated by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars), either sex combinations (yellow bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
specialties are more likely to perceive themselves to be in a specialty dominated by the opposite sex, to lack exposure to same-sex mentors at their own institution, and be mentored by individuals of the opposite sex though wish to be mentored by individuals of the same sex. Our results show that social media allowed women in surgical specialties to expand their professional networks, increase their knowledge, validate positive social identities, obtain social support and information from same-sex mentors, and to find community. We also offer criteria identified by surgical respondents to render mentorship via social media successful.
4.1. Types of social media Social media may be classified in a number of ways to reflect the
diverse range of existing platforms, such as collaborative projects (eg, Wikipedia), content communities (eg, YouTube), text blogging (eg, WordPress, Twitter), social networking sites (eg, Facebook, LinkedIn), and virtual game and social worlds (eg, World of Warcraft, Second Life).13 The different social media platforms each have their advantages and disadvantages, which has previously been delineated by Humphries et al.14
4.2. Role of social media in healthcare In the field of healthcare, patients have been actively utilizing social media to establish online patient communities. PatientsLikeMe is an example of an online quantitative research platform for patients with illnesses to share their experience using patient-
Fig. 4. Number of mentors and mentees for all respondents separated by surgical as compared to medical specialties, by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Fig. 5. Mentorship needs and behaviors of respondents in surgical specialties separated by sex, women (red bars) and men (blue bars). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
reported outcomes, find other people like them matched on demographic and clinical characteristics and learn from aggregated data reports of others to improve their outcomes.15 Participation in online communities has been shown to heighten patient emotional well-being, perceived control over disease, personal empowerment, level of medical knowledge and understanding through peerto-peer support and advocacy.16 Physicians have begun to rapidly participate in social media for professional purposes to allow for professional interactions and collaboration, build an online reputation/digital presence, engage in continued education, facilitate patient education, expand research efforts, disseminate campaigns to increase disease awareness and communicate new research findings and bestpractice guidelines.17 Given its broad reach and potential for privacy and professionalism breaches, organizational bodies such as the American Medical Association have worked to provide policies on the professional use of social media by physicians to maximize responsible use.18 Social media not only offers peer-to-peer support for patients, it also offers physicians an opportunity to provide patient-centered care and support through their lived experience of illness. On Twitter , there is a growing movement of patients and physicians coming together to create virtual communities built around a disease-specific hashtag, for example, #BCSM (breast cancer community) #LCSM (lung cancer) and #MPNSM (myeloproliferative neoplasms). Through weekly Tweet chats patients and their caregivers join physicians, nurses, researchers and allied health professionals to discuss symptoms, updates in treatment and other related issues.19 These have been utilized to not only empower patients to gain control over their illness, but to also to create a social climate that allows for mutual understanding and social grounding in a trusted environment. Furthermore, social media has allowed physicians to bring surgical scholarship to Twitter, for example, #TSSMN (thoracic surgery social media network) is a collaborative effort by leading journals in thoracic surgery field to bring social media attention to key publications in the specialty.20 Journal clubs are utilized to help physicians keep abreast with the developments in their field of practice and as a means to teach trainees to critically appraise the literature
and apply it to clinical practice.21e23 Bridging of journal clubs to the virtual world by tweet chats, the #IGSJC (international general surgery journal club) and #SOCJC (surgical outcomes club) allow participants in both the medical and non-medical world to learn through mutual engagement of developments shaping future surgical practice. Social media has also been used to share and document academic surgical meetings by “tweeting the meeting” to expand the available audience and broaden the discussion venue for scholarly activity.24 4.3. Role of social media in medical education The medical education realm has also seen the potential of social media to promote learning beyond the classroom with the emergence of ‘classrooms without walls’ to create virtual learning communities.25 A recent meta-analysis of 14 studies26 evaluating medical education interventions using social media tools found that they were associated with improved knowledge (eg, examination scores), attitude (eg, empathy), and skill (eg, reflective writing) by harnessing the principles of adult learning23 through increased learner engagement, feedback and collaboration. Telementoring technology is also an emerging method to help disseminate new techniques and improve surgical skill for surgeons in remote areas, and has shown success in many fields e particularly for advanced laparoscopic techniques. 4.4. Women in medicine and surgery: importance of mentorship Although females make up 49e51% of all students in medical school, females comprise only 32e34% of all general surgical residency graduates, citing their primary deterrent to choosing surgery as a career choice as being the absence of a mentor or role model.29,30 Mentorship has long been recognized as important for both male and female students to provide personal, professional and education support.31 It has been demonstrated that new physicians who were able to identify a positive role model in the surgical specialty, irrespective of sex matching, were twice as likely to be interested in a surgical career (p < 0.001).32 Although the majority of women in surgical specialties are mentored by men, female
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Fig. 6. Mentorship characteristics for respondents in surgical specialties separated by sex and by mentor-mentee sex concordance. Same sex mentor-mentees (red bars), either sex combinations (yellow bars) and opposite sex mentor-mentees (blue bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
surgical mentors may be able to offer an understanding of unique matters to the female sex. However, given that the field is dominated by the opposite sex, women are significantly less likely to encounter surgical role models of the same sex compared with men.33,34 Reasons why men have less opposite sex mentoring relationships and women have more opposite sex mentoring relationships are likely based on the availability of women mentors in
senior positions and traditional relationships based on culture of the specialty. Thus, formal mentoring relationships35 or mentorship via social media may play a larger role, particularly for women in surgical specialties. It has been previously shown that mentee with informal mentors report that their mentors provided more career development, psychosocial functions and demonstrate greater overall satisfaction
Fig. 7. Respondents ranking of important criterion to render mentorship via social media successful and respondents' impressions regarding the content that they find important to be present on mentor/mentee social media sites, as separated by specialty. Respondents in surgical specialties (blue bars) and medical specialties (red bars) are shown. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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with their mentors than mentees with formal mentors.35 Reasons behind this striking difference has been suggested to be in the initiation, structure and processes of these relationships.36 Mentees perceive that formal relationships rely on the overuse of checklists to track their career development, are short term, and the relationship lacks individualized mentee advice, role modeling, counseling, and friendship functions that are vital to mentorship.36 Given that social media serves as an informal platform for communication and serendipitous relationships to occur based on mutual interests and goals, it allows for the same-sex informal relationships that are not possible in person for women in surgical specialties to occur in a virtual space. Interestingly, our study revealed significant differences in the types of interactions between mentees/mentors for women in surgical fields compared to men. Women in surgical fields mostly interacted with mentees/mentors of the opposite sex by formal meetings, social events, emails and telephone conversations. Whereas, there was no predilection for men in surgical fields to interact with mentees/mentors of either sex differently; these include the above methods as well as the viewing of social media sites, reposting, replying and messaging via social media. This finding may be attributed to the lack of women in the specialty or inherent differences in choice of communication that deserves further exploration. The value of informal socialization between resident and attending surgeons has been shown to increase the satisfaction of residents in the program and to feel that they could rely on their superiors to listen to their concerns.37 Others have examined the implications of collegial interactions among medical colleagues, citing collegial relationships with colleagues as significantly associated with physician motivation and job satisfaction (p < 0.001).38,39 These collegial relationships have been suggested to act as a medium through which peer recognition, communication and support can be fostered.39 Thus, beyond the potential of attracting women to a surgical specialty, social media interactions may have potential to better retain women in surgery.
career and to provide the opportunities and experiences to reach their full potential.40
4.5. Potential of social media to create a global community
Regardless of the vehicle or means of access, surgical mentorship is essential. Social media brings a new dimension to mentorship, reinventing the way we communicate with others, such that interactions may be asynchronous and with individuals who are geographically remote. Our study shows that social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution. Longitudinal studies surrounding the effectiveness of this emerging method of mentorship are warranted.
Social media has the ability to rapidly connect and unify individuals on shared issues globally where community is no longer a function of geography but rather, may offer possibilities that local communities may not. The #ILookLikeASurgeon campaign is one such example that formed a global community of surgeons and created a space for conversation, collaboration, support, encouragement and mentorship.12 Furthermore, Kramer et al. demonstrate that emotional contagion can occur online despite the absence of non-verbal cues typical of in-person interactions.27 This finding has broad implications in the potential for emotional contagion in social media networks to magnify the intensity of global emotional synchrony and its utility in providing social support to users on the interface.28 The voluntary nature of participation within social networks and virtual communities provide flexibility for online participants to actively engage or passively observe. Importantly, observers continue to belong to and reap the benefits of the community by accessing content that can be stored and reviewed at a later date if they are unable to participate at the time. Social media can offer more than real-life interactions can by creating a shared space of like-minded individuals to foster professional growth across geographical boundaries, interact synchronously (in real time) or asynchronously and combine the expertise and energy of all to achieve goals that would have previously been unattainable by individual participants. Beyond individual mentorship, social media also has the potential to establish a community of mentors for mentees with expertise to aid multiple areas or stages of their
4.6. Limitations This study was conducted online and distributed via email and social media. Therefore, respondents represent a subpopulation of individuals who already use web-based technologies and may be more inclined to use social media. Individuals who do not use webbased technologies were by default were excluded from the study. Furthermore, we were unable to calculate the response rate secondary to the method of survey distribution. This survey is limited in that it is a single snapshot in time. Although the vast majority of respondents to the survey were female, the power of the study depends on the total number of respondents to the survey and is thus, representative of the population. This study provides important information about the role of social media in the mentorship of surgeons, it brings up many issues worthy of further study. Further investigation is required to elucidate the effectiveness of mentorship by social media compared to other forms of mentorship. Furthermore, beyond sex differences, the role of social media in the mentorship of certain populations of individuals such as those of ethnic minority and rural communities deserve exploration. Despite the pattern of mentees to seek out mentors whom they identify with, it remains unknown whether there is a difference in outcomes for sex-matched mentorship as well as individual as compared to community mentorship. Longitudinal studies are required to assess for differences in career paths, professional advancement, satisfaction and productivity. We look forward to conducting subsequent investigations to evaluate these findings in a more robust cohort consisting of respondents sought from other avenues. 5. Conclusion
Funding source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements The authors wish to acknowledge the invaluable contribution of the study participants to the surgical community by their willingness to help distribute the survey via their social media platforms and to share their perceptions and experiences for analysis and publication. Appendix A. Supplementary data Supplementary data related to this article can be found at https://doi.org/10.1016/j.amjsurg.2018.02.011.
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