- Email: [email protected]
Social Media Use for Professional Purposes in the Neurosurgical Community: A Multi-Institutional Study
Original Article
Social Media Use for Professional Purposes in the Neurosurgical Community: A Multi-Institutional Study H. Westley Phillips1, Jia-Shu Chen1, Bayard Wilson1, Methma Udawatta1,7, Giyarpuram Prashant1, Daniel Nagasawa1, Isaac Yang1-7
BACKGROUND: Since the debut of Facebook in 2004, social media (SoMe) has garnered increased popularity and usage worldwide. Given its appeal and visibility, many industries have used SoMe to promote products for professional purposes. Specialized sites have subsequently been created to connect users in similar disciplines. Although SoMe sites have amassed over 1-billion followers, SoMe usage in the neurosurgical community has not yet been well described.
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METHODS: We present an online survey administered to neurosurgery faculty, fellows, and residents in 102 U.S. accredited programs to gauge usage and perception of SoMe for professional purposes.
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RESULTS: Of all surveys distributed, 241 neurosurgeons responded with an attending, resident, to fellow breakdown of 137, 96, and 8, respectively. A total of 55.97% of respondents were under the age of 34, 2% were over the age of 75, and 81% of respondents identified as men. An overwhelming majority cited conferences (83%) and in-person meetings as their preferred method of networking. However, 70% state they use SoMe for professional purposes with Doximity and LinkdIn listed as the most popular (49% and 48%, respectively) platforms. Lack of time and perceived value, in addition to privacy concerns, were noted to be the main factors for those refraining from SoMe use.
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CONCLUSIONS: As SoMe becomes increasingly popular and its use expands, the majority of neurosurgeon respondents are also using SoMe for professional purposes. Although lack of time, lack of perceived value, and privacy
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Key words Neurosurgery - Outreach - Social media -
Abbreviations and Acronyms SoMe: Social media ARPANET: Advanced Research Projects Agency Network
concerns were hindrances to usage, other factors like age do not seem to correlate with SoMe adoption for professional aims.
INTRODUCTION
S
ocial Media (SoMe) is a group of computer-based platforms designed to facilitate the exchange of information and ideas across virtual networks. SoMe has a long history dating back to the 1970s with ARPANET, or the Advanced Research Projects Agency Network, a Department of Defense project as a means to electronically connect researchers for the exchange of ideas across campuses. As the popularity and accessibility of the internet began to rise in the 1990s, SoMe platforms followed suit by expanding its content and subsequently its range of audiences. Since the debut of Facebook in 2004, and later the ubiquity of SoMe compatible smart phones, SoMe has garnered increased popularity and usage worldwide with an estimated 70% or higher percentage of teenagers being active Facebook users.1 Given its universal appeal and visibility, many industries have used SoMe as a means to promote and advertise their products for professional purposes. Specialized sites, such as Doximity, an SoMe community targeting health care professionals, have subsequently been created to connect users in similar disciplines. Given the rising use of SoMe in the daily lives of many, it is no surprise that it has now been used for the dissemination of health information, both to patients and between providers. For example, Facebook ads have been used to recruit hard to reach participants for behavioral health interventions and to increase the use of longacting reversible contraception.2,3 SoMe use can range from
6
Harbor-UCLA Medical Center, 7David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA To whom correspondence should be addressed: Isaac Yang, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2019) 129:e367-e374. https://doi.org/10.1016/j.wneu.2019.05.154 Journal homepage: www.journals.elsevier.com/world-neurosurgery Available online: www.sciencedirect.com
From the Departments of 1Neurosurgery, 2Radiation Oncology, and 3Head and Neck Surgery, 4 Jonsson Comprehensive Cancer Center, 5Los Angeles Biomedical Research Institute,
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targeting large groups of individuals (to share information about HIV prevention and treatment, for example) to smaller, more specialized groups (such as those sharing information about the role of selective dorsal rhizotomy in the treatment of spasticity in cerebral palsy).4,5 SoMe is not only used to share information between patients or family members within support groups but also for hospitals and providers to share information with their patients, and for providers to share information among themselves. As such, we devised a survey to begin to further examine how SoMe was used by neurosurgeons. Although subspecialties such as oncology, plastic and reconstructive surgery, and general surgery have explored SoMe usage in their field, there is a dearth of information regarding the use of SoMe among neurosurgeons.6 Given the lack of literature delineating the usage patterns and preferences of individuals in the neurosurgical community, we present a national survey of residents, fellows, and attendings to gauge their attitudes toward SoMe usage as a mean for professional tools. METHODS Here, we present an online survey administered to neurosurgery faculty, fellows, and residents in 102 U.S. accredited programs accounting for approximately 2,400 neurosurgeons to gauge usage and perception of SoMe for professional purposes. An electronic survey using SurveyMonkey was designed to establish participation, interest, and sentiment regarding SoMe as a professional tool in the neurosurgery community. A copy of the survey is included as Appendix 1. Basic demographic information was collected (age, sex, level of neurosurgical training) and other questions asked participants’ preferred methods of collaboration, use of professional SoMe accounts, collaboration via SoMe, interactions with patients via SoMe, and opinions on the perceived usefulness of SoMe platforms for professional development. The institutional board review of the University of California, Los Angeles approved the study. The surveys were sent to program coordinators at each respective program to distribute freely to their cohort once per month from October to December 2017. Responses were collected 4 months after the initial distribution of surveys. Participation was voluntary, anonymous, and no compensation was provided. Participant characteristics were then compiled using the resultant responses to elucidate the demographics of the participating respondent group. Following the data collection period, the responses from the distributed SurveyMonkey survey were imported into RStudio Version 1.1.453 (RStudio Inc., Boston, Massachusetts, USA) for management, characterization, and statistical analysis of the data. Because of the small sample size of respondents who classified themselves as fellows (n ¼ 8), the fellows and residents were further categorized together as “neurosurgical trainees” for the purpose of unbiased statistical analysis. The c2 test was used to assess the difference in SoMe opinions and habits between different demographics of neurosurgeons. Bidirectional stepwise regression was performed to predict for SoMe opinions, SoMe habits, and neurosurgical position. The bidirectional stepwise regression was performed with the intention of identifying significant predictors for the aforementioned SoMe opinions and
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habits, as well as a respondent’s neurosurgical level. The models with the lowest Akaike Information Criterion score for each dependent variable were selected to assess the most significant predictors of different SoMe opinions, SoMe habits, and neurosurgical training levels. RESULTS Of all surveys distributed, a total of 241 neurosurgeons responded with an attending, resident, to fellow breakdown of 96, 137, and 8, respectively (Table 1 and Figure 1). Of those who responded, 56.4% were under the age of 34, 2.1% were over the age of 75, and 81% of respondents identified as men. In this cohort, an overwhelming majority cited conferences and in-person meetings (82.2%) as one of their preferred methods of networking. However, 70.5% state that they use SoMe for professional purposes, with Doximity and LinkedIn listed as the most popular (49% and 48%, respectively) SoMe platforms (Table 1). Overall, there was not a significant difference in opinions and habits of SoMe between neurosurgical trainees and faculty. However, there was a significant amount of neurosurgical attendings who find SoMe irrelevant to neurosurgery (P ¼ 0.0415). Additionally, neurosurgical trainees are significantly more likely to use LinkedIn professionally (P ¼ 0.0286), whether it be to collaborate with fellow neurosurgeons or interact with patients (Figure 2). Interestingly, there was not a significant difference between neurosurgical trainees and neurosurgical attendings who use the major traditional SoMe platforms, such as Facebook, Twitter, and Instagram, for professional purposes (P ¼ 0.4128, 0.3936, and 0.4032, respectively) (Figure 3). Facebook and Instagram were reported to be more commonly used among neurosurgical trainees (20.7% and 9.0% vs. 15.6% and 5.2%, respectively), whereas neurosurgical attendings reported a higher usage of Twitter or no SoMe platform at all, relative to the trainees (19.8% and 33.3% vs. 13.1% and 26.9%, respectively) (Table 2). Furthermore, although there is not a significant difference between trainees and attendings who believe that SoMe lacks value in the neurosurgical setting and that SoMe potentially compromises patient privacy (Figure 4), it is surprising to note that a greater proportion of neurosurgical trainees believe that SoMe has no intrinsic value in neurosurgery (24.14% vs. 18.75%) and that SoMe puts patient confidentiality at risk (22.07% vs. 16.67%) (Table 3). When predicting for neurosurgical level, the stepwise regression analysis highlighted several predictors for neurosurgical trainee and neurosurgical attending. Positive associations with neurosurgical trainees were found for the use of Twitter specifically for collaboration with fellow neurosurgeons (P ¼ 0.0128), the use of LinkedIn for general career assistance (P ¼ 0.0146), the belief that SoMe currently possesses no value in a neurosurgical practice (P ¼ 0.0179), previous history being referred literature through SoMe (P ¼ 0.0095), and a positive outlook on the potential of SoMe in neurosurgery (P ¼ 0.0232) (Table 4). Significant positive associations with neurosurgical attendings were found for the use of Twitter and Doximity for general career assistance (P ¼ 0.0003 and P ¼ 1.4e-04, respectively). Additionally, the stepwise regression analysis highlighted several pertinent
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Table 1. Demographics and General Social Media Practices Among All Respondents Total Respondents (n) [ 241 Demographics
Respondents
Neurosurgical position Attending Fellow Resident
96 (39.8%) 8 (3.3%) 137 (56.8%)
Sex Female
46 (19.1%)
Male
195 (80.9%)
Age range (years) 25e34
136 (56.4%)
35e44
46 (19.1%)
45e54
29 (12.0%)
55e64
17 (7.1%)
65e74
8 (3.3%)
75þ
5 (2.1%)
Preferred collaboration modalities* Conferences/courses
198 (82.2%)
E-mail
135 (56.0%)
Telephone
53 (22.0%)
LinkedIn
17 (17.1%)
Doximity
8 (3.3%)
Facebook
16 (6.6%)
Twitter
12 (5.0%)
Other
7 (2.9%)
Figure 1. Respondents categorized into neurosurgical attending or trainee.
privacy and confidentiality at risk (P < 0.001). Stepwise regression analysis also highlights that believing SoMe lacks value in medicine is a significant positive predictor and a perceived lack of time for SoMe in profession is a significant negative predictor for respondents who prefer traditional means of communication (P ¼ 0.0496 and P ¼ 0.0019) (Table 5). DISCUSSION Many cite barriers to SoMe use among physicians as lack of privacy, efficacy, or efficiency. Although many opponents of SoMe use in a medical practice point to SoMe’s negative impacts as
SoMe platforms for professional use* Facebook
45 (18.7%)
Twitter
38 (15.8%)
Instagram
18 (7.5%)
LinkedIn
115 (47.7%)
Doximity
113 (46.9%)
No accounts
71 (29.5%)
SoMe, social media. *Respondents could select multiple options.
predictors of SoMe opinions and habits. Being a neurosurgical trainee was a significant predictor of believing that SoMe currently lacks value in neurosurgery (P ¼ 0.0287). Furthermore, the main reasons why respondents avoid using SoMe in their medical practice was because of the perceived lack of time (P < 0.001), preference for more traditional means of communication (P ¼ 0.039), and beliefs that SoMe puts patient
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Figure 2. Comparison of opinions on SoMe contribution to neurosurgery between the different neurosurgical levels (attending and trainee). P values were computed through c2 testing. SoMe, social media.
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Table 2. Demographics and General Social Media Practices Among Neurosurgical Attendings and Trainees Total Respondents (n) [ 241 Demographics and Practices
Neurosurgical Attendings
Neurosurgical Trainees
96
145
Total Sex Female
13 (13.5%)
33 (22.8%)
Male
83 (86.5%)
112 (77.2%)
25e34
8 (8.3%)
128 (88.3%)
35e44
29 (30.2%)
17 (11.7%)
45e54
29 (30.2%)
0
55e64
17 (17.7%)
0
65e74
8 (8.3%)
0
75þ
5 (5.2%)
0
Conferences/courses
76 (79.2%)
122 (84.1%)
E-mail
57 (59.4%)
78 (53.8%)
Telephone
23 (24.0%)
30 (20.7%)
LinkedIn
6 (6.3%)
11 (7.6%)
Doximity
4 (4.2%)
4 (2.8%)
Facebook
4 (4.2%)
12 (8.3%)
Twitter
2 (2.1%)
10 (6.9%)
Other
4 (4.2%)
2 (1.4%)
Facebook
15 (15.6%)
30 (20.7%)
Twitter
19 (19.8%)
19 (13.1%)
Age range (years)
Figure 3. Comparison of SoMe usage between neurosurgical attendings and trainees. P values were computed through c2 testing.
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described by Lau et al. such as marketing of injurious products and behavior, there are also supporters of SoMe who highlight the positive impact on health care delivery, which includes rapid and widespread transfer of information afforded by SoMe. One such example is the swift mobilization of physicians for the Doctors for Obama campaign, a grass roots organization amassing a member population of 10,000þ members during Obama’s 2008 campaign.7 Although Facebook and other sites have amassed over 1-billion users and capitalize on their influence as professional tools, SoMe usage in the neurosurgical community has not yet been well described. Alotaibi et al. describes the relative popularity of SoMe among neurosurgical departments, journals, and non-profit organizations on the 3 popular SoMe platforms, Facebook, Twitter, and YouTube, respectively, which demonstrated similar usage rates and popularity to other medical subspecialties with a predominance in the private sector.8-10 Furthermore, his group would later describe the relationship between SoMe metrics and academic indices of neurosurgery programs and journals, which associated the presence of SoMe account with a statistically significantly higher value of academic impact metrics for both academic programs and journals with SoMe accounts.8-10 Wagner et al.6 described SoMe usage in the general surgery community, with the majority stating they used some form of SoMe for professional purposes. Although a perceived lack of time, preference for more traditional communication methods in professional settings, and concern for patient privacy are all significant predictors for not using SoMe in a neurosurgical practice, it is interesting to note that a perceived lack of value is not a significant predictor. Recent studies have highlighted the important roles SoMe plays in the surgical community, indicating that the intangible, positive impacts of SoMe may be changing traditional perceptions of SoMe.11 In a recent study conducted by Luc et al,12 the authors concluded that SoMe is a valuable tool that improves the networking and
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Preferred collaboration modalities*
SoMe platforms for professional use*
Instagram
5 (5.2%)
13 (9.0%)
LinkedIn
37 (38.5%)
78 (53.8%)
Doximity
51 (53.1%)
62 (42.8%)
No accounts
32 (33.3%)
39 (26.9%)
SoMe, social media. *Respondents could select multiple options.
mentorship of surgeons, especially for women in a surgical specialty in which direct exposure to same-sex mentors is difficult to access. Leow et al.13 highlighted SoMe’s ability to improve surgical practices on a global scale by allowing rural clinics to consult specialists in urban and metropolitan areas, as well as provide “telementoring,” or remote guidance and teaching, of surgical procedures to low- and middle-income countries. Additionally, Camp et al.14 and Curry et al.15 discussed the benefits SoMe has for patient recruitment and physician marketing in reconstructive and orthopedic surgery, and to some degree,
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Table 4. Stepwise Regression Analysis for Significant Predictors of Neurosurgical Position Predictor
Coefficient
Odds Ratio
P Value
Sex (male)
0.136
1.145
0.0739
Uses Twitter for professional purposes
0.369
1.447
0.0003*
Uses Doximity for professional purposes
0.294
1.341
1.4e-04*
Does not use SoMe for professional purposes
0.173
1.189
0.0824
Used SoMe to collaborate with neurosurgeons before
0.182
1.199
0.0638
0.373
0.688
0.0128*
Uses Twitter to collaborate with other neurosurgeons
Figure 4. Comparison of SoMe perceptions between neurosurgical attendings and trainees. P values were determined through c2 testing. SoMe, social media.
patient information and education. Despite these notable and effective implementations of SoMe in various surgical specialties resulting in improved perceptions of SoMe value in medicine, it is clear that barriers still exist between surgeons and adoption of SoMe within their medical practice.14,15 According to the regression results, several of these barriers include unfamiliarity with SoMe, which predisposes neurosurgeons to stick with conventional communication methodologies, time restraints, and a
Table 3. Perceptions of Social Media Among Neurosurgical Attendings and Trainees Total Respondents (n) [ 241
Perceptions Total
Neurosurgical Neurosurgical Attendings Trainees 96
145
Lacks time for SoMe
17 (17.7%)
27 (18.6%)
Believes that SoMe lacks neurosurgical value
18 (18.8%)
35 (24.1%)
Prefers traditional means of communication
24 (25.0%)
27 (18.6%)
Concern that SoMe compromises patient privacy
16 (16.7%)
32 (22.1%)
Does use SoMe for professional purposes
43 (44.8%)
73 (50.3%)
Does not use SoMe for professional purposes
32 (33.3%)
39 (26.9%)
Interacts with patients through SoMe
11 (11.5%)
29 (20.0%)
SoMe, social media.
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Uses Instagram for professional purposes
0.210
0.810
0.0860
Uses LinkedIn for professional purposes
0.190
0.827
0.0146*
Believes SoMe lacks value in medical practice
0.191
0.826
0.0179*
Referred neurosurgical literature through SoMe
0.183
0.833
0.0095*
Positive perspective on SoMe potential
0.089
0.915
0.0232*
SoMe, social media. *The variable—neurosurgical level—was categorized into a binary outcome with 0 representing neurosurgical trainee and 1 representing neurosurgical attending.
general fear of violating patient privacy and facing litigation. A recent exploratory qualitative study into SoMe usage by physicians conducted by Campbell et al.16 reaffirms all of our regression findings by discussing in detail the aforementioned points. The study further states that participants felt very “unprepared” when beginning to use SoMe and “confused about the rules and etiquette” of SoMe use. However, the authors also mentioned that the majority of participants were involved in traditional communications prior to engaging in SoMe but began to enjoy the SoMe sphere after understanding how to use it effectively. Additionally, they highlight the uncertainty regarding potential negative repercussions, especially the fear of malpractice litigation, and or comprising clinical efficiency in lieu of maintaining an SoMe presence.16 A potential point of future investigation in SoMe use is highlighted by our regression modeling in the association between perceived lack of time and preference for traditional means of communication. This is underscored in the discrepancy between the perception of inadequate time for SoMe and the preference for traditional forms of communication with patients. This finding could potentially highlight a deficiency with status quo methods of patient outreach and communication within the neurosurgical community, and thus provide a clear value proposition to the skeptical practitioner. Ultimately, given the perceived and apparent benefits of SoMe in other specialties, it is worth exploring these barriers to maximize SoMe’s full potential in the modern era.
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Table 5. Stepwise Regression Analysis for Significant Predictors of Social Media Beliefs Predictor(s) Social Media Beliefs
Coefficient
Odds Ratio
P Value
0.112
0.894
0.025*
Does not use SoMe in medical practice Uses Facebook in profession Uses LinkedIn in profession
0.245
0.783
1.37e-07*
Uses Doximity in profession
0.233
0.792
2.19e-07*
Lacks time for SoMe in profession
0.205
1.227
1.93e-04*
Prefers traditional means of communication
0.109
1.115
0.039*
Believes SoMe compromises patient privacy
0.195
1.215
2.74e-04*
0.099
0.905
0.0287*
Believes SoMe lacks value in medical practice Neurosurgical position: attending Lacks time for SoMe in profession
0.211
1.235
0.0011*
Prefers traditional means of communication
0.138
1.148
0.0284*
Uses SoMe in profession
0.252
0.777
1.39e-05*
Positive perspective on SoMe potential
0.119
0.894
1.78e-05*
Uses conferences and courses for collaboration
0.182
1.199
0.0018*
Uses telephone in profession
0.121
1.128
0.0208*
Does not use SoMe for profession
0.172
1.188
0.0138*
Lacks time for SoMe in profession
Prefers traditional means of communication
0.207
0.813
0.0019*
Believes SoMe lacks value
0.124
1.132
0.0496*
Uses SoMe in profession
0.316
0.729
3.32e-07*
Neurosurgical position
0.073
0.929
0.1046
Sex (male)
0.094
0.910
0.0948
0.298
1.348
1.45e-06*
0.231
0.793
3.68e-05*
0.068
0.934
0.1321
Believes SoMe compromises patient privacy
Does not use SoMe in profession Uses SoMe in profession Interact with patients through SoMe Neurosurgical position: attending Uses Instagram in profession
0.221
1.247
0.011*
Uses SoMe in profession
0.079
1.083
0.0800
Collaborated with neurosurgeons using SoMe
0.315
1.370
1.09e-05*
Perspective on SoMe potential
0.053
1.054
0.0473*
SoMe, social media. *Statistical significance.
This study is not without limitations. First, the response rate was approximately 10% of all neurosurgeons queried. This low response rate could have been due to many factors, such as an inadequate time period in which the survey was distributed and in which answers were recorded. Future studies could query surgeons for more than a few months. The low response rate could have been owing to the survey being distributed toward the end of the year, because of it
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being misrepresented (either in subject or in the amount of time and effort necessary to complete it), or simply because of a lack of interest. It can be inferred that those who responded to the survey harbored strong feelings, either negative or positive toward SoMe. To tease apart some of these potential issues, future studies could include questions about SoMe use amid other surveys for neurosurgeons (to eliminate some of the response bias) and could also
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gauge neurosurgeons’ interest in the study of SoMe use in neurosurgery. Also, the electronic nature of the survey may have created a bias toward more tech savvy respondents. Another limitation was the limited demographic information collected on the survey. Further studies could collect more information about respondents’ locations and types of practice (academic, private, etc.) to reveal geographic trends or other patterns. Additionally, this survey was only distributed to academic neurosurgical programs, which does not accurately reflect the entire neurosurgical community.
REFERENCES 1. Jain SH. Practicing medicine in the age of Facebook. N Engl J Med. 2009;361:649-651. 2. Wozney L, Turner K, Rose-Davis B, McGrath PJ. Facebook ads to the rescue? Recruiting a hard to reach population into an Internet-based behavioral health intervention trial. Internet Interv. 2019; 17:100246. 3. Byker T, Myers C, Graff M. Can a social media campaign increase the use of long-acting reversible contraception? Evidence from a cluster randomized control trial using Facebook [e-pub ahead of print]. Contraception. https://doi.org/10. 1016/j.contraception.2019.04.001, accessed April 18, 2019. 4. Taggart T, Grewe ME, Conserve DF, Gliwa C, Isler MR. Social media and HIV: a systematic review of uses of social media in HIV communication. J Med Internet Res. 2015;17:e248. 5. Canty MJ, Breitbart S, Siegel L, et al. The role of social media in selective dorsal rhizotomy for children: information sharing and social support [e-pub ahead of print]. Childs Nerv Syst. https://doi. org/10.1007/s00381-019-04197-x, accessed May 15, 2019. 6. Wagner JP, Cochran AL, Jones C, Gusani NJ, Varghese TK Jr, Attai DJ. Professional use of social media among surgeons: results of a multiinstitutional study. J Surg Educ. 2018;75:804-810.
CONCLUSIONS As SoMe becomes increasingly popular and its use expands, the majority of neurosurgeons that responded are also using SoMe for professional purposes. Although lack of time, lack of perceived value, and privacy concerns were hindrances to SoMe usage, other factors such as age do not seem to correlate with adoption of SoMe use for professional aims.
7. Lau AY, Gabarron E, Fernandez-Luque L, Armayones M. Social media in health–what are the safety concerns for health consumers? Health Inf Manag. 2012;41:30-35. 8. Alotaibi NM, Samuel N, Guha D, et al. Social media for academic neurosurgical programs: the University of Toronto experience. World Neurosurg. 2016;93:449-457. 9. Alotaibi NM, Guha D, Fallah A, et al. Social media metrics and bibliometric profiles of neurosurgical departments and journals: is there a relationship? World Neurosurg. 2016;90:574-579. 10. Alotaibi NM, Badhiwala JH, Nassiri F, et al. The current use of social media in neurosurgery. World Neurosurg. 2016;88:619-624. 11. Mata-Gómez J, Gilete-Tejero IJ, Rico-Cotelo M, Royano-Sánchez M, Ortega-Martínez M. Current use of social media in neurosurgery in Spain. Neurocirugia (Astur). 2018;29:109-115. 12. Luc JGY, Stamp NL, Antonoff MB. Social media in the mentorship and networking of physicians: important role for women in surgical specialties. Am J Surg. 2018;215:752-760. 13. Leow JJ, Pozo ME, Groen RS, Kushner AL. Social media in low-resource settings: a role for Twitter and Facebook in global surgery? Surgery. 2012;151: 767-769. 14. Camp SM, Mills DC II. The marriage of plastic surgery and social media: a relationship to last a lifetime. Aesthet Surg J. 2012;32:349-351.
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15. Curry E, Li X, Nguyen J, Matzkin E. Prevalence of internet and social media usage in orthopedic surgery. Orthop Rev (Pavia). 2014;6:5483. 16. Campbell L, Evans Y, Pumper M, Moreno MA. Social media use by physicians: a qualitative study of the new frontier of medicine. BMC Med Inform Decis Mak. 2016;16:91.
Conflict of interest statement: H. Westley Phillips is funded by National Institutes of Health/National Cancer Institute grant R25 NS079198. Methma Udawatta is supported by the David Geffen Medical Scholarship. Isaac Yang is supported by the UCLA Visionary Ball Fund Grant, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research UCLA Scholars in Translational Medicine Program Award, Jason Dessel Memorial Seed Grant, UCLA Honberger Endowment Brain Tumor Research Seed Grant, Stryker Research Award, and Stop Cancer (US) Research Career Development Award. Received 28 January 2019; accepted 16 May 2019 Citation: World Neurosurg. (2019) 129:e367-e374. https://doi.org/10.1016/j.wneu.2019.05.154 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
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APPENDIX 1
d. LinkedIn
SURVEY QUESTIONS
e. Doximity f. No accounts
1. What is your current level of neurosurgical training?
g. Other (please specify) 6. If you do not have any professional social media accounts, what is your reason? (select all that apply)
a. Resident b. Fellow c. Attending 2. What is your age?
a. Lack of time b. Lack of perceived value
a. 18e24 b. 25e34
c. Prefer more traditional methods of communication or collaboration
c. 35e44
d. Privacy concerns (patient or personal)
d. 45e54
e. N/A
e. 55e64
f. Other (please specify) 7. Have you ever collaborated with a colleague that was only known to you through social media?
f. 65e74 g. 75þ 3. What is your sex?
a. Yes
a. Male b. Female 4. What is your preferred method of collaborating and meeting neurosurgeons from different institutions? (select all that apply) a. Conferences/courses b. E-mail
c. No social media platform 10. Regarding the use of social media platforms in terms of professional development, I believe that it can be
e. Doximity f. Facebook
a. Highly beneficial
g. Twitter h. Other (please specify) 5. Do you have any social media accounts for professional use? (select all that apply)
c. Instagram
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b. No 9. Do you regularly interact with patients or non-medical professionals through your social media platform?
b. No
d. LinkedIn
b. Twitter
a. Yes
a. Yes
c. Telephone
a. Facebook
b. No 8. Have you ever read a journal article that you were introduced to through another individual’s social media post?
b. Somewhat beneficial c. Neutral or irrelevant d. Somewhat harmful e. Highly harmful f. Other (please specify)
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Social Media Use for Professional Purposes in the Neurosurgical Community: A Multi-Institutional Study H. Westley Phillips1, Jia-Shu Chen1, Bayard Wilson1, Methma Udawatta1,7, Giyarpuram Prashant1, Daniel Nagasawa1, Isaac Yang1-7
BACKGROUND: Since the debut of Facebook in 2004, social media (SoMe) has garnered increased popularity and usage worldwide. Given its appeal and visibility, many industries have used SoMe to promote products for professional purposes. Specialized sites have subsequently been created to connect users in similar disciplines. Although SoMe sites have amassed over 1-billion followers, SoMe usage in the neurosurgical community has not yet been well described.
-
METHODS: We present an online survey administered to neurosurgery faculty, fellows, and residents in 102 U.S. accredited programs to gauge usage and perception of SoMe for professional purposes.
-
RESULTS: Of all surveys distributed, 241 neurosurgeons responded with an attending, resident, to fellow breakdown of 137, 96, and 8, respectively. A total of 55.97% of respondents were under the age of 34, 2% were over the age of 75, and 81% of respondents identified as men. An overwhelming majority cited conferences (83%) and in-person meetings as their preferred method of networking. However, 70% state they use SoMe for professional purposes with Doximity and LinkdIn listed as the most popular (49% and 48%, respectively) platforms. Lack of time and perceived value, in addition to privacy concerns, were noted to be the main factors for those refraining from SoMe use.
-
CONCLUSIONS: As SoMe becomes increasingly popular and its use expands, the majority of neurosurgeon respondents are also using SoMe for professional purposes. Although lack of time, lack of perceived value, and privacy
-
Key words Neurosurgery - Outreach - Social media -
Abbreviations and Acronyms SoMe: Social media ARPANET: Advanced Research Projects Agency Network
concerns were hindrances to usage, other factors like age do not seem to correlate with SoMe adoption for professional aims.
INTRODUCTION
S
ocial Media (SoMe) is a group of computer-based platforms designed to facilitate the exchange of information and ideas across virtual networks. SoMe has a long history dating back to the 1970s with ARPANET, or the Advanced Research Projects Agency Network, a Department of Defense project as a means to electronically connect researchers for the exchange of ideas across campuses. As the popularity and accessibility of the internet began to rise in the 1990s, SoMe platforms followed suit by expanding its content and subsequently its range of audiences. Since the debut of Facebook in 2004, and later the ubiquity of SoMe compatible smart phones, SoMe has garnered increased popularity and usage worldwide with an estimated 70% or higher percentage of teenagers being active Facebook users.1 Given its universal appeal and visibility, many industries have used SoMe as a means to promote and advertise their products for professional purposes. Specialized sites, such as Doximity, an SoMe community targeting health care professionals, have subsequently been created to connect users in similar disciplines. Given the rising use of SoMe in the daily lives of many, it is no surprise that it has now been used for the dissemination of health information, both to patients and between providers. For example, Facebook ads have been used to recruit hard to reach participants for behavioral health interventions and to increase the use of longacting reversible contraception.2,3 SoMe use can range from
6
Harbor-UCLA Medical Center, 7David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA To whom correspondence should be addressed: Isaac Yang, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2019) 129:e367-e374. https://doi.org/10.1016/j.wneu.2019.05.154 Journal homepage: www.journals.elsevier.com/world-neurosurgery Available online: www.sciencedirect.com
From the Departments of 1Neurosurgery, 2Radiation Oncology, and 3Head and Neck Surgery, 4 Jonsson Comprehensive Cancer Center, 5Los Angeles Biomedical Research Institute,
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targeting large groups of individuals (to share information about HIV prevention and treatment, for example) to smaller, more specialized groups (such as those sharing information about the role of selective dorsal rhizotomy in the treatment of spasticity in cerebral palsy).4,5 SoMe is not only used to share information between patients or family members within support groups but also for hospitals and providers to share information with their patients, and for providers to share information among themselves. As such, we devised a survey to begin to further examine how SoMe was used by neurosurgeons. Although subspecialties such as oncology, plastic and reconstructive surgery, and general surgery have explored SoMe usage in their field, there is a dearth of information regarding the use of SoMe among neurosurgeons.6 Given the lack of literature delineating the usage patterns and preferences of individuals in the neurosurgical community, we present a national survey of residents, fellows, and attendings to gauge their attitudes toward SoMe usage as a mean for professional tools. METHODS Here, we present an online survey administered to neurosurgery faculty, fellows, and residents in 102 U.S. accredited programs accounting for approximately 2,400 neurosurgeons to gauge usage and perception of SoMe for professional purposes. An electronic survey using SurveyMonkey was designed to establish participation, interest, and sentiment regarding SoMe as a professional tool in the neurosurgery community. A copy of the survey is included as Appendix 1. Basic demographic information was collected (age, sex, level of neurosurgical training) and other questions asked participants’ preferred methods of collaboration, use of professional SoMe accounts, collaboration via SoMe, interactions with patients via SoMe, and opinions on the perceived usefulness of SoMe platforms for professional development. The institutional board review of the University of California, Los Angeles approved the study. The surveys were sent to program coordinators at each respective program to distribute freely to their cohort once per month from October to December 2017. Responses were collected 4 months after the initial distribution of surveys. Participation was voluntary, anonymous, and no compensation was provided. Participant characteristics were then compiled using the resultant responses to elucidate the demographics of the participating respondent group. Following the data collection period, the responses from the distributed SurveyMonkey survey were imported into RStudio Version 1.1.453 (RStudio Inc., Boston, Massachusetts, USA) for management, characterization, and statistical analysis of the data. Because of the small sample size of respondents who classified themselves as fellows (n ¼ 8), the fellows and residents were further categorized together as “neurosurgical trainees” for the purpose of unbiased statistical analysis. The c2 test was used to assess the difference in SoMe opinions and habits between different demographics of neurosurgeons. Bidirectional stepwise regression was performed to predict for SoMe opinions, SoMe habits, and neurosurgical position. The bidirectional stepwise regression was performed with the intention of identifying significant predictors for the aforementioned SoMe opinions and
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habits, as well as a respondent’s neurosurgical level. The models with the lowest Akaike Information Criterion score for each dependent variable were selected to assess the most significant predictors of different SoMe opinions, SoMe habits, and neurosurgical training levels. RESULTS Of all surveys distributed, a total of 241 neurosurgeons responded with an attending, resident, to fellow breakdown of 96, 137, and 8, respectively (Table 1 and Figure 1). Of those who responded, 56.4% were under the age of 34, 2.1% were over the age of 75, and 81% of respondents identified as men. In this cohort, an overwhelming majority cited conferences and in-person meetings (82.2%) as one of their preferred methods of networking. However, 70.5% state that they use SoMe for professional purposes, with Doximity and LinkedIn listed as the most popular (49% and 48%, respectively) SoMe platforms (Table 1). Overall, there was not a significant difference in opinions and habits of SoMe between neurosurgical trainees and faculty. However, there was a significant amount of neurosurgical attendings who find SoMe irrelevant to neurosurgery (P ¼ 0.0415). Additionally, neurosurgical trainees are significantly more likely to use LinkedIn professionally (P ¼ 0.0286), whether it be to collaborate with fellow neurosurgeons or interact with patients (Figure 2). Interestingly, there was not a significant difference between neurosurgical trainees and neurosurgical attendings who use the major traditional SoMe platforms, such as Facebook, Twitter, and Instagram, for professional purposes (P ¼ 0.4128, 0.3936, and 0.4032, respectively) (Figure 3). Facebook and Instagram were reported to be more commonly used among neurosurgical trainees (20.7% and 9.0% vs. 15.6% and 5.2%, respectively), whereas neurosurgical attendings reported a higher usage of Twitter or no SoMe platform at all, relative to the trainees (19.8% and 33.3% vs. 13.1% and 26.9%, respectively) (Table 2). Furthermore, although there is not a significant difference between trainees and attendings who believe that SoMe lacks value in the neurosurgical setting and that SoMe potentially compromises patient privacy (Figure 4), it is surprising to note that a greater proportion of neurosurgical trainees believe that SoMe has no intrinsic value in neurosurgery (24.14% vs. 18.75%) and that SoMe puts patient confidentiality at risk (22.07% vs. 16.67%) (Table 3). When predicting for neurosurgical level, the stepwise regression analysis highlighted several predictors for neurosurgical trainee and neurosurgical attending. Positive associations with neurosurgical trainees were found for the use of Twitter specifically for collaboration with fellow neurosurgeons (P ¼ 0.0128), the use of LinkedIn for general career assistance (P ¼ 0.0146), the belief that SoMe currently possesses no value in a neurosurgical practice (P ¼ 0.0179), previous history being referred literature through SoMe (P ¼ 0.0095), and a positive outlook on the potential of SoMe in neurosurgery (P ¼ 0.0232) (Table 4). Significant positive associations with neurosurgical attendings were found for the use of Twitter and Doximity for general career assistance (P ¼ 0.0003 and P ¼ 1.4e-04, respectively). Additionally, the stepwise regression analysis highlighted several pertinent
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Table 1. Demographics and General Social Media Practices Among All Respondents Total Respondents (n) [ 241 Demographics
Respondents
Neurosurgical position Attending Fellow Resident
96 (39.8%) 8 (3.3%) 137 (56.8%)
Sex Female
46 (19.1%)
Male
195 (80.9%)
Age range (years) 25e34
136 (56.4%)
35e44
46 (19.1%)
45e54
29 (12.0%)
55e64
17 (7.1%)
65e74
8 (3.3%)
75þ
5 (2.1%)
Preferred collaboration modalities* Conferences/courses
198 (82.2%)
135 (56.0%)
Telephone
53 (22.0%)
17 (17.1%)
Doximity
8 (3.3%)
16 (6.6%)
12 (5.0%)
Other
7 (2.9%)
Figure 1. Respondents categorized into neurosurgical attending or trainee.
privacy and confidentiality at risk (P < 0.001). Stepwise regression analysis also highlights that believing SoMe lacks value in medicine is a significant positive predictor and a perceived lack of time for SoMe in profession is a significant negative predictor for respondents who prefer traditional means of communication (P ¼ 0.0496 and P ¼ 0.0019) (Table 5). DISCUSSION Many cite barriers to SoMe use among physicians as lack of privacy, efficacy, or efficiency. Although many opponents of SoMe use in a medical practice point to SoMe’s negative impacts as
SoMe platforms for professional use* Facebook
45 (18.7%)
38 (15.8%)
18 (7.5%)
115 (47.7%)
Doximity
113 (46.9%)
No accounts
71 (29.5%)
SoMe, social media. *Respondents could select multiple options.
predictors of SoMe opinions and habits. Being a neurosurgical trainee was a significant predictor of believing that SoMe currently lacks value in neurosurgery (P ¼ 0.0287). Furthermore, the main reasons why respondents avoid using SoMe in their medical practice was because of the perceived lack of time (P < 0.001), preference for more traditional means of communication (P ¼ 0.039), and beliefs that SoMe puts patient
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Figure 2. Comparison of opinions on SoMe contribution to neurosurgery between the different neurosurgical levels (attending and trainee). P values were computed through c2 testing. SoMe, social media.
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Table 2. Demographics and General Social Media Practices Among Neurosurgical Attendings and Trainees Total Respondents (n) [ 241 Demographics and Practices
Neurosurgical Attendings
Neurosurgical Trainees
96
145
Total Sex Female
13 (13.5%)
33 (22.8%)
Male
83 (86.5%)
112 (77.2%)
25e34
8 (8.3%)
128 (88.3%)
35e44
29 (30.2%)
17 (11.7%)
45e54
29 (30.2%)
0
55e64
17 (17.7%)
0
65e74
8 (8.3%)
0
75þ
5 (5.2%)
0
Conferences/courses
76 (79.2%)
122 (84.1%)
57 (59.4%)
78 (53.8%)
Telephone
23 (24.0%)
30 (20.7%)
6 (6.3%)
11 (7.6%)
Doximity
4 (4.2%)
4 (2.8%)
4 (4.2%)
12 (8.3%)
2 (2.1%)
10 (6.9%)
Other
4 (4.2%)
2 (1.4%)
15 (15.6%)
30 (20.7%)
19 (19.8%)
19 (13.1%)
Age range (years)
Figure 3. Comparison of SoMe usage between neurosurgical attendings and trainees. P values were computed through c2 testing.
7
described by Lau et al. such as marketing of injurious products and behavior, there are also supporters of SoMe who highlight the positive impact on health care delivery, which includes rapid and widespread transfer of information afforded by SoMe. One such example is the swift mobilization of physicians for the Doctors for Obama campaign, a grass roots organization amassing a member population of 10,000þ members during Obama’s 2008 campaign.7 Although Facebook and other sites have amassed over 1-billion users and capitalize on their influence as professional tools, SoMe usage in the neurosurgical community has not yet been well described. Alotaibi et al. describes the relative popularity of SoMe among neurosurgical departments, journals, and non-profit organizations on the 3 popular SoMe platforms, Facebook, Twitter, and YouTube, respectively, which demonstrated similar usage rates and popularity to other medical subspecialties with a predominance in the private sector.8-10 Furthermore, his group would later describe the relationship between SoMe metrics and academic indices of neurosurgery programs and journals, which associated the presence of SoMe account with a statistically significantly higher value of academic impact metrics for both academic programs and journals with SoMe accounts.8-10 Wagner et al.6 described SoMe usage in the general surgery community, with the majority stating they used some form of SoMe for professional purposes. Although a perceived lack of time, preference for more traditional communication methods in professional settings, and concern for patient privacy are all significant predictors for not using SoMe in a neurosurgical practice, it is interesting to note that a perceived lack of value is not a significant predictor. Recent studies have highlighted the important roles SoMe plays in the surgical community, indicating that the intangible, positive impacts of SoMe may be changing traditional perceptions of SoMe.11 In a recent study conducted by Luc et al,12 the authors concluded that SoMe is a valuable tool that improves the networking and
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Preferred collaboration modalities*
SoMe platforms for professional use*
5 (5.2%)
13 (9.0%)
37 (38.5%)
78 (53.8%)
Doximity
51 (53.1%)
62 (42.8%)
No accounts
32 (33.3%)
39 (26.9%)
SoMe, social media. *Respondents could select multiple options.
mentorship of surgeons, especially for women in a surgical specialty in which direct exposure to same-sex mentors is difficult to access. Leow et al.13 highlighted SoMe’s ability to improve surgical practices on a global scale by allowing rural clinics to consult specialists in urban and metropolitan areas, as well as provide “telementoring,” or remote guidance and teaching, of surgical procedures to low- and middle-income countries. Additionally, Camp et al.14 and Curry et al.15 discussed the benefits SoMe has for patient recruitment and physician marketing in reconstructive and orthopedic surgery, and to some degree,
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Table 4. Stepwise Regression Analysis for Significant Predictors of Neurosurgical Position Predictor
Coefficient
Odds Ratio
P Value
Sex (male)
0.136
1.145
0.0739
Uses Twitter for professional purposes
0.369
1.447
0.0003*
Uses Doximity for professional purposes
0.294
1.341
1.4e-04*
Does not use SoMe for professional purposes
0.173
1.189
0.0824
Used SoMe to collaborate with neurosurgeons before
0.182
1.199
0.0638
0.373
0.688
0.0128*
Uses Twitter to collaborate with other neurosurgeons
Figure 4. Comparison of SoMe perceptions between neurosurgical attendings and trainees. P values were determined through c2 testing. SoMe, social media.
patient information and education. Despite these notable and effective implementations of SoMe in various surgical specialties resulting in improved perceptions of SoMe value in medicine, it is clear that barriers still exist between surgeons and adoption of SoMe within their medical practice.14,15 According to the regression results, several of these barriers include unfamiliarity with SoMe, which predisposes neurosurgeons to stick with conventional communication methodologies, time restraints, and a
Table 3. Perceptions of Social Media Among Neurosurgical Attendings and Trainees Total Respondents (n) [ 241
Perceptions Total
Neurosurgical Neurosurgical Attendings Trainees 96
145
Lacks time for SoMe
17 (17.7%)
27 (18.6%)
Believes that SoMe lacks neurosurgical value
18 (18.8%)
35 (24.1%)
Prefers traditional means of communication
24 (25.0%)
27 (18.6%)
Concern that SoMe compromises patient privacy
16 (16.7%)
32 (22.1%)
Does use SoMe for professional purposes
43 (44.8%)
73 (50.3%)
Does not use SoMe for professional purposes
32 (33.3%)
39 (26.9%)
Interacts with patients through SoMe
11 (11.5%)
29 (20.0%)
SoMe, social media.
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Uses Instagram for professional purposes
0.210
0.810
0.0860
Uses LinkedIn for professional purposes
0.190
0.827
0.0146*
Believes SoMe lacks value in medical practice
0.191
0.826
0.0179*
Referred neurosurgical literature through SoMe
0.183
0.833
0.0095*
Positive perspective on SoMe potential
0.089
0.915
0.0232*
SoMe, social media. *The variable—neurosurgical level—was categorized into a binary outcome with 0 representing neurosurgical trainee and 1 representing neurosurgical attending.
general fear of violating patient privacy and facing litigation. A recent exploratory qualitative study into SoMe usage by physicians conducted by Campbell et al.16 reaffirms all of our regression findings by discussing in detail the aforementioned points. The study further states that participants felt very “unprepared” when beginning to use SoMe and “confused about the rules and etiquette” of SoMe use. However, the authors also mentioned that the majority of participants were involved in traditional communications prior to engaging in SoMe but began to enjoy the SoMe sphere after understanding how to use it effectively. Additionally, they highlight the uncertainty regarding potential negative repercussions, especially the fear of malpractice litigation, and or comprising clinical efficiency in lieu of maintaining an SoMe presence.16 A potential point of future investigation in SoMe use is highlighted by our regression modeling in the association between perceived lack of time and preference for traditional means of communication. This is underscored in the discrepancy between the perception of inadequate time for SoMe and the preference for traditional forms of communication with patients. This finding could potentially highlight a deficiency with status quo methods of patient outreach and communication within the neurosurgical community, and thus provide a clear value proposition to the skeptical practitioner. Ultimately, given the perceived and apparent benefits of SoMe in other specialties, it is worth exploring these barriers to maximize SoMe’s full potential in the modern era.
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Table 5. Stepwise Regression Analysis for Significant Predictors of Social Media Beliefs Predictor(s) Social Media Beliefs
Coefficient
Odds Ratio
P Value
0.112
0.894
0.025*
Does not use SoMe in medical practice Uses Facebook in profession Uses LinkedIn in profession
0.245
0.783
1.37e-07*
Uses Doximity in profession
0.233
0.792
2.19e-07*
Lacks time for SoMe in profession
0.205
1.227
1.93e-04*
Prefers traditional means of communication
0.109
1.115
0.039*
Believes SoMe compromises patient privacy
0.195
1.215
2.74e-04*
0.099
0.905
0.0287*
Believes SoMe lacks value in medical practice Neurosurgical position: attending Lacks time for SoMe in profession
0.211
1.235
0.0011*
Prefers traditional means of communication
0.138
1.148
0.0284*
Uses SoMe in profession
0.252
0.777
1.39e-05*
Positive perspective on SoMe potential
0.119
0.894
1.78e-05*
Uses conferences and courses for collaboration
0.182
1.199
0.0018*
Uses telephone in profession
0.121
1.128
0.0208*
Does not use SoMe for profession
0.172
1.188
0.0138*
Lacks time for SoMe in profession
Prefers traditional means of communication
0.207
0.813
0.0019*
Believes SoMe lacks value
0.124
1.132
0.0496*
Uses SoMe in profession
0.316
0.729
3.32e-07*
Neurosurgical position
0.073
0.929
0.1046
Sex (male)
0.094
0.910
0.0948
0.298
1.348
1.45e-06*
0.231
0.793
3.68e-05*
0.068
0.934
0.1321
Believes SoMe compromises patient privacy
Does not use SoMe in profession Uses SoMe in profession Interact with patients through SoMe Neurosurgical position: attending Uses Instagram in profession
0.221
1.247
0.011*
Uses SoMe in profession
0.079
1.083
0.0800
Collaborated with neurosurgeons using SoMe
0.315
1.370
1.09e-05*
Perspective on SoMe potential
0.053
1.054
0.0473*
SoMe, social media. *Statistical significance.
This study is not without limitations. First, the response rate was approximately 10% of all neurosurgeons queried. This low response rate could have been due to many factors, such as an inadequate time period in which the survey was distributed and in which answers were recorded. Future studies could query surgeons for more than a few months. The low response rate could have been owing to the survey being distributed toward the end of the year, because of it
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being misrepresented (either in subject or in the amount of time and effort necessary to complete it), or simply because of a lack of interest. It can be inferred that those who responded to the survey harbored strong feelings, either negative or positive toward SoMe. To tease apart some of these potential issues, future studies could include questions about SoMe use amid other surveys for neurosurgeons (to eliminate some of the response bias) and could also
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gauge neurosurgeons’ interest in the study of SoMe use in neurosurgery. Also, the electronic nature of the survey may have created a bias toward more tech savvy respondents. Another limitation was the limited demographic information collected on the survey. Further studies could collect more information about respondents’ locations and types of practice (academic, private, etc.) to reveal geographic trends or other patterns. Additionally, this survey was only distributed to academic neurosurgical programs, which does not accurately reflect the entire neurosurgical community.
REFERENCES 1. Jain SH. Practicing medicine in the age of Facebook. N Engl J Med. 2009;361:649-651. 2. Wozney L, Turner K, Rose-Davis B, McGrath PJ. Facebook ads to the rescue? Recruiting a hard to reach population into an Internet-based behavioral health intervention trial. Internet Interv. 2019; 17:100246. 3. Byker T, Myers C, Graff M. Can a social media campaign increase the use of long-acting reversible contraception? Evidence from a cluster randomized control trial using Facebook [e-pub ahead of print]. Contraception. https://doi.org/10. 1016/j.contraception.2019.04.001, accessed April 18, 2019. 4. Taggart T, Grewe ME, Conserve DF, Gliwa C, Isler MR. Social media and HIV: a systematic review of uses of social media in HIV communication. J Med Internet Res. 2015;17:e248. 5. Canty MJ, Breitbart S, Siegel L, et al. The role of social media in selective dorsal rhizotomy for children: information sharing and social support [e-pub ahead of print]. Childs Nerv Syst. https://doi. org/10.1007/s00381-019-04197-x, accessed May 15, 2019. 6. Wagner JP, Cochran AL, Jones C, Gusani NJ, Varghese TK Jr, Attai DJ. Professional use of social media among surgeons: results of a multiinstitutional study. J Surg Educ. 2018;75:804-810.
CONCLUSIONS As SoMe becomes increasingly popular and its use expands, the majority of neurosurgeons that responded are also using SoMe for professional purposes. Although lack of time, lack of perceived value, and privacy concerns were hindrances to SoMe usage, other factors such as age do not seem to correlate with adoption of SoMe use for professional aims.
7. Lau AY, Gabarron E, Fernandez-Luque L, Armayones M. Social media in health–what are the safety concerns for health consumers? Health Inf Manag. 2012;41:30-35. 8. Alotaibi NM, Samuel N, Guha D, et al. Social media for academic neurosurgical programs: the University of Toronto experience. World Neurosurg. 2016;93:449-457. 9. Alotaibi NM, Guha D, Fallah A, et al. Social media metrics and bibliometric profiles of neurosurgical departments and journals: is there a relationship? World Neurosurg. 2016;90:574-579. 10. Alotaibi NM, Badhiwala JH, Nassiri F, et al. The current use of social media in neurosurgery. World Neurosurg. 2016;88:619-624. 11. Mata-Gómez J, Gilete-Tejero IJ, Rico-Cotelo M, Royano-Sánchez M, Ortega-Martínez M. Current use of social media in neurosurgery in Spain. Neurocirugia (Astur). 2018;29:109-115. 12. Luc JGY, Stamp NL, Antonoff MB. Social media in the mentorship and networking of physicians: important role for women in surgical specialties. Am J Surg. 2018;215:752-760. 13. Leow JJ, Pozo ME, Groen RS, Kushner AL. Social media in low-resource settings: a role for Twitter and Facebook in global surgery? Surgery. 2012;151: 767-769. 14. Camp SM, Mills DC II. The marriage of plastic surgery and social media: a relationship to last a lifetime. Aesthet Surg J. 2012;32:349-351.
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15. Curry E, Li X, Nguyen J, Matzkin E. Prevalence of internet and social media usage in orthopedic surgery. Orthop Rev (Pavia). 2014;6:5483. 16. Campbell L, Evans Y, Pumper M, Moreno MA. Social media use by physicians: a qualitative study of the new frontier of medicine. BMC Med Inform Decis Mak. 2016;16:91.
Conflict of interest statement: H. Westley Phillips is funded by National Institutes of Health/National Cancer Institute grant R25 NS079198. Methma Udawatta is supported by the David Geffen Medical Scholarship. Isaac Yang is supported by the UCLA Visionary Ball Fund Grant, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research UCLA Scholars in Translational Medicine Program Award, Jason Dessel Memorial Seed Grant, UCLA Honberger Endowment Brain Tumor Research Seed Grant, Stryker Research Award, and Stop Cancer (US) Research Career Development Award. Received 28 January 2019; accepted 16 May 2019 Citation: World Neurosurg. (2019) 129:e367-e374. https://doi.org/10.1016/j.wneu.2019.05.154 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
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APPENDIX 1
d. LinkedIn
SURVEY QUESTIONS
e. Doximity f. No accounts
1. What is your current level of neurosurgical training?
g. Other (please specify) 6. If you do not have any professional social media accounts, what is your reason? (select all that apply)
a. Resident b. Fellow c. Attending 2. What is your age?
a. Lack of time b. Lack of perceived value
a. 18e24 b. 25e34
c. Prefer more traditional methods of communication or collaboration
c. 35e44
d. Privacy concerns (patient or personal)
d. 45e54
e. N/A
e. 55e64
f. Other (please specify) 7. Have you ever collaborated with a colleague that was only known to you through social media?
f. 65e74 g. 75þ 3. What is your sex?
a. Yes
a. Male b. Female 4. What is your preferred method of collaborating and meeting neurosurgeons from different institutions? (select all that apply) a. Conferences/courses b. E-mail
c. No social media platform 10. Regarding the use of social media platforms in terms of professional development, I believe that it can be
e. Doximity f. Facebook
a. Highly beneficial
g. Twitter h. Other (please specify) 5. Do you have any social media accounts for professional use? (select all that apply)
c. Instagram
e374
www.SCIENCEDIRECT.com
b. No 9. Do you regularly interact with patients or non-medical professionals through your social media platform?
b. No
d. LinkedIn
b. Twitter
a. Yes
a. Yes
c. Telephone
a. Facebook
b. No 8. Have you ever read a journal article that you were introduced to through another individual’s social media post?
b. Somewhat beneficial c. Neutral or irrelevant d. Somewhat harmful e. Highly harmful f. Other (please specify)
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.05.154