Advertisement
Adult: Education| Volume 12, P315-328, December 2022

Download started.

Ok

Increased social media utilization and content creation by cardiothoracic surgery programs during the coronavirus disease 2019 pandemic

Open AccessPublished:September 28, 2022DOI:https://doi.org/10.1016/j.xjon.2022.09.004

      Abstract

      Objectives

      The coronavirus disease 2019 (COVID-19) pandemic has changed the landscape of professional activities, emphasizing virtual meetings and social media (SoMe) presence. Whether cardiothoracic programs increased their SoMe presence is unknown. We examined SoMe use and content creation by cardiothoracic surgery programs during the COVID-19 pandemic.

      Methods

      We searched the Accreditation Council for Graduate Medical Education to identify all cardiothoracic surgery residency programs (n = 122), including independent (n = 74), integrated (n = 33), and congenital (n = 15) training programs at 78 US cardiothoracic surgery teaching institutions. We then manually searched Google, Facebook, Instagram, LinkedIn, and Twitter to identify the associated residency and departmental accounts. The timeline for our search was between 10/2021 and 4/2022. March 2020 was used as the starting point for the COVID-19 pandemic. We also contacted the account managers to identify account content creators. The data are descriptively reported and analyzed.

      Results

      Of 137 SoMe accounts from 78 US cardiothoracic surgery teaching institutions, 72 of 137 (52.6%) were on Twitter, 34 of 137 (24.8%) on Facebook, and 31 of 137 (22.6%) on Instagram. Most accounts were departmental accounts (105/137 = 76.6%) versus 32 of 137 (23.4%) training program accounts. Most training program-specific SoMe accounts across all platforms were created after the COVID-19 pandemic, whereas departmental accounts were pre-existing (P < .001). The most pronounced SoMe growth was on Instagram at the training program level, with 91.7% of Instagram accounts created after the pandemic. Trainees are the content creators for 94.4% of residency accounts and 33.3% of departmental accounts. Facebook's presence was stagnant. Congenital training programs did not have a specific SoMe presence.

      Conclusions

      SoMe presence by cardiothoracic surgery training programs and departments has increased during the pandemic. Twitter is the most common platform, with a recent increased trend on Instagram. Trainees largely create content. SoMe education and training pathways may be needed for involved trainees to maximize their benefits.

      Key Words

      Abbreviations and Acronyms:

      ACGME (Accreditation Council for Graduate Medical Education), COVID-19 (coronavirus disease 2019)
      Figure thumbnail fx1
      Social media platform utilization over time.
      Social media presence by cardiothoracic surgery training programs and departments has increased during the pandemic. Social media content is largely created by trainees.
      Social media presence by cardiothoracic surgery training programs and departments has increased during the pandemic. Twitter is the most common platform, with a recent increased trend on Instagram. Trainees largely create content. Social media education and training pathways may be needed for involved trainees to maximize their benefits.
      Several studies have highlighted the role of social media in scientific dissemination, networking, and opening doors for academic opportunities.
      • Luc J.G.Y.
      • Archer M.A.
      • Arora R.C.
      • Bender E.M.
      • Blitz A.
      • Cooke D.T.
      • et al.
      Social media improves cardiothoracic surgery literature dissemination: results of a randomized trial.
      ,
      • Corsini E.M.
      • Luc J.G.Y.
      • Antonoff M.B.
      Women in thoracic surgery: social media and the value of mentorship.
      The coronavirus disease 2019 (COVID-19) pandemic imposed several restrictions on many day-to-day activities within residency programs and departments, including thoracic surgery.
      • Luc J.G.Y.
      • Archer M.A.
      • Arora R.C.
      • Bender E.M.
      • Blitz A.
      • Cooke D.T.
      • et al.
      The thoracic surgery social media network experience during the COVID-19 pandemic.
      ,
      • Giordano L.
      • Cipollaro L.
      • Migliorini F.
      • Maffulli N.
      Impact of Covid-19 on undergraduate and residency training.
      Most programs suspended in-person interviews and shifted toward virtual interviews for their respective residency match.
      Coalition for physician accountability releases recommendations on 2021-22 residency season interviewing. The match, national resident matching program.
      Although these platforms were safe alternatives for in-person interviews, they impacted the abilities of program directors to assess candidate interpersonal skills and for candidates to assess crucial factors in residency programs such as a program's fit, place, and character.
      • Klammer R.M.
      • Haydel M.J.
      • Gallahue F.
      • Bruno E.C.
      • Langdorf M.I.
      • Cheaito M.A.
      • et al.
      Program visits and residency interviews.
      To circumvent this, there were significant increases in social media use among candidates and surgical residency programs during the COVID-19 era across different specialties, including dermatology, general surgery, neurology, orthopedic surgery, otolaryngology, pediatric, and urology residency programs in 2020 compared with previous years.
      • Yong T.M.
      • Pappas M.A.
      • Ray G.S.
      • McManus T.G.
      • Coe M.P.
      Analyzing the proliferation of social media use among orthopaedic surgery residency programs.
      • Ho P.
      • Margolin E.
      • Sebesta E.
      • Small A.
      • Badalato G.M.
      #AUAMatch: the impact of COVID-19 on social media use in the urology residency match.
      • Gaini R.R.
      • Patel K.M.
      • Khan S.A.
      • Singh N.P.
      • Love M.N.
      A rise in social media utilization by U.S. neurology residency programs in the era of COVID-19.
      • Clay Pruett J.
      • Deneen K.
      • Turner H.
      • Kozar T.
      • Singh N.P.
      • King T.W.
      • et al.
      Social media changes in pediatric residency programs during COVID-19 pandemic.
      • Fang H.A.
      • Boudreau BS H.
      • Khan S.
      • Singh N.P.
      • Rais-Bahrami S.
      • King T.W.
      • et al.
      An evaluation of social media utilization by general surgery programs in the COVID-19 era.
      It is unknown whether cardiothoracic surgery departments or training programs have adopted a greater social media presence. The effect of the COVID-19 pandemic as a catalyst for cardiothoracic programs has not been examined. Cardiothoracic surgery training programs are generally smaller in complement and have substantial differences in terms of workload compared with other specialties. In addition, within cardiothoracic surgery, there are several training pathways and accredited subspecialties. Thus, a better understanding of social media trends among these different training pathways is needed.
      In this context, we assessed how cardiothoracic surgery residency programs used social media platforms before and after the pandemic. Specifically, we examined the trends for independent training programs, integrated programs, and congenital fellowship programs, in addition to department-level use. We also assessed the parties responsible for content creation. The findings can help guide programs using the most trending platforms, maximize reach, and provide training and education for content creators.

      Methods

      Data Collection

      We searched the Accreditation Council for Graduate Medical Education (ACGME) to identify all cardiothoracic surgery residency programs, including independent (n = 74), integrated (n = 33), and congenital (n = 15) training programs at 78 US teaching institutions. We then manually searched Google, Facebook, Instagram, and Twitter to identify the associated training and departmental accounts. We accessed the programs' official websites and their department and residency social media accounts on Twitter, Facebook, and Instagram. We excluded unofficial private or personal accounts. The timeline for our search was between October 2021 and April 2022. All data and accounts are public; therefore, the study was deemed exempt from the Loyola University Chicago Institutional Review Board.
      We standardized nomenclatures by defining a department account as the account dedicated to the department of cardiothoracic surgery or department of surgery of the given institution. The residency account is the one dedicated to the cardiovascular and thoracic surgery residency program at a respective institution. For Twitter, the account creation date is publicized in the biographical section. For Instagram, it is not publicized; however, we estimated the account's creation date as the first post's date. Finally, for Facebook, the date of creating the account is present in the page transparency section. Accounts were classified as created before or after March 1, 2020, which denotes an account created pre- or post-COVID-19 pandemic.
      We included accounts for independent, integrated, and congenital cardiothoracic surgery programs. If the account was devoted to cardiothoracic surgery and other surgical specialties, we only counted accounts with information related to cardiothoracic surgery. We searched the visiting student application services for virtual subinternship and the history of each included account in the study for posts announcing hiring for candidates, live virtual open houses, virtual subinternship opportunities, or interactive meetings. We excluded informational videos, video tours, and noninteractive posts and then counted the number of available virtual opportunities per social media account/page. For estimating the number of tweets per month in 2019 and 2020, we used the web-based service “Tweetstats.com.”
      Tweet stats.
      Most of the social media accounts did not specify the type of the program, whether it was independent, congenital, or integrated. In other words, some accounts covered more than 1 program type in the same institution. We considered the programs that belong to the same cardiothoracic teaching institution and have one nonspecific account as one program.
      To clarify who creates content for the social media account, we surveyed 128 of 137 accounts by sending them a direct query on each respective social media platform. Nine accounts already announced who runs their account, so those programs were not queried.
      Finally, we identified a program director for each program using the ACGME to estimate the use of social media by program directors. We searched program directors' accounts on LinkedIn, Twitter, Facebook, and Instagram. We considered a program director using social media if they had a presence on any of those platforms.

      Statistical Analysis

      Data are presented as medians and ranges for scaled data and percentages for nominal data. Statistical analyses included the χ2 test, which was used for categorical variables, and Wilcoxon rank-sum test for continuous variables, as appropriate. All statistical tests were 2-sided. All data were analyzed using SPSS, version 25 (IBM Corp), and RevMan manager, version 5.4.1 (Cochrane), program. Table E1 lists all accounts and handles.

      Results

      Overview

      One hundred twenty-two thoracic surgery programs were identified from the ACGME database. There were 74 independent, 33 integrated programs, and 15 congenital at the 78 US teaching institutions. Of 137 social media accounts from the 78 US cardiothoracic surgery teaching institutions, 72 of 137 (52.6%) were on Twitter, 34 of 137 (24.8%) on Facebook, and 31 of 137 (22.6%) on Instagram. Most accounts were departmental accounts (105/137 = 76.6%) versus 32 of 137 (23.4%) training program accounts. Congenital cardiac surgery fellowships did not have any social media presence at the time of data collection.
      Most training program-specific social media accounts across all platforms were created after the COVID-19 pandemic (25/32 = 78.1%) (P < .001), whereas most departmental accounts were created before the pandemic (85/105 = 81%) (P < .001). The most pronounced social media growth was in Instagram at the training program level, as 91.7% of Instagram accounts were created after the pandemic. Across all platforms, 32.8% of all accounts were created after March 1, 2020. About 16.4% of the programs announced cardiothoracic surgery residence/fellowship virtual open house on different social media platforms or official websites; however, virtual sub-internships were not found.
      Of note, all programs had representative websites that were easily identifiable by a Google search. Eighty-seven of 122 programs (71.3%) had social media accounts for the program director. There were 95 program directors for 122 programs, and 74.7% of program directors had some form of personal social media presence across platforms.
      The content creation survey response rate was 20.9% for a total of 36 accounts with information on content creators. Trainees managed or comanaged content creation in 63.9% of all social media accounts. Specifically, trainees managed or comanaged content creation for 94% of the training program's social media accounts, whereas 66.7% of departmental-level accounts' social media content was managed by a communication professional from the media department, marketing team, or program administrator.

      Twitter

      There were 72 Twitter accounts; 55 were departmental level accounts, and 17 were training program accounts, as shown in Table 1. Most training program Twitter accounts were created after the pandemic, P = .004 (Figure 1). The median number of residency accounts' tweets per month (based on available data from 133 accounts) increased significantly after the pandemic from 0 (range, 0.3-31.1 tweets) to 4 (range, 0-14.9 tweets); P = .005 (Table 1). Trainees managed content creation for all Twitter training program accounts, and 68.2% of all Twitter accounts responded to the survey.
      Table 1Twitter descriptive statistics for the cardiothoracic surgery programs
      ParameterBefore March 2020, total no. (%)After March 2020, total no. (%)P value
      Residency4 (23.5%)13 (76.5%).004
      Department44 (80%)11 (20%)<.001
      Total48 (66.7%)24 (33.3%)<.001
      Number of tweets, median (range)
       Residency0 (0-14.9)4 (0.3-31.1).005
       Department16.9 (0-140.5)20.25 (0-458.9).265
      Independent
       Residency10 (71.4%)4 (28.6%).04
       Department10 (18.5%)44 (81.5%)<.001
       Total20 (29.4%)48 (70.6%)<.001
      Integrated
       Residency3 (100%)0 (0%).07
       Department1 (100%)0 (0%).34
       Total4 (100%)0 (0%).04
      Figure thumbnail gr1
      Figure 1Social media use by cardiothoracic surgery program across platforms over time as measured by new accounts created.

      Instagram

      Thirty-one accounts were identified on Instagram: 19 were departmental, and 12 were training program accounts (Table 2). Most training program Instagram accounts were created after the pandemic (P = .001). Trainees managed content creation of 80% of training programs' Instagram accounts and 75% of all Instagram accounts.
      Table 2Instagram descriptive statistics for the cardiothoracic surgery programs
      ParameterBefore March 2020, total no. (%)After March 2020, total no. (%)P value
      Residency1 (8.3%)11 (91.7%).001
      Department14 (73.7%)5 (26.3%).005
      Total15 (48.4)16 (51.6%).80
      Independent
       Residency9 (100%)0 (0%).003
       Department5 (26.3%)14 (73.6%).005
       Total14 (50%)14 (50%).11
      Integrated
       Residency2 (66.7%)1 (33.3%).42
       Department00NA
       Total2 (66.7%)1 (33.3%).42
      NA, Not applicable.

      Facebook

      Thirty-four accounts were identified on Facebook: 3 residency accounts and 31 department accounts (Table 3). There was no significant change in the number of residency accounts number, before or after the pandemic (P = .42) (Figure 1 and Table 3). Trainees created content for 33% of all Facebook accounts.
      Table 3Facebook descriptive statistics for the cardiothoracic surgery programs
      ParameterBefore March 2020 total no. (%)After March 2020 total no. (%)P value
      Residency2 (66.7%)1 (33.3%).42
      Department27 (87.1%)4 (12.9%)<.001
      Total29 (85.3%)5 (14.7%)<.001
      Independent
       Residency1 (33.3%)2 (66.7%).16
       Department3 (10.3%)26 (89.7%)<.001
       Total4 (12.5%)28 (87.5%)<.001
      Integrated
       Residency00
       Department1 (50%)1 (50%).999
       Total1 (50%)1 (50%).999

      Discussion

      In this first study assessing the use of social media platforms by academic cardiothoracic surgery programs during the COVID pandemic, we found that (1) most academic cardiothoracic surgery programs have at least 1 social media platform, with Twitter being the most common; (2) social media presence by cardiothoracic surgery training programs and departments has increased during the pandemic, and that (3) trainees largely manage content on cardiothoracic social media accounts. The findings have several relevant implications.
      With the COVID-19 pandemic, in-person interviews, hospital tours, preinterview mixers, and social breaks have been replaced by one virtual interview, losing the social aspect of the interview and, along with it, the “gut feeling” that a program is right for the residency or fellowship candidate. Digital presence comes in many forms, and it is important for programs to have up to date social media and websites to highlight their faculty and trainees, and attract candidates.
      • Nelson D.B.
      • White P.T.
      • Rajaram R.
      • Antonoff M.B.
      Showcasing your cardiothoracic training program in the virtual era.
      • Rajaram R.
      • Abreu J.A.
      • Mehran R.
      • Nguyen T.C.
      • Antonoff M.B.
      • Vaporciyan A.
      Using quality improvement principles to redesign a cardiothoracic surgery fellowship program website.
      • Miller V.M.
      • Padilla L.A.
      • Schuh A.
      • Mauchley D.
      • Cleveland D.
      • Aburjania Z.
      • et al.
      Evaluation of cardiothoracic surgery residency and fellowship program websites.
      Recent studies have highlighted how redesigned training program websites can help showcase what training programs have to offer.
      • Nelson D.B.
      • White P.T.
      • Rajaram R.
      • Antonoff M.B.
      Showcasing your cardiothoracic training program in the virtual era.
      • Rajaram R.
      • Abreu J.A.
      • Mehran R.
      • Nguyen T.C.
      • Antonoff M.B.
      • Vaporciyan A.
      Using quality improvement principles to redesign a cardiothoracic surgery fellowship program website.
      • Miller V.M.
      • Padilla L.A.
      • Schuh A.
      • Mauchley D.
      • Cleveland D.
      • Aburjania Z.
      • et al.
      Evaluation of cardiothoracic surgery residency and fellowship program websites.
      In the eyes of candidates, social media is one aspect of bridging the gap and replacing some of the social element that is lost behind the screen.
      • Renew J.R.
      • Ladlie B.
      • Gorlin A.
      • Long T.
      The impact of social media on anesthesia resident recruitment.
      While training program social media accounts are meant to attract potential future trainees, departmental accounts tend to attract a different following—primarily potential patients and employees.
      Our study showed that Instagram accounts for training programs saw the most growth recently, and most accounts were created after the pandemic. A similar trend was seen in other specialties in recent years.
      Coalition for physician accountability releases recommendations on 2021-22 residency season interviewing. The match, national resident matching program.
      ,
      • Yong T.M.
      • Pappas M.A.
      • Ray G.S.
      • McManus T.G.
      • Coe M.P.
      Analyzing the proliferation of social media use among orthopaedic surgery residency programs.
      ,
      • Ho P.
      • Margolin E.
      • Sebesta E.
      • Small A.
      • Badalato G.M.
      #AUAMatch: the impact of COVID-19 on social media use in the urology residency match.
      ,
      • Kim Y.H.
      • Ali N.S.
      • Vidal N.Y.
      Social media use in residency recruitment during the COVID-19 pandemic.
      Instagram is viewed as the most highly engaged social platform, and users regularly interact with posts, whereas Twitter is the least engaged platform. Forty percent of adults use Instagram, about double that of Twitter.
      Social media use in 2021. Pew research center: internet, science & tech.
      So, although the largest increase in social media use noted in this study was on Instagram, the most commonly used social media platform by cardiothoracic surgery residency programs overall was Twitter. Twitter is used by 22% of the US population, and one study shows that Twitter users, on average, have a greater level of education than the general public.
      How twitter users compare to the general public. Pew research center: internet, science & tech.
      It is a platform that is generally preferred by professionals in the medical field as a means of networking, circulating research, advocacy, and showing one's accomplishments. In one study evaluating the use of Twitter among residency applicants, the majority of applicants reported using the platform to gain information about residency programs.
      • Friedman B.J.
      • Chen I.
      • Asantey K.
      • Loeb S.
      • Kim S.P.
      • Malik R.D.
      • et al.
      Twitter engagement of medical students applying to urology residency during COVID-19: a mixed methods study.
      The recent rise in Instagram use is likely a reflection of the current generational makeup of current trainees and prospective candidates. Instagram does not have the character limitations of Twitter, relies on visual media such as pictures and videos rather than text, and may be more useful to showcase the social aspects of a training program. However, a direct comparison of the platform preferences between academic programs versus the general population is not possible.
      The results demonstrate how cardiothoracic training programs increased social media presence during the pandemic. We hypothesize this was to maximize the outreach for candidates and highlight critical areas for future direction. Since the start of the COVID-19 pandemic, medical education and the process of the medical residency program application cycle have dramatically changed. Zoom meetings, virtual interviews, online teaching, and telehealth are the norm nowadays. Our results showed a significant “surge” in residency accounts created and residency accounts' tweets posted after March 2020, coinciding with the initial period of the COVID pandemic. Similarly, these findings were parallel to other specialties' findings on social media usage.
      Coalition for physician accountability releases recommendations on 2021-22 residency season interviewing. The match, national resident matching program.
      ,
      • Yong T.M.
      • Pappas M.A.
      • Ray G.S.
      • McManus T.G.
      • Coe M.P.
      Analyzing the proliferation of social media use among orthopaedic surgery residency programs.
      ,
      • Ho P.
      • Margolin E.
      • Sebesta E.
      • Small A.
      • Badalato G.M.
      #AUAMatch: the impact of COVID-19 on social media use in the urology residency match.
      That being said, it is difficult to confidently ascertain whether the pandemic directly caused the increase in social media presence. Extrapolating from business models, adoption of new technology follows an S curve with 4 stages: initial slow growth, rapid growth, late-stage slow growth, and stationary demand. Whether the year of the pandemic just happened to coincide with the stage of rapid growth, or did the pandemic itself shift the curve for an earlier rapid growth stage is not certain. We favor the latter, as we believe that the pandemic may have served as a catalyst for social media adoption.
      Other benefits of social media should not be overlooked. Corsini and colleagues
      • Corsini E.M.
      • Luc J.G.Y.
      • Antonoff M.B.
      Women in thoracic surgery: social media and the value of mentorship.
      ,
      • Corsini E.M.
      • Boeck M.
      • Hughes K.A.
      • Logghe H.J.
      • Pitt S.C.
      • Stamp N.
      • et al.
      Global impact of social media on women in surgery.
      highlighted the little-talked-about benefits of social media for underrepresented minorities, specifically for women in surgery, in networking, sponsorship and mentorship. Women remain a minority in surgical fields, and women surgeons often report that lack of mentorship is a prominent barrier for career selection. Mentorship and networking for women physicians through social media has been found to be successful and highly desired by mentees in cardiothoracic surgery as well as other medical fields.
      • Luc J.G.Y.
      • Stamp N.L.
      • Antonoff M.B.
      Social media as a means of networking and mentorship: role for women in cardiothoracic surgery.
      ,
      • Ernst M.
      • Badkhshan S.
      #UroStream101: social media as a medium for mentorship in urology.
      Social media and other virtual platforms help to bridge the gap and connect individuals who may not have in-person opportunities.
      One key finding from the present study is the fact that trainees manage almost all training program social media platforms and a large number of department accounts, keeping in mind that in some instances, the departmental accounts include the training program accounts and there is no separation of accounts. That is concerning because medical training lacks social media training. Another concern is that trainees likely do not get protected time nor reimbursement for their time spent on work-related social media matters. When the lines are blurred, there is room for error, unprofessional behavior, and Health Insurance Portability and Accountability Act violations.
      15+ real-world examples of social media HIPAA violations—etactics.
      Portraying a professional online persona while demonstrating the enjoyable and humane aspect of residency to prospective candidates and the rest of the world is not a simple task. Social media is a powerful tool that can have many benefits when used properly. However, it can be a double-edged sword. Improper use of social media has led to retracted peer-reviewed papers and even termination of employment.
      • Ventola C.L.
      Social media and health care professionals: benefits, risks, and best practices.
      A Washington ER doctor was allegedly terminated after publicly criticizing his hospital for not protecting its staff. Time.
      • Hardouin S.
      • Cheng T.W.
      • Mitchell E.L.
      • Raulli S.J.
      • Jones D.W.
      • Siracuse J.J.
      • et al.
      Prevalence of unprofessional social media content among young vascular surgeons.
      Providing trainees proper training in social media and adequate ancillary support to do it is needed. Social media training has been shown to decrease inappropriate or unprofessional online behavior.
      What's up, doc? Emergency room doctor fired for posting photos on Facebook. TLNT.
      Although we all agree that doctors are human and they make mistakes, the reality is that doctors are held to a higher standard in the eyes of their colleagues and the public.
      What's up, doc? Emergency room doctor fired for posting photos on Facebook. TLNT.
      Professionalism in the use of social media. American medical association.
      How social media can aid medical residency program searches. American Medical Association.
      • Kilic Y.
      • Chauhan D.
      • Avery P.
      • Horwood N.
      • Nakov R.
      • Disney B.
      • et al.
      The public's attitude towards doctors' use of Twitter and perceived professionalism: an exploratory study.
      To mitigate this, several medical associations, such as the American Medical Association and American Medical Student Association, have published material on social media etiquette.
      Social media guidelines for medical students and physicians. AMSA.
      There are also ethical standards in social media participation published specifically pertaining to cardiothoracic surgery, and we suggest its incorporation into the residency curriculum.
      • Varghese Jr., T.K.
      • Entwistle III, J.W.
      • Mayer J.E.
      • Moffatt-Bruce S.D.
      • Sade R.M.
      Cardiothoracic Ethics Forum. Ethical standards for cardiothoracic surgeons' participation in social media.
      This study has several limitations. First, this is an observational study of publicly accessible accounts. It is unknown whether there are private accounts that some programs send specific invites to medical students or interview candidates. Second, given the rapidly growing nature of social media that could cause chronologically dependent variability, we are limited by the events and programs up to the “last accessed date” of each account by this study's authors. Some platforms, such as Instagram, have time-limited features or vanishing content, and therefore we have no access to that if it was created in the past. Moreover, we do not have data on the social media accounts of prospective candidates, nor of individual faculty accounts that post or tweet on behalf of their institutions if there are institutional restrictions on departmental account creation. Finally, a report on the actual individual content of tweets and posts is beyond the scope of this paper. As such, we are unable to assess the intent of the increase of social media presence, nor are we able to estimate whether this increased utilization was more effective in terms of candidate recruitment. Notwithstanding these limitations, we believe the results are timely and essential for trainees and training programs to be aware of to find and provide the most relevant information on these rapidly expanding platforms.
      • McHugh S.M.
      • Shaffer E.G.
      • Cormican D.S.
      • Beaman S.T.
      • Forte P.J.
      • Metro D.G.
      Use of social media resources by applicants during the residency selection process.
      In this study, we viewed the increased social media presence as a positive, and that programs have “adapted” to the constraints of the pandemic. It would be prudent to balance the discussion with an opposing view, mentioning the potential negative effects of social media. These include digital overload, peer pressure, unrealistic expectations by candidates about programs or the fear of missing out (ie, “FOMO”), and trainee distraction. Indeed, several strategies of mental wellbeing include digital minimalism. These should be taken into consideration when analyzing the impact of social media.
      In conclusion, cardiothoracic surgery training programs and departments have adapted to the COVID-19 pandemic by increasing their social media presence, particularly on Instagram. Social media presence is largely driven and managed by trainees. Cardiothoracic training programs should invest in their social media presence to maximize their virtual reach and develop social media education and training pathways for involved trainees and faculty. Even as we emerge from the pandemic, social media is here to stay, and residency programs and departments will have to continue to adapt to the changing digital world. This generation will also soon become our patients, and being able to speak their language is an essential part of increasing trust in health care.

      Conflict of Interest Statement

      The authors reported no conflicts of interest.
      The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

      Appendix E1

      Table E1List of institutions and training programs with their respective social media accounts
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director SoMe platform
      University of Alabama Medical CenterUABSurgery
       IndependentWeiLinkedIn
      University of Arizona College of Medicine-TucsonUofAZSurgeryuofazsurgery
       IndependentUAsurgeryFoxLinkedIn
      UCLA David Geffen School of MedicineUCLASurgery
       IndependentSheminTwitter
      University of California (San Francisco)UCSFSurgeryucsfsurgery
       IndependentSurgeryFresnoUCSFKratzLinkedIn
      Stanford Health Care-Sponsored Stanford UniversityStanfordCTSurg
       IndependentstanfordctsurgStanfordSurgeryFischbein
       IntegratedFischbein
       CongenitalMainwaringLinkedIn
      Loma Linda University Health Education Consortium
       IndependentRazzoukLinkedIn
      University of California (San Diego) Medical CenterUCSDsurgeryhumansofsurgery
       IndependentThistlethwaiteLinkedIn
      University of California Davis HealthUCDavisSurgery
       IndependentUcSurgeryucdavissurgeryCardiothoracicSurgeryCookeLinkedIn + Twitter
       IntegratedRaff
      University of Southern CaliforniaFightOnThoracicusccardiacsurgery
       IndependentUSCCardiacSurgeryBakerLinkedIn + Twitter
       IntegratedBakerLinkedIn + Twitter
       CongenitalCleveland
      Cedars-Sinai Medical CenterDeptSurgeryCS
       IndependentCheng
       IntegratedCheng
      University of ColoradoCUDeptSurg
       IndependentFullerton
       CongenitalJaggersLinkedIn
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director's SoMe platform
      Yale-New HavenYaleCardiacSurgyalectsurgery
       IndependentDetterbeckLinkedIn
       IntegratedyalectsurgeryDetterbeckLinkedIn
      University of FloridaUFSurgery
       IndependentManningLinkedIn
       IntegratedManningLinkedIn
      University of Miami/Jackson Health System
       IndependentLamelasLinkedIn + Twitter
      Emory University School of MedicineEmoryCTSurgery
       IndependentemorycardiothoracicsurgeryEmoryCardiacSurgeryResidencyPickensLinkedIn + Twitter
       IntegratedPickensLinkedIn + Twitter
       CongenitalShashidharanLinkedIn
      McGaw Medical Center of Northwestern UniversityNM_Lung
       IndependentNorthwesternMedicineThoracicSurgeryChicagoILMalaisrieTwitter
       IntegratedMalaisrieTwitter
       CongenitalMonge
      Rush University Medical CenterRushSurgery
       IndependentrushctsurgerySederLinkedIn
      University of Chicagouchicagosurgery
       IndependentUChicagoCTSurgUChicagoSurgeryFergusonLinkedIn
      Loyola University Medical CenterLoyolaSurgery
       IndependentloyolathoraciccvfellowsPerez-TamayoLinkedIn
      Indiana University School of MedicineIU_SurgeryIU_surgery
       IndependentIusurgeryLeeLinkedIn
       IntegratedLeeLinkedIn
      Educational institution and program typeTwitterInstagramFacebookProgram directorPD SoMe platform
      University of Iowa Hospitals and ClinicsUIowa_SurgeryUIowa_surgery
       IndependentKeechLinkedIn
       IntegratedKeechLinkedIn
      University of Kansas School of MedicineKU_SurgeryKUMedicalCenterDepartmentofSurgery
       IndependentDaon
       CongenitalO'BrienLinkedIn
      University of Louisville School of MedicineUofL_cts
       IndependentUofLCTSurgerySlaughterLinkedIn
      University of Kentucky College of MedicineUKSurgeryDept
       IndependentThoracicUkUKCardiothoracicSurgeryClinicMeyersonTwitter
       IntegratedMeyersonTwitter
      Ochsner Clinic Foundation
       IndependentGaudetLinkedIn
      Johns Hopkins UniversityHopkinsCTSurg
       Independent
      University of MarylandMarylandSurg
       IndependentMarylandCTSurgKilicTwitter
       IndependentForbessLinkedIn
       IntegratedForbessLinkedIn
      Massachusetts General HospitalMGHSurgeryMGHthoracicsurgery
       IndependentMGHctsurgeryMorseLinkedIn
       CongenitalFynn-ThompsonLinkedIn
      Beth Israel Deaconess Medical CenterBIDMCSurgery
       IndependentGangadharanLinkedIn + Twitter
      Tufts Medical Center
       IndependentChen
      Brigham and Women's HospitalBrighamThoracic
       IndependentJaklitschTwitter
       IntegratedJaklitschTwitter
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director SoMe platform
      University of Michigan Health SystemUMichSurgeryMichigan_surgery
       IndependentUMichCTSurgeryChang
       IntegratedChang
       CongenitalRomanoTwitter
      University of MinnesotaUMNSurgery
       IndependentDepartment-of-Surgery-University-of-MinnesotaKellyLinkedIn
      Mayo Clinic RochesterMayoClinicCVS
       IndependentShenLinkedIn
      University of Mississippi Medical CenterUMMCsurgery
       IndependentUMMC_ctsurgresUMMC_ctsurgresUMMCsurgeryde DelvaLinkedIn
      Washington University/B-JH/SLCH ConsortiumWashU_CTWashUsurg
       IndependentUWCTSurgResWashUSurgeryPuri
       CongenitalEghtesadyLinkedIn
      University of Nebraska Medical Center
       IndependentLackner
      Rutgers Health/Newark Beth Israel Medical Center
       IndependentKaranamLinkedIn
      Memorial Sloan Kettering Cancer CenterMSK_Thoracic
       IndependentHuangLinkedIn
      Albany Medical Center
       IndependentFabianLinkedIn
      New York Presbyterian Hospital (Cornell Campus)WCM_CTSurgeryWCMsurgery
       IndependentGirardi
       IntegratedArgenzianoLinkedIn
      Icahn School of Medicine at Mount SinaiSHSSurgerySinaithoracic
       IndependentAdams
       IntegratedBoateng
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director SoMe platform
      Oregon Health & Science UniversityOHSUsurgery
       IndependentSchipper
      Temple University HospitalTempleSurgery
       IndependentErkmen
      Penn State Milton S Hershey Medical CenterPSU_Surgery
       IndependentReedLinkedIn
      University of Pennsylvania Health Systempennsurgerypennsurgery
       IndependentCevasco
       IntegratedCevasco
       CongenitalFullerLinkedIn
      UPMC Medical EducationUPMC_CTSurgery
       Independentupmc_ctsurgSchuchertLinkedIn
       IntegratedSchuchertLinkedIn
      Allegheny Health Network Medical Education Consortium (AGH)
       IndependentMcGregor
      Vanderbilt University Medical Center
       IndependentVUMCSurgResNesbitt
      Methodist Hospital (Houston)HMethodistCVHMSurgicalAssociatesWest
       IndependentReulTwitter
      Baylor University Medical Center
       IndependentDiMaioLinkedIn
      University of Texas Medical Branch HospitalsUTMB_CTSurgery
       IndependentLickLinkedIn
      University of Texas MD Anderson Cancer Center/University of Texas Medical School at Houston
       IndependentAntonoffLinkedIn + Twitter
      Spectrum Health/Michigan State UniversityMSU_SurgeryMSUsurgery
       IndependentSpurlock
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director SoMe platform
      Montefiore Medical Center/Albert Einstein College of Medicine
       IndependentDeRoseLinkedIn
       IntegratedDeRoseLinkedIn
      Zucker School of Medicine at Hofstra/Northwell
       IndependentLICTSurgeonManettaLinkedIn
       IntegratedManettaLinkedIn
      NYU Grossman School of Medicine
       IndependentGrossiLinkedIn
       IntegratedGrossiLinkedIn
      University of RochesterURochesterSurgurmc.ct.surgery
       IndependentURMCsurgeryresidencyPeyreLinkedIn
       IntegratedPeyreLinkedIn
      Vidant Medical CenterECUSurgery
       IndependentECU_ThoracicECUSurgerySpeicherLinkedIn
      Wake Forest University School of Medicine
       IndependentKincaid
      Duke University HospitalDukeCTSurgeryDukesurgery
       IndependentHaneyLinkedIn
       IntegratedHaneyLinkedIn
       CongenitalTurekTwitter
      Case Western Reserve University/University Hospitals Cleveland Medical Center
       IndependentUHCTSurgeryLindenLinkedIn
      Cleveland Clinic Foundation
       IntegratedJohnstonLinkedIn
       IndependentCleveland-Clinic-Thoracic-and-Cardiovascular-SurgeryJohnstonLinkedIn
       CongenitalKaramlouLinkedIn
      Ohio State University HospitalOhioStateSurg
       IndependentMokadamLinkedIn + Twitter
       IntegratedMokadamLinkedIn + Twitter
      Educational institution and program typeTwitterInstagramFacebookProgram directorProgram director SoMe platform
      Texas Heart Institute/Baylor College of MedicineBCM_ThoracicBCM_surgeryBCMSurgery
       IndependentBCM_CTSurgeryBCM_ctsurgeryCoselliLinkedIn + Twitter
      Baylor College of Medicine
       IntegratedCoselliLinkedIn + Twitter
       CongenitalCaldarone
      University of Texas Southwestern Medical CenterUTSW_SurgeryUTSWsurgery
       IndependentReznikTwitter
      University of Utah HealthUofUSurgery
       IndependentUniversity of Utah Department of SurgeryPereiraLinkedIn + Twitter
       IntegratedPereiraLinkedIn + Twitter
      University of Virginia Medical Center
       IndependentUVA_TCV_SurgeryKernLinkedIn
       IntegratedKernLinkedIn
      Virginia Commonwealth University Health SystemVCU_SurgeryVCUsurgery
       IndependentShahLinkedIn
      University of WashingtonUWSurgeryUWDOS
       IndependentUWCTSurgResUWCTsurgeryresidentsBerfieldLinkedIn
       IntegratedBerfieldLinkedIn
       CongenitalPermutLinkedIn
      West Virginia University School of MedicineWVU_surgery
       IndependentCookLinkedIn
      Medical College of Wisconsin Affiliated Hospitals, IncmcwsurgeryMCWSurgery
       IndependentMCWSurgeryJohnstoneLinkedIn
      University of Wisconsin Hospitals and ClinicsWiscSurgeryWiscsurgeryUWsurgery
       IndependentDeCampLinkedIn
      University of North Carolina HospitalsUNCSurgery
       IntegratedUNCCTsurgeryUNC_CT_surgeryHaithcockTwitter
      Medical University of South Carolina
       IntegratedCT_MUSCMUSCi6residencyKatzLinkedIn + Twitter
      University of Texas Health Science Center San AntonioUTHealthSA_CTSUTHealthSACTS
       IntegratedUTHealthSA_CTSCarpenterLinkedin
      University of Cincinnati Medical Centerucincinnatictsurgery
       IndependentUCincyCTSurgStarnesLinkedIn + Twitter
       IntegratedStarnesLinkedIn + Twitter
       CongenitalTweddellLinkedIn
      SoMe, Social media.

      References

        • Luc J.G.Y.
        • Archer M.A.
        • Arora R.C.
        • Bender E.M.
        • Blitz A.
        • Cooke D.T.
        • et al.
        Social media improves cardiothoracic surgery literature dissemination: results of a randomized trial.
        Ann Thorac Surg. 2020; 109: 589-595https://doi.org/10.1016/j.athoracsur.2019.06.062
        • Corsini E.M.
        • Luc J.G.Y.
        • Antonoff M.B.
        Women in thoracic surgery: social media and the value of mentorship.
        J Thorac Dis. 2021; 13: 464-472https://doi.org/10.21037/jtd.2020.04.11
        • Luc J.G.Y.
        • Archer M.A.
        • Arora R.C.
        • Bender E.M.
        • Blitz A.
        • Cooke D.T.
        • et al.
        The thoracic surgery social media network experience during the COVID-19 pandemic.
        Ann Thorac Surg. 2020; 110: 1103-1107https://doi.org/10.1016/j.athoracsur.2020.05.006
        • Giordano L.
        • Cipollaro L.
        • Migliorini F.
        • Maffulli N.
        Impact of Covid-19 on undergraduate and residency training.
        Surgeon. 2021; 19: e199-e206https://doi.org/10.1016/j.surge.2020.09.014
      1. Coalition for physician accountability releases recommendations on 2021-22 residency season interviewing. The match, national resident matching program.
        • Klammer R.M.
        • Haydel M.J.
        • Gallahue F.
        • Bruno E.C.
        • Langdorf M.I.
        • Cheaito M.A.
        • et al.
        Program visits and residency interviews.
        J Emerg Med. 2019; 57: e133-e139https://doi.org/10.1016/j.jemermed.2019.04.028
        • Yong T.M.
        • Pappas M.A.
        • Ray G.S.
        • McManus T.G.
        • Coe M.P.
        Analyzing the proliferation of social media use among orthopaedic surgery residency programs.
        JB JS Open Access. 2021; 6: e21.00017https://doi.org/10.2106/JBJS.OA.21.00017
        • Ho P.
        • Margolin E.
        • Sebesta E.
        • Small A.
        • Badalato G.M.
        #AUAMatch: the impact of COVID-19 on social media use in the urology residency match.
        Urology. 2021; 154: 50-56https://doi.org/10.1016/j.urology.2021.05.019
        • Gaini R.R.
        • Patel K.M.
        • Khan S.A.
        • Singh N.P.
        • Love M.N.
        A rise in social media utilization by U.S. neurology residency programs in the era of COVID-19.
        Clin Neurol Neurosurg. 2021; 207: 106717https://doi.org/10.1016/j.clineuro.2021.106717
        • Clay Pruett J.
        • Deneen K.
        • Turner H.
        • Kozar T.
        • Singh N.P.
        • King T.W.
        • et al.
        Social media changes in pediatric residency programs during COVID-19 pandemic.
        Acad Pediatr. 2021; 21: 1104-1107https://doi.org/10.1016/j.acap.2021.06.004
        • Fang H.A.
        • Boudreau BS H.
        • Khan S.
        • Singh N.P.
        • Rais-Bahrami S.
        • King T.W.
        • et al.
        An evaluation of social media utilization by general surgery programs in the COVID-19 era.
        Am J Surg. 2021; 222: 937-943https://doi.org/10.1016/j.amjsurg.2021.04.014
      2. Tweet stats.
        https://new.tweetstats.com/
        Date accessed: January 8, 2022
        • Nelson D.B.
        • White P.T.
        • Rajaram R.
        • Antonoff M.B.
        Showcasing your cardiothoracic training program in the virtual era.
        Ann Thorac Surg. 2021; 111: 1102-1110https://doi.org/10.1016/j.athoracsur.2021.01.022
        • Rajaram R.
        • Abreu J.A.
        • Mehran R.
        • Nguyen T.C.
        • Antonoff M.B.
        • Vaporciyan A.
        Using quality improvement principles to redesign a cardiothoracic surgery fellowship program website.
        Ann Thorac Surg. 2021; 111: 1079-1085https://doi.org/10.1016/j.athoracsur.2020.05.158
        • Miller V.M.
        • Padilla L.A.
        • Schuh A.
        • Mauchley D.
        • Cleveland D.
        • Aburjania Z.
        • et al.
        Evaluation of cardiothoracic surgery residency and fellowship program websites.
        J Surg Res. 2020; 246: 200-206https://doi.org/10.1016/j.jss.2019.09.009
        • Renew J.R.
        • Ladlie B.
        • Gorlin A.
        • Long T.
        The impact of social media on anesthesia resident recruitment.
        J Educ Perioper Med. 2019; 21: E632
        • Kim Y.H.
        • Ali N.S.
        • Vidal N.Y.
        Social media use in residency recruitment during the COVID-19 pandemic.
        Dermatol Online J. 2021; 27https://doi.org/10.5070/D327654053
      3. Social media use in 2021. Pew research center: internet, science & tech.
      4. How twitter users compare to the general public. Pew research center: internet, science & tech.
        • Friedman B.J.
        • Chen I.
        • Asantey K.
        • Loeb S.
        • Kim S.P.
        • Malik R.D.
        • et al.
        Twitter engagement of medical students applying to urology residency during COVID-19: a mixed methods study.
        Urology. 2022; 165: 120-127https://doi.org/10.1016/j.urology.2021.11.046
        • Corsini E.M.
        • Boeck M.
        • Hughes K.A.
        • Logghe H.J.
        • Pitt S.C.
        • Stamp N.
        • et al.
        Global impact of social media on women in surgery.
        Am Surg. 2020; 86: 152-157
        • Luc J.G.Y.
        • Stamp N.L.
        • Antonoff M.B.
        Social media as a means of networking and mentorship: role for women in cardiothoracic surgery.
        Semin Thorac Cardiovasc Surg. 2018; 30: 487-495https://doi.org/10.1053/j.semtcvs.2018.07.015
        • Ernst M.
        • Badkhshan S.
        #UroStream101: social media as a medium for mentorship in urology.
        Urology. 2021; 158: 39-44https://doi.org/10.1016/j.urology.2021.08.001
      5. 15+ real-world examples of social media HIPAA violations—etactics.
        • Ventola C.L.
        Social media and health care professionals: benefits, risks, and best practices.
        P T. 2014; 39: 491-520
      6. A Washington ER doctor was allegedly terminated after publicly criticizing his hospital for not protecting its staff. Time.
        • Hardouin S.
        • Cheng T.W.
        • Mitchell E.L.
        • Raulli S.J.
        • Jones D.W.
        • Siracuse J.J.
        • et al.
        Prevalence of unprofessional social media content among young vascular surgeons.
        J Vasc Surg. 2020; 72 ([retracted article]): 667-671
      7. What's up, doc? Emergency room doctor fired for posting photos on Facebook. TLNT.
      8. Professionalism in the use of social media. American medical association.
      9. How social media can aid medical residency program searches. American Medical Association.
        • Kilic Y.
        • Chauhan D.
        • Avery P.
        • Horwood N.
        • Nakov R.
        • Disney B.
        • et al.
        The public's attitude towards doctors' use of Twitter and perceived professionalism: an exploratory study.
        Clin Med (Lond). 2021; 21: e475-e479https://doi.org/10.7861/clinmed.2021-0357
      10. Social media guidelines for medical students and physicians. AMSA.
        • Varghese Jr., T.K.
        • Entwistle III, J.W.
        • Mayer J.E.
        • Moffatt-Bruce S.D.
        • Sade R.M.
        Cardiothoracic Ethics Forum. Ethical standards for cardiothoracic surgeons' participation in social media.
        Ann Thorac Surg. 2019; 108: 666-670https://doi.org/10.1016/j.athoracsur.2019.04.003
        • McHugh S.M.
        • Shaffer E.G.
        • Cormican D.S.
        • Beaman S.T.
        • Forte P.J.
        • Metro D.G.
        Use of social media resources by applicants during the residency selection process.
        J Educ Perioper Med. 2014; 16: E071