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ORIGINAL ARTICLE
Year : 2023 | Volume
: 31
| Issue : 1 | Page : 18-22
The attitudes of plastic, reconstructive, and esthetic surgery residents toward social media usage
Cagla Cicek, Mehmet Akkurt, Gaye Filinte
Department of Plastic, Reconstructive and Aesthetic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul, Turkey
Correspondence Address:
Dr. Cagla Cicek
E-5 Karayolu Üzeri, Şemsi Denizer Caddesi, Kartal Dr. Lütfi Kırdar Şehir Hastanesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Kliniği, 6. Kat Kartal, İstanbul
Turkey
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/tjps.tjps_59_22
Aims: Plastic, reconstructive, and esthetic surgeons and practitioners associated with medical tourism actively use social media platforms to disseminate or receive information on medical technologies and developments, professional news, and academic productions, as well as to advertise, promote, or even educate the public about their professions. The present study analyzes the perspectives of plastic, reconstructive, and esthetic surgery residents on social media use in this context. Subjects and Methods: A survey consisting of 14 multiple-choice questions was administered to plastic surgery residents who were continuing their specialty training. Statistical Analysis: Research data were evaluated using SPSS 20.0. Normality assumptions were checked for the variables, and cross tables and Chi-square statistics were used to evaluate the differences between groups. P = 0.05 or less was considered significant in all tests. Results: This study found that most plastic surgery residents did not have professional social media accounts, possibly owing to a hesitation to open a professional social media account during residency training. Consistent with the literature, most plastic surgery residents thought that social media use was a professional necessity that requires further training. Plastic surgeons must learn to use social media tools for patient education, advertising, and defense from inaccuracy. Formulating legal regulations in accordance with residents' attitudes has become a necessity in the changing world. Conclusions: Plastic surgeons lag behind in the ever-increasing competition for attention, and they must find a way of using social media tools for patient education, advertising, and defense from inaccuracy.
Keywords: Facebook, Instagram, plastic surgery residency, social media, Twitter
Social media is a term used to refer to the technological environment in which people share their thoughts, knowledge, and views with other people. Online forums, social networks, video-sharing sites, blogs, audio files, and online chat rooms are all various types of social media platform.[1] Thousands of gigabytes of data (pictures, sound recordings, videos, etc.) can be uploaded instantaneously on these platforms, all over the world. With the Web 2.0 design developed by Tim O'Reilly in 2004, internet content that could previously only be surfed can now be uploaded as user-created data.[2] Users can actively participate in creating shared content and can have a significant presence on the platforms. Social media has opened new horizons in terms of communication and interaction in the field of health,[3] and its uses and effects therein have become a new, exciting area of research. With the rise in medical tourism in Turkey, social media platforms have become increasingly important in recent years. Plastic, reconstructive, and esthetic surgeons working in medical tourism sector and in close contact with medical tourism actively use these platforms to share information about medical technologies and developments, to access professional news, to share medical experiences, to educate patients, to share academic productions, and to advertise and promote their professions. Since plastic, reconstructive, and esthetic surgery residents' perspectives on social media use are the main factor determining their social media behaviors and predispositions, the aim of this study was to analyze these perspectives.
Subjects and MethodsA survey consisting of 14 multiple-choice questions was administered to plastic surgery residents who were continuing their specialty training. Following approval from Kartal Dr. Lütfi Kırdar City Hospital Ethics Committee (Decision No: 2022/514/220/2), the questionnaire was sent to the Turkish Plastic, Reconstructive and Aesthetic Surgery Association's resident mailing group and shared on various social networks via the web-based application Google Forms. Participants responded on a voluntary basis, and the survey link was shared with the participants a total of three times, with a 2-week interval, between March 1, 2022, and April 1, 2022. On April 5, 2022, the survey link was removed from the web-based application. The goal was to reach all plastic surgery residents training throughout Turkey, regardless of gender or year of training. The questionnaire consisted of questions about demographics, preferred social media platforms, opinions about social media platforms, and characterizations of social media account interactions and how professional posts affect these. Research data were evaluated using SPSS 20.0 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). Descriptive statistics were presented as numbers and percentages and mean ± standard deviations. Normality assumptions were checked for the variables, and cross tables and Chi-square statistics were used to evaluate the differences between groups. P = 0.05 or less was considered statistically significant in all tests.
ResultsIn line with the data obtained from the Turkish Plastic, Reconstructive and Aesthetic Surgery Association, 161 of 294 residents undergoing specialty training (54.7%) participated in the survey. About half the respondents (50.3%) were aged 27–30, and 65 (40.3%) of them were in the first 2 years of residency training. Forty-three participants (26.7%) were in the last 2 years of residency training. One hundred and thirty-seven (85.0%) participants were male, 20 (12.4%) were female, and 4 identified as “other” (2.4%). Eighty-eight (54.5%) participants were pursuing their education in Istanbul and Ankara. Participation was lowest from foundation university hospitals (n = 2). By contrast, participation was highest from university hospitals (n = 96, 59%), followed by training and research hospitals (n = 40, 24.8%). For 138 participants (85.7%), Instagram was the most frequently used social media platform. Facebook was the least used social media platform (n = 3, 1.8%) [Table 1] and [Table 2]. Thirty-three and a half percent of the participants stated that they shared a personal post once a month (n = 54), while 31.0% shared a personal post once a week (n = 50). When asked whether they had a separate social media account for professional posts, 69.5% (n = 112) stated that they did not. Twenty-four (14.9%) participants who did have a professional social media account stated that they shared content from this account once a week. In another question analyzing the accounts with which the participants interacted, 122 (75.7%) respondents stated that 0%–20% of the accounts they followed belonged to plastic surgeons, whereas only three (1.9%) participants stated that 70%–100% of the accounts they followed did. Regardless of whether they have social media accounts, the participants were asked about the relevance of social media to plastic surgery; 71.4% (n = 115) of them stated that social media had a positive impact on the profession, but the second most frequent answer was that social media use had a negative impact on the profession. In a question about the purpose of plastic surgery posts on social media platforms, 54 (17.1%) participants stated that posts were shared in order to inform patients; 46 (14.6%) stated that posts were shared with the aim of educating young colleagues and guiding them academically; 116 (36.8%) stated that surgeons wanted to increase their patient numbers by reaching more people; and 99 (31.4%) stated that posts were shared for personal satisfaction and to increase popularity. When asked for their opinions on sharing patient data and the procedure applied on social media accounts, 42.2% (n = 68) of the participants stated that it is ethically unproblematic to share such data if the patient's personal information and details that could reveal their identities are not shared (even if the patient gives permission), whereas 31.6% (n = 51) stated that it is ethically appropriate to share patients' personal information given their permission. Thirty-five (21.7%) participants thought that no patient data should be shared whatsoever. Participants were asked the question, “To what extent do the images shared on social media reflect the surgeon's skill and success?” While 45.3% (n = 73) of the participants stated that these posts only contributed to the public's formulation of a general opinion about the surgeon's work, 37.8% (n = 62) of the participants stated that the shared data are not criteria for assessing the surgeon's skill or success. When asked whether they would like to receive training on social media use or management at any point in their careers, 55.9% (n = 90) of the participants said “yes” [Table 3] and [Table 4]. No significant difference was found between the preferred social media platforms, the frequency of shared posts, the increase in the number of plastic surgeon accounts followed, the perception of social media use having a positive or negative effect on one's plastic surgery career, or the perception about social media posts' ethical situation (with respect to the year of residency) (P > 0.05). However, there was a significant difference between the opinions of plastic surgery residents about the extent to which the patient photos shared on social media show the surgeon's skills and success with respect to their year of residency (P < 0.05). Furthermore, no statistically significant correlation was found between the institutions at which the participants were receiving training and the preferred social media platforms, the frequency of shared posts, the number of plastic surgeon accounts the participants followed, the perception of social media use having a positive or negative effect on one's plastic surgery career, the perception of whether or not social media posts are ethical, or the participants' views about the extent to which the photographs shared on social media reflect the skill and success of the surgeon (P > 0.05). A statistically significant relationship was found between the type of clinic with which plastic surgery residents are affiliated and the city in which the clinic is located (P < 0.05). No significant difference was found between male and female participants' tendencies or behavioral changes in social media use (P > 0.05). There was a statistically significant relationship between the social media platforms used by plastic surgery residents and the frequency of sharing on these platforms (P < 0.05). While Instagram users shared posts once a month and Facebook users shared posts once a week, residents with Twitter accounts did not share anything but used Twitter only to follow others. The social media platforms most frequently used by plastic surgery residents had a statistically significant relationship with the percentage of social media accounts the residents followed that were related to plastic surgery (P < 0.05). Accordingly, while Facebook users followed more plastic surgeons, Instagram and Twitter users followed fewer plastic surgeons.
DiscussionThe use of social media in plastic, reconstructive, and esthetic surgery is an issue that has increased in popularity in recent years with technological innovations. At the beginning of the 2000s, with the future potential of social media evident, plastic surgeons started to realize that social media can be one of the profession's most powerful marketing tools. A study conducted in the USA in 2019 showed that the determining factor in plastic surgeons' Google rankings was their social media footprint – rather than their academic background and experience.[4] While 1st-year residents feel that the shared content does not reflect a surgeon's talent and success, this opinion begins to shift in later years, where senior residents believe that shared content does reflect this. Over the years, academic education and residencies have become longer, and with increased interaction with patients, plastic surgery residents have developed an orientation in accordance with the perception of society in Dorfman's study.[4] Additionally, unlike other disciplines, plastic surgery predominantly consists of esthetic procedures, which requires the profession to be more visible on social media platforms. For this reason, it has become imperative to understand the use of these rapidly growing platforms and to invest in them.[5] There are studies showing that the target audience tends to evaluate social media posts according to their content. Gould et al. stated that the target audience wants to be exposed to the surgeon's social life, hobbies, and family life as well as their posts about the patients.[6] This is why not only professional but also social posts that may attract the target audience's attention are shared from professional accounts. The present study observed that most plastic surgery residents did not have professional social media accounts. Although there is no legal restriction on this issue, it was understood that resident physicians were hesitant to open a professional social media account during residency training. This suggested that they felt intimidated by the authority (clinical chief, administrative, and training officers) with whom they were affiliated for their training, or that they refrained from sharing professional content because they lacked information about legal responsibilities.
Plastic surgeons are creative and adaptable to innovations and new technologies.[7] This is a competitive advantage in the health-care industry. However, although social media is commonly used by plastic surgeons, very few of them have knowledge about effective social media use.[8],[9],[10] Consistent with the literature, most of plastic surgery residents who participated in the survey thought that the use of social media was a professional necessity and stated that they wanted to receive training on this subject. Ben Naftali et al. showed that posts related to patient education or academic studies attracted little attention, but photos of attractive women, personal posts, and surgical videos attracted more attention from nonusers of plastic surgery.[11] Although very few of the accounts that plastic surgery residents followed were plastic surgeon accounts, the participants' answer to the question “What is the purpose of plastic surgeons' social media posts?” was that informing patients and sharing academic information was not the main purpose of social media use for plastic surgeons. Residents do not follow plastic surgeons on social media because professional accounts are mostly results – oriented and designed to attract public attention, thus not intended for the education of young colleagues; on the contrary, social media accounts are used for popularity and personal satisfaction. This indicates that plastic surgery residents are aware of the fact that social media posts are tailored to users' expectations. With the introduction of Facebook in 2004, Twitter in 2006, and Instagram in 2010, there are currently more than 3.5 billion active social media users around the world.[12] Nadkarni and Hofmann showed that Facebook users mostly use this platform for shopping, organizing events, playing games, and sharing photos.[13] However, while Facebook attracts users aged 20–49 years, Instagram and Twitter are more popular among younger individuals (under 30 years old).[14] In the present study, more than 80% of the participants were under the age of 30 and the two most frequently used social media platforms were Twitter and Instagram. There are legal regulations in Turkey regarding the sharing of confidential patient information and the protection of patient privacy, as stated in Law No. 1219 on the Execution of Medical Sciences and the Regulation on Medical Deontology, which determines the principles of medical practice. Although the participants were not asked about this law or this regulation, they were thought to have sufficient knowledge of these issues, as the law and regulation are very old and the medical curriculum includes lectures about them. However, one of the biggest recent problems in all medical branches has been the performance of surgical and nonsurgical procedures by unauthorized persons and institutions. While it is legally impossible for physicians to post advertisements, promotions, or campaigns on social media in violation of ethical standards, unauthorized accounts share numerous posts that reach thousands of people every day. Most of the participants in the present study thought that sharing patient photos on social media (regardless of whether or not patient information is shared) is ethical. This indicates that the new generation of professionals is aware of the one-sided restriction in social media and has developed appropriate behavior. Perhaps, for lawmakers, this change and new understanding will guide the regulations in line with the current necessity of social media. One of the limitations of the study is the inability to contact more residents and the other is limited participation of residents for 4 years and more because the “senior” residents who are 4 years older or more will guide the social media in the future.
ConclusionsThe marriage of plastic surgery and social media is certainly here to stay. Plastic surgeons lag behind in the ever-increasing competition for attention, and they must find a way of using social media tools for patient education, advertising, and defense from inaccuracy. Understanding the attitudes of residents who will determine future trends and ensuring that legal regulations are established accordingly have become necessities in the changing world and the Internet era.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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