Dermatopathology and Social Media: A Survey of 131 Medical Professionals From 29 Countries

Although prior studies and treatises have discussed these aforementioned topics, the utility of social media as an educational and collaborative tool in the field of dermatopathology has not previously been investigated in depth. The aim of this study was to reach those physicians who already use social media, assess how they use social media, and discover their perceived strengths and weaknesses in the use of social media as a professional tool in dermatopathology.

The authors constructed 2 identical surveys by using Google Forms (Mountain View, California), which contained single and multiple selection answer choices as well as fill-in responses pertaining to the survey respondents' demographics and their opinions regarding the use of social media for dermatopathology. The surveys were distributed to social media users on Twitter and Facebook by means of hyperlinks to a survey corresponding to the social media site from which the hyperlink was obtained. On Facebook, the hyperlink was shared via a closed group, “Dermatopathology,” and was also shared by the investigators' Facebook posts, accessible by those able to view each investigator's page. On Twitter, the hyperlink was tweeted from the investigators' Twitter accounts. The surveys were left open to collect responses for a period of 10 days. The survey was conducted during April/May 2015.

To assess usage patterns among respondents, we conducted 3 different sets of analyses. The first analysis assessed opinions related to the usefulness of social media (Table 1). The second analysis assessed frequency of different types of social media usage—for example, frequency of sharing, liking, commenting, and posting on social media about dermatopathology subjects (Table 2). The third analysis assessed in a binary fashion professional applications of social media—for example, to identify collaborators for projects, locate job postings, locate potential staff to hire, or find/share rare cases. Usage questions with associated acronyms can be found in Table 3.

The first 2 analyses—opinion about utility and frequency of use—used questions that were measured on Likert-type scales. Opinion questions ranged from 1 (strongly disagree) to 5 (strongly agree). There were 5 items in the opinion scale. The frequency of use measure used 4 items, with answer choices ranging from 1 (never) to 7 (several times daily). In each case, a higher number indicates a greater endorsement of social media—either through a higher opinion of its utility or by more frequent use.

For both of these outcomes, reliability coefficients and factor structures were analyzed to determine whether it was appropriate to combine them into a single measure. In both cases, responses showed a strong single factor structure with good reliability. Scree plots can be found in the supplemental digital content at www.archivesofpathology.org in the February 2018 table of contents. The opinion scale (α = 0.84) and the frequency scale (α = 0.80) were used as outcome measures in multiple linear regression models.

The specific professional usage patterns, being binary responses, were assessed by performing factor analysis on the return matrix resulting from a polychoric correlation of the items. The results of this assessment revealed that there were multiple latent factors. As such, the items were not combined into a single index. Rather, the 5 most frequently endorsed professional uses of social media—KITKnow (Keep in touch with other pathologists/dermatologists/dermatopathologists I already know well personally), MeetNewInField (Meet new pathologists/dermatologists/dermatopathologists whom I have never met before in person), Promote (View, “like,” “share” cases in pathology discussion groups on Facebook), Comment (Comment on cases in pathology discussion groups on Facebook), and KITMeet (Keep in touch with other pathologists/dermatologists/dermatopathologists I recently met at a medical meeting)—were analyzed by using multiple logistic regression.

All models—the 2 linear models for opinion and frequency and the 5 logistic models—were developed by using a backward stepwise process.

The initial models included types of social media accounts held by respondents, age, discipline, and the respondent's United Nations Digital Access Index (UNDAI; countries are assigned a value, 0–1, to measure their access to information and communication technology). Age and discipline were maintained in all final models regardless of statistical significance. Age, measured categorically, the UNDAI, and type of social media account held by the respondent were removed from the model by using an α cutoff (<0.10). The α cutoff was selected owing to the exploratory nature of the analysis. All data were analyzed with STATA v.13 (College Station, Texas).

This study was approved by University of Arkansas for Medical Sciences (Little Rock) Institutional Review Board (IRB protocol No. 204469).

In total there were 131 respondents from 29 different countries. Table 4 shows the basic description of all outcome variables, predictor variables, and covariates. Table 5 shows the results from the first 2 linear regression models—opinion and frequency. Unstandardized and standardized coefficients are shown for covariates in Table 4, as interpretation without knowledge of the conditional distribution function of each variable would be difficult. Table 6 shows the results from the 5 logistic regression models.

Table 4 shows the composition of our sample population. The opinion scale, ranging from 5 to 25, had a mean of 14.6. The frequency scale, ranging from 6 to 30, had a mean of 15.45. Most respondents were between the ages of 25 to 34 years (49.6% [65 of 131], 95% CI: 40.9%–58.3%) and 35 to 44 years (32.1% [42 of 131], 95% CI: 24%–40.2%). Most respondents were pathologists (60.3% [79 of 131], 95% CI: 51.8%–68.8%) or dermatopathologists (24.4% [32 of 131], 95% CI: 17%–31.9%). Nearly all respondents held a Facebook account, 55.7% (73 of 131) held a Twitter account, and 44.3% (58 of 131) held a LinkedIn (Sunnyvale, California) account. Only 13.7% (18 of 131) held a Doximity (San Francisco, California) account. By current users of popular social media sites, social media is viewed as a useful tool to enhance professional relationships and promote dermatopathology-specific knowledge. The 5 most common specific uses of social media among respondents were as follows: Promote (View, “like,” or “share” cases in pathology discussion groups on Facebook; 67.2% [88 of 131], 95% CI: 59%–73%), KITKnow (Keep in touch with other pathologists/dermatologists/dermatopathologists I already know well personally; 64.1% [84 of 131], 95% CI: 55.8%–72.4%), MeetNewInField (Meet new pathologists/dermatologists/dermatopathologists whom I have never met before in person; 63.4% [83 of 131], 95% CI: 55%–71.7%), Comment (Comment on cases in pathology discussion groups on Facebook; 55% [72 of 131], 95% CI: 46.3%–63.4%), and KITMeet (Keep in touch with other pathologists/dermatologists/dermatopathologists I recently met at a medical meeting; 43.5% [57 of 131], 95% CI: 34.9%–52.1%).

Although most respondents reported using social media to keep in touch with professionals they knew personally (64.1%, 84 of 131) and to meet new professionals they have never met in person (63.4%, 83 of 131), a minority of respondents (43.5%, 57 of 131) used social media to keep in touch with other pathologists/dermatologists/dermatopathologists whom they recently met at a medical meeting. Even fewer (29.8%, 39 of 131) respondents reported using social media to meet new physicians in other specialties whom they have never met before in person.

Less commonly, social media users reported using social media platforms to pursue and advertise job opportunities. With respect to seeking and publicizing employment opportunities, few respondents reported using social media in an attempt to find a job for themselves (13.7%, 18 of 131) and few have used social media to hire someone for a job (9.9%, 13 of 131).

Social media is viewed as having a relevant role in dermatopathology education with room for expansion of that role. Eighty percent of respondents agree dermatopathology cases seen on social media are useful and relevant to their practice. Interestingly, although of the 131 respondents, 90 respondents (69.0%) agreed photomicrographs, medical photography, and “pearls” posted on Facebook and Twitter were as useful and up-to-date as traditional resources, only 56 respondents (42.6%) reported learning at least as much dermatopathology information from Facebook and Twitter as they did from traditional educational resources such as textbooks and medical journal articles. It is possible that bias may have some influence on the perception of traditional resources as being more educationally valuable than social media, which is commonly perceived as being mostly a source of entertainment and leisure rather than a bona fide educational tool. Perhaps over time this view will change with increased exposure to social media as an academic resource. In fact, most respondents (84.5%, 111 of 131) agreed they would like to see more utilization of social media for educational purposes in the field of dermatopathology and most (81.7%, 107 of 131) would like to see more medical professionals with interest in dermatopathology actively using social media.

Table 5 shows the results of the multiple linear regression of the opinion scale and frequency scale. Respondents in higher UNDAI regions (ie, countries with greater overall access to information and communication technologies) had much higher frequency of use scores than respondents in lower UNDAI regions. This is a logical association; social media use is more frequent in locations with easier access to technology.

Table 6 shows the predicted change in odds of reported use of each of the 5 most common specific applications of social media to dermatopathology practice and research. Increased age significantly predicted lower odds of keeping in touch with other pathologists/dermatologists/dermatopathologists whom respondents already knew well personally. Dermatopathologists were significantly more likely to keep in touch with those they knew personally or those they met recently at a medical meeting than dermatologists. Higher UNDAI scores predicted significantly higher odds of commenting, viewing, “liking,” and “sharing” cases in pathology discussion groups on Facebook. For each additional social media profile held, odds increased 50% that respondents would view, “like,” and “share” cases in pathology discussion groups on Facebook. Compared to respondents who did not hold Doximity accounts, respondents with Doximity accounts had much higher odds of keeping in touch with other pathologists/dermatologists/dermatopathologists they already knew well personally (odds ratio [OR] = 4.175, P = .04) and had met at a medical conference (OR = 6.97, P < .001). Additionally, compared to respondents who did not hold Doximity accounts, respondents with Doximity accounts also demonstrated higher odds of commenting on cases in pathology discussion groups on Facebook (OR = 3.092, P = .05).

Social media is ubiquitous in the 21st century, connecting those across the globe. This technology has permeated through cultures and has interconnected people of all walks of life in ways that no one could have predicted even a decade ago. These platforms have facilitated communication over great distances at the click of a button. These trends are reflected in our current cross-sectional study, as our modest survey of 131 procured responses from medical professionals from 29 countries, with most responders coming from outside the United States. Of note, we collected these responses in only 10 days, using nothing more than an online survey platform and distribution via our own social media channels. This of itself is evidence of the broad reach and interconnectivity that social media provides to its users. Many scientists have already recognized the benefits of sharing research and disseminating knowledge through social media.²⁵  The ability to collaborate with colleagues across borders through social media has even inspired the birth of academic social networks, such as ResearchGate (San Francisco, California) and Academia.edu (San Francisco, California), to name a few.²⁶  However, these networks are on a scale that is a fraction of that of Facebook or Twitter, with merely a few million users, as opposed to more than a billion.²⁶  Regardless, the trend of using social media for educational use has long since been recognized and continues to gain momentum.

We found that most of those who responded to our survey were younger than 45 years. This is not surprising, especially since age has been found to be inversely proportional to use of social media,²⁷  and most social media services began with young adults as their target audience. However, the “over 65” population has been making strides. For the first time, in 2014, it was reported that 31% of all seniors in the United States are now on Facebook.¹  Unfortunately, in our survey, there were no respondents older than the age of 65 years. Thus, we cannot conclude much about if or how dermatopathologists older than 65 years use social media services.

More than half of those who took this survey reported they found Facebook to be more useful than Twitter in dermatopathology for their professional usage. In general, Facebook is a more popular social media platform according to reports.¹  This outcome may simply reflect the popularity of the site and not true preference. One other consideration is that as our survey was conducted nearly 1.5 years before preparation of this article, it may not be fully reflective of the current state of the various social networks studied. Social networks change quickly, and Twitter in particular has experienced an enormous surge in activity among pathologists over that time frame.²⁸ 

More than half of those who responded to our survey reported that they access Facebook or Twitter several times daily. This seems to be slightly more than that of the general population.¹  In addition, more than three-quarters of medical professionals in our survey reported using social media for both social and professional purposes. This finding may be due to many factors: One possibility is that, owing to the young population of respondents to the survey, this group of physicians may be more likely than an older population to use social media both socially as well as professionally. And since those social media users may be using these sites more frequently, they may have been more likely to see and respond to these surveys in the first place. Considering the short time frame for which the survey was released, we may have been able to reach a broader population of users, both social, professional, and both, if a longer window of access had been made available.

There is plenty of room for expansion when it comes to a dermatopathologist's role in social media. Most of our responses highlighted the desire of physicians using social media for dermatopathology to see more of their peers actively engaged. Most physicians reported passive daily activities in dermatopathology social media such as viewing posts and “liking” or “retweeting.” A minority reported daily active use including posting and tweeting original content. The dermatopathology population may be underperforming in this regard when compared to the general population.¹  Although the survey did not address this directly, there are a few plausible explanations. First and foremost is time; physicians are typically very busy in their professional lives and adding an additional commitment, such as posting interesting cases, may not seem worth the time to an overworked physician. In addition to the time factor, there may be a lack of understanding about the logistics and etiquette involved in participating in posting original content or being part of a discussion on social media. There are also the lingering legal and privacy risks that are always in the back of the physician's mind, which may be just enough to deter one from reaching active educational use of social media.²¹  These barriers may be addressed by increased awareness, education about appropriate professional social media use for medical professionals, and encouragement of participation by pathology and dermatology organizations and by key leaders in the field.

Most respondents agree that there should be more utilization of social media for dermatopathology education; however, it is interesting that most Facebook and Twitter respondents were either neutral or disagreed with the premise that they “learn at least as much dermatopathology information from Facebook and Twitter as from traditional educational resources such as textbooks and medical journal articles.” Dermatopathologists, pathologists, and their respective professional associations (eg, United States and Canadian Academy of Pathology, American Society of Dermatopathology) can be instrumental in championing and disseminating more content including recently published peer-reviewed articles and concise teaching pearls through their Twitter and Facebook accounts. These practices have been suggested by other disciplines as a mechanism to create a more balanced and educated approach to controversial topics.¹ 

A minority of respondents reported using social media to contact those outside the field of dermatology and dermatopathology, suggesting that most dermatopathologists do not currently see social media as a medium for interdisciplinary discussion in dermatopathology. Interdisciplinary communication and collaboration plays a vital role in the quotidian dermatopathology practice to manage a variety of skin diseases including melanoma,^29–31  squamous cell carcinoma,³¹  and lymphoproliferative disorders.³²  More investigation is necessary to determine how social media and interdisciplinary discussion can be used to increase collaboration and problem-solving.

Regions with a high UNDAI were more likely to use social media; perhaps this is simply due to the ease of access to technology when compared to lower scoring countries. In addition to providing and receiving interesting educational cases, social media can serve as a venue for consultative services in resource-limited regions of the world. Static image telepathology has been described as a low-cost solution for providing second opinions from experts across the world.³³  As Internet access becomes more readily available, social media sites could be repurposed as a portal through which low-cost microscopic imaging systems, such as via smartphone microscopy (either free hand or using an adapter) technique,^34–41  more sophisticated low-resource whole slide imaging systems,⁴²  and low-cost telepathology applications,⁴³  could create another avenue for consultation around the world.

Many concerns have been raised previously regarding physician use of social media. Social media in medicine has been described as underutilized and unregulated.⁴⁴  Limitations due to the lack of content regulation and validity are legitimate. Internet content is a universal struggle in the medical community. Many have accused and poked fun at the infamous “Dr Google,” naming the physician a less-than-reputable clinician.^45–47  But unlike artificial intelligence, the collaboration of dermatopathologists and those from other specialties can engage in value-generating cocreation, which not only advances education but may ultimately benefit the patient. In a recent poll conducted by one of the authors, most respondents who were doctors (89.7%; 691 of 770) agreed or strongly agreed that social media posts about medicine or pathology helped improve the way they practiced medicine (enabling them to better care or provide diagnoses for their own patients in real life).⁴⁸ 

Social media is a potentially powerful tool with the ability to instantaneously share dermatopathology with a great number of medical professionals all over the world. This study reveals the opinions and characteristics of the population of medical professionals currently using social media for education and collaboration in dermatopathology. Further research focused on improving aspects such as quality control and organization of dermatopathology information in social media is needed.