Social media has become widely adopted by pathologists and other physicians for professional purposes. While engagement has likely increased over time, there remain few concrete data regarding attitudes toward its use.
To assess pathologists’ use of and attitudes toward social media over time.
We created a survey regarding personal and professional use of social media and circulated it via multiple channels in December 2017 and again in February 2022. Results of the 2 surveys were compared for statistically significant differences.
The 2017 survey was completed by 97 participants, and the 2022 survey by 305 participants. Respondents were predominantly female and academics, included pathologists in all age categories and all time-in-practice length. In both surveys, Twitter (now X) was the most popular platform for professional use and Facebook was the most popular for personal use. Professional barriers to social media use remained consistent between the 2 surveys, including the amount of time required. Education was seen as the main benefit of social media use in both surveys, while other benefits such as networking and increasing professional visibility were endorsed significantly less often in the second survey. While the second survey received more than 3 times as many responses as the first, several aspects of social media use (mainly demographics) remained similar during the timeframe, while other aspects (such as usage and perceived values) decreased.
Pathologists continue to find social media valuable. Barriers remain, though overall pathologists of all ages and practice settings appear receptive to using social media to further educational and other opportunities.
Social media, once considered the realm of the young and unprofessional, has become widely adopted by physicians for professional purposes through the years. Pathologists were some of the earliest adopters of this new avenue for online education and networking1 and have created robust communities on social media platforms such as Facebook (Meta Platforms, Inc), LinkedIn (Microsoft Corporation), and Twitter (now X, X Corp).2–4 This has ultimately led to opportunities for professional advancement, patient interaction, and even research collaborations.5–8
Despite these changes during the past decade, controversy remains regarding the utility and future of social media, including but not limited to its role in medicine going forward.9 Pathologist advocates of social media have found value in the platform’s ability to offer opportunities for speed-of-light networking, engagement, and visibility.10 Opponents of social media cite concerns about risks, professionalism, and confidentiality.9,11 Barriers to increased adoption of social media include a poor understanding of social media and stereotypes about social media users and their habits.12 Social media is rapidly evolving; recent changes have been made to performance and branding for certain platforms, notably Twitter/X.
Even with the evolving role of social media in pathologists’ lives, there remain few concrete data regarding attitudes toward its use. This study aims to describe characteristics and habits of pathologists around the world who use social media for professional purposes and to assess whether these opinions have changed over time.
MATERIALS AND METHODS
The authors collaboratively drafted a Qualtrics (Qualtrics International Inc) survey containing multiple questions on pathologist attitudes toward and uses of social media. This survey, which also requested demographic data, was then circulated twice, during a 2-week period in December 2017 and during a 2-week period in February 2022. Both times, the survey was promoted by the authors via several channels, including social media platforms and emails sent via Pathology Outlines (PathologyOutlines.com), in order to attract participants. Survey questions asked about demographics, geographic location, years in practice, platforms used for personal versus professional purposes, subspecialty, frequency of social media use, and barriers and benefits to social media use. Sample survey questions are shown in Figure 1; the full survey can be found in the supplemental digital content at https://meridian.allenpress.com/aplm in the October 2024 table of contents.
χ2 or Fisher exact tests were used to characterize the relationship between categorical variables, as appropriate. Logistic regression modeling was performed for examining factors associated with social media usage for family and professional purposes. All statistics were assessed by using 2-sided tests with P values <.05 considered statistically significant. Statistical analyses were performed with SPSS for Windows, version 28 (IBM).
RESULTS
Demographics of survey participants, as well as social media use patterns, are provided in Table 1. The 2017 survey was started by 102 participants, and the 2022 survey was started by 366 participants. The completion rate was relatively high, as the 2017 survey was completed by 99 participants (99 of 102, 97%) and the 2022 survey was completed by 354 participants (354 of 366, 96%). Demographic information among those who completed the survey was somewhat similar between 2017 and 2022. Most respondents were female during both periods, with an increase over time (51 of 96 [53%] in 2017 versus 199 of 309 [64%] in 2022, P = .055). Most respondents were 20 to 40 years old (58 of 98 [59%] in 2017 versus 171 of 312 [55%] in 2022, P = .74). Respondents were represented in all age categories ranging from 20 to 81+ years. Most practice lengths were well represented, from trainees to those practicing more than 20 years, with no significant changes during the 2 periods. Most participants were in academic practice during both periods (49 of 95 [52%] versus 175 of 306 [57%], P = .50), and a large number were in the United States (39 of 96 [41%] versus 121 of 304 [40%]), though most participants opted not to provide their country. There was a significant decrease in percentage of pathologists from the United Kingdom and Canada in 2022 compared to 2017 (P = .02), likely due to the proportion of pathologists from other countries increasing.
The platform used by the most respondents for professional use by far during both periods was Twitter, with a decrease during the 2 periods (77 of 99 [78%] versus 242 of 354 [68%], P = .07). Of note, because our surveys were conducted during the period when this platform was named Twitter, we continue to use this name throughout this article. Facebook was the second most used for professional purposes, though professional usage decreased significantly (40 of 99 [40%] versus 104 of 354 [29%], P = .04). While use of Instagram increased for both personal and professional purposes, this difference was not significant, and overall, no significant differences in usage between periods were seen for the other platforms. LinkedIn was the third most popular (31 of 99 [31%] versus 103 of 354 [29%], P = .67); only Instagram gained popularity between the 2 surveys (12 of 99 [12%] versus 53 of 354 [15%], P = .47). For personal use, Facebook was the most frequently used platform in both 2017 and 2022, but there was a significant decrease in usage over time (76 of 99 [77%] versus 219 of 354 [62%], P = .006). Twitter was the second most popular for personal use in 2017 and Instagram the second most popular in 2022, though the changes between the 2 periods in percentage usage of other platforms were not statistically significant (Figure 2, A and B).
Cytopathology, general anatomic pathology/clinical pathology, and surgical pathology were the specialties most commonly self-reported by respondents, though there was no significant associations between specialty and social media use.
Length of social media use unsurprisingly increased in the 2022 survey, with 199 of 318 participants (63%) saying they had used social media for more than 2 years (versus 35 of 92 [38%] in 2017, P = .002). Most participants reported they used social media for pathology multiple times per day (67 of 93 [72%] versus 182 of 312 [58%]) or daily (21 of 93 [23%] versus 98 of 312 [31%]). Perceived barriers to further adoption of social media by pathologists remained largely similar during the study timeframe. The most common barrier reported was the amount of time that usage of social media can take (53 of 83 [64%] versus 177 of 267 [66%]). The other barriers, “Too complicated to learn” (6 of 83 [7%] versus 24 of 267 [9%]), “I dislike social media” (9 of 83 [11%] versus 31 of 267 [12%]), and “I feel that social media is for younger pathologists” (7 of 83 [8%] versus 11 of 267 [4%]) were reported by much smaller numbers of respondents. No statistically significant differences between 2017 and 2022 were observed in reporting of any of these barriers. The greatest barriers mentioned by the respondents are summarized in Figure 3. In both surveys, more than 10% of respondents gave varied other concerns as their greatest barrier to social media use. These concerns included negative perceptions of social media from coworkers, concern about confidentiality, concern about language fluency, misinformation on the Internet, and firewall/connectivity concerns.
The most commonly mentioned benefit by far for most participants was education (81 of 93 [87%] versus 288 of 316 [91%], P = .25). Compared to 2017, in 2022 fewer pathologists mentioned “networking,” “Learn from meetings in which I am not in attendance,” and “Increase my professional visibility” (74 of 93 [80%] versus 207 of 316 [66%], P = .01; 65 of 93 [70%] versus 183 of 316 [58%], P = .04; and 57 of 93 [61%] versus 156 of 316 [49%], P = .04, respectively), though most respondents endorsed these as benefits in both periods. When participants were asked to select a single “greatest benefit,” “education” was also the most frequently mentioned benefit of social media use in both years, with a marked increase from year 2017 to 2022 (40 of 92 [44%] versus 186 of 308 [60%], P = .10) (Figure 4).
Pathologists practicing in academic centers were 5.05 times more likely to use social media for professional/career reasons than private practice pathologists (95% CI, 1.27–19.99, P = .02), after adjusting for age, sex, and practice year; this was not observed for personal/family use of social media (Table 2).
DISCUSSION
Our 2 surveys demonstrate the evolution in social media use, and attitudes regarding its use, among pathologists from 2017 to 2022. Participation in the surveys increased by more than 200%, and more respondents in 2022 were female than in 2017. Most participants were in academic practice, with the percentage increasing over time. The most used social media platform for professional pathology activity at both time points was Twitter, and the main factor driving use at both time points was the educational opportunities available. This information has implications for predicting future trends in social media in pathology and helps those contributing to social media to understand their audience.
The limitations of this study include the survey methodology, limited sample, and self-selection bias. While no reliable data are available on the number of pathologists as a whole who are on social media, 2 Twitter lists curated by one of the study authors cataloged more than 8800 pathologists on that platform.13 The survey respondents would thus represent a small minority of pathologists who use social media. Surveys as a methodology are limited in that they rely on self-reported data; responses as to frequency and usage of these platforms are based on what respondents remember rather than concrete data on usage (ie, apps such as “screen time”). The survey was promoted via social media and an email list, which are both forms of online communication. Pathologists who are not on social media or are not diligent about reading emails may represent a population who are inherently more averse to using technology for educational or other purposes; this population is likely underrepresented in our survey results. Our survey respondents are thus potentially skewed toward more favorable attitudes toward social media. Despite this limitation, the survey provides interesting information on how those pathologists who do use social media are using the platforms, what value they find in these experiences, and how the platforms and usage have changed over time.
Evidence suggests that the use of social media in health care professions has increased over time,14,15 and the increase in survey responses in our study indicates this holds true for pathology as well. This may of course be in part due to the COVID-19 pandemic, during which numerous educational opportunities transitioned from in-person to virtual opportunities, including annual conferences and lecture series. This likely also explains the drop in social media usage for aspects such as “networking” and “[learning] from meetings in which I am not in attendance.” Social media reportedly played a key role in resident education during the pandemic in fields such as surgery16 and appears to have spurred interest in online pathology education resources as well.17,18 The pandemic may have confounded some aspects of the surveys, which occurred before the pandemic and following the initial lockdown efforts, most notably increased usage, though other aspects appear to have remained unaffected/constant. Most participants in both of our studies were female, which may be partly explained by data suggesting that women are better represented in pathology than in some other medical specialties,19,20 although one survey suggested that women may receive fewer professional advancement benefits from social media use than men.21 While most responses came from pathologists who are arguably “young” for career professionals (aged 20–40 years), the surveys encouragingly received a spread of responses from pathologists aged from 20 to 30 all the way to 81+ years, underscoring that no one is “too old” for finding benefits from social media.22
Survey participants offered several reasons that they used social media. The most common was educational benefit, which was noted as being the greatest benefit by most respondents (57%) overall. Since pathology and health care in general require “lifelong learning,” it is not surprising that pathologists would seek cutting-edge ways to learn from peers.23–25 Indeed, much of the existing literature on pathology in social media has focused on its educational content, including subspecialty-focused knowledge26,27 and social media’s worldwide reach,28 offering educational opportunities to eager learners who may simply lack the resources to participate in traditional educational channels. While our surveys did not request further specifics regarding educational usage, our experience and the literature have shown that pathologists use social media to share interesting cases, “quiz” other users regarding challenging material, offer study aids and tips regarding board exam preparation, and disseminate lecture material posted online or presented at in-person conferences.2,15,23,26–29 Networking was also reported as an important aspect of social media use, though interest in social media as a professional networking tool appears to have decreased over time, in a significant fashion. In 2017, 80% of participants reported networking as a benefit, compared to 66% in 2022, and in 2017, 24% of participants considered it the most important benefit, compared to 15% in 2022. In addition to the aforementioned potential impact of the pandemic, this could also relate to the fact that social media has become more established in the pathology landscape; while networks continue to grow as new pathologists enter the field,30 this may be overshadowed by the fact that most active social media users have now had many years to get to know one another. Nevertheless, new knowledge and educational information are being created and posted daily.31 Other benefits reported by at least half of survey participants included learning from pathology meetings they could not attend32 and keeping up-to-date on news in the field. Increasing professional visibility and furthering career opportunities were important to some participants, particularly those in academic practices. Even with the bias inherent in the survey (namely, pathologists interested in social media are presumably interested in completing a survey on social media), this underscores the enthusiasm that many pathologists have toward the medium. In our experience, stereotypical aspects of social media in general, such as posting memes, arguing with other community members, or promoting products for sale, while encountered, are relatively uncommon among pathologists using social media.
While many survey participants reported positive aspects of social media use for professional purposes, they acknowledged barriers to use as well. The main drawback was cited as the amount of time it takes to use social media to any significant degree, and this remained constant at around 65% of respondents in both surveys. Perhaps to this point, fewer participants reported using social media “multiple times per day” in 2022 than in 2017, though “daily” use increased slightly. Many other barriers and limitations were discussed in free-text comments, including concerns about privacy, concerns about online misinformation, language barriers, institutional policies, and firewalls. Professional concerns in pathology have previously been reported in the literature, resulting in guidelines on the ethics of sharing images33 and on key legal and ethical considerations.34 This is of course not unique to pathology, as health care professionals in all fields should consider best practices when using a platform that is patient-facing and can include posting of patient information (even when de-identified).35
Another broader potential drawback to social media use is overreliance on such platforms, or more generally online resources, to educate pathologists on not only educational topics but also matters such as professionalism. While this arguably occurred in the early days of the pandemic, mainly due to wariness regarding in-person interaction, it appears that fears of new trainees being disproportionately educated online are unlikely to be a concern in general. Online educational content can be a boon in underresourced settings (as perhaps indicated by the increased usage in countries other than the United States or United Kingdom), but trainees with ample educational opportunities appear willing to seek them out wherever available, whether that be online or in-person, as evidenced by renewed interest in attending conferences and other meetings in person. Therefore, while social medial usage may continue to increase, it likely will continue to serve an accessory role in the traditional paradigm of resident education, as many aspects of preparing residents for a successful career as a physician likely require in-person guidance and feedback.
Another notable finding in our survey results is the shifting landscape of social media platforms over time. Respondents reported their preferred social media platforms for both professional and personal use. From a professional standpoint, the most dominant platform was Twitter, used by 78% of participants in 2017 and 68% in 2022. The second most popular platform was Facebook, used by 40% and 29% of participants. While both of these decreased in use over time, Instagram gained some popularity, going from 12% to 15%. The exact reason for these trends in unclear but may relate to Instagram’s focus on sharing images, compared to the more text-focused Twitter and Facebook, which may lend itself better to sharing pathology images and educational material. A minority of respondents mentioned additional platforms they use, including WhatsApp (WhatsApp Inc), KiKo (KiKo, LLC), and Doximity (Doximity, Inc). As various factors cause social media Web sites to manifest, grow, decline, and die, these numbers will continue to shift and additional platforms may gain some measure of popularity in the professional pathology community, including TikTok (TikTok Pte Ltd)36 and Mastodon (Mastodon gGmbH).37 Personal use (ie, for friends and family rather than pathology content) showed a slightly different picture. Facebook was the most popular platform for this activity, used by 77% of respondents in 2017 and 62% in 2022, with a significant decrease in usage between the 2 periods. This illustrates that no social media platform excels at every potential application, and that usage patterns of social media platforms is a dynamic landscape, which also indicates why some pathologists use multiple social media platforms for their professional endeavors.
A key finding is that surveyed pathologists practicing in an academic center are significantly much more likely—5.05-times more—to use social media for professional/career reasons than those in private practice (P = .02), after adjusting for age, sex, and practice year. This finding may be explained by the benefits reported (eg, education, networking) to have potentially greater importance or salience for academic pathologists, for whom education and establishing a reputation are paramount to the promotion process. Social media may be seen by academic pathologists as an important tool for achieving professional goals, a point emphasized by the literature.5,23
In conclusion, social media continues to be a popular adjunct aspect to a career in pathology for many, with interest and engagement likely increasing over time. Social media adopters include pathologists across all age ranges, levels of experience, and practice settings. The main perceived benefit is the educational content made freely available; networking is decreasing as a motivator but remains important to some. The main perceived drawback is the amount of time required to become fluent in social media. Twitter remains the most popular social media network for professional pathology use, though platform use is changing over time, and it will be interesting to see whether the recent changes to this platform will impact utility. Social media remains a popular tool for pathologists to use to achieve their professional goals.