https://orcid.org/0000-0001-9780-7537
In May 2023, Bryan Carmody, MD, a pediatric nephrologist and associate program director for Eastern Virginia Medical School’s Pediatrics Residency, generated buzz on X (formerly known as Twitter) with this post: “Last week, Tennessee passed legislation to allow international medical graduates to obtain licensure and practice independently *without* completing a U.S. residency program. This is BIG news. So you know what that means. Time to break it down, Winners & Losers style.”1
Dr. Carmody’s lead post on this topic generated 1 million impressions on X. His influence on social media reflects a growing trend of residents, fellows, and faculty utilizing digital media platforms to engage with both academic and general audiences.2,3 For example, “tweetorials,” or short post threads on X, educate followers on clinical topics.4 But applications of social media in graduate medical education (GME) have diversified beyond medical knowledge alone. Residents and fellows leverage social media for public health awareness, mental health advocacy, and policy change.5 Similarly, GME programs and faculty utilize social media to publicize program updates, share application tips, and offer career advice.6,7 In plastic surgery alone, 84 of 88 accredited programs run an Instagram account.8
As social media platforms change their user experience, trainees, faculty, and GME programs have expressed interest in learning about other platforms,9 including Mastodon, Bluesky, and Threads (Table 1). But whether a trainee wants to explain cutting-edge papers to peers or a program director wants to recruit new applicants, distinguishing between social media platforms helps achieve these aims.
Social network theory can help evaluate the utility of social media platforms. This is an established academic field that identifies and classifies the nature of relationships and how they influence behavior.10 We apply a novel interpretation of social network theory to offer a framework for trainees, faculty, and program leaders to effectively conceptualize and use social media platforms for GME applications. Three factors set the stage for this framework: density, diffusion, and complexity.11,12 Density refers to the extent to which members of a network know each other. Diffusion refers to the degree to which information can spread through and even outside a network, or “virality.” And complexity refers to the multiple ways in which a social network serves different functions; in this case, it correlates to features like commenting, direct messaging, live streaming, or video calling.
These 3 concepts allow us to distinguish platforms via a framework—“network” vs “topic-based” dissemination—that can guide trainees, faculty, and GME programs in choosing a platform based on audience and impact. For example, we describe Facebook, LinkedIn, Instagram, and Clubhouse as “network-based,” where content primarily circulates among users with established connections (such as family or friends), indicating a high network density. However, these networks exhibit more limited diffusion capability, or reach, to individuals outside one’s network. This is a tradeoff of their focus on sharing information within one’s own network, as seen in example GME applications (Table 2). These networks also demonstrate moderate complexity, generally limiting individuals to features like commenting or replying to comments, though some offer capabilities for livestreaming and video posts.
On the other hand, “topic-based” dissemination platforms, including TikTok, YouTube, X, Threads, Mastodon, Bluesky, and Reddit, prioritize content based on users’ interests. Personal connections still influence what one sees, as on X. However, platforms predominantly facilitate information sharing through topic alignments, like Reddit’s thematic “subreddits” and TikTok’s algorithm that prioritizes users’ demonstrated interests. Thus, this design promotes high diffusion capacity, allowing trainee/faculty/program reach beyond immediate networks (Table 2). But these platforms typically have lower network density; interactions are more public and less personal. Functions like direct messaging exist but are secondary to the focus on topic-driven content sharing, marking moderate complexity, like network-based platforms.
Applications for GME
Trainees, faculty, and GME programs can leverage this framework to appropriately select a social media platform and optimize their engagement, based either on broad “categories” (network vs topic-based dissemination) or smaller “factors” (density, diffusion, and complexity). Below, we offer examples of how this framework applies to GME, or “use cases.”
For trainees, applying this framework can tailor educational and professional use cases of social media. For example, a cardiology fellow who wants to disseminate recent paper findings to new audiences should utilize topic-based platforms such as X or TikTok that facilitate greater diffusion outside personal networks. On the other hand, a graduating family medicine resident seeking advice from acquaintances on public health advising opportunities should use a network-based platform like LinkedIn. At a granular level, this framework can allow better understanding of platforms with new engagement approaches. For example, Clubhouse emphasizes real-time interaction, allowing members to join live chatrooms of up to 5000 individuals and engage in audio-only conversations.13 This live dialogue–based platform offers high complexity, given the live audio interactions. But greater complexity comes at the expense of decreased diffusion capability, as chatrooms have limited capacity. Ultimately, trainees will need to consider the tradeoffs between density, diffusion, and complexity in each platform.
Trainees also need to consider another tradeoff: deep versus shallow engagement on social media. In this case, deep engagement could mean building an Instagram following to feature high-yield educational medical content, while shallow could mean reading and commenting on one video on YouTube about medical myths. While deep engagement can impact a larger audience, it requires significant commitment, meaning trainees must tailor their level of engagement to their interests and capacity.
From a faculty or GME program standpoint, this framework drives additional use cases in recruitment and education, allowing them to target and inform desired audiences. A program director interested in publicity, whether for applicant recruitment, faculty achievements, or recent program publications, should utilize topic-based networks that allow higher diffusion capability to target audiences outside direct networks. For instance, platforms like X or Bluesky may best serve this goal, while Facebook or Instagram could be better suited for sharing internal program-related news or connecting current residents with alumni. With technology evolving, faculty can even employ advanced AI tools to streamline the creation of engaging and informative posts, such as crafting captions or post ideas to maximize engagement.
Another use case centers on program education. Faculty can invite guest speakers to lead discussions on GME social media applications, whether regarding patient advocacy or medical education. These sessions could focus on best practices or case studies of clinicians who have successfully leveraged social media. Programs also can learn from their own residents, some of whom have engaged with social media in a robust and meaningful way. But based on our experience, given limited bandwidth, we recommend faculty and programs keep “deep” engagement to 1 or 2 platforms, whether in education or in recruitment.
Along with these opportunities come well-known pitfalls in social media. Engagement requires a learning curve, which not all trainees, faculty, and program leaders can commit to given clinical demands. Social media platforms contain medical misinformation as well as “trolling” activities, in which other users provoke arguments via personal attacks. This can discourage trainees and faculty from social media engagement. Finally, maintaining professional standards remains an evergreen concern on social media platforms.14
Nonetheless, the trend of trainees and faculty worldwide utilizing social media to access and act on information shows no signs of slowing. Especially as social media platforms continue to evolve rapidly—with some platforms now crossing the boundary between network and topic-based dissemination15—trainees and faculty can play a pivotal role in modeling new digital media use cases through a focus on GME. Applying this framework, derived from social network theory, may lead to more effective GME program and trainee use of rapidly changing social media.
