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Social Media Use by Health Care Professionals and Trainees: A Scoping Review

Hamm, Michele P. PhD; Chisholm, Annabritt; Shulhan, Jocelyn; Milne, Andrea MLIS; Scott, Shannon D. PhD; Klassen, Terry P. MD, MSc; Hartling, Lisa PhD

doi: 10.1097/ACM.0b013e31829eb91c

Purpose To conduct a scoping review of the literature on social media use by health care professionals and trainees.

Method The authors searched MEDLINE, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and ProQuest for studies published between 2000 and 2012. They included those reporting primary research on social media use by health care professionals or trainees. Two reviewers screened studies for eligibility; one reviewer extracted data and a second verified a 10% sample. They analyzed data descriptively to determine which social media tools were used, by whom, for what purposes, and how they were evaluated.

Results The authors included 96 studies in their review. Discussion forums were the most commonly studied tools (43/96; 44.8%). Researchers more often studied social media in educational than practice settings. Of common specialties, administration, critical appraisal, and research appeared most often (11/96; 11.5%), followed by public health (9/96; 9.4%). The objective of most tools was to facilitate communication (59/96; 61.5%) or improve knowledge (41/96; 42.7%). Thirteen studies evaluated effectiveness (13.5%), and 41 (42.7%) used a cross-sectional design.

Conclusions These findings provide a map of the current literature on social media use in health care, identify gaps in that literature, and provide direction for future research. Social media use is widespread, particularly in education settings. The versatility of these tools suggests their suitability for use in a wide range of professional activities. Studies of their effectiveness could inform future practice.

Supplemental Digital Content is available in the text.

Dr. Hamm is research associate, Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Ms. Chisholm is research student, Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Ms. Shulhan is research student, Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Mrs. Milne is research librarian, Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Dr. Scott is associate professor, Faculty of Nursing, and associate professor (adjunct), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Dr. Klassen is professor, Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, and director of research, Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada.

Dr. Hartling is director, Alberta Research Centre for Health Evidence, and assistant professor, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Funding/Support: M.P.H. was supported by a KT Canada Fellowship Award from Knowledge Translation Canada. This study was supported in part by a Knowledge Synthesis Grant from the Canadian Institutes of Health Research. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Other disclosures: None.

Ethical approval: Not applicable.

Supplemental digital content for this article is available at and

Correspondence should be addressed to Dr. Hamm, 4-482B Edmonton Clinic Health Academy, 11405-87 Ave., Edmonton, Alberta, Canada T6G 1C9; telephone: (780) 492-1241; e-mail:

Advances in technology have markedly changed the way health care providers and consumers access and use information. Social media tools such as Facebook, Twitter, and YouTube have been used to train medical personnel, provide information to patients, and allow rapid communication in times of crisis.1 Currently, Facebook has more than one billion active users, approximately 62% of whom access the site on any given day.2 As of February 2012, 15% of adults using the Internet in the United States were on Twitter, up from 8% in November 2010.3 YouTube has more than 800 million unique users monthly, with over 72 hours of video uploaded every minute.4

Social media encompasses a group of online applications that allow for the creation and exchange of content generated by users and can be categorized into five groups: (1) collaborative projects (e.g., Wikipedia), (2) blogs or microblogs (e.g., Blogger, Twitter), (3) content communities (e.g., YouTube), (4) social networking sites (e.g., Facebook), and (5) virtual gaming or social worlds (e.g., Second Life).5 Social media represents a significant evolution in the way in which information is developed and shared, including between people who may not have been able to connect without this technology. The past decade has seen a widespread shift from knowledge primarily created and disseminated by individuals to an environment in which all users with Internet access have the opportunity to participate in a more collaborative information-sharing system.5,6

Yet, the adoption of social media tools in health care has been slow,7 despite the fact that many have advocated its use.7–14 In addition, social media has the potential for aiding in knowledge translation, or implementation science, which seeks to close the gaps between knowledge and practice15 and focuses on novel forms of dissemination. Proponents of the use of social media in health care point to three key features that make these tools highly effective, features that also overlap with the objectives of knowledge translation—personalization, presentation, and participation.16 The tailoring of content (personalization) allows users to access and share information that is most valuable to them, while the versatility of social media as a whole creates numerous options for how information is shared (presentation). In addition, social media is immediate, allowing for the timely dissemination of relevant information, and multiple formats (e.g., microblogs, social networking sites) exist that can be used depending on the purpose of the tool and the preferences of the target population. The collaborative nature of social media allows for a meaningful contribution (participation) from all user groups. In The Wisdom of Crowds, James Surowiecki17 stated, “Groups are remarkably intelligent, and are often smarter than the smartest people in them.” This sentiment has been echoed by supporters of social media, who promote the benefits of this synergistic relationship.18

Whereas some have advocated the use of social media in health care, others have criticized it. One of the primary concerns relates to patient privacy and confidentiality.8 With such a wide and instantaneous reach, an error in judgment involving an online post can have profound implications in terms of trust and professionalism.19,20 The availability of misinformation is also a risk as health care providers cannot control what is posted or discussed online.7,21 In addition, the inappropriate substitution of online information or advice for in-person visits to a health care provider, with potentially harmful results, has been cited as a limitation of the use of both social media and the Internet in health care in general.7,22

Despite the enthusiasm surrounding the use of social media in health care, little evidence documents the current state of the science and whether or not these tools can be used to benefit specifically education and practice. Given the rapid expansion and adoption of this technology, evaluating the new opportunities that have become available is important.

We conducted a scoping review of the literature (1) to map the existing literature examining the use of social media by health care professionals and trainees, (2) to determine the extent and type of evidence available to inform more focused knowledge syntheses, and (3) to identify gaps in the literature for future research. We asked specific questions to guide our review, including (1) What social media tools are being used by health care professionals and trainees? (2) In which disciplines and specialties are social media tools being used? (3) For what purposes are social media tools being used? and (4) What types of evidence and research designs have been used to examine social media tools?

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We conducted this scoping review on the use of social media by health care professionals and trainees in conjunction with a review on the use of social media by patients and caregivers23; therefore, we conducted the literature search and screening for study eligibility for both reviews concurrently. We developed the review protocol a priori.

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Search strategy

A research librarian (A.M.) searched 11 databases in January 2012: MEDLINE, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and ProQuest. She restricted the dates of the search to 2000 or later, corresponding to the advent of Web 2.0—the platform that supports continuous user participation, therefore social media—and applied no language or study design restrictions. See Supplemental Digital Appendix 1,, for the MEDLINE search strategy.

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Study selection

Two of four reviewers (M.P.H, A.C., J.S., A.M.) independently screened the titles and abstracts of each study for eligibility. Two of three reviewers (M.P.H, A.C., J.S.) also independently assessed the full text of the studies, assessing them as “relevant” or “unclear” using a standard form. Discrepancies were resolved by consensus or adjudication by a third party.

We included studies if they reported primary research (quantitative or qualitative), were conducted in a population of health care professionals or trainees, and examined the use of a social media tool. We defined social media according to Kaplan and Haenlein’s5 classification scheme (collaborative projects, blogs or microblogs, content communities, social networking sites, and virtual worlds). We excluded studies that examined mobile health (e.g., apps), one-way transmission of content (e.g., podcasts), and real-time exchanges mediated by technology (e.g., Skype, chat rooms). We included electronic discussion forums and bulletin boards because they incorporate user-generated content and we judged them to lie within the spectrum of social media. We did not define outcomes a priori because they were to be included as part of our description of the literature. We adapted likely categories for objectives and outcomes for professionals and trainees from those outlined in Coulter and Ellins’24,25 proposed framework for strategies to inform, educate, and involve patients.

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Data extraction

One reviewer (M.P.H.) abstracted data using standardized forms and entered them into Microsoft Excel (Microsoft, Redmond, Washington). Another reviewer (A.C.) checked a 10% sample for accuracy and completeness.26 Reviewers resolved discrepancies through consensus. Extracted data included study and population characteristics, description of the social media tools used, objectives of the tools, outcomes measured, and authors’ conclusions.27

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Data synthesis

We synthesized data descriptively to map different aspects of the literature as outlined in our key questions. We then grouped studies according to the tool described and the target audience. As discussion forums may be considered precursors to modern social media platforms, we present our findings both for all included studies and for studies that investigated tools other than discussion forums. We calculated descriptive statistics using StataIC 11 (StataCorp, College Station, Texas).

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We included 96 studies in the review. See Figure 1 for a flowchart of our literature search and study selection process and Table 1 for a summary of the included studies. See Supplemental Digital Appendix 2,, for a complete reference list and description of the included studies. The majority of studies were conducted in North America (60/96; 62.5%) and Europe (21/96; 21.9%), most commonly in the United States (54/96; 56.3%) and the United Kingdom (9/96; 9.4%). We extracted data on the countries involved in each study, which rarely differed from the country of the corresponding author. The exception was studies examining preexisting, well-established tools such as Wikipedia, for which the audience was not restricted by geography. The median duration of included studies was four months, ranging from one month to four years. For all included studies, the median start date was 2006 (range 1995–2011). When we removed discussion forums from the analysis, study dates were more recent (median 2008, range 2000–2011). The majority of authors (62/96; 64.6%) concluded that there was evidence to support the use of social media in educational or practice settings.

Figure 1

Figure 1

Table 1

Table 1

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Social media tools studied

See Table 2 for a summary of the social media tools studied. Discussion forums were the most commonly studied tools (43/96; 44.8%). In 31 (32.3%) studies, the social media tool was included as a component of a complex intervention. Often, investigators created their own tool to evaluate. In those studies, however, that made use of a preexisting tool and in those examining usage patterns and preferences, the most common tools were Facebook (8/96; 8.3%), YouTube (8/96; 8.3%), Twitter (7/96; 7.3%), Wikipedia (4/96; 4.2%), and Second Life (4/96; 4.2%).

Table 2

Table 2

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Social media user group setting

We divided social media users’ settings into three categories: education, practice, and general purpose (see Table 3). The largest group, education, included 66 (68.8%) studies. The most studies (22/96; 22.9%) fell into the discipline of medical education, followed by nursing education (17/96; 17.7%). Social media tools were studied to a limited extent in continuing education and in professional development; however, nearly all these interventions were aimed at students or residents. In all disciplines, a range of social media tools was studied. In allied health, interdisciplinary education, medicine, and nursing, discussion forums were studied most often; however, in dentistry/dental hygiene and public health, blogs or microblogs were, and, in pharmacy, collaborative projects were.

Table 3

Table 3

Social media use in professional practice was examined in 18 (18.8%) studies (see Table 3). The most studies again fell into the discipline of medicine (7/96; 7.3%). As with education, a range of tools was studied, with the exception of virtual worlds. Blogs or microblogs were studied most frequently, often in the context of general posts targeted for other professionals.

The general purpose category included studies in which health care professionals were asked about their perceptions and attitudes towards social media tools and studies that analyzed health-related content posted online either descriptively or for accuracy. Ten studies (10.4%) fell into this category (see Table 3). Of these 10 studies, 4 were cross-sectional examinations of how social media is being used, and 6 were content analyses of user-generated general health or medical posts online.

We included medical specialties that appeared in more than one study in Table 3. Together, administration, critical appraisal, and research were studied most frequently (11/96; 11.5%), followed by public health (9/96; 9.4%). In 33 (34.4%) studies, the investigation ranged across multiple specialties. The tool studied did not seem to vary by specialty.

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Purpose of social media use

We divided the objectives of the social media tools into three categories: knowledge, skills, and communication (see Table 2). In 59 (61.5%) studies, the purpose of the tool was to facilitate communication. This ranged from peer-to-peer or instructor-to-student communication within classes, to communication between clinicians and their patients, to clinicians communicating with the public via tools such as blogs. Nearly all studies of blogs or microblogs (25/27; 92.6%) and social networking sites (15/16; 93.8%) included communication as a main focus. Studies of social media tools as part of a complex intervention were least likely to evaluate communication (14/31; 45.2%). In 41 (42.7%) studies, researchers evaluated increases in knowledge, and in 19 (20.8%) studies, improvement in skills. Collaborative projects (11/20; 55.0%) and discussion forums (22/43; 51.2%) were often used to increase knowledge, and virtual worlds to improve or learn clinical skills (4/9; 44.4%).

We classified the outcomes measured in each of the included studies in one of three categories: clinicians’ knowledge, clinicians’ experience, and professional behavior (see Table 4). Most studies measured outcomes related to clinicians’ experience, which included satisfaction levels and the degree or type of communication. Few studies measured outcomes related to professional behavior; when researchers did measure such outcomes, most were related to skills. We also included professional boundaries in this category, which encompassed topics such as how personal and professional lines could be blurred with easily accessible information online and the use of social media by professionals to access information on their patients. When we excluded discussion forums from this analysis, we found less of an emphasis on measures that were prominent in educational settings—namely, peer-to-peer and instructor–student communication. All of the studies that examined boundaries and privacy used tools other than discussion forums.

Table 4

Table 4

For most studies, the most commonly measured outcome was related to peer-to-peer communication (see Table 4). For those that evaluated collaborative projects, however, satisfaction was most commonly studied.

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Evaluation of social media use

Quantitative studies represented 56.3% (54/96) of the sample, 41 (42.7%) of which were cross-sectional studies, whereas qualitative studies represented 21.9% (21/96) (see Table 1).

Thirteen quantitative studies evaluated the effectiveness of a social media tool—5 randomized controlled trials, 1 nonrandomized controlled trial, 1 controlled before–after study, and 6 before–after studies. Of the 5 randomized trials, 4 were in medical or dental education, and all evaluated discussion boards and targeted knowledge. Three of these 5 studies found statistically significant improvements in knowledge and exam performance, 1 found a positive trend, and the other described the intervention as “promising.” Similarly, 6 of the 8 comparative studies using other designs were conducted in educational settings (medicine, pharmacy, and dental hygiene). They demonstrated greater diversity than the randomized trials in the tools studied, evaluating blogs, wikis, and virtual worlds. These studies aimed to improve both knowledge and skills. In 12 of the 13 studies that evaluated the effectiveness of a social media tool, the authors concluded that the intervention had positive value. However, only 6 reported statistically significant findings for their primary outcome.

Most of the qualitative studies were conducted in nursing education settings (9/21; 42.9%) and evaluated discussion forums (13/21; 61.9%). Researchers in 76.2% (16/21) of the qualitative studies evaluated social media tools that facilitated communication. Mixed-methods studies made up 11.5% (11/96) of the sample and were used across disciplines. Nine of these 11 studies (81.8%) included a survey as one component of the mixed-methods design.

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The use of social media in health care education and practice is growing, and a significant body of literature examines its uses. Most of these studies, however, have been descriptive, either analyzing the content that exists online or investigating users’ preferences. Given the rapid evolution of social media technology, early studies likely will be exploratory; however, the use of social media platforms and tools has become sufficiently widespread that studies of effectiveness are beneficial and could inform the development and adoption of tools in the realm of education.

Because of the changing nature and continual progression of social media, establishing an operational definition to determine eligibility in our study proved challenging. Social media is defined inconsistently in the literature28,29; therefore, we selected Kaplan and Haenlein’s5 classification scheme because they used discrete groups to categorize social media platforms, providing a framework but also allowing flexibility in the tools that we could include. However, we still encountered gray areas, most significantly in deciding whether or not to include discussion forums in our review. Although they did not fall into one of Kaplan and Haenlein’s5 prespecified categories, we agreed that, because discussion forums and online bulletin boards included user-generated online content, we should consider them to be early versions of social media and thus include them in our study.

Despite the popularity of specific tools like Facebook and YouTube, most of the studies we found evaluated tools that were developed specifically for the study team’s purposes, most commonly blogs and wikis. We were not surprised by this finding given that the populations evaluated in many of the studies included trainees, and these particular platforms lend themselves to educational settings because of the high level of detail they can incorporate. Of those studies for which the researchers evaluated existing tools, about one-third asked participants about their current online presence. Studies specific to Facebook tended to be related to issues of professional boundaries and privacy. Those studying YouTube and Second Life were skills based, evaluating whether participants could demonstrate techniques or allowing them to practice a learned skill.

Issues related to professionalism, privacy, and confidentiality were addressed only in a small number of included studies; however, these issues remain a major concern and potential barrier in the adoption of social media in health care. In conjunction with future research on the benefits of social media use, researchers also should explore the potential dangers.

Although education was the predominant setting in the included studies, social media use was evaluated in a variety of disciplines, indicating widespread interest in its potential. With the aim of facilitating instruction and an overarching focus on health care, findings from different professional groups likely are applicable across disciplines and can be used to inform future applications and research in the area. Similarly, social media use was spread across a diverse range of specialties, with multidisciplinary coverage in approximately one-third of studies. This finding suggests that although the content may be tailored to a particular group, the tools and platforms are relevant to many different user groups.

Not surprisingly, facilitating communication was the most common purpose for using social media. Social media tools were created to enable interaction and have expanded from primarily acting as channels of personal contact to providing opportunities for professional conduct. We found that researchers explored unique applications specific to their professional context, particularly with regard to those tools that have been used to target improvements in knowledge and skills. With their intrinsic focus on personalization and interactivity, social media platforms are ideal to become highly versatile tools that can be used to enable knowledge translation, a key goal in health care education today.

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The findings from this review provide a map of the current literature on the use of social media in health care and, as such, can be used to identify gaps in that literature and to provide direction for future research. We identified three key areas that could drive the future research agenda: (1) choice of social media tool, (2) effectiveness studies, and (3) outcomes-based research.

First, the largest proportion of studies included in our review evaluated the use of discussion forums; however, exploring the unique applications in the education setting of newer tools, such as collaborative projects, content communities, and virtual worlds, has great potential. Studies of the impact of wikis on collaborative, in-class learning and the hands-on, practical training opportunities provided by tools such as YouTube and virtual worlds could advance instructional methods, if shown to be effective. Second, conducting effectiveness studies will be critical to understanding whether social media tools truly benefit education and practice in health care or whether their use is driven primarily by the novelty of the medium. As most included studies were descriptive, an opportunity exists to advance the methodological rigor of this body of literature through controlled, comparative study designs. Although we identified 13 effectiveness studies, the intervention in each included the social media tool as one component of a complex intervention; therefore, studies that evaluate the effectiveness of social media tools independently would be informative. Additionally, of the included studies that measured the effectiveness of these tools, nearly all reported that the use of social media was beneficial, but only half provided statistically significant findings to substantiate this claim, lending uncertainty to the strength of these results. Finally, the primary focus of most of the included studies was outcomes related to clinicians’ and trainees’ experience—namely, measures of communication between peers and participants’ satisfaction with the use of the social media tool. However, evidence of these tools’ broader utility and application to professional behavior change would propel the evidence base beyond these short-term outcomes to the more relevant impact of social media use on the education and training of clinicians, potentially improving the health care they provided and, ultimately, patient outcomes.

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Social media is a relatively new concept and is continually undergoing transformations. As such, no universal definition exists, adding complexity to the process of determining study eligibility in our review. The constantly changing nature of social media also proved challenging in defining our literature search, and the novelty of the topic made it difficult to keep the search up to date with the steady influx of new reports. However, as we conducted a scoping review, the broad categorization of the uses of social media was our focus and likely would not change with the addition of studies published since we conducted our literature search. Finally, one-third of the included studies examined social media as one component of a complex intervention, making it difficult to determine the specific impact of the tool. This concern applied mostly to studies that included discussion forums; other tools tended to be evaluated on their own.

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This scoping review provides a map of the literature on the uses of social media by health care professionals and trainees. The existing body of evidence is extensive, focusing primarily on the use of social media in education and providing descriptive findings related to how such tools are being used. Considering the popularity and prevalence of these tools, research must keep pace, delving further into whether or not social media is effective for professional and educational purposes through qualitative and quantitative research, and must focus on innovation to capitalize on the potential held by this technology.

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