INTRODUCTION
The branch of medicine continues to expand with each day and it becomes a major challenge for the physicians to stay abreast with the developments.[1,2] As a matter of fact, practice-based learning and improvement (also known as a lifelong learner) has been recognized as one of the core competencies that a student must acquire as a part of the medical training.[3,4] The renewal of the license of medical practitioners in most of the state medical councils depends on the collection of the stipulated number of credit hours that they should acquire within the renewal period. These proposed credit hours can be either acquired via attending continuous medical education programs or through scientific publications. However, with the advancement in information technology and the emergence of the coronavirus disease 2019 (COVID-19) pandemic, a significant inclination toward online mode and social media has been reported.[2,5] The purpose of the current review is to explore the role of the TikTok application in improving medical education and healthcare delivery services.
METHODS
An extensive search of all materials related to the topic was carried out on the PubMed search engine. Relevant research articles focusing on the use of TikTok application in medical education and medicine published in the period 2017 to 2022 were included in the review. The search was carried out between the period of April 20, 2022 and May 24, 2022 by single reviewer. A total of 53 studies similar to current study objectives was identified initially, of which, four were excluded due to the unavailability of the complete version of the articles. As only one search engine was used, no duplicate studies were identified. Overall, 49 articles were selected based upon their suitability with the current review objectives as mentioned in the article and included. Keywords used in the search include TikTok and medicine in the title alone only (viz. TikTok [ti] AND medical education [ti]; TikTok [ti] AND content [ti]; TikTok [ti] AND COVID-19 [ti]; TikTok [ti] AND misinformation [ti]; TikTok [ti] AND video [ti]; TikTok [ti]). The articles published in only the English language were included in the review [Figure 1]. The collected information is presented under the following sub-headings, namely, Social media and TikTok, TikTok and medical education, TikTok, medicine and public health, TikTok and COVID-19 pandemic, TikTok and Medical streams, TikTok and Surgical streams, TikTok: Oral hygiene and Substance use, TikTok: COPD and Diabetes, TikTok and specific ailments, TikTok and Public health issues, and Potential limitations and counteractive measures.
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Figure 1: Flowchart for selection of research articles
Social media and TikTok
With the introduction of a number of social media applications, a wide range of avenues has opened for consumers to browse, chat, share videos, pictures, information, and interact with each other regardless of their geographical location.[6,7] TikTok is one of the social media applications that has gained wide popularity since its launch in the year 2016. In fact, the application has crossed 2 billion mobile downloads in the month of October 2020, and this is a marker of its acceptance among people from different walks of life across the world.[8] The application is designed to post short videos, ranging from 15 sec to 10 min, and has been widely used for the sake of fun and entertainment globally. The application tends to attract its users owing to its user-friendly interface which makes it extremely easy for the users to develop and share the contents with a huge and diversified group of viewers.[8,9,10]
TikTok and medical education
Social media applications (such as Facebook, Instagram, WhatsApp, Twitter, YouTube, etc.) have shown their potential in medical education by providing a platform to share medical information in different forms, promoting student engagement, and encouraging active learning.[11] In contrast to the other social media applications, the utility of TikTok as one of the structured tools to facilitate the delivery of medical education globally is still in the earlier stages.[12] However, considering that a wide range of content can be posted regardless of the stream, even TikTok videos explaining medical content have featured covering anatomy, the correct way to don and doff personal protective equipment, or lifesaving emergency procedures.[13,14] Further, we must acknowledge that TikTok does possess the merits of other social media applications such as being free, readily accessible, promotes active learning, and student engagement.[15,16] Moreover, as the length of the posted videos is short, it ensures that student concentration remains high and the educational content is delivered in a condensed manner.[13,15]
TikTok, medicine, and public health
TikTok has emerged as one of the very popular video sharing application, and has been extensively used to share videos pertaining to medicine, and public health-related topics. The application has been used in different parts of the world to post content pertaining to COVID-19, handwashing, promotion of community engagement, nutrition, vaccine, autism, climate health, eating disorders, stress & anxiety, etc.[17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43] In fact, considering the potential public health-related consequences of most of these conditions, the TikTok has emerged as a platform for the different stakeholders to either indulge in research activities, make evidence-based decisions, or even engage in different issues of public health concerns.[9,10,17] Furthermore, we cannot rule out the role of TikTok application in teaching basic science concepts and laboratory techniques.[18]
TikTok and COVID-19 pandemic
The occurrence of the COVID-19 pandemic was associated with an extensive amount of fear and anxiety among the general population in the initial stages of the disease as there was lots of uncertainty about the mode of transmission.[19] Soon it was realized that the disease spreads by close contact and in an attempt to interrupt the chain of transmission, varying degrees of lockdown were enforced in different nations.[10,19] In these situations, like many other online social media applications, TikTok emerged as an application that played a crucial role in the propagation of information pertaining to the disease (such as the importance of maintaining social distancing, do's and don'ts, the necessity for isolation, avoiding unnecessary travels, etc.) to the different segments of the community.[19]
The content pertaining to COVID-19 on the TikTok app has been shared in the form of animations, documentaries, speeches, pictorial slideshows, role-plays, dances, demonstrations, etc.[10,20] The videos posted in the application covered multiple themes like personal precautions, recognizing the efforts of COVID warriors, appealing to people to stop stigmatizing or spreading rumors about the infection, increasing awareness about the disease, real-time insights into public views, the myths circulating in the social media, and the ways to strengthen the emergency response by individuals and society.[10,20,21] The platform was used by the people to share their individual perceptions and experiences (of those who have contracted the infection, those who were put in isolation, and those who were staying indoors during lockdown) about the infection.[20]
In order to mitigate the impact of the pandemic, the TikTok application was also utilized as a platform to promote testing for the early detection of the infection.[22] As early detection was one of the most important strategies to prevent the transmission of infection to multiple secondary contacts, the application was used to propagate about the same and encourage symptomatic people to go for testing.[22] The application was also widely used to create awareness about handwashing with the help of videos and different people posted the videos about the correct way to perform the same.[23] This proved to be quite a useful strategy to interrupt the chain of transmission of the novel viral infection.[23]
TikTok has also been employed to create awareness and promote the usage of face masks in the community in an attempt to interrupt the chain of transmission.[24] The findings of a study revealed that #WearAMask attracted in excess of 500 million views worldwide, and thus had an immense reach.[24] During the ongoing pandemic, the nursing staff played an instrumental role in the containment of the infection by risking their own lives.[25] In these stressful times with limited social interaction, the nursing staff resorted to the TikTok application to not only let out their feelings and experiences but also spread awareness about the infection.[25]
TikTok and medical streams
The incidence of dermatological ailments (such as acne, psoriasis, tinea, skin rash, hair fall, etc.) has remarkably increased among people of different ages.[9] TikTok platform has been utilized to create awareness about these diseases and also provide simple domestic tips (viz. short videos for glowing skin, skincare, home remedies for acne, prevention of sunburns, measures to reduce hair fall, etc.) to stay healthy.[9,26,27] The platform has also been used to teach dermatology residents about common skin ailments and their management.[13] On a similar note, the app has also proved of significant value for the radiologists and radiology technicians and it has been advocated that there is huge potential for ensuring the active engagement of radiologists.[28] The app has also been employed to educate parents about peer pressure and the need to promote healthy internet use among their kids, thereby avoiding any incidence of psychological illnesses.[29]
TikTok and surgical streams
Any kind of surgical procedure is a major event in the life of a person and it has been linked with lots of anxiety and fear. In order to minimize this preoperative anxiety, a study was carried out, wherein patients were asked to browse TikTok for 20 min before their surgery and it was compared with a control group.[30] The findings of the study revealed that the intervention group had definite low levels of preoperative anxiety and some impact was also reported in terms of reduction in the heart rate and blood pressure amongst the patients.[30] The results obtained from other studies have also shown that TikTok videos have been useful for oral and maxillofacial surgery, and plastic surgery.[8,31] In addition, the platform has also been by the youth and adolescents to get preliminary understanding and information pertaining to concussion and head injuries, especially while playing sports.[32]
TikTok: Oral hygiene and substance use
It is a well-known fact that poor oral hygiene has been associated with the development of periodontal disease and dental caries.[33] In order to create awareness about the same, the TikTok platform was employed to spread awareness and share educational content about the same.[33] The findings of the study reported encouraging responses wherein multiple users accessed the posted videos and benefitted.[33] With the progress in the field of medicine, a number of treatment options have surfaced for the management of substance use disorders, nevertheless, their uptake in the target population has been quite poor.[34] With the rise in the popularity of the TikTok application, innovative strategies (viz. videos related to reducing the intake of substances, abstaining from them, providing hope to the patients that they can quit the substance, sharing life examples of people who have succeeded in quitting, etc.) have been tried to attract the people suffering from substance use and thereby facilitate their recovery process.[34] Further, the application has also been used to spread awareness about vaping and it is one of the effective steps towards quitting smoking.[35]
TikTok: COPD and diabetes
Chronic obstructive pulmonary disease (COPD) has been identified as one of the commonest global public health problems. Acknowledging the scope that most of these patients might be on social media, the TikTok application was utilized to disseminate health information about the disease for their self-care, better management, and treatment outcomes.[36] Like COPD, even the prevalence of diabetes has grown immensely, with all nations reporting cases of the disease.[36] The TikTok application can be utilized to share content about the dietary restrictions, the importance of treatment adherence, the need and utility of self-care, the significance of periodic follow-up, etc.[37] However, at the same time, concerns were also raised about the authenticity of the content of the posted videos in both chronic conditions.[36,37]
TikTok and specific ailments
Owing to the long working hours, corporate culture, and poor ergonomic designs, the incidence of back pains has increased enormously worldwide.[38] TikTok platform has been utilized to share content pertaining to the acute non-specific back pain resulting because of wrong posture and long working hours, and the modifications that can be brought about by the people in their daily lives to reduce their suffering.[38] A qualitative study has been carried out to assess the utility of the TikTok platform and the shared content (such as awareness, eating during recovery, personal stories, etc.) in facilitating the recovery of patients from eating disorders.[39] On a similar note, the application has also been used to share videos dealing with the management of erectile dysfunction and has attracted millions of users.[40]
TikTok and public health issues
TikTok has been identified as one of the social media applications to aid the public health authorities in their contingency planning and to mount a better response to a global emergency or pandemic of infectious disease.[41] In addition, the app has also shown potential to augment the knowledge of the general population about different public health issues owing to the multiple features and merit of the application.[42] In fact, it has been advocated to combine more than one social media application to augment the overall benefits, as the reach of a combination of applications is always higher than a single application.[40,42] Climate change is another global public health concern as many people are losing their lives to the climate deterioration and millions of them are suffering because of the adverse climate.[43] TikTok app has been utilized to gain an insight into the views of important stakeholders and the strategies that can be implemented by people at the domestic level to arrest the deterioration of climate or emission of greenhouse gases.[43]
Potential limitations and counteractive measures
Like any other social media application, even TikTok has its share of constraints, and these need to be carefully dealt with to enhance the overall effectiveness of the app.[17,29,44,45,46,47,48,49] The limitations of the app include the quality of the videos shared, which can be quite variable, and the best approach to deal with this issue is to have a tie-up with some media agency or recording in a good quality camera.[44,45] Another limitation has been the spread of misinformation or disinformation on the app by the users and thus there is always a threat of posting incorrect information, which might result in long-term public health implications.[46,47,48] Further, there is a possibility of viewing sensitive or hateful content on the application, and there arises the need for the administrators of the app to ban hate speech (such as racism, sexism, xenophobia, etc.) and issue warnings for posting any sensitive content.[17]
Moreover, we cannot rule out the possibility of damage to self-esteem or cyberbullying due to the sharing of sensitive content targeting a single or group of individuals.[29] Further, concerns have also been raised about its indiscriminate usage and addiction to the platform, and thus there is a need to explore and identify facilitators and barriers in the usage of the application.[17] In addition, the use of these social media applications has also been linked with depression, anxiety, stress, and memory loss.[49] These problems can be avoided by minimizing the time spent on the application or dedicating a specific amount of time per day.
Implications for future and research
TikTok social media application has multiple applications in the field of medicine. However, considering that the introduction of app is still in its initial stages, a lot can be accomplished to strengthen the process of delivery of medical education. This can be attained by carrying out both quantitative and qualitative research works, wherein students are inquired about their views pertaining to the significance and application of TikTok in improving their knowledge acquisition. At the same time, research work can also identify the potential challenges that play a part in reducing the overall potential of the TikTok application. The limitation of the current review is that only one search engine has been used for the selection of research articles.
CONCLUSION
To conclude, the TikTok application has brought about significant reforms in social media networking. However, considering the fact that the application appeals to users from all streams, it is the need of the hour to explore and use the app for augmenting the health care delivery, improve management of public health problems, and facilitate better delivery of medical education.
Review details: The review was not registered, but the review protocol can be accessed. No amendments to the designed protocol were made during the review.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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