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When Medicine Is Becoming Collaborative: Social Networking Among Health-Care Professionals

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Abstract

In recent years, Wikis, blogs, microblogs, and other social networking platforms have become available to health care professionals facilitating information sharing and interprofessional collaboration. Online health-care provider communities act as “apomediaries” helping users seek, filter, and select relevant information. Interactions with professional peers on these platforms also provide opportunities for sharing, creating, and applying knowledge within their scope of practice. This chapter examines the use of web-based collaborative applications and social networking platforms by health professionals. Specifically, we outline the potential impacts on professional development, collaboration among health-care professionals, professional mentoring and support, and patient outcomes. We identify ways to address use barriers and outline potentials in fostering health-care professionals’ participation and engagement and conclude with future research directions.
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When Medicine is Becoming Collaborative: Social Networking Among
Healthcare Professionals
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Thoër,!C.,!Millerand,!F.,!&!Duque,!N.!(2017).!When!Medicine!is!Becoming!Collaborative:!
Social!Networking!Among!Healthcare!Professionals.!In!The$Digitization$of$Healthcare:$New$
Challenges$and$Opportunities$(Palgrave!Macmillan!UK,!pp.!119–!134).!Menvielle,!L.,!
Menvielle,!W,!Audrain-!Pontevia,!A-F.!
!
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Introduction
Staying informed on the newest evidence-based practices is necessary for healthcare professionals
(HPCs) and plays a critical role in the quality of care provided (Archambault et al., 2013).
However, remaining up-to-date is becoming more and more of a challenge for HCPs as healthcare
knowledge changes and expands rapidly (McGowan et al., 2012). Tacit knowledge (clinical
experiences, skills, know-how) is of particular importance to enhancing the quality of medical
diagnosis and decisions (Panahi, 2014).
With the development of the Internet, arrays of online resources for healthcare professionals
looking for scientific knowledge and best practices have emerged. Among them, are specialized
medical websites such as Medscape, QuantiaMD, and iMedExchange. Online information can be
accessed in different ways (Labrecque et Beaupré, 2013). The passive approach (push) consists in
registering on various websites to receive email alerts on medical topics such as critical reviews
or better practice suggestions. The second method is active (pull), the user retrieves information
on demand. The third, which we will focus on in this chapter, is interactive and calls for a
discussion of information with colleagues using various tools such as wikis, blogs, open social
networking platforms (e.g., Twitter or Facebook) and online professional networks. Use of these
resources for information sharing as a part of continuing educational activities or discussing
clinical issues is growing (Georges, Roviniak et Kraschnewski, 2013). Informal communication
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among colleagues (oral or written) is not a new phenomenon; it is rooted in the medical culture
(Kuo, 1998). When looking for new medical developments or when caring for a patient with severe
problems, clinicians will often turn to peers and colleagues (Haug, 1997). Social media websites
and web-based applications offer new potentials for supporting informal communication, allowing
for the rapid dissemination of information to a broad audience (Ellison and boyd, 2013).
Understanding how everyday communication practices take place online is essential.
This chapter examines the professional use of social networking websites and applications in
healthcare practices. We outline the reasons HCPs use social media and examine the potential
impacts on professional development, collaboration, mentoring, and patient outcomes. We then
identify the factors that enable an active participation in these networks as well as ways to address
identified use barriers. We conclude by suggesting future research directions.
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1 How and why do healthcare professionals use social media to communicate
with peers?
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1.1 Professional social media use is on the rise
Social media use by health professionals has increased in the past decade (George, Rovniak and
Kraschnewski, 2013; Hamm et al., 2013; Antheunis, Tates and Nieboer, 2013). Social Media
websites and applications can be used for social or professional networking (Facebook, Twitter,
LinkedIn), media sharing (YouTube), content production (blogs), collaborative writing and
knowledge aggregation (Wikis and Google Docs), and virtual reality and gaming environment
interactions (George, Rovniak and Kraschnewski, 2013; Hamm et al., 2013; Antheunis, Tates and
Nieboer, 2013). Healthcare professionals can also access information and interact with peers on
specialized professional online communities developed by healthcare organizations, professional
associations, healthcare and pharmaceutical companies or as part of ongoing research projects.
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Such networks are commonly restricted to targeted professions (George, Rovniak and
Kraschnewski, 2013; Hamm et al., 2013; Antheunis, Tates and Nieboer, 2013). Studies that
evaluate the use of social media by HCPs are of variable quality (Ross et al., 2016). An online US
survey of 4000 connected physicians (with access to computers and mobile technology) conducted
by QuantiaMD, found that more than 90% of the doctors surveyed use social media websites and
web-based applications for personal purposes with Facebook topping the list of website use.
Moreover, 65% of the physicians used some form of social media for professional purposes,
chiefly online physician communities (28%), LinkedIn (17%) and Facebook (15%) (Modahl,
Tompsett and Moorhead, 2011). Online media is now the preferred information source for health
profession students whose rates of social media use are found to be over 90%, a fact not so
surprising, as most of them have grown up in a technologically socially mediated world (Brown,
Ryan, and Harris, 2014; Usher et al., 2014; Giordano et Giordano, 2011; George, Rovniak and
Kraschnewski, 2013). However, social media use varies widely among HCPs, between age cohorts
and across practice settings (Adilman et al., 2016), but most studies have focused on physicians
and nurses (Rolls et al., 2016). There are also national differences. A survey conducted in 2012
and involving 6700 physicians in European countries, the USA, Japan, Brazil, India, China and
Russia showed that the use of social media and online physician communities for professional
networking is much more developed in emerging countries, the UK, Germany, and the USA than
it is in Italy or France (Cegedim Strategic Data, 2012).
What motivates social media use by HCPs is also varied. A qualitative study conducted among 22
physicians around the world revealed six critical adoption factors: staying connected with
colleagues, reaching out and networking with the wider community, sharing knowledge, engaging
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in continued medical training, benchmarking, and branding (Panahi, 2014). These motivations are
examined in the following sections.
1.2 Using social media to address information overload
Finding and sharing medical information online regarding issues relevant to their field and staying
updated on evidence-based practice guidelines has become very popular, especially among the
younger physicians (Almaiman et al., 2015). Online resources act as “apomediaries” helping users
seek, filter and select relevant information (Eysenbach, 2003). Following what colleagues are
sharing and discussing among themselves is likewise an effective way of addressing informational
overload as well as being one of HPCs’ most popular activities on open and restricted social
networks. (Antheunis, 2013). Through Twitter, for instance, healthcare workers can quickly find
peer-reviewed information (Panahi, 2014). Social media also facilitates tacit and experiential
information exchange such as clinical experiences or practical tips. They enable the sharing of
information through stories that are “usually carriers of profound contextual understanding,
knowledge, and experience that a person shares with other people in very simple language”
(Panahi, 2014). As Grindrod et al. (2014) point out; social media have reintroduced the power of
patient stories and anecdotes that are included in the making of collective medical knowledge.
1.3 Social media use for professional education
Likewise, social media tools are increasingly used for educational purposes and, especially so, by
medical students (George, Rovniak and Kraschnewski, 2013). In some US pharmacy programs
students are provided access to course material on Facebook, which seems to be their preferred
option (Grindrod et al., 2014). Social media also offer access to information that complements
those offered in the traditional medical school curricula, and this knowledge has the benefit of
being retrievable on demand (Cartledge, Miller, and Phillips, 2013). In a qualitative study on
Twitter use by medical students, participants reported that the active use of Twitter provided them
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with access to corresponding information, enabling them to increase their learning opportunities
through the sharing of articles and study techniques, while connecting, outside of the classroom,
with students and instructors sharing similar interests (Chretien et al., 2015). These students were
also able to reach experts they might not have been able to otherwise. However, such benefits were
only observed among the active users of Twitter, which represented a minority in the study.
Another qualitative study focusing on the use of collaborative writing applications such as Google
Docs by medical residents cited that learning consolidation was the main advantage of using social
media, but at the same time revealed that motivating residents to contribute to these platforms or
applications was a challenge (Archambault et al., 2009). While feedback from users is positive,
more evidence on the effectiveness of social media use for educational purposes is needed
(Cartledge et al., 2013).
1.4 Asking for advice from peers online
Seeking medical advice at the point of care is another often-mentioned objective for utilizing social
networking platforms and participating in specialized online communities. Healthcare
professionals are progressively turning to social media to connect with peers and colleagues when
they have questions regarding diseases, diagnoses, or treatment options. Social media is especially
useful as it provides the opportunity to exchange texts, photos, and videos. On restricted password
protected networks intended for HCPs only, these contents can be exchanged securely.
Crowdsourced social networked answers to clinical questions likewise seem effective in providing
expert advice rapidly. For particular healthcare specialties, such as clinicians requiring information
during infectious disease outbreaks, accessing information in real-time is critical (Goff, Kullar,
and Newland, 2015). In addition to using their personal computer to access information, many
HCPs are now using their mobile devices. Studies conducted in emergency departments show that
such devices enable HCPs to retrieve information in varying environments and times, while
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“fitting better” within the daily workflow (Curran and Abidi, 2007). By providing exchange
opportunities between organizations, social media use can also reduce the professional isolation
experienced by HCPs working in rural areas (Rolls et al., 2014). It also updates HCPs on the
various ways of practicing medicine around the world allowing them to benchmark the most
efficient ones (Panahi, 2014).
1.5 Collaborative knowledge development
Collaborative platforms offer the opportunity to develop and apply knowledge embedded in use.
This practice mirrors the concept of Communities of Practice where participants organized around
a common purpose engage in a process of collaboration and reflective practice (Wenger, 1998). In
the healthcare field, collaborative platforms and web-based writing applications such as wikis
allow users to create online content that can be accessed or edited by professionals within specific
health departments or by anyone wanting to contribute if the wiki is not restricted. Such tools show
potential for updating evidence-based clinical practice guidelines and optimizing clinical practice
(Archambault et al., 2013). For example, they can be used at the point of care to store and update
protocols within emergency departments (Archambault et al., 2013). Social media can also
facilitate healthcare research project collaborations as well as enable access to study results.
Platforms such as Twitter expand professional and scientific audiences, contributing to the
dissemination of knowledge on a global scale (Goff, Kullar, and Newland, 2015).
1.6 Understanding the broader healthcare context and the patient’s perspective
Social media offers HCPs and students the opportunity to discuss controversial healthcare issues,
health policies or healthcare reforms with other caregivers and health sector actors (including
patients), developing a better understanding of the context in which they practice healthcare
(Chretien et al., 2015).
Social media, especially health blogs, Twitter or forums allow clinicians access to the patient’s
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perspective, changing the way they see and do medicine (Chretien et al., 2015). Through blogs,
chronic patients and family caregivers share their illnesses and everyday life experiences,
including interactions with the healthcare systems, giving meaning to their experiences. A patient’s
disease narrative is crucial to understanding and contextualizing the lived experience of being ill.
This key healthcare dimension can be very helpful in improving communication between HCPs
and their patients, and, especially, in promoting reflective practices and empathy. It also helps
clinicians better understand the way patients navigate the healthcare system, enabling them to
direct patients towards the best resources (Batt-Rawden, et al., 2014).
1.7 Building a meaningful professional identity
Sharing a profile on social media is, furthermore, used for “personal branding” reasons serving to
establish one’s professional status and credibility while developing partnership opportunities and
interprofessional collaborations (Panahi, 2014). Social networking platforms offer spaces where
HCPs can discuss with peers about their practice experiences (Lagu et al., 2008). Blogs are
especially popular. These types of online publications are easy to produce, and the information
published is more inviting and accessible than those found in academic journals. Additionally, they
allow HCPs to communicate their stories and to express their views and feelings in alternative
manners. They can address the doubts, fears, and frustrations experienced in their daily practice
(Vartabedian, Amos and Baruch, 2011). Participation on open networking platforms such as
Twitter also contributes to a professional sense of meaning and community (Chretien et al., 2015)
and promotes interest and passion for patient care (Batt-Rawden, et al., 2014).
Healthcare professionals differ in their use of social media, but a common outcome is a noticeable
change in the way they interact and learn. While the reasons HCPs use social media vary, the main
benefits seem to be a widening of knowledge networks, access to expertize from colleagues and
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peers, and the provision of emotional support (Pereira et al., 2015). Active social media use can
enhance professional practice and judgment and provide better patient care.
2 Barriers to social media use for Health Care Professionals
While social media use among HCPs is growing, studies have reported several barriers to their
adoption. HCPs face several social media adoption challenges (Panahi, 2014), and regular
professional use of social media is still limited especially for microblogging platforms such as
Twitter and wikis (Chretien et al., 2013).
2.1 Privacy issues and liability and litigation concerns
Privacy issues and concerns about liability and litigation are some of the main obstacles. Posting
information, photos or videos on a social networking website can be a breach of patient
confidentiality and could result in legal actions taken against the HCP or his employer (Ventola,
2014). This legal obstacle explains in part the lack of support given to social media use from
regulating bodies and medical schools whose discourse has mainly focused on the risks and ethical
issues that are associated with its practice (George, Rovniak and Kraschnewski, 2013; Grindrod et
al., 2014). Anonymization of personal health information shared on the Internet is one way to
minimize risks, but it can sometimes prove difficult. Information provided in a particular case,
even if anonymous, could still allow for patient identification within the healthcare community
(Ventola, 2014). Communicating through password-restricted communities might be helpful, but
HPC participation in specialized online communities is still limited. Changes in the open social
networking platforms that many HCPs use personally, for example, Facebook’s private groups
offer potential avenues for addressing these privacy issues (George, Rovniak and Kraschnewski,
2013). Another recommendation from regulating bodies is that HCPs draw a strict line between
their personal and professional identities when dealing with patients and peers online by using
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separate social media profiles. Although, the line between social and professional use is easily
blurred: if I blog on my nursing practice, is it professional or personal? Some applications (such
as Google + for instance) allow users to tailor their profile information to different audiences
(George, Rovniak and Kraschnewski, 2013). Users might find, nonetheless, that establishing clear
personal/professional profile boundaries is not always the best thing to do. A 2015 study by
Chretien et al. (2013) on Twitter use among medical students showed that participants preferred
using their personal Twitter account to exchange medical and scientific information with
colleagues, emphasizing the importance of being authentic as it proved useful to develop one’s
professional network (Chretien et al., 2013). Concerns over privacy are also an issue in the
classroom as “friending” colleagues or students on Facebook could be considered a violation of
age and gender boundaries (Grindrod et al., 2014).
2.2 Concerns with the quality of information on social medial
The scientific quality of the information resources available on social media is also of concern
among HCPs as these platforms facilitate fast dissemination of information from varying sources
(Panahi, 2014). Sufficient participation on social media platforms improves the quality of the
information offered as incorrect information is flagged, but trust and identifying whom to follow
is a chief concern for many HPCs. In Panahi’s 2014 study, conducted among 22 active social media
user physicians, participants reported establishing trusted online relations first by connecting with
people they knew offline, then by using peer recommended resources, through authenticity, and
by relying on professional standing, and engaging in consistent communication, and lastly, by
favoring non-anonymous posting and moderated websites (Panahi, 2014). Reliability of
information is also an issue on collaborative writing applications because of the lack of traditional
authorship (Archambault et al., 2009).
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2.3 Limited time and lack of social media skills
Other barriers and challenges that HCPs experience when using social media include the lack of
skills and self-efficacy to exploit theses online resources efficiently and to deal with information
overload and anarchy (Antheunis et al., 2013; Pereira et al., 2015). Finding time to follow
healthcare issues and topics and post information can also be a problem and some HCPs have
limited access to social media in their place of work. Finally, a lack of understanding of the benefits
that social media use can provide HCPs and a feeling that professional engagement on these
platforms is a waste of time limits their use, especially with older and established HCPs (George,
Rovniak and Kraschnewski, 2014).
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3 Addressing social media use barriers
To improve the potential of social media use, researchers have identified several ways to address
the barriers to their use and to foster HCPs participation and engagement on these platforms.
3.1 Guiding social media practice
There is a need to provide HCPs and medical students with directives and clear guidelines to help
them develop the best possible social media practices (Househ, 2013). Faculty should address e-
professionalism and encourage students to reflect on their use of social media (Grindrod et al.,
2014). Professional organizations and regulation bodies should also focus less on social media
misuse and instead develop strategies to use these platforms effectively to communicate with
patients and peers (George, Rovniak, and Kraschnewski, 2013). University curricula, as well as
continuing education programs, should include workshops on HCP social media strategies and
provide institutional credits for participation. One way this could be done is by reaching out and
partnering with non-medical disciplines such as Communication Studies (George, Rovniak, and
Kraschnewski, 2013).
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3.2 Encouraging active social media users to act as mentors
Active professional participation on social networks is equally an issue. Compensating established
HCPs leaders for sharing information and for engaging on these platforms (for example, by
providing continuing education credits) would be very useful as the available time HCPs have to
participate on social media is limiting. Their experience can serve as best practice examples for
students and other professionals (George, Rovniak, and Kraschnewski, 2013). Social media can
also be used to strengthen mentoring activities especially for HCPs who subspecialize (Ventola,
2014) as well as encouraging the positive use of these platforms (George, Rovniak, and
Kraschnewski, 2013).
3.3 Using social media will make you a better healthcare professional
Incorporating social media use into healthcare training should target enhancing HCPs’ reflective
practice. Patients’ presence on these platforms is increasing, and this is changing the way they deal
with their health issues as well as the way they interact with HCPs (Thoër, 2013; Grindrod, 2014).
HCPs should take advantage of these patient-focused networks to gain insights on patient
experience and on ways to manage treatments better so that patients can easily adopt them. Social
media also offers great interaction enhancing potential between patients and various professionals.
Because medical knowledge is no longer within the exclusive control of medical experts on social
media, it is crucial that HCPs participate on these platforms (Thoër, 2013; Grindrod, 2014). HCPs
engagement on social networks is critical to improving the quality of health information provided
to the community through the Internet (Ventola, 2014).
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Conclusion
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Social media use by healthcare professionals is on the rise, but its use is still limited and varies
according to specific professions and practice settings. This relatively slow appropriation of social
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media by HCPs can be explained in part by the fact that regulation bodies, medical training centers,
and schools and healthcare organizations have not encouraged their use. Moreover, these practices
may be seen as contrary to the prevailing medical culture, which prioritizes individual and face-
to-face communication, confidentiality, and the formal production and movement of knowledge
(Brown, Ryan and Harris, 2014; George and Green, 2012). Practices are rapidly changing, and the
younger generations are more apt to adopt social media. Several organizations and schools are now
promoting efficient and active use of social media.
The literature suggests that there are several benefits to social media use by HCPs. Among them,
they enhance the sharing of evidence-based and tacit knowledge. Accordingly, their use could
facilitate and accelerate the exchange of informal information that is at the heart of HCPs practices.
Also, as social media can expand connections and networks of relationships as one of their key
features, an increased use by HCPs may foster the development of new contacts and partnerships
between HCPs within a professional domain as well as between domains. There are, however,
legitimate concerns regarding confidentiality, private/public boundaries and the accuracy of online
information. Further research will be needed to understand exactly how it is that social media use
contributes to improved knowledge, skills, and quality of care outcomes as well as healthcare
professionals’ satisfaction (Batt-Rawden et al., 2014; McGowan et al., 2012). So far, research on
social media and HCPs has focused mainly on documenting uses with a marked preference on
doctor-patient communication practices. Examining how and in what contexts the use of social
media transforms communication practices among healthcare professionals will be essential in
understanding and evaluating the impacts of social media use by HCPs. It will also be necessary
to document how health professionals, other than doctors, use these platforms for peer interactions.
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These traces will help identify successful social networking strategies and those that should be
shared as well as promoted among clinicians (George, Rovniak, and Kraschnewski, 2013).
As such, further research is needed to develop, implement and evaluate the training strategies that
would encourage the appropriation of social media in clinical practice, for patient communication,
but also among colleagues and peers. In general, communication between HCPs occupies little
space in most training programs (Galarneau, et al., 2016). The increase in social media use by
patients, as well as by HCPs, offers researchers not only the opportunity to reflect on professional
health communication practices but also an occasion to reconsider and rethink these practices.
While professional social media use is still limited, we believe that it will become an essential tool
for everyday medical practice.
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... Il semble pertinent d'intégrer l'apprentissage des réseaux sociaux aux formations existantes TICE (Technologies de l'Informations et de Communication pour l'Enseignement). L'étude suggère également l'intérêt d'ateliers de formations professionnelles continues autour des réseaux sociaux mêlant professions et générations.(20,21) ...
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Introduction: Since February 2020, a Covid-19 epidemic has taken place in France. During the first quarantine, in the department of Maine-et-Loire (49), general practitioners set up a network called "Coville-49" in the form of outpatient consultation centers dedicated to COVID-19 and co-articulated between the ARS Pays de la Loire, the University Hospital of Angers, the Council of the Departmental Order of Physicians and the ADOPS49 (Association for the Organization of Permanent Care). A Telegram "Coville 49" instant messaging discussion thread was created and brought together all the physicians involved in the field. The purpose of the study was to assess the help that the creation of a specific “Coville-49” network could have given to general practitioners and to describe their reorganization mechanisms to face the COVID-19 crisis, in particular through the contribution of digital tools (social networks, teleconsultation). Method: This was a survey carried out from 11/04/2020 to 25/04/2020, based on an anonymous survey "Google Forms", sent to practitioners registered in the discussion thread "Coville 49" by Telegram messaging. This system included 541 registered doctors. The survey addressed the impact of the COVID-19 crisis on organizational and practical levels and on the difficulties encountered in their exercise. Results: 52.4% (240/458) of active discussion members responded to the survey. 79% of the respondents were general practitioners. 82.1% participated in the Coville-49 outpatient network. 89.8% felt it made it easier for them to exercise. The Telegram wire was their primary information resource and a direct peer-to-peer exchange. Teleconsultation was used for more than 90.5% of them. Despite a destabilization for 79.5% of them and a drop in activity for 97.9%, respondents' sense of usefulness in the face of the crisis achieved an average score of 6.4 / 10. Liberal outpatient doctors were more worried about their patients’ situation of their relatives’ than for themselves. Conclusion: The intersectoral, inter-structural, inter-professional Coville-49 network has been able to pool a diversity of strengths, exchanges and experience sharing which was acclaimed by all participants. It was an innovative response adapted to the crisis situation. It may open up to new practices between health professionals and general medicine.
... For example, the medical field utilizes digital social media tools to enhance professional learning and development (Gonzalo, Thompson, Haidet, Mann, & Wolpaw, 2017;Roberts et al., 2015;Roland, Spurr, & Cabrera, 2017;Thoër, Millerand, & Duque, 2017). Chretien, Tuck, Simon, Singh, and Kind (2015) examined the role of Twitter for professional learning and development amongst a group of medical students. ...
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Healthcare professionals (HCPs) are using social media tools to communicate, educate and engage with their peers worldwide. Twitter allows HCPs to deliver easily accessible "real-time" clinical information on a global scale. Twitter has over 500 million active users who generate over 58 million tweets and 2.1 billion search queries every day. In this paper, we describe why Twitter is important, how and when an infectious diseases (ID) HCP should use Twitter, the impact it has in disseminating ID news, and the educational value of Twitter. We also describe various tools within Twitter, such as Twitter Chat, that connect and bond HCPs on a specific topic. For the ID HCP, Twitter may help teach the global responsible use of antimicrobials in a world of escalating antimicrobial resistance. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Keeping up-to-date with new health information is a necessity for healthcare professionals. Today, social media platforms such as Twitter, among others, are important sources for healthcare professionals. Within the Arab world, little is known about how healthcare professionals use social media to update their healthcare information. This study aims to estimate the prevalence of healthcare professionals, primarily physicians, in seeking online health information in Saudi Arabia. We conducted a web-based survey among Twitter participants between February 1 and March 10, 2015. The primary outcome measures were the self-reported rates of Twitter use, perceived effects, and the influence of Twitter information on clinical practice. Our results revealed that the prevalence rate of physician's seeking online health information was 79% (n=166); the majority of them (71.4%, n=150) reported that Twitter had a significant impact in increasing their medical knowledge and in improving their clinical practice. Over half of the survey participates reported the need for investment in establishing trustworthy and credible health Twitter accounts. The participants reported that their preference for social media health accounts that focus on women's health, non-communicable disease and psychotherapy (20%, 18.1% and 14.5% respectively). The findings showed clearly that seeking web-based medical information through social media is popular among physicians, in general, but especially among younger physicians in Saudi Arabia. The study findings indicate to the necessity for further research on designing and implementing a national social media based educational outreach program to provide evidence-based healthcare information and improve healthcare providers' knowledge and skills in Saudi Arabia.
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