Discussion

This study provides insights into the use of SM within the clinical and academic rheumatology community. Widespread use of SM by healthcare professionals and trainees to facilitate communication has previously been reported,8 including its use in postgraduate education9 and within individual specialties.10 However, this has not been evaluated in the field of rheumatology.

It was notable that 83% of those completing the survey were active users of at least one SM platform with a mean weekly use of 6 hours and with the majority of use being carried out in a work-related manner. Comparing our results with those from a survey undertaken among oncologists in Canada,10 overall, 11% more rheumatologists reported using SM; whereas the use was highest in oncologists aged 25–34 years, in our survey the use was highest in a slightly older age group, that is, those aged 30–39 years, although there is some overlap in the two groups. This may be due to the fact that the survey was primarily disseminated via the EMEUNET community, which represents members of the specific age group.

SM was predominantly used for news updates, which are among the known uses of SM.11 In our survey, a small, but significant proportion reported using SM for rheumatology clinical and research updates. From a research perspective, SM has been shown to assist in the recruitment of patients for qualitative research and the collection of data supporting the content validity of patient-reported outcome measures.12

Facebook was the dominant platform used with the highest proportion of people reporting daily use for both general and work-related reasons. LinkedIn was reported as ‘often’ used SM and could represent an effective platform for professional communication and interaction. The survey revealed that using SM as a source of information was popular, in addition to expanding professional networks. Using SM to establish a professional online presence was also commonly reported. These findings were similar to the survey results among oncologists and oncology trainees, where it was highlighted that there was a large educational gain from SM use, even when only used passively.10

SM is increasingly providing new significant possibilities for learning and development in a fast, novel and modern way. One such example of this is a monthly rheumatology journal club that takes place on Twitter (using the hashtag #RheumJC).13 ,14 The success of such initiatives in engaging people is demonstrated by the nearly 7000 tweets sent by almost 1500 participants during the 4 days of the EULAR congress of 2015, marked with the official conference hashtag #EULAR2015.15 This was equivalent to just over 70 tweets per hour.

Recent analysis of ARD SM metrics has highlighted the positive impact using these platforms can have on readership, reach and indeed gauging the interests of the wider research community. For example, at the time of the American College of Rheumatology conference in November 2015, the most popular ARD tweet highlighted a recent online ARD article, providing insight into the interests of the wider rheumatology community. Journals can subsequently use this information in article selection for publication, therefore, choosing articles with a wide reach and interest that will encourage more citations.

Furthermore, in 2015 the potential SM impressions on ARD platforms increased by 162% compared with the previous year. This helps to increase followers (ARD reported an increase in Twitter followers in 2015 by 60% compared with the preceding year). It is clear that increasing followers and reach impact on readership and content dissemination, and also potentially promote the ARD brand and enhance the face of ARD. This is evident, again when SM metrics were applied to ARD SM platforms and the top retweeted tweet from the ARD platform was identified. The content of this tweet announced the new impact factor for ARD in 2015, which was the highest retweeted tweet of the year. Directly comparing the SM statistics from 2014 with 2015, it is clear that interest in SM is growing as seen by a large increase in activity (68% increase in Tweets, 233% increase in favourites, 252% increase in retweets and a 60% increase in followers).

Lack of knowledge on how to use SM was the most commonly reported reason for not using SM, highlighting the need to better understand the value of SM and an opportunity to educate potential users on how to positively use it to facilitate learning and interprofessional relationships.9 In light of these findings, EMEUNET launched a 10-day online training programme to facilitate a better understanding and use of Twitter for professional purposes. In the future, further resources may be considered to extend such learning to a wider audience via sessions at EULAR annual conferences and dedicated training for academics and clinicians via courses, written materials or online self-directed learning. A recent successful example is a SM for healthcare certificate provided by the Mayo Clinic in collaboration with Hootsuite, to provide the basics of SM for healthcare professionals.16

Only a few people expressed concern regarding a possible negative impact on their reputation when using SM, highlighting that this may not be a major barrier to its use; still over a third of respondents not using SM expressed concerns regarding its safety. However, this is in contrast to almost two-thirds of respondents who felt that SM is a safe way of communicating with other people, emphasising how mixed and user-dependent these perceptions are. While such concerns are valid, proper education on the safe use of SM, setting adequate privacy settings and relevant guidelines, such as those from the American Medical Association on the ethical use of SM can help limit its disadvantages.17 Other perceived pitfalls may be creating additional traffic on SM pages, committing time/resources to managing an SM presence, responding to feedback and producing new content.

This survey provides insights into identifying and understanding mechanisms behind current SM practice and perceptions. Still it did not explore reasons for specific perceptions regarding the use of SM or access to SM, as limitations of the study. Similarly, the survey did not capture details in the use of specific SM platforms such as YouTube, although this area was broadly addressed when respondents were asked to indicate which media sharing sites they used most frequently. Furthermore, only 10% of the respondents were older than 40 years, which limits the generalizability of the results across different age groups. The true acceptance and use of SM across older age groups may be lower and limits the external validity of our results beyond our target age group.

At the same time when our study participants further develop in their careers, we expect that the impact of SM will grow over the next decade. The increasing use of SM among medical professionals is likely to improve accessibility to new information, hence enhance self-directed learning, networking opportunities, communication between different forums and improved efficiency/effectiveness of current healthcare systems. The ease and accessibility in which large volumes of information can be obtained via SM is likely to have implications for time management in a professional setting. In addition to this, with the emergence of compatible SM platforms on mobile phones and tablets, the use of these programmes outside of working hours is likely to be quick and convenient with a minimum time commitment.18 Assessing patient-reported outcomes in some countries is already performed via online platforms and mobile applications, which accelerate routine work process in rheumatology clinics. In the future, given such trends in SM usage in both the personal and work-life of medical professionals, trainees and students over the last decade, SM is likely to have an integral role in education and mutual communication.

In conclusion, the results of this survey highlight that SM is used by both rheumatology professionals and basic scientists for professional development, networking and education. Due to its ease of access, wide variety of information and convenience (ie, via mobile applications), SM provides a dynamic medium for medical education, interactive and collaborative learning and the potential for networking. However, creating and sharing information on SM is user-dependent and the lack of knowledge on how to use SM in a work-related manner is one of the key identified unmet needs in this survey highlighting a potential for further development and training in this area.