Twelve Tips for Creating Your Program's Social Media Footprint

Social media is an emerging and underutilized tool in graduate medical education. Current generations of physicians increasingly rely on social media for information and connectedness. The use of social media in medical education provides a low-resource/high-impact strategy to improve physician wellness, reduce burnout, enhance medical knowledge, and supplement residency programs' recruiting efforts. Creating and maintaining an effective social media presence necessitates the use of a well-rounded team of residents at varying levels of training to ensure diverse posting perspectives. Account managers should establish goals and policies to ensure continuity and cohesiveness in their posting. Social media teams should work to increase the account's reach and interaction through engaging images, topical hashtags, location geo-tags, and tagging other accounts and follow their own progress through analytics. Using these twelve tips will help your program create a robust, impactful social media presence.


Introduction:
The current Millennial generation relies heavily on social media for information and social connectedness, the latter of which has a large impact on wellness in residency (Shapiro, Zhang, and Warm, 2015;Sterling et al., 2017). With residents often spread out across several campuses and on a variety of circadian shifts, the need to develop an ever present 'virtual home' is more important than ever (Pearson, Bond, and Kegg, 2015). Experts recommend lowresource/high-impact strategies may be the most effective for reducing burnout and that loneliness correlates with burnout in a dose-dependent fashion: social media may be part of the solution (Pearson, Bond, and Kegg, 2015;Shapiro, Zhang, and Warm, 2015). The ability to make it easier for learners to be more present and feel more central within their community/network may alleviate feelings of loneliness and temper burnout. Additionally, by creating a social media home for residency programs, learners not only increase personal wellness but are exposed to current medical literature and increase educational curiosity. Exposure to the internet and processing of vast amounts of information from an early age, predisposes current and future learners to benefit from a more mobile easily accessible form of knowledge (Scott et al., 2014;Sterling et al., 2017). Having real-time discussions regarding content via social media without the need to be physically present can enhance the educational environment (Hayes et al., 2015;Topf, Sparks, and Phelan, 2017). The ability to use social media to an advantage to create resources such as 'virtual journal clubs' and updating learners on content from program conferences increases medical knowledge and participation amongst learners and staff.
While the benefits of social media on medical education and increasing learner involvement is a primary focus of recent literature, the benefits seen in wellness and recruitment are anecdotal, but favor similar positive outcomes. The creation of social media pages can also encourage learners to create their own pages, allowing them to benefit from all aspects of a social media program, not only the educational component (Galiatsatos et al., 2016).
Social media can also enhance recruitment for future learners who may be interested in their program (Pearson, Bond, and Kegg, 2015). Applicants feel as though they're getting an 'inside look' into the true spirit of a program, and this is often enticing. Active use of social media can thus help applicants in choosing the program that will most likely fit their needs.

Tip 1: Select the right team
In order to have an effective social media program, team members need to be able to post on your social media platforms. Team members should be trustworthy, knowledgeable, and available. There should not be any concerns with team members in terms of the content that will be posted, and this can be further emphasized by specific and realistic expectations about content. A mixture of faculty and residents is ideal to get maximum coverage and content variability. Including residents at different levels of training is ideal so that post material will be more relatable across the program and users, i.e. interns vs. senior residents. Additionally, it helps to include residents on varying schedules to ensure that posts from different campuses, night shifts, and day shifts are posted. This provides followers maximal exposure to the program, its diversity, and your desired content.

Tip 2: Know your program/hospital's social media policy and be HIPAA compliant
First and foremost, we are bound by HIPAA to protect PHI (Pillow, Hopson, and Bond, 2014). Providing an honest and interesting view of your program for social media will inevitably involve photos that may potentially contain PHI, such as computer screens or photos in an area that may have patients. Protecting PHI can be easily accomplished through intentional positioning of subjects and careful angles or by editing photos. Helpful in-app editing features include color filters, adjustment of contrast, or tilt-shift filters, and additional photo editing apps with dedicated blur functions can also help. Our program uses FaceTune® for its selective blurring brush, in addition to in-app features. Many programs and hospitals may already have social media policies in place, and these should be noted prior to creating a new social media platform (Pearson, Bond, and Kegg, 2015).

Tip 3: Select the social media platforms your residents prefer
For a program's social media outreach to be effective, learners must be able to see posts. Integral to this is knowing which platforms learners in your program prefer to use, as it does not benefit the program to have accounts that no one follows. Using platforms with which most of the learners are already familiar makes it easier for them to start following and interacting with a program account. This maximizes interaction between learners and the program. Many institutions may be familiar with certain programs already such as Twitter®, but it is encouraged to find out Fick L, Potini Y, Axon K MedEdPublish https://doi.org/10.15694/mep.2019.000169.1 Page | 3 the tools learners actually prefer to be able to get the most from your social media program. Our social media survey identified Instagram® as the preferred platform for residents, though we also utilize Facebook® and Twitter®.

Tip 4: Set expectations for account managers
All account managers should have the same understanding regarding the content of posts. Setting and communicating major goals for the accounts is key to having effective posts. For example, a program Twitter may be used primarily to perpetuate virtual learning and host virtual Journal Clubs. An Instagram account can then focus on creating social connectedness amongst learners and fostering personal wellness. These are just examples, but these expectations should be established at the onset of account management to create a cohesive presence. Additionally, expectations regarding the number of posts should also be established early on. For example, a new media team of two residents and one faculty could start with expecting each team member to post once per week, with any additional posts as a bonus, as this would ensure an active account with three posts per week total with minimal time commitment. These goals are not concrete and as the nature and reach of the accounts grows, these goals would likely change. The expectations should be routinely revisited to ensure maximum effectiveness of all accounts.

Tip 5: Select an easily searchable account name
To achieve the goals of the account (i.e. hosting online journal club or fostering social connectedness), increasing the account's reach and interaction is key. One way to achieve this is by making the account simple and easy to find. An account name that is easily searchable and linked to your program will allow current and future learners to easily find and follow your program. Something simple yet memorable that easily describes your program is ideal when choosing your account's name. A generic example: State University's Internal Medicine program may name their Instagram account "SUIMResidency."

Tip 6: Tag your posts with searchable hashtags and location to boost visibility
Another way to increase visibility, interaction, and reach is by writing captions that also include hashtags and location geotags. Both Instagram and Twitter utilize hashtags, which are searchable keywords to tag a post and make it easy to find. Location geo-tags also can improve visibility for people in your area. Thus, you can organically build followers through the apps themselves without relying solely on word of mouth. Additionally, a post's caption should be topical, short, and creative. Typically, a caption is followed by hashtags relevant to that post and its content. Relevant universal hashtags such as #foamed, #internalmedicine, and #residencylife are just a few of many examples that can help you target audiences who are looking for similar posts. You should also consider creating searchable hashtags that are personalized for your program: our program uses #stvimwellness and #stvimresidency. Location can also be key: for example, tagging the location of a national conference in your posts from said conference can dramatically increase the visibility of your program account.

Tip 7: Use variety in content and timing
Every learner is different not only in how they learn, but also in what types of posts they respond to. A broad variety of content addressing education, wellness, and the social aspect of your program is ideal to ensure all followers can find something they're interested in and improve overall appeal of your program's account. Posts that incorporate multiple content ideas tend to do especially well and can pique the interest of more followers. Additionally, followers access platforms at different times of the day, so posting at various times during the day and night, as mentioned previously, will keep followers engaged.

Tip 8: Follow other SM accounts and hashtags for your specialty or other residency programs
To maximize the benefits of your social media accounts, following other accounts related to your specialty, other residency programs, and relevant hashtags can help you and your followers find new accounts and disseminate knowledge. Following accounts of journals and professional organizations allows account managers to see posts about practice guidelines, up to date literature, and interesting cases that can then be reposted for your own followers. Also, following other programs is helpful as they may be utilizing and featuring programming on their account that you could then implement in your own program. Finally, following hashtags that are relevant to you and your followers can link you to new accounts and posts that might be of benefit to you. We recommend following smaller, specific hashtags so your feed doesn't become overwhelmed with posts only loosely related to your program's account goals. For example, we follow our own #stvimresidency as well as other program's hashtags, but do not follow #internalmedicine as this hashtag is often unrelated to our posting goals.

Tip 9: Improve reach and visibility by using photos, retweets, shares, and likes other posts
Posts on Twitter do not require an image, in contrast to Instagram, which is an image-based social media platform. In our experience, image-based posts perform better overall on Twitter. On Instagram, photos of people specifically rather than still-life or text-images perform better. Feature your students, residents, and faculty at or away from work. Often, our learners enjoy being featured and it further promotes social connectedness to see colleagues featured on the account. When featuring persons, account managers should gain their permission to post the image on social media. Reposting (or retweeting on Twitter) and liking posts is another way to improve engagement and reach. As mentioned above, reposting is a great way to easily spread knowledge, interact with other programs, and cite original sources for information.
Tip 10: Don't "follow" your learners unless they give permission or want to be followed; tag without following Though many of your program's residents and rotating students may follow your account, it is important to not follow them back. This allows your program to foster a feeling of safety on social media and eliminate any "big brother" aspect that learners might be concerned about, leaving learners open to freely express themselves outside of work. If specific learners request being followed back, this is acceptable. Here again, it is important to establish a standing policy amongst all account managers at the onset of social media account management. Followers can still be tagged in posts even if the program account doesn't follow them back, and this eliminates the necessity for programs to follow everyone they want to highlight. To truly keep tabs on any program-related posts, we recommend encouraging followers and learners to use our designated program hashtag with the caveat being that we will see those posts.

Tip 11: Advertise your accounts/hashtags on recruiting and conference information
While including hashtags and locations in your posts and following other hashtags will increase your reach organically, it still is helpful to advertise your accounts whenever possible. When presenting during conferences, include a slide that highlights the social media accounts and reminds people to follow them. We also recommend including social media handles and relevant hashtags as part of your work email signature. Including handles on program websites and recruiting materials can also help to disseminate your accounts. Through social media analytics, you can watch your impact grow. Particularly on Instagram, we recommend creating a business account. This allows you access to Instagram's built in analytic function. Through analytics, you can monitor the number of followers, follower demographics, and number of likes, both overall and per post. Analytics can also show which hashtags create the most interaction, which times of day are best to post, and overall reach and interaction trends. You can then use this information to tailor your post content and timing for optimal interaction with your followers.

Take Home Messages
Developing a residency program's social media footprint is a low-resource/high-yield way to promote resident connectedness, enhance medical knowledge, and assist recruitment strategies. By selecting the right team of account managers and capitalizing on each platform's capabilities such as hashtags, analytics, and location and follower tagging, the account's visibility can be customized to meet your programs' objectives. For additional ideas to get started, view our program account (and those of our followers) on Instagram @stvimresidency and Twitter @STVIM.