








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2023 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Content, engagement, social media, Twitter, 
urology

None declared. Received on October 20, 2022 
Accepted on January 16, 2023 
This article has been peer reviewed.

Soc Int Urol J. 2023;4(2):105–111

DOI: 10.48083/KTOL8925

“Likes” in Social Media:  
Does It Carry Any Implications?

Justin Loloi,Justin Loloi,11* Ari P. Bernstein, Ari P. Bernstein,2* Justin M. DubinJustin M. Dubin3

1 Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States  
2 Department of Urology, NYU Langone Health, New York, United States 3 Memorial Healthcare System, Aventura, United States  
*Contributed equally as co-first authors.

Abstract

Social media usage has drastically increased in recent years. In particular, social media usage among medical 
providers has become commonplace. It may offer a variety of benefits in the medical arena, with respect to information 
dissemination, health promotion, and education. However, the implications of social media usage and engagement 
remain to be seen. This narrative review aimed to describe and highlight the effects of social media usage and 
engagement and to provide guidance for engaging in social media as a medical professional. Our review demonstrates 
that active social media engagement unequivocally affords the urologist with meaningful opportunities for self-
promotion, branding, education, networking, research, and enhanced recruitment efforts, but this engagement comes 
with the risk for burdensome exposure to misinformation and harassment. We encourage adherence with American 
Urological Association/European Association of Urology (AUA/EAU) social media best practices and provide our 
own recommendations for social media engagement.

Introduction

Social media (SoMe) represents a dynamic and interactive technology-based communication interface that 
has dramatically impacted virtually every aspect of society, including the field of medicine. Specifically, SoMe in 
healthcare has been utilized in a variety of ways, including promoting institutional branding and maintaining 
or improving both peer-to-peer and patient-to-clinician interactions[1]. There are several modalities of SoMe 
platforms, including Wikipedia, social networking sites such as Facebook, media-sharing venues such as YouTube, 
and microblogging platforms such as Twitter[2], all of which are ubiquitous and used worldwide. More recently, 
video-sharing platforms such as Instagram and TikTok have gained increasing recognition in the realm of medical 
knowledge acquisition and distribution[3].

Among its many potential roles, SoMe has become a significant tool for disseminating medical information and 
eliciting health promotion and education[4]. Possibly the best example of the widespread use of SoMe for information 
dissemination is the role SoMe played during the COVID-19 pandemic, where people relied on fast and effective plat-
forms to seek, search, share, and distribute health-related information[5]. Indeed, many people rely on these platforms 
to consume information; in 2015, it was estimated that more than 60% of the entire US adult population utilized the 
internet and subsequently, more than 70% of users endorsed seeking medical information online[6].

The field of urology has readily adopted and incorporated SoMe into their practices. With the majority of both 
training and practicing urologists actively engaging in SoMe platforms, there has been increasing interest in the roles 

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and potential consequences of SoMe usage[7,8]. SoMe 
usage itself is not to be confused with SoMe engage-
ment, which is the measurement of how people interact 
with a SoMe creator’s account and content. Engage-
ment metrics include likes, comments, favorites, clicks, 
mentions, shares, and other engagement actions based 
on the specific platform. 

SoMe engagement is essential in measuring whether 
a creator’s content is resonating with their audience. For 
SoMe influencers, high engagement often translates into 
sponsorships and financial success. But when it comes 
to medical professionals, what is the significance of 
SoMe engagement? Is being on SoMe enough or should 
medical professionals be encouraged to be more active 
on platforms instead of just “lurking”? In this narrative 
review, we investigate the implications of SoMe usage 
and engagement and provide recommendations for 
engaging in SoMe as a medical professional.

Social Media and Research
Content creation on SoMe prov ides users w it h 
significant opportunities at the personal, professional, 
and institutional levels. From a research perspective, 
SoMe utilization can improve paper citation rates. 
Eysenbach demonstrated a statistically significant 
positive correlation between tweets and citations[9]. 
Furthermore, highly tweeted articles (those in the 
top 25th percentile with respect to tweets) were 
approximately 11 times more likely to be top-cited 
articles[9]. With this information, the author concluded 
that SoMe metrics such as tweets can be used by scholars 
and institutions to not only monitor the impact of their 
research but also as a filter to direct users to highly 
impactful works.

Interestingly, this relationship between Twitter pres-
ence and academic citations has garnered substan-
tial support. A study by Ozkent et al. showed a 
significant relationship between increased number 
of tweets about an article and the article’s increased 
number of citations[10], again suggesting the util-
ity of Twitter in disseminating academic and schol-
arly work. In a systematic review aimed to describe 
the varying tactics and strategies employed by medical 
journals to both engage with their readers and spread 
their research, Erskine et al. concluded that promotion 
via Twitter may improve a variety of metrics such as  

article dissemination, article readership, and citations, 
which may ultimately result in higher-impact work. 
In response to these data, several key strategies were 
adopted by medical journals to increase public atten-
tion to scholarly work; these include tweeting the link 
and title of their published articles, including info-
graphics, having podcasts, and hosting monthly virtual 
journal clubs[11]. It appears that study authors should 
not only have a Twitter account to keep up with the 
most recent literature but also be tweeting about their 
work to best capture audiences and maximize research 
impact. Despite this data, it is not entirely clear whether 
more content engagement by consumers yields a greater 
impact. While further research is needed, there remains 
an overall positive sentiment on the utilization of SoMe 
in this manner.

Social Media and Self-Promotion
SoMe can play a role in the promotion of one’s practice, 
institution, or brand. When looking at the Twitter 
engagement of over 340 medical residency training 
programs, it was noted that accounts that were tweeting 
more often had significantly more followers than those 
with fewer tweets (240 followers vs. 107 followers, 
respectively). Furthermore, the authors found that all 
types of content engagement with Twitter (such as likes, 
tweets, retweets, and comments) was associated with a 
larger following[12].

In surveying physicians who endorsed utilizing SoMe 
(eg, Facebook, YouTube, blogs), Campbell et al. revealed 
that participants highlighted SoMe utility in branding, 
marketing, and networking[13]. Additional survey data 
has substantiated that branding represents a common 
reason for physicians to adopt SoMe[14]. As evidenced 
by our plastic surgery colleagues, a beneficial means 
of incorporating SoMe into practice is by offering the 
public a glimpse into the life and practice of a surgeon; 
by creating an Instagram account and categorizing a 
portion of the content as “Private Life,” a significant 
number of likes, clicks, and new followers were obtained 
when compared to posts designated as “Scientific”[15]. 
Thus, the personalization and access to a provider’s 
daily life may attract a large SoMe following and enable 
enhanced branding and marketing opportunities.

From a professional standpoint, creating SoMe 
accounts may improve one’s chances of academic 
promotion or tenure. As SoMe continues to be imple-
mented into medicine, programs may consider devel-
oping and implementing institution-specific protocols 
describing an explicit set of guidelines delineating the 
types of SoMe activities and presence that may be 
considered for career advancement[16]. Criteria for 
SoMe-based scholarship in health professions education 
have already been suggested; a consensus of 52 health 

Abbreviations 
AUA American Urological Association
EAU European Association of Urology
SMD social media disorder
SoMe social media

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professional educators from 20 organizations in four 
countries defined four key criteria for designation as 
SoMe-based scholarship, including originality, advanc-
ing the field, content being saved in more permanent 
states and disseminated among formal channels, and 
providing the community the ability to comment on and 
provide feedback in order to elicit discussion[17]. In eval-
uating 98 studies that assessed the use and benefits of 
engaging in SoMe for health communication, Moorhead 
et al. described several key overarching benefits. Namely, 
increased interactions with others, increased accessibil-
ity to information, peer social support, and the potential 
to influence health policy[4]. Truly, SoMe engagement—
not just usage—has shown to help advance the careers of 
medical professionals in more ways than one.

Social Media and Education
SoMe can also facilitate medical education. Cheston et 
al. performed a systematic review aiming to gauge the 
use of SoMe in medical education in order to ascertain 
how educational interventions affect a host of factors 
such as satisfaction, knowledge, attitudes, and skills 
of physicians and physicians in training. They found 
that the incorporation of SoMe tools into educational 
pursuits was associated with increased knowledge, 
skillset, and attitude. SoMe tools (eg, blogs, YouTube 
videos, Twitter, and Facebook posts) were particularly 
effective in promoting learner engagement, eliciting 
feedback, and fostering collaboration and professional 
development[18]. A considerably useful role for SoMe 
use in education resides in the education of residents. 
After introducing Twitter as a tool to facilitate education, 
the SMART-ME study showed that 38 of 40 (95%) 
residents felt that SoMe could be useful as a medical 
education medium. Interestingly, even prior to the 
intervention, 77% of participants were already using 
SoMe for educational purposes[19].

Within the realm of urology, SoMe use has evolved to 
encompass multiple areas including acquiring urologic 
knowledge and conference participation[20]. In review-
ing a European survey assessing the perceived role of 
SoMe in acquiring urology-related knowledge, 63% of 
participants rated SoMe as having a moderate-to-high 
impact on knowledge acquisition[21]. Supporting the 
importance of SoMe for urology residency, Dubin et 
al. highlighted that more than 99% of urology trainees 
utilized SoMe and 67.6% felt it was important to have 
SoMe presence during residency[8].

Furthermore, as it pertains to urology, social media 
may allow for virtual mentorship and dissemination 
of clinical practices and techniques, particularly for 
challenging procedures that may have a steep learning 
curve such as laser enucleation of the prostate[22]. From 
a research perspective, informational graphics may 

serve as powerful tools for advertising and information 
dissemination[23]. These were especially relevant during 
the COVID-19 pandemic, which had a profound impact 
on urological care[24]. Thus, with virtually all residents 
on and engaging in SoMe, it is imperative that urological 
training programs and associations continue to adopt 
new approaches toward educating trainees via SoMe.

Social Media and the Match
The implications of enhanced content engagement are 
far-reaching beyond the obvious effects on education 
and research. In the field of urology specifically, the 
impact of United States residency applicant engagement 
with residency programs on platforms such as Twitter 
and Instagram have been shown to inf luence match 
statistics. With the COVID-19 pandemic fueling an 
increased dependence on a virtual interview process, 
applicants are challenged with an inability to engage 
with residency programs directly in person. In lieu 
of in-person interactions, SoMe has provided both 
programs and applicants a unique opportunity to learn 
about and engage with one another. A recent study by 
Manning et al. revealed this interesting shift in content 
focus on Twitter within the urological community 
following COVID-19. Their trigram (three-word 
combination) analysis of academic urology program 
tweets demonstrated a major shift toward recruitment 
and education, with a focus on utilizing SoMe for 
recruitment efforts in the match process[25].

But beyond focusing content efforts on recruitment 
and the match, does SoMe engagement impact the 
match results itself? Heard et al. surveyed both resi-
dency applicants and program directors during the 2021 
applicant season regarding their perspectives on SoMe 
and its role in the residency match process. Approxi-
mately 76% of applicants and 77% of program directors 
who were surveyed claimed to use SoMe in the resi-
dency match process, with the vast majority of activity 
occurring on Twitter[26]. While the majority (66%) of 
applicants followed their matched residency program 
on Twitter prior to matching, few had direct content 
engagement with matched program accounts prior to 
the match. Nonetheless, 66% of program directors felt 
their program’s SoMe presence provided some benefit to 
the match, and 60% of applicants felt they gained better 
insight into residency programs from their SoMe activ-
ity. Importantly, no observed link between SoMe usage 
and match outcomes was found[26].

Despite observing no direct effect of SoMe activity 
on match outcomes, when questioned about specific 
circumstances, 15% of program directors in the above 
study noted that an applicant’s SoMe activity helped 
their chances of matching, whereas 12% noted that an 
applicant’s activity hurt their chances, suggesting a 

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meaningful influence of SoMe activity on a more indi-
vidual basis[26]. Carpinito et al. similarly found that 
applicants to a single urology resident program utilized 
SoMe as a means of information gathering, though 
increased content generation and engagement did not 
impact match outcomes to that specific institution[27]. 
However, Friedman et al. also evaluated applicants to 
urology residency during the 2021 cycle and found that 
matched students were significantly more likely to have 
Twitter accounts (59% matched vs. 28% unmatched, 
P = 0.02), and that matched students were more likely 
to have Twitter accounts with more followers[28].  
A study by Bukavina et al. also supported the idea that 
increased applicant SoMe engagement was associated 
with better match outcomes: among 250-matched and 
45-unmatched urology applicants, matched applicants 
had higher numbers of Twitter followers and overall 
tweet likes. Having more followers, individual tweet 
likes, and total number of tweets increased overall odds 
of matching. Notably, all matched applicants followed 
their matched program on Twitter[29]. SoMe appears 
to play an important and evolving role on the part of 
both applicants and programs as the virtual application 
cycle becomes the norm, though direct effects of content 
engagement remain to be elucidated.

Negative Implications of Social Media
SoMe has many clear benefits, but its use can also have 
negative implications. Social media disorder (SMD) 
is a condition characterized by a behavioral addiction 
to SoMe, diagnosed in subjects meeting five or more 
of the nine criteria on the validated Social Media 
Disorder Scale (preoccupation, tolerance, withdrawal, 
persistence, escape, problems, deception, displacement, 
and conf lict)[30]. In two studies, Dubin et al. found 
that 6.1% of practicing urologists and 11.3% of urology 
trainees met criteria for SMD[7,8]. Many aspects of 
SMD align with those involved in physician burnout. 
Burnout rates among urologists are one highest in all 
medical subspecialties[31,32]. It is possible, therefore, 
that increases in SoMe use could be associated with 
physician burnout. With a growing emphasis on the 
identification and prevention of physician burnout, a 
better understanding of SoMe and its contribution to 
burnout development will be imperative.

Another concerning finding in one of the studies 
was that 17.7% of practicing urologists reported online 
harassment by other physicians, highlighting issues 
with professional conduct by physicians on SoMe plat-
forms[7]. These concerns were further warranted, as 
both studies by Dubin et al. revealed that the majority 
of urology attendings and trainees have never reviewed 
professional guidelines on the appropriate use of SoMe. 
It is clear that despite ubiquitous use of SoMe by urol-
ogists, there exists great need and potential for formal 

interventions geared toward educating urologists on best 
practices in SoMe use.

Social Media and Medical Misinformation
Content engagement on SoMe platforms and its apparent 
benefits across a multitude of medical specialties is not 
entirely without its challenges. Medical misinformation 
is rampant, and there are no current standards to which 
users must adhere when sharing health-related content. 
Studies have consistently shown poor overall quality of 
information regarding various urological conditions 
across YouTube, TikTok, and Instagram, with calls 
for the medical community to conduct collaborative 
efforts to enhance overall quality of information[33–36]. 
Increased content engagement inherently comes with 
increased reach and perceived influence on the part of 
users, and therefore efforts to address misinformation 
are pivotal in the hopes of preventing the propagation 
of medically false information or inaccurate claims. 
Engaging content filled with inaccuracies may be viewed 
as truthful simply by measure of popularity, a problem 
inherent to SoMe that must remain at the forefront 
of any campaign to address misinformation. In the 
following section we provide recommendations for 
SoMe engagement as well as suggestions for managing 
medical misinformation online.

Recommendations for Social Media 
Engagement
While having a SoMe presence as a medical professional 
has been controversial in the past, it has now become 
clear that the potential benefits of utilizing SoMe 
outweigh the potential pitfalls (Figure 1). The risks, 

FIGURE 1.

Potential benefits of social media engagement

Education

Research

Residency 
recruitment

Networking

Information 
dissemination

Personal and  
institutional  

branding/promotion

Social Media

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however, are still potentially significant, and it is 
imperative that urologists who choose to engage in 
SoMe be thoughtful of their online activities. Despite 
both the American Urological Association (AUA) and 
the European Association of Urology (EAU) providing 
SoMe best-practice guidelines, the majority of urology 
trainees and attendings have not reviewed either[7,8]. 
Thus, we recommend that any urologist active on SoMe 
platforms familiarize themselves with these guidelines 
to optimize their SoMe experience.

Since the start of the COVID-19 pandemic, medical 
information and misinformation online has become 
a growing concern among medical professionals. 
Current research has confirmed fears of the promo-
tion of misinformation through SoMe platforms such 
as TikTok, Instagram, and YouTube[33–36]. In an 
attempt to address medical misinformation, urologists 
and other physicians have begun to focus their SoMe 
efforts on discounting inaccurate information online 
while endorsing more medically accurate information. 
This kind of online engagement can potentially result 
in unwelcome consequences including harassment and, 
understandably, can defer many urologists from actively 
addressing medical misinformation on SoMe. While 
not all urologists may feel compelled to dispute medical 
misinformation online, we think it is essential that every 
physician understand the ways in which they can best 
provide patients with accurate information both online 
and offline (Figure 2).

Urologists interested in actively addressing medical 
misinformation on SoMe should engage in manners that 
align with the AUA/EAU best practices. It is import-

FIGURE 2.

Recommendations for engaging in social media

Review AUA & EAU best practice guidelines on SoMe

Endorse medically accurate information

Be prepared to address medical misinformation online

Invest in quality educational tools on SoMe

Recommendations 
for engagement 
in social media

ant to provide accurate, thoughtful commentary on 
the medical information and, if possible, limit personal 
commentary on the accounts/people providing the 
misinformation, as providing personal commentary can 
distract from the message and encourage further harass-
ment. Other ways in which the urological community 
can continue to expose medical misinformation is by 
continuing to invest in good online educational tools 
for patients interested in researching their health. The 
Urology Care Foundation website is an excellent tool 
that provides accurate and easily digestible informa-
tion for patients[37]. The creation of YouTube channels 
by many urologists through which they provide medi-
cally accurate information has also become a popular 
and important tool for patient education. Urologists 
should continue to support and promote these websites 
to patients both online and offline. Although SoMe is 
a valuable tool for medical information, the best way 
to provide medically accurate information remains 
through direct patient engagement. Medical informa-
tion is personal and private. By creating a safe environ-
ment and talking with their patients, physicians give 
themselves the best opportunity to address any patient 
concerns or questions about medical misinformation.

Conclusions
Through significant research efforts as well as the 
events following the COVID-19 pandemic, prior 
questions regarding the value and sustainability of 
SoMe in medicine have been answered: social media 
in medicine is here to stay. SoMe is used by virtually all 
training and attending urologists and provides its users 
with various personal and professional opportunities. 

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Simply having a SoMe account is much different than 
actively engaging on the platforms and although both 
provide benefits, there is growing literature supporting 
that increased SoMe engagement provides users with 
increased benefits. Increasing engagement may come 
with risks and so we urge all urologists on SoMe to 
familiarize themselves with the AUA/EAU social media 
best practices. Despite the continuing pressure and clear 
benefits of being present on SoMe, urologists should 
not feel compelled to be online. SoMe engagement 
often requires time and resources, and with the already 
established high rates of burnout among urologists, 
urologists should engage in SoMe only if they are 
interested.

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Acknowledgements
Funding
No funds, grants, or other support was received.

Author Contributions
J.L., A.P.B., and J.M.D prepared the manuscript and 
figures. All authors approved the submitted manuscript.

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111SIUJ.ORG SIUJ  •  Volume 4, Number 2  •  March 2023

“Likes” in Social Media: Does It Carry Any Implications?

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