








































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

Social media, Facebook, Instagram, Twitter, 
TikTok, medical student, medical education

None declared. Received on October 1, 2022 
Accepted on January 16, 2023 
This article has been peer reviewed.

Soc Int Urol J. 2023;4(2):112–116

DOI: 10.48083/JKKQ6501

Urology Reach on Social Media: Appealing to  
Future Potential Applicants

Rachel E. Kaufman,1 Madeline Snipes,1 Catherine Wallace,2 Martha Terris2

1 Medical College of Georgia, Augusta, United States 2 Department of Urology, Medical College of Georgia, Augusta, United States

Abstract

Objective On average, internet users aged 16 to 29 years spend 3 hours per day on social media platforms. Previous 
research has identified social media as an important tool for prospective applicants in the age of virtual residency 
interviews, but no study to date has included TikTok as a social media platform of interest. TikTok is the fastest-
growing social network in the United States, and there were predictions it would reach 1.8 billion users by the end of 
2022. This study seeks to understand the difference in reach of Facebook, Instagram, Twitter, and TikTok to inform 
medical student engagement efforts.

Methods A binary (Yes/No) poll was posted on MCG Urology accounts on Facebook, Twitter, Instagram, and 
TikTok. The poll asked the question “Are you a medical student?” and was open for viewing and/or response on each 
platform for 24 hours. The number of total views and the number and percentage of respondents were recorded for 
each application. Engagement was determined by the percentage of viewers who responded to the poll.

Results A total of 3038 views and 839 responses were collected from all social media platforms. TikTok had the 
highest number of views (1838) and responses (617) but low engagement (33.56%). The highest percentage of “Yes” 
responses was on Twitter (61%); however, Twitter had the lowest engagement of 7.2%. Results of a chi-square test 
showed that while the total raw number of medical students reached was highest on TikTok, of all those who engaged 
with the poll, there were statistically significantly more medical students on Twitter (P < 0.0001).

Conclusions Medical student outreach can be successfully conducted through social media. Twitter allows for 
engagement with a statistically significantly larger proportion of medical students, and TikTok allows access to a 
grossly larger audience of medical students. Urology residency programs should consider the utility of both Twitter 
and TikTok for student outreach.

Introduction

On average, internet users aged 16 to 29 years spend 3 hours per day on social media platforms. In the age of virtual 
interviews, many students have resorted to using social media to engage with residency programs, and in turn, 
programs have utilized social media as a recruiting tool. A study of general surgery applicants from the 2020–2021 
cycle found that the majority of applicants utilized social media to inform and educate themselves about the programs 
they applied to[1]. In response to increased student engagement on social media, the number of general surgery 
residency social media accounts and usage of these accounts significantly increased in 2020, following the COVID-19 
pandemic[2,3]. Similar trends were identified for orthopedic surgery, plastic surgery, otolaryngology, and integrated 
vascular surgery matches[4–7].

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A study of urology applicants from the 2021 applica-
tion cycle found that students applying to urology resi-
dency increasingly utilized Twitter during the COVID-19 
pandemic. They also found that students who matched 
in urology were more likely to have a Twitter account[8]. 
Additionally, another study on the use of social media 
in the urology residency match found that the majority 
of applicants had an Instagram account[9]. While Heard 
et al. found that there was no relationship between the 
presence of applicants on social media and their urol-
ogy match outcomes[10], a majority of applicants and 
program directors believed that social media use aided 
them in some way in the 2021 urology match process.

Aside from the match, urology is one of the lead-
ing specialties that has utilized social media such as 
Twitter, Instagram, Facebook, and now TikTok as an 
opportunity for education of patients, students, and 
physicians. An analysis of urology residency program 
presence on social media found that 86% of urol-
ogy residency programs have a Twitter account, 39% 
have an Instagram account, and 34% have a Facebook 
account[11].

A study published in association with the European 
Association of Urology Guidelines Office Dissemination 
Committee analyzed the usage of hashtags and found 
that hashtags are a valuable tool in the urologic commu-
nity for education and communication via social media 
content[12]. Hashtags are topic indicators that facilitate 
content organization using a hash symbol (#) followed 
by a key word or phrase. If one searches for a particu-
lar hashtag on a social medial platform, only the content 
that contains that key word or phrase will populate. 
Different social media platforms have variable user 
interfaces and utilize different algorithms to show users 
content on the application or website. However, across 
the four major platforms examined in this study, content 
creators may associate their posts with captions and/or 
hashtags, and new posts are algorithmically directed to 
users who have demonstrated interest in similar content.

The Facebook and Instagram algorithms work simi-
larly to display content on the platform in which posts 
from followed accounts are arranged in a non-chrono-
logical order on the main “home” page. The Twitter 
algorithm displays posts chronologically and includes 
original posts and retweets from followed accounts as 
well as occasional posts labeled as “based on your likes.” 
These posts are identified via key word similarities and 
hashtags, #UroSoMe, for example.

The TikTok algorithm is constructed differently, as it 
primarily curates videos for users based on a combination 
of demonstrated interests through viewed and searched 
hashtags, likes, and comments. For example, a first-time 
user will open the application and see a random assort-
ment of videos; however, based on the user’s engagement 

with videos, machine learning is able to identify user 
interests and present similar content on their “For You” 
page, which is the default interface on the application.

TikTok is the fastest-growing social network in the 
United States, having grown more than 900% since 
January 2018, when the application had approximately 
11 million monthly active users, to more than 100 
million American monthly active users in August 2020, 
and predictions that it would reach 1.8 billion users by 
the end of 2022. Of these 100 million monthly active 
users, 50 million are on the app every day, 41% of whom 
are between 16 and 24 years of age. The current land-
scape of literature about TikTok is primarily focused on 
content quality analysis. To our knowledge, no previous 
study has examined TikTok as a potential social medial 
platform for student outreach.

Materials and Methods
A binary (Yes/No) poll was posted on MCG Urology 
accounts on Facebook, Twitter, Instagram, and TikTok. 
The native software on each of the platforms was utilized 
to conduct each poll. The poll asked the question “Are 
you a medical student?” and was open for viewing 
and/or response on each platform for 24 hours on July 
23, 2021. A 24-hour polling period was conducted to 
account for constraints of the native software across 
platforms, with Instagram, Facebook, and Twitter only 
allowing for a 24-hour polling period during which a 
respondent can respond only once. The specific date was 
chosen arbitrarily, as there was no difference in follower 
activity between dates according to account analytics.

The number of total views and the number and 
percentage of respondents were recorded for each appli-
cation using the native analytics features on each of the 
platforms. At the time of the poll, the MCG Urology 
Twitter account had 4.8K followers, Instagram had 1.6K 
followers, Facebook had 1.5K followers, and TikTok 
had 48K followers. The difference in number of follow-
ers across platforms was accounted for by measur-
ing engagement. Engagement was determined by the 
percentage of those who viewed the poll who responded 
either “Yes” or “No.” Statistical analysis was conducted 
using SPSS software. The proportion of medical 
students’ “Yes” responses were compared across social 
media platforms using the chi-square test (P < 0.01).

Demographic and geographic data of poll viewers 
were collected on TikTok only, as this was the only plat-
form to release this data. Demographic and geographic 
data of poll respondents could not be collected due to 
constraints of the social medial platforms.

Results
A total of 3038 views and 839 responses were collected 
from Facebook, Twitter, Instagram, and TikTok in the 

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24-hour period during which the poll was open for 
viewing and response on each platform.

Facebook and Instagram had the highest engage-
ment compared to Twitter and TikTok, with 45.5% 
and 55.4%, respectively. The poll on Facebook had 156 
total views and 71 total responses, representing 45.5% 
engagement with the poll (Figure 1). Instagram had a 
similar breakdown to Facebook, with a total of 157 views 
and 87 total responses, representing 55.4 % engagement 
(Figure 1). While the poll on Twitter had the highest 
percentage of medical students at 61% (39), it also had 
the lowest engagement of 7.2%, representing 64 total 
votes of 887 views (Figure 1). TikTok had the highest 
number of views (1838) and responses (617), with 35.98% 
engagement.

On Facebook, 53.52% of respondents (38) indicated 
that they were medical students (Figure 2). Of those who 
responded to the poll on Instagram, 54.02% (47) indi-
cated that they were medical students (Figure 2). TikTok 
had lowest percentage of those who indicated that they 
were medical students, at 36%; however, although the 
proportion of those who responded “Yes” to the poll on 
TikTok was the smallest, TikTok had the largest total 
number of medical students reached, at 222 students 
(Figure 2).

Chi-square test results showed that while the total 
raw number of medical students reached was highest 
on TikTok, of all those who engaged with the poll, there 
were statistically significantly more medical students on 
Twitter (P < 0.0001) (Table 1).

Demographic and geographic data collected on 
TikTok showed that the majority of poll viewers, regard-
less of engagement or response, were 25 to 35 years old 
(Figure  3), equally likely to be male (50%) or female 
(50%), and from the United States (63%).

Discussion
While Twitter has traditionally been used for medical 
student outreach, it had the lowest engagement and 
the lowest total medical students reached, though of 
all the students who engaged with the poll, there were 
statistically significantly more medical students on 
Twitter compared to other social media platforms 
(P < 0.0001) (Table 1). Conversely, TikTok, which has 
been the least utilized social media platform by academic 
urolog y programs for outreach, had the smallest 
percentage of medical students respond, but it reached 
the largest total number of medical students compared 
to other social media platforms.

The differences in the results can be explained by 
the different algorithms of the platforms, as Instagram, 
Twitter, and Facebook have home pages that primarily 
show users posts from accounts that they have already 

FIGURE 1.

Poll total views and responses (engagement)

Facebook

156

(45.51%) (55.41%)

(7.22%)

(35.98%)

157
71 87 64

887

617

1838

Instagram Twitter TikTok

2000

1800

1600

1400

1200

1000

800

600

400

200

0

Views Responses

FIGURE 2.

“Are you a medical student?” Yes/No responses

TikTok

222

395

700

600

500

400

300

200

100

0

Yes No

Facebook

38
33

Twitter

39
25

Instagram

47

40

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followed. TikTok, however, uniquely directs users to the 
“For You” page that includes content from accounts that 
users may or may not follow but that are algorithmi-
cally tailored to their interests, according to their likes, 
comments, and searches. While most social media plat-
forms do use machine learning to tailor content to users 
based on previously demonstrated interests, TikTok 
does so on its main user interface and to a greater extent.

Twitter and TikTok are both perhaps better able to 
tailor content to users based on hashtags. Hashtags used 
as topic indicators on TikTok and Twitter are able to 
demonstrate content to specific groups of users such as 

TABLE 1.

Results of chi-square analysis

CV Outcome Yes No Row Totals

Facebook 38 (29.28) [2.60] 33 (41.72) [1.82] 71

Instagram 47 (35.88) [3.45] 40 (51.12) [2.42] 87

Twitter 39 (26.39) [6.02] 25 (37.61) [4.23] 64

TikTok
222 (254.45) 

[4.14]
395 (362.55) 

[2.90]
617

Column Totals 364 493
839  

(Grand Total)

FIGURE 3.

Age distribution of viewers on TikTok

23%

6%

11%

23%

37%

18-24 25-34 35-44 45-54 55 and up

medical students. The more a user interacts with posts 
that contain a certain hashtag, the more they will see 
other posts that contain that hashtag or content that is 
similar. However, the audience reached on TikTok was 
larger than that on Twitter. The fact that the TikTok 
main user interface focuses on all accounts rather than 
those accounts that users have deliberately followed 
may have contributed to the larger audience reached 
on TikTok. In contrast, the home page on Twitter is less 
utilized to show users novel content and is more focused 
on accounts that users have followed. This could be the 
reason that those who engaged with the poll on Twitter 
were statistically significantly more likely to be medi-
cal students, as studies have shown that Twitter is the 
primary social media platform used by residency appli-
cants during the match[8].

Our study did have some important limitations. 
Due to the nature of the degree of anonymity of users 
on social media, there was no ability to verify the accu-
racy of the responses or to run the poll for longer than 24 
hours while ensuring only one response per person per 
poll. Additionally, while the breakdown of followers of 
MCG Urology accounts is similar to other institutions 
on Facebook, Instagram, and Twitter, the MCG Urology 
TikTok account has a significantly larger following on 
TikTok compared to the other social media platforms, 
and this may have contributed to the increased reach on 
TikTok. However, as there are so few urology residency 
programs on TikTok, it is difficult to assess as to whether 
the large number of followers on TikTok would be 
unique to MCG Urology. Perhaps there is a large audi-
ence on TikTok that could be reached by other programs. 
Further research is necessary to determine the practical 
utility of TikTok for medical student outreach.

Conclusion
Although urologists are in high demand across the 
country, too many medical students are exposed to 
the field later than many other specialties due to lack 
of early curricular exposure[13]. Social media may be 
an important remedy for this. An undecided medical 
student with accounts on each platform may follow a few 
academically focused accounts on Twitter, Facebook, 
and Instagram, but their home page will primarily 
consist of tweets from accounts they follow or tweets that 
were liked, retweeted, or replied to by accounts that they 
already follow. However, on TikTok, if the student liked 
a TikTok from an account that had some connection to 
urology, they will be more likely to see content from a 
program that may not have noticed.

Additionally, previous research has consistently 
shown that social media is an invaluable asset in the resi-
dency application process for urology as well as other 
surgical specialties. While our analysis was consistent 

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with previous research that has shown that Twitter 
has been the mainstay of social media engagement for 
residency recruitment, TikTok may be an emerging 
player in student outreach efforts. Twitter and TikTok 
both have utility for medical student outreach: Twitter 
allows for engagement with a statistically significantly 
larger proportion of medical students and TikTok 

allows access to a grossly larger audience of medical 
students. Instagram and Facebook may be falling out of 
favor by medical students for engagement with urology 
programs. With increasingly younger students entering 
medical education, urology residency programs should 
consider the utility of both Twitter and TikTok for 
student outreach.

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