A Digital Ethnography of Medical Students who Use Twitter for Professional Development.

Background: While researchers have studied negative professional consequences of medical trainee social media use, little is known about how medical students informally use social media for education and career development. This knowledge may help future and current physicians succeed in the digital age.

Objective: We aimed to explore how and why medical students use Twitter for professional development.

Design: This was a digital ethnography.

Participants: Medical student "superusers" of Twitter participated in the study

Approach: The postings ("tweets") of 31 medical student superusers were observed for 8 months (May-December 2013), and structured field notes recorded. Through purposive sampling, individual key informant interviews were conducted to explore Twitter use and values until thematic saturation was reached (ten students). Three faculty key informant interviews were also conducted. Ego network and subnetwork analysis of student key informants was performed. Qualitative analysis included inductive coding of field notes and interviews, triangulation of data, and analytic memos in an iterative process.

Key Results: Twitter served as a professional tool that supplemented the traditional medical school experience. Superusers approached their use of Twitter with purpose and were mindful of online professionalism as well as of being good Twitter citizens. Their tweets reflected a mix of personal and professional content. Student key informants had a high number of followers. The subnetwork of key informants was well-connected, showing evidence of a social network versus information network. Twitter provided value in two major domains: access and voice. Students gained access to information, to experts, to a variety of perspectives including patient and public perspectives, and to communities of support. They also gained a platform for advocacy, control of their digital footprint, and a sense of equalization within the medical hierarchy.

Conclusions: Twitter can serve as a professional tool that supplements traditional education. Students' practices and guiding principles can serve as best practices for other students as well as faculty.