What’s new in academic international medicine? Social media and electronic platforms in medical education – Time to reevaluate, recalibrate, and re-prioritize?

Social media, remote presence, and electronic learning platforms proved indispensable during the coronavirus 2019 disease pandemic, facilitating the continuity of essential services and programs despite strict social distancing mandates.[1] For the first time in human history, educational programs, broad range of healthcare activities, and other critical areas were able to fulfill their primary missions while minimizing the amount of invested time and effort, circumventing distancing restrictions, and significantly reducing necessary resources.[2-4] However, despite the innumerable benefits of modern technology and its contributions to the improvement of virtually every domain of human life, some important downsides emerged in parallel.[5-7] More specifically, the emergence of significant, pervasive, and at times overwhelming mental health issues was noted across the globe, exacerbated by the psychological trauma of the pandemic, burnout, substance abuse, intentional and unintentional misuse of social media platforms, social isolation, and lack of healthcare infrastructure to meet the needs of the growing segment of the population requiring critical mental health services, affecting both the elderly and the young.[8-16] This article will highlight some of the aspects related to the adverse effects of nonmoderated social media platforms (NMSMPs)[17] on the mental health, social functioning and integration, and overall well-being of college and professional students, with focus on medical students.[13,18-20] It is hoped that a conversation can be constructed around the emerging need for reframing, refocusing, and reemphasizing the importance of a healthy balance between virtual, social media-based, and in-person activities as it pertains to the development of the next generation of doctors and other healthcare providers. The reader should note that artificial intelligence is not included in the current argument but is likely to modulate and confound some of the topics and proposed solutions discussed herein.[21] It is important to note that social media use in general may be considered a habit-forming activity.[22-24] As such, the end-user of social media platforms, and especially NMSMPs, is continually exposed to positive reinforcing stimuli, such as “likes” or the emergence and support of groups consisting of similarly-minded individuals that provide affirmation, regardless of its conceptual or logical validity.[25-27] At the same time, users are also periodically exposed to trauma, at both “micro” and “macro” levels, by the presence of nonmoderated, often abusive (e.g., cyberbullying, cyberharassment, cyberstalking, cyberrevenge phenomena, etc.), and intentionally critical content/feedback, also characterized by varied levels of validity.[25,26] Even the seemingly innocent act of “disliking” or “unfollowing,” another individual on social media may prompt an experience of trauma and loss.[28] For many, the end effect of such high-frequency, often unexpected and harsh stimuli, may lead to the emergence and subsequently loop-reinforcement-based worsening of anxiety and depression.[28-30] The intensity of NMSMP use may correlate with the severity of the above manifestations, but this is not a universal relationship and likely depends on multiple individual factors, such as psychological vulnerability versus resilience.[30,31] Ultimate manifestations of dysfunctional NMSMP use may include significant mental health deterioration, social withdrawal, and in extreme cases, self-harming behaviors.[32,33] How does the above relate to medical education and the development of the next generation of healthcare professionals? Although some may view the various behaviors and harms associated with NMSMP as “generational changes” or “acceptable by-product” of the progress/benefits gained from the above social online platforms, it is becoming evident that without some system-wide initiatives and preventive measures, we risk losing a small but non-trivial proportion of our professional community’s members to otherwise preventable circumstances, from unacceptable/unprofessional uses of social media to mental health issues and self-harm.[34-36] For the author of this article, the threshold of harm tolerance related to social media is very low, and even one professional career lost to social media misuse due to unhealthy online habits is considered both potentially preventable and unacceptable. Regardless of circumstances or other factors any disability or loss of life due to self-harm associated with NMSMP-based bullying and abuse, constitutes an unspeakable tragedy and is totally unacceptable. Yet, there are hundreds, if not thousands, of affected individuals, families, friends, and colleagues around the globe.[37-39] What can we do as a society, and more specifically as healthcare professionals and leaders? A significant body of objective evidence is now available for review and possible implementation regarding various methods of reducing social media-related harm, with varied levels of reported effectiveness.[40-45] Reduction in “screen time” or “exposure tonnage” to NMSMP is potentially the most effective strategy, but it is also very difficult to implement/enforce, especially if self-directed and not actively monitored (or incentivized/supported).[42] Another important strategy involves broad-based educational efforts to increase awareness of the mechanisms of harm associated with excessive NMSMP use or misuse.[46] The critical nature of early intervention has also been mentioned as an important starting point, especially if it allows de-escalation of excessive NMSMP use before any other downstream harmful effects become apparent.[47] Legal and regulatory initiatives designed to ensure accountability and promote responsibility both among users and platform owners can also be potentially effective.[48] However, perhaps, the best remedy for NMSMP addiction and misuse is the return to the old-and-proven “in-person” presence, where empathy and authentic human interactions displace the “sterile communications” and “anonymous aggression” that are all-too-prevalent on the modern social media platforms. It should be possible for the medical education community to harness the best attributes of social media while minimizing any negative side effects of its misuse or abuse. Using social media as a constructive tool for sharing knowledge, skills memories, and experiences, rather than as a “substitute for social interactions,” should be the focus of our educators, educational institutions, and all key stakeholders and participants in the modern, borderless, and global discourse.