Our cross-campus study draws on the use of SNSs which can be transformed by faculty and students from medical and health sciences into an authentic digital footprints where they can work collaboratively within the medical community. Overall, approximately one third of the students’ cohort actively used SNSs for education, while almost one half of the cohort found SNSs as an effective and useful medium for education. The staggering upsurge of the adaptation of global digital applications is clearly fueling the use of SNSs as approximately 45% of the world population is using some kind of social media every day [16].Twitter, Instagram, and Pinterest were the three most popular SNSs choices by our study cohort for their learning activities. Likewise, the study inferred that the students most commonly used SNSs for conceptual learning, connection with community practice, e-portfolio, and collaborative learning. Surprisingly, publishing ideas and opinions in real-time was the least preferred learning modality among the study cohort. This could be attributed to the poor writing and publishing skills of students who need further training on critical appraisals and micro-reflections.

In this study, Twitter was found to be the most popular SNS for medical education. By following hashtags, tweeting, and retweeting, students used Twitter to communicate with their peers, tutors, and faculty. Twitter usage promoted a variety of informal learning activities, such as self-directed, independent, and collaborative assignment work [17]. It aided in the formation of e-learning communities in a cyberspace interprofessional milieu, fostering flexible and collegial learning outside of regular work hours, particularly among medical students [18]. Junco et al., investigated the impact of Twitter on college students in 125 pre-health majors and concluded that Twitter had a positive impact on both students’ engagement and assessment grades [19]. On the other hand, a study by Scot et al., found a decline tendency in academic use of Twitter over time, notably in anatomy education [20]. Several possible explanations for this decline have been proposed, including social media fatigue, changing the nature and content of social media platforms, becoming bored and frustrated with a particular platform over time, and the young generation’s constant desire to switch to a newer and trending platform, such as moving away from Facebook and Twitter to Instagram and TikTok [21].

The second most popular SNS in our study was Instagram, a smartphone- and a tablet-based program with an image-sharing service, which asynchronously publishes images using a plethora of digital filters [22]. Because of its video and photo upload and sharing capabilities, it is becoming increasingly popular in human anatomy, radiology, and dental education [23, 24].

The majority of Instagram users are young students aged 18 to 29 where they frequently upload informal peer-to-peer study-related material. Although Instagram has its own terms of service, which prohibit the publication of unlawful and confidential content, it still lacks quality control, confidentiality, and ethical and legal regulations for posting sensitive or personal information. Educators have an opportunity and responsibility to guide and engage the young minds in professional, and quality-assured informative in SNSs [20].

Pinterest, the third most popular SNS in our study, is an online service for creating and sharing images with an opportunity to create instructional resources [25]. A classic example of an image-sharing application in Pinterest is CTisus.com, a radiology-teaching website that enables users to browse a host of images of a specific illness with insightful notes and guidance. A great majority of students uses Pinterest to pin (add images), re-pin, comment, describe, and download images and flow chart for the academic activities.

In our study, CoM-UoS had the most active users of SNSs for education (453/514; 88%) when compared to other colleges. This could be due to the  fact that CoM-UoS students had the highest representation, as well as due to their constantly evolving affinity for SNSs. A study in 2014 at the CoM-UoS on the use of a Facebook page in anatomy teaching found a similar effect, with the majority of students embracing and finding it utility for learning [26]. This was followed by another study in 2016 where the authors reported YouTube and Facebook were the top ranked SNSs used by the students in CoM-UoS [27]. Senior students from CHS-UoS received the highest mean rank for their degree of online application connectivity. Likewise, CoM-UoS and USIM students showed the highest agreement with the statement ‘I have found social networking sites useful for educational purposes’. Another interesting observation from our research was that senior students above the age of 27 had higher mean ranks than their peers. This could be due to the nature of education, particularly clinical training and increased exposure to medical apps in patient care, thus more empowered to use SNSs professionally based on experiences [28], despite the fact that the process is unsupervised and unstructured.

From our study cohort, responding to the statement, ‘medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes’, 63% students agreed for the need of professional training for the educational use of SNSs. There is no disagreement with this finding, although some medical schools offer a structured course or module on the educational use of SNSs [14, 15], the usage of SNSs in education is still inconsistent and fragmented. Furthermore, there have been multiple reports of medical students acting in an unprofessional or questionable manner, breeching privacy, compromising confidentiality, and blurring personal and professional lines, all of which have resulted in uncertain legal ramifications [29, 30]. The live workshop session was held to support students and raise awareness about the use of SNSs in medical education, notably Twitter, Instagram, and Pinterest. Additionally, the educational intervention highlighted the emerging concept of e-professionalism, “attitudes and behaviors (some of which may occur in private settings) reflecting traditional professionalism paradigms that are manifested through digital media” [31]. The interventional workshop, according to the vast majority of students, improved their knowledge of social networking sites for medical education as well as Web 2.0 technology and its applications in the digital sphere. We believe, for a successful use of SNSs in medical education, a thorough review of all SNSs and professional development programs for faculty, healthcare practitioners, and students is required. Finally, all stakeholders should have access to institutional regulations for implementing, maintaining, and monitoring a safe and legal digital policy.

Study limitations

This study has few potential limitations. First, there was a small sample of students who attended the online session. Despite the small sample size, the engagement and response rates were satisfactory. Second, the limited access to various SNSs, as determined by their local laws and regulations, could have influenced the study findings. Third, a selection bias of the attitudes and practices of the respondents who used SNSs were different from non-respondents who potentially did not use SNSs. Despite these limitations, we believe that this study accomplished its objectives of measuring SNSs usage among medical and health sciences students and in guiding them for their better educational application.