Adv in Health Sci Educ DOI 10.1007/s10459-014-9495-7
Social media in health professional education: a student perspective on user levels and prospective applications Stephen Maloney • Alan Moss • Dragan Ilic
Received: 22 August 2013 / Accepted: 3 February 2014 Springer Science+Business Media Dordrecht 2014
Abstract Social Networking Sites (SNS) have seen exponential growth in recent years. The high utilisation of SNS by tertiary students makes them an attractive tool for educational institutions. This study aims to identify health professional students’ use and behaviours with SNS, including students’ perspectives on potential applications within health professional curricula. Students enrolled in an undergraduate physiotherapy program were invited to take part in an anonymous, online questionnaire at the end of 2012. The survey consisted of 20 items, gathering demographic data, information on current use of SNS, and opinions regarding the application of SNS into education. Both quantitative and qualitative data were gathered. A total of 142 students, from all years of study, completed the online questionnaire. Only two participants were not current users of social media. Facebook and YouTube had been utilised for educational purposes by 97 and 60 % of participants respectively; 85 % believed that SNS could benefit their learning experience. Only five respondents were not interested in following peers, academic staff, clinicians or professional associations on Facebook. Four key themes emerged: peer collaboration, need for separation between personal and professional realms, complimentary learning and enhanced communication. Students wish to make educational connections via SNS, yet expressed a strong desire to maintain privacy, and a distinction between personal and professional lives. Educational utilisation of SNS may improve communication speed and accessibility. Any educator involvement should be viewed with caution. Keywords Social media eLearning Technology Communication Clinical education Pedagogy
S. Maloney (&) A. Moss Department of Physiotherapy, Monash University, PO Box 527, Frankston, VIC 3199, Australia e-mail: [email protected] D. Ilic Department of Epidemiology and Preventive Medicine, Monash University, Frankston, VIC, Australia
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Introduction Educators are in perpetual pursuit of ways to improve students’ learning. The education sector has a history of repurposing popular technologies in an effort to ‘go to where the students are’ and improve learner engagement and flexibility (Ophus and Abbitt 2009). With increasing competition in the educator sector, and associated economic imperatives, social media sites are being explored as emerging environments for teaching and learning. Social Network Sites (SNS) are websites that allow individuals to construct a public or semipublic profile within a bounded system; articulate a list of other users with whom they share a connection; and view and traverse their list of connections and those made by others within the system (Boyd and Ellison 2007). The nature and nomenclature of these connections may vary from site to site. Social Network Sites play host to hundreds of millions of users; Facebook alone boasts over 650 million daily active users (Facebook 2013). A 2006 study indicated that over 90 % of undergraduate students at the University of North Carolina used Facebook (Stutzman 2006), a finding replicated by recent studies around the world (Kim et al. 2011; Lampe et al. 2006; Ophus and Abbitt 2009; Smith and Rainie 2011). This presents an undeniable opportunity for educators to utilise SNS as a viable educational tool (Johnson et al. 2007). The use of SNS in education is an emerging, evolving and controversial field of scholarship. The controversy lies in the perception of social media sites as purely informal social tools, ‘educational distractions’ incongruent with focused academic pursuit (Cassidy 2006). This can be amplified in health professional education, where the use of social media may violate societal expectations of the profession (Greysen et al. 2010), or be viewed as conduct unbecoming of a professional clinician or health professional trainee (McGowan 2011). Greysen et al. (2010) report that members of the public may view a healthcare professional’s activity on SNS as a proxy for their trustworthiness in handling patient care. Currently, there is limited high quality evidence regarding the effectiveness of SNS on student learning outcomes and the student learning experience. However, SNS may allow for desirable educational features including flexibility of learning through decentralised and remote access to resources, and facilitated engagement in socially constructivist pedagogy (Cheston et al. 2013; Maloney 2007). The 2013 systematic review by Cheston et al. (2013) identified 14 studies [only one randomised controlled trial (RCT)] and concluded that SNS may enhance medical education and have a positive impact on learning outcomes. Limited information exists on how university students utilise SNS, be it for educational or strictly social purposes. The reach of SNS make them an attractive tool for educational institutions, however successful implementation of any technology which has been repurposed for education requires an informed integration process (Ophus and Abbitt 2009). Issues such as privacy, security settings, cost, technical issues, and user proficiency should be considered when developing interventions which utilise SNS (Cheston et al. 2013). The primary objective of this study is to identify the behaviours of entry-level health professional students surrounding SNS. This study also aims to examine student perspectives on the potential application of SNS into health professional teaching and learning activities.
Methods Participants Students enrolled in a Bachelor of Physiotherapy program at a single University campus were invited to take part in an online cross-sectional study at the end of 2012. The Bachelor
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of Physiotherapy program is a 4 year undergraduate course. Students were invited to participate in the study via a bulk email to student email accounts. This initial call for volunteers was supplemented by an announcement through the university’s Virtual Learning Environment (VLE), the typical mode of communication between students and academic staff. Procedure Students who agreed to take part in the study were asked to complete an online questionnaire. No validated survey was available which suited the purpose of this study, therefore a custom tool was developed by the authorship team. The survey was piloted by a former member of the student cohort prior to its deployment. Subsequent refinements were made to improve the survey’s face validity (Holden 2010). The questionnaire consisted of 20 items, gathering both quantitative and qualitative data. Various response types were utilised, including multiple choice options, five-point Likert scales ranging from strongly agree to strongly disagree, and free text. We collected basic demographic and descriptive data such as age, gender, and year level. Four questions gathered data regarding current usage of SNS, including frequency, and on what device (mobile phone, laptop etc.) SNS were visited. Five point Likert scales were used to discern frequency of popular SNS use. Twelve of the most utilised SNS in Australia were listed as options (Cowling 2013; Friedlieb 2013), however participants were provided with the option to specify further alternatives. Additionally, participants were asked to classify themselves as an active (viewer and contributor), passive (viewer that generally does not contribute), or non-user of SNS. Thirteen questions investigated academic utilisation of SNS. Participants were asked about their previous educational use, its potential to benefit their learning, and willingness to ‘follow’ certain educational groups. Open-ended questions and free text responses asked participants to comment on the appropriateness of integrating SNS into their learning, anticipated or requested applications in which SNS would be suitable, as well as expected benefits, problems and concerns. Data were collected over a 4-week period. This timeframe was chosen as online survey response rates significantly decrease after 2 weeks (Madge and O’Connor 2002). At 2 weeks, a reminder email and VLE announcement was circulated. Free text comments, relating to the formal integration of SNS into undergraduate health professional curricula, underwent thematic analysis (Braun and Clarke 2006). All quotes are presented verbatim, and are provided to give context to key emergent themes. Quantitative data underwent descriptive analysis using SPSS. Ethics approval was granted by the Monash University Human Research Ethics Council, and all data collected were anonymous.
Results A total of 284 students were invited to participate in the study, with 142 students completing the online questionnaire (response rate of 50 %). Participants from all years of study took part, with predominant involvement by 1st and 2nd year students, 34 and 35 % respectively of all responses returned. Ages of participants ranged from 17 to 42, with the average age 21 years; 74 % were female. A total of 66 % of respondents classified themselves as active users of SNS, defined in the survey as both viewers and contributors of content to a SNS; 35 % classified themselves as viewers only; two participants did not
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use social media. Proportions of all three categories were similar between genders (v2 test: p = 0.58). Mobile phones and tablet computers were utilised to view SNS by 68 and 9 % of respondents respectively. Facebook, Youtube, Instagram and Google? were found to be the most utilised SNS, being accessed three or more times per week by 97, 87, 30 and 26 % of participants respectively; 67 % of participants reported using Facebook more than twice per day. Additionally, Facebook, Youtube and Google? had been utilised for educational purposes by 97, 60 and 18 % of participants respectively. A total of 85 % of respondents believed that SNS could benefit their learning experience. Students indicated that to benefit their learning they would be interested in using Facebook to follow peers (93 %), academic staff (69 %), clinicians (65 %), and professional associations (62 %). Respondents were able to select multiple groups to follow. Only five respondents (4 %) were not interested in following any of these groups. The majority of students (73 %) felt it was appropriate to use social media in the professional work setting for educational research, or professional communication purposes. Thematic analysis of free text responses identified four key themes: peer collaboration, need for separation between personal and professional realms, complementary learning and enhanced communication. These are presented below. Theme 1: Peer collaboration The benefits of SNS as tools for facilitating educational communication and collaboration were consistently reported. Social media (particularly facebook) has already proven to be a useful means of communication for group assignments, a forum for questions and as a general centre for communication with peers There is already a second year physiotherapy facebook page run by students. We offer each other advice on topics, and that acts as a reminder for assignment due dates Facebook was highlighted as being specifically suited to small group learning due to the ability to create groups and share media. Groups also allow for wider discussion and development of social supports amongst year levels. [Facebook is] great for group work. Also great for building a support network with peers for asking questions during revision periods Theme 2: Separation of personal and professional Participants reported that the social nature of SNS may present a significant distraction if utilised for learning. Social media is distracting enough as it is. I don’t think it is a good idea to incorporate [it into] education Integrating social media into the way we learn only provides another form of distraction that we do not need Even if we used social media as communication it is easy to [get] side tracked as it is not an educational tool usually and we will fall back into old habits
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Conversely, combining social and educational arenas may impact on students’ ability to take time away from their studies. This fuelled concerns that educational use of SNS may prevent the development of a healthy work/life balance. I feel it is important to keep work/study and social life separate I think it may make it difficult to keep study and relaxation separate, and therefore it is difficult to ensure you take time away from university. Social media for me is ‘social’, in other words I use and enjoy it for social purposes and would not want to use it for educational/work purposes Issues of privacy were consistently reported, due to the vast amount of personal information available through SNS. The impact such personal information may have upon one’s professional life was deemed a significant barrier to the introduction of SNS in education. I think [SNS] can already get people into enough trouble with their schools or workplaces due to the content of photos/comments etc.… I would be very hesitant to be ‘‘following’’ or allowing my supervisors access to what I post or other people post about me on [SNS]. It is nice to have somewhere to talk to your friends without having to worry about everything you write potentially being seen negatively by a professional – e.g. slang typing, language, clothes you wear out/activities you get up to (all of which should have nothing to do with your professional relationships and responsibilities). Social media is too personal to affiliate with the professional lifestyle of university or workplace Theme 3: Complementary learning The alternative learning methods offered by SNS such as Youtube were strongly praised as a beneficial adjunct to traditional learning. This was deemed especially pertinent in the Physiotherapy curriculum due to the large practical component. YouTube has the potential to be a very powerful aide. Many people, like myself are visual learners [Social Network Sites are] great for posting pictures or helpful links Youtube can be used to not only watch practical videos but can also be helpful when attempting to understand physiology, biology, anatomy, etc. I have found it very helpful in this sense Theme 4: Enhanced communication Participants stated accessible and instantaneous communication between university staff and students as well as peer to peer communication, was a benefit afforded by SNS. This was highlighted as an improved method for delivering announcements, administrative updates and information.
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Social media is just another form of communication that is quick, easily accessible and very popular in current society. If it was used for educational purposes it also allows a large number of people to be reached very quickly More efficient communication of information, as more students tend to access social media more frequently than their uni email We all check our emails maybe daily but most people check at least one social media site more than once daily if not hourly. Respondents further solidified SNS as a superior announcement and communication platform due to their ease of access via mobile devices. Incorporating it into the curriculum is useful because almost everyone uses a phone or laptop with internet. Accessing information is useful when it is handy on a phone as well Social media so widely used by most people these days with the popular use of smart phones and it is frequently checked so there is always going to be large and great exposure
Discussion Social Network Sites present an opportunity for educators to reach students on an unprecedented scale. The exponential growth of SNS has resulted in a user base in the hundreds of millions, this includes 75 % of internet users aged 18–24 and over 95 % of British undergraduate students (Lenhart 2009; Madge et al. 2009). Our results mirror this sentiment in a health professional student population, with 97 % of students currently using Facebook, and less than 2 % not utilising SNS. Empowering students by reaching them in their area of familiarity may better engage learners. However, our results show a strong conflict of opinion among students regarding this assumption; some report ‘‘it is the way of the future’’ whilst others believe it should be kept as a social tool, ‘‘not formalised’’ and ‘‘forced’’ upon them. Online learning is appropriate for adult learners (Mason 2006). This is reflected in our findings as 85 % of respondents supported the use of SNS to benefit their learning experience, a practice which has been associated with academic gains (Klein 2008). A 2007 study of 9–17 year old students, parents and school district leaders found that 60 % of students utilised SNS to discuss education, with 50 % discussing specific work (Karlin 2007). This practice continues, and is even more pronounced, in an undergraduate population. In our research, 97 % of physiotherapy students indicated that they have used Facebook for educational purposes. In the absence of educator involvement, students independently incorporated SNS into their learning by generating and maintaining a year level page on Facebook where students can ‘‘ask questions [and] clarify things.’’ This selfcreated student community supports the proposition that students will ‘‘invest time and energy in building relationships around shared interests and knowledge [on SNS]’’ (Maloney 2007). Schroeder and Greenbowe (2009) compared the use of similar educational Facebook groups with traditional online learning tools amongst undergraduate students. Facebook was reportedly utilised 400 % more than traditional online educational tools, with questions receiving more detailed responses.
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Pedagogical practices are evolving as we enter the highly connected digital age of ubiquitous information (Mcloughlin and Lee 2008a, b). Learning is an active, networked, and intensely social process (McMahon 1997; Paavola and Hakkarainen 2005). Current educational research identifies the importance of supporting learning with communication technologies such as SNS, as they continue to become an integral part of society (Andone et al. 2007; Lee and McLoughlin 2008). Doing so affords learners the opportunity to embed learning within real-life tasks and culturally relevant scenarios, providing a more meaningful learning experience (Herrington et al. 2003; Reeves et al. 2002). SNS provide users with opportunities for collaboration, abundant feedback, and exposure to other’s perspectives. As such, SNS reflect a social and psychological constructivist pedagogy (Richardson 2003). By providing access to peers, experts and the wider community, learners have the opportunity to participate in networked communities of knowledge construction, develop autonomous learning skills, and ultimately construct an understanding together which may not have been possible alone (Greeno et al. 1996; Mcloughlin and Lee 2008a, b). Our research shows that learners would utilise SNS to establish learning connections; 93 % of students would connect with peers via Facebook, and 62–69 % with clinicians, lecturers and professional associations. Tagney et al. (2001) further contend that technologies such as SNS allow for ‘cultural constructivism’, in which students not only construct their own knowledge in a social context, but produce knowledge for the good of their learning community. Learning via knowledge creation is an emerging process with ever increasing support and recognition (Lee et al. 2008). The benefits of this online social arena extend to student wellbeing and social capital. With 93 % of teens online, and 32 % reportedly using the internet to help them make new friends, almost all students are experienced social networkers prior to attending tertiary education (Lenhart and Lewis 2001; Lenhart et al. 2007). Having this familiar space to interact with new peers may assist in the transition into university life, providing an avenue for social acceptance and establishing a sense of belonging (Klein 2008). Social capital is broadly defined as ‘‘the benefits we receive from our social relationships’’ (Steinfield et al. 2008). This includes information and support, and has been linked to the psychological well-being of young people (Morrow 1999). A 2007 survey of undergraduate students found that Facebook was closely related to the development and maintenance of social capital (Ellison et al. 2007). Conversely, a negative consequence of online communication is the potential for cyber-bullying. Research into cyber-bullying via SNS is an area still in its infancy; it is currently unclear if academic engagement on SNS alters cyber-bullying behaviours. A recent survey of undergraduate students reported 51 % had observed cyberbullying; rates were highest on Facebook. However, the level of involvement in SNS by students was inversely correlated with rates of victimisation, observation or involvement in bullying behaviour, thereby potentially supporting their increased use (Carter 2013). The mode in which SNS are accessed is continuing to evolve. Since the introduction of smart phones, people are becoming increasingly connected through mobile devices. A total of 68 % of our participants indicated that they commonly view social media on their mobile phone. Near immediate communication to a wide audience is therefore a logistically and fiscally feasible option to educational institutions. Our respondents identified the benefit of utilising SNS in such a way; ‘‘it would be most useful to provide updates … This in particular would be more effective as people check Facebook … much more frequently than [formal VLEs]’’. Additionally, 67 % of participants reported viewing Facebook more than twice per day. Other institutions have successfully implemented similar systems with positive results (Campbell 2008). Further administrative benefits have also been reported.
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Mack et al. (2007) found that students preferred SNS to ask research and reference related questions, more so than email or face-to-face. Reluctance to involve this technology into education is not unfounded, and significant issues must be overcome if SNS are to be beneficial for teaching and learning. Social Network Sites are purpose built for socialisation, potentially producing high degrees of distraction from any form of education attempting to utilise the platform (Cassidy 2006). Our research identified that whilst students currently use SNS for education, the formalising of this practice is often viewed with reluctance; ‘‘if it’s officially integrated into university curriculum it becomes more formal and … supervised … [leading] to less use of it’’. Students feel free to discuss learning in an informal fashion via SNS, a practice our respondents deemed not possible if educators were involved. However, educators may play a beneficial role by adapting to their role as facilitators, not participants, in this online social learning process (Bauersfeld 1995), encouraging, rather than participating in SNS facilitated learning. Concerns regarding the use of SNS for education were expressed by 42 % of our participants. Privacy concerns were a major barrier, a finding supported by previous research (Ophus and Abbitt 2009). Connell (2009) reported that 12 % of students preferred not to be contacted via SNS because of the potential to infringe on their sense of privacy. The huge amount of personal information being broadcast on SNS gives rise to concerns that one’s personal life may be viewed in the professional context and directly influence their education, professional life or employment prospects (Barnes 2006); ‘‘Facebook should be left for friend to friend interaction. I…use Facebook to ask other students work related questions but I would be very hesitant to…[allow] my supervisors access to what I post or other people post about me on Facebook’’. Health professional students have a greater risk of professional ramifications. Societal and organisational expectations require healthcare practitioners, such as physiotherapists, to display a standard of behaviour that warrants the trust and respect of the community (APA 2008; Chretien et al. 2009). Application of these existing principles to the realm of social media is a complex issue, one which has been recognised by the Australian Medical Association (Mansfield et al. 2011). Certain actions displayed on SNS, such as off-duty drinking, may be deemed unprofessional by members of the public, despite not being a breach of the principles of professional conduct (Greysen et al. 2010). Current Australian Physiotherapy Association and Australian Medical Council codes of conduct provide no guidance in this area (AMC 2009; APA 2008). The desire for a separation of personal and professional information extends beyond issues of privacy. Our research identified that incorporating education into students’ social lives may disrupt the healthy work life balance, making it ‘‘difficult to ensure you take time away from university’’. Educators are not immune from the potential side effects of SNS. Our participants reported that using SNS might open less professional lines of communication between educators and learners, which may ‘‘blur lines of respect of professionalism’’. Furthermore, educators’ credibility may be damaged if they violate what student’s perceive to be proper behaviour (Mazer et al. 2007). However, Mazer et al. (2007) propose that despite this risk, teachers have the potential to enhance their standing in the eyes of students by ‘‘signifying an understanding of contemporary student culture’’. Additionally, Schwartz (2009) reports that interactions between students and educators in higher education through SNS are comparable to face-to-face meetings, and can be a valid form of interactive educational communication and allow for pedagogical mentoring. A possible limitation of this work was the specificity of the population studied. While there is no reason to suggest the university involved has a unique culture, a larger sample
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size with involvement from other institutions and students outside the Physiotherapy discipline may increase confidence in the results. Cultural differences may also exist internationally. However, the similarity between our findings and those of studies conducted in other countries supports our results. The use of mixed response methods also allows deeper understanding of student beliefs and culture. Despite the comparatively high response rate when compared to other survey studies in this area (Ellison et al. 2007; Sandars and Schroter 2007), the invitee response rate is a potential limitation of this study. No demographic information is available for non-responders, therefore it is unclear whether a bias affected survey participation. It should be noted that the survey has undetermined construct validity.
Conclusions Utilisation of SNS appears almost universal amongst current undergraduate students. Students wish to make educational connections via SNS to augment their learning. Students will invest time and energy to independently develop and maintain structured communities of learning where none currently exist. This extends to developing networks with experts, practitioners and professional associations, a practice highly congruent with social constructivist pedagogical theory. However, this study has identified a reluctance for this process to be formalised or for student activity to be visible beyond peer groups. Encouraging and providing integrated opportunities for student managed use of SNS, such as study or year level groups, may provide both educational and social benefits to students. The desire to maintain privacy, and a distinction between personal and professional lives drives student concerns about the application of SNS within their education. This concern is heightened in the healthcare field due to societal and professional expectations. One-way communication, such as utilising SNS as a platform for instantaneous and accessible announcements, or students ‘following’ clinicians, not ‘be-friending’ them, may avoid these issues. Any educator involvement should be viewed with caution.
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Social media in health professional education: a student perspective on user levels and prospective applications Stephen Maloney • Alan Moss • Dragan Ilic
Received: 22 August 2013 / Accepted: 3 February 2014 Springer Science+Business Media Dordrecht 2014
Abstract Social Networking Sites (SNS) have seen exponential growth in recent years. The high utilisation of SNS by tertiary students makes them an attractive tool for educational institutions. This study aims to identify health professional students’ use and behaviours with SNS, including students’ perspectives on potential applications within health professional curricula. Students enrolled in an undergraduate physiotherapy program were invited to take part in an anonymous, online questionnaire at the end of 2012. The survey consisted of 20 items, gathering demographic data, information on current use of SNS, and opinions regarding the application of SNS into education. Both quantitative and qualitative data were gathered. A total of 142 students, from all years of study, completed the online questionnaire. Only two participants were not current users of social media. Facebook and YouTube had been utilised for educational purposes by 97 and 60 % of participants respectively; 85 % believed that SNS could benefit their learning experience. Only five respondents were not interested in following peers, academic staff, clinicians or professional associations on Facebook. Four key themes emerged: peer collaboration, need for separation between personal and professional realms, complimentary learning and enhanced communication. Students wish to make educational connections via SNS, yet expressed a strong desire to maintain privacy, and a distinction between personal and professional lives. Educational utilisation of SNS may improve communication speed and accessibility. Any educator involvement should be viewed with caution. Keywords Social media eLearning Technology Communication Clinical education Pedagogy
S. Maloney (&) A. Moss Department of Physiotherapy, Monash University, PO Box 527, Frankston, VIC 3199, Australia e-mail: [email protected] D. Ilic Department of Epidemiology and Preventive Medicine, Monash University, Frankston, VIC, Australia
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Introduction Educators are in perpetual pursuit of ways to improve students’ learning. The education sector has a history of repurposing popular technologies in an effort to ‘go to where the students are’ and improve learner engagement and flexibility (Ophus and Abbitt 2009). With increasing competition in the educator sector, and associated economic imperatives, social media sites are being explored as emerging environments for teaching and learning. Social Network Sites (SNS) are websites that allow individuals to construct a public or semipublic profile within a bounded system; articulate a list of other users with whom they share a connection; and view and traverse their list of connections and those made by others within the system (Boyd and Ellison 2007). The nature and nomenclature of these connections may vary from site to site. Social Network Sites play host to hundreds of millions of users; Facebook alone boasts over 650 million daily active users (Facebook 2013). A 2006 study indicated that over 90 % of undergraduate students at the University of North Carolina used Facebook (Stutzman 2006), a finding replicated by recent studies around the world (Kim et al. 2011; Lampe et al. 2006; Ophus and Abbitt 2009; Smith and Rainie 2011). This presents an undeniable opportunity for educators to utilise SNS as a viable educational tool (Johnson et al. 2007). The use of SNS in education is an emerging, evolving and controversial field of scholarship. The controversy lies in the perception of social media sites as purely informal social tools, ‘educational distractions’ incongruent with focused academic pursuit (Cassidy 2006). This can be amplified in health professional education, where the use of social media may violate societal expectations of the profession (Greysen et al. 2010), or be viewed as conduct unbecoming of a professional clinician or health professional trainee (McGowan 2011). Greysen et al. (2010) report that members of the public may view a healthcare professional’s activity on SNS as a proxy for their trustworthiness in handling patient care. Currently, there is limited high quality evidence regarding the effectiveness of SNS on student learning outcomes and the student learning experience. However, SNS may allow for desirable educational features including flexibility of learning through decentralised and remote access to resources, and facilitated engagement in socially constructivist pedagogy (Cheston et al. 2013; Maloney 2007). The 2013 systematic review by Cheston et al. (2013) identified 14 studies [only one randomised controlled trial (RCT)] and concluded that SNS may enhance medical education and have a positive impact on learning outcomes. Limited information exists on how university students utilise SNS, be it for educational or strictly social purposes. The reach of SNS make them an attractive tool for educational institutions, however successful implementation of any technology which has been repurposed for education requires an informed integration process (Ophus and Abbitt 2009). Issues such as privacy, security settings, cost, technical issues, and user proficiency should be considered when developing interventions which utilise SNS (Cheston et al. 2013). The primary objective of this study is to identify the behaviours of entry-level health professional students surrounding SNS. This study also aims to examine student perspectives on the potential application of SNS into health professional teaching and learning activities.
Methods Participants Students enrolled in a Bachelor of Physiotherapy program at a single University campus were invited to take part in an online cross-sectional study at the end of 2012. The Bachelor
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of Physiotherapy program is a 4 year undergraduate course. Students were invited to participate in the study via a bulk email to student email accounts. This initial call for volunteers was supplemented by an announcement through the university’s Virtual Learning Environment (VLE), the typical mode of communication between students and academic staff. Procedure Students who agreed to take part in the study were asked to complete an online questionnaire. No validated survey was available which suited the purpose of this study, therefore a custom tool was developed by the authorship team. The survey was piloted by a former member of the student cohort prior to its deployment. Subsequent refinements were made to improve the survey’s face validity (Holden 2010). The questionnaire consisted of 20 items, gathering both quantitative and qualitative data. Various response types were utilised, including multiple choice options, five-point Likert scales ranging from strongly agree to strongly disagree, and free text. We collected basic demographic and descriptive data such as age, gender, and year level. Four questions gathered data regarding current usage of SNS, including frequency, and on what device (mobile phone, laptop etc.) SNS were visited. Five point Likert scales were used to discern frequency of popular SNS use. Twelve of the most utilised SNS in Australia were listed as options (Cowling 2013; Friedlieb 2013), however participants were provided with the option to specify further alternatives. Additionally, participants were asked to classify themselves as an active (viewer and contributor), passive (viewer that generally does not contribute), or non-user of SNS. Thirteen questions investigated academic utilisation of SNS. Participants were asked about their previous educational use, its potential to benefit their learning, and willingness to ‘follow’ certain educational groups. Open-ended questions and free text responses asked participants to comment on the appropriateness of integrating SNS into their learning, anticipated or requested applications in which SNS would be suitable, as well as expected benefits, problems and concerns. Data were collected over a 4-week period. This timeframe was chosen as online survey response rates significantly decrease after 2 weeks (Madge and O’Connor 2002). At 2 weeks, a reminder email and VLE announcement was circulated. Free text comments, relating to the formal integration of SNS into undergraduate health professional curricula, underwent thematic analysis (Braun and Clarke 2006). All quotes are presented verbatim, and are provided to give context to key emergent themes. Quantitative data underwent descriptive analysis using SPSS. Ethics approval was granted by the Monash University Human Research Ethics Council, and all data collected were anonymous.
Results A total of 284 students were invited to participate in the study, with 142 students completing the online questionnaire (response rate of 50 %). Participants from all years of study took part, with predominant involvement by 1st and 2nd year students, 34 and 35 % respectively of all responses returned. Ages of participants ranged from 17 to 42, with the average age 21 years; 74 % were female. A total of 66 % of respondents classified themselves as active users of SNS, defined in the survey as both viewers and contributors of content to a SNS; 35 % classified themselves as viewers only; two participants did not
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use social media. Proportions of all three categories were similar between genders (v2 test: p = 0.58). Mobile phones and tablet computers were utilised to view SNS by 68 and 9 % of respondents respectively. Facebook, Youtube, Instagram and Google? were found to be the most utilised SNS, being accessed three or more times per week by 97, 87, 30 and 26 % of participants respectively; 67 % of participants reported using Facebook more than twice per day. Additionally, Facebook, Youtube and Google? had been utilised for educational purposes by 97, 60 and 18 % of participants respectively. A total of 85 % of respondents believed that SNS could benefit their learning experience. Students indicated that to benefit their learning they would be interested in using Facebook to follow peers (93 %), academic staff (69 %), clinicians (65 %), and professional associations (62 %). Respondents were able to select multiple groups to follow. Only five respondents (4 %) were not interested in following any of these groups. The majority of students (73 %) felt it was appropriate to use social media in the professional work setting for educational research, or professional communication purposes. Thematic analysis of free text responses identified four key themes: peer collaboration, need for separation between personal and professional realms, complementary learning and enhanced communication. These are presented below. Theme 1: Peer collaboration The benefits of SNS as tools for facilitating educational communication and collaboration were consistently reported. Social media (particularly facebook) has already proven to be a useful means of communication for group assignments, a forum for questions and as a general centre for communication with peers There is already a second year physiotherapy facebook page run by students. We offer each other advice on topics, and that acts as a reminder for assignment due dates Facebook was highlighted as being specifically suited to small group learning due to the ability to create groups and share media. Groups also allow for wider discussion and development of social supports amongst year levels. [Facebook is] great for group work. Also great for building a support network with peers for asking questions during revision periods Theme 2: Separation of personal and professional Participants reported that the social nature of SNS may present a significant distraction if utilised for learning. Social media is distracting enough as it is. I don’t think it is a good idea to incorporate [it into] education Integrating social media into the way we learn only provides another form of distraction that we do not need Even if we used social media as communication it is easy to [get] side tracked as it is not an educational tool usually and we will fall back into old habits
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Conversely, combining social and educational arenas may impact on students’ ability to take time away from their studies. This fuelled concerns that educational use of SNS may prevent the development of a healthy work/life balance. I feel it is important to keep work/study and social life separate I think it may make it difficult to keep study and relaxation separate, and therefore it is difficult to ensure you take time away from university. Social media for me is ‘social’, in other words I use and enjoy it for social purposes and would not want to use it for educational/work purposes Issues of privacy were consistently reported, due to the vast amount of personal information available through SNS. The impact such personal information may have upon one’s professional life was deemed a significant barrier to the introduction of SNS in education. I think [SNS] can already get people into enough trouble with their schools or workplaces due to the content of photos/comments etc.… I would be very hesitant to be ‘‘following’’ or allowing my supervisors access to what I post or other people post about me on [SNS]. It is nice to have somewhere to talk to your friends without having to worry about everything you write potentially being seen negatively by a professional – e.g. slang typing, language, clothes you wear out/activities you get up to (all of which should have nothing to do with your professional relationships and responsibilities). Social media is too personal to affiliate with the professional lifestyle of university or workplace Theme 3: Complementary learning The alternative learning methods offered by SNS such as Youtube were strongly praised as a beneficial adjunct to traditional learning. This was deemed especially pertinent in the Physiotherapy curriculum due to the large practical component. YouTube has the potential to be a very powerful aide. Many people, like myself are visual learners [Social Network Sites are] great for posting pictures or helpful links Youtube can be used to not only watch practical videos but can also be helpful when attempting to understand physiology, biology, anatomy, etc. I have found it very helpful in this sense Theme 4: Enhanced communication Participants stated accessible and instantaneous communication between university staff and students as well as peer to peer communication, was a benefit afforded by SNS. This was highlighted as an improved method for delivering announcements, administrative updates and information.
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Social media is just another form of communication that is quick, easily accessible and very popular in current society. If it was used for educational purposes it also allows a large number of people to be reached very quickly More efficient communication of information, as more students tend to access social media more frequently than their uni email We all check our emails maybe daily but most people check at least one social media site more than once daily if not hourly. Respondents further solidified SNS as a superior announcement and communication platform due to their ease of access via mobile devices. Incorporating it into the curriculum is useful because almost everyone uses a phone or laptop with internet. Accessing information is useful when it is handy on a phone as well Social media so widely used by most people these days with the popular use of smart phones and it is frequently checked so there is always going to be large and great exposure
Discussion Social Network Sites present an opportunity for educators to reach students on an unprecedented scale. The exponential growth of SNS has resulted in a user base in the hundreds of millions, this includes 75 % of internet users aged 18–24 and over 95 % of British undergraduate students (Lenhart 2009; Madge et al. 2009). Our results mirror this sentiment in a health professional student population, with 97 % of students currently using Facebook, and less than 2 % not utilising SNS. Empowering students by reaching them in their area of familiarity may better engage learners. However, our results show a strong conflict of opinion among students regarding this assumption; some report ‘‘it is the way of the future’’ whilst others believe it should be kept as a social tool, ‘‘not formalised’’ and ‘‘forced’’ upon them. Online learning is appropriate for adult learners (Mason 2006). This is reflected in our findings as 85 % of respondents supported the use of SNS to benefit their learning experience, a practice which has been associated with academic gains (Klein 2008). A 2007 study of 9–17 year old students, parents and school district leaders found that 60 % of students utilised SNS to discuss education, with 50 % discussing specific work (Karlin 2007). This practice continues, and is even more pronounced, in an undergraduate population. In our research, 97 % of physiotherapy students indicated that they have used Facebook for educational purposes. In the absence of educator involvement, students independently incorporated SNS into their learning by generating and maintaining a year level page on Facebook where students can ‘‘ask questions [and] clarify things.’’ This selfcreated student community supports the proposition that students will ‘‘invest time and energy in building relationships around shared interests and knowledge [on SNS]’’ (Maloney 2007). Schroeder and Greenbowe (2009) compared the use of similar educational Facebook groups with traditional online learning tools amongst undergraduate students. Facebook was reportedly utilised 400 % more than traditional online educational tools, with questions receiving more detailed responses.
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Pedagogical practices are evolving as we enter the highly connected digital age of ubiquitous information (Mcloughlin and Lee 2008a, b). Learning is an active, networked, and intensely social process (McMahon 1997; Paavola and Hakkarainen 2005). Current educational research identifies the importance of supporting learning with communication technologies such as SNS, as they continue to become an integral part of society (Andone et al. 2007; Lee and McLoughlin 2008). Doing so affords learners the opportunity to embed learning within real-life tasks and culturally relevant scenarios, providing a more meaningful learning experience (Herrington et al. 2003; Reeves et al. 2002). SNS provide users with opportunities for collaboration, abundant feedback, and exposure to other’s perspectives. As such, SNS reflect a social and psychological constructivist pedagogy (Richardson 2003). By providing access to peers, experts and the wider community, learners have the opportunity to participate in networked communities of knowledge construction, develop autonomous learning skills, and ultimately construct an understanding together which may not have been possible alone (Greeno et al. 1996; Mcloughlin and Lee 2008a, b). Our research shows that learners would utilise SNS to establish learning connections; 93 % of students would connect with peers via Facebook, and 62–69 % with clinicians, lecturers and professional associations. Tagney et al. (2001) further contend that technologies such as SNS allow for ‘cultural constructivism’, in which students not only construct their own knowledge in a social context, but produce knowledge for the good of their learning community. Learning via knowledge creation is an emerging process with ever increasing support and recognition (Lee et al. 2008). The benefits of this online social arena extend to student wellbeing and social capital. With 93 % of teens online, and 32 % reportedly using the internet to help them make new friends, almost all students are experienced social networkers prior to attending tertiary education (Lenhart and Lewis 2001; Lenhart et al. 2007). Having this familiar space to interact with new peers may assist in the transition into university life, providing an avenue for social acceptance and establishing a sense of belonging (Klein 2008). Social capital is broadly defined as ‘‘the benefits we receive from our social relationships’’ (Steinfield et al. 2008). This includes information and support, and has been linked to the psychological well-being of young people (Morrow 1999). A 2007 survey of undergraduate students found that Facebook was closely related to the development and maintenance of social capital (Ellison et al. 2007). Conversely, a negative consequence of online communication is the potential for cyber-bullying. Research into cyber-bullying via SNS is an area still in its infancy; it is currently unclear if academic engagement on SNS alters cyber-bullying behaviours. A recent survey of undergraduate students reported 51 % had observed cyberbullying; rates were highest on Facebook. However, the level of involvement in SNS by students was inversely correlated with rates of victimisation, observation or involvement in bullying behaviour, thereby potentially supporting their increased use (Carter 2013). The mode in which SNS are accessed is continuing to evolve. Since the introduction of smart phones, people are becoming increasingly connected through mobile devices. A total of 68 % of our participants indicated that they commonly view social media on their mobile phone. Near immediate communication to a wide audience is therefore a logistically and fiscally feasible option to educational institutions. Our respondents identified the benefit of utilising SNS in such a way; ‘‘it would be most useful to provide updates … This in particular would be more effective as people check Facebook … much more frequently than [formal VLEs]’’. Additionally, 67 % of participants reported viewing Facebook more than twice per day. Other institutions have successfully implemented similar systems with positive results (Campbell 2008). Further administrative benefits have also been reported.
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Mack et al. (2007) found that students preferred SNS to ask research and reference related questions, more so than email or face-to-face. Reluctance to involve this technology into education is not unfounded, and significant issues must be overcome if SNS are to be beneficial for teaching and learning. Social Network Sites are purpose built for socialisation, potentially producing high degrees of distraction from any form of education attempting to utilise the platform (Cassidy 2006). Our research identified that whilst students currently use SNS for education, the formalising of this practice is often viewed with reluctance; ‘‘if it’s officially integrated into university curriculum it becomes more formal and … supervised … [leading] to less use of it’’. Students feel free to discuss learning in an informal fashion via SNS, a practice our respondents deemed not possible if educators were involved. However, educators may play a beneficial role by adapting to their role as facilitators, not participants, in this online social learning process (Bauersfeld 1995), encouraging, rather than participating in SNS facilitated learning. Concerns regarding the use of SNS for education were expressed by 42 % of our participants. Privacy concerns were a major barrier, a finding supported by previous research (Ophus and Abbitt 2009). Connell (2009) reported that 12 % of students preferred not to be contacted via SNS because of the potential to infringe on their sense of privacy. The huge amount of personal information being broadcast on SNS gives rise to concerns that one’s personal life may be viewed in the professional context and directly influence their education, professional life or employment prospects (Barnes 2006); ‘‘Facebook should be left for friend to friend interaction. I…use Facebook to ask other students work related questions but I would be very hesitant to…[allow] my supervisors access to what I post or other people post about me on Facebook’’. Health professional students have a greater risk of professional ramifications. Societal and organisational expectations require healthcare practitioners, such as physiotherapists, to display a standard of behaviour that warrants the trust and respect of the community (APA 2008; Chretien et al. 2009). Application of these existing principles to the realm of social media is a complex issue, one which has been recognised by the Australian Medical Association (Mansfield et al. 2011). Certain actions displayed on SNS, such as off-duty drinking, may be deemed unprofessional by members of the public, despite not being a breach of the principles of professional conduct (Greysen et al. 2010). Current Australian Physiotherapy Association and Australian Medical Council codes of conduct provide no guidance in this area (AMC 2009; APA 2008). The desire for a separation of personal and professional information extends beyond issues of privacy. Our research identified that incorporating education into students’ social lives may disrupt the healthy work life balance, making it ‘‘difficult to ensure you take time away from university’’. Educators are not immune from the potential side effects of SNS. Our participants reported that using SNS might open less professional lines of communication between educators and learners, which may ‘‘blur lines of respect of professionalism’’. Furthermore, educators’ credibility may be damaged if they violate what student’s perceive to be proper behaviour (Mazer et al. 2007). However, Mazer et al. (2007) propose that despite this risk, teachers have the potential to enhance their standing in the eyes of students by ‘‘signifying an understanding of contemporary student culture’’. Additionally, Schwartz (2009) reports that interactions between students and educators in higher education through SNS are comparable to face-to-face meetings, and can be a valid form of interactive educational communication and allow for pedagogical mentoring. A possible limitation of this work was the specificity of the population studied. While there is no reason to suggest the university involved has a unique culture, a larger sample
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size with involvement from other institutions and students outside the Physiotherapy discipline may increase confidence in the results. Cultural differences may also exist internationally. However, the similarity between our findings and those of studies conducted in other countries supports our results. The use of mixed response methods also allows deeper understanding of student beliefs and culture. Despite the comparatively high response rate when compared to other survey studies in this area (Ellison et al. 2007; Sandars and Schroter 2007), the invitee response rate is a potential limitation of this study. No demographic information is available for non-responders, therefore it is unclear whether a bias affected survey participation. It should be noted that the survey has undetermined construct validity.
Conclusions Utilisation of SNS appears almost universal amongst current undergraduate students. Students wish to make educational connections via SNS to augment their learning. Students will invest time and energy to independently develop and maintain structured communities of learning where none currently exist. This extends to developing networks with experts, practitioners and professional associations, a practice highly congruent with social constructivist pedagogical theory. However, this study has identified a reluctance for this process to be formalised or for student activity to be visible beyond peer groups. Encouraging and providing integrated opportunities for student managed use of SNS, such as study or year level groups, may provide both educational and social benefits to students. The desire to maintain privacy, and a distinction between personal and professional lives drives student concerns about the application of SNS within their education. This concern is heightened in the healthcare field due to societal and professional expectations. One-way communication, such as utilising SNS as a platform for instantaneous and accessible announcements, or students ‘following’ clinicians, not ‘be-friending’ them, may avoid these issues. Any educator involvement should be viewed with caution.
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