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#Workhardplayhard - A Social Media Analysis Of Wellness Culture In Plastic Surgery Residency
Rose S. Maisner, BS, Kailash Kapadia, MD, Emily Keenan, BA, Vaishali Ravikumar, BS, Haripriya S. Ayyala, MD, Edward Lee, MD
Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ

Background: Burnout, “a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment”, afflicts almost one third of plastic surgeons and over half of plastic surgery residents. Given that burnout can detriment resident training and patient outcomes through diminished professionalism, workplace morale, empathy, and ability to teach and learn, cultivating wellness during residency training is essential. The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to create environments that optimize faculty and resident wellness. With increasing Instagram use by plastic surgery residency programs, this study aims to analyze their posts for wellness-related content.
Methods: Integrated plastic surgery residency programs were identified from the American Council of Academic Plastic Surgeons (ACAPS) and Fellowship and Residency Electronic Interactive Database (FREIDA) websites. Associated Instagram accounts were found through Instagram and Google searches. The authors reviewed all post images, captions, and comments made by the program’s account, until November 26, 2020. Posts meeting wellness criteria included portrayal of resident 1) work/life balance, 2) attendance to physical health, 3) team building activities, 4) healthy work environments, 5) activities or lectures specifically designed to promote wellness, 6) images that imply but do not directly show residents participating in wellness activities, or 7) educational events that incorporated any of the aforementioned wellness criteria. Video posts were excluded. Hashtags relating to wellness criteria were recorded.
Results: Seventy-six of 82 (93.9%) programs had Instagram accounts, totaling 7955 posts. Of these, 1845 (23.2%) posts met at least one wellness criteria, specifically 933, 451, 52, 98, 57, 26, and 545 posts, showed content related to resident work/life balance, physical health, team building activities, healthy work environments, wellness activities or lectures, indirect wellness promotion, and educational events incorporating wellness activities, respectively. Twelve-hundred forty-nine of 7955 posts included at least one wellness-related hashtag. Interestingly, 738 (59%) of such posts did not meet wellness criteria. The most utilized hashtags were #residentlife (588), #residencylife (187), #teamwork (98), #residentwellness (70), #team (60), #residentfamily (57), #plasticsurgeryresidentlife (54), #wellness (50), and #workhardplayhard (46).
Conclusion: Despite the importance of burnout prevention during residency, less than a quarter of content on integrated plastic surgery program Instagram accounts promotes wellness. Posts are not using wellness-related hashtags specifically for wellness-related content. Instagram is a valuable tool for showcasing how residency programs are incorporating wellness into their curricula to attract applicants, but it requires further investigation whether residencies lack sufficient wellness initiatives or are not advertising such programming on social media.


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