In the corporate world, it is increasingly clear that organizations with a diverse and inclusive workforce have improved levels of performance and innovation.¹ Health care is no different. Studies have shown that increasing the diversity, equity and inclusion (DEI) of employees within health care is associated with improved patient outcomes, reductions in health disparities and potential health care cost savings.² Within our field, the AUA Diversity and Inclusion Task Force has been tasked with identifying actionable steps to improve DEI in urology. Current census projections predict that by 2044, the majority of the United States population will belong to a minority group other than non-Hispanic White. Yet data show an opposite trend, with a decline in underrepresented minority (URM) candidates in medicine matriculating into a urology residency.⁴ While multiple stakeholders will be involved in developing DEI initiatives, an important platform that can disseminate and accelerate the changes we yearn to see is social media networks. In this article we discuss how social media have been used to increase awareness of DEI, how various societies and institutions are using them as a tool for change, and discuss the growing body of peer review literature on these topics.

Use of Social Media to Increase Awareness of DEI

Social media can be an important vehicle for the promotion and execution of DEI initiatives. In a study evaluating the use of Twitter chats to increase awareness of studies discussing gender equity issues in medicine, it was found that this improved the impact of the articles as measured by the Altmetric score, and significantly increased the number of downloads and readership.⁵ Twitter led to a robust discussion with crowdsourcing of ideas for addressing gender equity issues. The role of public outreach and DEI recruitment strategies in academic science through social media has not only been encouraged, but it has also been suggested that these engagement activities should have weight in merit, tenure and promotion assessments for academic physicians.⁶ Increasingly, social media strategy will be an important lever for academic institutions and programs as they advance initiatives focusing on DEI.

What Are Societies and Institutions Doing to Promote DEI through Social Media?

Multiple specialties have been trying to understand how to best use social media to diversify the workforce pipeline. Recently, the Journal of the American College of Radiology published an article on leveraging social media for DEI recruitment.⁷ During the 2020 virtual application cycle for radiology, more than 50% of programs used social media for highlighting, advancing and promoting DEI initiatives.

Some urology residency programs have embraced this by establishing new initiatives to promote DEI. Most of the recruitment for these endeavors has occurred on social media, allowing accessibility for prospective URM urology applicants to engage regardless of geography, cost considerations or other limitations. One example is the University of California–San Francisco’s (UCSF) UReTER (UnderRepresented Trainees Entering Residency) mentorship program (@UCSFUrology) that connects urology residents across the country with URM applicants.

The Michigan Urology Academy (#MUA21) and UroVersity (@UroVersity_UM) programs, developed by the Department of Urology at the University of Michigan, have also tried to address URM recruitment. Preliminary data on who is participating in these efforts are promising. Activity on Twitter for the Michigan Urology Academy this year led to more than 43,000 impressions. Candidates included 52% women, 43% Black/African American, 12% Hispanic/Latinx and 17% multiracial/-ethnic individuals. Importantly, 51% of these candidates did not have a home urology program for mentorship, showing how important this virtual outreach can be to promote diverse candidates toward successful entry into urology. Table 1 provides a list of relevant organizations, both outside and within urology, that have taken an active role in creating virtual communities to promote DEI through social media.

Peer-Reviewed Literature on DEI in Urology

As noted by this special edition, the AUA Publications Office is committed to raising awareness of DEI initiatives in our field. The Journal of Urology^® is the number 1 urological journal on Twitter, with over 36,000 followers. It therefore has a prominent role in disseminating peer-reviewed content through social media. Table 2 highlights recent studies focused on diversity, equity and disparities published in @JUrology and @UrologyPractice. All of these articles have been promoted through the journals’ social media channels, where access to articles is free for the first 60 days after publication. These efforts increase media attention and citation of journal content.⁸

In a recent study, Loeb and colleagues assessed how the urological community responded on Twitter to the hashtag #ILookLikeAUrologist, which has been used to encourage greater female representation in urology.⁹ In their study period, this hashtag was used in over 3,600 tweets by 1,348 unique contributors from 35 countries, reaching a large global audience with over 8 million impressions. An analysis of these tweets determined gender was the most common theme; however, other saliant themes included personal narratives, opinions and camaraderie. Studies like this lay the framework for investigating causal relationships between online DEI content and real-world implications.

Conclusions

Social media are an increasingly important communication tool for advocacy, education and building a sense of community. As programs move from discussion to enacting change, future work will assess whether engagement in social media translates to improved diversity across gender, race, ethnicity and other demographic characteristics. Importantly, there has to be greater rigor in evaluating the benefits and pitfalls of using social media for DEI initiatives. In particular, social media can tend to propagate what is popular, and sometimes only the loudest voices get noticed. However, it is our belief that social media can be a great “leveler”–providing access and encouragement for medical students who may not necessarily consider urology to be a home for them. Future work has to identify metrics to determine success, and assess whether current efforts are resulting in a more diverse and inclusive workforce. This will help to clarify what methods work and what do not. This will allow our profession to focus resources on initiatives that make a lasting impact.