Social Media Application in Education During the COVID-19 Pandemic; Pros and Cons: A Systematic Review

Abstract
Background: In addition to morbidity and mortality, the COVID-19 pandemic affected various fields such as medical and academic education. The purpose of this study was to investigate the types of social media used in medical and academic education and identify their advantages and disadvantages.
Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify published studies related to the effects of social media on medical and academic education during the COVID-19 pandemic. The retrieved records were screened in a two-step process; first by title/abstract and then by full text by two independent researchers and the most relevant studies were selected applying the eligibility criteria. 
Results: Facebook, YouTube, Zoom, WhatsApp, Moodle, and Skype were the most used platforms. The main purpose of using these applications was to provide distance education to students in the pandemic era. The advantages of using online platforms outweighed the disadvantages. Advantages include the availability of information at any time and place, maintaining communication between students and classmates and instructors, and the possibility of presenting conferences and assignments. Disadvantages comprised infrastructure and internet problems.
Conclusion: Social media and messengers have a great potential to meet educational purposes in the epidemic era. Although online platforms can serve as an efficient public repository of learning resources, achieving this needs some prerequisite and infrastructural tasks. 
Keywords: Coronavirus, COVID-19, Education, Learning, Medical education, Social media

Introduction
COVID-19 pandemic started to spread in late 2019 and overwhelmed lives around the world (1,2). The pandemic likewise drastically affected the higher education sector by imposing national lockdown in most countries and compulsory closure of universities and schools (3,4). Nevertheless, virtual education played a central role in the new educational assembly where distance education became widespread and much higher education events were picked up through social media applications (5-7). Such transformation from conventional education to e-learning unveiled the need for developing support systems aiding many services which assist learners to achieve pre-defined goals, knowledge, expertise, and skills (8). Social media were the sought-after to support distance learning ventures during the pandemic. Each technology has been confirmed by unique features in studies (9). Social media play a significantly useful role in educating the public about health information in critical situations such as the COVID-19 pandemic (10,11). Rapid data dissemination and easy access by residents and healthcare professionals allows for individual and group learning as well as quick access to information (4,12,13). By contrast, virtual education further suffered from some challenges and concerns (14,15). One challenge was the failure to organize in-person and practical learning sessions in medical sciences universities, where social media platforms and other software encountered many barriers and disruptions in educational courses (16).
Abbasi et al reported motivation to improve media literacy skills, identifying talented and creative teachers, and versatility in class schedule as advantages; by contrast, non-universal access to cyberspace particularly in deprived and remote areas, slow Internet speed, nomophobia (Internet and smartphone addiction), and demotivation in some students are some of the disadvantages (17). Isyaku Hassan described some of the challenges that students may encounter using web-based technologies during the pandemic such as the dearth of technical information, failure to load big files, and forgetting passwords (18). The pandemic has promoted the public use of specialized virtual networks in academic associations, while it has contrarily caused the fading of non-verbal communication, failure to substitute clinical activities, and professor-student-patient interactions (19). The use of social media in advancing educational goals during the COVID-19 pandemic had various positive and negative effects. Knowing the strengths and weaknesses of social media in the field of public health education and specialized education can be very useful. However, there is a shortage of a comprehensive report on the strengths and weaknesses of using social media for education. Therefore, the purpose of this study is to investigate the pros and cons of social media platforms’ utilization for medical and academic education.

Materials and Methods
A systematic search of Google Scholar, PubMed, Scopus, and Web of Science was conducted on November 30th, 2022, to identify published studies related to the effects of social media on medical and academic education during the COVID-19 pandemic. This review study performed adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement (20).

Data Sources
We carried out a systematic literature search using the following online databases: PubMed, Scopus, and Web of Science. The references of included articles were also searched to identify additional relevant literature.

Search Strategy
The search strategy was defined by the first and corresponding authors combining different keywords as follows:
A: COVID-19 OR SARS-CoV-2 OR “Corona virus” OR COVID OR “Coronavirus disease-2019” OR “Novel coronavirus”
B: “Social Media” OR “Social Medium” OR “virtual network” OR “Social network” OR “Communication Media” OR “virtual communities” OR “Web 2.0” OR Facebook OR Twitter OR Instagram or telegram OR WhatsApp OR podcast
C: train OR teach OR education OR Educate OR “Literacy Program” OR learn OR academic OR instruct OR guide 
D: [A] AND [B] AND [C]

Eligibility Criteria
Articles retrieved from databases met the following eligibility criteria:
1. The original studies surveyed social media and virtual networks on education during the COVID-19 pandemic.
2. Published studies from the beginning of the COVID-19 to August 31st, 2021. 
We excluded the articles that met one of the following criteria:
1. Non-English language.
2. Non-original articles including reviews and editorials, comments, position papers, case reports, and clinical trial protocol.
3. Articles without obtainable full texts, short communication, abstract papers, and conference abstracts.
4. Any duplicated and suspicious outcomes in databases.

Data Screening and Study Selection
The EndNote software was used to organize the retrieved records. Search results from reviewed databases combined in a single EndNote library and duplicates were removed. Two independent researchers screened the retrieved records by titles against inclusion and exclusion criteria.

Data Extraction
The extraction data included: The first author, type of study, country, population, educational organization, objectives of the study, social media platforms, reported advantage/disadvantage, and other relevant findings. This information was collected by two independent researchers and organized in table 1. To ensure the consistency and reliability of the results, the selected articles were investigated by other researchers once again. Any discrepancies were addressed by a third researcher.

Quality Assessment
We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to determine the quality and accuracy of the selected articles and outcomes. Three independent researchers surveyed the quality of the articles and the probable risk of bias. Any disagreement was addressed by a consensus among authors.

Table 1. Description of the findings reported in eligible studies

Table 2. The proportion of using social media platforms for education in COVID-19 pandemic

Table 3. Advantage of using social media in education in the COVID-19 pandemic

Results
We identified 160 related articles by searching keywords in the online databases. After removing the duplicates, 129 articles remained; 92 articles were excluded by screening titles and abstracts, and the full texts of 37 remained articles were assessed for eligibility. Finally, 13 articles were included in this review as figure 1 shows. 
One record was an intercontinental study: America, Europe, and Asia; other studies were conducted in Indonesia, Turkey, Taiwan, India, Spain, Saudi Arabia, Iraq, Zambia, Egypt, Malaysia, Greece, and Morocco. 
Almost all of the studies included university students and only in two of them, school students were assessed. The most frequently used social media applications were Zoom, Facebook, Dropbox, YouTube, WhatsApp, Skype, and Instagram. However, other applications such as Google Forms, Google classrooms, Moodle, WordPress, Telegram, Viber, MSN chat, Tumbler, Twitter, Text messaging, Wikis, Social bookmarking, Lifesize, Forums and LinkedIn were also used in some studies (Table 2). The purpose of using these applications was to provide distance education to students in the pandemic era. They were mainly used for the communication of continuous and updated information in medical students.
The advantages of using each platform in learning are reported in table 3. In education, using online platforms, access to educational materials and resources are not location-dependent and could be freely available worldwide. Online learning could reduce the negative emotions and increase the engagement of teachers in preparing the syllabus, materials, and resources even on their off-days. During the COVID-19 pandemic, the use of applications successfully replaced the face-to-face training and used as an effective measure for continues communication between students and their peers as well as their mentors. Moreover, discussion about the assignments and projects and feedbacks can be easily done through online platforms. 
The advantages of using these platforms obviously outweigh the disadvantages; however, there could be some disadvantages to the using online platforms for education as follows: lack of infrastructure and absence of professional information, lack of clear policies and actions to support online education, limited methodology, lack of internet in rural areas, expensive cost of internet and its low quality, weak adjustment of students with this new academic approach, more stress and anxiety experienced by final semester students, passive participation of students, overload of information, and difficulties in using some apps (Table 1).

Discussion
Increasing public interest in social media has speeded up the expansion of maiden forms of social linkage, creating a growingly excellent opportunity for the education process. Social media has created new possibilities to study and teach using the potency and availability of social media (33). However, it is important to emphasize the growing tendency and trust to use social media as a public network for studying and getting information. This offers a great opportunity to make proper use of these platforms and promote the scientific information and the level of health literacy in the community (34). The aim of this study was to investigate the impact of social media in medical and academic education and identify their advantages and disadvantages.
In this study, we found broad advantages of a social media application in education. Most resources noted that social media has a remarkable capability facilitating the communication between students and teachers (22,23,25-27). It allows shaping the education in an individual mood and in the classroom to motivate learners solving educational problems eagerly and be more engaged in the class. It also facilitates the timely communication, which increases the handiness of knowledge and raises the level of feedback in the teacher-student interaction (5,35). Moreover, resources and materials can be efficiently distributed through social media in a short period of time. Accordingly, this medium serves as a repository of learning resources that can be used by all learners. This use reinforces the spread of information and a sense of community. It also functions as an alternative platform for online discussion among learners on educational content and exam preparation, and especially it can be applied by residents and medical students to communicate with directors in their areas of interest. Social media have been particularly effective to facilitate more access to surgical education, academic videos, links, and materials around the world. It also enables searching the journal articles and eBooks (26,36).
Based on the findings of this study, other advantages of social media in education are: helping improve the mental health of students, facilitating the exchange of educational resources, facilitating the evaluation process of students, and reducing the stress caused by the outbreak of the disease. To minimize the risk of virus spread, most educational institutions around the world were shut down during the COVID-19 pandemic. Although most of them were not entirely ready for the transition to e-learning, in both developing and developed countries; more opportunities were created to apply technological development in educational programs for conducting online learning. Social media and messengers were suggested as options for providing educational services. Nonetheless, these means were not fully intended to execute the full-fledged pedagogical actions. In addition, their application in the educational process is associated with some advantages and disadvantages. The advantages could fulfill several necessary educational tasks to meet the objectives of the education system during COVID-19 lockdown (37).
Despite the many advantages of using social media for education in the era of COVID-19, this technology also had disadvantages such as: lack of infrastructure and absence of professional information, lack of clear policies and actions to support online education, limited methodology, and lack of internet in rural areas. A reliable technological infrastructure is the foundation of a successful E-learning. Among all perquisites of education with social media, inadequate power of electricity, internet costs and unreliable internet connections with the low quality, especially in rural areas are the drawbacks to the use of social media for educational purposes. Besides, professional information technology support to maintain online education is sometimes essential to tackle these concerns (37). 
The literature determined some other problems of E-learning such as the flexibility of pedagogical approaches, difficulties with the design of training courses, etc. This emphasizes the need for adequate support from teachers. However, some studies indicated that many students were deprived of adequate educational support (25,26,37,38). However, there some shortcomings to the use of E-learning such as information overload on social media, low accuracy of surgical videos and contents, failure to demonstrate videos, and large misinformation (24,29,39). These limitations have resulted from a lack of peer review and content control. It forces the learner to evaluate by whom the information is provided and notice the quality of information. Content accuracy, especially in the educational videos that are shared on some social media is a matter of concern and should be considered with uncertainty. Improvement of social media content to minimize the spread of misinformation should be a priority to improve the educational outcomes (40).

Conclusion
This review provided valuable knowledge on the available social media tools for educational purposes and presented successful cases of using social media for educational goals during the COVID-19 pandemic. Education has been seriously influenced by the COVID-19 pandemic; as a result, the use of social media for education during epidemic appears to be increasing. Overall, the educators’ feedback was positive; the advantages of using social media for distance learning outbalanced the disadvantages. These findings suggest that the unique features and availability of social media can be invaluable in learning activities, although additional investigations are needed. 

Acknowledgements 
This study was conducted in collaboration with Esfarayen University of Medical Sciences, and Kermanshah University of Medical Sciences (KUMS)

Conflict of Interest
The authors declare no conflict of interest.

Ethics approval and consent to participate 
This study was extracted from the study project with code IR.ESFARAYENUMS.REC.1400.010 entitled " impact of social media on medical and academic education during COVID-19 pandemic:  a systematic review” conducted at Esfarayen University of Medical Science. We thank all the participants for taking the time to contribute to the project.