Social media has reshaped how health care professionals communicate, collaborate, and engage with patients and peers [1,2]. Among these platforms, X (formerly Twitter) has become especially prominent in scientific communication and professional networking [1-5]. X has facilitated greater connectivity among scientists and physicians, enabling rapid exchange of information and online community growth through the usage of health care–related hashtags, fostering a more collaborative digital environment [1]. While such connectivity offers opportunities for education, advocacy, and patient engagement, it also brings challenges, including the spread of misinformation and concerns about professionalism [1]. In response, organizations such as the American Medical Association adopted policies that guide health care professionals’ conduct on these platforms [6,7]. Despite these efforts, unprofessional behavior persists as a key challenge. To bridge this gap, we developed a novel survey aimed at evaluating the perceptions of professionalism among health care providers on X.

Among 80 respondents, the majority (n=55, 73.3%) were based in the United States. Most respondents (n=52, 65.0%) were aged 25‐34 years and 58.8% (n=47) were male. Respondents included medical students (n=34, 42.5%), researchers (n=16, 20.0%), trainees (n=14, 17.5%), and patient advocates (n=3, 3.8%).

Approximately 65.0% (n=52) of the respondents had<100 followers, majority (n=44, 55.7%) used their professional accounts daily, while 75.0% (n=60) rarely posted. Respondents primary used X for research (n=40, 50.0%), personal interests (n=40, 50.0%), and networking (n=37, 46.3%). Overall, 42.5% (n=34) of respondents reported occasional unprofessional activity and 21.3% (n=17) encountered such activity frequently. Furthermore, 76.3% (n=61) reported witnessing false or misleading information, 20.0% (n=16) encountered the sharing of sensitive medical information, and 78.8% (n=63) observed collegial disagreements (α=0.69 W=0.243) (Figure 1).

Nearly half of the respondents (n=33, 44.0%) reported a lack of institutional guidelines regarding professional social media use.

Social media platforms like X offer considerable benefits, such as facilitating rapid information dissemination, professional networking, patient engagement, and broader health care awareness [1,8]. These benefits coexist with potential risks, including misinformation, breaches of patient confidentiality, and contentious professional exchanges [9]. In our sample, 76.3% of respondents reported witnessing false or misleading information. This observation does not establish the prevalence of misinformation on X, but it suggests that respondents commonly perceived it in their online experience [9]. Likewise, the frequent observation of collegial disagreements (78.8%) illustrates that professional dialogue, while valuable for the effective exchange of thoughts and ideas, carries the risk of unprofessional discourse that may undermine the credibility of health care professionals. Explicit guidelines are essential to help health care professionals navigate the blurred boundary between personal and professional identity online [6,7]. The reported lack of such guidance reported in our study suggests that clearer, practical policies that promote digital professionalism may be useful for health care providers on social media.

This study has several limitations. Our study reliance on a single institutional X account for survey dissemination may introduce selection bias and limit generalizability. The small sample size and respondent composition limit the external validity of the findings. Response bias is also possible, as individuals with stronger opinions or more frequent exposure to social media content may have been more likely to participate. Additionally, while we captured general patterns of platform use, more granular measures of engagement, such as number of interactions or time spent on the platform were not assessed. The results showed moderate or borderline internal consistency and limited agreement among responses, likely indicating the multidimensional and subjective nature of online professionalism as the survey assessed several related but distinct domains. These metrics are interpreted in line with the hypothesis-generating nature of the instrument rather than formal validation. Furthermore, the use of subjective frequency categories without standardized definitions may have introduced variability in how respondents interpreted and selected responses. The survey did not go through a comprehensive validation process, and a formal factor analysis was not conducted due to the small sample size and exploratory nature of the study. An additional limitation of this study is the absence of predefined categories for “unprofessional activity” or “collegial disagreements.”

While social media provides significant opportunities for health care communication, our results demonstrate persistent challenges regarding unprofessional conduct and a lack of institutional guidelines. Education on best practices, integration of social media professionalism into medical training, and the establishment of clear institutional policies in conjunction with platform-specific regulations may help promote professionalism among health care providers on social media.