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Objective: To examine patterns of Twitter use by surgery departments with residency programs and understand relevant motivations and concerns. The primary outcome was to quantify account prevalence and activity. The secondary outcomes were to identify reasons for use and perceived benefits and concerns., Design Setting, and Participants: A cross-sectional study was performed on Twitter accounts of departments of surgery with Accreditation Council of Graduate Medical Education accredited general surgery residencies. An anonymous survey was distributed to all programs with accounts. Data acquisition was completed in August 2019 and analysis was completed in February 2020., Results: Among the 319 departments of surgery, only 80 (25%) had department of surgery Twitter accounts. Mean account age was 3.5 years (range: 0-9.8), with the highest account creation in 2017 (n = 23, 29%). Median total tweets per account was 314 (range 3-21,893), and median number of followers was 454 (range 18-22,353). Having a Twitter account was associated with program type: 66/123 (54%) university-based, 1/9 (11%) military, 13/124 (11%) community/university-affiliated, and 0/63 (0%) community (p < 0.01). Survey response rate was 40% (n = 32). Only 59% had formal posting guidelines. Daily logins (78%) and daily tweeting (53%) were common. The most frequent perceived benefits were "highlighting new research and major events" (97%), "increasing visibility within the academic community" (91%), and "improving resident engagement" (75%). The most common concerns were "professionalism" (72%), "privacy" (63%), and "time commitment" (53%)., Conclusions: Though only a quarter of departments of general surgery had Twitter accounts, they were felt to be key for improving academic reach. Formal posting guidelines existed for 59% of survey respondents, although concerns about privacy and content were common. An underutilized tool for surgery departments to promote academic achievements, Twitter use represents a potential opportunity to engage the surgical community more broadly., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)