Medical students post unprofessional content online

A majority of medical schools surveyed report they have experienced incidents of students posting unprofessional content online, including incidents involving violation of patient confidentiality, with few schools having policies to address these types of postings, according to a study in the September 23/30 issue of JAMA, a theme issue on medical education.

Internet applications built around user-generated content, termed Web 2.0, include social networking sites (e.g., Facebook, Twitter), media-sharing sites (e.g., Flickr, YouTube), blogs, wikis, and podcasts. A risk of these sites in the posting of unprofessional content online that can reflect poorly on individuals, affiliated institutions, and the medical profession, according to background information in the article. "Medical schools are tasked with establishing the foundation of professional behavior in a generation of students who use Web 2.0 and expect digital connectedness. There are few data to document unprofessional behavior in medical student-posted online content. Also, the adequacy of current institutional professionalism policies, given these new challenges, is unknown," the authors write.

Katherine C. Chretien, M.D., of the Washington D.C. VA Medical Center, and colleagues examined reported incidents of medical students posting unprofessional content online at U.S. medical schools. An anonymous survey was sent to deans of student affairs, their representatives, or counterparts from each institution in the Association of American Medical Colleges. Data were collected in March and April 2009, with 60 percent of U.S. medical schools responding (78/130).

The researchers found that of the schools that responded, 60 percent (47/78) reported ever having incidents involving students posting unprofessional content. "In the past year, 13 percent (6/47) of these had no incidents, 78 percent (36/47) had fewer than 5 incidents, 7 percent (3/47) had 5 to 15 incidents, and 2 percent (1/47) had some incidents but did not know how many. Incidents involving violation of patient confidentiality in the past year were reported by 13 percent (6/46). Student use of profanity, frankly discriminatory language, depiction of intoxication, and sexually suggestive material were more commonly reported. Issues of conflict of interest were rare," the authors write.

"Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67 percent) and 3 reported student dismissal (7 percent). Policies that cover student-posted online content were reported by 38 percent (28/73) of deans. Of schools without such policies, 11 percent (5/46) were actively developing new policies to cover online content. Deans reporting incidents were significantly more likely to report having such a policy (51 percent vs. 18 percent), believing these issues could be effectively addressed (91 percent vs. 63 percent;), and having higher levels of concern."

According to the researchers, there are a number of actions that medical schools could take that might address some of the concerns raised by these findings. "The formal professionalism curriculum should include a digital media component, which could include instruction on managing the 'digital footprint,' such as electing privacy settings on social networking sites and performing periodic Web searches of oneself. This is important given that residency program directors, future employers, and patients may access this information."

"Discussions among students, residents, and faculty should occur to help define medical professionalism in the era of Web 2.0."