Study: 'Web 2.0' Technologies Pose Challenges in Teaching Medical Professionalism

Facebook, Twitter Postings Can Hurt Patients, Students' Careers, Say Educators

January 20, 2010 04:45 pm Barbara Bein

A recent study( in the Journal of the American Medical Association suggests that the growing popularity of Internet applications built around user-generated content, such as blogs, social networking sites and media-sharing sites -- collectively known as "Web 2.0" -- is creating new challenges for medical schools and their task of teaching medical professionalism.

Many of the medical schools surveyed for the study reported incidents of students posting unprofessional content online, including discussing patients in violation of privacy and confidentiality laws. In addition, the study found that disciplinary actions medical schools imposed for such infractions were mostly informal warnings. Student dismissals for these incidents were rare.

Even so, it's imperative to raise students' consciousness that such postings can hurt their careers and their relationships with future patients, said medical educators interviewed by AAFP News Now. According to the study, medical schools would do well to include discussions about digital media in their curriculum on professionalism.

Extent of the Problem

Many students, accustomed to sharing information online, may not know that posting personal information could reflect negatively on their professionalism and hurt them personally, says the JAMA study.

The study results are based on a survey in March and April 2009 by researchers at George Washington University, or GWU, Washington, D.C., and Johns Hopkins University, Baltimore. Researchers surveyed the deans of student affairs or their proxies in each of the (then) 130 accredited allopathic U.S. medical schools represented by the Association of American Medical Colleges, or AAMC. The survey asked about incidents of unprofessional student-posted online content, level of concern about the problem, and the existence of plans for developing institutional policies covering student-posted online content.

Of the 78 medical schools that responded to the survey, 60 percent reported such incidents, including violations of patient confidentiality, profanity, discriminatory language, depiction of intoxication or illicit substance use, sexually suggestive material and negative communications about the medical profession or patients.

The most frequent incidents reported in the study involved profanity, intoxication and sexually suggestive material. Postings that violated patient confidentiality -- mostly blogs that described clinical experiences with details that could identify patients -- were not the most common incidents, but they were certainly cause for concern, according to the study's lead author, Katherine Chretien, M.D., an assistant professor of medicine at the GWU School of Medicine and Health Sciences.

"Students need to be aware that their professionalism and character may be judged on what they put out there on the Internet," Chretien told AAFP News Now.

"We've heard so many stories of people getting fired from their jobs for what they write or post online, and the same can hold true for medical students -- and residents and staff physicians. Protecting patient privacy is paramount and everyone who deals with protected health information needs to be vigilant about this," she added.

Indeed, said George Harris, M.D., M.S., of Lee's Summit, Mo., assistant dean for year 1 and 2 medicine at the University of Missouri-Kansas City School of Medicine, or UMKC, and professor of medicine in the UMKC Department of Community and Family Medicine. Some students "have crossed over from an innocent mode of socialization to unprofessional behavior," he noted.

"These unprofessional activities have the potential to affect the students' applications to a residency program, their first job interviews as a physician and, eventually, their caring for patients," he told AAFP News Now. The consequences of posting such sensitive information could imperil one's own reputation or that of another student, colleague or faculty member, said Harris.

But beyond the personal consequences, the postings can have the effect of discriminating against patients, perhaps even limiting their access to care, he added.

Focus on Web 2.0 Apps

Some medical school deans in the study -- 38 percent -- reported that their schools' professionalism policies broadly cover student-posted online content, although fewer -- 18 percent -- said the policies explicitly mention use of Web 2.0 applications, such as blogs, social networking sites (e.g., Facebook, Twitter) and media-sharing sites (e.g., Flickr, YouTube).

A much larger group -- 62 percent -- said their schools' current professionalism policies do not cover student-posted online content or they weren't sure whether they did.

Of deans in medical schools without policies covering student-posted online content, 11 percent said they were developing or revising existing policies to address this issue, and 50 percent said they were planning to make such changes. Others did not think revisions or new policies were necessary (20 percent) or they weren't sure (20 percent).

The study concluded, "Many responding schools had incidents of unprofessional student online postings, but they may not have adequate policy in place" to deal with such incidents.

Possible Remedies

According to the study authors, medical schools should integrate a digital media component into their professionalism curriculum to deal with the problems created by inappropriate postings. This component should include teaching students how to manage their "digital footprint" by, for example, electing more restrictive privacy settings on social networking sites and performing periodic Web searches on themselves to see what information is available to residency directors, future employers and the general public.

Moreover, discussions on relevant laws, such as the Health Insurance Portability and Accountability Act and the Family Educational Rights and Privacy Act, also should be incorporated into the curriculum.

"At the very least, there should be increased awareness, education and conversation about this in medical school," Chretien said. "Whether schools develop Internet-specific policies is up to individual schools. Students' views and perspectives need to be incorporated in whatever path a school chooses to best prepare students entering this profession in our increasingly digital world."