Medical students post inappropriate content online

Originally published in Insidermedicine

The posting of unprofessional and inappropriate content online by medical students is a relatively common occurrence that medical schools are going to have to learn to deal with, according to research published in the Journal of the American Medical Association.

Here are some reasons why it is not desirable for medical students to post inappropriate content online:

• The content may contain information that violates patient confidentiality

• It can reflect poorly on the student’s institution and on physicians as a whole

• It can reflect poorly on students themselves, possibly impairing future employment opportunities

Researchers from the Washington D.C. VA Medical Center sent anonymous surveys to the deans of student affairs, or their counterparts, of all the medical schools belonging to the Association of American Medical Colleges. The survey included questions about whether students have been found to have posted inappropriate or unprofessional content online and what was done about it.

Overall, 60% of the deans responded to the survey, and among these respondents 60% reported that indeed students had posted inappropriate content online, including 13% who reported that students had posted information that violated patient confidentiality. Other common transgressions included the posting of profanity or frankly discriminatory comments or the posting of depictions of intoxication or sexually suggestive material. Among the 45 deans who reported an incident and responded to questions about how the situation was handled, 67% reprimanded the student informally, while 13% dismissed the student. Overall, 38% of deans reported having policies covering student-posted online content, and 11% of schools without such policies were developing them. Deans who reported incidents were more likely to report having such policies, believing the issues could be effectively addressed, and having higher levels of concern about the topic.

Today’s research demonstrates how the advent of social networking sites like Facebook and content-sharing sites such as Flickr and YouTube are creating a new challenge for medical schools with respect to how their students represent themselves online. Policies for handling unprofessional behavior will need to be implemented.

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  • jsmith

    It’s amazing how these students don’t realize that when you become a doctor, you give up your right to let other people see you being crazy, immature or rude. This is medicine, not creative literature or art, where perhaps such attributes are more acceptable. Some students seem to have little understanding of the seriousness and importance of medicine. Perhaps med schools need to go over professionalism in the first week or two. People trust us with their lives. They must not think that we are fools, even if we sometimes are.

  • LizM

    Yes it is true that sometimes some cross the line and post things that can affect their career and trust of the people. But being doctor doesn’t mean you can’t have social life ,everybody knows Medical School drives a sane person into one with different view and of course become to speak more freely about ‘taboo’ issues that people outside the breach find it unusual or rude. A Student shouldn’t be judged or expelled by his Twitter or Face-book posts ,they should be lead on better way and helped to study better and do their job perfectly like must be done!

  • Brad Miller

    I agree somewhat with jsmith, but also strongly disagree in certain aspects. While I was in medical school I was completely amazed at the differences between medical students and other people our age – differences in income, social lives, etc. My outside friends could go out and be social while we spent a good portion of our early 20s in a library. Those outside friends had an opportunity to socially mature, while we had our heads in books. Students do need to be appropriate, but they also need social outlets. I think that the pent-up desire to be social just completely releases when people are on facebook. Instead of only issuing things that medical students can’t do, I think our entire medical training system needs to better support people and their social needs – not just their academic setting. Medical school takes so much time at a critical social maturing point of people’s lives that it seems like it in effect stunts future docs’ maturity.

  • Chris P

    It is odd that the survey was of deans and not of medical students. This suggests that deans have full knowledge of everything the students are doing. Are medical schools so restrictive?

  • Alchemipedia

    The historical truth is that many pillars of the medical profession, who behave with utmost probity professionally, have had youthful experiences that they would prefer were not public knowledge. The difference now is that the new social networking world can document these youthful excesses for posterity.

    It would seem sensible for institutions to warn students of the risks associated with web 2.0 and social networking. The ethics curriculum would be an ideal place for this. I also believe that ethics teaching should begin in the first year of medical training and continue at regular intervals until graduation.

  • PeterJ

    Initially, I found this to be both frightening and startling. However, I then realized that I have been pretty much self-filtering for years now, easily since I started med school back in 2002. Blogs I would have liked to have written, words or phrases I may have used, were all eschewed in favor of something that was more, well, sanitized. All in an effort to ensure I didn’t divulge anything confidential, or anything that could be used against me.

    I completely agree with the need to protect patient confidentiality. However, aside from that, I do find it saddening that we are either compelled by extrinsic forces (threat of reprimand or worse) or intrinsic reasons (fear of reprimand or worse) to sanitize our online interactions. I often feel that I just cannot “live” they way some of my friends who are in other fields can.

  • no one

    Well get over yourself. Why should you be any different than anyone else? Nobody can staple lewd and nekkid pictures of themselves on local lamposts with identifying information along side and expect it won’t impact their lives. Not the teacher, not your mom, not the real estate agent or student doctor.

    That’s what you’re doing when you “just live” all over some blog or website.

    Yikes. You docs are really naive about the internet aren’t you? Please don’t get EMR when you’re in practise. Stick with a pencil.

  • Patrick B

    Posting profanity? How $%*$@’ing shocking!

  • patient x

    Why do medical students use their real names when they’re being asses on the internet.

    One such revelation being bragged about was the hazing of a new student in the O.R. doing his first pelvic on an unconscious obese patient. The “antics” that followed was so disgusting that I will never chose a teaching hospital if I can help it.

  • jsmith

    Hear Hear no one and patient X. PeterJ . You can do all the crazy stuff other people do, but you just shouldn’t post those things on the internet. Seems a small price to pay, especially when your salary will be several times the salary of the average American.

  • PeterJ

    Good points. Honestly, though, it has nothing to do with even really crazy things. Simple things like just venting about work and people you run into there are often frowned upon and can be cause for official reprimands and action.

    I agree that no one should be doing really crazy things and posting that. But I know people who have been officially reprimanded for something as basic as posting profanity or complaining about a difficult person they interacted with (in a non-specific, non-confidentiality breaking manner).

    As for the final comment aobut the salary: pure and utter rubbish.

  • PeterJ

    Sorry, and by rubbish, I meant that that was a rubbish argument. There are just too many variables that play into it to use that as a justification.

  • jsmith

    PeterJ, I don’t think so. When you become a doctor, you become a member of a privileged, elite group of people who are held in high regard by the public. You might not believe this, but it’s true. I have never been unemployed and I never will be. I don’t kowtow to corporate types. People treat me (us) with a deference that most people can only dream about, and I am paid a hell of lot more money than almost any non-physician I know. That’s our reality. People don’t want to hear us whine, and I don’t blame them.
    You started med school in 2002. Maybe you’re still in residency, which, I agree, is abusive. When you get out, it will be a different world.

  • William Hsu

    I have many pointed criticism people who criticize facebook in general.

    I don’t really think people over the age of 27 understand why people use facebook. At this point, for people under the age of 25 it’s almost a social necessity- like having a cell phone or an email account. I’ll explain it like this- if all my friends have facebook, and they communicate through facebook. If i don’t have facebook, i essentially get left out of the loop.

    Why is age 27 the magical number? because facebook popularity started around 2004-2005. If you graduated college before then(2003) you could have set your entire social network without facebook. Currently for a college student, it’s almost social suicide not to use facebook.

    It’s my belief that people under the age of 27 will be hurt socially(and possibly economically) in the future if they don’t use facebook. Trending forward, the percentage of facebook users in the medical profession will go up. People who don’t use facebook in the future will only isolate themselves from the emergent facebook using medical community.

    As for “inappropriate content”. Here’s the JAMA article results.

    Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported.

    I would argue only violations of patient confidentiality constitutes “inappropriate content.”

    People who criticize facebook posters for “sexually suggestive material, profanity and depictions of intoxication” simply don’t understand that’s the norm in facebook. I don’t have that stuff on my facebook because i’m a bit of a nerd. But when i see my friends post stuff like that…. it’s almost like white noise to me- I don’t even blink. 20 years from now…. when the facebook using med students of today become the doctors of tomorrow I truely believe this problem will become a non issue. Like how many hippies of the 60s became the leaders of today.

    As for “descriminatory content”… i’m sorta on the fence about that. I don’t know what administrators define as frankly descriminatory language. Personally, i wouldn’t constitute anything posted from my friends as frankly descriminatory. So i’m sort of confused by that issue.

    I do think that there needs to be some education on social networking sites, especially concerning patient confidentiality. But the issue isn’t as problematic as the posted video makes it out to be

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