Katherine C. Chretien

Online Professionalism and the Mirror of Social Media

The rise of social media—content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs—has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they “tread” through the World Wide Web, they leave behind a “footprint” that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for “online professionalism.” Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.

Physicians on Twitter

mutation with outcome in patients with chemotherapy-refractory metastatic colorectal cancer treated with cetuximab. JAMA. 2010;304(16):1812-1820. 2. De Roock W, Claes B, Bernasconi D, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapyrefractory metastatic colorectal cancer: a retrospective consortium analysis. Lancet Oncol. 2010;11(8):753-762.

Social Media and Clinical Care: Ethical, Professional, and Social Implications

It is an exciting time to practice medicine during our digital “coming of age.” Social media, the freely available Web-based platforms that facilitate information sharing of user-generated content, such as social networking sites, media-sharing sites, blogs, microblogs, and wikis, have transformed the way we communicate as a society. Through community building, message amplification, rapid dissemination, and engagement, social media has changed our interactions with others and, by direct consequence, our relationships. For health care, this represents a veritable social revolution. 1 Indeed, medicine is constantly evolving to adapt to new technologies. These advances have led to new therapies, diagnostic tools, and ways of communicating. As physicians and lifelong learners, it has been imperative to embrace the new when it has meant better and more efficient patient care while holding on to the stable tenets of medicine that root our profession: humanism, integrity, ethics, professionalism, and trust. Patients have been active on social media to find health information, find support through discussion groups and forums, and chronicle their illness journeys.2 Naturally, they are also interested in using social media to facilitate communication between themselves and their providers. In a survey of patients of an outpatient family practice clinic, 56% wanted their providers to use social media for appointment setting and reminders, diagnostic test results reporting, health information sharing, prescription notifications, and answering general questions.3 For those patients who do not use social media, many would start if they knew that they could connect with their providers there.3 Physicians are also exploring ways to use social media, both personally and professionally, although personal use is more common.4–6 Some physicians use social media professionally to find and share health information, communicate/network with colleagues and trainees, disseminate their research, market their practice, or engage in health advocacy. In …

Social media policies at US medical schools

Abstract Background/Purpose: Todays medical students are learning in a social media era in which patient confidentiality is at risk yet schools’ social media policies have not been elucidated. The purpose of this study is to describe the presence of medical schools on top social media sites and to identify whether student policies for these schools explicitly address social media use. Method: Websites of all 132 accredited US medical schools were independently assessed by two investigators for their presence (as of March 31, 2010) on the most common social networking and microblogging sites (Facebook and Twitter) and their publicly available policies addressing online social networking. Key features from these policies are described. Results: 100% (n=132) of US medical schools had websites and 95.45% (126/132) had any Facebook presence. 25.76% (34/132) had official medical school pages, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups on Facebook. 10.6% of medical schools (14/132) had Twitter accounts. 128 of 132 medical schools (96.97%) had student guidelines or policies publicly available online. 13 of these 128 schools (10.16%) had guidelines/policies explicitly mentioning social media. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible under any circumstances, or mentioned strongly discouraged online behaviors. 53.85% (7/13) encouraged thoughtful and responsible social media use. Conclusions: Medical schools and their students are using social media. Almost all US medical schools have a Facebook presence, yet most do not have policies addressing student online social networking behavior. While social media use rises, policy informing appropriate conduct in medical schools lags behind. Established policies at some medical schools can provide a blueprint for others to adopt and adapt.

The Reflective Writing Class Blog: Using Technology to Promote Reflection and Professional Development

ABSTRACTINTRODUCTIONThe hidden (informal) curriculum is blamed for its negative effects on students’ humanism and professional development. To combat this, educational initiatives employing mentored reflective practice, faculty role-modeling, and feedback have been advocated.AIMPromote reflection on professional development using collaborative, web-based technology.SETTINGFour-week basic medicine clerkship rotation at an academic institution over a one-year period.PROGRAM DESCRIPTIONStudents were asked to contribute two reflective postings to a class web log (blog) during their rotation. They were able to read each other’s postings and leave feedback in a comment section. An instructor provided feedback on entries, aimed to stimulate further reflection. Students could choose anonymous names if desired.PROGRAM EVALUATIONNinety-one students wrote 177 posts. One-third of students left feedback comments. The majority of students enjoyed the activity and found the instructor’s feedback helpful. Assessment of the posts revealed reflections on experience, heavily concerned with behavior and affect. A minority were not reflective. In some cases, the instructor’s feedback stimulated additional reflection. Certain posts provided insight to the hidden curriculum.DISCUSSIONWe have discovered that blogs can promote reflection, uncover elements of the hidden curriculum, and provide opportunities to promote professional development.

It's your own risk: medical students' perspectives on online professionalism.

Background U.S. medical schools have reported unprofessional online content by medical students. To inform institutional policies and curricula, we conducted a qualitative study exploring medical student perspectives on online posting. Method Six focus groups were conducted with students from a single institution in November 2009. Interviews were recorded, transcribed, and analyzed using qualitative methods. Results Sixty-four students participated. Besides HIPAA violations and illegal activities, students disagreed as to what was inappropriate to post. They experienced online identity conflicts and described ambivalence toward Facebook. Students were concerned about online activity risks and lack of personal control. Their postings were guided by common sense and what they believed was expected from medical students. Students desired recommendations for appropriate content and suggested raising awareness through discussion. Conclusions Medical students viewed online postings through a lens of personal risk. They desired recommendations but were sensitive to feeling controlled by their school.

Comparison of blogged and written reflections in two medicine clerkships

Medical Education 2011: 45: 166–175

Twelve tips for using social media as a medical educator

Background: We now live, learn, teach and practice medicine in the digital era. Social networking sites are used by at least half of all adults. Engagement with social media can be personal, professional, or both, for health-related and educational purposes. Use is often public. Lapses in professionalism can have devastating consequences, but when used well social media can enhance the lives of and learning by health professionals and trainees, ultimately for public good. Both risks and opportunities abound for individuals who participate, and health professionals need tips to enhance use and avoid pitfalls in their use of social media and to uphold their professional values. Aims and methods: This article draws upon current evidence, policies, and the authors’ experiences to present best practice tips for health professions educators, trainees, and students to build a framework for navigating the digital world in a way that maintains and promotes professionalism. Results and conclusions: These practical tips help the newcomer to social media get started by identifying goals, establishing comfort, and connecting. Furthermore, users can ultimately successfully contribute, engage, learn, and teach, and model professional behaviors while navigating social media.

Reflective Writing in the Internal Medicine Clerkship: A National Survey of Clerkship Directors in Internal Medicine

Background and Purpose: Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. Methods: We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. Results: Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students’ grade. Respondents believed assignments contributed to students’ learning in multiple domains, most often Professionalism (97%) and Communication (77%). Conclusions: Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.

A Qualitative Study of the Meaning of Physical Examination Teaching for Patients

BACKGROUNDPhysical examination teaching using actual patients is an important part of medical training. The patient experience undergoing this type of teaching is not well-understood.OBJECTIVETo understand the meaning of physical examination teaching for patients.DESIGNPhenomenological qualitative study using semi-structured interviews.PARTICIPANTSPatients who underwent a physical examination-based teaching session at an urban Veterans Affairs Medical Center.APPROACHA purposive sampling strategy was used to include a diversity of patient teaching experiences. Multiple interviewers triangulated data collection. Interviews continued until new themes were no longer heard (total of 12 interviews). Interviews were recorded and transcribed verbatim. Coding was performed by two investigators and peer-checked. Themes were identified and meanings extracted from themes.KEY RESULTSSeven themes emerged from the data: positive impression of students; participation considered part of the program; expect students to do their job: hands-on learning; interaction with students is positive; some aspects of encounter unexpected; range of benefits to participation; improve convenience and interaction. Physical examination teaching had four possible meanings for patients: Tolerance, Helping, Social, and Learning. We found it possible for a patient to move from one meaning to another, based on the teaching session experience.CONCLUSIONSPhysical examination teaching can benefit patients. Patients have the potential to gain more value from the experience based on the group interaction.