Rationale and Objectives
Digital professionalism is increasingly being integrated into postgraduate medical education. We developed a small-group, reflective practice–based session incorporating radiology-specific cases to heighten residents’ awareness about digital professionalism.
Materials and Methods
Case-based, radiology-specific scenarios were created for a small-group, reflective practice–based session on digital professionalism. Anonymous pre- and postsession surveys evaluating residents’ use of social media and their thoughts about the session were administered to the radiology residents.
Results
Twenty-five of 38 (66%) residents responded to the presession survey with 40% (10/25) reporting daily social media use; 50% (12/24) witnessing an unprofessional posting on Facebook; and 8% (2/25) posting something unprofessional themselves. Of the 21 residents who attended the session, 13 (62%) responded to the postsession survey. Residents reported that the session added to their understanding of professionalism 3.92, 95% CI (3.57–4.27). As a result of the session, residents stated that they were more aware of protecting patient privacy and confidentiality on social media sites 3.92, 95% CI (3.47–4.37), and would take a more active role in ensuring professional use of social media as it relates to patient care 4.00, 95% CI (3.66–4.34).
Conclusion
Residents favorably viewed the reflective case–based session on digital professionalism as a means to be more aware of ways to avoid unprofessional interactions on the internet. Our results suggest that such reflective sessions are an effective method to educate residents on key concepts regarding digital professionalism.
Introduction
As the Internet has become fully integrated into society, the ability to access personal information through social networking and media-sharing sites has proliferated. Radiologists, like other professionals, use sites such as Facebook to communicate and share thoughts with colleagues and friends. The multiple benefits of this technology include instantaneous communication, networking, and consultation. The ease of accessibility of such sites, however, often blurs the boundary between professional and personal identities. This is especially concerning because patients, colleagues, and future employers may have access to this online information.
There is no clear definition for digital professionalism, but the American Medical Association has guidelines on the Professional Use of Social Media ( ; Appendix 1 ) and both medical schools and residency programs must ensure professional behavior among their trainees, as the Accreditation Council for Graduate Medical Education has mandated professionalism as one of the core competencies . The issue is pervasive in graduate medical education as well; a survey of US medical schools revealed that 60% of schools reported incidents of students posting unprofessional online content .
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Materials and methods
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Table 1
Digital Professionalism Presession Handout
Physician use of social media is on the rise and is evolving as a means of communication. The boundary between personal and public aspects of physicians’ lives on the web can often be unclear. Even if inadvertent, breaches of patient privacy can occur via Facebook, Twitter, or other media despite using secure privacy settings. So how can physicians use social media safely? In this session, we will discuss some of the recent cases surrounding social media as well as radiology-specific case scenarios to better understand the issues surrounding patient confidentiality, what constitutes acceptable online professional conduct, and how to safely incorporate social media into both personal and professional lives.Clinical Cases: Employees used a camera phone to take a picture of an x-ray and text it to one another. The image also was posted to one employee’s personal Facebook page, but has since been removed and no information identifying the name or other information about the patient was displayed with the image. Question: Is this a breach of patient privacy? Should these employees be disciplined? Dr. T. communicated a few of her clinical experiences in the hospital’s emergency department on her Facebook account but never specifically named the patients. However, one patient’s injuries were such that an unidentified third party was able to identify the person. Question: Should the doctor be found guilty of “unprofessional conduct” and should her clinical privileges be terminated?Radiology department–specific scenarios:
Table 2
Preassessment Digital Professionalism Survey
Statement Number/Respondents (%) What is your age? A. <30 years 12/25 (48.0) B. 30–39 years 13/25 (52.0) C. 40–49 years 0/25 (0.0) D. 50–59 years 0/25 (0.0) E. 60+ years 0/25 (0.0) What is your gender? A. Female 8/25 (32.0) B. Male 17/25 (68.0) I feel comfortable using digital forms of media including Facebook and Twitter. A. Strongly disagree 1/25 (4.0) B. Disagree 5/25 (20.0) C. Neither agree or disagree 3/25 (12.0) D. Agree 4/25 (16.0) E. Strongly agree 12/25 (48.0) Over the past year I have used: A. Facebook 21/21 (100.0) B. Twitter 4/21 (19.0) C. LinkedIn 5/21 (23.8) D. Google+ 6/21 (28.6) E. MySpace 0/21 (0.0) F. Other 2/21 (9.5) I use a social media site: A. Daily 10/25 (40.0) B. About once per week 7/25 (28.0) C. About once per month 3/25 (12.0) D. Less than once per month 5/25 (20.0) I use a social media site for: A. Personal reasons 18/22 (81.8) B. Professional reasons 0/22 (0.0) C. Both 4/22 (18.2) Over the past 6 months, I have used my Facebook or Twitter account either to communicate with colleagues at work or discuss work place matters. A. Daily 0/25 (0.0) B. About once per week 0/25 (0.0) C. About once per month 2/25 (8.0) E. Once or twice 4/25 (16.0) F. Never 19/25 (76.0) I have been contacted by an attending physician by Facebook or Twitter. A. Strongly disagree 9/25 (36.0) B. Disagree 5/25 (20.0) C. Neither agree or disagree 4/25 (16.0) D. Agree 6/25 (24.0) E. Strongly agree 1/25 (4.0) The number of unprofessional postings that I have witnessed on Facebook or Twitter over the past month is: A. None 12/24 (50.0) B. One 2/24 (8.3) C. Two 2/24 (8.3) D. Three or more 8/24 (33.4) I have posted something unprofessional on Facebook or Twitter. A. Yes 2/25 (8.0) B. No 23/25 (92.0) I have friended the following people on Facebook. Nurse 13/20 (65.0) Attending physician 14/20 (70.0) Physician assistant 8/20 (40.0) Technologists 11/20 (55.0) Medical assistant 4/20 (20.0) Administrative staff 7/20 (35.0) Other 8/20 (40.0) Do you feel competent in navigating privacy settings on your social media provider? Completely confident 5/24 (20.8) Somewhat confident 3/24 (12.5) Somewhat unconfident 14/24 (58.3) Completely unconfident 2/24 (8.4) Do you believe your use of social media has impacted your professional career? Yes, it has positively affected me 2/24 (8.3) No, it has not impacted me 22/24 (91.7) Yes, it has negatively affected me 0/24 (0.0) Please give an example of something appropriate to post on a social media website. Please give an example of something inappropriate to post on a social media website.
Table 3
Postassessment Digital Professionalism Survey
Statement Number/Respondents (%) How helpful was it to complete the presession survey? A. Not at all helpful 1/13 (7.7) B. Somewhat helpful 10/13 (76.9) C. Very helpful 2/13 (15.4) Was it helpful to preview the radiology specific case scenarios prior to the session? A. Not at all helpful 3/13 (23.0) B. Somewhat helpful 5/13 (38.5) C. Very helpful 5/13 (38.5) How helpful was the open discussion format for this session? A. Not at all helpful 0/13 (0.0) B. Somewhat helpful 3/13 (23.1) C. Very helpful 10/13 (76.9) Would you have preferred a didactic format? A. Yes 0/13 (0.0) B. No 13/13 (100.0) Did the microphone or knowledge that you would be recorded inhibit your participation in any way? A. Not at all 7/13 (53.8) B. Somewhat 6/13 (46.2) C. A lot 0/13 (0.0) Was there sufficient time to review the survey results during the session? A. Yes 12/13 (92.3) B. No 1/13 (7.7) Was there sufficient time allotted for the session? A. Yes 13/13 (100.0) B. No 0/13 (0.0) Did you feel safe discussing your opinion with the program directors present? A. Yes 10/13 (76.9) B. Somewhat 2/13 (15.4) C. No 1/13 (7.7) Would you prefer to have the session facilitated by a peer or noninvolved professional? A. Yes 3/13 (23.1) B. No 10/13 (76.9)ContentRate agree/disagree 1–5 scale (1 strongly disagree, 2 disagree, 3 neither disagree or agree, 4 agree, 5 strongly agree)StatementMean (95% CI) This session focused on the importance of maintaining professionalism on social media sites. 3.77 (3.27–4.27) This session made me reflect on my own use of social media. 3.62 (3.09–4.14) This session made me think about radiology in a way that I have not yet done. 3.46 (2.85–4.07) This session added to my understanding of professionalism. 3.92 (3.57–4.27) This session made me think differently about how I will use social media in the future. 3.46 (2.85–4.07) I will apply what I learned in this session to my residency training. 3.62 (3.05–4.18)Professionalism TopicsRate the importance of this topic using a 1–5 scale (not at all important, unimportant, neither important nor unimportant, important, extremely important) with regard to:StatementMean (95% CI) Radiology in general 3.92 (3.54–4.29) Radiology residency 3.92 (3.54–4.29) Your future career 4.08 (3.79–4.37)As a result of participating in this session (strongly disagree, disagree, neither agree or disagree, agree, strongly agree):StatementMean (95% CI) I will change how I use social media personally. 3.42 (2.85–3.98) I will change how I use social media professionally. 3.50 (2.93–4.07) I will be more aware of protecting patient privacy and confidentiality on the internet and social media sites. 3.92 (3.47–4.37) I will take a more active role in ensuring professional use of social media as it relates to patient care. 4.00 (3.66–4.34) As a result of this session my use of social media will: A. Increase 1/12 (8.3%) B. Stay the same 11/12 (91.7%) C. Decrease 0/12 (0.0%) Name at least two strengths of this session Name at least two weaknesses of this session This session could be improved by Any other thoughts/suggestions
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Results
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Discussion
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Appendix I
AMA policy: Professionalism in the use of social media
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References
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