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Brave New World of Social Media

Social networking is transforming the way medical students communicate with one another, but is online content meeting professional standards?

The New Physician January-February 2010
Social MediaMaybe you’re looking to get advice on how to treat a rare disease. Or perhaps you’re looking to connect with other medical students to learn about residency programs. Either way, you will likely start your search by going online. Increasingly, medical students are turning to social networking sites to connect with one another to share clinical insights, collaborate on difficult cases and exchange best practices.

Originally havens for college students and teenagers, Facebook, Twitter, YouTube and other sites have become “virtual water coolers” where people congregate online. Facebook has attracted a number of group sites for medical students specifically, and there are many posts on Twitter about issues facing medical students. Several sites like Sermo and Ozmosis specifically geared toward doctors have popped up and include everything from medical news and job postings to discussion forums on clinical and lifestyle topics.

“The concept behind professional social networks is that doctors need a place where they can exchange medical, clinical, practice management and policy information, discuss cases, review journal articles or any other information on the Web in a trusted environment—somewhere where there aren’t other eyes looking in,” says Dr. Jason Bhan, co-founder of Ozmosis, a social media site for physicians.

Bhan started the site when he finished residency and became a family practitioner in Virginia. Even though he practiced in a group setting, he felt isolated and wanted to connect with other doctors online. The site launched in 2008 and has steadily grown to include several thousand members.

Experts say that doctors should consider information from social networks in the same way they hear advice from colleagues—information shared online is not meant to be a substitute for medical opinion.

Facebook user Abraham Hafiz Rodriguez, a first-year at the University of Illinois at Chicago College of Medicine, uses social networks to stay informed on current news and research. “It is a great thing that we are all staying interconnected via social networks,” he says, “and sharing information at speeds that have never before been obtained with less centralized forms of communication.”

Virtual doctor’s lounge

With 250 million users, Facebook is by far the most popular social networking site, followed by MySpace, with 130 million monthly users. Hundreds of groups have been started by doctors and other medical professionals. One of the more popular Facebook pages for medical students is called “We are doctors and medical students,” with nearly 45,000 fans talking about a variety of topics. Another favorite is “You might be in med school if,” which has attracted more than 13,000 fans.

With so many visitors and new groups forming daily, many national medical organizations have created Facebook groups. The American Medical Association (AMA) keeps its physician members updated on many policy issues, particularly around health care reform. The American Medical Student Association (AMSA) also has a Facebook page along with several school-based chapters of AMSA.

Doctors use social networks for different reasons, says Bhan. One purpose is to meet and collaborate with peers to bounce ideas around and share different clinical approaches. Another reason is to utilize social networks to communicate with patients. For instance, some doctors have used Twitter to let their patients know when the H1N1 vaccine was available.

“The way that Twitter has become useful is if doctors read an article or see something on the Web that they find interesting, they can pass it to others,” Bhan says.

While anyone can join Facebook, MySpace and Twitter, most professional social networks require that doctors’ identification be verified. In most cases, however, medical students are not allowed to join these sites because they lack medical licensure.

One site, Within3, allows medical students to participate if they are invited by a group or doctor. Sermo, the largest site with more than 110,000 members, only permits licensed physicians. Currently, Ozmosis does not allow medical students to be members either, but that will change in the near future, Bhan says. Ozmosis formed a new advisory board to figure out how to integrate students into the site.

“We definitely believe medical students have a significant amount to add to the education on Ozmosis,” Bhan explains. “It’s really a matter of how to best do it without disrupting the community.”

Pitfalls of social networking

There are many advantages to social networking, but a recent Journal of the American Medical Association study sent shockwaves through the profession by demonstrating the downsides of the new technology. The study found that 60 percent of U.S. medical school deans surveyed reported incidents of students posting unprofessional content online. Profanity and discriminatory language were most common, followed by alcohol abuse and sexually suggestive material. Incidents involving violation of patient confidentiality were rare.

“Most of the incidents resulted in informal warnings; some were serious enough to lead to dismissal,” explains study author Dr. Katherine Chretien, medicine clerkship director at the Veteran Affairs Medical Center in Washington, D.C. “Our study was not designed to identify what is inappropriate, but work needs to be done to determine what is professional versus unprofessional.”

The study findings prompted several medical schools to immediately form task forces to create or update their policies. “Some schools addressed the issue the same day the study came out because they had inadequate policies in place,” says Chretien.

Mayo Clinic has guidelines in place, and Mount Sinai Medical Center formed a 20-member committee that is updating its codes of professionalism, says committee chair Dr. David Reich. “It will be a very straightforward policy that provides our students with a road map on proper online conduct with several real-life examples.”

On a national level, there are no current guidelines for doctors to follow. The American College of Physicians is working on a policy, and the Association of American Medical Colleges (AAMC), which represents 131 accredited U.S. medical schools, will develop recommendations around social networking through its national committee on student affairs.

“We do not like to write policies for medical schools, but our committee will likely end up developing recommendations over the next six to 12 months,” explains Dr. Henry Sondheimer, AAMC’s senior director of student affairs and student programs. “With the Internet and social networking, boundaries today are different than they were a generation ago, and we need to understand whether medical students are changing their boundaries once they enter medical school.”

Chretien is conducting a follow-up study collecting medical students’ opinions about what is appropriate and inappropriate online content and how it should be addressed by schools or national groups. The study is expected to be published later this year.

“Our first study only focused on views from deans’ offices,” adds Chretien. “This study will capture perspectives from students which will provide a totally different point of view on how to appropriately use social networking tools.”


Social Networking Dos & Don’ts

Follow these six tips to safeguard your professional reputation and protect your medical career from being tarnished.

1. Privacy is critical. Stifle the urge to tell the world about that extremely rare and fascinating case you experienced that day. Remember that information can potentially identify a patient, even without divulging a patient’s name or social security number. Safeguarding protected health information is not only an ethical obligation, but a legal one.

2. Check your school’s policy. Whether your school has a specific policy on online conduct or a general code of professionalism, you may be forced to interpret what is appropriate versus inappropriate. Use good judgment and always avoid criticizing your school, professors and deans online.

3. Think before you write. Consider everything that you write on the Internet is permanent—there is no undo online. While you may be able to delete a post or comment, it is usually archived somewhere and accessible in the future. Quick reference: If you would be embarrassed if your dean read your statements, then you’re better off not posting them.

4. Clean up your Facebook page. Don’t use a profile picture of you holding a bottle of Jack Daniels from your friend’s last party. Physician recruiters and residency programs regularly check Facebook to screen and identify candidates. Use the privacy settings with Facebook, but remember that such controls are only a deterrent, not an absolute insulator. Additionally, exercise your right to un-tag yourself from photos or ask your friends to take compromising photos down.

5. Not so funny. What you think is funny may be considered inappropriate and offensive by others. Try to limit the use of jokes on social network sites unless you think it’s clean and funny enough that your future employer might laugh.

6. Pick your friends carefully. Consider wisely before adding patients as “friends” on Facebook, MySpace, or other social networks. And if your friends post questionable information on your Facebook wall, delete it immediately.

Paul Wynn is a freelance health care writer based in Brooklyn, New York.