A brief intro to social media and discussion on the way that GME educators should approach SoMe. Delivered at the Lenox Hill Hospital GME Sub-Committee Retreat on March 31st, 2016.

1. You are What You Tweet:
Physicians, Professionalism, and
Social Media
David A. Marcus, MD
EMIMDoc.org - @EMIMDoc
Attending Physician, Northwell Health Division of Medical Ethics
Director, Professionalism Thread, Hofstra-Northwell SOM
Delivered at Lenox Hill Hospital GMEC Retreat - March 31, 2016

2. Goals
We will
• Talk about some things you know
• Talk about some things that may be new
• Explore future directions

3. Background

4. Found under creative commons at: https://www.flickr.com/photos/briansolis/2735401175

5. A Little About the World Wide Web
• Web 1.0 – Static, unidirectional, limited
access
• Web 2.0 – Dynamic, interactive, by and for
users. Social networks and file sharing sites
as a manifestation.
• Web 3.0 – The Semantic Web. AI,
Intelligent networks predicting our needs.
You are
here!

6. Sorting It All Out
• Social Networks
• Professional/Niche Networks
• Blogging/Microblogging
• Photo/Video Sharing Services
• Social Bookmarking
Doximity

7. So What?
• It’s where our learners are
▫ > 95% of medical students are active on SoMe
▫ 75% of students access their accounts multiple
times daily
▫ > 90% of residents (IM, Peds) have SoMe
accounts, >50% use them more than once daily.
▫ 30% of Midwestern surgical residents have
identifiable Facebook accounts

8. So What?
• It’s where our faculty are
▫ 25% of Midwestern surgical faculty have
identifiable Facebook accounts
▫ 48% of surgeons use LinkedIN

9. So What?
• It’s where our patients are
▫ 56% of people online over age 65 use Facebook
▫ 73% of US adults use SoMe
▫ Dr. Google and the ePatient movement
▫ 75% of patients do not verify authenticity of online
medical information

10. It’s also where other educators are
http://www.aliem.com/em-im-residency-on-twitter/

11. The Case for Participation
• Education
• Research/Practice
• Professional Development
• Physician and Trainee Wellness
• The Ethical Imperative

12. Examples
• Students who participated in moderated, blog
based discussions scored higher than non
participants.
• Professionalism course with online component
associated with preserved empathy in MS3
• EM Lyceum (NYU)
• #FOAMed ; #EMconf
• SMART-ME (Hopkins) – Twitter based
educational intervention, viewed favorably,
quickly adopted.

13. Challenges to Participation
• Patient Privacy/HIPAA Violations
• Violation of the public trust, unclear expectations
• Fear of legal liability
• Technical challenges
• Lack of perceived benefit

14. Professionalism
• A contract between physicians and society which
forms the foundation of patient-physician trust.
• Expectations outlined by various codes of ethics
• Large gray zone

15. Online Misconduct
• Sexual remarks about a patient?
• Privacy violations?
• Images of doctors with a glass of wine?
• Intoxicated docs?
• Medical student O.R. photos?
• Complaining about a colleague? Consultant?
• Physician/student comedy skits?
• Using medical equipment in videos?
• Doctors at a party?
• Political remarks?

16. Mixed Perceptions
• Students are more likely than faculty to report
having posted unprofessional content.
• Students and faculty are much more likely to
report having seen unprofessional content than
to have posted it themselves.
• 26% of surgical residents have unprofessional
content on their profiles

17. Mixed Perceptions
• Students are more likely than faculty to use
identity protection strategies.
• Students are more likely than faculty to identify
the link between current account content and
future implications.

18. Don’t I Get to Have a Life?
Man Woman by Victor Victori
https://en.wikipedia.org/wiki/Victor_Victori#/media/File:Man_Woman_Multiplism_by_Victor_Victori.jpg
Trainees undergoing professional identity formation may not yet
appreciate the changing societal expectations and professional
boundaries facing them in the online world.

19. Where to From Here?

20. The Educator’s Approach
Maslow’s Hierarchy of Needs
SoMe in Medicine Hierarchy of Needs, from Chretien and Kind,
Climbing Social Media in Medicine’s Hierarchy of Needs.
Acad Med. 2014;89:1318–1320.

21. 1) Play Safe
• Caveat emptor
• Anonymity is dead
• Nothing is deleteable, everything is discoverable
• Treat people with respect
• Maintain professional standards
• Do not violate local policies and laws
• You and your digital persona are inseparable

22. 2) Foster Reflection
Curricula to help trainees:
• Reflect as they develop their professional identity
• Define how professional boundaries relate to
online patient interactions
• Deal with technical challenges
• Critically evaluate educational resources
• Understand the importance of personal branding
to their future careers

23. 3) Promote Discovery
Curricula also to guide:
• Networking and generation of new content
• Lifelong learning
• Exploration of resources

24. “Anything that is in the world when you’re born is
normal and ordinary and is just a natural part of
the way the world works. Anything that’s invented
between when you’re fifteen and thirty-five is new
and exciting and revolutionary and you can
probably get a career in it. Anything invented after
you’re thirty-five is against the natural order of
things.” - Douglas Adams

25. THANK YOU.
All images used in this slideset are Creative Commons, except for the “Hierarchy of Needs in Social Media”

26. Citations and Other Readings – Page 1
• Azoury et al. Surgeons and social media: Threat to professionalism or an essential part of
contemporary surgical practice? Bulletin of the American College of Surgeons. Published
online: August 1, 2015. Accessed: March 20, 2016.
http://bulletin.facs.org/2015/08/surgeons-and-social-media-threat-to-professionalism-
or-an-essential-part-of-contemporary-surgical-practice/
• Barlow et al. Unprofessional behaviour on social media by medical students. Med J Aust.
2015 Dec 14;203(11):439.
• Cartledge,et al. The use of social-networking sites in medical education. Med Teach (2013)
Oct;35(10):847-57.
• Cheston et al. Social Media Use in Medical Education:A Systematic Review. Acad Med.
2013;88:893–901.
• Chretien and Kind. Climbing Social Media in Medicine’s Hierarchy of Needs. Acad Med.
2014;89:1331–1334.
• Chretien et al. Online posting of unprofessional content by medical students. JAMA. 2009
Sep 23;302(12):1309-15.
• Galiatsatos et al. The use of social media to supplement resident medical education the
SMART-ME initiative. Med Educ Online 2016, 21: 29332
• Herron, PD. Opportunities and ethical challenges for the practice of medicine in the digital
era. Curr Rev Musculoskelet Med (2015) 8:113–117

27. • Kesselheim et al. A National Survey of Pediatric Residents’ Professionalism and Social
Networking: Implications for Curriculum Development. Academic Pediatrics, 2016;16:110–
114
• Kitsis et al. Who's misbehaving? Perceptions of unprofessional social media use by medical
students and faculty. BMC Med Educ. 2016 Feb 18;16(1):67.
• Langenfeld et al. An assessment of unprofessional behavior among surgical residents on
Facebook: a warning of the dangers of social media. J Surg Educ. 2014 Nov-Dec;71(6):e28-
32.
• Langenfeld et al. The Glass Houses of Attending Surgeons: An Assessment of
Unprofessional Behavior on Facebook Among Practicing Surgeons. J Surg Educ. 2015 Nov-
Dec;72(6):e280-5
• Lewis, MA and Dicker, AP. Social Media and Oncology: The Past, Present, and Future of
Electronic Communication Between Physician and Patient. Semin Oncol. 2015
Oct;42(5):764-71.
• Pereira et al. Thou shalt not tweet unprofessionally: an appreciative inquiry into the
professional use of social media. Postgrad Med J 2015;91:561–564.
• Peters et al. A Twitter Education: Why Psychiatrists Should Tweet. Curr Psychiatry Rep
(2015) 17: 94
• Weiner, J. A personal reflection on social media in medicine: I stand, no wiser than before.
Int Rev Psychiatry (2015) Apr;27(2):155-60.
Citations and Other Readings – Page 1