Most popular services among physicians/worldwide. Excluding other tools such as virtual meeting services, file sharing, etc
Education: Asynch, personalized, can force critical evaluation of cases and concepts, spaced repetition, content creation as learning, foster lifelong learning, has been shown to contribute to improved knowledge, skills and attitudes Research/Clinical Practice: Accelerated knowledge translation, access to thought leaders, distance learning/conferences, collaboration Professional Development: Networking, marketing, access to patients/potential patients, publication, loss of control over personal reputation Wellness: Sense of community, reflective tool, decreased isolation Ethical case: Increase pt awareness to standard of care, we should deal will inaccurate/false info, provide alternatives or curated sources,
Professional identity formation
You Are What You Tweet - Physicians, Professionalism, and Social Media
You are What You Tweet:
Physicians, Professionalism, and
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
• Talk about some things you know
• Talk about some things that may be new
• Explore future directions
Found under creative commons at: https://www.flickr.com/photos/briansolis/2735401175
A Little About the World Wide Web
• Web 1.0 – Static, unidirectional, limited
• 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.
Sorting It All Out
• Social Networks
• Professional/Niche Networks
• Photo/Video Sharing Services
• Social Bookmarking
• It’s where our learners are
▫ > 95% of medical students are active on SoMe
▫ 75% of students access their accounts multiple
▫ > 90% of residents (IM, Peds) have SoMe
accounts, >50% use them more than once daily.
▫ 30% of Midwestern surgical residents have
identifiable Facebook accounts
• It’s where our faculty are
▫ 25% of Midwestern surgical faculty have
identifiable Facebook accounts
▫ 48% of surgeons use LinkedIN
• 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
It’s also where other educators are
The Case for Participation
• Professional Development
• Physician and Trainee Wellness
• The Ethical Imperative
• Students who participated in moderated, blog
based discussions scored higher than non
• 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,
Challenges to Participation
• Patient Privacy/HIPAA Violations
• Violation of the public trust, unclear expectations
• Fear of legal liability
• Technical challenges
• Lack of perceived benefit
• A contract between physicians and society which
forms the foundation of patient-physician trust.
• Expectations outlined by various codes of ethics
• Large gray zone
• 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?
• 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
• 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
Don’t I Get to Have a Life?
Man Woman by Victor Victori
Trainees undergoing professional identity formation may not yet
appreciate the changing societal expectations and professional
boundaries facing them in the online world.
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.
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
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
3) Promote Discovery
Curricula also to guide:
• Networking and generation of new content
• Lifelong learning
• Exploration of resources
“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
All images used in this slideset are Creative Commons, except for the “Hierarchy of Needs in Social Media”
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.
• 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)
• Cheston et al. Social Media Use in Medical Education:A Systematic Review. Acad Med.
• Chretien and Kind. Climbing Social Media in Medicine’s Hierarchy of Needs. Acad Med.
• Chretien et al. Online posting of unprofessional content by medical students. JAMA. 2009
• 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
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• Kesselheim et al. A National Survey of Pediatric Residents’ Professionalism and Social
Networking: Implications for Curriculum Development. Academic Pediatrics, 2016;16:110–
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students and faculty. BMC Med Educ. 2016 Feb 18;16(1):67.
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Facebook: a warning of the dangers of social media. J Surg Educ. 2014 Nov-Dec;71(6):e28-
• Langenfeld et al. The Glass Houses of Attending Surgeons: An Assessment of
Unprofessional Behavior on Facebook Among Practicing Surgeons. J Surg Educ. 2015 Nov-
• Lewis, MA and Dicker, AP. Social Media and Oncology: The Past, Present, and Future of
Electronic Communication Between Physician and Patient. Semin Oncol. 2015
• 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