This document discusses how medical students should interact with social networking sites professionally. It notes that while 75% of medical students have Facebook profiles, interactions on social media can jeopardize patients' confidentiality and the doctor-patient relationship if not managed carefully. The document advocates introducing a module in undergraduate medical education to teach students how to manage their digital footprint and reduce risks to confidentiality posed by social media use. The goal would be for students to harness social media's potential while maintaining professional standards of conduct online.

1. 1
Luke
Farmery
©
Words:
798
How
should
medical
students
interact
with
social
networking
sites?
Written
by
Luke
Farmery
–
Brighton
&
Sussex
Medical
School
l.farmery1@uni.bsms.ac.uk
Introduction:
Facebook
(Menlo
Park,
CA,
USA)
originated
as
a
college
prank
before
rapidly
evolving
into
a
multi-­‐billion
dollar
super
system
boasting
845
million
monthly
users
across
the
world.1
Other
social
networking
sites
(SNS)
combine
with
Facebook
to
form
a
consortium
of
user-­‐led
web
pages
known
collectively
as
the
‘Web
2.0’.
The
range
of
utilities
and
sheer
number
of
active
users
participating
in
the
Web
2.0
community
suggests
SNS
have
the
potential
to
revolutionise
how
people
access
and
communicate
health
information
(Table
1).
2,
3
TABLE
1:
Popular
Social
Networking
Sites
contributing
to
the
‘Web
2.0’
and
their
relevance
to
healthcare
2
Social
Media
Healthcare
Relevance
Facebook
The
most
popular
social
networking
site;
enables
messages
to
be
sent
between
colleagues.
Also
enables
dissemination
of
health
information
to
patients.
Patient
support
groups
for
common
chronic
diseases
already
use
Facebook.
The
site
has
already
been
used
as
an
educational
forum
and
the
large
user
population
could
also
be
used
for
research
recruitment.
YouTube
The
most
popular
video
uploading
site
that
enables
reference
to
a
range
of
medical
material.
Medical
students
and
doctors
can
also
upload
their
own
tailored
media
to
target
a
specific
cohort
of
patients,
students
or
colleagues.
Tumblr
An
example
of
a
popular
blog
site
that
enables
users
to
keep
an
online
journal.
Doctors
may
use
a
blog
to
keep
colleagues
or
patients
up-­‐to-­‐date
with
tailored
information.
Medical
students
are
encouraged
to
keep
journals
for
reflective
assignments.
Blogs
can
be
used
for
this
purpose
since
they
can
be
password
protected.
LinkedIn
An
example
of
more
formal
social
networking
site
that
might
be
better
suited
to
health
care
professionals
who
want
to
maintain
online
social
presence.
Current
medical
students
are
part
of
a
generation
that
has
grown
up
engrossed
in
SNS.4,
5
Surveys
indicate
that
up
to
75%
of
medical
students
have
Facebook
profiles6,
7,
8
These
students
are
positioned
to
harness
social
media’s
potential
later
in
their
careers
if
they
can
first
overcome
the
recurrent
issues
of
online
professional
misconduct.9

2. 2
Luke
Farmery
©
Words:
798
Online
Professionalism
&
Confidentiality
Issues:
Medical
students
rely
heavily
on
specialised
social
boundaries
when
interacting
with
patients.
The
student
maintains
personal
privacy
to
establish
professionalism,
whilst
patients
expect
confidentiality
at
the
expense
of
their
own
privacy.
Facebook’s
mission
‘to
make
the
world
more
open
and
connected’1
threatens
to
disrupt
the
doctor-­‐patient
relationship.
The
increasing
amount
of
personal
information
published
on
SNS
has
lead
to
multiple
cases
of
professional
misconduct
and
breaches
of
confidentiality.
These
have
almost
cost
students
their
future
careers.10
Despite
this,
unprofessional
behavior
is
still
reported
in
the
literature
and
students
still
risk
liberal
privacy
settings.11,
12
A
survey
of
56
UK
medical
students
revealed
52%
considered
their
Facebook
pictures
to
be
‘embarrassing’.
4
A
larger
study
of
367
students
found
95
‘open
profiles’
with
52
counts
of
unprofessional
content
(Figure
1
–
please
turn
over).
6

3. 3
Luke
Farmery
©
Words:
798
FIGURE
1:
A
spider
diagram
showing
the
ways
in
which
online
content
can
be
disruptive
to
the
doctor-­‐patient
relationship
and
the
maintenance
of
a
professional
image.
(Original
image:
influenced
by
reference
3&4)

4. 4
Luke
Farmery
©
Words:
798
Breaches
in
professionalism
and
patient
confidentiality
often
occur
by
accident
due
to
‘snowballing
posts’
or
audience
misconception.
This
is
highlighted
both
anecdotally
and
by
the
BMA
guidance.13,
14
Current
interaction
with
social
media
jeopardises
the
potential
use
of
the
Web
2.0
in
healthcare.
The
BMA
guidance
agrees
that
medical
students
should
be
able
to
reap
both
the
personal
and
professional
benefits
of
SNS.14
However,
due
to
the
informal
nature
of
social
media
it
can
be
challenging
to
maintain
an
entirely
formal
presence.2
A
survey
of
130
US
medical
schools
showed
that
50%
reported
issues
with
online
professional
conduct
yet
still
offered
no
formal
guidance
on
the
subject.6
The
BMA
guidance
suggests;
“knowing
the
risks
and
[interacting]
in
a
way
to
reduce
them,”
14
but
this
advice
is
limited
if
students
are
not
first
taught
the
risks.
Therefore,
the
literature
suggests
introducing
a
module
on
‘managing
the
digital
footprint’
to
undergraduate
medical
education.3
This
guidance
should
be
delivered
by
those
with
knowledge
of
the
social
media,
not
just
teaching
staff.
For
example,
schools
could
work
directly
with
interested
students
to
produce
a
more
directed
module.15
Students
need
to
realise
that
issues
with
online
professional
misconduct
and
breaches
of
confidentiality
have
the
same
ramifications
as
they
do
in
real
life,
and
thus
SNS
should
be
used
in
a
professional
and
conservative
manner.
Personal
profiles
should
be
kept
under
strict
privacy
settings
and
professional
pages
should
be
regularly
updated.
The
Potential
use
of
Social
Networking
Sites:
A
review
of
Facebook
in
2009
found
290,962
users
subscribed
to
757
medically
related
groups.
These
groups
consisted
of
patient
support
forums,
fund
raising
events
and
27
groups
relating
to
medical
research
recruitment.16
The
large
number
of
users
using
Facebook
for
medical
means
indicates
a
need
for
a
medical
presence
to
mediate
discussion.
These
groups
offer
a
way
to
rapidly
communicate
information
to,
and
receive
feedback
from,
a
large
number
of
patients
who
might
not
otherwise
engage
with
healthcare.17
Facebook
advertising
provides
an
opportunity
for
research
recruitment
of
users
who
are
not
already
subscribed
to
the
relevant
Facebook
groups.18
“The
internet
isn’t
written
in
pencil…it’s
written
in
ink”
–
The
Social
Network
(film)
2010

5. 5
Luke
Farmery
©
Words:
798
Medical
students
should
recognize
the
educational
benefit
of
SNS
(i.e.
YouTube),
which
have
a
wealth
of
educational
material
uploaded
to
them.19
There
is
also
the
ability
to
liaise
with
tutors
on
SNS,
however
it
is
argued
that
this
use
is
limited
by
the
informal
nature
of
social
media.20
Conclusion:
The
question
of
how
medical
students
should
interact
with
SNS
is
overshadowed
by
the
unprofessional
behavior
of
the
minority.2
Problems
with
professional
conduct
are
often
due
to
lack
of
student
awareness,
accidents
or
misconceptions.3,
4,
6,
7,
10,
13,
14
Formal
teaching
has
been
proposed
as
a
way
of
enlightening
students
to
the
risks
of
the
online
domain.3,
15
The
medical
potential
of
SNS
can
only
be
harnessed
after
the
above
issues
are
resolved.9
Students
should
make
use
of
conservative
privacy
settings
and
maintain
a
professional
account
separately
from
their
personal
account.
Students
should
also
interact
with
SNS
as
an
extension
of
the
public
domain.14
It
is
hoped
that
SNS
will
eventually
be
used
to
communicate
rapidly
with
large
cohorts
of
patients
and
colleagues
across
the
globe.16,
18
The
user-­‐led
‘Web
2.0’
could
give
rise
to
‘Healthcare
2.0,’
if
the
true
utility
of
SNS
is
further
defined.
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©
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