Professional readiness
Facebook and the professional behaviours of undergraduate medical students Jayne Garner and Helen O’Sullivan, Centre for Excellence in Developing Professionalism, School of Medicine, University of Liverpool, UK
It has been suggested that interaction in virtual communities erodes elements of responsibility, accountability and social trust
SUMMARY Background: The rapid growth and accessibility of social networking websites has fundamentally changed the way people manage information about their personal and professional lives. In particular, it has been suggested that interaction in virtual communities erodes elements of responsibility, accountability and social trust that build traditionally meaningful communities. The purpose of this study was to investigate how undergraduate medical students use the social network website Facebook, and to identify any
unprofessional behaviour displayed online. Methods: A voluntary anonymous online survey was devised by the University of Liverpool, and emailed to students. Question topics included the use of Facebook, privacy settings, groups relating to the course and professional behaviours. Results were input to SPSS for analysis. Results: The response rate was 31 per cent (n = 56). The majority of respondents did have a Facebook account and admitted there were photos they found embarrassing on the site. Over half of the respondents reported they had seen unprofessional
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behaviour by their colleagues on Facebook. Although students say that they are aware of the UK’s General Medical Council (GMC) guidance, unprofessional behaviour is still demonstrated on the site. Discussion: This research highlights the issue of social networking websites and professionalism amongst medical students. Further guidance from the GMC and medical schools should remind students that images and information placed on social networking sites is in the public domain, and could impact upon their professional reputation and identity.
Growth and accessibility of social networking websites has …changed the way people manage information about their personal and professional lives
INTRODUCTION
T
here is increased debate in medical education about effective ways to define, develop and measure professional behaviours.1–3 Recent guidance in the UK has placed an emphasis on medical schools to provide a supervised environment where undergraduate medical students can learn professional behaviours, so that they are fit to practise upon graduation, and understand the standards expected of them personally and professionally.
Students must be aware that their behaviour outside the clinical environment, including in their personal lives, may have an impact on their fitness to practise. Their behaviour at all times must justify the trust the public places in the medical profession.4 As in other disciplines, advances in web-based technology have had a massive impact on how individuals interact in their personal and professional lives. Many current students in medical education have grown up with rapidly advancing technological communication, including the internet and mobile phones, which has coined the term ‘generation Y’.5 The rapid growth and accessibility of social networking websites has fundamentally changed the way people manage information about their personal and professional lives. In particular, interaction in virtual communities has been suggested to erode elements of responsibility, accountability and social trust that build traditionally meaningful communities.6 A recent study in the USA measured the frequency and content of online social networking
among medical students and residents.7 The authors reported concerns with regard to inappropriate and unprofessional behaviours being publically accessible on individual profiles, and in groups. Additional research has shown that US medical schools are aware of unprofessional posting by students online, but do not have policies in place to address this behaviour.8
RESULTS
Facebook is a social networking website where individuals create a personal profile to share information about their lives, advertise social activities and share photographs.9 Users can become friends and associate with each other. This research investigates the use of Facebook by students at one UK medical school, and sought to identify any unprofessional behaviour being displayed on the website.
The majority (96%) of respondents had a Facebook account, and of these 96 per cent said it was listed under their real name. Most respondents (90%) said that they used privacy settings on Facebook that limited access to their personal profile information, yet the remainder (10%) did not.
METHODS The survey was hosted on the University of Liverpool server. The survey link was e-mailed to 180 medical students at the University of Lancaster during May–June 2009 by the course administrator. Participation was entirely voluntary and anonymous. No incentives were offered for the completion of the survey. Data results from the survey were transferred to an EXCEL spreadsheet for analysis.
As Lancaster is a new medical school following the University of Liverpool MBchB curriculum, respondents were in years 1–3. In total, 56 students voluntarily completed the survey (a response rate of 31%). Most respondents were female (70%), reflecting the general population of the cohort group.
A series of questions asked students about their use of Facebook, with Yes or No answers stipulated. A significant number of respondents (19%) admitted that they had accepted friendship requests from people that they did not know well. Over half of the respondents (52%) admitted that there were photographs of themselves on Facebook that they found embarrassing. More worryingly, over half of the respondents (54%) reported that they had seen unprofessional behaviour by their colleagues on Facebook,
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‘Employers in all walks of life use Facebook to judge applicants in all jobs, and medicine should be no different’
Other respondents took a more rounded view, expressing concern about some behaviour on Facebook that could impact upon students in their professional capacity.
such as excessive drinking, various states of undress and the discussion of clinical experiences with patients. Respondents were asked how much they agreed with a series of statements relating to Facebook, with a particular focus on the GMC’s fitness to practice guidance. The responses are presented in Table 1. The survey provided a freetext box at the end of the questions for comments relating to Facebook and the professional behaviour of students. Six students took the opportunity to make a comment. These varied in
theme, with some students feeling that their activity on Facebook was their own personal business, and was unrelated to their medical career.
I feel that it is unprofessional of the STAFF to use Facebook as a manner of ‘spying’ on their students. My behaviour on Facebook reflects my behaviour in real life, none of which I feel the need to hide. However, the thought of being checked up on by the course in such an underhand manner disappoints me. Respondent 20
Table 1. Statement results Strongly Strongly agree Agree Neither Disagree disagree What happens on websites such as Facebook is separate from what happens in medical school Medical student behaviour outside the clinical environment could impact on fitness to practice I understand what the medical school would classify as unacceptable behaviour I am aware of the GMC’s fitness to practice guidance on personal and professional behaviour
16%
30%
18%
28%
8%
30%
58%
4%
8%
0%
I accept that everyone has a private life, and that should also be respected; however, employers in all walks of life use Facebook to judge applicants in all jobs, and medicine should be no different. Several of my colleagues have been shown in a poor light on Facebook, and if this was seen by members of the public it would seriously undermine their professional practice if they were then seen in clinical practice too. Respondent 27 I think it’s important to use the privacy settings on Facebook so that only actual friends can see your profile. I believe we all recognise the need to be professional and how our behaviour outside of work can impact our career; however, at the end of the day we are normal people, we curse, we get drunk and we have embarrassing photos of ourselves, these things should not make us less of a doctor. Respondent 43 DISCUSSION
26%
52%
12%
8%
2%
32%
52%
12%
2%
2%
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The results of the survey suggest contradictory opinions amongst the students. Although some clearly think their personal activities should be their own concern, over a third (36%) disagree that what happens in medical school is separate from
what happens on Facebook. The majority of respondents (88%) agree that what happens outside the clinical environment could impact upon their fitness to practise, so they are aware of the potential outcome of unprofessional behaviour generally.
that could raise fitness-to-practise issues. This advice could avoid future problems with unprofessional behaviour on Facebook, and might reduce any need for medical schools to monitor their student’s social networking activity.
As highlighted by Thompson et al.,7 some students are not relating fitness to practise guidance to social networking forums, yet this information is available in the public domain, and could prove to be problematic in their careers, as several students commented.
Farnan et al.10 have developed a policy that requires material relating to an individual’s role as a medical trainee, or that identifies their institution, should be reviewed by faculty members for appropriateness prior to posting. How other medical educators address this issue remains a current challenge in medical education.
CONCLUSIONS Although the sample size of the study is small, the findings are certainly interesting enough to warrant further investigation. In response to the original research questions, some behaviour displayed on Facebook is, by the students own admission, unprofessional, and could have repercussions for their future career. Medical schools would be advised to remind their students about the public nature of information placed on Facebook, how to set appropriate privacy settings on the site and types of behaviour
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attitudes within UK medical schools: reported difficulties and good practice. Med Educ 2006;40:1072–1080. 4. GMC. Medical students: professional behaviour and fitness to practise. London: The General Medical Council; 2007. 5. Shapira I. What comes next after generation X? In: The Washington Post 6 July 2008. Available at http://www.washingtonpost.com/ wp-dyn/content/article/2008/07/ 05/AR2008070501599.html. Accessed on 18 November 2009.
Some behaviour displayed on Facebook is… unprofessional, and could have repercussions for their future career
6. Barney D. The Network Society. Cambridge: Polity Press; 2004, p. 161. 7. Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, Paradise Black N. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954–957. 8. Chretien KC, Greyson SR, Chretien J-P, Kind T. Online posting of unprofessional content by medical students. JAMA 2009;303:1309– 1315. 9. Jain SH. Practising medicine in the age of Facebook. N Engl J Med. 2009;361:649–651. 10. Farnan JM, Paro JAM, Higa JT, Reddy ST, Humphrey HJ, Arora VM. The relationship status of digital media and professionalism: it’s complicated. Acad Med 2009;84: 1479–1481.
Corresponding author’s contact details: Jayne Garner, Centre for Excellence in Developing Professionalism, School of Medicine, University of Liverpool, Room 4.16, Cedar House, Ashton Street, Liverpool, L69 3GE, UK. E-mail:
[email protected]
Funding: Centre for Excellence in Developing Professionalim, University of Liverpool. Conflict of interest: None. Ethical approval: Ethical approval for this study was granted by the University of Liverpool Ethics Committee.
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