This study sought to determine if and how 501 medical students and 312 residents are using Facebook at a large university in the southeastern United States. Results reveal that medical students and residents are using Facebook and about twothirds of users maintain public profiles. While there is variation in the types of information provide within profiles, many medical students seem unaware of or unconcerned with the possible ramifications of sharing personal information in publicly available online profiles even though such information could impact their professional lives. Thus, this study provides data based evidence that online tools such as social networking sites should become a part of the dialogue related to preparing future physicians to meet the Accreditation Council on Graduate Medical Education (ACGE) professionalism competency.
According to the Accreditation Council for Graduate Medical Education (ACGME), medical students and residents are expected to demonstrate accountability to patients, society and the profession.  And, while medical educators are struggling with how to conceptualize, teach and assess professionalism in their programs (Wear and Aultman, 2006; Wear and Kuczewski, 2004; Mareiniss, 2004), the digital world is providing new opportunities as well as potential challenges. Social networking sites such as Facebook and MySpace allow medical students and residents to communicate and share information via personalized online profiles. These profiles may include information about political and religious views, sexual orientation and relationship status. The profiles may also include a myriad of photographs, a list of online friends and affiliated online groups, and even information such as address, phone number and daily schedule.
Unfortunately, medical students and residents may not understand how their publicly available content is a direct reflection on their professionalism. For instance, medical educators, colleagues, and even patients have access to view their content online. The promise of these social networking tools is the ability to temper the increasingly negative sentiments and skepticism from the general public regarding the medical community (Pescosolido, et al., 2001; Irvine, 2003). However, the potential pitfall is that unprofessionalism in social networking sites could exacerbate such attitudes.
A recent study of how prospective teachers’ use Facebook suggests that unprofessional uses of social networking tools are commonplace (Coutts, et al., 2007). This study set out to determine if and how medical students and residents were using Facebook. It provides a context within which medical educators can begin to consider the ramifications of the digital world broadly and social networking tools specifically on the ACGME professionalism competency.
Data for this study was collected from the Facebook accounts of 501 medical students and 312 medical residents enrolled at a large university in the southeast United States. A medical student is a person attending medical school whereas a resident is a person who has graduated from medical school and is now receiving postgraduate medical training, normally within a given specialty. As such, by definition, residents are more advanced in practice and age than medical students. Facebook data is publicly available and the University’s Institutional Review Board (IRB) approval was received for this study.
We first determined whether each student or resident had a Facebook account and whether that account was private or public. An account listed as private meant that we could only designate that they had an account. For public accounts, we collected whether they included the following information:
- Field of study
- Sexual orientation
- Relationship status
- Political view
- Email address
- AOL screen name
- Home residence (different than current address)
- Phone number
We also collected details on the number of friends they had, the number of photo albums displayed, and the number of groups they had joined. Finally, if there was anything extreme in their profile (such as a picture, a group they had joined, etc.) we documented this in an ‘other’ column to be used for qualitative analyses.
Medical students and residents are using Facebook, although more medical students are using it. Overall, 362 of the 813 participants in this study (44.5 percent) have a Facebook account. However, examining use by group, data suggests that only 12.8 percent (40 out of 312) of residents use Facebook compared to 64.3 percent of medical students (322 out of 501).
About twothirds of all participants kept their Facebook account public. This means that the public could see the user’s pictures, groups, and message boards. Altogether 227 of the 362 Facebook users (62.7 percent) kept their accounts public. This was similar across residents (27 out of 40; 67.5 percent) and medical students (200 out of 322; 62.1 percent).
Both genders use Facebook; however, there are gender differences between medical students and residents. Of the 362 Facebook users in this study, 52.8 percent were male (n=191) and 47.2 percent were female (n=171). However, this was not representative across residents and medical students. Only 20 percent (n=8) of resident Facebook users were women, compared to 50.6 percent (n=163) of female medical students.
Medical students and residents use Facebook to share personal information. Medical students and residents seem willing to share personal information in public spaces. Eighty percent (n=288) shared their specific field of study, 77.9 percent (n=282) were willing to share a picture of themselves as a screenshot (either in solo or group pose), and 6.1 percent of participants (n=22) shared their home address .
However, other private information was also shared within public accounts (n=227). We found that 52.4 percent (n=119) were willing to share their sexual orientation (homosexual, heterosexual, or bisexual), with 58.6 percent (n=133) were willing to share whether they were currently in a relationship. Additionally, 50.2 percent (n=114) shared their political perspective. We also found that 83.3 percent (n=189) shared their email address and 41.4 percent (n=94) shared their AOL instant messanger screen name. Finally 31.7 percent (n=72) of participants publicly shared their home residence and 7.5 percent shared a phone number (n=17). Table 1 summarizes the specific differences between medical students and residents. Further statistical analyses were not completed within program areas for residents due to the low sample within those residency areas.
Table 1: Medical student and resident sharing of personal information . Users who shared ... Medical Student Resident n % n % Field of study 264 82.0 24 60.0 Screenshot 258 80.1 24 60.0 Address 19 5.9 3 7.5 Sexual orientation 103 51.5 16 59.3 Relationship 118 59.0 15 55.6 Political view 103 51.5 11 40.7 Email 176 88.0 13 48.1 Messenger 88 44.0 6 22.2 Residence 65 32.5 7 25.9 Phone 13 6.5 4 14.8
Medical students use some Facebook features more than residents. The number of friends, photo albums, and groups joined within public Facebook accounts were measured and analyzed comparing medical students and residents. Table 2 summarizes the descriptive statistics comparing the two groups.
Table 2: Comparison of Facebook numbers by residents and medical students. Type N Mean Std. deviation Std. error mean Friends resident 27 24.04 40.55 7.80 medical student 200 140.81 152.72 10.80 Photo albums resident 27 1.11 3.29 .63 medical student 200 2.33 3.37 .248 Groups resident 27 3.30 5.27 1.01 medical student 200 12.22 15.19 1.07
An independent samples ttest measured the differences in the means. The mean difference of 116.7 more Friends for medical students (equal variances not assumed) was statistically significant (ρ<.01). The mean difference of the number of photo albums (1.21 more albums for medical students; equal variances assumed) was not statistically significant (ρ>.05). Finally, medical students having, on average, 8.91 more groups than residents (equal variances not assumed) was statistically significant (ρ<.01).
There are important relationships between the year of study of medical students and various Facebook features. Medical students in this study were described as being in Years 14. A Pearson Product Moment Correlation was run to compare the year of the student, the number of friends, the number of photo albums, and the number of groups subscribed to (see Table 3).
Table 3: Comparison of medical student use of various Facebook features.
Note: * Correlation is significant at the 0.05 level (2tailed).
** Correlation is significant at the 0.01 level (2tailed).
Year Friends Photo albums Groups Year Pearson correlation 1 -.487(**) -.127 -.279(**) Sig. (2tailed) .000 .056 .000 N 227 227 227 227 Friends Pearson correlation -.487(**) 1 .149(*) .598(**) Sig. (2tailed) .000 .024 .000 N 227 227 227 227 Photo albums Pearson correlation -.127 .149(*) 1 .175(**) Sig. (2tailed) .056 .024 .008 N 227 227 227 227 Groups Pearson correlation -.279(**) .598(**) .175(**) 1 Sig. (2tailed) .000 .000 .008 N 227 227 227 227
The year of the medical student had an indirect relationship with friends, photo albums, and groups. In other words, the earlier a student was in their program, the more likely they were to have more friends and photo albums. They were also more likely to have joined more groups. The correlations between year and friends (-.487; ρ<.01) and year and groups were significant (-.279; pρ<.01). One could have hypothesized that the longer you are in medical school the more friends you would make. One could also reason from our results that as you continued in your education, you would specialize and thus focus your area of engagement. It is also possible that students in earlier years are younger and perhaps more inclined to use these innovative tools.
Correlation analyses were also run on friends, photo albums, and groups. As can be expected, the more friends that medical students had, the more likely they were to have more photo albums (.149; ρ<.05) and have joined more groups (.598; ρ<.01). Finally, the more groups that someone belonged to, the more likely they were to have a higher number of photo albums (.175; ρ<.01).
Some of these outcomes are expected, and they point to a basic concept within social networking. In other words, the more you network online, the more features within social networking you will use (e.g., join groups, share pictures). However, these numbers are important because they point to another potential problem. Step one is for medical educators to teach existing users about professional uses of social networking tools. However, if medical students and residents who are current social network users then find professional uses, doesn’t the onus fall on medical educators to then work with those who do not currently use social networking tools?
A similar percentage of residents use Facebook across multiple residency programs. Facebook use within residency programs is fairly consistent. Use within programs range from 9.8 percent to 18.8 percent with two outliers. No resident participants in Obstetrics and Gynecology (OBGYN) (n=15) or Radiation Oncology (n=18) use Facebook. A summary of participation is available in Table 4.
Table 4: Summary of medical resident Facebook use by program. Account Yes No % Users ER 2 14 12.5 Family practice 4 20 16.7 Internal medicine 9 67 11.8 Neurology 1 8 11.1 Neurosurgery 3 13 18.8 OBGYN 0 15 0.0 Pathology 2 11 15.4 Pediatrics 10 47 17.5 Psychiatry 5 22 18.5 Radiation oncology 0 18 0.0 Surgery 4 37 9.8
Medical educators need to become more involved in electronic social networking. One of the major findings of this study is that medical students and residents are using Facebook. If students and residents are using this tool, educators need to examine how they can proactively use such sites to teach about professionalism. This could include both discussion and mentoring. Wear and Kuczewski (2004) suggest that the academic environment must use dialogue to construct a theory of professionalism. In other words, if medical students and residents are making use of this tool, it needs to become part of public discourse so that students can understand the implications of their own postings.
In terms of mentoring and professionalism, role modeling has been discussed as the teaching method that most residents preferred (Ratanawongsa, et al., 2006). As such, medical educators need to examine their own practice, focusing specifically on social networking. This could include setting up their own Facebook or MySpace account to better understand how such online environments work.
Medical students, residents, and educators need to understand the professionalism associated with sharing private information publicly. In this information age, it is relatively easy to look up someone’s name, address, and phone number. However, certain information is kept private unless revealed by the owner of that information. Medical students and residents need to have open conversations with educators about the outcomes on their current and future practice of sharing sexual orientation, relationship status, political views, and other personal information.
Having said that, medical education is a very timeconsuming life choice. Posting on MySpace or Facebook is not unprofessional — in and of itself nor is finding friends or future partners online. Medical students and residents should not be punished for taking part in these activities. An open conversation will help delineate positive and negative uses and outcomes of public vs. private online social networking.
Additional research needs to be done in this area. If medical students and residents are using social networking tools, we need more research to learn more about of who is using Facebook and how they are using it. Why are an equal number of medical student Facebook users female, and yet such a small percentage of residents are? Why are there such a low percentage of residents using Facebook compared to medical students? Are residents using other networking tools like MySpace or are they avoiding online social networking? Why do certain resident groups like OBGYN and Radiation Oncology not seem to use Facebook?
Papadakis, et al. (2005) find that physicians in training who engaged in unprofessional behavior are more likely to be disciplined by a medical board as a practicing physician. Mareiniss (2004) has suggested that unprofessional behavior may be correlated with burnout. And, according to Mareiniss (2004), stress through abusive treatment, financial concerns, and uncertainty may lead to unprofessional behavior. Therefore, an interesting research question is whether Facebook and MySpace could be used as a predictor of burnout. If unprofessional behavior is noted, an educator may be able to use that as an indicator of a need for intervention. Or, perhaps students and residents are using Facebook as a way to release some of that stress.
Perhaps most importantly, the purpose of this study was to determine if medical students and residents use of Facebook and to paint a portrait of the information they share. Further research should examine the content of the groups and photos that are being shared as they have direct implications for teaching about professionalism. Figures 1 and 2 document two screenshots from medical students and residents used in our study.
Figure 1: Screenshot from one of the participants.
Figure 2: Screenshot from one of the participants.
Medical students in our study were also part of various groups. The following is a list of groups that students and residents in our study were a part of:
- I don’t need sex cause grad school f***s me everyday
- Keep your f***ing hand down in lecture and shut the f*** up
- Neurologists are sexy
- Party of Important Male Physicians (PIMP)
- Physicians looking for trophy wives in training
- Med School Mafia!
- I should have gone to a blacker college
It needs to be clearly stated that we are not suggesting content analyses would reveal total unprofessional uses of Facebook. Many medical students and residents use Facebook to share pictures with distant family members. Others join a variety of groups to support peace or Virginia Tech victims. However, the fact that even some of the medical students and residents joined groups like the aforementioned or had images of questionable taste for their screenshots says something important about the use of Facebook in medical education.
Many medical students consider professionalism an important aspect of their daily work (Ratanawongsa, et al., 2006). Yet, only a small proportion of medical students in a recent study reported they were adequately prepared in the areas of professionalism and ethics (Roberts, et al., 2004). The findings from this study suggest medical students may be even more poorly prepared than they realize. Many medical students seem unaware of or unconcerned with the possible ramifications of sharing personal information in publicly available online profiles even though such information could affect their professional lives. Thus, this study provides preliminary evidence that online tools such as social networking communities should become a part of the dialogue related to preparing future physicians to meet the ACGME professionalism competency.
About the authors
Richard E. Ferdig is an Associate Professor of Educational Technology at the University of Florida’s College of Education. His research interests focus on educational gaming, the uses of innovative media for teaching and learning, virtual and online education, and what he calls a deeper psychology of technology. He graduated from Calvin College with a B.A. in Psychology and from Michigan State University with a M.A. in Educational Psychology. He received his Ph.D. from Michigan State University in Educational Psychology. At UF, he codirects the facetoface and online graduate programs in Educational Technology. Direct comments to rferdig [at] ufl [dot] edu
Kara Dawson is an Associate Professor of Educational Technology in the School of Teaching and Learning at the University of Florida (UF). Her research relates to investigating innovative ways in which technology supports teaching and learning processes. She graduated from Edinboro University of Pennsylvania with a B.A. in Education and a M.A. in Education/Educational Technology. She received her Ph.D. in Instructional Technology from the University of Virginia. At UF, she currently serves as program coordinator for the facetoface and online Educational Technology programs.
Erik W. Black is a Doctoral Fellow and Ph.D. Candidate in Educational Technology at the University of Florida’s College of Education. His research blends contemporary psychological and pedagogical theory in the analysis of quantitative data derived from technology rich environments. Mr. Black received a B.S. in Marketing Management from Virginia Tech and an M.A. in Human Services from the College of New Jersey.
Nicole M. Paradise Black is a Clinical Assistant Professor of Pediatrics at the University of Florida’s College of Medicine. In addition to her work as a Pediatric Hospitalist at Shands Childrens Hospital, she is the associate residency director of the UF Pediatric Residency Program. A graduate of the College of William and Mary and Georgetown Universitys College of Medicine, Dr. Blacks research interests include the use of simulation in medical education and the educational impact of bedside teaching and familycentered rounds.
Lindsay A. Thompson is an Assistant Professor of Pediatrics at the University of Florida’s College of Medicine and a health services researcher who specializes in outcomes in medical education and racial and ethnic disparities in pediatric health care. She earned an A.B. from Brown University, a medical degree from Dartmouth Medical School and received an M.S. in Biostatics while engaged in her residency program at Dartmouth. She is currently collaborating with the College of Education to investigate the effects of contemporary media on childhood health.
1. ACGME, 2007, p. 2.
2. This information is available publicly even if the account is listed as private. Therefore, the percentages are taken out of 362 total users.
3. Percentages for field of study, screenshot, and address are calculated using all Facebook users (medical students, n=322; residents, n=40). The remainder of the variables were only observable on public accounts (medical students, n=200; residents, n=27).
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Paper received 9 April 2008; accepted 10 August 2008.
Copyright © 2008, First Monday.
Copyright © Richard E. Ferdig 2008 All Rights Reserved.
Medical students’ and residents use of online social networking tools: Implications for teaching professionalism in medical education
by Richard E. Ferdig, Kara Dawson, Erik W. Black, Nicole M. Paradise Black, and Lindsay A. Thompson
First Monday, Volume 13 Number 9 - 1 September 2008
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