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Graduating student pharmacists’ perspectives on e-professionalism and social media: Qualitative findings Genevieve Lynn Ness, Amy Heck Sheehan, and Margie E. Snyder
Received June 19, 2013, and in revised form September 6, 2013. Accepted for publication October 23, 2013.
Abstract Objective: To characterize students’ views and opinions of professionalism on popular social media sites and compare responses about social media behavior among students in different groups. Design: Cross-sectional survey. Setting: Four colleges of pharmacy in midwestern United States. Participants: 516 graduating student pharmacists. Interventions: Online survey with open-ended questions. Main outcome measures: Qualitative analysis of responses and themes. Results: A total of 212 student pharmacists completed surveys (41% response rate). Mean (± SD) age was 25.2 ± 4.6 years, and 72% of respondents were women. Major overarching themes identified in the qualitative analysis were separation of personal and professional lives, how accountability for actions should vary by severity, and the extent of representation of the students’ character on social media. Conclusion: Identified themes provided important insights into the ways in which student pharmacists view social media and use this widely accessible means of personal communication. Keywords: Social media, student pharmacists, e-professionalism, social networking, qualitative analysis. J Am Pharm Assoc. 2014;54:138–143. doi: 10.1331/JAPhA.2014.13188
Genevieve Lynn Ness, PharmD, is Associate Director, Christy Houston Foundation Drug Information Center, and Assistant Professor of Pharmaceutical, Social and Administrative Sciences, Belmont University College of Pharmacy, Nashville, TN; at the time of the research, she was Regulatory Pharmaceutical Fellow in Drug Information, Purdue University, Eli Lilly and Company, and the Food and Drug Administration. Amy Heck Sheehan, PharmD, is Associate Professor of Pharmacy Practice, and Margie E. Snyder, PharmD, MPH, is Assistant Professor of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN Correspondence: Genevieve Lynn Ness, PharmD, College of Pharmacy, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Funding: Dr. Snyder’s effort was supported in part by KL2RR025760 (A. Shekhar, principal investigator), National Institutes of Health, and a portion of Dr. Snyder’s effort was supported by grant number K08HS022119 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Dr. Ness and Dr. Sheehan’s efforts were supported in part by the Gloria Niemeyer Francke Grant Program from the Department of Pharmacy Practice, Purdue University College of Pharmacy. Previous presentations: Quantitative but not qualitative results presented at the Great Lakes Pharmacy Residency Conference, West Lafayette, IN, April 26, 2012; American Association of Colleges of Pharmacy Annual Meeting, Kissimmee, FL, July 16, 2012; and American Society of HealthSystem Pharmacy Midyear Clinical Meeting, Las Vegas, NV, December 4, 2012.
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E
-professionalism is “the attitudes and behaviors (some of which may occur in private settings) reflecting traditional professionalism paradigms that are manifested through digital media.”1 This is particularly important for health care professional students engaging in social media. Several studies have examined this issue.2–8 In one focus group study, medical students said they understood the importance of maintaining patient privacy online; however, there were differences among student responses in regard to what they defined as inappropriate behavior.9 While understanding medical students’ views is critical, pharmacy schools have reported using social media within the classroom, resulting in a much-needed understanding of student pharmacists’ views of e-professionalism.10–13 Our research question (“How do graduating student pharmacists view e-professionalism?”) was assessed using an embedded mixed-methods approach to enable an in-depth exploration into these attitudes and provide an opportunity for explanation of quantitative findings by examining qualitative findings.14
At a Glance Synopsis: This survey of 212 graduating student pharmacists at four midwestern colleges of pharmacy shows how social media are being used and examines students’ attitudes and behaviors during engagement in these sites.. Qualitative analysis of open-ended survey responses reveals 11 overarching themes: separation of personal and professional lives, use of different social media for personal and professional purposes, consideration of the levels of behavior severity, the idea that information is public and accessible to all, “cleaning up” profiles, limiting posted content can create an incomplete picture of a person, posted content could be representative of one’s true character, patients and employers can be affected by student pharmacists’ posted content, social media can be used as “evidence” of unprofessional or illegal acts, general societal norms apply to social media, and profiles can be old or outdated. Analysis: Social media is a popular way for individuals to connect with friends, but professionalism on these sites is a concern. The themes identified in this analysis provide important insights into ways student pharmacists view and use social media. The findings may inform educational programs aimed at reducing inappropriate uses of social media and serve as the foundation of future research.
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Objectives The objectives of this study were to determine the use patterns of social media among student pharmacists completing their advanced pharmacy practice experiences, reveal students’ views and opinions of professionalism on popular social media sites, and compare responses about social media behavior among students seeking different types of employment.15 Our qualitative findings (addressing the second and third objectives) are described in this report.
Methods Recruitment and inclusion criteria for this study were described in detail previously.15 Briefly, the investigators modified a survey instrument developed by Cain et al. to include questions concerning students’ attitudes on e-professionalism during their search for postgraduate opportunities.2 The survey was pilot-tested on paper with 85 second-professional-year student pharmacists. In November 2011, following minor revisions, all graduating student pharmacists at Purdue University (n = 147), The University of Findlay (n = 60), Butler University (n = 117), and Midwestern University (Illinois campus, n = 192) received an e-mail inviting completion (using the Qualtrics software) of the 39-question survey instrument (see Appendix 1, supplemental content available on JAPhA.org). The survey included 14 open-ended questions collecting students’ rationales for responses to yes/no questions; questions could also be left blank. The recruitment e-mail message stated that the purpose of the survey was to “evaluate the use of social media and attitudes of e-professionalism.” The online survey was open for 3 weeks, with reminders sent out weekly to encourage responses. Respondents could enter their contact information separately from their responses to be entered into a drawing for a $25 gift card. Responses were anonymous, and the project received approval from the Purdue University, The University of Findlay, Butler University, and Midwestern University Institutional Review Boards. Qualitative analysis was conducted using MAXQDA10 to categorize responses and identify themes. Using an inductive coding process, two researchers independently read student responses and developed draft conceptual codes. The investigators discussed and reached consensus on the codes before independently applying them to responses. Coding decisions were then compared and discrepancies resolved through discussion. This process was repeated for subcoding. The investigators kept an audit trail of the analysis process and maintained a corresponding code dictionary. These procedures were followed for responses to each openended question separately. Themes identified for each question were then examined to identify “overarching themes” noted across responses to different items. j apha.org
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Table 1. Characteristics of respondents to social media survey (n = 212)15 Category Previous Degree (n = 169) Type of degree currently held (n = 53) Baccalaureate Masters Other Plans after graduation (n = 170) Community pharmacist Residency Hospital pharmacist Other Fellowship Consultant pharmacist Pharmaceutical industry
n (%) 52 (31) 46 (87) 4 (8) 3 (6) 71 (42) 63 (37) 15 (9) 12 (7) 5 (3) 3 (2) 1 (1)
Finally, the investigators examined and explained differences among groups in the quantitative analyses by comparing patterns of coding that emerged through the qualitative analysis, which has been published previously.15 Quantitative analysis was conducted using SPSS version 19 software, and comparisons between groups were analyzed using the Pearson’s chi-square statistical test accompanied by the Bonferroni adjustment for post hoc pairwise tests to control for multiple comparisons.15 Subgroups compared in the quantitative analysis and further analyzed in the qualitative analysis were based on type of employment, gender, and age.15
Results Overall, a 41% response rate (n = 212) was achieved. Respondents had an average age of 25.2 ± 4.6 years and 72% were mostly women (Table 1). The following summaries of responses to each open-ended question are organized by question topic. The parenthetical “n” indicates the number of students who provided responses. Some representative quotations are also provided. Reasons for not having a social media profile (n = 12) As reported in the quantitative findings, 7% of students reported not having active social media profiles.15 Common reasons included privacy and professionalism concerns, general communication preferences (e.g., prefer to connect with friends via telephone), and time constraints. Definition of e-professionalism (n = 144) Student respondents defined terms related to this survey subject, including the technology involved (e.g., “Internet” or “social media”) and those affected by its use, such as colleges or employers. Students also described 140 JAPhA | 5 4 :2 | M AR/AP R 2014
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such unprofessional online behavior as using profanity or making references to alcohol or drugs. In addition, students discussed general components of e-professionalism, including maintaining professional standards whether in person or online. Accountability for illegal acts discovered through social media (n = 136) The majority of respondents believed that online information is “public” and “illegal is illegal,” regardless of how any illegal acts are discovered, as expressed by this respondent: “If a student allows evidence of illegal activity to be posted online…[he or she] should be held accountable, just as if someone found a picture/hard copy of illegal evidence….” Some students expressed a need for “evidence” of illegal acts outside of what is posted on social media sites, as well as a need to define the extent to which site postings could be used as evidence. While some believed that information posted on a social media site could be used as a starting point for an investigation or inquiry, the majority believed that such information would suffice as evidence. The majority of students reported that employers should hold their employees accountable for illegal acts described on social media sites. Students wrote that accountability should depend on the severity of an illegal act and when it occurred. Accountability for unprofessional acts discovered through social media (n = 129) The majority of respondents believed that professionals have the right to a personal life and that nonwork activities should not be used to gauge professionalism. A smaller number of respondents expressed that students and pharmacists should maintain professionalism in all aspects of their lives. Students wrote that accountability should be attributed to schools, employers, patients, themselves, and the profession as a whole. Students also discussed how one’s definition of “unprofessional” might vary. Some students suggested specific methods for preventing accusations of unprofessional behavior (e.g., privacy settings). Additionally, students distinguished between illegal and unprofessional acts. “Unprofessional behavior is disappointing but should not be punished,” wrote one respondent. Students were conflicted regarding the need for evidence beyond what is posted on a social media site. Opinions regarding employers researching (n = 98) and considering (n = 117) candidates’ social media profiles when making hiring decisions Many respondents believed that the employer review of social media sites is justified because what is posted on such sites represents one’s “true character.” “Actions speak louder than words,” said one student. “All social media actions are a reflection of the character and personality of that person.” Other students expressed that Journal of the American Pharmacists Association
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Table 2. Overarching themes identified in qualitative analysis of student pharmacist responses about social media and e-professionalism (n = 212) 1. 2.
Separation between personal and professional lives Use of different types of social media (e.g., Facebook for personal, LinkedIn for professional) 3. Consideration of the levels of behavior “severity” 4. Information presented is public and accessible to everyone 5. Student “cleaning up” their profiles to eliminate inappropriate content 6. Limiting posted content can create an incomplete picture of an individual 7. Representative of an individual’s true character 8. Various stakeholders (e.g., patients, employers) are affected by information posted 9. Use of social media for “evidence” of either unprofessional or illegal acts 10. General societal norms (e.g., professional behavior) apply while accessing social media 11. Presence of old or outdated material on personal profiles
their online profiles are for personal use and should not be considered by employers, while some believed this depends on what is revealed and discovered. For example, if the information posted on a social media site is illegal or could affect the privacy/safety of patients, it should be taken into account by a potential employer. Respondents noted that Internet postings are inherently public, with the exception of information marked as “private” (i.e., only for “friends” or “followers”). Accordingly, some respondents discussed the need to be responsible in all instances of social media use (e.g., never post personal information or always use privacy settings.) Other respondents expressed that while employers have the right to review candidates’ online profiles before making hiring decisions, employees’ work performance should be the sole consideration once hired. Discrimination was also a concern. “Someone’s social media profile may contain information which is not appropriate to ask about in a job interview (religious beliefs, sexual orientation, marital status, etc.),” wrote one respondent. Along the same lines, some students wrote that job applicants have the right to privacy on social media sites and are entitled to their personal lives. Profile edits before interviews or career fairs (n = 41) Some student pharmacists reported planning to make changes to their social media sites before the Midyear Clinical Meeting of the American Society of HealthSystem Pharmacists (ASHP) (where many contacts are made for residencies and other positions) or upcoming career fairs. These respondents reported they intended to focus on general cleanup (e.g., “untagging” photos) or the use of privacy settings. Others expressed plans to delete their profiles or make them unsearchable. Lastly, Journal of the American Pharmacists Association
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some wrote they would only display positive information about themselves (i.e., as a marketing tool.) Use of privacy settings (n = 139) The majority of respondents reported limiting their profile view to “friends,” with some limiting the view to just themselves. Others chose to block certain “friends” from access to specific content or to prevent their names from being searched. Students also compared their use of privacy settings on different types of social media sites (e.g., Facebook, LinkedIn), with some expressing concern about the available options. Social media profile representation of students as individuals (n = 103) and professionals (n = 114) Most respondents believed their profiles accurately portrayed who they are as a person, but some felt the accuracy depended on the type of social media site (i.e., professional or personal). Many students reported accessing social media solely for personal entertainment. In addition, some students expressed that their professional image should be judged only by personal interactions. Others said they filter for appropriateness the information that they and their friends post. Even those students who post a large amount of personal information said they do not believe it presents a complete picture of who they are. Social media’s effect on public opinion of students as health care professionals (n = 95) Numerous students reported that information presented on social media sites could affect the public’s opinion of them as professionals. A few respondents also provided examples of negative behavior on social media sites that could change the public’s opinion of them, while others believed the public should not make judgments based on information discovered via social media but rather from opinions based on personal interactions. Many students reported not posting questionable material that could potentially change the public’s opinion of them. Providing information on social media that one would not want a potential employer to view (n = 79) Many students reported that they do not have inappropriate information posted on their social media sites. Some provided examples of the types of content they would not want viewed by a potential employer, with a few students reporting the protection of such information through the use of privacy settings. Others noted that some material posted on their social media sites is no longer representative of who they are today. “Unfortunately, especially when I was in my first year or so of college, I did not really think much about employers viewing my pages,” wrote one respondent.
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Overarching themes Major overarching themes were evident within the open-ended responses to this survey (Table 2). Comparative analysis: Type of employment As reported previously, more students pursuing residencies planned changes to their social media profiles before career fairs or the ASHP Midyear Clinical Meeting than those planning to obtain a community pharmacist position (residency: 47%, community: 22%, P = 0.003).15 Students planning to obtain residency positions reported they would delete their current social media profiles, while those pursuing community pharmacist positions emphasized a need to “clean up” their profiles (e.g., delete photos). Those students pursuing positions other than as community pharmacists or residents were more focused on discussing privacy settings and made more comments about editing online profiles to emphasize their positive attributes. Comparative analysis: Gender More men than women students said that residency directors or supervisors should be able to research candidates online using social media information (men: 67%, women: 44%, P = 0.009).15 Comments emphasized that the information posted on such sites represents individuals’ “true character.” Only men students made any statements concerning employer or applicant “rights” as related to social media use. Additionally, more men than women discussed issues of discrimination. Men students also placed greater emphasis on making a distinction between professional and personal lives. Some women respondents believed that employers should be allowed to consider social media profile information, but not as the sole determinant in making hiring decisions. Other women stressed that candidates should only be evaluated on their interviews. Comparative analysis: Age More students younger than 25 planned profile changes before career fairs or the ASHP Midyear Clinical Meeting than students aged 25 and older (younger: 37%, older: 19%, P = 0.03).15 Approximately one-half of students reported the intent to “clean up” their profiles, but with plans to do so in different ways. Younger students were more likely to remove comments or delete their profiles, while older students mentioned deleting photos and implementing new privacy settings.
Discussion Student pharmacists reported similarities to medical students such as planning to step up the use of privacy settings and other online protection techniques when searching for employment.9 Despite these measures, medical and pharmacy students still reported plans to proceed with caution in using social media. 142 JAPhA | 5 4 :2 | M AR/AP R 2014
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This work provides a foundation for additional research. Those who employ recent graduates can use these results to justify the need for new policies and educational training related to social media. Students are the future; identifying their outlook on such issues is essential. Future research should assess students’ attitudes about e-professionalism at different levels of pharmacy school. It may also prove beneficial to compare the responses of students from institutions that implement social media policies with those of students attending schools that lack such policies, as well as to compare the responses of health care professional students to those of students pursuing other degrees.
Limitations This research does have some limitations. The authors’ professional backgrounds may have influenced the interpretation of results. The investigators also did not identify respondents’ institutions; therefore, any variations across schools are unknown. The majority of the respondents were women; therefore, generalizability to men is limited. Finally, as data were collected via a crosssectional survey in only four schools of pharmacy, additional themes could have emerged in surveying more students.
Conclusion Identified themes provide important insights into the ways in which student pharmacists view social media. These findings may inform educational programs aimed at reducing inappropriate social media use and serve as a foundation for future research. References 1. Cain J, Romanelli F. E-professionalism: a new paradigm for a digital age. Curr Pharm Teach Learn. 2009;1(2):66–79. 2. Cain J, Scott DR, Akers P. Pharmacy students’ Facebook activity and opinions regarding accountability and e-professionalism. Am J Pharm Educ. 2009;73(6):104. 3. Cain J, Fink JL. Legal and ethical issues regarding social media and pharmacy education. Am J Pharm Educ. 2010;74(10):184. 4. Cain J. Social media in health care: the case for organizational policy and employee education. Am J Health Syst Pharm. 2011;68(11):1036–1040. 5. Giordano C, Giordano C. Health professions students’ use of social media. J Allied Health. 2011;40(2):78–81. 6. MacDonald J, Sohn S, Ellis P. Privacy, professionalism, and Facebook: a dilemma for young doctors. Med Educ. 2010;44(8):805–813. 7. Hall M, Hanna LE, Huey G. Use and views on social networking sites of pharmacy students in the United Kingdom. Am J Pharm Educ. 2013;77(1):9. 8. Lie D, Trial J, Schaff P, Wallace R, Elliott D. “Being the best we can be”: medical students’ reflections on physician responsibility in the social media era. Acad Med. 2013;88(2):240–245.
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9. Chretien KC, Goldman EF, Beckman L, Kind, T. It’s your own risk: medical students’ perspectives on online professionalism. Acad Med. 2010;85(10 suppl):S68-S71. 10. DiVall MV, Kirwin JL. Using Facebook to facilitate course-related discussion between students and faculty members. Am J Pharm Educ. 2012;76(2):32. 11. Estus EL. Using Facebook within a geriatric pharmacotherapy course. Am J Pharm Educ. 2010;74(8):145. 12. Vincent AH, Weber ZA. Using Facebook within a pharmacy elective course. Am J Pharm Educ. 2011;75(1):13c.
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13. Cain J, Policastri A. Using Facebook as an informal learning environment. Am J Pharm Educ. 2011;75(10):207. 14. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications; 2007. 15. Ness GL, Sheehan AH, Snyder ME, Jordan J, Cunningham JE, Gettig JP. Graduating student pharmacists’ perspectives on e-professionalism and social media. Am J Pharm Educ. 2013;77(7):146.
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Graduating student pharmacists’ perspectives on e-professionalism and social media: Qualitative findings Genevieve Lynn Ness, Amy Heck Sheehan, and Margie E. Snyder
Received June 19, 2013, and in revised form September 6, 2013. Accepted for publication October 23, 2013.
Abstract Objective: To characterize students’ views and opinions of professionalism on popular social media sites and compare responses about social media behavior among students in different groups. Design: Cross-sectional survey. Setting: Four colleges of pharmacy in midwestern United States. Participants: 516 graduating student pharmacists. Interventions: Online survey with open-ended questions. Main outcome measures: Qualitative analysis of responses and themes. Results: A total of 212 student pharmacists completed surveys (41% response rate). Mean (± SD) age was 25.2 ± 4.6 years, and 72% of respondents were women. Major overarching themes identified in the qualitative analysis were separation of personal and professional lives, how accountability for actions should vary by severity, and the extent of representation of the students’ character on social media. Conclusion: Identified themes provided important insights into the ways in which student pharmacists view social media and use this widely accessible means of personal communication. Keywords: Social media, student pharmacists, e-professionalism, social networking, qualitative analysis. J Am Pharm Assoc. 2014;54:138–143. doi: 10.1331/JAPhA.2014.13188
Genevieve Lynn Ness, PharmD, is Associate Director, Christy Houston Foundation Drug Information Center, and Assistant Professor of Pharmaceutical, Social and Administrative Sciences, Belmont University College of Pharmacy, Nashville, TN; at the time of the research, she was Regulatory Pharmaceutical Fellow in Drug Information, Purdue University, Eli Lilly and Company, and the Food and Drug Administration. Amy Heck Sheehan, PharmD, is Associate Professor of Pharmacy Practice, and Margie E. Snyder, PharmD, MPH, is Assistant Professor of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN Correspondence: Genevieve Lynn Ness, PharmD, College of Pharmacy, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212. E-mail: [email protected] Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Funding: Dr. Snyder’s effort was supported in part by KL2RR025760 (A. Shekhar, principal investigator), National Institutes of Health, and a portion of Dr. Snyder’s effort was supported by grant number K08HS022119 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Dr. Ness and Dr. Sheehan’s efforts were supported in part by the Gloria Niemeyer Francke Grant Program from the Department of Pharmacy Practice, Purdue University College of Pharmacy. Previous presentations: Quantitative but not qualitative results presented at the Great Lakes Pharmacy Residency Conference, West Lafayette, IN, April 26, 2012; American Association of Colleges of Pharmacy Annual Meeting, Kissimmee, FL, July 16, 2012; and American Society of HealthSystem Pharmacy Midyear Clinical Meeting, Las Vegas, NV, December 4, 2012.
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E
-professionalism is “the attitudes and behaviors (some of which may occur in private settings) reflecting traditional professionalism paradigms that are manifested through digital media.”1 This is particularly important for health care professional students engaging in social media. Several studies have examined this issue.2–8 In one focus group study, medical students said they understood the importance of maintaining patient privacy online; however, there were differences among student responses in regard to what they defined as inappropriate behavior.9 While understanding medical students’ views is critical, pharmacy schools have reported using social media within the classroom, resulting in a much-needed understanding of student pharmacists’ views of e-professionalism.10–13 Our research question (“How do graduating student pharmacists view e-professionalism?”) was assessed using an embedded mixed-methods approach to enable an in-depth exploration into these attitudes and provide an opportunity for explanation of quantitative findings by examining qualitative findings.14
At a Glance Synopsis: This survey of 212 graduating student pharmacists at four midwestern colleges of pharmacy shows how social media are being used and examines students’ attitudes and behaviors during engagement in these sites.. Qualitative analysis of open-ended survey responses reveals 11 overarching themes: separation of personal and professional lives, use of different social media for personal and professional purposes, consideration of the levels of behavior severity, the idea that information is public and accessible to all, “cleaning up” profiles, limiting posted content can create an incomplete picture of a person, posted content could be representative of one’s true character, patients and employers can be affected by student pharmacists’ posted content, social media can be used as “evidence” of unprofessional or illegal acts, general societal norms apply to social media, and profiles can be old or outdated. Analysis: Social media is a popular way for individuals to connect with friends, but professionalism on these sites is a concern. The themes identified in this analysis provide important insights into ways student pharmacists view and use social media. The findings may inform educational programs aimed at reducing inappropriate uses of social media and serve as the foundation of future research.
Journal of the American Pharmacists Association
RESEARCH
Objectives The objectives of this study were to determine the use patterns of social media among student pharmacists completing their advanced pharmacy practice experiences, reveal students’ views and opinions of professionalism on popular social media sites, and compare responses about social media behavior among students seeking different types of employment.15 Our qualitative findings (addressing the second and third objectives) are described in this report.
Methods Recruitment and inclusion criteria for this study were described in detail previously.15 Briefly, the investigators modified a survey instrument developed by Cain et al. to include questions concerning students’ attitudes on e-professionalism during their search for postgraduate opportunities.2 The survey was pilot-tested on paper with 85 second-professional-year student pharmacists. In November 2011, following minor revisions, all graduating student pharmacists at Purdue University (n = 147), The University of Findlay (n = 60), Butler University (n = 117), and Midwestern University (Illinois campus, n = 192) received an e-mail inviting completion (using the Qualtrics software) of the 39-question survey instrument (see Appendix 1, supplemental content available on JAPhA.org). The survey included 14 open-ended questions collecting students’ rationales for responses to yes/no questions; questions could also be left blank. The recruitment e-mail message stated that the purpose of the survey was to “evaluate the use of social media and attitudes of e-professionalism.” The online survey was open for 3 weeks, with reminders sent out weekly to encourage responses. Respondents could enter their contact information separately from their responses to be entered into a drawing for a $25 gift card. Responses were anonymous, and the project received approval from the Purdue University, The University of Findlay, Butler University, and Midwestern University Institutional Review Boards. Qualitative analysis was conducted using MAXQDA10 to categorize responses and identify themes. Using an inductive coding process, two researchers independently read student responses and developed draft conceptual codes. The investigators discussed and reached consensus on the codes before independently applying them to responses. Coding decisions were then compared and discrepancies resolved through discussion. This process was repeated for subcoding. The investigators kept an audit trail of the analysis process and maintained a corresponding code dictionary. These procedures were followed for responses to each openended question separately. Themes identified for each question were then examined to identify “overarching themes” noted across responses to different items. j apha.org
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Table 1. Characteristics of respondents to social media survey (n = 212)15 Category Previous Degree (n = 169) Type of degree currently held (n = 53) Baccalaureate Masters Other Plans after graduation (n = 170) Community pharmacist Residency Hospital pharmacist Other Fellowship Consultant pharmacist Pharmaceutical industry
n (%) 52 (31) 46 (87) 4 (8) 3 (6) 71 (42) 63 (37) 15 (9) 12 (7) 5 (3) 3 (2) 1 (1)
Finally, the investigators examined and explained differences among groups in the quantitative analyses by comparing patterns of coding that emerged through the qualitative analysis, which has been published previously.15 Quantitative analysis was conducted using SPSS version 19 software, and comparisons between groups were analyzed using the Pearson’s chi-square statistical test accompanied by the Bonferroni adjustment for post hoc pairwise tests to control for multiple comparisons.15 Subgroups compared in the quantitative analysis and further analyzed in the qualitative analysis were based on type of employment, gender, and age.15
Results Overall, a 41% response rate (n = 212) was achieved. Respondents had an average age of 25.2 ± 4.6 years and 72% were mostly women (Table 1). The following summaries of responses to each open-ended question are organized by question topic. The parenthetical “n” indicates the number of students who provided responses. Some representative quotations are also provided. Reasons for not having a social media profile (n = 12) As reported in the quantitative findings, 7% of students reported not having active social media profiles.15 Common reasons included privacy and professionalism concerns, general communication preferences (e.g., prefer to connect with friends via telephone), and time constraints. Definition of e-professionalism (n = 144) Student respondents defined terms related to this survey subject, including the technology involved (e.g., “Internet” or “social media”) and those affected by its use, such as colleges or employers. Students also described 140 JAPhA | 5 4 :2 | M AR/AP R 2014
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such unprofessional online behavior as using profanity or making references to alcohol or drugs. In addition, students discussed general components of e-professionalism, including maintaining professional standards whether in person or online. Accountability for illegal acts discovered through social media (n = 136) The majority of respondents believed that online information is “public” and “illegal is illegal,” regardless of how any illegal acts are discovered, as expressed by this respondent: “If a student allows evidence of illegal activity to be posted online…[he or she] should be held accountable, just as if someone found a picture/hard copy of illegal evidence….” Some students expressed a need for “evidence” of illegal acts outside of what is posted on social media sites, as well as a need to define the extent to which site postings could be used as evidence. While some believed that information posted on a social media site could be used as a starting point for an investigation or inquiry, the majority believed that such information would suffice as evidence. The majority of students reported that employers should hold their employees accountable for illegal acts described on social media sites. Students wrote that accountability should depend on the severity of an illegal act and when it occurred. Accountability for unprofessional acts discovered through social media (n = 129) The majority of respondents believed that professionals have the right to a personal life and that nonwork activities should not be used to gauge professionalism. A smaller number of respondents expressed that students and pharmacists should maintain professionalism in all aspects of their lives. Students wrote that accountability should be attributed to schools, employers, patients, themselves, and the profession as a whole. Students also discussed how one’s definition of “unprofessional” might vary. Some students suggested specific methods for preventing accusations of unprofessional behavior (e.g., privacy settings). Additionally, students distinguished between illegal and unprofessional acts. “Unprofessional behavior is disappointing but should not be punished,” wrote one respondent. Students were conflicted regarding the need for evidence beyond what is posted on a social media site. Opinions regarding employers researching (n = 98) and considering (n = 117) candidates’ social media profiles when making hiring decisions Many respondents believed that the employer review of social media sites is justified because what is posted on such sites represents one’s “true character.” “Actions speak louder than words,” said one student. “All social media actions are a reflection of the character and personality of that person.” Other students expressed that Journal of the American Pharmacists Association
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Table 2. Overarching themes identified in qualitative analysis of student pharmacist responses about social media and e-professionalism (n = 212) 1. 2.
Separation between personal and professional lives Use of different types of social media (e.g., Facebook for personal, LinkedIn for professional) 3. Consideration of the levels of behavior “severity” 4. Information presented is public and accessible to everyone 5. Student “cleaning up” their profiles to eliminate inappropriate content 6. Limiting posted content can create an incomplete picture of an individual 7. Representative of an individual’s true character 8. Various stakeholders (e.g., patients, employers) are affected by information posted 9. Use of social media for “evidence” of either unprofessional or illegal acts 10. General societal norms (e.g., professional behavior) apply while accessing social media 11. Presence of old or outdated material on personal profiles
their online profiles are for personal use and should not be considered by employers, while some believed this depends on what is revealed and discovered. For example, if the information posted on a social media site is illegal or could affect the privacy/safety of patients, it should be taken into account by a potential employer. Respondents noted that Internet postings are inherently public, with the exception of information marked as “private” (i.e., only for “friends” or “followers”). Accordingly, some respondents discussed the need to be responsible in all instances of social media use (e.g., never post personal information or always use privacy settings.) Other respondents expressed that while employers have the right to review candidates’ online profiles before making hiring decisions, employees’ work performance should be the sole consideration once hired. Discrimination was also a concern. “Someone’s social media profile may contain information which is not appropriate to ask about in a job interview (religious beliefs, sexual orientation, marital status, etc.),” wrote one respondent. Along the same lines, some students wrote that job applicants have the right to privacy on social media sites and are entitled to their personal lives. Profile edits before interviews or career fairs (n = 41) Some student pharmacists reported planning to make changes to their social media sites before the Midyear Clinical Meeting of the American Society of HealthSystem Pharmacists (ASHP) (where many contacts are made for residencies and other positions) or upcoming career fairs. These respondents reported they intended to focus on general cleanup (e.g., “untagging” photos) or the use of privacy settings. Others expressed plans to delete their profiles or make them unsearchable. Lastly, Journal of the American Pharmacists Association
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some wrote they would only display positive information about themselves (i.e., as a marketing tool.) Use of privacy settings (n = 139) The majority of respondents reported limiting their profile view to “friends,” with some limiting the view to just themselves. Others chose to block certain “friends” from access to specific content or to prevent their names from being searched. Students also compared their use of privacy settings on different types of social media sites (e.g., Facebook, LinkedIn), with some expressing concern about the available options. Social media profile representation of students as individuals (n = 103) and professionals (n = 114) Most respondents believed their profiles accurately portrayed who they are as a person, but some felt the accuracy depended on the type of social media site (i.e., professional or personal). Many students reported accessing social media solely for personal entertainment. In addition, some students expressed that their professional image should be judged only by personal interactions. Others said they filter for appropriateness the information that they and their friends post. Even those students who post a large amount of personal information said they do not believe it presents a complete picture of who they are. Social media’s effect on public opinion of students as health care professionals (n = 95) Numerous students reported that information presented on social media sites could affect the public’s opinion of them as professionals. A few respondents also provided examples of negative behavior on social media sites that could change the public’s opinion of them, while others believed the public should not make judgments based on information discovered via social media but rather from opinions based on personal interactions. Many students reported not posting questionable material that could potentially change the public’s opinion of them. Providing information on social media that one would not want a potential employer to view (n = 79) Many students reported that they do not have inappropriate information posted on their social media sites. Some provided examples of the types of content they would not want viewed by a potential employer, with a few students reporting the protection of such information through the use of privacy settings. Others noted that some material posted on their social media sites is no longer representative of who they are today. “Unfortunately, especially when I was in my first year or so of college, I did not really think much about employers viewing my pages,” wrote one respondent.
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Overarching themes Major overarching themes were evident within the open-ended responses to this survey (Table 2). Comparative analysis: Type of employment As reported previously, more students pursuing residencies planned changes to their social media profiles before career fairs or the ASHP Midyear Clinical Meeting than those planning to obtain a community pharmacist position (residency: 47%, community: 22%, P = 0.003).15 Students planning to obtain residency positions reported they would delete their current social media profiles, while those pursuing community pharmacist positions emphasized a need to “clean up” their profiles (e.g., delete photos). Those students pursuing positions other than as community pharmacists or residents were more focused on discussing privacy settings and made more comments about editing online profiles to emphasize their positive attributes. Comparative analysis: Gender More men than women students said that residency directors or supervisors should be able to research candidates online using social media information (men: 67%, women: 44%, P = 0.009).15 Comments emphasized that the information posted on such sites represents individuals’ “true character.” Only men students made any statements concerning employer or applicant “rights” as related to social media use. Additionally, more men than women discussed issues of discrimination. Men students also placed greater emphasis on making a distinction between professional and personal lives. Some women respondents believed that employers should be allowed to consider social media profile information, but not as the sole determinant in making hiring decisions. Other women stressed that candidates should only be evaluated on their interviews. Comparative analysis: Age More students younger than 25 planned profile changes before career fairs or the ASHP Midyear Clinical Meeting than students aged 25 and older (younger: 37%, older: 19%, P = 0.03).15 Approximately one-half of students reported the intent to “clean up” their profiles, but with plans to do so in different ways. Younger students were more likely to remove comments or delete their profiles, while older students mentioned deleting photos and implementing new privacy settings.
Discussion Student pharmacists reported similarities to medical students such as planning to step up the use of privacy settings and other online protection techniques when searching for employment.9 Despite these measures, medical and pharmacy students still reported plans to proceed with caution in using social media. 142 JAPhA | 5 4 :2 | M AR/AP R 2014
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This work provides a foundation for additional research. Those who employ recent graduates can use these results to justify the need for new policies and educational training related to social media. Students are the future; identifying their outlook on such issues is essential. Future research should assess students’ attitudes about e-professionalism at different levels of pharmacy school. It may also prove beneficial to compare the responses of students from institutions that implement social media policies with those of students attending schools that lack such policies, as well as to compare the responses of health care professional students to those of students pursuing other degrees.
Limitations This research does have some limitations. The authors’ professional backgrounds may have influenced the interpretation of results. The investigators also did not identify respondents’ institutions; therefore, any variations across schools are unknown. The majority of the respondents were women; therefore, generalizability to men is limited. Finally, as data were collected via a crosssectional survey in only four schools of pharmacy, additional themes could have emerged in surveying more students.
Conclusion Identified themes provide important insights into the ways in which student pharmacists view social media. These findings may inform educational programs aimed at reducing inappropriate social media use and serve as a foundation for future research. References 1. Cain J, Romanelli F. E-professionalism: a new paradigm for a digital age. Curr Pharm Teach Learn. 2009;1(2):66–79. 2. Cain J, Scott DR, Akers P. Pharmacy students’ Facebook activity and opinions regarding accountability and e-professionalism. Am J Pharm Educ. 2009;73(6):104. 3. Cain J, Fink JL. Legal and ethical issues regarding social media and pharmacy education. Am J Pharm Educ. 2010;74(10):184. 4. Cain J. Social media in health care: the case for organizational policy and employee education. Am J Health Syst Pharm. 2011;68(11):1036–1040. 5. Giordano C, Giordano C. Health professions students’ use of social media. J Allied Health. 2011;40(2):78–81. 6. MacDonald J, Sohn S, Ellis P. Privacy, professionalism, and Facebook: a dilemma for young doctors. Med Educ. 2010;44(8):805–813. 7. Hall M, Hanna LE, Huey G. Use and views on social networking sites of pharmacy students in the United Kingdom. Am J Pharm Educ. 2013;77(1):9. 8. Lie D, Trial J, Schaff P, Wallace R, Elliott D. “Being the best we can be”: medical students’ reflections on physician responsibility in the social media era. Acad Med. 2013;88(2):240–245.
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9. Chretien KC, Goldman EF, Beckman L, Kind, T. It’s your own risk: medical students’ perspectives on online professionalism. Acad Med. 2010;85(10 suppl):S68-S71. 10. DiVall MV, Kirwin JL. Using Facebook to facilitate course-related discussion between students and faculty members. Am J Pharm Educ. 2012;76(2):32. 11. Estus EL. Using Facebook within a geriatric pharmacotherapy course. Am J Pharm Educ. 2010;74(8):145. 12. Vincent AH, Weber ZA. Using Facebook within a pharmacy elective course. Am J Pharm Educ. 2011;75(1):13c.
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13. Cain J, Policastri A. Using Facebook as an informal learning environment. Am J Pharm Educ. 2011;75(10):207. 14. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications; 2007. 15. Ness GL, Sheehan AH, Snyder ME, Jordan J, Cunningham JE, Gettig JP. Graduating student pharmacists’ perspectives on e-professionalism and social media. Am J Pharm Educ. 2013;77(7):146.
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