E-learning & technology
Survey of medical students’ use of social media James Kang1, Hosnieh Djafari Marbini2, Prabir Patel2, Nicola Fawcett2 and Laurence Leaver1 1
Green Templeton College, University of Oxford, UK Oxford University Hospitals, NHS Trust, Oxford, UK
2
SUMMARY Background: Medical students are not sufficiently knowledgeable about the dangers of online social media, and education about how to use it responsibly may be beneficial. Methods: We conducted an online questionnaire to assess whether or not medical students in years 2–6 of study at the University of Oxford would intuitively know what doctors
should and should not do on social media. We also assessed whether the study intervention of sending out guidance about appropriate use of social media published by the UK General Medical Council (GMC) would improve students’ knowledge of how to use social media correctly. Results: We found that, although social media use was widespread among medical students, the
majority were unaware of GMC guidance on this issue. Administration of GMC guidance significantly improved the proportion of GMC-correct responses in four of 16 questionnaire items. Discussion: It is possible that educating medical students about the dangers of online social media, and how to use it appropriately, could be worthwhile.
Medical students are not sufficiently knowledgeable about the dangers of online social media
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 373
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11/12/2015 11:55:55 AM
Participants posted a mean of 5.28 times per week on social media websites, with 54 per cent having posted on medical topics
INTRODUCTION
T
he use of social media websites such as Facebook and Twitter has grown rapidly in recent years. Medical professionals and students who post opinions and upload personal material online can unintentionally create a negative online image of themselves, their colleagues or their patients, which may in turn adversely affect their professional standing. Therefore, it is important that medical students and doctors are aware of the potential risks associated with social media. The UK General Medical Council (GMC) recently published practical and ethical guidelines about the appropriate use of social media;1 however, it is uncertain how widely known these guidelines are among medical students. This study aimed to explore whether or not Oxford medical students were aware of the GMC guidelines on social media use, and whether they would intuitively know what doctors should and should not do when using social media. Their knowledge was re-assessed after sending out the GMC guidelines to all students in the study.
METHODS In October 2013, Oxford medical students from years 2–6 were invited by e–mail to complete an online questionnaire. The survey asked about the students’ awareness of the existence of the GMC guidelines. The questionnaire also sampled knowledge of the contents of the guidance by asking participants to label statements about responsible use of social media as either ‘true’ or ‘false’ according to the GMC guidelines (Table 1). Each statement was labelled as ‘true’ or ‘false’ according to the GMC guidance. All authors reviewed the questions and then decided whether each statement
was to be labelled as ‘true’ or ‘false’, according to the guidelines; the questions were then further reviewed by a consultant. Questionnaire items were only included in the final survey if all authors and the consultant agreed on the same ‘correct’ answer. Our study intervention, the GMC guidelines, was sent by e–mail to the medical students 1 week after the initial questionnaire was sent. Students were encouraged to read the guidelines before the survey was re-administered 1 week later, i.e. 2 weeks after the first questionnaire. The proportion of correct responses before and after the administration of the GMC guidelines was compared using the chi-squared test. To account for multiple comparisons, the p–value was set at 0.01. To incentivise participation in the study, all respondents were invited to take part in two prize draws for £100 of shopping vouchers. This study was approved by the University of Oxford Medical Sciences Inter-Divisional Research Ethics Committee. Gender and stage of training but no other identifiable information was held in coded information; however, participants choosing to be entered into the prize draw were required to provide an e–mail address. All participants gave informed consent. Permission to distribute the GMC guidelines was obtained from the Chair of the Education and Training Advisory Board and the Director of Education and Standards at the GMC.
RESULTS In all, 755 medical students were invited to take part in the study. The first survey received 213 responses (28% response rate), of which 212 completed the questionnaire. Survey–1
participants who had already read the GMC guidelines were excluded from analyses of the ‘true/false’ questions that explored their knowledge of the GMC guidelines. There were 115 responses to the second survey (a response rate of 15%). The responses of survey–2 participants who were not aware of the GMC guidelines were added to the survey–1 database for analyses of the ‘true/false’ questions. Not all participants answered every question. In survey 1, 95/212 (45%) respondents were female and 106/212 (50%) respondents were male, whereas 11/212 (5%) did not disclose their gender. Students were evenly distributed across all of the year groups studied. The majority (169/201, 84%) posted content on social media websites on at least a weekly basis. Participants posted a mean of 5.28 times per week (standard deviation 14.0) on social media websites, with 108/201 (54%) having posted on medical topics. Of 201 students, 104 (52%) were aware of GMC guidance, and of these, 18 (9%) had actually read the guidelines. Despite most students having not read the guidelines, or even being aware of their existence, many questions were answered correctly. The percentages of correctly answered questions ranged from 49 to 99 per cent (with a median of 83.5%). There was no difference in response between year groups. In survey 2, there was a significant improvement in awareness of the guidelines, with 103/111 (93%) participants having read the guidance. Despite a high proportion of correct responses for most questions in survey 1, a significant increase in the proportion of correct answers occurred for four of 16 questions that evaluated knowledge of the content of the GMC guidelines (Table 2).
374 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377
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Table 1. List of ‘true/false’ questions and answers Question: Please mark the following question as ‘true’ or ‘false’.
‘Correct’ answer (in accordance with GMC guidance)
1. Patients, employers and potential employers may be able to access your personal information
‘True’
2. It is illegal for employers to access personal information of employees and potential employees on social media
‘False’
3. Career prospects have been put at risk through unintentional disclosure of personal information on social media
‘True’
4. The standards expected of doctors are the same through social media as in traditional media and face-to-face contact
‘True’
5. Interaction with patients using social media is acceptable if a private profile page is used and their medical condition is not discussed
‘False’
6. Discussion of individual patient matters in online forums is acceptable if the patients are anonymised
‘False’
7. The management of specific patients can be posted online but only in forums accessible exclusive to qualified medical practitioners
‘False’
8. Professional matters should never be discussed in private profile pages
‘True’
9. Electronic consultations can be made on social media, provided private profile pages are used
‘False’
10. Individuals should identify themselves when expressing opinions as a medical professional online
‘True’
11. Anonymous opinions should not be posted online as from a qualified medical professional
‘True’
12. Doctors should always declare conflicts of interest when professional opinions are posted online, in exactly the same way as when these opinions are put in print
‘True’
13. Postings referring to individuals or organisations are not subject to the same defamation laws as written or verbal communications, as long as the postings are anonymous
‘False’
14. Postings on social media are not subject to the same copyright laws as communications in print, as long as the postings are anonymous
‘False’
15. Statements made by medical professionals on social media websites are not legally binding in the same way as statements made in print
‘False’
DISCUSSION Concerns have been raised about the possibility of medical students and doctors publishing unprofessional content online that may violate patient privacy or reflect negatively on individuals, institutions and the medical profession in general.2,3 Inappropriate online behaviour by medical professionals has been reported in the British press. A nurse was sacked after making comments about patients and co–workers.4 In a separate incident, a Scottish junior doctor was suspended
over remarks made about a senior colleague on a doctors’ online forum.5 Although online activity that breaches patient confidentiality is clearly unprofessional, other actions may be more ambiguous, particularly if written outside of work and intended as private communications. The possible blurring of boundaries between personal and professional lives is of concern. Medical students may be at greater risk of engaging in unprofessional activity online
Medical students may be at greater risk of engaging in unprofessional activity online compared with qualified doctors
compared with qualified doctors. Many have grown up using various social media, and risk posting inappropriate content by continuing online habits from their pre-professional lives. Personally identifiable information was listed in 83 per cent of student and resident accounts at a medical school in the USA, with only one-third of the accounts set as private, and some had published potentially unprofessional material.3 Chretian et al. surveyed 78 US medical school deans about inappropriate online activity by medical students: almost two-thirds of the deans
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 375
tct_12320.indd 375
11/12/2015 11:55:56 AM
The majority [of medical students] were unaware of GMC guidance on this issue
Table 2. Proportion of responses that were ‘correct’ according to the GMC guidelines, before and after administration of guidance Proportion of ‘correct’ responses (in accordance with GMC guidance)
P-value
Survey 1
Survey 2
1
162/190 (85%)
101/102 (99%)
0.000
2
179/189 (95%)
101/102 (99%)
0.066
3
185/186 (99%)
100/102 (98%)
0.255
4
171/187 (91%)
99/102 (97%)
0.066
5
150/186 (81%)
73/102 (72%)
0.078
6
141/187 (75%)
87/102 (85%)
0.049
7
90/184 (49%)
46/102 (45%)
0.536
8
136/183 (74%)
79/101 (78%)
0.463
9
150/183 (82%)
78/102 (77%)
0.266
10
165/182 (91%)
84/102 (82%)
0.041
11
110/181 (61%)
96/102 (94%)
0.000
12
138/181 (76%)
91/102 (89%)
0.008
13
169/181 (93%)
102/104 (98%)
0.077
14
166/181 (92%)
101/102 (99%)
0.011
15
156/180 (87%)
97/101 (96%)
0.012
16
142/180 (79%)
93/102 (91%)
0.008
reported incidents of unprofessional postings, whereas just 13 per cent reported breaches of patient confidentiality.6 Garner and O’Sullivan conducted a survey of UK medical students: 52 per cent of respondents had posted photos on Facebook that they considered to be embarrassing, and 54 per cent reported that they had seen unprofessional behaviour by their colleagues on Facebook.7 What constitutes unprofessional online behaviour is not clearly defined, and opinion may vary between students and doctors. An online survey of US medical students, doctors and non-medical personnel asked participants to rate the appropriateness of screenshots of mock medical students’ Facebook profiles. Compared with medical students, doctors and non-health care staff judged the images as
being significantly less appropriate.8 Osman et al. revealed differing opinions when they asked UK medical students, foundation doctors, registrars and consultants about how much they agreed with a series of statements on online behaviour and professionalism. For example, 45 per cent of medical students compared with only 17 per cent of registrars or consultants agreed that what happens on Facebook is separate from what happens at the medical school or hospital.9 Therefore, medical students are insufficiently knowledgeable about the dangers of online social media, and should be educated about how to use it responsibly. There is currently no teaching about professional social media use in the Oxford University curriculum. The present study is limited by the small number of
respondents, which prevented extensive subgroup analyses. There is also the possibility of responder bias, with participants perhaps more likely to have greater experience or concern than those who did not respond. The study was conducted at just a single institution; however, we have no reason to believe that students at other UK medical schools would have different patterns of social media use or attitudes about professionalism. For five questions, the proportion of correct answers was lower in the second survey compared with the first. We are unable to explain these differences. The most appropriate answers to these questions are not always clear, and although we have labelled each statement as either ‘true’ or ‘false’ we recognise that the contrary position may be equally valid depending on the circumstances. The GMC guidance itself uses the word ‘should’ rather than ‘must’. Jane O’Brien, the head of Standards and Ethics at the GMC, explained this phrasing as follows: ‘We use this language to support doctors exercising their professional judgment. This means we think it is good practice but not that it is mandatory’.10 Therefore, the aim of our study is to explore student knowledge of what doctors should and should not do in relation to the recently published GMC guidelines. In conclusion, social media use was widespread among the Oxford medical students who participated in this online questionnaire study; however, the majority were unaware of GMC guidance on this issue. Interestingly, there was no improvement in the proportion of correct answers to questions about professional online activity, according to the GMC guidance, between younger and older medical students. This suggests that medical students enter university, progress through training and finally qualify as doctors without gaining further
376 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377
tct_12320.indd 376
11/12/2015 11:55:56 AM
understanding of what constitutes professional online conduct. The administration of GMC guidance significantly improved the proportion of correct responses in six of the 16 questionnaire items. It is possible that educating medical students about the dangers of online social media, and how to use it, could be worthwhile. REFERENCES 1. General Medical Council. Doctors’ use of Social Media (25 March 2013). Available at http://www. gmc-uk.org/guidance/10900.asp. Accessed on 9 July 2014. 2. Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med 2008;23:1642–1646.
3. Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, Black NP. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954–957. 4. STV. Nurse sacked for remarks about colleague online (7 December 2011). Available at http://news. stv.tv/west-central/214609nurse-sacked-for-remarks-aboutcolleague-online/. Accessed on 9 July 2014. 5. The Press and Journal. Junior doctor suspended over online comments about professor (6 September 2008). Available at http://www.pressand journal.co.uk/Article.aspx/825541. Accessed on 9 July 2014. 6. Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA 2009;302:1309–1315.
7. Garner J, O’Sullivan H. Facebook and the professional behaviours of undergraduate medical students. Clin Teach 2010;7:112–115. 8. Jain A, Petty EM, Jaber RM, Tackett S, Purkiss J, Fitzgerald J, White C. What is appropriate to post on social media? Ratings from students, faculty members and the public. Med Educ 2014;48:157–169.
The administration of GMC guidance significantly improved the proportion of correct responses
9. Osman A, Wardle A, Caesar R. Online professionalism and Facebook – falling through the generation gap. Med Teach 2012;34:e549–e556. 10. O’Brien J. Note on doctors’ use of social media (2013). Available at http://www.facebook.com/notes/ general-medical-council-gmc/ doctors-use-of-social-media/ 549553408401395. Accessed on 9 July 2014.
Corresponding author’s contact details: James Kang, Green Templeton College, Oxford, OX2 6HG, UK. E-mail: [email protected]
Funding: Funding for this study was obtained from the Green Templeton College (University of Oxford) Competitive Conference and Fieldwork Fund and from MedicineAfrica. Conflict of interest: None. Acknowledgements: None. Ethical approval: Ethical approval was obtained from the University of Oxford Medical Sciences Inter-Divisional Research Ethics Committee (reference number: MSD-IDREC-C1-2013-158). doi: 10.1111/tct.12320
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 377
tct_12320.indd 377
11/12/2015 11:55:56 AM
Survey of medical students’ use of social media James Kang1, Hosnieh Djafari Marbini2, Prabir Patel2, Nicola Fawcett2 and Laurence Leaver1 1
Green Templeton College, University of Oxford, UK Oxford University Hospitals, NHS Trust, Oxford, UK
2
SUMMARY Background: Medical students are not sufficiently knowledgeable about the dangers of online social media, and education about how to use it responsibly may be beneficial. Methods: We conducted an online questionnaire to assess whether or not medical students in years 2–6 of study at the University of Oxford would intuitively know what doctors
should and should not do on social media. We also assessed whether the study intervention of sending out guidance about appropriate use of social media published by the UK General Medical Council (GMC) would improve students’ knowledge of how to use social media correctly. Results: We found that, although social media use was widespread among medical students, the
majority were unaware of GMC guidance on this issue. Administration of GMC guidance significantly improved the proportion of GMC-correct responses in four of 16 questionnaire items. Discussion: It is possible that educating medical students about the dangers of online social media, and how to use it appropriately, could be worthwhile.
Medical students are not sufficiently knowledgeable about the dangers of online social media
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 373
tct_12320.indd 373
11/12/2015 11:55:55 AM
Participants posted a mean of 5.28 times per week on social media websites, with 54 per cent having posted on medical topics
INTRODUCTION
T
he use of social media websites such as Facebook and Twitter has grown rapidly in recent years. Medical professionals and students who post opinions and upload personal material online can unintentionally create a negative online image of themselves, their colleagues or their patients, which may in turn adversely affect their professional standing. Therefore, it is important that medical students and doctors are aware of the potential risks associated with social media. The UK General Medical Council (GMC) recently published practical and ethical guidelines about the appropriate use of social media;1 however, it is uncertain how widely known these guidelines are among medical students. This study aimed to explore whether or not Oxford medical students were aware of the GMC guidelines on social media use, and whether they would intuitively know what doctors should and should not do when using social media. Their knowledge was re-assessed after sending out the GMC guidelines to all students in the study.
METHODS In October 2013, Oxford medical students from years 2–6 were invited by e–mail to complete an online questionnaire. The survey asked about the students’ awareness of the existence of the GMC guidelines. The questionnaire also sampled knowledge of the contents of the guidance by asking participants to label statements about responsible use of social media as either ‘true’ or ‘false’ according to the GMC guidelines (Table 1). Each statement was labelled as ‘true’ or ‘false’ according to the GMC guidance. All authors reviewed the questions and then decided whether each statement
was to be labelled as ‘true’ or ‘false’, according to the guidelines; the questions were then further reviewed by a consultant. Questionnaire items were only included in the final survey if all authors and the consultant agreed on the same ‘correct’ answer. Our study intervention, the GMC guidelines, was sent by e–mail to the medical students 1 week after the initial questionnaire was sent. Students were encouraged to read the guidelines before the survey was re-administered 1 week later, i.e. 2 weeks after the first questionnaire. The proportion of correct responses before and after the administration of the GMC guidelines was compared using the chi-squared test. To account for multiple comparisons, the p–value was set at 0.01. To incentivise participation in the study, all respondents were invited to take part in two prize draws for £100 of shopping vouchers. This study was approved by the University of Oxford Medical Sciences Inter-Divisional Research Ethics Committee. Gender and stage of training but no other identifiable information was held in coded information; however, participants choosing to be entered into the prize draw were required to provide an e–mail address. All participants gave informed consent. Permission to distribute the GMC guidelines was obtained from the Chair of the Education and Training Advisory Board and the Director of Education and Standards at the GMC.
RESULTS In all, 755 medical students were invited to take part in the study. The first survey received 213 responses (28% response rate), of which 212 completed the questionnaire. Survey–1
participants who had already read the GMC guidelines were excluded from analyses of the ‘true/false’ questions that explored their knowledge of the GMC guidelines. There were 115 responses to the second survey (a response rate of 15%). The responses of survey–2 participants who were not aware of the GMC guidelines were added to the survey–1 database for analyses of the ‘true/false’ questions. Not all participants answered every question. In survey 1, 95/212 (45%) respondents were female and 106/212 (50%) respondents were male, whereas 11/212 (5%) did not disclose their gender. Students were evenly distributed across all of the year groups studied. The majority (169/201, 84%) posted content on social media websites on at least a weekly basis. Participants posted a mean of 5.28 times per week (standard deviation 14.0) on social media websites, with 108/201 (54%) having posted on medical topics. Of 201 students, 104 (52%) were aware of GMC guidance, and of these, 18 (9%) had actually read the guidelines. Despite most students having not read the guidelines, or even being aware of their existence, many questions were answered correctly. The percentages of correctly answered questions ranged from 49 to 99 per cent (with a median of 83.5%). There was no difference in response between year groups. In survey 2, there was a significant improvement in awareness of the guidelines, with 103/111 (93%) participants having read the guidance. Despite a high proportion of correct responses for most questions in survey 1, a significant increase in the proportion of correct answers occurred for four of 16 questions that evaluated knowledge of the content of the GMC guidelines (Table 2).
374 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377
tct_12320.indd 374
11/12/2015 11:55:56 AM
Table 1. List of ‘true/false’ questions and answers Question: Please mark the following question as ‘true’ or ‘false’.
‘Correct’ answer (in accordance with GMC guidance)
1. Patients, employers and potential employers may be able to access your personal information
‘True’
2. It is illegal for employers to access personal information of employees and potential employees on social media
‘False’
3. Career prospects have been put at risk through unintentional disclosure of personal information on social media
‘True’
4. The standards expected of doctors are the same through social media as in traditional media and face-to-face contact
‘True’
5. Interaction with patients using social media is acceptable if a private profile page is used and their medical condition is not discussed
‘False’
6. Discussion of individual patient matters in online forums is acceptable if the patients are anonymised
‘False’
7. The management of specific patients can be posted online but only in forums accessible exclusive to qualified medical practitioners
‘False’
8. Professional matters should never be discussed in private profile pages
‘True’
9. Electronic consultations can be made on social media, provided private profile pages are used
‘False’
10. Individuals should identify themselves when expressing opinions as a medical professional online
‘True’
11. Anonymous opinions should not be posted online as from a qualified medical professional
‘True’
12. Doctors should always declare conflicts of interest when professional opinions are posted online, in exactly the same way as when these opinions are put in print
‘True’
13. Postings referring to individuals or organisations are not subject to the same defamation laws as written or verbal communications, as long as the postings are anonymous
‘False’
14. Postings on social media are not subject to the same copyright laws as communications in print, as long as the postings are anonymous
‘False’
15. Statements made by medical professionals on social media websites are not legally binding in the same way as statements made in print
‘False’
DISCUSSION Concerns have been raised about the possibility of medical students and doctors publishing unprofessional content online that may violate patient privacy or reflect negatively on individuals, institutions and the medical profession in general.2,3 Inappropriate online behaviour by medical professionals has been reported in the British press. A nurse was sacked after making comments about patients and co–workers.4 In a separate incident, a Scottish junior doctor was suspended
over remarks made about a senior colleague on a doctors’ online forum.5 Although online activity that breaches patient confidentiality is clearly unprofessional, other actions may be more ambiguous, particularly if written outside of work and intended as private communications. The possible blurring of boundaries between personal and professional lives is of concern. Medical students may be at greater risk of engaging in unprofessional activity online
Medical students may be at greater risk of engaging in unprofessional activity online compared with qualified doctors
compared with qualified doctors. Many have grown up using various social media, and risk posting inappropriate content by continuing online habits from their pre-professional lives. Personally identifiable information was listed in 83 per cent of student and resident accounts at a medical school in the USA, with only one-third of the accounts set as private, and some had published potentially unprofessional material.3 Chretian et al. surveyed 78 US medical school deans about inappropriate online activity by medical students: almost two-thirds of the deans
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 375
tct_12320.indd 375
11/12/2015 11:55:56 AM
The majority [of medical students] were unaware of GMC guidance on this issue
Table 2. Proportion of responses that were ‘correct’ according to the GMC guidelines, before and after administration of guidance Proportion of ‘correct’ responses (in accordance with GMC guidance)
P-value
Survey 1
Survey 2
1
162/190 (85%)
101/102 (99%)
0.000
2
179/189 (95%)
101/102 (99%)
0.066
3
185/186 (99%)
100/102 (98%)
0.255
4
171/187 (91%)
99/102 (97%)
0.066
5
150/186 (81%)
73/102 (72%)
0.078
6
141/187 (75%)
87/102 (85%)
0.049
7
90/184 (49%)
46/102 (45%)
0.536
8
136/183 (74%)
79/101 (78%)
0.463
9
150/183 (82%)
78/102 (77%)
0.266
10
165/182 (91%)
84/102 (82%)
0.041
11
110/181 (61%)
96/102 (94%)
0.000
12
138/181 (76%)
91/102 (89%)
0.008
13
169/181 (93%)
102/104 (98%)
0.077
14
166/181 (92%)
101/102 (99%)
0.011
15
156/180 (87%)
97/101 (96%)
0.012
16
142/180 (79%)
93/102 (91%)
0.008
reported incidents of unprofessional postings, whereas just 13 per cent reported breaches of patient confidentiality.6 Garner and O’Sullivan conducted a survey of UK medical students: 52 per cent of respondents had posted photos on Facebook that they considered to be embarrassing, and 54 per cent reported that they had seen unprofessional behaviour by their colleagues on Facebook.7 What constitutes unprofessional online behaviour is not clearly defined, and opinion may vary between students and doctors. An online survey of US medical students, doctors and non-medical personnel asked participants to rate the appropriateness of screenshots of mock medical students’ Facebook profiles. Compared with medical students, doctors and non-health care staff judged the images as
being significantly less appropriate.8 Osman et al. revealed differing opinions when they asked UK medical students, foundation doctors, registrars and consultants about how much they agreed with a series of statements on online behaviour and professionalism. For example, 45 per cent of medical students compared with only 17 per cent of registrars or consultants agreed that what happens on Facebook is separate from what happens at the medical school or hospital.9 Therefore, medical students are insufficiently knowledgeable about the dangers of online social media, and should be educated about how to use it responsibly. There is currently no teaching about professional social media use in the Oxford University curriculum. The present study is limited by the small number of
respondents, which prevented extensive subgroup analyses. There is also the possibility of responder bias, with participants perhaps more likely to have greater experience or concern than those who did not respond. The study was conducted at just a single institution; however, we have no reason to believe that students at other UK medical schools would have different patterns of social media use or attitudes about professionalism. For five questions, the proportion of correct answers was lower in the second survey compared with the first. We are unable to explain these differences. The most appropriate answers to these questions are not always clear, and although we have labelled each statement as either ‘true’ or ‘false’ we recognise that the contrary position may be equally valid depending on the circumstances. The GMC guidance itself uses the word ‘should’ rather than ‘must’. Jane O’Brien, the head of Standards and Ethics at the GMC, explained this phrasing as follows: ‘We use this language to support doctors exercising their professional judgment. This means we think it is good practice but not that it is mandatory’.10 Therefore, the aim of our study is to explore student knowledge of what doctors should and should not do in relation to the recently published GMC guidelines. In conclusion, social media use was widespread among the Oxford medical students who participated in this online questionnaire study; however, the majority were unaware of GMC guidance on this issue. Interestingly, there was no improvement in the proportion of correct answers to questions about professional online activity, according to the GMC guidance, between younger and older medical students. This suggests that medical students enter university, progress through training and finally qualify as doctors without gaining further
376 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377
tct_12320.indd 376
11/12/2015 11:55:56 AM
understanding of what constitutes professional online conduct. The administration of GMC guidance significantly improved the proportion of correct responses in six of the 16 questionnaire items. It is possible that educating medical students about the dangers of online social media, and how to use it, could be worthwhile. REFERENCES 1. General Medical Council. Doctors’ use of Social Media (25 March 2013). Available at http://www. gmc-uk.org/guidance/10900.asp. Accessed on 9 July 2014. 2. Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med 2008;23:1642–1646.
3. Thompson LA, Dawson K, Ferdig R, Black EW, Boyer J, Coutts J, Black NP. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954–957. 4. STV. Nurse sacked for remarks about colleague online (7 December 2011). Available at http://news. stv.tv/west-central/214609nurse-sacked-for-remarks-aboutcolleague-online/. Accessed on 9 July 2014. 5. The Press and Journal. Junior doctor suspended over online comments about professor (6 September 2008). Available at http://www.pressand journal.co.uk/Article.aspx/825541. Accessed on 9 July 2014. 6. Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA 2009;302:1309–1315.
7. Garner J, O’Sullivan H. Facebook and the professional behaviours of undergraduate medical students. Clin Teach 2010;7:112–115. 8. Jain A, Petty EM, Jaber RM, Tackett S, Purkiss J, Fitzgerald J, White C. What is appropriate to post on social media? Ratings from students, faculty members and the public. Med Educ 2014;48:157–169.
The administration of GMC guidance significantly improved the proportion of correct responses
9. Osman A, Wardle A, Caesar R. Online professionalism and Facebook – falling through the generation gap. Med Teach 2012;34:e549–e556. 10. O’Brien J. Note on doctors’ use of social media (2013). Available at http://www.facebook.com/notes/ general-medical-council-gmc/ doctors-use-of-social-media/ 549553408401395. Accessed on 9 July 2014.
Corresponding author’s contact details: James Kang, Green Templeton College, Oxford, OX2 6HG, UK. E-mail: [email protected]
Funding: Funding for this study was obtained from the Green Templeton College (University of Oxford) Competitive Conference and Fieldwork Fund and from MedicineAfrica. Conflict of interest: None. Acknowledgements: None. Ethical approval: Ethical approval was obtained from the University of Oxford Medical Sciences Inter-Divisional Research Ethics Committee (reference number: MSD-IDREC-C1-2013-158). doi: 10.1111/tct.12320
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 373–377 377
tct_12320.indd 377
11/12/2015 11:55:56 AM
