Sept. 22, 2009 -- It is not uncommon for medical students to post unprofessional and even illegal information on social networking sites like Facebook and media-sharing sites like YouTube, a survey of medical schools shows.
In an anonymous poll of student affairs administrators from schools across the country, 60% said they were aware of incidents in which students had posted unprofessional content online and 13% said the incidents involved breaches of patient confidentiality.
Three of the incidents resulted in students being dismissed from medical school, but just half of the school administrators said they either had policies in place or were developing policies to define inappropriate online content.
Federal law prohibits health care providers from disclosing a patient's health information unless the patient has given his or her consent to do so.
But study researcher Katherine C. Chretien, MD, of the Washington VA Medical Center, tells WebMD that online posts by medical students and residents often include descriptions of medical situations that could identify a patient, even when the patient is not named.
The survey results were published this week in The Journal of the American Medical Association.
"We need to do a better job of making medical students aware of what is and is not OK," she says. "Keeping a patient's name out of a post may not be enough."
Most of the incidents reported by survey respondents did not involve illegal violations of patient confidentiality, but instead were potentially embarrassing and damaging to the students themselves.
Forty-seven of the 78 responding medical school administrators were aware of improper student posts, and about half of these posts included profanity or racist or sexist language. Descriptions or pictures of intoxication or lewd behavior were also common.
Of 36 specific examples of unprofessional posts provided, 10 were sexually suggestive, including sexually provocative photographs, sexually suggestive comments, or requests for inappropriate friendships with patients via Facebook.
Seven described or showed intoxication or illegal drug use.
In most cases the online transgression was reported to student affairs by a medical school faculty member or non-faculty trainee. Only two of the incidents were reported by patients or family members of patients.
Pediatrics professor Lindsay Acheson Thompson, MD, says there is no doubt that breaches of patient confidentiality are occurring more often than patients realize, but she says posts that are personally embarrassing and potentially career damaging appear to be more common.
In a study reported in July 2008, Thompson and colleagues at the University of Florida examined the Facebook profiles of more than 800 medical students and residents.
They found, among other things, photos of posters dressed as pimps or cross-dressing. One Facebook photo featured the physician-in-training wearing a lab coat labeled "Kevorkian Medical Clinic."
Some of the students and residents had joined Facebook groups that could be considered sexist, racist, or otherwise vulgar with names like PIMP -- Party of Important Male Physicians.
Seven of 10 randomly chosen Facebook pages included photos of the student or resident drinking alcohol.
Thompson tells WebMD that the value of social networking sites like Facebook is clear for keeping in touch with former classmates, distant friends, and family.
"But students need to think carefully about the kinds of things they post," she says. "Even a photo as seemingly innocuous as drinking alcohol may not be in someone's best interest when they are applying for residency."
Slightly more than a third of the student affairs officials polled reported that their school had a policy in place to define appropriate and inappropriate content on social networking sites.
Thompson says she is working with colleagues at the University of Florida to develop such a policy, but she adds the intent is not to censor students.
"Some schools are moving toward censorship -- telling students they shouldn't use social networking sites like Facebook," she says. "But that is not very realistic in the world we live in today. We think it is important to have a good policy, but I can't tell you what that policy will look like yet."