Professional Identity and Social Media

A. NING ZHOU AND ERICK HUNG PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

INTRODUCTIONS PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

OBJECTIVES

▸ Discuss frameworks for understanding professional identity tensions in the age of social media.

▸ Deﬁne professional policies, best practices, and principles relate to social media use.

▸ Discuss professional boundary issues relevant to social media use.

▸ Reﬂect on one’s online presence, describe privacy features, and adjust privacy settings on Facebook and Twitter. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

WORKSHOP AGENDA

▸ Frameworks for social media use and professional identity

▸ AMA and UCSF guidelines and best practices

▸ Boundary issues

▸ Audit your online presence and adjust your privacy settings PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

Professional Personal

Public Social Media TEXT TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

DEFINITIONS

Social networking site (SNS)

“…web-based services that allow individuals to (1) construct a public or semi- public proﬁle within a bounded system, (2) articulate a list of other users with whom they share a connection. and (3) view and traverse their list of connections and those made by others within the system.” (Boyd, 2007) TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

INCREASING IMPORTANCE OF SOCIAL MEDIA

13% 33% 67% 87%

Personal Use Professional Use

Ryne, 2012 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

DIGITAL NATIVES VS. DIGITAL IMMIGRANTS

Ginrory, 2012 and Chretien, 2011 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

ONLINE DISINHIBITION EFFECT

▸ While online, some people self-disclose or act out more frequently or intensely than they would in person

▸ Anonymity

▸ Invisibility

▸ Asynchronicity

▸ Minimization of authority

Suler, 2004 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

SMALL WORLD ETHICS

Lannin and Scott, 2013 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PROFESSIONALISM: ONE-MINUTE PAPER

▸ What is professionalism?

▸ Why do we uphold it?

▸ How do we uphold it? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PROFESSIONAL IDENTITY FORMATION

Cruess, 2015 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

GUIDELINES AND POLICIES

▸ AMA Policy on Professionalism and Social Media Use

▸ UCSF Social Media Policies for Personal Accounts PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA UCSF POLICY AMA POLICY

1. Respect conﬁdentiality 1. Patient privacy/conﬁdentiality

2. You speak for yourself, but 2. Use privacy settings your actions reﬂect those of 3. Maintain appropriate UCSF boundaries 3. Live by the law 4. Separate personal and 4. UCSF is subject to laws professional online content regarding political speech 5. Report unprofessional content 5. Understand HIPAA and CMIA 6. Online behavior may affect 6. Act as if you were at work reputation and have consequences 7. Perception is reality PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA UCSF BEST PRACTICES AMA BEST PRACTICES

1. The internet is a public 1. Take responsibility and use (and permanent) space judgement 2. Think before you post 2. Be honest about who you are 3. Protect patient privacy 4. Respect work commitments 3. Be respectful 5. Identity yourself

4. Think it through 6. Use a disclaimer

5. Listen 7. Respect copyright and fair use laws

6. Add value to the discussion 8. Protect proprietary information 9. See expert guidance 7. Avoid arguments PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #1 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

RESPECTFUL COMMUNICATION ONLINE

▸ An active debate has sprung up in a residency class. A black female resident submitted the following post on Facebook: “I am so upset that I did not get the research award today from the Clinical and Translational Science Institute! I worked my butt off. This is another example of white privilege working against me!” Some of her classmates feel that this post is disrespectful. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

RESPECTFUL COMMUNICATION ONLINE

▸ Has the resident followed the UCSF best practice guidelines on social media communication?

▸ Does the resident have a right to express her opinion?

▸ What feedback might we give to the resident?

▸ How could we facilitate a constructive discussion in the residency cohort? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #2 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PROFESSIONAL COMMUNICATION FROM PERSONAL ACCOUNTS

▸ A urology resident recently began posting her medical opinions on Twitter. The same day that the United States Preventative Services Task Force came out with a recommendation against routine Prostate-Speciﬁc Antigen (PSA) screening in healthy men for prostate cancer, she posted the following tweet. “Speaking of prostate cancer screening, I would like to tell the Task Force where they can stick their new guidelines. They are completely blind to the individual needs of our patients!” The tweet has now gone viral and has been read by many of her patients, colleagues, fellow researchers, and friends. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PROFESSIONAL COMMUNICATION FROM PERSONAL ACCOUNTS

▸ Has the resident followed the UCSF best practice guidelines on social media communication?

▸ Does the resident have a right to express her opinion?

▸ What feedback might we give to the resident? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #3 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PERSONAL BEHAVIORS ONLINE

▸ A Department Chair informs her fellowship program director that a fellow has been tagged in a Facebook post outside of a restaurant following the annual Department holiday party. The fellow is with other fellows in the photograph and has what appears to be a joint in his hand. The Department Chair feels this is unprofessional and wants the program director to discipline the fellow. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PERSONAL BEHAVIORS ONLINE

▸ Do you consider this unprofessional?

▸ Why would the Department Chair be concerned about this post?

▸ How should the program director engage the fellow in a productive conversation? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA SORTING EXERCISE

YOU ARE A MEMBER OF THE STATE MEDICAL BOARD! WOULD YOU TAKE DISCIPLINARY ACTION? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

Greysen, 2013 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

Greysen, 2012 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

STRICTLY FORBIDDEN VS. STRONGLY DISCOURAGED

▸ Strictly forbidden

▸ Violating patient conﬁdentiality

▸ Reporting privacy academic information

▸ Neglecting ofﬁcial work commitment when interacting online

▸ Strongly discouraged

▸ Use of vulgar language

▸ Implying disrespect

▸ Presentation of alcohol misuse, substance use, sexual promiscuity

▸ Posting unﬂattering material on another individual’s website

Greysen, 2013 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

BOUNDARIES PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

BOUNDARIES

▸ Deﬁnition

▸ The “edge” of appropriate professional behavior

▸ Boundary Issue Types

▸ Boundary Crossing

▸ Boundary Violation PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PRINCIPLES TO CONSIDER IN BOUNDARY VIOLATIONS

▸ Ethical principles

▸ Self-disclosure

▸ Multiple relationships

Lannin, 2013 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

BOUNDARIES

▸ Boundaries with colleagues

▸ Boundaries with patients PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

BOUNDARIES WITH COLLEAGUES TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

FACEBOOK FRIENDS WITH COLLEAGUES

▸ Study of clerkship directors in internal medicine in June 2010

▸ 53% received a “friend request” from a current student

▸ 63% received a “friend request” from a current resident

▸ 19% accepted the student request

▸ 48% accepted the resident request

▸ Becoming friends with a former student, resident, or colleague was perceived as more appropriate

Chretien, 2011 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #4 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

FRIENDING WITH STUDENTS AND FACULTY

▸ Michelle is a PGY-2 resident in Surgery. She is very close to her faculty career advisor who is not in an academic supervisory role for her. She sends her career advisor on Facebook a friend request.

▸ John is a 4th-year medical student who receives a Facebook friend request from a PGY-2 resident. He had worked closely with the resident on his core clerkship one year ago. John feels pressure to accept the request. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

FRIENDING WITH STUDENTS AND FACULTY

▸ Are there any advantages to be Facebook friends with a student? What are the disadvantages?

▸ Are there any advantages to be Facebook friends with a faculty member? What are the disadvantages?

▸ What factors would you consider in accepting or not accepting a Facebook friend request from someone above or below your training level? TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #5 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

RECRUITMENT OF APPLICANTS

▸ A chief resident and a faculty member on a resident selection committee discover that one of the medical students applying to the residency program is an underwear model for a popular underwear company. The medical student is a URM applicant from a top medical school and has received high board scores, honors in most clerkships, and has strong community advocacy experience. The chief resident does not view this as unprofessional nor does she feel that this experience should impact the selection committee’s decision on whether to invite the student to interview. The faculty member feels this is unacceptable behavior. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

FRIENDING WITH STUDENTS AND FACULTY

▸ How should the faculty member explain her rational with the chief resident?

▸ How might the chief resident explain her rationale with the faculty member?

▸ Would it be appropriate for the faculty member or the chief resident to give feedback to the medical student? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

4 TYPES OF BOUNDARY MANAGEMENT BEHAVIORS

Integrated Segregated

Self-Validation OPEN AUDIENCE

Self-Enhancement CONTENT CUSTOM

Ollier-Malaterre, 2013 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

BOUNDARIES WITH PATIENTS TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PATIENT FRIEND REQUESTS

▸ Study of 187 Australian physicians in 2014

▸ 19% received a “friend request” from a patient

▸ 35% would decline the request and do nothing more

▸ 28% would decline the request and discuss at the next consultation

▸ 12% would decline the request and send a private message explaining why

▸ 23% would do nothing

▸ 3% would accept the request

Brown, 2011 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

VIGNETTE #6 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PATIENT DATING REQUEST

▸ A PGY-3 internal medicine resident has decided to explore the online dating scene. One day, he receives a message on a dating app from a former patient. He treated the patient in an outpatient specialty clinic over the course of several months in his PGY-2 year. He remembers having a lot of shared interests and connecting with this patient. He is no longer the patient’s clinician. He considers whether to respond. PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PATIENT DATING REQUEST

▸ In what circumstances would it be permissible to respond to the former patient?

▸ Does your specialty have speciﬁc guidelines about dating former patients? If so, what are they?

▸ If the scenario was reversed and the resident had messaged his former patient ﬁrst, how might this impact the situation? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

QUESTIONS TO CONSIDER WITH DUAL RELATIONSHIPS

▸ Is entering into a relationship in addition to the professional one necessary, or should I avoid it?

▸ Can the dual relationship potentially cause harm to the patient?

▸ If harm seems unlikely or unavoidable, would the additional relationship prove beneﬁcial?

▸ Is there a risk that the dual relationship could disrupt the therapeutic relationship?

▸ Can I evaluate the matter objectively? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PRIVACY TEXT PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PRIVACY

▸ Study of 338 physicians who graduated in 2006 and 2007 from University of Otago

▸ 65% had Facebook accounts

▸ 37% had public proﬁles (46% photos of drinking alcohol, 10% intoxicated)

▸ Study of 281 urology residents who graduated in 2015

▸ 72% had publicly identiﬁable Facebook accounts

▸ 40% included unprofessional or potentially objectionable behavior

MacDonald, 2011 and Koo, 017 PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

LET’S GOOGLE YOURSELF! PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

GOOGLE SEARCHES PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PRACTICAL TIPS FOR MANAGING YOUR PRIVACY

▸ Select audience options

▸ Public, friends, custom, only me

▸ Check your audience before posting

▸ Manage your privacy settings

▸ Use friend lists

▸ Periodically audit your proﬁle

▸ View as the public or a speciﬁc person

▸ Be wary of shared Facebook albums PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

PRIVACY SETTINGS PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

USING THE VIEW AS TOOL PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

TIMELINE AND TAGGING PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

INSTAGRAM PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

REFLECTIONS ON SOCIAL MEDIA PRESENCE

▸ Why do you use social media?

▸ How do you use your privacy settings? Do you regularly audit your proﬁle and online presence?

▸ How would you feel if a co-resident/attending/department chair saw your proﬁle?

▸ How do you separate your personal and professional identities online?

▸ Take some time to search for yourself online! PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

TAKE HOME POINTS

▸ Frameworks for social media and professionalism exist

▸ Professional identity formation is an ongoing process

▸ Follow UCSF best practices and AMA guidelines

▸ Maintain appropriate professional boundaries

▸ Use appropriate privacy settings

▸ Periodically audit yourself and reﬂect on your online presence PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

QUESTIONS? PROFESSIONAL IDENTITY TENSIONS IN THE AGE OF SOCIAL MEDIA

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