Web 2.0 technology has had an impact on education by facilitating a transition from static online resources to dynamic user-created resources. Such modern systems allow for continuous modification of content through the participation of users. These features present numerous educational opportunities for instructors and students alike.
Unsurprisingly, this technology has been embraced in medical education. Namely, social media have been increasingly used to educate healthcare trainees. A recent review of social media with medical education has revealed that collaborative online educational projects use platforms such as Wikimedia, and social bookmarking applications. This technology also uses blogs and forums such as Twitter and WordPress or phpBB which allows for interaction between instructor and learners through the posting of comments. Features of both of these technologies have led to content communities existing on platforms such as YouTube, Flickr, and Slideshare, and the use of social networking sites such as Facebook, ResearchGate and LinkedIn (Hamm et al., 2013). North American medical educators have led this adoption of Web 2.0 technology. A recent review revealed that approximately 63% of such resources are created by those based in this geographic location. Of the available technologies discussion forums, blogs and social networking are the most popular platforms used within medical education (Hamm et al., 2013).
This has led to discussions and the exchange of information formally confined to the clinical environment being brought online and made widely and publically available. This raises some important questions about professionalism. For example, nursing students who posted photos of a placenta, which they examined on an obstetrical rotation, on Facebook were expelled for unprofessional activity (Parkinson & Turner, 2014). Similarly, a recent study surveying Facebook profiles of medical students within one medical school class revealed 1% of trainee profiles demonstrating unprofessional content, such as demonstrations of excessive alcohol consumption or explicit language (Gupta et al., 2015). Likewise, 60% of American medical schools’ report cases of medical students inappropriately using social media in a clinical context (Moses et al., 2014). Such cases require the careful attention of those creating and using medical education content online within the educational context. Another concern is the dissemination of medical knowledge and possible and inappropriate use of this information. Liability concerns for content creators also warrants consideration.
Issues about patient confidentiality and professional boundaries are inherently raised through the adoption of these technologies. The greatest strength of free open access medical education (FOAM) is the ability to democratize medical knowledge. This requires the use of Web 2.0 technologies and for public dialogue. This same strength when misused can lead to professionalism and boundary concerns. Medical educators and trainees must find a balance between empowering medical professionals and students, facilitating reflection and self-expression, while defining necessary boundaries.
To assist those using these resources most regulatory bodies within medicine have created guidelines for the appropriate use of social media (College of Physicians and Surgeons of Ontario, 2016). Generally, this involves maintaining the professional and ethical principles expected within the clinical environment, especially those regarding patient confidentiality. Often it is also recommended that disclaimers be added to any general medical advice provided, and to be careful to represent professional designations carefully. Also, it is recommended that healthcare and academic institutions develop auditing policies for trainees and faculty (Moses et al., 2014). Through the mindful use of online digital tools, traditional medical education instructional methods can be enhanced. However, like any new technology, we must be aware of its limitations and potential dangers. The clinical setting holds some unique challenges that require particular attention in this respect and the specific rules governing appropriate use require frequent updating and re-evaluation as these digital tools rapidly evolve.
College of Physicians and Surgeons of Ontario. (n.d.). Social Media - Appropriate Use by Physicians. Retrieved February 07, 2016, from http://www.cpso.on.ca/policies-publications/positions-initiatives/social-media-appropriate-use-by-physicians
Gupta, S., Singh, S., & Dhaliwal, U. (2015). Visible Facebook profiles and e-professionalism in undergraduate medical students in India. Journal of Educational Evaluation for Health Professions, 12(50), 1-5. doi:10.3352/jeehp.2015.12.50
Hamm, M. P., Chisholm, A., Shulhan, J., Milne, A., Scott, S. D., Klassen, T. P., & Hartling, L. (2013). Social Media Use by Health Care Professionals and Trainees. Academic Medicine, 88(9), 1376-1383. doi:10.1097/acm.0b013e31829eb91c
Moses, R. E., Mcneese, L. G., Feld, L. D., & Feld, A. D. (2014). Social Media in the Health-Care Setting: Benefits but Also a Minefield of Compliance and Other Legal Issues. The American Journal of Gastroenterology, 109(8), 1128-1132. doi:10.1038/ajg.2014.67
Parkinson, J., & Turner, S. (2014). Use of social media in dental schools: Pluses, perils, and pitfalls from a legal perspective. Journal of Dental Education, (78), 1558-1567.