Is there any such thing as “IRL” ?

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Social media is all pervasive – it is nigh on impossible to see an advertisement nowadays without a hastag, facebook, pinterest or twitter handle attached.  Social media has been credited with sparking revolutions, riots and bringing down criminals, and is even used by the Pope to spread his message to the world.

Perhaps it isn’t terribly surprising that medical students are enthusiastic users, with over 90% reporting regular use in some studies.  The varied subjects covered on social media make it perfect for sharing not only pictures of cats, but also valuable educational materials and lessons.  Indeed, there is a conference specifically aimed at those who work in critical care and use social media (SMACC) – it is well worth checking out #tags like #RespEd and #FOAMed on twitter for up to the minute reviews of new developments in medicine, and medical education.

There is, of course a double edge to this particular sword.

In a profession which is renowned for using dark humour as a coping strategy for the difficult situations which are it’s core business, it can be easy for users of social media to fall foul of the usual standards expected in day to day life.  Various organisations, including the GMC and RCGP have offered guidance on social media use in the medical profession – here and here

For younger members of our profession, who are growing up with social media as a normal part of life, concerns not for patients, but for themselves may be around the corner.

Residency programmes in the US have previously been surveyed about their willingness to use internet searches to find background information on applicants through their social media profiles (see here). 10% already use social media searches to inform their selection processes, and nearly 60% did not indicate that using these methods would constitute any violation of the applicants privacy.

When the potential recipients of such attention are asked, the responses are somewhat different.  Medical students in the US were surveyed for their attitudes towards the screening of their social media profile (Facebook specifically) in a study recently published in PMJ.  The question being reported was part of a larger survey into medical student use of Facebook.  The students were asked if a posting on Facebook with pictures showing the student intoxicated, wearing a lewd halloween costume should have any bearing on their application for a residency programme.

The respondents didn’t share the views of the residency programmes – with a third of respondents indicating that such pictures should have no influence on their application as they are irrelevant, and only 2.8% feeling that such pictures would be sufficient for an application to be rejected due to the pictures alone.

So we have 60% of residency programmes feeling that they have the right to screen social media for background on their applicants, and 33.7% of applicants thinking that photos of themselves displaying unprofessional conduct are irrelevant.

This gap in the perception of the importance of social media in revealing underlying attitudes, and even ethical viewpoints is important.

Medical students of old were famously badly behaved – Doctor in the House made great use of this reputation to win a BAFTA in 1955.  Those medical students are now grown up, and helping to administer training programmes.  The behaviours of todays medical students are probably not vastly different from those a few decades ago, but it is the exposure of them to the wider world which seems to be disagreeable.  The use and abuse of alcohol, dark humour, irreverent behaviour still goes on, but now that pictures of these activities can fly around the world in a split second and remain online in perpetuity, they take on a new significance.  What were once seen as rites of passage in medical school, are now seen as grounds for dismissal or rejection.

The advice given in the paper, is sound, to a point – students should be aware that there is little privacy on the internet, that future employers can find information easily, that online information is nigh on impossible to delete, and that their online activities can affect their professional reputation.

But one piece of advice which sits less comfortably with me is that students should ensure they know how to keep their activities behind privacy settings.  This is clearly a pragmatic approach, and sensible advice for individuals, but it does not address the heart of the issue.  It seems that if we put up screens around our activities, we might shroud them once again from the public, and save students from public embarrassment, but we won’t have made any progress in understanding why there is such a powerful hidden curriculum in medical education, and what effects it has on out trainees.

Just because social media exists in the ‘virtual’ online world, we should not forget that, actually there is no virtual, online, or alternative reality, there is only IRL

(IRL = in real life for those who aren’t up to speed…)


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