The social networking tools that help keep medical students in touch with friends and family could end up being the reason they someday have a hard time finding the job they want. A study in the Sept. 23/30 Journal of the American Medical Association found that 60% of U.S. medical schools surveyed reported incidents of students posting unprofessional content online. Meanwhile, social networking sites such as Facebook and Twitter are becoming the newest tools used by recruiters to identify and screen potential job candidates, including those well out of medical school. Because of the interest in social media, the National Assn. of Physician Recruiters has added a special session on the subject to its annual meeting next April. Susan Masterson, a recruiter with TeamHealth in Knoxville, Tenn., said using social networking sites is a "strategy that anyone in recruiting, whether it be physicians or otherwise, needs to incorporate in their plan. It's here. It's here to stay. "My concern with social networking candidate marketing is how to manage the message consistently and professionally. Social networking, with the word social, sometimes is not as professional as the traditional resources we've used in the past." Experts say that just because you wrote a curse word online or posted a picture of yourself holding a bottle of beer doesn't mean you've become unemployable. While there is agreement that anything that would be considered inappropriate and unethical for a physician to do in real life is verboten online as well, there is a lot of gray area in what constitutes "inappropriate" conduct. "Beyond those definite clear-cut ones, it's very murky, and people have different opinions of what's appropriate," said Katherine Chretien, MD, an internist at the VA Medical Center in Washington, D.C., and co-author of the JAMA study. Dan Rizzo, manager and master recruiter for Schumacher Group, an emergency physician staffing company based in Chattanooga, Tenn., said he has never seen anything so egregious that it ruined someone's chances at a job. But he has seen postings that made him hesitate. What's going on online According to the JAMA study, "Online Posting of Unprofessional Content by Medical Students," 13% of the 78 medical schools that responded to the survey found postings that violated patient confidentiality; 52% found postings containing profanity; 48% found postings containing discriminatory language; 39% found depictions of intoxication and 38% found sexually suggestive material. The results were nearly identical to those in a similar study done more than a year ago by researchers from the University of Florida College of Medicine. 60% of U.S. medical schools have reported incidents of students posting unprofessional content online. After the Florida study was released, awareness started to grow about the need to be more professional online, said Lindsay Thompson, MD, author of that study. "I was disappointed to see that the problem didn't go away, but [the JAMA study's findings] didn't surprise me, to be honest," said Dr. Thompson. While medical schools and hospitals have every right to control what physicians or students post about patients, they have less control over more ambiguous categories, such as use of profanity, comedic content, depictions of alcohol use or even disparaging remarks about the schools. The JAMA study noted that "socially inappropriate medical student shows (in which medical students write and perform satirical comedy skits) ... may serve important coping and stress-release functions during difficult training; however, when disseminated on media-sharing sites such as YouTube or Google Video, they carry the potential for significant public impact and viral spread of content." About three out of four schools that noted unprofessional online conduct said they had only five or fewer incidents reported, with trainees, nonfaculty staff and faculty most likely to complain. But researchers reached the same conclusion as Dr. Thompson: Many medical schools "may not have adequate policy in place" to address online conduct. Susan Barnes, professor of communication and associate director of the Lab for Social Computing at Rochester (N.Y.) Institute of Technology, said education on what is appropriate online behavior needs to start much earlier than medical school. Many of the medical students today have been using social networking sites since they were teens, Barnes said. "It's been talked about, but there really hasn't been a concerted effort by churches, schools, social organizations to really teach people how to use these tools appropriately and inappropriately." Consequences of online content According to the JAMA study, in a few cases medical students with inappropriate online conduct already have suffered consequences, including dismissal. But those were cases where patient confidentiality was breached, or where there were multiple incidences of behavior, including discriminatory language or depiction of alcohol and drug use. In the vast majority of cases students were warned, or nothing was done. Sachin Jain, MD, a research fellow and resident at the Dept. of Medicine at the Brigham and Women's Hospital in Boston, learned firsthand that what is appropriate is often open for interpretation. Dr. Jain wrote an article in the Aug. 13 New England Journal of Medicine about receiving a friendship request from a patient on Facebook. Despite his uneasiness, he accepted the request, only to learn later that the patient wanted to ask his advice about medical school. Most would argue that friending patients on a social networking site is never appropriate. But in this case, Dr. Jain said, the relationship could be defined as professional and appropriate. Dr. Jain, who often advises premed students applying for medical school, said the first thing he tells them is to clean up their Facebook pages. But students don't seem to understand why that's important. Rusty Weston, chief blogger at the social networking Web site My Global Career, said one way physicians and medical students can help protect themselves is to take advantage of the privacy tools on social networking sites. For example, profile pages on Facebook can be set to display pictures only to people in your network or even specific people in your network, Weston said. "You can set those controls, and most people don't." One university included in the JAMA study teaches students how to elect privacy settings on Facebook. That resulted in an 80% decrease in publicly accessible accounts. As more recruiters use the sites to identify potential job candidates, any student or doctor using social media probably would want to make their images as clean as possible, Dr. Jain said. "Less is more." The full and original article can be found here: