Defining Potentially Unprofessional Behavior on Social Media for Health Care Professionals: Mixed Methods Study

Abstract

Background Social media presence among health care professionals is ubiquitous and largely beneficial for their personal and professional lives. New standards are forming in the context of e-professionalism, which are loosening the predefined older and offline terms. With these benefits also come dangers, with exposure to evaluation on all levels from peers, superiors, and the public, as witnessed in the #medbikini movement. Objective The objectives of this study were to develop an improved coding scheme (SMePROF coding scheme) for the assessment of unprofessional behavior on Facebook of medical or dental students and faculty, compare reliability between coding schemes used in previous research and SMePROF coding scheme, compare gender-based differences for the assessment of the professional content on Facebook, validate the SMePROF coding scheme, and assess the level of and to characterize web-based professionalism on publicly available Facebook profiles of medical or dental students and faculty. Methods A search was performed via a new Facebook account using a systematic probabilistic sample of students and faculty in the University of Zagreb School of Medicine and School of Dental Medicine. Each profile was subsequently assessed with regard to professionalism based on previously published criteria and compared using the SMePROF coding scheme developed for this study. Results Intercoder reliability increased when the SMePROF coding scheme was used for the comparison of gender-based coding results. Results showed an increase in the gender-based agreement of the final codes for the category professionalism, from 85% in the first phase to 96.2% in the second phase. Final results of the second phase showed that there was almost no difference between female and male coders for coding potentially unprofessional content for students (7/240, 2.9% vs 5/203, 2.5%) or for coding unprofessional content for students (11/240, 4.6% vs 11/203, 5.4%). Comparison of definitive results between the first and second phases indicated an understanding of web-based professionalism, with unprofessional content being very low, both for students (9/222, 4.1% vs 12/206, 5.8%) and faculty (1/25, 4% vs 0/23, 0%). For assessment of the potentially unprofessional content, we observed a 4-fold decrease, using the SMePROF rubric, for students (26/222, 11.7% to 6/206, 2.9%) and a 5-fold decrease for faculty (6/25, 24% to 1/23, 4%). Conclusions SMePROF coding scheme for assessing professionalism of health-care professionals on Facebook is a validated and more objective instrument. This research emphasizes the role that context plays in the perception of unprofessional and potentially unprofessional content and provides insight into the existence of different sets of rules for web-based and offline interaction that marks behavior as unprofessional. The level of e-professionalism on Facebook profiles of medical or dental students and faculty available for public viewing has shown a high level of understanding of e-professionalism.

Differences between doctors of medicine and dental medicine in the perception of professionalism on social networking sites: the development of the e-professionalism assessment compatibility index (ePACI)

“…As previous coding schemes had been developed for a different era of professionalism and especially in the wake of the “medbikini affair” [ 39 , 55 ], a re-examination of professional standards became necessary and a SMePROF coding scheme that included a SMePROF rubric for the assessment of unprofessional content on Facebook was developed by Vukušić Rukavina et al [ 40 ]. Categorizing of content has been arranged in three distinct groups: professional, potentially unprofessional, and unprofessional, taking into consideration new and updated perceptions of the professional online behaviour of HCPs.…”

“…Categorizing of content has been arranged in three distinct groups: professional, potentially unprofessional, and unprofessional, taking into consideration new and updated perceptions of the professional online behaviour of HCPs. As the SMePROF coding scheme [ 40 ] can now be percieved as the centre value for e-professionalism, tendencies of professionalism can be explored: either towards a more lenient, relaxed perception—liberal, or a more cautious and rigid perception—conservative. PCA confirmed our initial coding of the modified White et al’s e-professional behaviour perception items [ 12 ].…”

“…In other words, we wanted to see whether content that respondents perceived as “unprofessional” really was “unprofessional”, and to what extent they were able to distinguish “professional” content. The correct answer was defined using the SMePROF rubric for the assessment of unprofessional content on Facebook developed in Vukušić Rukavina et al (SMePROF rubric) [ 40 ].…”

“…ePACI was designed to measure not only perception in line with the expected answer, but also the direction of deviation which is, according to this study’s fourth aim, the investigation of tendencies and differences among MDs and DMDs regarding values demonstrated by the ePACI index. This was achieved by creating an additive index where the correct answer regarding an item (or perception that matches the criteria based on Vukušić Rukavina et al [ 40 ]) was coded as 0, deviating toward professional items was coded as +2, and deviating towards unprofessional items was coded as −1. The fact that professional items were awarded more points is a result of weighting because of the difference in the number of items measuring each type of post (10 unprofessional against 5 professional).…”

“…In the wake of the “medbikini affair” re-examination of the current e-professionalism standards for posting textual, photographic or video content on SNSs became necessary. A novel “Social Media e-Professionalism” (SMePROF) coding scheme, that includes the SMePROF rubric for assessment of unprofessional content on Facebook, has been developed by Vukušić Rukavina et al [ 40 ]. The SMePROF rubric, whose design is based on current perceptions of professional online behaviour, can be used to assess online content and classify it into one of three distinct categories: professional, potentially unprofessional, and unprofessional.…”