To #medbikini or not to #medbikini: Potentially Unprofessional Behavior on Social Media for Healthcare Professionals – The Devil is in the Details (Preprint)

BACKGROUND Social media (SM) presence among healthcare professionals (HCPs) 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 general public, as witnessed in the #medbikini affair. The “devils in the details” of e-professionalism boundaries are explored in this paper. OBJECTIVE Objectives of this study are: a) to develop a new coding scheme for the assessment of unprofessional behavior on Facebook (FB) of medical/dental students and faculty, b) to compare reliability between the old and new coding schemes, c) to compare gender-based differences for the assessment of the professional content on FB, d) to validate the new coding scheme, and e) to assess the level of and to characterize online professionalism on publicly available FB profiles of medical/dental students and faculty. METHODS A search was performed via a new FB account using 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 “new coding scheme”, developed for this study. RESULTS Inter-coder reliability (ICR) shows an increase when “new coding matrix” was used for the comparison of gender-based coding results. Results show an increase in the gender-based agreement of the final codes for the category professionalism, from 85% in the 1st phase to 96.2% in the 2nd phase. Final results of the 2nd phase show there was almost no difference between women and men for coding “potentially unprofessional” content (2.9% vs. 2.6%), nor for coding “unprofessional” content (4.6% vs. 4.9%). For the definitive results, significant differences between students and faculty were identified regarding the existence of identifiable FB accounts (49.2% vs. 20.2%; χ21=30.73, P<.001) and affiliation of the school was revealed (93.7% vs. 65.2%, χ21=20.1, P<.001). In professionalism variable, students had less “potentially objectionable” content than faculty (2.9% vs. 4.2%), however more “unprofessional” content (5.8% vs. 0%). CONCLUSIONS “New coding matrix” for assessing professionalism of HCPs on FB is a validated and a more objective instrument. Gender of coders did not affect results for coding “unprofessional” nor “potentially objectionable” content using the newly developed methodology and criteria. This research emphasizes the role that context plays in perception of “unprofessional” and “potentially unprofessional/objectionable” content, and provides insight into the existence of different sets of rules for online and offline interaction, that marks behavior as e-(un)professional. The level of e-professionalism on FB profiles available for public viewing of medical/dental students and faculty has shown a high level of understanding of e-professionalism.