소셜미디어에 적절한 포스팅은? 학생, 교수, 대중의 평가(Med Educ, 2014)

소셜미디어에 적절한 포스팅은? 학생, 교수, 대중의 평가(Med Educ, 2014)

What is appropriate to post on social media? Ratings from students, faculty members and the public

Anuja Jain,1 Elizabeth M Petty,2 Reda M Jaber,3 Sean Tackett,4 Joel Purkiss,3 James Fitzgerald5

& Casey White6

도입

INTRODUCTION

사용자 제작 콘텐츠 교환을 용이하게하는 소셜 미디어 웹 사이트는 매우 짧은 시간에 많은 사람들의 삶에 중대한 영향을 미쳤습니다. 특히 2004 년 이전에 Facebook이 존재하지 않는다고 상상하기 어려웠던 젊은 성인들에게 심대한 영향을 미쳤습니다.

Social media websites, which facilitate exchange of user-generated content, have had a profound impact on the lives of many in a very short time, especially among young adults who find it hard to imagine that Facebook did not exist before 2004.

소셜미디어에 대한 프로페셔널리즘 가이드라인

Professionalism guidelines on social media

예를 들어, 의사의 약 90 %가 개인용 또는 전문 용 Facebook 페이지를 보유하고 있으며, 거의 모든 의대는 Facebook을 보유하고 있습니다 .5

The medical profession uses social media as much as the general population.3 For example, nearly 90% of   practising doctors have Facebook pages for personal or professional use,4 and nearly all medical   schools have some Facebook presence.5

2010 년 11 월 미국 의사 협회 (American Medical Association)와 2012 년 1 월 미국 의사 협회 (American College of Physicians)는 전문성을 온라인으로 유지하기위한 가이드 라인을 발표했습니다.

The American Medical Association in November 2010 and the American College of Physicians in January 20128 published guidelines for maintaining professionalism online.

이 두 가이드라인에서는 전문적인 경계를 유지하고 환자 정보와 함께 기밀성을 유지하기 위해 온라인 환경에 프로페셔널리즘 표준을 확장하는 것을 지지합니다.

Both advocate extending standards of professionalism to the online environment to maintain appropriate professional boundaries and confidentiality with patient information.8

호주 의학 협회 (Australian Medical Association)는 의과학생이 환자와의 접촉에서 다른 동료를 비방하는 것까지 다양한 상황에서 소셜 미디어 사이트를 탐색하도록 돕기 위해 '행동 강령'을 만들었습니다.

the Australian Medical Association has created a ‘Code of Conduct’ to help medical students navigate using social media sites in various situations ranging from contact with a patient to defaming another colleague.9

마찬가지로 영국의 일반 의학위원회 (General Medical Council)와 캐나다 의학 협회 (Canadian Medical Association)는 의대생을 대상으로 소셜 미디어 사용에 관한 지침을 제공합니다.

Similarly, the General Medical Council in the UK and the Canadian Medical Association have guidelines for medical students regarding social media use.10

의과대학생의 소셜미디어 활용

Medical students’ use of social media

2010 년의 질적 연구에 따르면 의대생들 사이에 UPB를 구성하는 것에 대한 합의가 이루어지지 않았다.

A 2010 qualitative study found that, there was no consensus among medical students for what constitutes unprofessional behaviour.12

일부 의대생은 의과 대학에서 '감시하고있다'는 느낌을 보고하며, 이를 침범intrusion으로 인식하며 분개하고있다.

some medical students have reported a sense of being ‘watched’ by their medical schools and they resent what they perceive to be an intrusion.13

전문직 정체성 형성

Professional identity formation

의과대학생들은 특히 초기에 의사가하는 것과 같은 방식으로 프로페셔널리즘을 보지 못합니다. 왜냐하면 그들은 매우 다른 발전 단계에 있기 때문입니다.

Medical students, particularly early on, do not view professionalism in the same way that doctors do, because they are at a very different stage of development.

자비스 - 셀린저 (Jarvis-Selinger)와 동료들 (17)은 의과대학생이 실제적으로 의사가되는 것의 의미를 깊이 이해하지 못했다고보고했다. 학생들은 이것을 '협소하게 정의하고 피상적으로 이해했다'.

Jarvis-Selinger and colleagues,17 reported that medical trainees do not have a deep understanding of what it actu-ally means to be a doctor; theirs is a ‘narrowly defined, superficial understanding’.17

자라면서 모든 유형의 정보를 공유해온 '디지털 원주민'이 개인 생활과 직업 생활을 분리하는 경계를 개발하는 것은 어려울 수 있습니다.

due to growing up sharing all types of information, it may be difficult for these ‘digital natives’ to develop boundaries that separate their personal lives from their professional lives.

소셜미디어 설문 연구

Social media surveys conducted

방법

METHODS

자료 수집

Data collection

A survey of currently enrolled medical students, medical school faculty members and non-doctor/non-student employees (‘public’) from all schools and units of the entire University of Michigan system was conducted in the winter of 2009. Our public population was not limited to the health system or medical school, and respondents in this category who were health care professionals were excluded from the analysis.

대상

Subjects

In total, 1546 people responded to the survey that was sent out to three list serves. As this was an online survey with list serve e-mail recruitment (i.e. we estimate that thousands could have accessed the survey through the list serve, but we have no way of determining how many deleted it before opening or how many opened and then deleted it), response percentages cannot be accurately determined. Respondents were first asked to identify themselves as health care professionals or non-health care professionals; health care professionals were asked what type they were (e.g. medical student, medical faculty member, other faculty member, other health care professionals of various types).

설문 설계

Survey design

Several of the study investigators, including medical school students and faculty members, designed the survey instrument based on what has been reported in existing literature and investigator hypotheses.10

We attempted to capture the following major themes with our screenshots picture selection: 

• same-sex pairs (posing together or kissing), 

• opposite-sex pairs (posing together or kissing), 

• comments on patients (e.g. ‘saw the fattest patient today’), 

• substance use (students using marijuana, drinking alcohol, smoking cigarettes), 

• comments on medical school (e.g. ‘just bombed the anatomy final’), 

• parties or dancing, 

• partial nudity, 

• clinical picture-domestic and 

• clinical picture-international.

Participants were told that the screenshots were taken from Facebook profiles of medical students with ‘public’ privacy settings and thus accessible by   search engines and all Facebook users, and they were told that the screenshots did not display any medical students from the University of Michigan. Participants were asked to review the screenshots, read the text descriptions within these mock posts, as well as the survey question prompts, and then to rate the pictures accordingly. 

• They rated the ‘appropriateness’ of each screenshot on a Likert scale from 1 (very appropriate to post on an online network) to 5 (not at all appropriate to post on an online network). 

• The subjects were also asked to respond to the question ‘Would you feel comfortable having the student who posted this as your doctor in the future?’ using a Likert scale ranging from 1 (would be very comfortable having this student as my doctor in the future) to 5 (absolutely would not feel comfortable having this student as my doctor in the future).

The instrument underwent pilot testing by 20 medical faculty members, 20 medical students from external institutions and 20 non-health professionals (public); these results were not used in the final data analysis. A link to the final survey, including screenshots, can be found here: http://www-personal.umich.edu/ purkissj/FacebookSurvey.pdf.

통계 분석

Statistical analysis

To determine whether respondent groups differed in their uses of Facebook
we conducted chi-squared tests of significance and tabulated Cramer’s V effect size measures. Cramer’s V = √(X2/(n[k  1]), where k = the smaller of the number of rows or columns. We interpret effect sizes from Cramer’s V using the following conventions: 0.1 = small, 0.3 = moderate, 0.5 = large (Table 2).

we performed a series of independent samples Kruskal–Wallis H′ tests (the H′ statistic is similar to H, but is adjusted for tie rankings). We utilised non-parametric techniques for these data, as some of our scale-based measures showed evidence of non-normal distributions. When statistically significant associations existed, we followed with Dunn–Bonferroni-adjusted post hoc comparisons to determine which groups differed significantly. To measure effect size for these associations, we used eta-squared (g2 = H′/[n  1]). We interpret effect sizes from eta-squared using the following conventions: 0.01 = small, 0.06 = moderate, 0.14 = large (Table 3). 

Finally, we conducted two multiple linear least-squares regression analyses to explore the relationship between overall assessments of the screenshots, respondent group and demographic characteristics. We elected to use simultaneous forced entry of all regression variables (i.e. enter method, with all variables included), given the absence of a theoretical framework that might guide a hierarchical approach to adding regression variables. This approach to multivariate regression analyses allowed us to explore the relationship between membership in the respondent groups and appropriateness and comfort ratings, while controlling for additional variables, including respondent gender, race ethnicity and age. To measure effect size for the regression analyses, we used Cohen’s f 2 (f 2 = (R2/[1  R2]). We interpret effect sizes from Cohen’s f 2 using the following conventions: 0.02 = small, 0.15 = moderate, 0.35 = large (Table 4). Throughout the study, we used p < 0.05 as our threshold for statistical significance. 

RESULTS

인구통계

Demographics

페이스북 사용

Facebook utilisation

표 2에서 볼 수 있듯이, 응답자 그룹은 다른 유형의 Facebook을보고 했습니까? 각각의 사용 유형 (모든 경우 p <0.05)과 약한 정도에서 중등도 범위의 효과 크기 (Cramer 's V의 범위는 0.08에서 0.20 사이)에 대해 통계적으로 유의미한 집단 차이를 보였다.

As shown in Table 2, respondent groups reported different types of Facebook
utilisation, with statistically significant group differences for each usage type (p < 0.05 in every case) and effect sizes in the weak-to-moderate range (Cramer’s V ranged from 0.08 to 0.20).

스크린샷 평가

Screenshot ratings

표 3에 제시된 데이터는 전반적으로 교수진과 대중이 더 보수적 이었음을 보여줍니다

Data presented in Table 3 show that, overall, faculty members and the public were more conservative 

표 3은 29 이미지 평균에 대한 결과 외에도 전반적인 (총) 응답자 등급에 따라 가장 적절하지 않은 것으로 분류되고 정렬 된 이미지 항목을 제공합니다.

In addition to results for the 29-image averages, Table 3 also presents the image topics categorised and sorted from least appropriate to most appropriate according to overall (total) respondent ratings.

표 4는 2 개의 다중 선형 최소 자승 회귀 분석 결과를 요약 한 것이다.

Table 4 summarises the results from two multiple linear least-squares regression analyses.

고찰

DISCUSSION

젊은 사람들 사이에서 소셜 미디어가 널리 보급되고 있으며, 65 세 이상 그룹을 포함하여 지난 5 년 동안 모든 연령대의 페이스 북 사용자 수가 증가했습니다. 22

The widespread use of social media is fairly recent and much more prevalent among younger individuals,11 but the number of Facebook users in all age groups has increased over the past 5 years, including those in the ‘over 65 years of age’ group.22  

일반적으로 교직원과 대중은 소셜 미디어 사이트에 게시 된 콘텐츠의 적합성에 대해 학생들보다 보수적이었습니다.

In general, faculty members and the public were more conservative than students about the appropriateness of content posted on social media sites.

본 연구에서 우리는 의과대학의 교수진, 의대생 및 일반인의 세 그룹에 의해 평가 된 적합성에 대한 인식에서 유의 한 차이를 발견했습니다. 참고로, 교수진은 대중의 적합성 등급보다 약간 더 많은 범주의 의대 학생과 비교하여 통계적으로 유의미한 낮은 적합성과 comfort 수준을 나타내므로 의대 교수진이 일반 대중보다 학생에 대해 가장 높은 전문성을 기대한다고 제안했습니다.

In our study we found significant differences in perceptions of appropriateness as rated by three groups: medical school faculty members, medical students and the public. Of note, faculty members indicated statistically significant lower appropriateness and comfort levels compared with medical students in slightly more categories than the public’s appropriateness ratings, suggesting that medical school faculty members expect the highest degree of professionalism among students than the general public (based on our sample). 

모든 응답자는 현재의 (환자에 대한 언급이 포함된) 전문직업성 표준이나 법률을 분명히 위반한 이미지를 가장 discomfort하다고 평가했으며, 그 뒤를 마리화나 이미지가 따랐다. 놀랍지 않게도, 우리 사회의 규범을 고려할 때, 서로 다른 성별 사이의 관계 (즉, 키스)를 묘사 한 이미지는 가장 덜 부적절한 것으로 여겨졌고, 모든 세 그룹 사이에서 가장 불편함을 덜 유발했습니다.

All respondents rated images that clearly violated current professional standards or laws, with comments on patients as the most inappropriate and causing the most discomfort, followed by an image with marijuana. Not surprisingly, given our societal norms, images depicting opposite-sex relationships (i.e. kissing) were viewed as least inappropriate and caused the least discomfort among all three groups.

일반적으로, 부적절하거나 적절한 소셜미디어 게시 유형에 대해서, 그리고 그러한 포스팅을 의대생이 아닌 사람들이 봤을 때에 수반되는 결과에 대해서 의대생이 갖고 있는 생각은 의사 및 일반 대중과 크게 다른 것으로 나타났습니다.

In general, we found that medical students differed significantly from doctors and the public in terms of the types of social media posting they find appropriate versus inappropriate, and in terms of the consequences of such postings when viewed by individuals who are not medical students.

우리의 연구 결과는 의대생은 교수 또는 일반 대중이 부적절하거나 프로페셔널하지 않은 것으로 생각할 의견, 사진을 게시 할 가능성이 높다는 것을 보여줍니다. 세 그룹의 스크린 샷 평가에서 통계적 차이가 발견되었으며 연령을 통제했을 때도 중요한 요소로 지속되었습니다.

Our findings suggest that medical students are more likely to post comments, images and photographs that medical school faculty members and the public would consider inappropriate or unprofessional. Statistical differences were found among the three groups’ ratings of the screenshots and persisted as a significant factor, even when we controlled for age.

추가 관심사는 특정 이미지 또는 코멘트가 사회적인 네트워크 사용자에 관하여 개인 정보를 계시했다이다. 기본 Facebook 프로필을 통해 사용자는 자신의 성적 취향뿐만 아니라 정치적 및 종교적 이데올로기를 공개적으로 확인할 수 있습니다. 이러한 정보는 전통적인 환자와의 만남에서는 드러나지 않으며, 따라서 환자가 이러한 정보를 알게 되면 의사에게 정보 제공을 보류하거나, 선입관을 갖거나, 또는 단순히 의사로서 그 사람에게 불편함을 느낄 수 있습니다. 우리 연구에서 이것을 발견했습니다. 일반인들은 더 높은 비율로 동성간의 관계에 관한 이미지를 부적절하다고 느꼈으며, 이러한 게시물을 올리는 학생들을 미래의 의사로서 덜 comfortable하게 느꼈다. 동성 관계에 대한 이미지를 의대생보다 교수진과 일반인이 더 부정적으로 보았다는 사실은 (특히 특정 인구통계학적 집단에서) 동성 간 관계에 대한 수용이 증가하고 있는 문화적 규범을 반영했을 것입니다. 

Of additional interest is that certain images or comments revealed personal information about social network users. The basic Facebook profile allows users to identify their sexual orientation publicly, as well as their political and religious ideologies. This information, which would probably not be revealed in a traditional patient encounter, could cause a patient to withhold information, to form preconceived biases or simply to feel uncomfortable with that individual as their doctor. We found this in our study – a higher percentage of the public group found images depicting same-sex relationships inappropriate and they were less comfortable having the student posting the image as their future doctor than were members of the student group. The fact that same-sex relationships were viewed more negatively among faculty members and public groups when compared with the medical student group probably reflects cultural norms, where there is growing acceptance of same-sex relationships, especially among certain demographic groups in our society.

남아있는 중요한 문제는 다음에 대해서 의대생들의 이해를 돕는 것이다.

• 학생들이 소셜 미디어 사이트에 게시해도 괜찮다고 생각하는 것이 교수, 일반인, 미래의 환자가 생각하는 것과는 크게 다르다는 것

• 다른 사람들이 부적절하다고 생각하는 게시물이 전문직업적 영향 또는 평판에 영향을 가져올 수 있다는 것

A major issue remains in how to help medical students understand that what they think is appropriate to post on a social media site is significantly different from what faculty members or the public, their future patients, might think, and that postings thought by others to be inappropriate could have professional or reputational consequences.

한계

Limitations

우리 설문 조사 응답자는 미국 내 다른 학술 의료 센터의 학생, 교수 및 일반인을 대표한다고 생각하지만이 연구는 중서부의 한 대형 기관에서 실시되었습니다.

Although we believe the respondents to our survey are representative of students, faculty members and the public from other academic medical centres in the country, the study was conducted at a single large Midwestern institution.

Summary and future directions

우리 연구 결과는 의대생들이 게시하기 전에 게시하려는 콘텐츠에 대해 배우는 것을 배우도록하기 위해 만들어진 가이드 라인 개발에 중요한 의미가 있다고 생각합니다. 의학 교육은 전통적으로 전문성에 관한 학습을위한 기본 도구로서 역할 모델링에 크게 의존했지만, 이러한 사이트의 사용 방법과 콘텐츠에 대한 관점이 연령별로 차이가있는 것으로 보아, 소셜 네트워킹에 대한 역할 모델링은 현실적이지 않거나 효과적이지 않을 수 있습니다.

We believe our findings have important implications for development of guidelines created to help medical students learn to reflect on content they intend to post before they post it. Although medical education has traditionally relied significantly on role modelling as a primary tool for learning about professionalism, given what appear to be age differences in how such sites are used and how content is viewed, role modelling about social networking might not be realistic or effective.

17 Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med 2012;87: 1185–90.

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Med Educ. 2014 Feb;48(2):157-69. doi: 10.1111/medu.12282.

What is appropriate to post on social media? Ratings from students, faculty members and the public.

Jain A1, Petty EM, Jaber RM, Tackett S, Purkiss J, Fitzgerald J, White C.

Author information

1

Children's Hospital Boston/Boston Medical Center, Boston, Massachusetts, USA.

Abstract

OBJECTIVES:

The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook(®) . The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patient's confidence in that student's clinical abilities.

METHODS:

An online survey was designed to investigate the perceptions of University of Michigan medical students, attending physicians and non-health care university-wide employees (that serves as a subset of the public) regarding mock medical students' Facebook(®) profile screenshots. For each screenshot, respondents used a 5-point Likert scale to rate 'appropriateness' and whether they would be 'comfortable' having students posting such content as their future doctors.

RESULTS:

Compared with medical students, faculty members and public groups rated images as significantly less appropriate (p < 0.001) and indicated that they would be less comfortable (p < 0.001) having posting students as future doctors. All three groups rated screenshots containing derogatory or private information about patients, followed by images suggesting marijuana use, as least appropriate. Images conveying intimate heterosexual couples were rated as most appropriate. Overall, the doctor group, females and older individuals were less permissive when compared with employee and student groups, males and younger individuals, respectively.

CONCLUSIONS:

The most significant conclusion of our study is that faculty members, medical students and the 'public' have different thresholds of what is acceptable on a social networking site. Our findings will prove useful for students to consider the perspectives of patients and faculty members when considering what type of content to post on their social media sites. In this way, we hope that our findings provide insight for discussions, awareness and the development of guidelines related to online professionalism for medical students.

© 2014 John Wiley & Sons Ltd.

Comment in

• Social media and medical professionalism. [Med Educ. 2014]

PMID:

 

24528398

 

DOI:

 

10.1111/medu.12282