Written by Emily Wu (Medicine, Class of 2023)
As I am sure most you of know by now, a now-retracted paper titled “Prevalence of unprofessional social media content among young vascular surgeons”(1), published in the August issue of Journal of Vascular Surgery stirred up quite a controversy among medical professionals in late July. Although this is perhaps an outdated topic and many other writers have eloquently dissected this situation, I thought it would be a good leeway to discuss professionalism in medical education as we step into a new school year.
The aforementioned paper consisted of a screening of the social media profiles of graduating vascular surgery trainees. Three screeners were tasked with identifying unprofessional content on the graduates’ Facebook, Twitter and Instagram accounts. The results were first presented at the annual meeting for the Society for Clinical Vascular Surgery in December 2019, but the article only gained infamy when it was published online and the criteria for “unprofessional content” were made aware to the public. Some of the potentially unprofessional content include holding alcohol, profanity and inappropriate attire, which is later further defined as “pictures in underwear, provocative Halloween costumes, and provocative posing in bikinis/swimwear”. (1)
This last point was particularly contentious and criticized by a flurry of healthcare workers for its gender bias. After all, most (if not all) “provocative posing in bikinis/swimwear” is done by female social media users. Furthermore, the social media profiles were screened by three men, with no consideration for implicit biases. The hashtag #medbikini started circulating on Twitter and other social media platforms, accompanied by pictures of female medical professionals and trainees wearing bikinis, holding alcohol, and other “unprofessional content”. The posts were used to protest misogyny and gender bias in medicine and science, as well as to show the absurdity of the criteria used by the paper. For example, a picture of a female physician wearing a bikini during a family holiday, or a picture of doctors holding champagne glasses during their wedding ceremony clearly show the flaws in the content screening process. (2, 3) However, female physicians should not have to give any excuses for such posts and should not be held to such unreasonable standards for “professionalism” on social media. As pointed out by one Twitter user, it is doubtful that a picture of a man in a swimsuit would garner the same label of unprofessionalism from the reviewers in this paper. (4)
In response to the backlash, one of the authors of the paper apologized in a now-deleted tweet, recognizing the biases involved in the methods of the paper. (5) The editors of the Journal of Vascular Surgery also released a statement of apology and decided to retract the study. (6) However, two other papers published in 2014 and 2017 examining professionalism of medical trainees and recent graduates on social media platforms have not garnered the same attention. They still remain in good standing with their respective journals despite using the same criteria for unprofessional content, albeit without explicitly citing bikinis as inappropriate attire. (7, 8) All three of these papers claim to be in pursuit of warning trainees and recent graduates from the harm of social media and to have the goal of helping students be more judicious of their use of such platforms. In fairness, some of the content surveyed in these articles could definitively be considered as actively harmful to patient care, such as clear HIPAA violations (e.g. posting radiographic images with patients’ names still visible). Further, all papers recognize the subjective nature of unprofessional content although the authors did not seem to have sought out patients’ opinions of potentially unprofessional behaviour from their medical providers.
Beyond #medbikini, there lies larger questions of what is “professional behaviour” on social media and who is defining the concept of “professionalism”. As shown by this recent study, using the male gaze to define professionalism can lead to some serious biases. If it is defined by a non-ethnically diverse group, will traditional attire from other cultures be considered “inappropriate” or “unprofessional”? Since our first day of orientation in medicine at McGill, professionalism has been hammered into us repeatedly. One instance that particularly stands out for me was a small group we had on the use of social media as medical students and future physicians. Our group facilitator discouraged its use and especially discouraged posting “controversial” advocacy content on our public platforms. The latter was also one of the examples of potentially unprofessional content used by the authors of the Journal of Vascular Surgery study, specifically singling out public stances on gun control and abortion. Although I definitively understand the need for self-aware and cautious use of social media, possible biases could be embedded in such recommendations. Who is deeming a post "too controversial”? Is there one side of the aisle that is more “appropriate” than the other?
These concerns of professionalism are not limited to the medical profession. A 2018 survey found that 70% of human resources managers look into the social media accounts of potential candidates. These recruiters had very similar examples of unprofessional content to the study that started this entire controversy, including drinking alcohol and provocative photographs. (9) Perhaps medical professionals are held to a higher standard than other occupations (10), or perhaps we are simply part of a new generation of young professionals growing in tandem with the use of social media platforms.
References
Hardouin S, Cheng TW, Mitchell EL, Raulli SJ, Jones DW, Siracuse JJ et al. Prevalence of unprofessional social media content among young vascular surgeons. J Vasc Surg [Internet]. 2020 Aug [cited 2020 Aug 6];72(2):667-671. Available from: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2819%2932587-X. doi: 10.1016/j.jvs.2019.10.069
Michos ED. I'm here in support of my female Vascular Surgery colleagues because (gasp) #WomenInCardiology also wear bikinis on family vacations. Women doctors are like real people. Having some fun in our free time does not make us unprofessional. Wellness makes us better doctors. #MedBikini [Internet]. 2020 Jul 24 [cited 2020 Aug 6]; Available from: https://twitter.com/ErinMichos/status/1286644197798432770?s=20
McCarthy C. Here I am with my wife enjoying a drink for #UnprofessionalMedTwitter at our wedding which was on social media. There was also… gasp… dancing. During the honeymoon there were #MedBikini photos. Proud #25percenterand supporter [Internet]. 2020 Jul 24 [cited 2020 Aug 6]; Available from: https://twitter.com/colmjmccarthy/status/1286626080313442304?s=20
Vonderwalde I. Does this make me look unprofessional? Or do those standards not apply to me? #medbikini #professionalism [Internet]. 2020 Jul 23 [cited 2020 Aug 6]; Available from: https://twitter.com/ilanvonder/status/1286411539860189185?s=20
Ray C. Health Workers Post Bikini and Alcohol Selfies, Slamming Study on Their Social Media Use as “Sexist” [Internet]. [place unknown]: Rogue Rocket; 2020 Jul 27 [cited 2020 Aug 6]. Available from: https://roguerocket.com/2020/07/27/study-social-media/
Gloviczki P, Lawrence PF. Editors’ Statement Regarding “Prevalence of unprofessional social media content among young vascular surgeons” J Vasc Surg 2020;72:667-71 [Internet]. [place unknown]: Society for Vascular Surgery; 2020 Jul 24 [cited 2020 Aug 6]. Available from: https://vascular.org/news-advocacy/editors%E2%80%99-statement-regarding-%E2%80%9Cprevalence-unprofessional-social-media-content-among
Langenfeld SJ, Cook G, Sudbeck C, Luers T, Schenarts PJ. An Assessment of Unprofessional Behavior Among Surgical Residents on Facebook: A Warning of the Dangers of Social Media. Journal of Surgical Education [Internet]. 2014 Nov-Dec [cited 2020 Aug 6];71(6):28-32. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1931720414001597?via%3Dihub. doi:10.1016/j.jsurg.2014.05.013
Koo K, Ficko Z, Gormley EA. Unprofessional content on Facebook accounts of US urology residency graduates. BJUI [Internet]. 2017 Apr 9 [cited 2020 Aug 6];119(6):955-960. Available from: https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/bju.13846. doi:10.1111/bju.13846
CareerBuilder. More Than Half of Employers Have Found Content on Social Media That Caused Them NOT to Hire a Candidate, According to Recent CareerBuilder Survey [Internet]. Chicago & Atlanta: PR Newswire; 2018 Aug 9 [cited 2020 Aug 6]. Available from: https://www.prnewswire.com/news-releases/more-than-half-of-employers-have-found-content-on-social-media-that-caused-them-not-to-hire-a-candidate-according-to-recent-careerbuilder-survey-300694437.html
Jain A, Petty EM, Jaber RM, Tackett S, Purkiss J, Fitzgerald J et al. What is appropriate to post on social media? R atings from students, faculty members and the public. Medical Education [Internet]. 2014 Jan 12 [cited 2020 Aug 6];48(2):157-169. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/medu.12282. doi:10.1111/medu.12282