CoChat
Sign Up
Cited by 84Social Media in Health EducationImpact of Technology on AdolescentsInnovations in Medical Education

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

Open access
Jain, Anuja, Petty, Elizabeth M, Jaber, Reda M, Tackett, Sean, Purkiss, Joel, Fitzgerald, James, White, Casey·2014·Medical Education
DOI 10.1111/medu.12282
Open this paper in CoChat — free accountOpen PDF

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 U niversity of M ichigan medical students, attending physicians and non‐health care university‐wide employees (that serves as a subset of the public) regarding mock medical students' F acebook ® profile screenshots. For each screenshot, respondents used a 5‐point L ikert 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.

AI snapshot

Written from the paper’s full text.

TL;DR

Medical students, faculty members, and a public sample rated fabricated Facebook screenshots of medical students differently: faculty and the public were more conservative than students about appropriateness and comfort with the posting student as a future doctor. All groups rated patient-related derogatory/private content and marijuana images as least appropriate, and opposite-sex couple images as most appropriate.

Key findings

  • Compared with medical students, faculty members and the public rated images as significantly less appropriate (p < 0.001) and were less comfortable having posting students as future doctors (p < 0.001).
  • On 29-image averages, lower scores meant less appropriate/comfortable: students had appropriateness mean 2.84, public 2.68, faculty 2.53 (Kruskal-Wallis H′ = 28.62, d.f. = 2, p < 0.001; η² = 0.02); comfort means were students 3.03, public 2.70, faculty 2.67 (H′ = 51.44, d.f. = 2, p < 0.001; η² = 0.04).
  • All three groups rated screenshots containing derogatory or private information about patients as least appropriate, followed by images suggesting marijuana use; images conveying intimate heterosexual couples were rated most appropriate.
  • In regression models controlling for age, gender, and race/ethnicity, faculty remained more conservative on appropriateness (B = −0.152, p = 0.003), students more permissive on comfort (B = 0.149, p = 0.006), females less permissive on appropriateness (B = −0.248, p < 0.001) and comfort (B = −0.252, p < 0.001), and older respondents more conservative on appropriateness (B = −0.013, p < 0.001) and comfort (B = −0.012, p < 0.001).

Methods

  • Online survey conducted in winter 2009 at the University of Michigan via three list serves: medical students, medical school faculty members, and non-health care university employees as a “public” subset; health care professionals in the public group were excluded.
  • Respondents rated 29 fabricated mock Facebook screenshots, presented in random order, on 5-point Likert scales for “appropriateness” and comfort with having the posting student as their future doctor; scales were reverse-coded for analysis.
  • Analysis used descriptive statistics, chi-squared tests with Cramer’s V, Kruskal-Wallis H′ tests with Dunn-Bonferroni post hoc comparisons, eta-squared effect sizes, and two simultaneous forced-entry multiple linear regressions in SPSS.

Limitations

  • The paper states: the study was conducted at a single large Midwestern institution; screenshots were created by authors rather than being actual Facebook profiles; unaccounted image variables (e.g., gender, ethnicity, age, clothing) may have influenced responses; the 29 screenshots were limited in scope per category; the study assumed profiles were viewable and not blocked by privacy settings; and an online survey made nuanced differences difficult to measure.
  • Evident from the text: response percentages cannot be accurately determined because recruitment used list-serve e-mails, and the “public” group was university-wide non-health care employees rather than a general population sample.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/medu.12282

Cites

16 of 16 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 12 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Relative to medical students, faculty members and the public reported significantly lower comfort with having the posting students as their future doctors.

    “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.”
    • Also stated in: § Screenshot ratings · plain
      “Post hoc comparisons identified significant differences between students (mean = 3.03) and the public (mean = 2.70) (p < 0.001), as well as a significant difference between students and faculty members (mean = 2.67) (p < 0.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.
  • Findingown data

    Group membership had a statistically significant weak-to-moderate global association with average comfort ratings across the 29 images (Kruskal-Wallis H′=51.44, df=2, p<0.001; η2=0.04).

    “There was also a highly significant but weak to moderate global association between group membership and average comfort rating, based on ratings of comfort with having the students who posted each of the 29 images as their doctor in the future (Kruskal-Wallis H′ = 51.44,d.f.= 2, p < 0.001; g 2 = 0.04).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.
  • Findingown data

    The public rated significantly lower appropriateness than medical students in six screenshot topic areas.

    “The public's appropriateness ratings were significantly lower than those of medical students in six topic areas (with p values ranging from < 0.001 to 0.018).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.
  • Findingown data

    In post hoc comparisons, the public and faculty members had significantly lower average comfort ratings than medical students.

    “Post hoc comparisons identified significant differences between students (mean = 3.03) and the public (mean = 2.70) (p < 0.001), as well as a significant difference between students and faculty members (mean = 2.67) (p < 0.001).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.
  • Findingown data

    Overall, older individuals were less permissive than younger individuals.

    “Overall, the doctor group, females and older individuals were less permissive when compared with employee and student groups, males and younger individuals, respectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    More public respondents than medical students judged same-sex relationship images inappropriate and felt less comfortable with the poster as their future physician.

    “We found this in our studya higher percentage of the public group found images depicting same-sex relationships inap-propriate and they were less comfortable having the student posting the image as their future doctor than were members of the student group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Respondents rated images containing comments on patients as the most inappropriate, followed by an image including marijuana.

    “Overall, respondents rated images that contained comments on patients as the most inappropriate, followed by an image that included marijuana.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Medical trainees have a narrowly defined, superficial understanding of what it means to be a doctor.

    “Jarvis-Selinger and colleagues, 17 using developmental theory as a foundation for describing identity formation, reported that medical trainees do not have a deep understanding of what it actually means to be a doctor; theirs is a 'narrowly defined, superficial understanding'.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Because they grew up sharing information through electronic media, 'digital natives' may struggle to separate their personal and professional lives.

    “Kaczmarcyzk and colleagues 18 cautioned that, due to growing up sharing all types of information, personal and otherwise, using electronic media, it may be difficult for these 'digital natives' to develop boundaries that separate their personal lives from their professional lives.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Image variables such as gender, ethnicity, age, and clothing were not accounted for and could have affected responses.

    “other variables presented in the images (i.e.gender, ethnicity, age, clothing, etc.) that were unaccounted for in our study may have influenced responses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was granted exemption from informed consent by the University of Michigan Health System institutional review board.

    “This study was granted exemption from informed consent by the institutional review board of the University of Michigan Health System.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Thompson and colleagues reported that 70% of medical student profiles included alcohol-related photographs, and 10-50% of photographs suggested excessive drinking.

    “Thompson and colleagues 14 found that 70% of medical students' profiles had photographs with alcohol, with a frequency of 10-50% of photographs that implied excess drinking.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The 29 screenshots were limited in scope; more images in each category would have been needed for a more comprehensive understanding of differences among categories.

    “Furthermore, the 29 screenshots were limited in scope in that we could have included more images of all of the categories to gain a more comprehensive understanding of the differences among the categories.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The more negative view of same-sex relationships among faculty and the public probably reflects cultural norms of growing acceptance of same-sex relationships, especially among certain demographic groups.

    “probably reflects cultural norms, where there is growing acceptance of same-sex relationships, especially among certain demographic groups in our society.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Some respondents provided partial responses, so the sample size was reduced for various portions of the analysis.

    “Some respondents provided partial responses to the survey, so the sample size was reduced accordingly for various portions of our analysis (e.g. as eight respondents provided either partial or no image rating data, the corresponding analysis had n = 1413).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The survey stated that the screenshots did not include University of Michigan medical students, but did not explicitly tell participants that the screenshots were not real.

    “It should be noted that our survey specifically stated that the screenshots did not have pictures of University of Michigan medical students.However, we did not explicitly explain to participants that the screenshots were not real and instead were created by the researchers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The profile images were fabricated by some authors to show content typical of medical student sites; they were not real profiles of current students.

    “Another limitation is that our screenshots of Facebook â profiles were created by several of the authors to depict specific content that is found on medical student sites, so they were not actual Facebook â profiles of current medical students.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    After removing 125 records, the analysis included 1421 respondents: 237 medical students, 206 medical school faculty, and 978 non-health care employees or public.

    “We excluded 125 records for respondents who either did not indicate their status or gender or whose self-reported status did not meet our criteria.Therefore, we ultimately included 1421 records in our analysis, representing those respondents classified as medical students (n = 237), medical school faculty member (n = 206) and the non-health care professional employees or 'public' (n = 978).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Before the final study, the instrument was tested with three groups of 20 people each-medical faculty, external medical students, and non-health professionals-and those results were excluded from the final analysis.

    “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.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent survey of internal medicine educators identified many behaviours that could be viewed as inappropriate when shown online.

    “In fact, a recent survey of internal medicine educators revealed a broad constellation of behaviours that might be considered inappropriate if depicted online.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The researchers deliberately selected images with diverse ethno-cultural backgrounds and matched behaviours between same-sex and opposite-sex pairs to reduce confounding.

    “We intentionally chose pictures of individuals from a wide range of ethno-cultural backgrounds.In addition, we attempted to choose images of individuals engaging in similar behaviours (e.g.kissing) in the same-sex pairs and opposite-sex pairs to avoid confounding variables.”
    Quote in the paperSubstantial claim
16 of 16

  • The paper relies on this without support.

    Posting unprofessional material damages a student's image and may reduce patients' trust in the student's clinical competence.

    “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.”

  • The paper relies on this without support.

    Many social media professionalism guidelines were created by practising doctors without input from medical students.

    “However, many of these guidelines have been created by practising doctors, and sometimes without the input of medical students.”

  • The paper relies on this without support.

    No current guidelines combine the perspectives of doctors, medical students, and the public.

    “To our knowledge, no guidelines exist that incorporate the views of practising doctors, medical students and the publicthree important groups of stakeholders.”

  • The paper relies on this without support.

    No prior published study has surveyed the general public about what they see as acceptable online conduct for their future physicians.

    “However, to our knowledge, no published study has asked what members of the general public, all of whom are current or potential patients, would consider as appropriate online behaviour for their future doctors.”

  • The paper relies on this without support.

    The non-health care university employees surveyed represent a subset of the general public.

    “non-health care university-wide employees (that serves as a subset of the public)”
    “represented, in our opinion, a subset of the public”

  • The paper relies on this without support.

    Participants' ratings of the mock screenshots reflect the judgments they would make about real Facebook profiles.

    “This was done so that we could determine the impressions of the participants as if the profile pictures were real.”

  • The authors state this as an assumption.

    The authors assumed that every profile and screenshot could be viewed without being blocked by privacy settings.

    “In addition, our study was based on the assumption that all profiles and, hence, screenshots were readily viewable and not blocked by privacy settings.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Patients, supervisors, and regulatory groups demonstrate more conservative views.

    “In contrast, patients, supervisors, and regulatory groups demonstrate more conservative views.”

    From Perceptions of Unprofessional Social Media Behavior Among Emergency Medicine Physicians (2017) · cites this paper as [15]

    The Results report that faculty members and members of the public rated the posts as less appropriate than medical students did, supporting the comparison for supervisors and for a public group representing potential patients. The study did not survey regulatory groups or establish their views; its section on professionalism guidelines only notes that some organisations have issued guidance. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • An online survey using mock Facebook profiles found that, compared to university students, faculty and members of the public rated images significantly less appropriate.

    “An online survey using mock Facebook profiles found that, compared to university students, faculty and members of the public rated images significantly less appropriate [156].”

    From Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review (2021) · cites this paper as [156]

    The Methods and Results report an online survey using mock Facebook screenshots and significantly lower appropriateness ratings from faculty members and the public group than from medical students (p < 0.001). The claim broadens the comparison group to university students generally; the surveyed students were medical students, and the public group consisted of non-health-care university employees. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Among students there is little consensus on what constitutes unprofessional behavior beyond the US HIPAA violations.

    “Survey results showed that among students there is little consensus on what constitutes unprofessional behavior beyond the US HIPAA violations, and students have felt that posting inappropriate material on personal SM sites was “unavoidable” [156].”

    From Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review (2021) · cites this paper as [156]

    The “Medical students’ use of social media” section reports an earlier qualitative study finding no consensus among medical students except on HIPAA violations and illegal behaviours. It also says one student—not students generally—called posting inappropriate material “unavoidable.” The citing sentence omits the exception for illegal behaviours and presents these reported findings as survey results without distinguishing them from this paper’s own survey. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Students have felt that posting inappropriate material on personal social media sites was unavoidable.

    “Survey results showed that among students there is little consensus on what constitutes unprofessional behavior beyond the US HIPAA violations, and students have felt that posting inappropriate material on personal SM sites was “unavoidable” [156].”

    From Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review (2021) · cites this paper as [156]

    The “Medical students' use of social media” section reports that one student in a cited 2010 qualitative study felt posting inappropriate material was “unavoidable.” The citing sentence generalizes that view to students and presents it as a survey result, whereas this paper does not report it as a finding of its own survey. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Risks such as privacy and accuracy of information, compromising confidentiality, eroding public trust, and loosening accountability were presented in previous research.

    “Likewise, risks such as privacy and accuracy of information, compromising confidentiality, eroding public trust, and loosening accountability were presented in previous research [156,188,189].”

    From Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review (2021) · cites this paper as [156]

    The paper’s ‘Professionalism guidelines on social media’ section discusses patient confidentiality and the doctor–patient relationship, and its Discussion addresses patient privacy violations and discomfort with a future doctor’s posts. These passages support the privacy and confidentiality risks, with some bearing on trust, but do not address information accuracy or loosening accountability. Page numbers are not available in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Maximum respondent age differs between text and table

    Minor

    The results give the overall age range as 19-79 years, but Table 1 gives 19-76 years. The highest age in any group in the table is also 76.

  • Public-group male percentage is incorrect

    Minor

    Table 1 lists 310 males among 978 public respondents, which is 31.7%, not 31.2%.

    Reported 31.2 · recomputed 31.697342

  • Public-group race nonresponse percentage is incorrect

    Minor

    Six nonresponses among 978 public respondents amount to approximately 0.6%, not 6.1%.

    Reported 6.1 · recomputed 0.613497

  • Age coefficient signs disagree in the comfort model

    Minor

    Table 4 gives a negative unstandardized age coefficient but a positive standardized coefficient for the same comfort model. Those coefficients should have the same sign; the positive standardized coefficient also conflicts with the stated interpretation that comfort declines with age.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Mayer MA, 2012, How medical doctors and students should use social media: a review to propose some practical recommendations, Stud Health Technol Inform, 180, 853

Cited by

Sorted by citations

Related

Authors
Jain, A., Petty, E. M., Jaber, R. M., Tackett, S., Purkiss, J., Fitzgerald, J., & White, C.
Affiliations
  • Boston Medical Center (US)
  • University of Wisconsin–Madison (US)
  • University of Michigan (US)
  • Johns Hopkins University (US)
  • University of Virginia (US)
Corresponding author
White, Casey
ORCID
Venue
Medical Education
Publisher
Wiley
Published
2014-01-12
Volume
48
Issue
2
Pages
157-169
ISSN
  • 0308-0110 (ISSN-L)
  • 1365-2923
DOI
10.1111/medu.12282
OpenAlex
W2170377479
Semantic Scholar
0430e5e4dbc1d5e164633ee79310851a0585fd09
Cited by
84
References
16
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 10 · 2020: 10 · 2019: 8 · 2018: 6 · 2017: 12 · 2016: 9 · 2015: 11 · 2014: 1
FWCI
14.05
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Medical Education (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Topics
  • Social Sciences › Health › Social Media in Health Education
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
social media, medical professionalism, medical students, Facebook, patient perspectives, teacher perceptions, public perception, patient privacy, cannabis use, intimate relationships, gender differences, age differences
MeSH terms
Adult, Aged, Alcohol Drinking, Attitude of Health Personnel, Data Collection, Ethics, Professional, Faculty, Medical, Female, Humans, Male, Middle Aged, Physician-Patient Relations, Public Opinion, Regression Analysis, Sexual Behavior, Social Perception, Students, Medical, Guidelines as Topic, Privacy, Young Adult, Social Media

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review