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Postgrad Med J 89:126-130 doi:10.1136/postgradmedj-2012-131283
  • Original articles

Influence of social networking websites on medical school and residency selection process

Press Release
  1. Jill M Graygo
  1. Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Carl I Schulman, Department of Surgery, University of Miami Miller School of Medicine, PO Box 016960 (D-40), Miami, FL 33101, USA; CSchulman{at}med.miami.edu
  • Received 5 July 2012
  • Revised 17 September 2012
  • Accepted 30 September 2012
  • Published Online First 8 November 2012

Abstract

Background Social networking (SN) has become ubiquitous in modern culture. The potential consequences of revealing personal information through SN websites are not fully understood.

Objective To assess familiarity with, usage of, and attitudes towards, SN websites by admissions offices at US medical schools and residency programmes.

Methods A 26-question survey was distributed in autumn 2009 to 130 US medical school admissions officers and 4926 residency programme directors accredited by the Accreditation Council for Graduate Medical Education.

Results A total of 600 surveys were completed, with 46 (8%) respondents who self-identified as reviewing only medical school applications, 511 (85%) who reported reviewing residency programme applications and 43 (7%) who reported reviewing both. 90/600 (15%) medical schools or programmes maintain profiles on SN websites and 381/600 (64%) respondents reported being somewhat or very familiar with searching individual profiles on SN websites. While a minority of medical schools and residency programmes routinely use SN websites in the selection process (53/600; 9%), more than half of respondents felt that unprofessional information on applicants’ SN websites could compromise their admission into medical school or residency (315/600; 53%).

Conclusions SN websites will affect selection of medical students and residents. Formal guidelines for professional behaviour on SN websites might help applicants avoid unforeseen bias in the selection process.

Introduction

The increasing popularity of social networking (SN) websites might affect the way in which medical students and residents seeking admission into schools and programmes are screened. With nearly 75% of US online adults aged 18–24 and 57% aged 25–34 reportedly using SN websites, the increasing availability of personal information online significantly affects applicants’ privacy and potential employers’ and educators’ ability to gain additional information about candidates. This unprecedented level of access to personal information could change the way medical schools and residency programmes screen applicants.1

Several groundbreaking studies have recently found that employers, college admission boards and even police departments use SN as a resource to gather information about applicants. A survey of employers found that 45% search job applicants’ SN profiles, an increase from 22% in 2008 and 11% in 2007.2 In 2008, a survey conducted by Kaplan Test Prep and Admissions, assessed the top 500 colleges with the most selective admissions on their use of SN sites to screen applicants.3 The survey showed that 32/320 (10%) of admissions officers reported visiting SN sites to evaluate applicants with 8/32 (25%) finding information that positively affected their views of the applicant, 12/32 (38%) finding information that negatively affected their views of the applicant and the remaining 12/32 (38%) reporting a neutral experience with information found on SN websites.

Similarly, researchers at the University of Massachusetts Dartmouth Centre for Marketing Research conducted a study on the use of social media by college admissions officers of all 4-year accredited institutions in the USA.4 The use of various forms of social media (ie, SN sites, blogs, message boards, etc) in 2007 and 2008 was evaluated. In both years, SN sites were the most familiar forms of social media. Importantly, a significant number of schools reported researching prospective students via search engines (26% in 2007; 23% in 2008) and SN sites (21% in 2007; 17% in 2008). Although schools did not report conducting online searches for every applicant, online research was not uncommon, particularly in considering candidates for scholarships or entry to more demanding programmes. A follow-up study found that college admissions officers researching prospective students via search engines is following a downward trend (16% in 2009; 13% in 2010); however, researching prospective students via SN sites is steadily increasing (17% in 2009; 19% in 2010).5

The problems concerning the use of SN websites in professions like medicine are broad and complex. They reach far beyond the medical school and residency application processes to encompass the medical profession and culture in its entirety.6 SN sites are becoming increasingly important sources of information about applicants to medical schools and residency programmes.

Given the rigorous and competitive nature of the medical school and residency programme application processes, studying and recommending guidelines for SN site professionalism may facilitate a smoother application process for students, residents, medical schools and residency programmes. There are no set boundaries or policies in place to determine the appropriateness of using online information as a measure of prospective students. The objective of this study was to assess familiarity with, usage of, and attitudes towards, SN sites by admissions offices at US medical schools and Accreditation Council for Graduate Medical Education (ACGME) accredited residency programmes.

Methods

Survey design and testing

A web-based survey was developed with WorldAPP Key Survey (Braintree, Massachusetts, USA) using questions adapted from a previous study7 and original questions based on investigator-generated hypotheses (appendix 1). The 26-question survey aimed to ascertain the type, frequency and use of information gathered from SN sites in the selection process for medical school and residency applicants. In addition, respondents were surveyed as to their personal knowledge and use of SN websites. Opinions about the potential use of SN websites in the selection process were graded on a five-point Likert scale. Skip logic was programmed to allow participants to bypass inapplicable questions.

The initial survey underwent pilot testing by two general surgery attending physicians and two general surgery administrators for clarity, quality and relevance. The study was granted exemption from consent by the institutional review board at the University of Miami Miller School of Medicine, Miami, Florida.

Data collection

In the fall of 2009, the web-based survey was emailed to all 130 US medical schools via both their general email addresses and the specific administrators who could be identified through medical schools’ admissions office websites. Email addresses were also obtained by calling individual medical schools. Concurrently, survey emails were sent to all 4926 programme directors listed in the online ACGME directory of US residency programmes. Email reminders were sent every 2 weeks over a 2-month period to those who had not completed the survey. The original and reminder emails emphasised the voluntary and anonymous nature of participation in the study. A waiver of signed consent was also obtained in order to ensure participant anonymity and confidentiality. Agreement to participate was indicated by the individual selecting a ‘Complete the survey’ link at the bottom of the informed consent email.

Statistical analysis

All completed surveys were exported from the WorldAPP Key Survey online to PASW Statistics 18.0 (SPSS, Inc, 2009, Chicago, Illinois, USA) for statistical analysis. Surveys that were over 50% complete when the participant hit ‘Submit’ at the end were included; however, any abandoned surveys were not included. Descriptive statistics were calculated for respondent characteristics and responses to survey questions. The data were examined using qualitative statistical measures and cross tabulations for comparing data by applicant type.

Results

Demographics

Of the 5026 surveys that were distributed, 600 completed surveys were returned. Forty-six (8%) respondents identified themselves as reviewing only medical school applications, 511 (85%) reported reviewing residency programme applications and 43 (7%) reported reviewing both. A total of 96 surveys were incomplete and thus were excluded from the results. The majority of respondents identified themselves as programme directors (344/600; 57%) or residency coordinators (166/600; 28%). Only 46/600 (8%) of total respondents were from medical schools but 46/130 (35%) of all medical schools responded (table 1).

Table 1

Distribution of survey respondents by applications they review

Use of social media

A minority of medical schools and residency programmes reported maintaining an SN profile (90/600 15%), with Facebook being the most commonly used SN site (83/90; 92%). Interestingly, 305/600 (51%) respondents reported having their own personal profile on a SN site, with Facebook (296/305; 97%) again being the most popular, followed by LinkedIn (68/305; 22%) and Twitter (39/305; 13%). Similarly, 381/600 (64%) respondents reported feeling somewhat or very familiar with researching individuals on SN sites. Despite this familiarity, only 53/600 (9%) schools or programmes admitted to using SN sites to evaluate applicants, although 112/600 (19%) reported using some type of internet search to find information on applicants (table 2).

Table 2

Use of internet and social networking (SN) sites by medical schools and residency programmes

Future use of social media

While a minority of programmes agreed or strongly agreed that they plan to search for potential student or resident information on the internet (89/600; 15%) or SN sites (83/600; 14%), 172/600 (29%) responded neutrally to both of these questions, suggesting that searching for applicants on the internet or SN sites could increase in the future. Similarly, respondents felt that medical school/residency programme admissions should use internet searches (140/600; 23%) and SN sites (120/600; 20%) to obtain additional information not included in the formal application and 238/600 (40%) remained neutral on both of these questions. In contrast, 111/600 (19%) agreed or strongly agreed that it is a violation of privacy for medical schools and residency programme admission boards to search for an applicant's name on SN sites, while an overwhelming 348/600 (58%) disagreed or strongly disagreed (table 3).

Table 3

Planned future use of internet and social networking (SN) sites by medical schools and residency programmes

Online professionalism

Perhaps most importantly, more than half (315/600; 53%) of programmes responded that online professionalism should be a factor for admission into medical schools or residency programmes and that unprofessional information (ie, questionable group membership, photos, wall posts and/or comments) on an applicant's SN profile should compromise their admission into medical school or residency, with only 30/600 (5%) disagreeing. Despite this, only 25/600 (4%) of schools/programmes reported that they had decided against admitting a student and/or a resident because of unprofessional/questionable information found on internet search engines (ie, Google) and 19/600 (3%) owing to unprofessional/questionable information found on an SN profile. Finally, 165/600 (28%) respondents felt that the survey had changed their view on the relationship between medical school/residency admissions and SN websites.

Discussion

Our study of admissions personnel in medical schools and medical residency programmes reveals their widespread personal use of SN sites, yet a small minority of these (15%) reported using SN sites to investigate applicants. Interestingly, a large percentage (40%) remained neutral on this question, suggesting that as familiarity with using SN for other facets of professional life emerges, this barrier may be broken. This shift in attitudes is also supported by the nearly 60% of respondents who reported that they did not feel it would be a violation of privacy to search for an applicant on SN sites. The social media issues raised have the potential to affect medical school and residency programme admissions decisions, thus influencing the future generation of physicians.

This study is the largest and most comprehensive study of the uses of SN sites and attitudes towards them in the selection process for medical schools and medical residency programmes. Similar studies investigated SN sites and admissions within specific specialties. One survey of pharmacy residency programme directors found that 91/454 (20%) had viewed applicants’ social media information, with 47/91 (52%) reporting having found potentially inappropriate content.8 A majority of pharmacy residency programme directors reported that they felt that information on public sites was ‘fair game’ to judge critical aspects of an applicant, including judgement and professionalism (404/454; 89%). A recent survey of programme directors for general surgery residency programmes found that 43/250 (17%) respondents reported visiting SN sites to gain more information about an applicant, leading 14/43 (33%) programme directors to rank an applicant lower after a review of their SN profile.9 The study recommended that SN profiles of residency applicants should reflect the professional standards to which physicians are held.

The concept of professionalism is often raised when discussing SN and its relation to the medical profession. Unfortunately, this remains vague and ill-defined owing to the lack of precise guidelines as to what constitutes unprofessional postings or material on SN sites. The American Medical Association released a policy on professionalism in the use of social media that highlights both the positive and negative effects of medical students and physicians engaging in social media.10 Perhaps the most poignant section of the policy states that physicians must recognise that their SN profile activity may negatively affect their reputations, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession. The British Medical Association recently published guidelines for practical and ethical use of social media.11 These guidelines are more detailed and suggest that doctors and medical students should adopt conservative social media privacy settings, protect patient confidentiality at all times and refrain from accepting friend requests from current and former patients. Approximately half of the respondents in our survey felt that online professionalism should be a factor in applicant selection and that a lack of professionalism should jeopardise an applicant's chances of success. However, it remains unclear how online professionalism can be measured and evaluated. Opinions are constantly changing about the use of SN, as shown by the almost 30% of respondents who changed their views about the relationship between SN sites and the admissions process solely by participating in the survey. It is unknown if these changing sentiments included a stronger or weaker relationship between SN sites and the admissions process.

The limitations of the study were that it was not a complete or random sample and had a relatively low response rate, 46/130 (35%) for medical schools and 511/4926 (10%) for residency programme directors and personnel. Since it was not a random sample, we cannot assume it is a representative sample of this population. Those that answered the survey might have been more technologically savvy or have a propensity to use the internet more frequently. This selection bias is inevitable, although attempts were made with repeated reminders to maximise response and minimise bias. Although the survey was anonymous, respondents might have chosen to answer questions in a manner that they felt would reflect positively on their particular school or programme. Additionally, individual interpretations of questions might have led to some misinterpretation of the original intent of the questions.

A larger repeat study to investigate SN sites and admissions over an extended period of time would be valuable in measuring trends in this relatively recent area of study. Future investigations into the relationship of SN sites and admissions decisions should include whether admissions officers and programme directors feel it is appropriate to use SN sites as a factor in the admissions process and, if so, whether formal SN guidelines for professionalism should be introduced. Such guidelines could standardise SN usage for medical school and residency applicants and possibly reduce unforeseen bias. Variability within SN sites, a lack of a regulatory body at each school or programme and backlash from applicants are a few problems that may prevent the introduction of standardised regulations on evaluating social media content for applicants. Increased awareness of the public nature of the content on SN sites may dissuade medical school and residency applicants, thus eliminating SN sites as a means to vet potential candidates. SN sites will inevitably affect future selection of doctors and residents. Criteria for professional behaviour and use of SN sites are lacking at this time. Formal guidelines for professional behaviour on SN sites may help applicants avoid unforeseen bias in the selection process.

Main messages

  • Social networking (SN) websites can affect future selection of medical students and residents.

  • While a minority of programmes routinely use SN websites in their selection process, more than half of respondents felt that unprofessional information on applicants’ SN websites could compromise their admission into medical school or residency.

  • Formal guidelines for professional behaviour on SN websites can help applicants avoid unforeseen bias in the selection process.

Current research questions

  • Do programme directors search medical school or residency applicants on SN websites?

  • Does information on social networking sites affect medical school or residency programmes’ admissions decisions?

  • How does online professionalism influence physicians?

Key references

  • Thompson LA, Dawson K, Ferdig R, et al. The intersection of online social networking with medical professionalism. J Gen Intern Med 2008;23:954–7.

  • Go PH, Klaasen Z, Chamberlain RS. Attitudes and practices of surgery residency program directos toward the use of social networking profiles to select residency candidates: a nationwide survey analysis. J Surg Education 2012;69:292–300.

Appendix 1: Web-based survey instrument

This survey should be completed by a member of the admissions office who is able to accurately evaluate your programmes’ screening of applicants. We encourage respondents to communicate with other team members in their school/programme to appropriately assess the impact of social networking sites as a possible evaluation tool of applicants.

  1. Please select one that best describes you:

    • Medical college admission board member

    • Programme officer

    • Programme director

    • Residency coordinator

    • Residency selection board member

    • Other: _____________________

  2. Which of the following do you review?

    • Medical school applications

    • Residency programme applications

    • Both medical school applications and residency programme applications

  3. Does your medical school or residency programme have a profile on a social networking website (ie, Facebook, Twitter, etc)?

    • Yes

    • No (skip to question 5)

  4. If yes, which social networking web site(s)? Choose all that apply.

    • MySpace

    • Facebook

    • Twitter

    • LinkedIn

    • Friendster

    • Hi5

    • Orkut

    • Bebo

    • Other_____________

  5. Do you have a personal profile on a social networking web site?

    • Yes

    • No (skip to question 7)

  6. If yes, which social networking web site(s)? Choose all that apply.

    • MySpace

    • Facebook

    • Twitter

    • LinkedIn

    • Friendster

    • Hi5

    • Orkut

    • Bebo

    • Other_____________

  7. How familiar are you with researching individuals on internet search engines (ie, Google)?

    • Very familiar

    • Somewhat familiar

    • Not at all familiar

  8. How familiar are you with researching individuals on social networking websites (ie, Facebook, MySpace, etc)?

    • Very familiar

    • Somewhat familiar

    • Not at all familiar

  9. What online research methods has your medical school or residency programme used to evaluate potential students or residents?

    • Social networking websites (ie, Facebook or MySpace)

    • Internet search engines (ie, Google)

    • Both social networking websites and search engines

    • None

    • Don't know

  10. What percentage of applicants does your school or programme evaluate online?

    • <10%

    • 10–25%

    • 26–50%

    • 50%

    • Not applicable

  11. What online research methods have you used to evaluate potential students or residents?

    • Social networking websites (ie, Facebook or MySpace)

    • Internet search engines (ie, Google)

    • Both social networking websites and search engines

    • None

    • Don't know

  12. What percentage of applicants do you evaluate online?

    • <10%

    • 10–25%

    • 26–50%

    • 50%

    • Not applicable

Please answer according to how much you agree or disagree with the following statements using the given scale. SELECT only one response per statement.

  • Strongly agree=5 Agree=4 Neutral=3 Disagree=2 Strongly disagree=1

  • 13. Our admission board normally searches for additional information on applicants through internet search engines (ie, Google).

  • 14. Our admission board normally researches applicants on social networking websites (ie, Facebook, MySpace, etc)

  • 15. Our admission board plans to search for potential student or resident information on internet search engines in the future.

  • 16. Our admission board plans to search for potential student or resident information on social networking websites (ie, Facebook, MySpace, etc) in the future.

  • 17. Medical/residency programme admissions should use internet search engines (ie, Google) to obtain additional information about applicants that is not included in their applications.

  • 18. Medical/residency programme admissions should use social networking websites (ie, MySpace, Facebook, etc) to obtain additional information about applicants that is not included in their applications.

  • 19. It is a violation of privacy for medical schools and residency programme admission boards to search for an applicant's name on internet search engines (ie, Google).

  • 20. It is a violation of privacy for medical schools and residency programme admission boards to search for an applicant's name on social networking websites (ie, Facebook, MySpace, etc).

  • 21. Online professionalism should be a factor for admission into medical schools or residency programmes.

  • 22. Unprofessional information (ie, questionable group membership, photos, wall posts and /or comments) on an applicant's social networking website profile would compromise their admission into our medical school or residency programme.

  • 23. Medical professionalism involves keeping activity and profiles on social networking websites professional, or not having one at all.

  • 24. Our admissions board has decided not to admit a student and/or resident because of unprofessional/questionable information found on internet search engines (ie, Google).

  • 25. Our admissions board has decided not to admit a student and/or resident because of unprofessional/questionable information found on a social networking website (ie, Facebook, MySpace).

  • 26. This survey has changed my view on the relationship between admissions and social networking websites.

Footnotes

  • Contributors Conception and design: CIS, FSB. Analysis and interpretation of the data: CIS, JMG. Drafting of the article: CIS, FK, KFW. Critical revision of the article for important intellectual content: CIS, FK, KFW, FSB, JMG. Final approval of the article: CIS, FK, KFW, FSB, JMG. Statistical expertise: CIS, JMG. Administrative, technical or logistic support: FK, KFW. Collection and assembly of data: CIS, FK, KFW.

  • Competing interest None.

  • Ethics approval Institutional review board exempt approval was obtained from the university.

  • Provenance and peer review Not commissioned; externally peer reviewed.

References


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