February 25, 2014

Teaching e-Professionalism

by Katie Brant, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital

Facebook, Twitter, Pinterest, YouTube, Instagram, LinkedIn … the list goes on and on. Social media has an increasing presence in our society and professional students are not immune to this cultural shift towards information sharing and social openness. As the social media and online forums grow, health professionals and students have more opportunities to interact with colleagues, patients, and faculty online — whether it is via email, social networking, blogging, or tweeting. My personal experience with social media began as an undergraduate student when Facebook was first emerging, continued through pharmacy school, and into my residency training. As a professional student, I can remember wondering if social networking websites were appropriate, whether I needed to change my profile when applying to post-graduate residency programs, where the line between my personal and professional life existed online, and how I was representing myself and my profession via social media. Professional students and faculty must make decisions regarding online social media resources and online communication etiquette; decisions that could potentially impact their careers.

Professionalism in the online domain, or e-professionalism, has become a significant issue in health professions education as well as practice. One of the goals of professional education is to instill values and a sense of responsibility in students.  E-professionalism is no less crucial than more traditional forms of professionalism and should be taught in the professional curriculum. E-professionalism has been defined by Cain and Romanelli as “the attitudes and behaviors (some of which may occur in private settings) reflecting traditional professionalism paradigms that are manifested through digital media.”1 E-professionalism not only encompasses professional behavior on social networking sites but also proper online communication etiquette, also termed “netiquette.” Netiquette includes using appropriate terms and tone when writing emails or posting on online discussion boards.1

Through the use of social media sources, a professional student creates an “online persona” based on choice of photographs, group affiliations, posts, and comments.1 Students digress from professional norms when they post derogatory comments about their educational institution, post pictures of drug or alcohol abuse, affiliate with groups that are disrespectful of certain races or sexualities, and post private patient information on public domains.1

Many health care institutions including The Ohio State University Medical Center, Mayo Clinic, and University of Maryland are now instituting policies with guidelines regarding use of social networking by employees in order to protect the reputation and privacy of their employees and the institution.2 The Ohio State University Medical Center now has Social Media Participation Guidelines which outline rules that employees are expected to follow when using social media sites. These rules prohibit using social media sites during work hours, using of a work email address on social media sites, and attributing any opinions or comments posted on a website to the institution.2

This then begs the question of how e-professionalism should be taught and when it should be introduced to professional students. Many universities already incorporate a professionalism course or module in their curricula.  Spending some time discussing e-professionalism would be a relatively seamless addition to these courses. Kaczmarczyk and colleagues recommend focusing on instruction regarding about e-professionalism and how it reflects professional values, ethics, and integrity. Educators can develop course materials that give students examples of what is acceptable online behavior and behaviors to avoid.2 Instructors should have students to evaluate online posts, discuss aspects of professionalism with peers, and reflect on how postings may be interpreted by outside viewers.2  It is also important that the institution’s honor codes and policies include e-professionalism too.1

Although there are limited data regarding best practice approaches to incorporating e-professionalism into the professional school curricula, there are many examples of how to effectively teach the general principles of professional behavior that could be applied.3 One example described in the literature comes from Auburn University’s Harrison School of Pharmacy (AUHSOP). This school promotes the development of professional behaviors from admission to graduation.  New students and recently hired faculty go through orientation to learn about the school’s culture as well as the values and expectations regarding professionalism and integrity. Professionalism behaviors are evaluated and acceptable performance is required for academic progression.  Severe professionalism lapses can lead to student dismissal. This curricular design instills the culture of professionalism and integrity at the very beginning of the students’ academic career.  Hopefully these behaviors and values continue beyond graduation.

I believe that incorporating e-professionalism instruction throughout the curriculum would be the most effective strategy for changing students’ perceptions and practices. New student orientation would be an ideal time to introduce the concept. Educators could discuss the importance of maintaining a professional online persona and conduct a workshop in which students evaluate social media profiles.  This would make the instruction more practical and relevant.  To reinforce what was taught in orientation, there could be an online module reviewing e-professionalism principles that students are required to complete annually. Finally, given that potential employers or residency directors may utilize social media websites when screening candidates, e-professionalism should be explored again a few months prior graduation.

Ness and colleagues conducted a study in which a survey was distributed to graduating pharmacy students at several Midwestern schools of pharmacy.4 A vast major (93%) of the pharmacy students used social media websites.  More importantly, 74% felt that they should edit their social media profiles before applying for jobs. Thus the prevalence of social media use is high among professional students and students understand the importance of censoring publically available information in order to portray a professional persona.

While social media and online communication is increasingly common, educating students about professionalism and role modeling appropriate behavior is not a new idea. Educators (and preceptors) should provide instruction on e-professionalism and online etiquette to help prepare the next generation of professional students for a successful career.


  1. Cain J, Romanelli F. E-professionalism: A new paradigm for a digital age. Currents in Pharmacy Teaching and Learning 2009;1:66–70.
  2. Kaczmarczyk JM, Chuang A, Dugoff L, et al. e-Professionalism: a new frontier in medical education. Teaching and Learning in Medicine 2013; 25(2): 165-170.
  3. Berger BA, Butler SL, Duncan-Hewitt W. Changing the culture: an institution-wide approach to instilling professional values. Am J Pharm Ed 2004; 68(1): Article 22.
  4. Ness GL, Sheehan AH, Snyder ME, et al. Graduating pharmacy students’ perspectives on e-professionalism and social media. Am J Pharm Ed 2013; 77(7): Article 146.

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