Sunday, September 4, 2011

Protecting institutions from medical students

It may be helpful to sort policy goals for students into three categories:

1- How to protect patients.
2- How to protect institutions.
3- How to protect students themselves.

This post addresses protecting institutions. I offer some typical institution-relevant guidelines, and then give my two cents. Your thoughts are greatly appreciated.

Good guidelines for protecting institutions that I've come across:

Be factually correct- don't overstate your knowledge. 

Be transparent- disclose your connection to and your role with the institution your institution.

Control your institution email address- only use you .edu address for official business.

Control your privacy settings.

Weak guidelines:

Adhere to the institution pledge/code- pledges and codes offer few specifics.

Obtain permission- what warrants permission? Every single tweet? Blog posts that mention the institution? 

My Two Cents:
One of the first things newly minted medical students do is sew their school’s seal on their white coat, offering a continual reminder that they represent their medical institution whenever they wear this coat. However, they do not have any badge to remind them of this when they are online.

Medical school has particular demands and stresses beyond those of many other educational settings. In my experience, stress and unhappiness were commonly transferred to professors, courses, and the institution as a whole, often with discomfiting vehemence. It was not uncommon to see these expressions find their way to facebook.

More than simply protecting themselves, medical schools owe it to their students to prepare them to represent the institutions to which they will belong in the future. As future doctors, medical students will find themselves building and maintaining professional relationships for decades, each with different cultures and expectations of openness, sharing, and representation. The earlier these skills are developed, the better off students will be.

Many of the obligations and features of operating in the social media space derive from issues of professionalism. Social media training is an opportunity to teach professionalism, not only in content but also in practice. In my experience, features of professionalism have been taught didactically, and participation has consisted only of personal reflection. Social media training, specifically regarding representing an institution, offers a means to actively engage students with these crucial issues.

How do we protect institutions from students’ damaging comments, made deliberately or spur-of-the-moment? Again, the middle way between abstinence and indifference lies in student training about creating content that appropriately represents those to whom institutional membership impinges upon. A first step is to characterize for students the nature and extent of their obligations to the institution. The specific stakeholders who depend on the institution’s “good name” should be detailed, along with their depth of connection. A potential method is to start with the individual student and work outward. When you speak about your school, you are indirectly speaking for yourself, your classmates, all students, and all alumni who have dedicated years of study and will have/do have certification/validation of their life’s calling in the form of diplomas. You speak for the faculty and staff who have staked their livelihood on service to the institution. You speak for the administration who have staked their professional reputations. You speak for the clinicians you aspire to be. You speak for the patients who have chosen to be treated here. You speak for the community members who respect your institution as an integral community fixture.


Anne Marie said...

This is very interesting. Surely if students have legitimate concerns they should be able to voice these. if they are using Facebook is it because the institution hasn't given them sufficient opportunity to do so?

Making anything better is hard work and if students are disappointed by their experiences of university it might be hard work for them to try and get the message through to the people who are making the decisions but ultimately it will be worthwhile.

So I think that alongside 'training' students to uphold the name of the university, the university should also be working to ensure that it deserves to be held in respect.

We want to do all we can to produce reflexive doctors who can think outside the box about the problems they come across. Becoming part of the solution to improving the quality of medical education is a good place to start.

Thanks again

Paul de Roos, MD said...

Hey Aaron,

As a former student activist.. I'm sad I didn't have the power of twitter / facebook at my disposal to push for change. In that sense I look at protesters in the middle east as role models.

I think students should listen with the ears of the media, see with the eyes of the patient and reason with the brain of an academic and communicate on social platforms in a way to push for change. I would love to see them seize the power of these tools to redefine their learning environment and their work environment. This will probably not happen if you only express things current establishment wants to hear. If things are wrong, they may also need to be exposed.

As I read your post, you almost ask students to behave like employees. While actually students are quite often customers and if they are not, then society is a customer and Tax payers also probably feel they are entitled to know what's happening with their money.

So in that sense... shouldn't we encourage students to communicate in a decent, yet clear manner on the issues that hospital/faculty leadership would rather see discussed in a different way (less public). Then.. if their educational experience is great, there's nothing to worry about! (love to see that happen anywhere in the world).

astupple said...

I agree with you both- of course people should be encouraged to speak freely, and of course institutions should work to earn respect, and in an ideal case, happy students comment about their wonderful institution. But how does a school make that happen?

The principle risk I see here is that students will wind up publishing negative comments more widely than they anticipated, and that it's incumbent on institutions to train their students to avoid doing so by mistake.

So yes, treating them like employees at first. If schools then genuinely create the appropriate atmosphere, and appropriately embrace SoMe, then the ideal free-exchange is, I'd guess, likely.

Thanks for your comments!