Social networking gaffes can jeopardize residency applications

2012 11 07 17 12 15 690 Facebook App 70

What you post on social media can hurt you, especially if you're applying for a residency or physician training program, according to a new BMJ study that surveyed personnel in charge of reviewing applications from potential medical residents and students. More than half of respondents said they were familiar with the practice of searching through applicants' personal social media websites.

Based on survey responses from more than 600 admissions personnel, the Florida research team concluded that social networking will increasingly influence medical student and trainee doctor selection. And if admissions personnel have any qualms about their "research" into applicants' Facebook pages and Twitter feeds, they didn't express them (BMJ, November 8, 2012).

"The thing that was impressive to me was not so much the actual numbers that were doing it, but that the significant majority felt it was OK; there seemed to be no moral or ethical concern about doing this," said lead author Dr. Carl Schulman, PhD, in an interview with "This is considered to be public information, and people feel OK about going out to look for it. Somehow when you're talking about selecting a future doctor, it seems to have different connotation than perhaps a nonprofessional occupation."

Schulman is an associate professor of surgery at the University of Florida in Miami.

Open availability

With a high percentage of young adults using social media, the research team suspected that the open availability of all this personal information could significantly affect the privacy of residency applications, leading to important changes in the way medical schools and residency programs screen applicants.

Certainly the practice of online applicant "research" isn't limited to medical schools. A number of studies have recently found that employers, college admission boards, and even police departments are using social media as a resource for gathering information. A 2008 survey found that 10% of 320 admissions officers reported visiting social media sites to glean information about applicants, with 38% finding information that negatively affected their views of applicants and 25% finding information that positively affected their views, the study authors wrote.

In another 2008 study, the University of Massachusetts found that 23% to 26% of medical schools (depending on the year) researched prospective applicants on search engines, while 17% to 21% admitted to searching social media sites. And the use of such techniques is only expected to grow as social media becomes more ubiquitous.

"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 programs," Schulman and colleagues wrote.

The study sought to assess respondents' familiarity with the use of social media research, and the attitudes of admissions officers about the practice from at U.S. medical schools and residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). The researchers graded opinions about the potential use of social networking sites in the selection process on a five-point Likert scale.

In the fall of 2009, the study authors distributed a 26-question online survey to 130 U.S. medical school admissions officers and 4,926 residency program directors, receiving 600 surveys in response. Forty-six (8%) of the respondents said they reviewed only medical school applications, 511 (85%) said they reviewed residency program applications, and 90 (15%) reported reviewing both.

More than half of respondents (51%) said they had their own personal profile on a social networking site, with Facebook being the overwhelming favorite (97%), followed by LinkedIn and Twitter.

Well over half of respondents (381/600, 64%) also reported "feeling somewhat or very familiar with researching individuals on social networking sites." Nevertheless, only 9% of schools or programs admitted to using social networking sites to evaluate applicants, though 19% said they had performed some kind of Internet search to find additional information about applicants.

"Our numbers could be grossly underreported in terms of the actual magnitude of the problem," Schulman said, inasmuch as it seems likely that some may have declined to take the survey or report their own searching of personal information. "Although the survey was completely anonymous, if you're doing something that you think is of questionable validity, then you might be less inclined to answer the survey question," he said.

Just 15% of programs said they planned to search the Internet for potential student or resident information, while 27% had a neutral response, suggesting that the practice could be ramped up in the future. And 23% of respondents said they believe medical schools and residency programs should be able to use Internet searches to obtain information about applicants that was not included in formal applications.

Interestingly, 19% agreed or strongly agreed that searching applicant information on social networking sites was a violation of privacy, but 58% (348/600) of respondents disagreed or strongly disagreed with this conclusion. And more than half (53%) of program admissions personnel said that online professionalism should be a factor for admission into medical schools or residency programs, and that unprofessional photos, posts, or group memberships should rightly compromise an applicant's case for acceptance into a program, though only 4% said they actually decided against candidates based on this kind of information.

No U.S. guidelines

There aren't really any national guidelines that govern the practice in medical schools or keep residency programs from using the information, Schulman said.

"It's all left up to the individual program or school as to whether they, No. 1, have a policy of routinely doing this, or No. 2, do it in cases where there's a question or concern or they're trying to make a decision between applicants, so it's a very open area," he said. "Once you enter medical school or residency, a lot of programs have been proactive in creating guidelines for their students and residents at that time, but prior to their acceptance it's pretty much a free-for-all."

The study revealed widespread use of social networking sites among respondents, the researchers concluded. And even though only about 15% reported using the sites to learn more about applicants, a large percentage were neutral about the question, suggesting that any barriers to this kind of research might be easily broken as people become increasingly comfortable with social media in their personal and professional lives.

"The social media issues raised have the potential to affect medical school and residency program admissions decisions, thus influencing the future generation of physicians," the authors wrote.

As for study limitations, the response rate was relatively low: 46/130 (35%) for medical schools and 511/4,926 (10%) for residency program directors and personnel. In addition, the survey data were acquired three years ago -- an eternity in Internet time -- and now that Facebook use has passed the 500 million mark, Schulman said he wants to repeat the study in today's more social-media-saturated environment.

As for residents and medical school applicants, the results make it clear that they need to keep close tabs on their online profiles, he said. Certain social networking sites have better privacy controls than others, and there's information that can and should be restricted.

"It's a little scary, and it's unfortunate because I don't think anybody begrudges someone going through their college or graduate years and enjoying themselves and perhaps doing things that might seem indiscreet, but if that's not carefully policed before you apply for the medical profession, it could come back to haunt you," he said. "My advice to applicants is that they should really clean up or be very careful of what they post for public consumption on their social media sites because this information is clearly being used, and in the future it's very possible that it could become more ubiquitous, and more programs and medical schools will routinely use this information -- so it's applicant beware."

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