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JMIR Med Educ. 2017 May 3;3(1):e9. doi: 10.2196/mededu.6879.

Erosion of Digital Professionalism During Medical Students' Core Clinical Clerkships.

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Department of Dermatology, Brigham & Women's Hospital, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.
Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Center for Patient Care and Outcomes Research, Health Systems Research Unit, Division of General Internal Medicine, Froedtert & Medical College of Wisconsin, Milwaukee, WI, United States.



The increased use of social media, cloud computing, and mobile devices has led to the emergence of guidelines and novel teaching efforts to guide students toward the appropriate use of technology. Despite this, violations of professional conduct are common.


We sought to explore professional behaviors specific to appropriate use of technology by looking at changes in third-year medical students' attitudes and behaviors at the beginning and conclusion of their clinical clerkships.


After formal teaching about digital professionalism, we administered a survey to medical students that described 35 technology-related behaviors and queried students about professionalism of the behavior (on a 5-point Likert scale), observation of others engaging in the behavior (yes or no), as well as personal participation in the behavior (yes or no). Students were resurveyed at the end of the academic year.


Over the year, perceptions of what is considered acceptable behavior regarding privacy, data security, communications, and social media boundaries changed, despite formal teaching sessions to reinforce professional behavior. Furthermore, medical students who observed unprofessional behaviors were more likely to participate in such behaviors.


Although technology is a useful tool to enhance teaching and learning, our results reflect an erosion of professionalism related to information security that occurred despite medical school and hospital-based teaching sessions to promote digital professionalism. True alteration of trainee behavior will require a cultural shift that includes continual education, better role models, and frequent reminders for faculty, house staff, students, and staff.


health information systems; medical informatics; professionalism; social media; undergraduate medical education

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