Citation: Robertson M, Shoss MK,

Original Publication  OPEN ACCESS

Broom MA. Social media: social
intelligence training module.
Social Media: Social Intelligence Training Module MedEdPORTAL. 2016;12:10442.
https://doi.org/10.15766/mep_2374-
Morgan Robertson, MS*, Mindy K. Shoss, PhD, Matthew A. Broom, MD 8265.10442
*Corresponding author: mrober58@slu.edu
Copyright: © 2016 Robertson et al.
This is an open-access publication
distributed under the terms of the
Abstract
Creative Commons Attribution-
Introduction: Physicians’ posts on social media have the potential to impact the patient-physician NonCommercial-Share Alike license.
relationship, interpersonal relationships at work, institutions’ reputations, and the public’s trust in health
care professionals. Empirical research, along with several very public cases of unprofessional behavior by Appendices
physicians on social media, suggests that resident physicians are not always aware of the implications of
their actions online. Residency programs are being charged with ways to model positive online presence. A. Social Media Module Slide
The goal of this project was to develop a social media training program that emphasized perspective Deck.pptx
taking and fostered appropriate social media use. Methods: This training program involves an interactive B. Social Media Module
lecture and discussion, with approximately 20 minutes of content, 20 minutes of small-group discussion, Faculty Guide.docx
and 10 minutes of large-group discussion. We evaluated the effectiveness of this program by asking C. Social Media Module
participants to complete presession and postsession surveys of social media knowledge, attitudes, and Handouts.docx
behaviors. Results: Survey responses (N = 16) suggest that the social media training program was D. Social Media Module
successful. Participants demonstrated an increase in knowledge of social media policies, ability to identify Evaluation.docx
potentially inappropriate media interactions, ability to identify appropriate responses to such interactions,
All appendices are peer reviewed as
and understanding of how their actions on social media affect others. Discussion: We believe that the integral parts of the Original
social media module is an effective and useful tool for members of the medical community as the internet Publication.

and social media continue to grow in popularity and lines between professional and personal realms are
continually blurred. While the effectiveness of this program was established with first-year pediatric
residents, the module material is applicable to a broader medical audience.

Keywords
Internship and Residency, Communication, Professionalism, Residency, Social Media, Emotional
Intelligence, Social Intelligence, Interpersonal Interaction, Professional Image

Educational Objectives
By the end of this session, learners will be able to:
1. Apply the American Medical Association’s social media policies when using social media.
2. Apply institutional social media policies when using social media.
3. Identify potentially inappropriate social media interactions.
4. Describe how their online actions using social media affect others (colleagues, attendings,
institution, the medical profession as a whole, etc.).
5. Identify appropriate responses to potentially inappropriate social media interactions.

Introduction
The use of the internet has changed the essence of social interaction such that “every social issue that we
are familiar with in the real world will now have its counterpart in the virtual world.”1 Before the internet,
individuals shared their experiences with others in small-group settings, in such places as homes, offices,
and break rooms. However, the internet and numerous social media sites have changed disclosure by
facilitating the sharing of experiences with a much larger audience (e.g., online friends, the internet as a
whole).2 Research suggests that the nature of the internet may lend itself to individuals providing a greater
amount, depth, and breadth of self-disclosure.3 As a consequence, the internet is “a place where people

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often end up revealing themselves far more intimately than they would be inclined to do without the
intermediation of screens and pseudonyms.”4
In 2011, the American Medical Association (AMA) issued a formal statement on professionalism in the use
of social media.4 Via six core principles, the AMA attempted to guide physicians by highlighting the
strengths of social media along with the pitfalls, particularly related to privacy and protected health
information, that encircle the online environment. This framework has subsequently served as a reference
for health care organizations looking to balance physician online presence with clinical services and
patient expectations. Academic institutions and health care systems are often partners in providing clinical
services; however, they may have different expectations and guidelines with regard to online presence,
particularly among physicians. At Saint Louis University (SLU), the institutional social media policy is very
clear regarding the merger of personal and professional responsibilities.5 The policy is outlined following
six general principles:
1. Protect your identity.
2. Be respectful of others.
3. Respect University property and resources.
4. Protect confidential and proprietary information.
5. Use of University e-mail address.
6. Use good judgment and think twice before you post.
Overall, the policy allows for individuality and expression with a positive light, being mindful of institutional
interests and patient/personal confidentiality. The document is very clear and resonates with the following
theme: “Individuals are personally and legally responsible for everything that they post.”5
The challenge for health care professionals is that social media create instances where social and
professional worlds collide.6 This raises concerns about potential negative consequences of social media
posts, including potential damage to the patient-physician relationship, damage to interpersonal
relationships at work, damage to institutions’ reputations, and damage to the public’s trust in health care
professionals. 7-10 One study investigated perceptions and acts of unprofessional behavior on Facebook
amongst health care profession students (e.g., medicine, nursing, dentistry, physical therapy).11 Forty-four
percent of students (out of 682) reported having observed posts that involved alcohol/drugs, sexual
content, patient information, and criticism of others, and 27% of students had posted such material
themselves. Such findings are not unique to students: Unprofessional content has been identified in blogs
of health care professionals as well.12 As of 2012, 71% of state medical boards had investigated doctors for
professional breaches online.13 Clearly, these issues are not going away. Hence, it is important that
training environments educate trainees on the appropriate use and implications of behavior online.
The Accreditation Council for Graduate Medical Education has milestones linked to specific competencies
(patient care, medical knowledge, system-based practice, practice-based learning and improvement,
professionalism, and interpersonal communication) for which residents are evaluated throughout their
training. 14 Milestones (basic knowledge, skills, and attributes) allow residents to be evaluated on behaviors
and performance, with the goal of clear progression during residency. Professionalism, system-based
practice, and interpersonal communication skills are competencies that allow for a clear linkage to social
media behavior in residency (see Table 1). Reviewing clinical examples and discussing possible methods
of response and interaction with colleagues, coworkers (e.g., nursing staff), patients, and families on social
media are critical to exposing trainees to the world of medical social media in which they live.
Understanding how online presence can affect patient care, team dynamics, professional image, and
communication is an important aspect of medical training for the millennial resident. Residency programs
are being charged with ways to model positive online presence (embracing the good aspects of social
media for physicians) and also develop systems and feedback mechanisms to teach residents about
potential negative consequences of social media presence and behavior.

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Table 1. Milestones14
Competency Milestone Description
Professionalism PROF1 Professionalization: a sense of duty and accountability to patients, society, and the
profession.
Professionalism PROF2 Professional conduct: high standards of ethical behavior, which includes maintaining
appropriate professional boundaries.
System-based practice SBP3 Work in interprofessional teams to enhance patient safety and improve patient care
quality.
Interpersonal ICS1 Communicate effectively with patients, families, and the public, as appropriate,
communication skills across a broad range of socioeconomic and cultural backgrounds.

Thus, the current project aimed to address some of the previously mentioned challenges via a social
media training program that would provide medical residents with academic and practical knowledge
regarding the effective use of social media. Moreover, this module contributes to the broader objective of
developing insight into the emotions and behaviors of self and others in order to promote empathy,
understanding, and effective action.

Methods
Participants (n = 16) were first-year pediatric residents at SLU. The social media module was incorporated
into the standard curriculum for SLU’s annual orientation program for first-year pediatric residents. This
module focuses on issues surrounding social media use by physicians and contributes to the broader
objective of developing insight into the emotions and behaviors of self and others in order to promote
empathy, understanding, and effective action.
The social media module was designed for one facilitator with the option of cofacilitators and is 1 hour in
length. The lead facilitator for the current project was the medical director of the primary care clinic in the
SLU Department of Pediatrics. Two cofacilitators who were more involved with content development also
attended the social media training. The cofacilitators’ roles during the facilitation involved ensuring the
PowerPoint technology worked properly as well as distributing and collecting training materials. It is
preferred that the facilitator of the social media module be someone with a medical background and/or
reputable medical knowledge. Moreover, the content may be best received if given by a facilitator whom
the participants have a working relationship with and/or interact with regularly.
The current module’s educational approach includes the following: (a) completion of a presession survey
assessing social media knowledge, attitudes, and behaviors; (b) participation in a 1-hour training session;
and (c) completion immediately following the session of a postsession survey that evaluates knowledge
and attitudes.
Upon arrival at the social media training, participants were asked to complete the Social Media Training
Evaluation–Pre-Survey (included in Appendix D). This presession survey is 38 items long and captures
typical social media behaviors for the self and others (e.g., “How frequently have you posted or observed a
colleague posting a picture of an individual having one alcoholic beverage?”) as well as general attitudes
and beliefs towards and overall knowledge of social media use (e.g., “Please indicate the extent to which
you agree or disagree that having stringent privacy settings ensures social media posts are only shared
with your intended audience”). Participants had 5 minutes to complete the presession survey. To maintain
anonymity regarding potentially sensitive content, participants were not asked to provide their names or
any demographic information. Presession surveys were collected upon completion.
Once participants had completed the presession survey, the social media module handout packet was
given to them, and the lecture began. The packet included the following: a description of AMA’s policy
regarding professionalism in the use of social media, SLU’s social media policy, and small-group facilitation
questions. Note that future facilitations of the current module will include the respective institution’s social
media policy in place of SLU’s social media policy. The lecture was designed to be interactive, with
approximately 20 minutes of content, 20 minutes of small-group discussion, and 10 minutes of large-
group discussion. The content provided participants with information regarding perspective taking, social
media policies (both our institution’s and AMA’s), and recommended responses to observing inappropriate
social media activities. The small-group discussion involved the introduction of case studies where

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participants were asked to apply perspective taking and social media policies to consider appropriate
courses of action. Lastly, large-group discussion offered the participants the opportunity to consider
potential situations that may lead individuals to act unprofessionally on social media (e.g., stress) as well as
strategies to more appropriately manage these situations. Note that the PowerPoint presentation was
organized so that small-group discussion and large-group discussion were mixed in with the delivery of
content.
Upon conclusion of the lecture portion of the social media training, participants were asked to complete
the Social Media Training Evaluation–Post-Survey (also included in Appendix D). This postsession survey is
38 items long. The measure evaluates overall module content. Specifically, the participant is asked to
evaluate the facilitator, seminar content, presentation slides, activities, and training environment as well as
to provide written answers regarding how his/her opinions of social media usage changed as a result of
the training program. This measure also reassesses participants’ general attitudes and beliefs towards and
overall knowledge of social media. Consistent with presession survey methods, participants had 5 minutes
to complete the postsession survey, and identifying information was not collected. Postsession surveys
were collected upon completion.
Attachments for the current module include a faculty/instructor guide (Appendix B), the pre- and
postsession surveys (Appendix D), PowerPoint slides (Appendix A), and a supplemental handout packet
(Appendix C). The faculty/instructor guide provides clear instructions for successful implementation of the
social media module.

Results
Presession Survey
Of participants, 75% (12 out of 16) reported that it would be helpful to have more information about how
various groups of people might interpret different social media content. Furthermore, over half of
participants reported having done the following or witnessed their colleagues doing the following:
displaying current relationship status, making opinionated comments about controversial issues, and
posting a picture of an individual having one alcoholic beverage.
Pre-Post Comparisons
Presession to postsession survey comparisons (see Table 2) suggest that participants’ awareness of both
AMA’s social media policy (p < .01) and institutional social media policy (p < .01) increased as a result of the
program. Overall understanding of how to use both AMA and institutional social media policies to guide
personal social media behavior also increased (p < .01). Postsession survey results show that participants
reported an increase in knowing how to respond to potentially inappropriate social media interactions that
they observe (p < .05) as well as increased confidence in their ability to identify appropriate responses to
potentially inappropriate social media interactions (p < .05).

Table 2. Presession and Postsession Survey Comparisons

Survey Response ( n = 16)
Question Presession Postsession t(15) p
I am aware of AMA’s social media policy. 2.94 4.19 −5.37 <.001
I am aware of my institution’s social media policy. 3.63 4.25 −3.48 0.003
I understand how to use AMA’s and my institution’s social media 3.5 4.19 −3.47 0.003
policies to guide my social media behavior.
I know how to respond to potentially inappropriate social media 3.13 4.19 −7.41 <.001
interactions that I observe.
I am confident in my ability to identify appropriate responses to 3.63 4.13 −2.45 0.03
potentially inappropriate social media interactions.

Overall Program Evaluation

Of participants, 87.6% (14 out of 16) reported that they thought the seminar was worth their time, and
93.8% (15 out of 16) found the length of the program to be just right. Overall, evaluations of the facilitator,
seminar content, presentation slides, activities, and training environment were positive. Additionally, an

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analysis of the qualitative data suggested that the social media training program was received well and
that the participants found the information presented helpful (see Table 3).

Table 3. Open-Ended Responses

Question Response
What was the most important “It is not what you mean, it’s how someone perceives it.
thing you learned in this There’s no such thing as free speech!”
seminar? “Be mindful of what is on social media.”
“Don’t post questionable content.”
Did your opinion of social “Yes, I will think more when posting.”
media usage change as a “Posts containing patient information can be damaging.”
result of today’s seminar? If “Don’t vent on social media.”
so, how?

Discussion
Research suggests that posts on social network sites can have potentially damaging consequences for the
individuals posting, their respective organizations, and the larger groups that they represent.8,9 The
current module provided information to first-year pediatric residents at SLU regarding issues surrounding
social media use by physicians. This module framed these issues in a manner to promote empathy,
understanding, and effective action.
Responses to the presession survey questions are in agreement with research that suggests
unprofessional disclosures online occur regularly.8,12,13 The presession survey results also suggest that
first-year resident students were not familiar with the AMA and institutional policies and procedures in
place to regulate social media.4,5 Moreover, first-year resident students had not taken time to consider
potential social media challenges and their reactions to such challenges.
The current program aims to address these deficits. The social media training program includes
approximately an hour of material. Specifically, participants complete a presession survey (the Social
Media Training Evaluation–Pre-Survey in Appendix D), which is directly followed by an interactive lecture
involving small- and large-group discussion. Lastly, participants are asked to complete a postsession
survey to evaluate the training program (the Social Media Training Evaluation–Post-Survey in Appendix D).
Results from the postsession survey suggest that the current program was successful in meeting the
learning objectives. Specifically, participants’ knowledge of social media policies increased as a result of
the social media training. Participants also reported an increase in the ability to identify potentially
inappropriate media interactions as well as to identify appropriate responses to such interactions. Lastly,
participants gained an understanding of how their actions on social media affect others.
We believe that the social media module is an effective and useful tool for members of the medical
community as the internet and social media continue to grow in popularity and lines between professional
and personal realms are continually blurred. While the effectiveness of this program was established with
first-year pediatric residents, the module material is applicable to a broader medical audience. Future work
is needed to examine this program in other groups and to evaluate the longer-term impact on larger
samples of learners. Future work might also expand this program to consider scenarios dealing with
different social media platforms as well as social media activities that cross platforms.

Morgan Robertson, MS: Doctoral Student, Department of Psychology, Saint Louis University

Mindy K. Shoss, PhD: Faculty Member, Department of Psychology, Saint Louis University

Matthew A. Broom, MD: Associate Professor of Pediatrics, Saint Louis University School of Medicine; Medical Director, Department of
Pediatrics, Saint Louis University School of Medicine

Disclosures
None to report.

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Funding/Support
None to report.

Ethical Approval
This publication contains data obtained from human subjects and received ethical approval.

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Received: April 4, 2016 | Accepted: August 3, 2016 | Published: August 26, 2016

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