Social Media Guidelines and Best Practices

Recommendations From the Council of Residency Directors Social Media Task Force

Malford T. Pillow, MD, Med; Laura Hopson, MD; Michael Bond, MD; Daniel Cabrera, MD; Leigh Patterson, MD; David Pearson, MD; Harsh Sule, MD, MPP; Felix Ankel, MD; Madonna Fernández-Frackelton, MD; Ronald V. Hall, MD; Jason A. Kegg, MD; Donald Norris; Katrin Takenaka


Western J Emerg Med. 2014;15(1):26-30. 

In This Article

Residency Program-Specific Issues


Residency programs should provide guidance and education to residents, fellows, faculty, and other personnel under their supervision regarding appropriate social media use. Particular attention should be paid to professionalism issues, including personal reputation and medical privacy.[38] Direct policing of individual resident or personnel activities on the Internet (aside from on the department-sponsored social media site) is discouraged as it represents a significant intrusion into resident privacy and is beyond the capability and purview of a residency program. However, should an issue involving a personal site be brought to the attention of a program, it is the responsibility of the program to take appropriate action to protect privacy and professionalism standards.

Professionalism and Privacy

Professionalism and privacy issues are accentuated on social media. The same standards of professionalism and privacy are required online as in person, but normal standards may not be sufficient to avoid misperceptions or legal issues. Residents should familiarize themselves with the American Medial Associations' Professionalism in the Use of Social Media guidelines.[39–40] Posted content must be assumed to be permanent, public, and even if deleted may still exist in an archive, database, or download formats. Information may prove to be damaging to an individual's reputation among colleagues and patients, and may affect future relationships and employment.[41] Privacy settings are relatively easy to circumvent and should not be relied upon to protect postings from public disclosure. Respect for patient confidentiality is essential as federal and state confidentiality laws apply to social media sites.[36,41–43] Even de-identified discussion of patients and specific medical cases on social media sites should be avoided.

Recruitment & Educational Relationships

A program should recognize the potential for inequitable relationships to exist through social media. Institutional guidelines with regard to harassment and appropriate relationships should be applied to interactions on social media as in other venues. It is our strong recommendation that people in a position of power/authority not initiate a personal online relationship with an individual in a subordinate position. Exceptions may be made for situations where it is appropriate for monitoring a remediation/probationary circumstance or for primarily educational group experience, such as with an online journal club hosted on a social media platform.

A program director or other individuals in positions of authority (e.g. chief resident) should apply a consistent action to requests for a social media relationships to avoid favoritism or perception of such. It is recommended that individuals in a position of authority maintain a separate public presence that may be used for residency purposes such as facilitating online educational interactions (e.g. Facebook® journal club) or monitoring a trainee for remediation purposes, including monitoring of professionalism if previous issues have existed.

Significant controversy exists with regard to whether a program should search for online information about prospective residents.[44] Each program should individually decide whether and how they will use online information and consistently apply the same standard to all applicants. This decision should encompass consideration of:

  • Search limitations (e.g. different names, common names, variation in presence on the Internet)

  • Lack of knowledge of context of posting, including whether or not an individual was aware of or had control of the image or information

  • Detection of information that is, under federal employment guidelines, considered off-limits for consideration for hiring purposes, including such issues as marital status, sexual orientation, religious beliefs, or health conditions

  • Pre-emptive determination of how potentially "illegal" or damaging information may be used in consideration of an applicant

  • Bias toward particular types of activities being posted

  • Generational differences in acceptability of postings

  • Whether a program will disclose searches to applicants