Survey of Individual and Institutional Risk Associated With the Use of Social Media

Manish Garg, MD; David A. Pearson, MD, MS; Michael C. Bond, MD; Michael Runyon, MD; M. Tyson Pillow, MD, Med; Laura Hopson, MD; Robert R. Cooney, MD; Jay Khadpe, MD; Jason T. Nomura, MD; Pholaphat C. Inboriboon, MD, MPH


Western J Emerg Med. 2016;17(3):344-349. 

In This Article

Abstract and Introduction


Introduction: Residents and faculty in emergency medicine (EM) residency programs might be unaware of the professional and legal risks associated with the use of social media (SM). The objective of this study was to identify and characterize the types and reported incidence of unprofessional SM behavior by EM residents, faculty, and nurses and the concomitant personal and institutional risks.

Methods: This multi-site study used an 18-question survey tool that was distributed electronically to the leaders of multiple EM residency programs, members of the Council of Emergency Medicine Residency Directors (CORD), and the residents of 14 EM programs during the study period May to June 2013.

Results: We received 1,314 responses: 772 from residents and 542 from faculty. Both groups reported encountering high-risk-to-professionalism events (HRTPE) related to SM use by residents and non-resident providers (NRPs), i.e., faculty members and nurses. Residents reported posting of one of the following by a resident peer or nursing colleague: identifiable patient information (26%); or a radiograph, clinical picture or other image (52%). Residents reported posting of images of intoxicated colleagues (84%), inappropriate photographs (66%), and inappropriate posts (73%). Program directors (PDs) reported posting one of the following by NRPs and residents respectively: identifiable patient information (46% and 45%); a radiograph, clinical picture or other image (63% and 58%). PDs reported that NRPs and residents posted images of intoxicated colleagues (64% and 57%), inappropriate photographs (63% and 57%), or inappropriate posts (76% and 67%). The directors also reported that they were aware of or issued reprimands or terminations at least once a year (30% NRPs and 22% residents). Residents were more likely to post photos of their resident peers or nursing colleagues in an intoxicated state than were NRPs (p=0.0004). NRPs were more likely to post inappropriate content (p=0.04) and identifiable patient information (p=0.0004) than were residents.

Conclusion: EM residents and faculty members cause and encounter HRTPE frequently while using SM; these events present significant risks to the individuals responsible and their associated institution. Awareness of these risks should prompt responsible SM use and consideration of CORD's Social Media Task Force recommendations.


The use of social media (SM) continues to increase among both emergency medicine (EM) residents and attending physicians. In a recent investigation covering a one-year period, the number of EM and critical care blogs increased from 130 to 201 and EM, and critical care information dissemination increased 10% via Twitter™ and 7% via Facebook™.[1] SM utilization in EM residency training programs is also on the rise. A recent survey of asynchronous education among 226 EM residents in 12 EM residency programs in the United States found that almost 70% of the residents endorsed EM podcasts as the most beneficial learning modality compared with textbooks, journals, and Google™.[2] In addition to asynchronous learning and educational resources, EM residency training programs use SM for professional marketing and for personal communication, socializing, and editorials.

The personal use of SM is of particular concern, as it could have substantial crossover professional implications. Healthcare workers in emergency departments (EDs) might share protected patient information on SM inappropriately or inadvertently, putting employees and institutions at risk. Furthermore, because the Accreditation Council for Graduate Medical Education (ACGME) has not yet established a standard for regulating the use of SM, EM residency programs have limited oversight of their departmental SM utilization. The combination of increased SM utilization, a lack of structured guidelines, and a lack of awareness of risk on the part of ED personnel presents substantial personal and institutional risk, as demonstrated by a number of recent highly publicized cases. For example, an EM physician was fired for a Facebook™ public overshare, in which community members were able to identify a patient from a post.[3]

We thus sought to characterize observed SM behavior by EM residents, faculty, and nurses that carries potential personal and institutional risks. To our knowledge, this study by the Social Media Committee of the Council of Emergency Medicine Residency Directors (CORD) is the first investigation of its kind.