Digital Smarts – A Common Sense Primer for Interns

June 14, 2012

I need your help.

Myself and pediatric resident Joey Spinner have been charged with creating a brief orientation on social media smarts for our incoming interns at Baylor College of Medicine/Texas Children’s Hospital.

But the challenge is this:  we’ve only got 30 minutes.

So we decided to flip the classroom by having our arriving interns listen in advance to a 20 minute recorded Keynote presentation with use of the 30 minutes in orientation to apply the concepts in discussion surrounding practical situations.  We’ll leave ‘em with a one-sheet concept summary with references to online content produced by many of you reading this post.

We want to keep the recorded presentation focused and pithy.  This isn’t a comprehensive presentation.  This orientation is intended to introduce broad concepts and initiate discussion concerning professionalism, safety and mindfulness with social media.  Details will be covered as part of a broader longitudinal curriculum on digital professionalism that’s in preparation.

So the challenge lies in using the limited time to offer meaningful messaging.

Here’s what we have cooked up and where we need your input.  Bold subheadings below represent slides/key concepts.  There is a brief description of what’s discussed under each slide/point.  Picture it as fast moving voiceover on a visually appealing Keynote backdrop.

Digital Smarts – A Common Sense Primer for Interns

Opening slide and introduction to what we’ll talk about.  As hard as it may be, image me at this point trying to tell an amazingly funny joke to set the mood.

Technology is outpacing doctors and the system

Brief mention that technology is outpacing our ability to legislate its use.  As trainees and physicians we need to be individually responsible with our social tools.

You’re a doctor now

3 points summarizing some core challenges posed to a resident in our culture of transparency and ambient monitoring.  We’re trying to make the point that residents have a new level of responsibility that goes beyond that of a medical student.

  • You have a digital footprint.
  • Your patients will judge you based on what you do
  • You are ambassadors for your residency.

Here we segue into 9 focused points for interns

1.  Avoid patient-specific dialog in public places

Our patient’s business is no one else’s.  We’ll follow with a 4-step process of what to do when faced with direct clinical questions in public spaces.  We’ll add Wendy Sue Swanson’s point that ‘we’re way worse in the elevator than we are online.’  The point here is that the rules of privacy and professionalism haven’t changed, despite new media.

2.  PRIP

When residents discuss cases with each other or on physician only networks we challenge them to consider PRIP (This arose from a discussion I had with digital professionalism guru Neil Mehta following a group program I did with he and his students at the Cleveland Clinic)

  • Privacy – Have you removed patient identifiers?
  • Respect – Does your communication reflect respect for the patient under discussion?
  • Intent – What’s the intent of using the case or illustration?  Is it intended to amuse others at the patient’s expense or educate others.
  • Perception – How will the discussion be perceived?  If the patient were listening in or could read what you’ve written, how would they feel?

3.  They’re your patients, not your friends

A brief discussion surrounding boundaries and their limitations between personal and professional lives.

4.  What happens on Twitter stays on Twitter

Discussion of the permanency of social dialog and the digital footprint (of course with the qualifier that social participation needs to look at opportunity as well as risk).

5.  Remember your mother’s watching

Follows from the permanency discussion with the idea that those around us are looking at what we’re doing.  The point here isn’t that we should be so concerned with our mother’s opinion but that our communities and close contacts should serve as a valuable check on what we do and say.

6.  Anonymity is a myth

Here we offer the warning that anonymity isn’t a reliable strategy for reputation management.

7.  Be careful with pictures in the clinical setting

Brief discussion of how images and video media can capture protected info in the clinical setting.

8.  Remember that perception trumps reality

We’ll drive home the point that that how we look is sometimes more important to what we’re doing.  The example is public social dialog during clinical work hours even though you’re caught up on your charts.

9.  Exercise ‘medical mindfulness’

Be mindful of your phones, tools and tables when with patients and understand that they may not understand that you’re using that tablet to look up medication doses, not play Angry Birds.  This iPhone Attribution Error also supports the concept that perception trumps reality.

Remember to balance risk and opportunity

We’ll finish with the important reminder that despite the modest risks we face with social media, there are tremendous opportunities available to doctors.  We must always think about what we can accomplish professionally and for our patients.


So, this is an uber-brief, non-comprehensive presentation, created with the intent of launching interactive discussion surrounding some posed dilemmas in social media.  With that, what would you add or take away from what we have planned?  I think we have room to add a couple of more strong, broad concepts if you could come up with them.

Again, our residents will have more comprehensive training in digital literacy through our longitudinal curriculum that’s under construction.

We value your input and we need your help.  Please comment below for everyone to see or if you’re the silent type, email me in private: bsv AT bcm dot edu

Thanks to Associate Director of Housestaff Education at BCM, Teri Turner, for allowing us the latitude to begin this initiative.


Alex Djuricich June 14, 2012 at 7:46 am

A phenomenal job of trying to capture the salient points without a “talk down to them” which tends to be the norm in orientation presentations. Kudos to you! In 30 minutes, though, message needs to be brief. “Keep it simple” is the mantra to remember.

DrV June 14, 2012 at 10:35 am

Thanks, Alex. KSS is key. I have wondered if it should even be more condensed and focused in its messaging, ie, 3 take home points only. I think that what we deliver has to be done in the context of what represents a staggering amount of material over a couple of days. Of course, they’re watching this in the comfort of their home or apartment.

Bob West June 14, 2012 at 9:33 am

I agree with Alex, this is already really well-conceived, not to mention the exemplary goal. If there’s one place for possible modification it would be adding emphasis on the “tremendous opportunities available to doctors”. Those of us familiar with this territory know what they are, you Bryan in particular. But “Digital Smarts” should include a couple key examples of the tremendous values, which will be necessary to properly balance the 9 contiguous essentially negative views of docs using social media. Too often the take home message from such a spiel is it’s complicated, hazardous, and I don’t have time anyway, so why bother?

DrV June 14, 2012 at 10:37 am

Agreed. Of course the question we’ve struggled with is, ‘what belongs in an introduction video and what belongs as part of a broader curriculum.’ In other words, I think that everything mentioned here deserves its own discussion. And this is what we’re looking to do but figuring out what belongs at the outset has been challenging.

Thank you for your input, Bob.

Kathy Mackey June 14, 2012 at 10:18 am

Decide the audience you want to speak to.
Understand that the content you share and the way you
share it shapes your audience.
Its easier and faster to gain a faithful and dedicated
following if you are consistent in message and are not
afraid to “Just Do It”.

Kathy Mackey

Jim Salwitz June 14, 2012 at 11:45 am

Very exciting. You must tell us how it is received. We are starting such a project at RWJMS and I am hungry for ideas. I agree with Bob, maybe even stronger. I would start by emphasizing the possibilities and opportunities, as well as noting that the interns have a unique advantage because of their natural comfort with the technology. This gives them a lead on the future unlike any of their predecessors. We desperately need them to experiment and develop social media, EHR and all their spin offs. Then I would throw in the caveats. If you lead with the negatives you might be heard (by those who do not know you) as an old fuddy duddy that is trying to suppress this vital future.


DrV June 15, 2012 at 8:23 am

I’m getting this echo that we should be emphasizing opportunity over risk. This is where I’m at, but given their stage I have to think that they need some boundaries, no? And I think it can be done in a non-fuddy duddy way.

But this has me thinking.

Peggy Polaneczky, MD June 14, 2012 at 11:56 am

Am struggling with this same issues, as I am slated to give a one hour talk on social media and medicine next month. In addition to the warnings, I think some best practice examples of social media done right would be helpful.

Look forward to seeing the finished product!


Suji June 15, 2012 at 7:52 am

Hi, Dr. Bryan. I’m not a medical intern but your post is really informative. I can also apply some of your tips in my own profession. Thanks for the post. Have an awesome weekend! :)

Henry Goldstein June 15, 2012 at 11:16 pm

You guys certainly have the guts of it really well done. I know you’ve spoken previously about the “scorched earth” idea as a transition into practice, and it’s becoming less feasible. Instead, we need to encourage an attitude of responsibility in the way all people (and by virtue prospective medicos) approach social media.

Here in Australia, our AMA released an excellent paper titled Social Media and the Medical Profession (PDF), which finds its way to junior docs and medical students alike.

Keep up the great work!

DrV June 16, 2012 at 7:19 am

Thanks, Henry. This document is beautiful and similar pieces are beginning to appear here in the States. I’d encourage everyone to check out Henry’s link. What I like is the simplicity and direct nature of they’ve done. Simple messaging.

Got me thinkin’ ; )

Julie Y June 23, 2012 at 6:02 pm

good discussion

Tamara G. Suttle, M.Ed., LPC June 24, 2012 at 8:31 pm

Hi, Bryan! Thanks so much for dipping your big toe into educating physicians on this topic. I am a licensed mental health professional but not a doctor. Half my practice is traditional counseling and psychotherapy; the other half of my practice is helping mental health and allied health professionals to build strong private practices. Concerning the latter, marketing a practice may entail a strategic dose of social media along with the face-to-face.

I agree with some of your colleagues here that noting some of the benefits would go a long way toward building interest and hooking your audience. After all, for the digital natives, this is how they build and maintain relationships. And, for any physician that eventually leaves agencies and hospital work behind, they will need to know that practices live (and die) based on the doc’s relationship with the community.

You’ve put together a nice package of concerns for interns. I particularly appreciated your reference to PRIP in #2. Many people forget that email and other asynchronous forms of communication (like online discusssion lists), even when supposed to be for “physicians only” are not HIPAA compliant and are not secure forms of communication. Even when using encryption, email is not secure . . . just more secure.

Thanks so much

Perhaps the standards of practice and codes of ethics are different for physicians than for mental health professionals? We are not permitted to consult en mass or online, must have the client’s permission to consult at all, and only then are we allowed to release just the info necessary to get the appropriate consult i.e. no unnecessary or incidental info is to be shared with the consulting professional.

Thanks so much, Bryan, for you blog. I don’t drop in here often enough or take time to comment. However, you always provide good food for thought and remind us of the standards of practice that we should be adhering to! (If I can support you in any way related to the use of social media, feel free to reach out! Happy to have you not step in some of the holes that I’ve stepped in along the way!)

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