Exploring changes in the perception of e-professionalism among medical and dental students: a quantitative cross-sectional study.

AIM: To compare e-professionalism perceptions between medical and dental students, focusing on their awareness and understanding of guidelines for developing e-professionalism. METHODS: A cross-sectional quantitative study was conducted at the University of Zagreb School of Medicine (UZSM) and School of Dental Medicine (UZSDM) in 2022/2023. Data were gathered through a questionnaire designed specifically for the survey. RESULTS: Of the 646 questionnaires collected, 626 were analyzed, with a response rate of 33.95% for UZSM and 37.83% for UZSDM. Most respondents (71.4%) were female, with a median age of 21. Medical students significantly more frequently considered it unprofessional to publish posts containing photos of patients/clients (96.5% vs 75.1%), endorsements of health products without conflict-of-interest disclosures (60.6% vs 33.0%), and posts describing patient interactions without revealing identifying information (51.7% vs 27.4%). In contrast, dental medicine students more frequently considered it unprofessional to publish posts with swearing or foul language (81.2% vs 67.4%), critical comments about lecturers (68.0% vs 46.9%), and criticisms of course material or the institution (52.3% vs 36.4%). Only 23.2% of students were aware of e-professionalism guidelines, with 37.9% of those familiar with their content. CONCLUSION: While medical and dental students recognize the importance of e-professionalism, their perceptions have substantial differences. The need for promoting existing guidelines and integrating e-professionalism into curricula is evident. Continuous monitoring and research in this domain are essential to ensure future health care professionals maintain high standards of online professionalism.

FAMILY PHYSICIAN OPINIONS ON ELECTRONIC TOOLS AND CARDIOVASCULAR DISEASE PREVENTION GUIDELINE AVAILABILITY, USAGE AND ADHERENCE IN CROATIA.

Family physicians are burdened with a great number of guidelines considering different conditions they treat. We analyzed opinions of family physicians on electronic tools which help managing chronic conditions and their influence on patient care by cardiovascular disease (CVD) prevention guideline availability, usage and adherence. A descriptive study was performed on a convenient sample of 417 (response rate 56.0%) Croatian family physicians. Data on physician characteristics and availability, usage and adherence to CVD prevention guidelines were analyzed. The χ2-test was used for comparisons. Significance was defined as p<0.05. Family physicians who used additional electronic tools in Electronic Health Record software on more than 80% of their patients had CVD prevention guidelines more available (p<0.01) and used them more frequently (p<0.01). A group who used electronic tools on more than 80% of their patients had CVD prevention guidelines available to them frequently and used them on more than 60% of their patients, also strictly adhering to the guidelines (p<0.01). Physicians who used CVD prevention guidelines on more than 60% of their patients spent more time doing patient education (p=0.036). Using electronic tools helps Croatian family physicians in terms of availability, usage and adherence to the guidelines and quality improvement.

Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review.

BACKGROUND: As we are witnessing the evolution of social media (SM) use worldwide among the general population, the popularity of SM has also been embraced by health care professionals (HCPs). In the context of SM evolution and exponential growth of users, this scoping review summarizes recent findings of the e-professionalism of HCPs. OBJECTIVE: The purpose of this scoping review is to characterize the recent original peer-reviewed research studies published between November 1, 2014, to December 31, 2020, on e-professionalism of HCPs; to assess the quality of the methodologies and approaches used; to explore the impact of SM on e-professionalism of HCPs; to recognize the benefits and dangers of SM; and to provide insights to guide future research in this area. METHODS: A search of the literature published from November 1, 2014, to December 31, 2020, was performed in January 2021 using 3 databases (PubMed, CINAHL, and Scopus). The searches were conducted using the following defined search terms: "professionalism" AND "social media" OR "social networks" OR "Internet" OR "Facebook" OR "Twitter" OR "Instagram" OR "TikTok." The search strategy was limited to studies published in English. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS: Of the 1632 retrieved papers, a total of 88 studies were finally included in this review. Overall, the quality of the studies was satisfactory. Participants in the reviewed studies were from diverse health care professions. Medical health professionals were involved in about three-quarters of the studies. Three key benefits of SM on e-professionalism of HCPs were identified: (1) professional networking and collaboration, (2) professional education and training, and (3) patient education and health promotion. For the selected studies, there were five recognized dangers of SM on e-professionalism of HCPs: (1) loosening accountability, (2) compromising confidentiality, (3) blurred professional boundaries, (4) depiction of unprofessional behavior, and (5) legal issues and disciplinary consequences. This scoping review also recognizes recommendations for changes in educational curricula regarding e-professionalism as opportunities for improvement and barriers that influence HCPs use of SM in the context of e-professionalism. CONCLUSIONS: Findings in the reviewed studies indicate the existence of both benefits and dangers of SM on e-professionalism of HCPs. Even though there are some barriers recognized, this review has highlighted existing recommendations for including e-professionalism in the educational curricula of HCPs. Based on all evidence provided, this review provided new insights and guides for future research on this area. There is a clear need for robust research to investigate new emerging SM platforms, the efficiency of guidelines and educational interventions, and the specifics of each profession regarding their SM potential and use.

Development and validation of scale for measuring attitudes towards e-professionalism among medical and dental students: SMePROF-S scale.

BACKGROUND: Social media permeated everyday life and consequently it brought some changes to behaviour of health professionals. New form of professionalism emerged called e-professionalism depicting professional behaviour while using social media. There are a number of studies conducted in the past several years measuring behaviour of different populations of health professionals on social media and social media sites. Many studies have investigated aspects of e-professionalism of medical or dental students as future health professionals, but there are no validated instruments made for assessing attitude towards e-professionalism of those two populations. Objective of this paper is to validate a newly developed scale for measuring attitudes towards e-professionalism among medical and dental students. METHODS: The original 32-item scale was developed and administered to 411 medical students (RR 69%), and 287 dental students (RR 49.7%). Exploratory factor analysis was used to investigate the existence of underlying factors. Principal component analysis was used as an extraction method with oblimin as selected oblique rotation method. Cronbach's alpha was used to assess reliability. RESULTS: Total of 698 student answers entered analysis. The final scale had 24 items that formed seven factors named: ethical aspects, dangers of social media, excluding physicians, freedom of choice, importance of professionalism, physicians in the digital age, negative consequences. Cronbach's alpha indicating scale reliability was .72. Reliability conducted on each factor ranged from .570 to .877. CONCLUSIONS: The scale measures seven factors of attitude towards e-professionalism and exhibits satisfactory reliability. Based on insights from validation, some possible improvements are suggested.

Social media use habits, and attitudes toward e-professionalism among medicine and dental medicine students: a quantitative cross-sectional study.

AIM: To describe and compare social media (SM) use habits, and attitudes of medical and dental students toward e-professionalism and to determine their opinion on potentially unprofessional behavior and posts. METHODS: In this quantitative cross-sectional questionnaire study, students of the University of Zagreb School of Medicine and those of the School of Dental Medicine completed a survey-specific questionnaire on the use of SM, SM habits, and attitudes toward e-professionalism. RESULTS: Of the 714 collected questionnaires, we analyzed 698 (411 from medical and 287 from dental students). The most commonly used SM were Facebook (99%) and Instagram (80.7%). Unprofessional content was recognized by both groups. Medical students significantly more frequently considered the posts containing patient photos (61% vs 89.8%; P<0.001), describing interaction with a patient not revealing any personal identifiable information (23% vs 41.8%; P<0.001), and containing critical comments about faculty (53% vs 39.7%; P=0.001) to be unprofessional. Dental medicine students were significantly more open to communication through SM (39.7% vs 16.3%; P<0.001), more often reported that they would accept (41.5% vs 12.2%; P<0.001), and had accepted (28.2% vs 5.6%; P<0.001) friend requests/follows/tracks from patients, and sent friend requests/follows/tracks to their patients (5.2% vs 1.2%; P=0.002). CONCLUSION: Both groups were highly aware of e-professionalism. Dental students were more desensitized to visual representations of patients, and more prone to SM interactions with patients, which might expose them to the risk of unprofessional behavior.

Application of a system dynamics model in forecasting the supply and age distribution of physicians.

AIM: To predict the future supply and age distribution of physicians with a simulation model, which can be used as an advising tool for policymakers who decide on enrollment and specialization training (ST) quotas at the national level. METHODS: A simulation model was created using the system dynamics (SD) method. Changes in the number of physicians and their age distribution were projected in the context of the expected future changes of the Croatian population under different scenarios covering the period from 2017 to 2041. RESULTS: The two scenarios showed that Croatia would not face physician shortage in the future. The scenario 1 projected that Croatia would certainly reach the current European Union (EU) average of 360 physicians per 100 000 inhabitants by 2021, and that this figure would increase to 430 per 100 000 inhabitants by 2041. The scenario 2 suggested a similar trend, with Croatia reaching the current EU average by 2021 and the number of physicians increasing to 451 per 100 000 inhabitants by 2041. Both scenarios indicated that the Croatian physicians' age distribution will recover in favor of younger age groups of specialists. CONCLUSION: There is no need to increase the enrollment into the medical schools to ensure sufficient number of physicians per capita in Croatia, but it is necessary to keep the recently reached level of 550 licenses for ST per year. The developed dynamic model is available online and can be adapted to the analysis of different scenarios in different health care systems.

Defining Potentially Unprofessional Behavior on Social Media for Health Care Professionals: Mixed Methods Study.

BACKGROUND: Social media presence among health care professionals is ubiquitous and largely beneficial for their personal and professional lives. New standards are forming in the context of e-professionalism, which are loosening the predefined older and offline terms. With these benefits also come dangers, with exposure to evaluation on all levels from peers, superiors, and the public, as witnessed in the #medbikini movement. OBJECTIVE: The objectives of this study were to develop an improved coding scheme (SMePROF coding scheme) for the assessment of unprofessional behavior on Facebook of medical or dental students and faculty, compare reliability between coding schemes used in previous research and SMePROF coding scheme, compare gender-based differences for the assessment of the professional content on Facebook, validate the SMePROF coding scheme, and assess the level of and to characterize web-based professionalism on publicly available Facebook profiles of medical or dental students and faculty. METHODS: A search was performed via a new Facebook account using a systematic probabilistic sample of students and faculty in the University of Zagreb School of Medicine and School of Dental Medicine. Each profile was subsequently assessed with regard to professionalism based on previously published criteria and compared using the SMePROF coding scheme developed for this study. RESULTS: Intercoder reliability increased when the SMePROF coding scheme was used for the comparison of gender-based coding results. Results showed an increase in the gender-based agreement of the final codes for the category professionalism, from 85% in the first phase to 96.2% in the second phase. Final results of the second phase showed that there was almost no difference between female and male coders for coding potentially unprofessional content for students (7/240, 2.9% vs 5/203, 2.5%) or for coding unprofessional content for students (11/240, 4.6% vs 11/203, 5.4%). Comparison of definitive results between the first and second phases indicated an understanding of web-based professionalism, with unprofessional content being very low, both for students (9/222, 4.1% vs 12/206, 5.8%) and faculty (1/25, 4% vs 0/23, 0%). For assessment of the potentially unprofessional content, we observed a 4-fold decrease, using the SMePROF rubric, for students (26/222, 11.7% to 6/206, 2.9%) and a 5-fold decrease for faculty (6/25, 24% to 1/23, 4%). CONCLUSIONS: SMePROF coding scheme for assessing professionalism of health-care professionals on Facebook is a validated and more objective instrument. This research emphasizes the role that context plays in the perception of unprofessional and potentially unprofessional content and provides insight into the existence of different sets of rules for web-based and offline interaction that marks behavior as unprofessional. The level of e-professionalism on Facebook profiles of medical or dental students and faculty available for public viewing has shown a high level of understanding of e-professionalism.

Using Simulation Modeling to Inform Policy Makers for Planning Physician Workforce in Healthcare System in Croatia.

The objective of this paper is to show how a simple but powerful simulation model can be build up using standard spreadsheet program and used to simulate future, needs and supply of physicians in order to inform policy makers at national level when deciding on enrollment to medical schools and immigration quotas for physicians. The Republic of Croatia is facing a serious shortage of physicians in the healthcare system and simulation results have shown that the gap between needs and supply will even increase if current enrollment qoutas to medical schools would persist. Increasing enrollment quotas, adjusting immigration policy, re-directing physicians from other professions to the healthcare system, task shift and skill mix options are just some of the measures needed to be taken promptly in order to prevent a huge deficit of physicians in the future. Simulation modeling is certainly a method for predicting changes within healthcare systems with a possibility to examine multiple different scenarios and suggest interventions.

Biomedical Informatics Workforce in Croatia: Qualitative Analysis of Teachers' Opinions on Needs and Employment Opportunities.

We report a qualitative analysis of higher education biomedical informatics (BMI) teachers' opinions on the needs for BMI workforce and employment opportunities in the Croatian health care system. Needs were perceived as considerable; however this was not coupled with adequate employment opportunities. Barriers were identified to correcting this imbalance, including the failure of the health care system planners to recognise BMI experts as an important part of the workforce and lack of adequate educational opportunities.

Use of System Dynamics Modeling in Medical Education and Research Projects.

The paper reviews experiences and accomplishments in application of system dynamics modeling in education, training and research projects at the Andrija Stampar School of Public Health, a branch of the Zagreb University School of Medicine, Croatia. A number of simulation models developed over the past 40 years are briefly described with regard to real problems concerned, objectives and modeling methods and techniques used. Many of them have been developed as the individual students' projects as a part of their graduation, MSc or PhD theses and subsequently published in journals or conference proceedings. Some of them were later used in teaching and simulation training. System dynamics modeling proved to be not only powerful method for research and decision making but also a useful tool in medical and nursing education enabling better understanding of dynamic systems' behavior.

Educational Landscape of Biomedical Informatics in Croatia: Who Are the Teachers and What Are Their Attitudes.

Lack of experts with complementary competences in the field of information technology as well as medicine and health care has been recognised as an important obstacle to successful computerisation of the health care system. Using a questionnaire survey, we aimed to describe the current educational landscape of biomedical informatics in Croatia, focussing on teachers' profiles and attitudes about existing educational opportunities in the field. Our findings show that Croatian institutions of higher education should better recognise the need for education in biomedical informatics. Dedicated programs need to be established and teacher force strengthened. Joint efforts of existing teachers-institutionalised through a working group focussing on education within the Croatian Society for Medical Informatics, for which strong support exists-might contribute to recognition of the field and improvement of educational opportunities.

Development of a Model for Planning Specialist Education of Medical Doctors in Croatia.

Development of a model for simulation of the needed number of specialists of different specialties in the Republic of Croatia by the year 2035 based on the expected changes in size and age structure of population and experts' estimates of the needs. The model will be implemented in the form of a computer program based on the estimated most potent predictors. The developed model will be used as a tool for the simulation of different scenarios for specialist education combined with other factors like migration flows, changes in retirement age and skill mixing in order to compare different possibilities and options for the renewal of the Croatian healthcare personnel. Results will enable the development of recommendations for decision making and the adoption of a rational plan of referral to specialist training. Indirectly, developed model will be useful for needs assessment and simulation and planning of workforce renewal of other health professionals and for other countries.