Older and wiser? Changes in unprofessional content on urologists' social media after transition from residency to practice.

OBJECTIVE: To characterize changes in the frequency and nature of unprofessional content on urologists' Facebook accounts during the transition from residency to practice. METHODS: Facebook was queried with the names of all 2015 US urology graduates 1 year after completion of residency. We identified unprofessional and potentially objectionable content on the public Facebook accounts using a rubric based on professionalism guidelines by the American Urological Association, the American Medical Association and the Accreditation Council for Graduate Medical Education. Comparisons of unprofessional content were made with data from this cohort collected at the completion of residency. To assess how professional identities were reflected on social media, we determined which urologists self-identified as a urologist on Facebook and any changes in their unprofessional content. RESULTS: Of 281 urologists, 198 (70%) had publicly identifiable Facebook accounts. Of these, 85 (43%) contained any unprofessional or potentially objectionable content, including 35 (18%) with explicitly unprofessional content. Examples included images of and references to intoxication, explicit profanity, and offensive comments about patients. Of the 201 Facebook accounts that had been publicly identifiable at the completion of residency, most profiles (182, 91%) had remained public; of the 19 that were no longer public, about half had previously contained unprofessional content. Similarly, of the 80 urologists without public profiles 1 year previously, most (64, 80%) had remained unidentifiable on Facebook; of the 16 accounts that had since become publicly identifiable, half had unprofessional content. Among the urologists on Facebook overall, 11 (6%) had posted new unprofessional or potentially objectionable content since entering practice. Comparing this cohort in practice vs at the completion of residency, there were no significant differences in how many urologists had public Facebook accounts (70% vs 71%) or whose accounts had concerning content (43% vs 40%). The presence of unprofessional content at the completion of residency strongly predicted having unprofessional content later in practice. More urologists overall self-identified as being a urologist on Facebook, and a larger proportion of these profiles also displayed unprofessional content (53% vs 47% 1 year previously). CONCLUSION: Most urologists maintained public Facebook accounts after the transition to practice, and about half of these contained unprofessional or potentially objectionable content. Amidst their increasing self-identification as urologists on social media, the majority of practising urologists had posted concerning content, which could have an impact on their professional identities and public perceptions of the specialty.

Unprofessional content on Facebook accounts of US urology residency graduates.

OBJECTIVE: To characterize unprofessional content on public Facebook accounts of contemporary US urology residency graduates. METHODS: Facebook was queried with the names of all urologists who graduated from US urology residency programmes in 2015 to identify publicly accessible profiles. Profiles were assessed for unprofessional or potentially objectionable content using a prospectively designed rubric, based on professionalism guidelines by the American Urological Association, the American Medical Association, and the Accreditation Council for Graduate Medical Education. Content authorship (self vs other) was determined, and profiles were reviewed for self-identification as a urologist. RESULTS: Of 281 graduates, 223 (79%) were men and 267 (95%) held MD degrees. A total of 201 graduates (72%) had publicly identifiable Facebook profiles. Of these, 80 profiles (40%) included unprofessional or potentially objectionable content, including 27 profiles (13%) reflecting explicitly unprofessional behaviour, such as depictions of intoxication, uncensored profanity, unlawful behaviour, and confidential patient information. When unprofessional content was found, the content was self-authored in 82% of categories. Among 85 graduates (42%) who self-identified as a urologist on social media, nearly half contained concerning content. No differences in content were found between men and women, MD and DO degree-holders, or those who did or did not identify as a urologist (all P > 0.05). CONCLUSION: The majority of recent residency graduates had publicly accessible Facebook profiles, and a substantial proportion contained self-authored unprofessional content. Of those identifying as urologists on Facebook, approximately half violated published professionalism guidelines. Greater awareness of trainees' online identities is needed.

Urology is a Sensitive Area: Assessing Patient Preferences for Male or Female Urologists.

INTRODUCTION: The number of women in urology training programs has recently surged. To date, to our knowledge, there have been no comprehensive studies of urology patients' preferences regarding the gender of the provider. We evaluated whether these preferences exist and for what subset of patients. METHODS: Convenience sampling of urology clinic patients at our rural academic center was used to collect data. Data on demographics/background, presenting diagnosis and presence or absence of gender preference were obtained. The chi-square, Fisher exact and Cochran-Mantel-Haenszel tests were used. Bivariate and multivariate analysis was performed comparing those with and those without gender preference. RESULTS: The survey response rate was 73.8% with 477 questionnaires collected and 457 had adequate data for analysis. Overall 80% of patients had no gender preference for their provider and 18% stated a preference for the same gender with 2% for the opposite gender (p <0.0001). There was no significant difference between these categories in demographic factors or new vs established patient visit. Evaluating subsets by presenting diagnosis and controlling for patient gender, patients with incontinence had a statistically significant preference for the gender of their provider (p=0.003). Patients with different diagnoses did not demonstrate statistically significant gender preferences. CONCLUSIONS: While most patients did not have a gender preference for their urology provider, a subset of patients did express a preference (ie patients with incontinence). Interestingly, other sensitive subjects such as erectile dysfunction were not associated with gender preference. As the female component of the urology workforce grows, a reasonable effort to meet patient preferences should be made while attempting to disabuse patients of stereotypical views.

High tech or high risk? An analysis of media reports about robotic surgery.

Robotic surgery continues to increase in popularity and prevalence. The adoption of robotic technology has generated controversy and frequent media coverage. We evaluate recent reports of surgical robotics in the lay press to characterize its objectivity. LexisNexis and Factiva consumer news databases were queried for articles pertaining to robotic surgery published during 2010-2015 in the three highest circulation national (US) newspapers as well as New England regional newspapers. Two independent reviewers performed content analysis and assessed headline bias with strong reliability (mean κ = 0.96). 82 articles met inclusion criteria. Urological and gynecologic procedures were the most cited (54 and 57%, respectively). Commonly discussed aspects of robotic surgery included increased cost (45 articles, 55%), increased complications (38 articles, 43%), and easier recovery (32 articles, 39%). A minority of headlines (45%) had a neutral or unbiased tone. National newspapers were significantly more likely to report robotic surgery unfavorably by discussing disadvantages of the technology, only quoting surgeons with negative opinions, or citing scientific studies discrediting the robot (all p < 0.05). Of the 27 news articles that referenced published research studies, all 27 quoted studies reported the disadvantages of robotic surgery, while only 7 (26%) cited findings favoring robotic approaches. News reports about robotic surgery in the popular press contain a high proportion of negative bias. Non-neutral headlines and emphasis on research unfavorable to robotics were common. Clinicians should be aware of these reporting biases, which may affect patients' perceptions of robotic surgery.

Successful transcloacal ureteral stent removal.

We report a percutaneous transcloacal approach for removal of a ureteral stent in a 15-year-old girl with a cloacal anomaly, spinal dysraphism, and complex pelvic anatomy, including a bicornuate uterus, reconstructed hindgut neobladder, and duplicated left pelvic kidney. The patient had undergone 3 previous unsuccessful attempts at stent removal, 2 endoscopic attempts by way of her neobladder, and 1 percutaneous transcloacal attempt before successful removal.