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.

Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators.

BACKGROUND: Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity. OBJECTIVE: This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs. METHODS: The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients. RESULTS: A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit (χ213=9.4, P=.742; χ2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=-0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit (χ24=2.5, P=.718; χ2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001). CONCLUSIONS: Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time.

Significance of Calcifications in Projection of Carotid Arteries on Orthopantomography for Detection of Carotid Artery Stenosis.

Introduction: Orthopantomography is amongst the most commonly used dental imaging modalities. Calcifications in the projection of carotids on orthopantomographs are found in 3-15% of general population and commonly represent calcified atherosclerotic plaques. Carotid atherosclerotic changes are one of the most frequent causes of stroke, which is the second most common cause of death and the leading cause of disability globally. Our aim was to determine the relationship between calcifications in the projection of carotids on orthopantomographs, carotid stenosis and stroke, and the correlation between stroke risk factors, calcifications on orthopantomographs and the degree of carotid stenosis. Materials and methods: Doppler ultrasound and brain MRI were performed in 41 patients with unilateral or bilateral calcifications on orthopantomographs. Anamnestic data relevant to stroke risk were gathered. Results: Significant stenosis >50% was found in almost 15% of our patients. There was a significant correlation between hypertension and carotid calcifications. No statistically significant correlation between calcifications and significant stenosis was found. Patients with previous stroke were approximiately 5 years older than those without stroke. Conclusion: Preliminary results show no statistically significant correlation between calcifications on orthopantomography and significant carotid stenosis, but further investigation is needed.

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.

Internet Use among Patients with Schizophrenia and Depression.

BACKGROUND: The high and increasing prevalence of internet use in the general population and the significant burden of depression and schizophrenia urge us to investigate the patterns of internet use among patients with these illnesses. The aim of this study is to assess internet use and mental health-related internet use among patients suffering from schizophrenia and depression. METHODS: A total of 104 patients with psychosis and 105 patients with depression were surveyed to assess their internet use and mental health-related internet use. RESULTS: The majority of participants were internet users (87.6%), with 66.7% of internet users with psychosis and 71.4% of internet users with depression using it as a source of information on mental health. Participants with psychosis significantly more attributed the internet and mental health internet forums as helpful in coping with their mental illness and were more interested in the utilization of online mental health services than participants with depression. CONCLUSIONS: General internet use in patients with schizophrenia and depression corresponds with the internet use of the general population; however, they use it more often as a source of health information than the general population. Mental health service providers should offer more online interventions and treatment programs to patients with psychosis and depression, as our study suggests there is an unmet need for online mental health services for such patients.

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.