title: Survey of Individual and Institutional Risk Associated with the Use of Social Media.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: Manish
authors.initials: M
authors.lastname: Garg
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
authors.affiliation: University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Bond
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina.
authors.forename: Michael
authors.initials: M
authors.lastname: Runyon
authors.affiliation: Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas.
authors.forename: M Tyson
authors.initials: MT
authors.lastname: Pillow
authors.affiliation: University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.
authors.forename: Laura
authors.initials: L
authors.lastname: Hopson
authors.affiliation: Conemaugh Memorial Medical Center, Department of Emergency Medicine, Johnstown, Pennsylvania.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cooney
authors.affiliation: SUNY Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York.
authors.forename: Jay
authors.initials: J
authors.lastname: Khadpe
authors.affiliation: Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Nomura
authors.affiliation: University of Missouri-Kansas City, Department of Emergency Medicine, Kansas City, Missouri.
authors.forename: Pholaphat C
authors.initials: PC
authors.lastname: Inboriboon
mesh_terms: D000328:Adult; D004635:Emergency Medicine / Q000193:education*; D004647:Employee Discipline; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D008297:Male; D008486:Physician Executives; D018907:Privacy / Q000331:legislation & jurisprudence*; D011361:Professional Competence / Q000592:standards*; D028743:Professional Misconduct / Q000331:legislation & jurisprudence*; D061108:Social Media / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D014481:United States