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Social media in dental education: The need for institutional policies and content regulation

Year: 2023

Type: article

Abstract: Social media (SM) has a high impact on everyday life, serving as a channel not only for entertainment and socializing but also for the broad dissemination of information. Oral health professionals can use SM to engage with wider audiences and have a broader impact in their communities. At the same time, dental students may refer to content on SM platforms (such as Instagram, Twitter, or YouTube) to learn and prepare for clinical procedures. However, educational content on SM is rarely evidence-based.1 Dental educators have the challenge and responsibility to capitalize on SM's benefits while minimizing risks caused by inaccurate information and noncompliance with ethical and legal standards.2 Some reported benefits of SM in dental education include enhanced student engagement, improved communication with patients and colleagues, networking, interprofessional education, patient education, health promotion, and community outreach.2-4 Reported risks comprise dissemination of inaccurate information, a negative digital footprint, privacy and/or boundary violations, poor content quality, loss of direct patient contact, use of nonsecure networks, and miscommunication.2, 4 The widespread use of SM in dental education is indisputable; however there is currently no established mechanism for quality assurance or standards for e-professionalism ("attitudes and behaviors reflecting traditional professionalism paradigms that are manifested through digital media"). Academic institutions should consider training students to critically evaluate the accuracy of information, disseminate evidence-based knowledge, and use professional standards when connecting with their patients and the community.2, 5-7 At the same time, dental school curricula should consider incorporating up-to-date, evidence-based, and peer-reviewed SM content into learning and teaching.1 The purpose of this review was to provide recommendations for creating SM policies that enhance e-professionalism and issue a Call for Action for dental schools and professional dental associations to develop a peer-review process to evaluate and validate SM content. A brief overview of several SM policies from fifteen universities was performed; surveyed institutions included, but were not limited to, those affiliated with the authors of this manuscript. Current policies and guidelines concerning SM usage in the workplace, content displayed on personal SM platforms of university employees, and guidelines for content development for educational purposes were examined. The information displayed was derived solely from online public domain. The salient points and best practices are summarized below and in Table 1A. All institutions recommend good ethical judgment as the top priority of their SM guidelines. Faculty, students, and staff are expected to follow University policies and Federal requirements, such as the Health Insurance Portability and Accountability Act of 1996 and the Family Educational Rights and Privacy Act. It is also frequently mentioned that appropriate consent must be obtained and documented before the online posting of any patient or student information and clinical photos should be de-identified. Managers and supervisors are advised to be cautious and exercise sound judgment when communicating on SM with employees, students, alumni, or others affiliated with the University. Institutional SM guidelines require respect for university property and warn against any potential harm to the Institution. Therefore, all communications on SM should be consistent with the University's policies, standards, and principles. Individuals are expected to maintain the confidentiality of the Institution's intellectual property and participate in any personal SM conversations on their own time and following the Institution's Standard Practice Guides. In addition, faculty, students, and staff should be advised to use their personal emails for nonuniversity-related business in order to maintain a clear distinction between professional and personal communications. The use of trademarks, logos, copyrighted, or other proprietary information of the University is also commonly mentioned with the general recommendation to limit their usage to university business. Students and University employees are expected to identify themselves as individuals in the community, not as spokespeople for the Institution. Anyone in a supervisory role should be extra cautious of "friending," "following," or being followed by a subordinate lest it appears as favoritism. Every user should frequently review privacy settings and access to personal information. Moreover, University employees should contact Human Resources and use caution before deciding to "cyber-vet" a staff employee, applicant, or job seeker during interviewing and hiring. In addition, cyber-vetting must be consistent with applicable law and University and department/unit policies, including, but not limited to, equal employment opportunity, recruitment and selection process, and unlawful discrimination and sexual misconduct. Some SM guidelines remark that online posts exist in perpetuity and that even if erased promptly, individuals must consider the liability to one's reputation or the Institution represented. A general best practice is to ask whether what is being posted is valuable, truthful, and accurate. Additionally, students and employees should always verify veracity before sharing a post or link from another source to avoid contributing to misinformation. Ultimately, users are reminded to correct mistakes and be open about any previous posts that have been altered. Another significant topic in University's SM guidelines addresses respect for others. Users are reminded to never make remarks that may be perceived as discriminatory, harassing, intimidating, threatening violence, or make similar inappropriate or unlawful comments. As a general best practice, users should always add a disclaimer, such as "presented views are my own, and do not necessarily represent the view or the opinions of my Institution." In the unlikely event that such content is made available, users should remove the post, take personal responsibility for the content, and apologize as necessary. The Institution may require staff, faculty, or students to remove posts that violate published policies. Despite best efforts, a post may still be perceived as unprofessional and could result in disciplinary action or termination of employment. In addition to establishing concrete guidelines for using SM within academic Institutions, there is also a critical need to ensure the dissemination of evidence-based information through these platforms. SM has been reported to promote misinformation and disseminate anecdotal evidence.8 This is particularly concerning when it relates to content that claims to have educational value. Therefore, developing and applying critical thinking skills to evaluate online content should be included as a learning objective of the dental curricula. Ask answerable questions. Access the best evidence. Appraise the evidence. Apply evidence to patient care. Assess the treatment outcomes. The Commission on Dental Accreditation (CODA), in their accreditation standards for dental education programs (https://coda.ada.org) note that "graduates must be competent in the use of critical thinking and problem-solving, including their use in the comprehensive care of patients, scientific inquiry and research methodology" (CODA Standard 2-10). In addition, CODA also emphasizes the importance of EBD and notes that "graduates must be competent to access, critically appraise, apply, and communicate scientific and lay literature as it relates to providing evidence-based patient care" (CODA Standard 2-22). Students, as future practitioners, will have access not only to increasing scientific evidence in peer-reviewed journals but also to misinformation and disinformation in "predatory" journals, which will likely be replicated in various SM and online forums. Thus, dental students must develop critical thinking skills and apply EBD strategies to critically consume online content. There are many ways to quickly detect misleading claims. For example, the "Baloney Detection" series of questions9 can be used by students as a guideline to detect the quality of the information online, including SM. The checklist encourages students to ensure the source of information is reliable and has been verified. It also emphasizes the importance of scientific evidence and identifying personal bias. Another structured framework, PROMPT,10 was developed to help students critically evaluate information. (P) Presentation: Is the information presented clearly? (R) Relevance: Does this match the actual information one is seeking? (O) Objectivity: Is this free of personal opinion and vested interests? (M) Method: Is the information collected using rigorous methodology? (P) Provenance: Is the source of information trustworthy? (T) Timeliness: Is this information up to date? Recommended guidelines on how to consume any SM content that claims to have educational value have been summarized in Table 1B. The growing popularity of SM use among dental students and the impact of such use on dental education are undoubtedly leading to a Call for Action for developing a mechanism to evaluate and validate SM content and train the next generation of dentists in e-professionalism. The inarguable right for freedom of individual expression and association, combined with the general lack of SM regulation, will always create a challenge in vetting the scientific accuracy of self-reported "educational" content on SM platforms. However, a peer-review process may, and should, still be developed. Faculty members from various Universities and key opinion leaders from professional organizations (such as the American Dental Association, specialty associations, etc.) can form SM peer-review groups or committees. SM content creators can submit their content for approval, similar to the process followed when submitting a scientific manuscript for publication in a peer-reviewed journal. Once the submitted content has been reviewed, edited as needed, and eventually approved, a "seal of approval" can accompany the SM post, indicating compliance with the peer-review process described above. If this process was to be established, SM users could start identifying content that utilizes scientific evidence and has been vetted by experts in the field. Using this process, a growing repository of validated content (posts, videos, etc.) can be created and then be used to complement the traditional dental school curriculum. Additionally, this process could provide faculty development, training, and calibration opportunities. In policy development, dental schools may refer to Table 1A and include specific examples of e-professional behavior with negative and positive impacts. In the meantime, developing a SM policy for all dental schools is highly recommended if one does not already exist. All decision-makers should be involved in the developing such policies, including students, residents, faculty, staff, patients, and the community. Most Universities are aware of the potential negative impact of SM on their Institution and its members, as well as in dental education. Many Universities have devised guidelines for SM content development and consumption. However, there is a need to educate students to be critical consumers of online healthcare information, including SM content. While critical thinking skills, and EBD, are formally taught in the predoctoral curriculum in the context of oral health care, students must also use e-professionalism, general frameworks, and known strategies to critically appraise online content. As a result of the scarcity of research on SM within the dental education literature, it is imperative that dental educators formally explore dental student outcomes, such as knowledge retention, to support best practices of SM use in dental education. Future research should investigate SM usage patterns among dental students and the extent to which the SM policies are implemented and enforced by dental school faculty and administration. Publishing the results of these studies in peer-reviewed journals will help integrate SM into the dental education curriculum. The authors would like to acknowledge Dr. Sarandeep Huja, Professor and Dean of the Medical University of South Carolina College of Dental Medicine, for his invaluable mentorship during the ADEA Leadership Institute and his instrumental feedback for the development of this project.

Source: Journal of Dental Education

DOI: 10.1002/jdd.13310

Authors: Gisele F. Neiva, Jennifer A. Hasslen, Despoina Bompolaki, Megan Pugach‐Gordon, Wanda Wright, Satish S. Kumar