Lindsay A. Thompson was shocked when she and her colleagues perused several hundred of their students' Facebook pages a few years ago. The students had posted pictures from alcohol-soaked parties and gag photos of cross-dressing, and joined groups with acronyms like PIMP.
Nothing unusual for Facebook, of course, but the profiles did not belong to undergraduates; they belonged to medical students and residents at the University of Florida, where Dr. Thompson is an assistant professor of pediatrics. These were people caring for patients. PIMP stood for Party of Important Male Physicians. One photograph even showed a physician-in-training wearing a lab coat that read Kevorkian Medical Clinic.
It's probably not how patients at a university hospital or clinic want to see their caregivers. But medical schools across the country are grappling with ways to rein in students who think nothing of posting pictures of last night's party—or even patients' photos—online.
State University of New York Upstate Medical University, for example, has added discussions of Facebook and ethics to its curriculum. The medical school made local headlines last fall when a doctor who had just done a residency there posted a color photo on Facebook of the top of a head with the brain exposed. According to the news reports, the doctor's friends left comments such as, "Do you feel like Hannibal Lecter sometimes?" and, "Love a good BRAIN in the early morning!" (The school investigated, concerned that the photo might be of a patient, but found no evidence that it was.)
Of 78 schools that responded to a survey last year published by The Journal of the American Medical Association, 47 reported that students had posted unprofessional information online. Six of those schools reported that the postings had included a breach of patient confidentiality.
"Medical students are out there seeing patients a week after they start medical school," says Henry M. Sondheimer, senior director of student affairs and student programs at the Association of American Medical Colleges. "They haven't thought about the implication that they are now in different roles with patients than they were two weeks ago."
Although concerns about online content and patient privacy are relatively new, medical students have been taking jokey pictures ever since they could get their hands on cameras.
A recent book, Dissection: Photographs of a Rite of Passage in American Medicine: 1880-1930, includes more than 100 photographs of medical students posing with their cadavers.
In some, students stand sternly around the corpses, but others are more lighthearted. In one photograph, titled "A Student's Dream," a student lies on the dissection table while several cadavers "stand" over him, posed to look like they are about to cut him open. In another, a young man pretends to play cards with a skeleton. Among some medical students, it was customary to send cards with pictures of themselves and their cadavers.
One of the book's authors, John Harley Warner, chairman of Yale University's history-of-medicine program, says many of the corpses—often stolen from graves—were African-American or poor, and relatives of such disenfranchised people were not likely to complain about breaches of privacy. The photographs may have served as a way for medical students to bond and to cope with a morbid situation, says Mr. Warner.
For some students today, postings on Facebook may still serve that function, but Mr. Warner says students at Yale are uneasy with the idea.
"Dark humor remains a part of things and helps them get through, but I think for our students the idea of taking a photograph like this, and certainly circulating it, doesn't fit their sense of self," he says.
But because that's not true for every student, medical schools are finding it necessary to add regulations about online material to their existing rules on patient privacy or professional behavior. About 30 of the schools in the JAMA study reported that they now have policies on student-posted online content, and five of the 46 schools that didn't have policies at the time of the survey were developing them.
Vanderbilt University put into effect a formal policy for its School of Medicine and School of Nursing last month. The new rule extends existing rules on presenting a professional image to explicitly include social media.
"Some of this is just reminding people that you represent yourself and you represent Vanderbilt if you're speaking about Vanderbilt, no matter what medium you're using," says Jill D. Austin, chief marketing officer at the university's medical center.
Beginning this July, the University of Michigan School of Dentistry will add discussions on professionalism and social media throughout students' tenure there, says Lynn Johnson, the school's assistant dean for informatics and innovation. "This is not going to go away," Ms. Johnson says. "I think it's only getting bigger."
Some students have realized that online postings can cause a problem, at least for their professional futures, says Lauren S. Hughes, president of the American Medical Student Association.
"I think the patient confidentiality is secondary," she says. "I've heard from many of my peers as they get close to their residency—just to be safe, they're increasing their security on their online presence." The association plans to discuss students' social-media use during its annual convention, in Anaheim, Calif., this March.
New recommendations or rules must balance students' right to free speech with the need to keep patient information private, says Meredith Szumski, director of student affairs at the University of California at Los Angeles's David Geffen School of Medicine. Last year Ms. Szumski and several colleagues surveyed students, faculty and staff members, and administrators, and found that, while most agreed on the importance of rules protecting patient privacy, they were divided on regulating outside student activities like drinking.
In other words, some at medical schools still think party pictures should be beyond a university's control.
"There really is a huge generational change in regard to privacy of information," says Sara Jo Grethlein, associate dean for graduate medical education at SUNY Upstate. The kinds of photographs she would have hidden from her parents when she was younger "are being posted for all the world to see."