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Anything posted on the Internet or through electronic communications could be online forever!

This policy applies to all postgraduate medical trainees (residents) registered with the University of Saskatchewan, College of Medicine, Postgraduate Medical Education Office. “Social media can be defined as a set of web-based and mobile technologies that allow people to monitor, create, share or manipulate text, audio, photos or video, with others. Social media place particular emphasis on interactive, user-driven communication.”1 This policy is relevant to all electronic communications and electronic networking which may include, but is not limited to: the internet, social networking sites, posting on blogs, online forums, wikis, texting, instant messaging (IM), email and listservs, posting to public media sites, mailing lists, and video sites. Some popular networking sites include Facebook, Twitter, MySpace, Linkedln and Flickr, to name a few.

The capacity to record, store and transmit information in electronic format brings responsibilities to those working in healthcare with respect to privacy of personal health information and ensuring public trust in our hospitals, institutions and practices. Significant educational benefits can be derived from this technology but trainees need to be aware that there are also potential problems and liabilities associated with its use. Material that identifies patients, institutions or colleagues and is intentionally or unintentionally placed in the public domain may constitute a breach of standards of professionalism and confidentiality that damages the profession and our institutions. Guidance for postgraduate medical trainees and the profession in the appropriate use of the internet and electronic publication is necessary to avoid problems while maintaining freedom of expression.

Postgraduate medical trainees are reminded that they must meet multiple obligations in their capacity as university students, as members of the profession and College of Physicians and Surgeons of Saskatchewan, and as employees of the university and other institutions, where applicable. Postgraduate trainees also agree to abide by all bylaws, rules and regulations in force and effect within respective health regions and at any health care facility in which they receive their training / employment.2

The College of Physicians and Surgeons of Saskatchewan grants licensure to postgraduate medical trainees throughout the duration of training, and as such trainees must be aware of and abide by the bylaws, policies, rules and regulations in force by that regulatory body - http://www.quadrant.net/cpss/

This Policy was developed with reference to existing standards and policies as set out in The Medical Profession Act, 1981, The College of Physicians and Surgeons of Saskatchewan Regulatory Bylaws, and the University of Saskatchewan College of Medicine Assessment of Postgraduate Trainees: Guiding Principles – Policies and Procedures: Promotion and deferral of promotion, Remediation, Probation, Dismissal, Appeal, September 16, 2009. It was also developed with reference to standards of the profession related to professionalism as defined within the CanMEDS / CanMEDS-FM/Triple C Curriculum competencies of the two national accrediting authorities – The Royal College of Physicians and Surgeons of Canada3 and the College of Family Physicians of Canada4

There is an expectation that postgraduate medical trainees will act in a way that is consistent with the principles of The Health Information Protection Act (HIPA) (http://www.qp.gov.sk.ca/documents/english/Statutes/Statutes/H0-021.pdf), and The Local Authority Freedom of Information and Protection of Privacy Act (http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/L27-1.pdf)

General Guidelines for Safe Use of the Internet (Social Media and Online Networking Forums)

Based on several foundational principles as follows:

  • You control your audience. You are responsible for what you put online, even if the information is handled in a way that you did not intend. Always think twice before posting
  • Respect for privacy and confidentiality is fundamental to the development of trust between physicians and their patient Respect for colleagues and co-workers in an inter-professional environment
  • The tone and content of electronic conversations should remain professional
  • Individual responsibility for the content of blogs
  • Respect the law; be aware of copyright, fair use, defamation and harassment
  • The permanency of published material on the Web, and through electronic communications (consider any action online or by electronic communications as permanent)
  • Be mindful of the risks as anything posted or communicated electronically are traceable even if posted anonymously
  • That all involved in health care have an obligation to maintain the privacy and security of patient records under The Health Information Protection Act (http://www.qp.gov.sk.ca/documents/english/Statutes/Statutes/H0-021.pdf) which defines a record as “information in any form and includes information that is written, photographed, recorded, digitized or stored in any manner”5

a) Sharing Information about Patients

Never communicate/post personal health information about an individual.

Personal health information as interpreted in the HIPA means with respect to an individual, whether living or deceased and any information about an individual in oral or recorded form, where the information identifies an individual or for which it is reasonably foreseeable in the circumstances that it could be utilized, either alone or with other information, to identify an individual.6

These guidelines apply even if the individual patient is the only person who may be able to identify him or herself on the basis of the posted description. Trainees should ensure that anonymized descriptions do not contain information that will enable any person, including people who have access to other sources of information about a patient, to identify the individuals described. Trainees must recognize that in the small area of medicine it is easy to unintentionally identify individuals leading to patient care and must take all precautions to assure anonymity.

Appropriate uses to communicate may be those outlined below - being mindful of your responsibilities to assure that patient confidentiality won’t be breached and understanding that there could be potential legal implications:

  1. With the express written consent of the patient or substitute decision-maker.
  2. Within secure internal hospital networks if expressly approved by the hospital or institution. Please refer to the specific internal policies of your hospital or institution.7
  3. Within specific secure course-based environments8 that have been set up by the University of Saskatchewan and that are password-protected or have otherwise been made secure.
    Even within these course-based environments, participants must:
    1. Adopt practices to “anonymize” individuals;
    2. Ensure there are no patient identifiers associated with presentation materials; and
    3. Use objective rather than subjective language to describe patient behavior. For these purposes, all events involving an individual patient should be described as objectively as possible, i.e., describe a hostile person by simply stating the facts, such as what the person said or did and surrounding circumstances or response of staff, without using derogatory or judgmental language.
  4. Entirely fictionalized accounts that are so labeled.

b) Sharing Information about Colleagues and Co-workers

Respect for the privacy rights of colleagues and co-workers is important in an inter-professional working environment. If you are in doubt about whether it is appropriate to post (share) any information about colleagues and co-workers, ask for their explicit permission – preferably in writing. Making demeaning or insulting comments about colleagues and co-workers to third parties is unprofessional behaviour.

Such comments may also breach the University’s codes of behavior regarding harassment including the University policy on Discrimination and Harassment Prevention (http://www.usask.ca/university_secretary/policies/health/3_14.php)

c) Professional Communication with Colleagues and Co-workers

Respect for colleagues and co-workers is important in an inter-professional working environment. Addressing colleagues and co-workers in a manner that is insulting, abusive or demeaning is unprofessional behavior.

Such communication may also breach the University policy on Discrimination and Harassment Prevention (http://www.usask.ca/university_secretary/policies/health/3_14.php)

d) Sharing Information Concerning Hospitals or other Institutions

Comply with the current hospital or institutional policies with respect to the conditions of use of technology and of any proprietary information such as logos or mastheads.

Postgraduate medical trainees must not represent or imply that they are expressing the opinion of the organization. Be aware of the need for a hospital, other institution and the university to maintain the public trust. Consult with the appropriate resources such as Public Relations Department of the hospital/health region, Postgraduate Medical Education Office, or institution who can provide advice in reference to material posted (shared) on the Web that might identify the institution.

Misrepresenting the standards of care of a hospital or other institution could result in disciplinary action.

e) Offering Medical Advice

Do not misrepresent your qualifications.

Postgraduate medical trainees are reminded that the terms of their registration with the College of Physicians and Surgeons of Saskatchewan limits the provision of medical advice within the context of the teaching environment. Provision of medical advice by postgraduate medical trainees outside of this context is inconsistent with the terms of educational registration.

f) Professional Boundaries – related to Patients

  1. Do not initiate an invitation to connect with patients or their family members over or through social media platforms or networks9 .
  2. Carefully consider an invitation from a patient to become an online friend. In general, avoid entering into dual relationships with patients by becoming online friends but be considerate of patients’ feelings when declining the invitation9

g) Academic Integrity extends to the Appropriate Use of the Internet (Social Media and Online Networking Forums)

The University of Saskatchewan has several policies which cover student and faculty practices and which also apply to social networking:

  1. Policies on academic dishonesty and misconduct may be breached by sharing examination questions, attributing work of others to oneself, collaborating on work where specifically instructed not to do so, as covered by academic integrity and student conduct policies and student academic dishonesty rules of the University of Saskatchewan Council whether these activities occur on line or not
    (http://www.usask.ca/university_secretary/honesty/index.php)
    (http://www.usask.ca/university_secretary/council/guide_conduct.php).
  2. Use of and behavior on social networking web sites are governed by applicable provincial and federal laws.
  3. Use of university facilities and equipment is also governed by university policies such as the Computer Use Policy
    http://www.usask.ca/university_secretary/policies/operations/4_11.php Policies
    and the Email Policy
    http://www.usask.ca/university_secretary/policies/operations/4_42.php , etc.
  4. Guidelines for faculty and students using internet social networking in the academic context10, etc.

Penalties for Inappropriate Use of the Internet (Social Media and Online Networking Forums)

The penalties for inappropriate use include:

  • Remediation, dismissal or failure to promote by the Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan
  • Discipline for breach of hospital, health region or institutional policy
  • Prosecution or a lawsuit for damages for a contravention of the HIPA
  • A finding of professional misconduct by the College of Physicians and Surgeons of Saskatchewan

Enforcement

All professionals have a collective professional duty to assure appropriate behavior, particularly in matters of privacy and confidentiality.

A person who has reason to believe that another person has contravened these guidelines should approach his/her immediate supervisor/program director for advice. If the issue is inadequately addressed, s/he may complain in writing to the Associate Dean, Postgraduate Medical Education, or to the College of Physicians and Surgeons of Saskatchewan through designated processes.

Complaints about breaches of privacy may be filed with the Office of the Saskatchewan Information and Privacy Commissioner (http://www.oipc.sk.ca/)

Resource

Adapted from McMaster University – Postgraduate Medical Education Guidelines for Appropriate Use of the Internet, Electronic Networking and Other Media http://fhs.mcmaster.ca/postgrad/documents/InternetGuidelines.pdf

Approved: Postgraduate Medical Education Committee – January 2014


1 Canadian Medical Association – Social media and Canadian physicians – issues and rules of engagement. http://www.cma.ca/advocacy/social-media-canadian-physicians

2 Collective Agreement Between the University of Saskatchewan and the Professional Association of Internes and Residents

3 Royal College of Physicians and Surgeons of Canada – CanMEDS http://rcpsc.medical.org/canmeds/index.php

4 College of Family Physicians of Canada – Standards for Accreditation – (Standard B5 pg 17) http://www.cfpc.ca/uploadedFiles/Red%20Book%20English.pdf

5 The Health Information Protection Act, Statutes of Saskatchewan, 1999 C. H-0.021, s.2(p)

6 The Health Information Protection Act, Statutes of Saskatchewan, 1999 C. H-0.021, s.2(m)

7 Faculty, instructors and postgraduate medical trainees are reminded that portable devices are not secure, and that personal health information should not be communicated outside the official channels provided by the health care institution or removed from the health care institution.

8 Faculty and instructors are reminded that the University network makes no assurances for security and thus should never be used to communicate personal health information.

9 Based on College of Physicians and Surgeons of British Columbia – Professional Standards and Guidelines – Social Media and Online Networking Forums, Sept. 2010

10 Academic Support Committee of Council – Guidelines for Faculty and Students using Internet Social Networking in the Academic Context at the University of Saskatchewan, May 2009 http://www.usask.ca/university_secretary/council/committees/teaching_learning_academic_resources/Archive_T LC_ASC/ASCreport_files/socialnetworking1.pdf