By Mark Kuczewski

On April 28, 2016, ten minutes before the NFL draft of college players was to begin, the Twitter account of Laremy Tunsil of the University of Mississippi, displayed a video of him wearing a gas mask and smoking from a bong.  Mr. Tunsil was a talented prospect widely believed about to become the second player drafted.  He had done an imprudent action at some point and, allegedly, a hacker made the video record available to the world.  A panic swept through the NFL executives making selections for their teams.  Mr. Tunsil was not selected second as predicted but was passed over until the Miami Dolphins took him with the number thirteen pick in the draft.  Because higher draft picks receive larger contracts than those drafted later, commentators estimate that the drop in draft rank likely cost Mr. Tunsil at least $8,000,000…

This scenario captures the imagination of everyone who has been interested in how social media impacts our current concern with professionalism in medical education and health care.  Most medical schools have seen photos/videos of students engaging in behavior incompatible with a professional image or learned of imprudently posted comments about clinical experiences.  I believe that we as educators and health-care professionals can learn three things from the case of Laremy Tunsil that might inform our efforts in medical schools to devise meaningful policies and to educate students and trainees appropriately.

First, we must strike a balance between enforcing standards of professionalism and stewarding the talent available to medicine.  Those teams that passed over Mr. Tunsil may have passed over an exceptional talent and will regret that decision in the future. The mission of medical schools to develop the best possible physician workforce to serve patients and society requires that we assess that talent realistically, not reactively.  Educators must look at any negative social media incident within context when considering applicants and attempt to determine whether such an incident is indicative of a pattern with a current student or just an easily remediable incident.

Second, medical educators should create learning opportunities that encourage students to make positive use of social media.  If patterns are what count, creating positive patterns, e.g., “digital footprints,” “online identities,” are activities and skills we should foster.  We can see this most clearly by considering the digital footprints of long-time practicing physicians who never use social media.  Googling their name will yield links to short profiles that may be assembled by their affiliated health-care institutions and a number of websites in which physicians are graded by patients. Most such sites will contain comments and ratings by only a small number of patients.  And, of course, patients motivated to enter such comments will often skew toward those who are unhappy with the physician. Thus, one or two negative comments can become the lens through which the clinician’s identity is judged.  The antidote can be to develop a robust online identity that sets forth the values, virtues, and accomplishments of which the clinician is proud. Against this backdrop, occasional outlier comments recede and become small blemishes. Similarly, one picture posted of a student drinking an alcoholic beverage with gusto means little against a developed and professional profile.

Third, we educators and administrators must recognize the value of forgiveness. It is easy to simply insist that medical school applicants and students have no social media blemishes.  But, talented and precocious young people will commit errors in judgment.  Moreover, in an age in which it is so easy to take a picture of another and post to a public forum without that person’s knowledge, virtually anyone can give an appearance of unprofessional behavior whether that impression is valid or created by an image lacking its proper context.  Thus, we will be challenged to understand a student or trainee’s professional formation in a way that can incorporate public mistakes into a narrative of developing values, virtues, and accomplishments.

Mark G. Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics.  He chairs the Department of Medical Education and directs the Neiswanger Institute for Bioethics at the Loyola University Chicago Stritch School of Medicine.