This study documents the use of Facebook by incoming pharmacy students at 3 schools and their attitudes/opinions toward use of Facebook profile information for character and professionalism judgments. The percentage of pharmacy students with Facebook profiles is consistent with those reported for college students in general.8
The large percentage of users and subsequent time spent using Facebook suggests that it plays at least a nominal role in their everyday lives. Discussants of this topic often mention generational differences with regard to usage and attitudes. Our study did not find any significant differences in students' attitudes or opinions with age. However, participants' ages only ranged from 21 to 28 years, and a broader population including older students would have been necessary to detect generational differences.
One of the most troubling aspects of college students and Facebook is the apparent disconnect on their opinions of fair use' of Facebook profiles by others and the reality of their open access nature. With regard to employers, Facebook provides information that resumes, transcripts, and interviews may not provide. While a literature review revealed no research on if/how employers of doctor of pharmacy (PharmD) graduates use online social networking information in hiring decisions, general population studies suggest that 11% of all employers access interviewees' Facebook profiles during the hiring process.9
Over half (57%) of the pharmacy students in this study with Facebook profiles indicated that it was unfair for employers to use this information, and 36% have posted some type of information that they would not want potential employers to see. These results suggest that many pharmacy students do not have a full understanding of what constitutes private versus public information and/or of the possible ramifications of making private information public. One might not want behaviors and attitudes from private settings to be used in judging professional or career-related abilities; however, once private actions become public, the distinct private life (as has been traditionally defined) ceases to exist. Because of the rapid onset of technologies that have created and popularized online personas, society has yet to adjust to this new paradigm. Philosophically, many of us are now struggling with how to delineate between public and private with regard to personal information freely provided in online settings. Until society is able to grasp the new paradigm, further discussion on online identity protection is warranted.
Additionally, a large percentage of pharmacy students (45%, n = 109) believed that academic institutions should not use information on Facebook as evidence of unprofessional behavior. While the merits and harms of Facebook scanning by colleges and schools can be philosophically debated, this opinion is indicative of the attitude that Facebook is intended only for students and what is posted there should only be used by students. The fact that the majority of students do not want faculty Facebook “friends” further supports that attitude. Although 90% of pharmacy students stated it was important or very important to be cautious with Facebook profile information, approximately a third indicated they have posted information they would not want faculty members, potential employers, or patients to see. This suggests that privacy concerns do not necessarily coincide with Facebook posting behavior, which is consistent with prior research involving college students. 10
The awareness of privacy settings does not necessarily mean that they are used. The results may also underscore the need to consider “e-professionalism” issues as a part of pharmacy student professionalism. As public and private information boundaries become less apparent, the criteria for judging one's professional image becomes more ambiguous, especially with regard to attitudes and behaviors displayed to patients.
One interesting finding of this study is the rather stark contrast between male and female students concerning attitudes and behavior in online social settings. Male students were significantly more likely to present online personas containing information they would not want faculty members, employers, and patients to see. Consequently, male students were also more likely than female students to oppose accountability to authority figures for information presented in online social network settings. It is unclear whether this simply reveals a more rebellious nature among male students, but is significant information in terms of specifically reinforcing e-professionalism (and possibly professionalism) to male students within education settings.
Approximately a third (n = 75) of the pharmacy students felt that professional students should not be held to a higher standard with regard to online personas. These same respondents did not think students should be held accountable for information posted in an online setting. This is further evidence that a substantial number of pharmacy students reject the notion that information displayed publicly can be considered “fair game” for others to interpret. This may also indicate a general lack of understanding of the professionalism construct in general.
Almost 85% (n = 207) of the pharmacy students indicated that their online personas accurately portrayed who they were as a person. However, only 65% (n = 159) indicated that their profiles reflected who they would be as a future healthcare provider. This difference could mean one of several things. First, it might reveal that some of these incoming pharmacy students recognized that professional growth and maturity was needed before entering the profession. For others, it could mean that online personas were something they had not previously considered and therefore, simply had not attempted to maintain a professional image online. Third, it could reflect the attitude that online social networking profile information should be off limits to judgments on character or professionalism. Because 2 of the 3 variables predicting whether a student's profile reflected a professional persona were attitudinal, this suggests that the third explanation may be the most correct.
While the overall results concerning usage, accountability, and professionalism may be alarming to some, they are not particularly surprising. There appears to be somewhat of a generation gap on attitudes toward online social activities, with the younger generations defining “appropriate” use differently than older generations. As evidenced by the slight majority (50%, n = 123) who indicated a change in their future online social networking behavior, educational sessions may be necessary to inform pharmacy students about the potential problems that may result from being overly transparent in online social networking settings. Understanding how cues in an online environment aid in impression formation is becoming a necessity in the 21st century, especially for those who work in professional fields.11
The opinions of many students toward accountability and standards in the online environment may be alarming to some. Many pharmacy students simply may be naïve about potential negative consequences associated with the public display of their private lives and the signals that it sends to others.12
Others may have deep-rooted attitudes that may be difficult to change, except through continued exposure to professionalism ideals. We do not expect pharmacy students to learn appropriate professional behavior without significant instruction, mentoring, and enculturation into the profession. Likewise, alongside traditional professionalism instruction, e-professionalism training and reinforcement may be required in this new digital age to address areas of concern with regard to online personas.
Limitations of this study include use of a census sample at only 3 institutions; however, the authors do not suspect significant differences among students at other schools. Research on other types of online behavior (e-mail, online discussion boards, and other social networking sites) would also be valuable. This study contained a self-report of student posting activities. Analysis of actual online personas may reveal different information in terms of types of information displayed. Further research is also needed with pharmacy students throughout all years of a pharmacy program. As students become acclimated to the professional school climate, their attitudes and online personas might change. Exposure to general professionalism tenets may alter students' views of accountability and professional image. However, without e-professionalism training, pharmacy students might also be influenced by the “informal curriculum” of other college students and project online personas that are contradictory to health professions ideals. Online personas that reveal disrespect to others, racist remarks, drug/alcohol abuse, or other unsavory personality characteristics may reflect poorly on an individual as a professional healthcare provider and negatively affect career opportunities.