Professionalism and the Internet in Psychiatry: What to Teach and How to Teach It

Abstract

The digital revolution has had a profound impact on medicine and patient care. Patients have a growing expectation that they can find medical information on the web and discuss it with their physician by e-mail (1). Physicians, including psychiatrists, are increasingly using blogs and Twitter to promote their practices (2, 3). The internet itself is used as a vehicle for therapeutic modalities, even psychotherapy (4). Social networking among patients, physicians, and other “friends” are blurring boundaries as never before (5, 6). The potential clinical, legal, ethical, and professionalism issues in using the internet and digital media in psychiatry have been outlined elsewhere, including explicit recommendations for resident education in this area (7). This article focuses on how to teach residents about appropriate use of the internet. The evidence of unprofessional online behavior among physicians and the complexity of the potential issues raised with internet use in psychiatry suggest that psychiatric residents, educators, and administrators need explicit teaching about potential clinical, ethical, and legal pitfalls of internet use. In 2010, the President of the American Association of Directors of Psychiatric Residency Training (AADPRT) established a Taskforce on Professionalism and the Internet, charged with reviewing the literature and creating a curriculum to teach psychiatric trainees about online professionalism. Participants in a Taskforce-run workshop on this subject were asked for examples from their own experience of online professionalism concerns (8), and an outpouring of vignettes ensued. TheTaskforce undertook to create a curriculum based on vignettes designed to promote similar discussion. The principles elicited in these vignettes might be seen as extensions of well-established principles of professionalism (9, 10). Trainees accustomed to continual use of interactive technologies, however, may overlook boundary and other professionalism issues if they are not made explicit in training. The curriculum strives to address principles, rather than specific technologies, since the latter are expected to continue to evolve rapidly. The vignettes in this curriculum (available online at aadprt.org (11)) are designed for either group discussion or individual study; they are accompanied by relevant references and a teacher’s guide. The vignettes are organized around nine issues that may be relevant to various teaching venues: liability, confidentiality, and privacy; psychotherapy and boundaries; safety issues; mandated reporting; libel; conflicts of interest; academic honesty; “netiquette;” and professionalism remediation. We discuss the first eight of these topics, using vignettes from the curriculum for illustration. Where vignettes are based on actual cases, all identifying details are disguised.