Civil Use of Social Media Technology in Health Professional Education

Purpose: Uncivil and discourteous use of social media technology, such as Facebook, blogs or wikis, online courses with discussion boards, chat rooms, or emails, is a global and pervasive concern among general college populations. Despite the high prevalence of online incivility, little is known about the phenomenon including its contexts, conditions, and consequences among health professional students and educators. The creation and maintenance of a civil learning environment is particularly important because incivility is likely to interfere with educators’ ability to communicate with students while negatively affecting student learning processes and outcomes (Altmiller, 2012; Clark, Ahten, & Werth, 2012). The purpose of this integrative review study was to describe main conceptual environments surrounding the phenomenon of online incivility and contribute to the current knowledge base by updating the literature and recommending guidelines and future directions for health professional educators.

Methods: Publications from January 2000 to May 2015 were retrieved through CINAHL, ERIC, Embase, and PubMed (MEDLINE) databases, with the last search made in June 2015. Extensive literature searches were conducted to locate published materials related to cyberincivility in health-related disciplines (i.e. medicine, nursing, and allied health). Various key terms and their combinations were used. Hand and ancestry searches were also conducted. The framework of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement (Moher et al., 2009) was used to guide the review process.

Results: The systematic screening process yielded 11 articles dating from November 2007 to May-June 2015. Studies involved more than 2,000 subjects (n = 2,065) from various health-related disciplines. Of the 11 studies, seven were undertaken in the U.S., one was conducted in the U.S. and Canada, and the other three were undertaken in Brazil, Canada, and the United Kingdom. The most frequently used research method was a non-experimental design that included surveys (n = 9), focus groups (n = 1), and mixed-methods studies (n=1). Various cyber environments were investigated. Of the 11 studies, two articles discussed the indirect effect of cyberincivility, such as personal risk and the possible negative perception of the student’s school or profession. Five studies discussed actions that students, educators, or institutions took or felt should be taken. Consequences reported as a result of uncivil or unprofessional behavior were a broad spectrum of actions that ranged from informal warnings to dismissals. 

Conclusion: Strong evidence exists that health professional students share potentially uncivil content on social media while both students and educators are experiencing incivility in online environments. Although what constitutes uncivil or unprofessional online behavior is debatable, mutual understanding as to which behaviors are acceptable and what is considered ‘uncivil’ in the online environment is of importance. Cyberincivility has a negative impact on students’ learning processes and outcomes as well as on the quality of education. If clear policies and guidelines are not available, educators and schools are likely to react passively, or they might over-react rather than promote a civil culture in a consistent and respectful way. Future studies need to determine the effectiveness of an academic curriculum that fosters cybercivility (Rocha & de Castro, 2014) and the positive impact of implementing policies and guidelines (Nyangeni et al., 2015). Future research also should expand on the development and evaluation of effective preventative interventions. Taken together, it is essential to create and foster civility environments in order to actively prevent cyberincivility.