HE INCREASE IN POPULARITY OFInternet applications built around user-generated content, collectively termed Web 2.0, has led to the development of innovative tools for health care and education. [1][2][3][4] These applications include social networking sites (eg, Facebook, Twitter), media-sharing sites (eg, Flickr, YouTube), blogs, wikis, and podcasts, among others. Web 2.0 use, especially among younger generations, is prevalent and increasing rapidly. 5 An estimated 75% of US adults aged 18 to 24 years who use the Internet and 57% aged 25 to 34 years use social networking sites. 5 Web 2.0 also risks broadcasting unprofessional content online that can reflect poorly on individuals, affiliated institutions, and the medical profession. 6,7 Other professions are struggling with similar issues. 8,9 However, the social contract between medicine and society expects physicians to embody altruism, integrity, and trustworthiness. 10,11 Furthermore, ethical and legal obligations to maintain patient confidentiality have unique repercussions. Yet, defining unprofessionalism online is challenging; there are no formal guidelines for physicians. 6,7 Medical schools are tasked with establishing the foundation of professional behavior in a generation of stu-dents who use Web 2.0 and expect digital connectedness. 5,12 There are few data to document unprofessional behavior in medical student-posted online content. Also, the adequacy of current institutional professionalism policies, given these new challenges, is unknown.The goals of this study were to describe reported incidents of medical students posting unprofessional content

The rise of social media--content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs--has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they "tread" through the World Wide Web, they leave behind a "footprint" that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for "online professionalism." Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.

The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl