The Relationship Between Unprofessional Social Media Posts and Personality Traits Made by Physician Assistant Students

Abstract

OBJECTIVES

Research has indicated that physician assistant (PA) students use social media in their medical education; however, research is scant on whether PA students use social media unprofessionally. This study aimed to determine if PA students badmouth others or post pictures or comments depicting substance use and whether a relationship exists between personality and unprofessional posts.

METHODS

PA Program Directors were emailed and asked to disseminate an anonymous survey to their students. The survey included descriptive questions, questions regarding badmouthing and substance use posts, and the Mini-International Personality Item Pool. Data analysis included descriptive statistics, Spearman's correlation coefficient, and Mann–Whitney U with p < .05 indicating significance.

RESULTS

Recruitment resulted in n = 497 participants. Clinical year students made significantly more alcohol-related posts than didactic students (p = .01) and were significantly less conscientious (p ≤ .01). Didactic students badmouthed professors significantly more than clinical year students (p < .05). Females made significantly more alcohol-related posts (p ≤ .01); however, males badmouthed friends more (p = .02). A statistically significant relationship was identified between extraversion and all types of badmouthing (p < .05), alcohol-related (p < .001), and recreational drug (p = .02) posts, and between neuroticism and badmouthing professors (p = .02); conversely there was a significant negative correlation between conscientiousness and badmouthing professors (p = .01).

CONCLUSION

Medical educational programs should address professionalism concerning social media with a program policy to encourage a professional and ethical digital profile.

Keywords

Professionalism personality traits leadership badmouthing social media physician assistant

Introduction

People of all ages use social media to express themselves and connect with friends and family. Of those in college, 96% use the Internet, and 86% have created a social media profile. This form of communication has encouraged individuals to lose their inhibitions and express themselves in a way they would not have if face-to-face with someone. Specifically, social media has led to new opportunities for online aggression in the form of bullying.¹ Bullying can take many forms, and 59% of teens report having been bullied or harassed online. Some bullying events teens report experiencing include offensive name-calling, spreading false rumors, receiving explicit messages without asking, sharing explicit images of them without their consent, and physical threats.² According to the Cambridge Dictionary, the definition of badmouthing is “to criticize someone or something in a very unpleasant manner.”³ Offensive name-calling, spreading false rumors, or saying something negative about someone else on social media can be considered badmouthing. Furthermore, social media often posts a picture commemorating an offline social event. These events often depict the user in a social situation drinking alcohol.⁴ These posts may also have references to drug use.

Badmouthing others and posting pictures depicting substance use is considered unprofessional, and research has demonstrated that employers have turned down applicants because of what they perceive as questionable digital behavior.⁵ According to CareerBuilder, 70% of employers have searched applicants’ social media sites for clues about their “off the clock” behaviors. Furthermore, they have chosen not to hire an applicant based on what was found on their social media site.⁶

Personality psychologists have reached a consensus that the domain of personality can best be described by the Big Five dimensions of the Five-Factor Model.⁷ These traits include extraversion, agreeableness, conscientiousness, neuroticism, and openness to new experiences and relate to people's conduct in a wide assortment of circumstances.⁸ Extraversion refers to a higher degree of sociability, assertiveness, and talkativeness, while agreeableness refers to being helpful, cooperative, and sympathetic toward others. Conscientiousness refers to being disciplined, organized, and achievement-oriented, while neuroticism refers to the degree of emotional stability, impulse control, and anxiety. Lastly, openness refers to being intellectually curious and preferring novelty and variety.⁷ This trait has also been referred to as intellect/imagination.

Personality has been studied extensively in various contexts and in relation to leadership practices, including ethical leadership.^9,10 Additionally, the relationship between personality and social media use has been explored.^11,12 Previous data have indicated that people higher in agreeableness made a greater number of postings about themselves. Highly conscientious people made significantly fewer wall postings and expressed more regret about posts made than less conscientious users.¹¹ Furthermore, those lower in agreeableness and conscientiousness engaged in more online badmouthing behaviors, and extraversion was significantly associated with the tendency to post references to substance use.¹²

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) mandates that professionalism be taught to students during the program's didactic phase.¹³ How this content is taught is left to the individual program to decide. Someone's behavior in their professors’ presence may not be how they present themselves in their personal and digital lives. Therefore, many programs have elected to instill social media policies and teach professionalism as part of the didactic curriculum. These policies may be in addition to those that the college creates. Research has indicated that PA students use social media as part of their medical education; however, there is no research to date on whether PA students use social media in an unprofessional manner.¹⁴ This study has two primary aims. The first is determining if PA students badmouth others or post pictures or comments depicting substance use on social media. The second aim is to determine if there is a relationship between personality and unprofessional social media posts made by PA students.

Materials and methods

This quantitative non-experimental research strategy was conducted as a survey of PA students after the researchers obtained approval from the New York Institute of Technology Internal Review Board on June 24, 2021, with approval number BHS1673. The data collection period was July–August of 2021, administered on REDCap software at the New York Institute of Technology in Old Westbury, NY. Student participants were obtained by emailing the Program Director of each PA program and asking them to disseminate the survey to their students, a snowball recruitment sample. The anonymous survey was administered through the REDCap web-based data collection software. The first survey question obtained the participant's informed consent with a question with answer choices “I consent” or “I do not consent.” The second answer choice would have resulted in stopping the data collection process for the participant. This consent process was approved in the IRB documentation review. Inclusion criteria were that the participant was to be a PA student with a social media account. As a characteristic of exclusion, a stop-point in the digital survey occurred if the participant reported “no” to the question “Are you currently enrolled in a Physician Assistant/Associate Program?” The participants without a social media account who indicated that they had never posted on social media were only included in the descriptive statistical analyses that included program phase, gender, race, ethnicity, age, and if their PA program had a social media or professionalism policy. To mitigate socially desirable answers and the over-reporting of normative behaviors, which is a well-known limitation of survey research,¹⁵ respondents were not asked to identify their respective PA programs.

Although many behaviors can be demonstrative of unprofessional behavior, badmouthing and substance use were utilized as they capture significant, common behaviors, which students may be more apt to admit than other more inflammatory actions in the parameter of this broad category. In deciding what behaviors to include in the broad category of unprofessional behaviors, the study discussed categories that were both common and more likely to be revealed by students since they were perceived to be less serious. We arrived at two: badmouthing others and substance abuse. Since no studies note the most common professionalism violations in social media among PA students, these categories were chosen based on face validity. The survey contained five questions regarding badmouthing and two regarding substance use posts that used a five-point Likert scale ranging from 1 = never; 2 = rarely; 3 = sometimes; 4 = very often; 5 = always. The Mini-International Personality Item Pool (Mini-IPIP) was used to collect data regarding personality. The Mini-IPIP is a short measure comprising 20 questions with four items associated with each Big Five trait: extraversion, agreeableness, conscientiousness, neuroticism, and intellect/imagination/openness. Two items for each trait use reverse (negative) scoring, except intellect/imagination, with three reversed scored items. Participants indicate responses using a five-point Likert scale from 1 = very inaccurate; 2 = moderately inaccurate; 3 = neither inaccurate nor accurate; 4 = moderately accurate; 5 = very accurate. Each participant's score is calculated for each trait by adding positively scored items and subtracting the negatively scored items¹⁶ (see Table 1). The Mini-IPIP created by Donnellan et al is based on a 50-question personality inventory by Goldberg. Five studies validated the tool for internal consistencies with alphas greater than .60. Retest correlations of the Mini-IPIP similar to the original 50-item IPIP-FFM at weeks and months. The Mini-IPIP also had high-reliability coefficients and validity coefficients similar to the IPIP-FFM.^16,17

Table 1.

Mini-IPIP 20 item.

ITEM	FACTOR
1. Am the life of the party	1. E
2. Sympathize with others’ feelings.	2. A
3. Get chores done right away	3. C
4. Have frequent mood swings.	4. N
5. Have a vivid imagination.	5. I
6. Don't talk a lot. (R)	6. E
7. Am not interested in other people's problems. (R)	7. A
8. Often forget to put things back in their proper place. (R)	8. C
9. Am relaxed most of the time. (R)	9. N
10. Am not interested in abstract ideas. (R)	10. I
11. Talk to a lot of different people at parties.	11. E
12. Feel others’ emotions.	12. A
13. Like order.	13. C
14. Get upset easily.	14. N
15. Have difficulty understanding abstract ideas. (R)	15. I
16. Keep in the background. (R)	16. E
17. Am not really interested in others. (R)	17. A
18. Make a mess of things. (R)	18. C
19. Seldom feel blue. (R)	19. N
20. Do not have a good imagination. (R)	20. I

E = Extraversion; A = Agreeableness; C = Conscientiousness; N = Neuroticism; I = Intellect/ Imagination/Openness; (R) = Reverse Scored Item.16

The calculation of the G-Power for the sample size collected was 50 participants for the Mann–Whitney U testing and 84 participants for the correlation testing. The sample size needed was calculated using G*Power for a correlation bivariate normal model. The type of power analysis performed was an a priori, two-tailed test with 0.80 power, .03 effect size (medium), and .05 error. This tool indicated that 84 subjects were necessary. The literature recommends calculating 30 subjects per cell for analyzing categorical variables, resulting in 90 participants if differences are identified among the three groups. Considering this approach, G*Power was approaching the adequate sample size needed. Therefore, the goal of this study was to include at least 90 participants so statistical significance could be achieved with all analyses performed.¹⁸

Statistical analysis

The data collected was exported from REDCap to SPSS statistical software. Data analysis included descriptive statistics with percentages, frequencies, means, and standard deviations. Spearman's correlation coefficient and Mann–Whitney U. Significance levels were established at 95% (p < .05). The differences in categorical variables were measured using the Mann–Whitney U test. Spearman's correlation coefficient was used to measure the degree of association between personality and unprofessional social media posts.

Results

The recruitment email was sent to 307 program directors, and 500 student surveys were completed; however, three surveys were discarded for not meeting the inclusion criteria. This resulted in 497 participants. Of those who participated, 26.4% were male (n = 131), 73.0% were female (n = 363), and 0.6% (n = 3) chose not to identify their gender. The age distribution was as follows: 50.1% (n = 249) were between 20 and 25 years of age, 31.4% (n = 156) were between 26 and 30 years of age, 10.1% (n = 50) were between 31 and 35 years of age, 5.6% (n = 28) were between 36 and 40 years of age, 2.2% (n = 11) were between 41 and 45 years of age and 0.6% (n = 3) were between 46 and 50 years of age (see Table 2).

Table 2.

Demographic frequencies.

	FREQUENCY	PERCENT
Gender
Man	131	26.4
Woman	363	73
Non-binary	0	0
I prefer not to say	3	0.6
Age
20–25	249	50.1
26–30	156	31.4
31–35	50	10.1
36–40	28	5.6
41–45	11	2.2
46–50	3	0.6
Phase of PA education
Didactic	294	59.2
Clinical	203	40.8
Social media account
Yes	472	95
No	25	5
PA program has a social media policy
Yes	261	52.5
No	14	2.8
I am not aware of a policy	222	44.7
PA program has a professionalism policy
Yes	463	93.2
No	1	0.2
I am not aware of a policy	33	6.6

Participants indicated their curriculum phase in the program: 59.2% (n = 294) were in the didactic phase/classroom instruction and 40.8% (n = 203) were in the clinical phase/medical rotations. The overwhelming majority of participants, 95% (n = 472), had a social media account, while 5% (n = 25) did not have a social media account. When asked if their PA program had a social media policy, 52.5% (n = 261) indicated “yes” 2.8% (n = 14) indicated “no” and 44.7% (n = 222) chose “I am not aware of a policy.” Participants were also asked if their PA program had a professionalism policy; 93.2% (n = 463) indicated “yes” while 0.2% (n = 1) indicated “no” and 6.6% (n = 33) chose “I am not aware of a policy.”

When asked about posting pictures or comments regarding drinking alcohol, 36.5% (n = 174) of participants reported “never” doing so. Furthermore, 32.6% (n = 155) indicated they “rarely” do, 26.5% (n = 126) indicated they “sometimes” do, 4% (n = 19) indicated they “often” do, while 0.4% (n = 2) indicated they “always” do. Conversely, 99% of students said they “never” posted pictures or comments about recreational drugs. Regarding badmouthing, 94.5% (n = 450) denied ever badmouthing their college, 95.1% (n = 453) their PA program, 94.5% (n = 450) their professors, 90.5% (n = 431) their friends, and 93% (n = 443) their peers.

Based on the program phase, there was a statistically significant difference in posting pictures with alcohol or posting alcohol-related comments. Specifically, students in the clinical phase posted more alcohol-related pictures or comments (U = 24055.0, p = .01). The data also demonstrated that clinical year students were significantly less conscientious than students in the didactic phase (U = 25360.5, p ≤ .01). However, students in the didactic phase badmouthed a professor significantly more than the clinical year students (U = 28679.0, p < .05). When considering gender, female students posted significantly more pictures or comments related to alcohol than males (U = 17648, p ≤ .01); however, males badmouthed their friends more than females (U = 22291, p = .02).

A statistically significant relationship was identified between being an extrovert and all types of badmouthing. A relationship was identified between extraversion and students badmouthing their college (r_s [497] = .123, p < .01), PA program (r_s [497] = .114, p = .01), professors (r_s [497] = .106, p = .02), friends (r_s [497] = .139, p < .01), and their peers (r_s [497] = .111, p = .01). A statistically significant relationship was also identified between neuroticism and badmouthing professors (r_s [497] = .106, p = .02); conversely there was a significant negative relationship identified between conscientiousness and badmouthing professors (r_s [497] = −.109, p = .01). A statistically significant relationship was also identified between being an extravert and posting pictures or comments regarding alcohol (r_s [497] = .263, p < .001) and recreational drugs (r_s [497] = .105, p = .02) (see Table 3).

Table 3.

Correlation results.

SPEARMAN's CORRELATIONS
VARIABLE	BADMOUTH COLLEGE	BADMOUTH PROGRAM	BADMOUTH PROFESSORS	BADMOUTH FRIEND	BADMOUTH PEERS	ALCOHOL ON SOCIAL MEDIA	DRUGS ON SOCIAL MEDIA	EXTRAVERSION	AGREEABLENESS	CONSCIENTIOUSNESS	NEUROTICISM
1. Badmouth college	Spearman's rho		—
	p-value		—
2. Badmouth program	Spearman's rho		0.632		—
	p-value		< .001		—
3. Badmouth professors	Spearman's rho		0.509		0.637		—
	p-value		< .001		< .001		—
4. Badmouth friend	Spearman's rho		0.306		0.304		0.335		—
	p-value		< .001		< .001		< .001		—
5. Badmouth peers	Spearman's rho		0.522		0.484		0.560		0.536		—
	p-value		< .001		< .001		< .001		< .001		—
6. Alcohol on social media	Spearman's rho		0.176		0.143		0.075		0.191		0.162	—
	p-value		< .001		0.002		0.102		< .001		< .001	—
7. Drugs social media	Spearman's rho		0.065		0.168		0.154		0.253		0.304	0.122	—
	p-value		0.160		< .001		< .001		< .001		< .001	0.007	—
8. Extraversion	Spearman's rho		0.123		0.114		0.106		0.139		0.111	0.263	0.105	—
	p-value		0.007		0.012		0.021		0.002		0.015	< .001	0.022	—
9. Agreeableness	Spearman's rho		0.013		0.061		0.004		−0.004		0.030	0.074	0.085	0.205	—
	p-value		0.778		0.185		0.926		0.932		0.520	0.106	0.065	< .001	—
10. Conscientiousness	Spearman's rho		−0.060		−0.079		−0.109		−0.032		−0.068	−0.064	−0.037	0.048	0.176	—
	p-value		0.192		0.086		0.017		0.493		0.141	0.165	0.426	0.295	< .001	—
11. Neuroticism	Spearman's rho		0.085		0.077		0.106		−0.011		0.076	0.014	0.008	−0.080	0.045	−0.086	—
	p-value		0.064		0.093		0.020		0.817		0.100	0.753	0.865	0.081	0.328	0.061	—
12. Intellect/Imagination	Spearman's rho		0.045		0.063		−0.001		0.011		0.018	−0.089	−0.053	0.149	0.194	−0.039	−0.034
	p-value		0.330		0.168		0.980		0.814		0.701	0.051	0.248	0.001	< .001	0.392	0.455

Discussion

Unsurprisingly, the overwhelming majority of PA students use social media, yet only half of the participants indicated their program had a social media policy. However, over 90% of participants were aware of their program's professionalism policy. Despite the high frequency of professionalism policies, two-thirds of the participants have made posts referencing or depicting alcohol, which may be deemed unprofessional by potential employers or professional peers. Students in the clinical phase made significantly more of these posts. One can postulate that these students may feel more comfortable doing so since they are away from their program and out on clerkships. Furthermore, clinical year students were significantly less conscientious than didactic students, which may explain their difference in alcohol posts since conscientiousness is associated with self-discipline.⁷ Conversely, students in the didactic phase badmouthed a professor significantly more than the clinical year students, which may reflect being in the classroom and immersed in their coursework.

Regarding gender, female students posted significantly more pictures or comments about alcohol than males. These findings support previous research that indicates that while sharing drinking images online provides enjoyment and an opportunity for self-display for both men and women, photo-taking during a night of socializing and drinking and subsequent uploading was considered a predominantly feminine practice.¹⁹ Ammi et al found in doctors’ personality traits that doctors are more agreeable, conscientious, extroverted, and neurotic than the other groups.²⁰ However, regarding negative posts, male participants badmouthed their friends more than females, supporting previous research that demonstrated that men were more likely than women to engage in online trolling.²¹

While the incidence of badmouthing was low, being an extrovert was associated with all types of badmouthing. Additionally, a relationship was identified between extraversion and making alcohol and recreational drugs posts. Previous research has indicated that more extroverted people use social media more frequently, which aligns with being more sociable and talkative.²² Furthermore, studies have identified that extraversion is associated with the tendency to post references to substance use.¹² The data from this study conflicts with prior research in that extraversion has also been associated with positive social media posts.²³ Neuroticism was associated with badmouthing professors, possibly due to the negative traits associated with anxiety, hostility, depression, self-consciousness, impulsiveness, and vulnerability. Conversely, a significant negative relationship was identified between conscientiousness and badmouthing professors. This trait is considered a positive personality trait associated with being efficient, decisive, reliable, responsible, dutiful, and self-disciplined, which may explain why this group badmouthed professors less.^7,24

In an effort to promote professionalism and to instill in students the importance of restraint with social media postings while meeting the accreditation standards, programs can promote knowledge with student education and expectations. Exercises and role-play scenarios to familiarize students with complex ethical and professional scenarios may instill second-order knowledge and retention of demonstrating professional behaviors.²⁵ These skills should be implemented at the introduction to the curriculum during orientation through the summation of the clinical year to compound knowledge and exposure.

Limitations

This cross-sectional study surveyed students at a specific time and does not identify if their social media habits have changed since matriculating into their PA program. This population was heavily female, and these results may not generalize to males. Further study may be warranted to explore the role of gender identity and to generalize to other graduate students. Despite the inability to calculate the exact student response rate, our population closely matches national PA student demographics provided by the 35^th PAEA Annual Report.²⁶ Because of the broad nature of unprofessional behavior, we were limited to only two common unprofessional behaviors for pragmatic reasons. Focus groups consisting of PA faculty and students could be conducted in the future to identify other negative social behaviors such as racism, political bias, violating patient privacy, or dehumanizing patients. Lastly, self-selection and providing socially desirable answers are a limitation of survey research and were beyond the control of this study.

Conclusion

Badmouthing others and posting pictures depicting substance use is considered unprofessional and can negatively affect a student's reputation, future employment opportunities, and the reputation of that student's academic program. Consequently, it behooves health professions programs to focus on professionalism concerning social media. Faculty should be mindful that certain personality traits can be associated with unprofessional posts, with prior research finding physicians to be more extroverted and neurotic, characteristics associated with increased unprofessional posting. Furthermore, if a program does not have a social media policy, it should create one, and if they do have a policy, it must explicitly inform students of its contents to prevent unprofessional posting.

Supplemental Material

sj-pdf-1-mde-10.1177_23821205241245855 - Supplemental material for The Relationship Between Unprofessional Social Media Posts and Personality Traits Made by Physician Assistant Students

Supplemental material, sj-pdf-1-mde-10.1177_23821205241245855 for The Relationship Between Unprofessional Social Media Posts and Personality Traits Made by Physician Assistant Students by Jaclyn N Cotgreave and Corri Wolf in Journal of Medical Education and Curricular Development

Footnotes

Acknowledgments

A particular point of gratitude to the Physician Assistant program directors who dispersed the study to their students and to the students who took the time to complete the survey.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Contributions

Both authors contributed to conceptualization, investigation, writing, methodology, review and editing, formal analysis, data curation, resources, and project administration.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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