L7 Prof Development Digital technology and professionalism

Overview

This lecture covers internet and social media use in New Zealand, why and how health professionals can use social media for professional development, and the risks this carries. It then turns to attention, flow and digital wellbeing (including the screen inferiority effect and an AI/critical-thinking study), persuasive app design and health misinformation on TikTok, and finally the codes of conduct, guidelines and practical checklists that govern professional and student social media use.

Internet and social media use in New Zealand

Data source: Digital 2025: New Zealand (DataReportal).

• Average daily time using the internet: 6h32m across all devices; 3h17m of that on mobile phones.
• 5.03 million internet users in NZ (+0.8%, +38,000 year-on-year); 4.14 million social media user identities (+0.2%, +10,000 year-on-year).
• Most-used platforms among NZ internet users 16+ (monthly use, Feb 2025): Facebook 83.2%, Messenger 78.7%, Instagram 67.1%, WhatsApp 49.9%, TikTok 47.7%, Snapchat 37.7%, iMessage 36.8%, Pinterest 33.7%, Reddit 30.6%, LinkedIn 30.5%, X 23.8%, Discord 13.6%, Telegram 10.9%, Skype 10.2%, Neighbourly 9.8%. (YouTube was not offered as an answer option in this particular survey question, so it does not appear despite likely high use.)
• Average monthly time per active user on each platform’s Android app (Nov 2024): TikTok 21h53m, Facebook 17h45m, YouTube 13h39m, Instagram 10h59m, Reddit 5h39m, Messenger 4h47m, WhatsApp 4h08m, Snapchat 4h06m, X 4h02m, Telegram 2h11m, LINE 1h19m, LinkedIn 1h08m, Pinterest 0h57m.
• Daily time with media overall: Internet total 6h32m (mobile 3h17m, laptop/desktop/tablet 3h15m), TV total 3h16m (linear/broadcast 1h49m, streaming/online 1h27m), Social media 2h03m, Music streaming 1h31m, Radio broadcast 1h05m, Press total 0h53m, Games console 0h43m, Podcasts 0h39m.
• Main reasons NZ users give for using social media: keeping in touch with friends/family 67.3%, filling spare time 49.3%, reading news stories 30.4%, finding content 30.2%, finding inspiration for things to do/buy 30.0%, seeing what’s being talked about 24.4%, finding like-minded communities 22.9%, finding products to purchase 21.2%, watching live streams 21.1%, posting about your life 20.1%, seeing favourite-brand content 19.8%, watching/following sports 19.6%, FOMO avoidance 18.4%, work-related networking/research 16.8%, sharing/discussing opinions 15.4%.

Medical students’ social media use and wellbeing (Otago data)

• Dunedin trainee-intern survey, 2015 (Chester et al., BMC Medical Ethics 2017;18(1):70): of respondents with a social media page containing personal information, 90.7% used Facebook, 16.7% Google+, 11.1% Twitter, 5.6% a personal blog, 5.6% had none, 9.3% used other platforms.
• Frequency of accessing their own social media pages: never 3.7%, less than once/day 13.0%, more than once/day 35.2%, 2-4 times/day 20.4%, more than 5 times/day 27.8%.
• 85.2% were aware of the Code of Professional Conduct for Medical Students’ guidelines on use of social media and the internet.
• A separate longitudinal Otago medical student wellbeing survey followed a cohort from 2nd to 5th year; in 2015 it asked 5th-years (103 female, 84 male with complete data) about digital wellbeing. Main finding: students who scored high on measures of problematic digital behaviour were more likely to show signs of burnout and depression.

Traditional media vs social media as communication models

• Traditional media: one-way, one-to-many broadcast from a single central source to separate recipients who do not communicate with one another.
• Social media: many-to-many; the source communicates bidirectionally with the audience, and audience members are also interconnected and communicate with each other, not just with the source.

Why and how to use social media professionally

Reasons a health professional might use social media:

• Stay up to date with the latest research/best practice
• Make professional connections
• Ask questions of experts
• Contribute to the body of knowledge
• Influence healthcare conversations
• Support professional development / build a professional learning network (PLN)
• Promote better health among the public
• Become a findable healthcare professional

Ways to use it:

• Follow relevant people, institutions, journals and conferences
• Find relevant content through podcasts, FOAMEd (Free Open Access Medical education materials), LinkedIn, X/Twitter, Bluesky, and Symplur healthcare hashtags
• Join professional or special-interest groups (e.g. LinkedIn digital health groups)

Possible issues:

• Finding good content, contacts and networks can be time-consuming
• Boundary issues
• Confidentiality and privacy concerns
• Can feel overwhelming
• Can be distracting

Attention, flow and digital wellbeing

• Flow (described by Mihaly Csikszentmihalyi, 1934-2021): a focused attentional state characterised by total involvement in a task; positively associated with happiness and wellbeing; requires commitment to a goal that challenges you; diminishes awareness of time passing; is intrinsically rewarding.
• Phones, computers and social media interactions are constant potential distractions. Humans cannot multitask; interrupted focus (switching between tasks) has an attentional cost. Flow only occurs with monotasking and is destroyed by interruptions.
• Reading is an activity where flow can occur under the right conditions, but how you read matters (illustrated by comparing reading the same journal article on paper vs on a screen).
• Screen inferiority effect: people take in less when reading from screens than from paper, and evidence suggests this encourages more surface-level processing (Liao, Yu, Kruger & Reichle, Trends in Cognitive Sciences 2024;28(1):43-55). Key points from that review: comprehension tends to be less effective on screens than paper, particularly for texts needing deeper understanding or read under time pressure; digital readers show a tendency toward more shallow/superficial processing and less metacognitive regulation; contextual factors guide reading-strategy use in digital environments alongside the visual/attentional constraints known from static-text reading; readers can develop adaptive strategies, but their effectiveness depends on cognitive, metacognitive and motivational factors.
• MIT study reported by TIME (2025) on ChatGPT and essay writing: participants first wrote essays either using ChatGPT or “brain-only.” When later asked to rewrite one essay without ChatGPT, the group that had used it first remembered little of their own essay and showed weaker alpha and theta brain waves, thought to reflect bypassed deep memory processes; the task was efficient but not integrated into memory networks. The group that wrote brain-only first, now allowed to use ChatGPT, performed well and showed a significant increase in brain connectivity across all EEG frequency bands. This suggests AI, used properly, could enhance rather than diminish learning. [slide does not elaborate on the underlying mechanism further]

Persuasive design and health misinformation on TikTok

• Apps have progressively improved their persuasive design; TikTok is described as leading this by being pushy and low-friction, learning what a user likes and ensuring they keep getting it, and encouraging participation through user-generated content.
• “TikTok Tics” study (Olvera, Stebbins, Goetz & Kompoliti, Movement Disorders Clinical Practice): TikTok tic/Tourette-related content and neurology-clinic presentations of tics both rose sharply during COVID-19. Videos tagged tic/Tourette/tourettes were reviewed to identify content creators (11 March 2020 to 30 March 2021), with a quantitative assessment of TikTok tics and a descriptive analysis of each creator’s video series. Cohort mean age 18.8 years, majority women. Unlike typical tic disorders (predominantly facial movements), arm movements were most frequent; average 29 tics per minute; almost all recorded tics were severe and disabling; coprolalia and self-injurious behaviour, rare in typical tic disorders, were present in the large majority of TikTok subjects. Conclusion: TikTok tics are distinct from typical Tourette syndrome, share features with functional tics, and are believed to represent mass sociogenic illness spreading through a group; clinicians need to stay aware of social media content since it affects the patients they see.
• TikTok and ADHD content quality (Yeung, Ng & Abi-Jaoude, Canadian Journal of Psychiatry 2022;67(12):899-906): the top 100 most popular ADHD videos were classified as misleading, useful, or personal experience using the PEMAT-A/V tool and JAMA benchmark criteria. Results: 52% misleading, 27% personal experience, 21% useful; inter-rater agreement 86% (kappa 0.7766); videos were highly understandable but had low actionability; non-healthcare providers uploaded most of the misleading videos, while healthcare providers uploaded higher-quality, more useful videos. Conclusion: about half of the analysed TikTok ADHD videos were misleading, so clinicians should be aware of the scale of health misinformation on social media and its potential impact on clinical care.

Professional guidelines, codes of conduct and policies

Example workplace/clinical policies (from a “Southern Policy” directory listing): Cellular Device Use Policy, Clinical Imaging Consent Form, Clinical Photography and Video Recording Flowchart, Clinical Photography and Video Recording Policy, Digital Recording of Clinical Images, General Photography Video Filming Consent, Live Streaming Clinical Procedures, Social Media Guidelines.

Otago Codes of Conduct relevant to digital professionalism: Code of Professional Conduct for Medical Students, A Guide to Academic Conduct, Medical Council of NZ and OMS Memorandum of Understanding (reviewed 2024), Medical Students and Informed Consent: a national consensus statement (2015), Code of Practice for Fitness to Practise, Guidelines on Maintaining Confidentiality of Clinical Material, Guide to Online Professionalism for Medical Practitioners and Medical Students, Taking and Sharing Images - A Guide for Otago Medical Students, Student Leave Policy, Students Viewing Patients’ Health Information Policy, Cultural Safety Statement.

Recommended guides (Australasian focus, med student involvement, worked examples):

• Guide to Online Professionalism for Medical Practitioners and Medical Students, a joint initiative of the Australian Medical Association Council of Doctors-in-Training, the NZ Medical Association Doctors-in-Training Council, the NZ Medical Students’ Association and the Australian Medical Students’ Association. Contents: always being seen as a doctor; confidentiality and the ubiquity of identifiers; considering who you friend or share information with; maintaining your professional reputation online; being responsible for your own advertising; managing negative patient comments online; using social media for advocacy; further reading.
• AMA Guide to Social Media & Medical Professionalism (2020): the tips and traps every doctor and medical student should know.
• Medical Council of New Zealand (2021): Statement on use of the internet and electronic communication.
• Surviving Medical School: Social Media (UK, Medical Protection).

Practical professionalism: reflection, posting safety and reminders

Reflection prompts (“Have you ever…”): Googled yourself and considered whether you’re comfortable with the results; posted information about a patient or workplace person on Facebook or Twitter; checked whether there is a social media policy where you work or are on placement; added patients as social media contacts; made a public comment that could be considered offensive; joined a group or liked a page that could be considered racist, sexist or otherwise derogatory; posted photos or videos you wouldn’t want patients, employers or workplace people to see; checked your Facebook privacy settings; noticed a friend post information that could have negative consequences for them and considered whether to tell them.

On being criticised for comments made outside work context: “the short answer is yes.” There is always a balance between freedom of speech and a person’s right to their own opinion, against the public’s expectation of how a doctor should behave. Even when posting as yourself, the public is likely to see you primarily as a doctor (Medical Protection, Surviving Medical School: Social Media).

Posting safety checklist, before posting ask:

• Would I say this out loud to a group of patients/peers (or my grandmother)?
• Am I about to make an offensive comment about another person or colleague?
• Am I about to make a comment that could be perceived as prejudiced against a person’s race, sexuality, gender, religion or other protected characteristic?
• Would what I am about to say damage the reputation of the medical profession?

Social media safety reminders:

• Personal vs professional accounts
• Update privacy settings
• Check workplace practices/guidelines
• Be a good communicator
• Be responsive rather than reactive
• Be open and honest
• Read everything before posting
• Own your mistakes

As a health professional in training:

• Be vigilant about your privacy and how you present yourself
• Be careful about what you post/share
• Be aware of the value and privilege of access to the internet
• Be prepared for patients/families who arrive having found (possibly inaccurate) health information online
• Manage your phone/social media use and commit to a goal, aiming for flow
• Put your phone down and go for a walk
• Use it well to develop your skills, networks and knowledge as a health professional

Self-test

1. According to the Digital 2025: New Zealand data, how much time do NZ internet users spend online daily overall and on mobile specifically, and which platform has the highest average monthly time per user?
2. Describe the structural difference between the traditional media model and the social media model of communication.
3. List the reasons given for why health professionals might use social media professionally.
4. Name three ways a health professional can find good professional content on social media, and describe one issue this can create.
5. Define flow and describe two of its defining features.
6. Explain why humans cannot truly multitask and why flow depends on monotasking.
7. Describe the screen inferiority effect and the kind of processing it is associated with.
8. Describe what the MIT/TIME study found when comparing a group that used ChatGPT first with a group that wrote unaided first, in terms of memory and EEG findings.
9. Explain what is meant by TikTok having “progressively better” persuasive design than earlier apps.
10. Describe the key findings of the “TikTok Tics” study, including how the tics differed from typical tic disorders and what explanation was proposed for them.
11. Describe what the TikTok ADHD content study found about video quality, and which group of creators produced the most misleading content.
12. From the Dunedin trainee-intern survey, describe the pattern of how often students accessed their own social media, and how aware they were of professional conduct guidance on social media.
13. What did the Otago medical student wellbeing survey find regarding problematic digital behaviour?
14. List the four questions in the posting safety checklist.
15. A colleague made a frustrated comment about a bad day at work on their personal Facebook page, outside work hours, and wonders if they can be criticised for it. Using the lecture’s guidance, explain how you would answer them.
16. Describe how the themes of persuasive app design, flow/attention, and professional social media guidelines connect: why might following the “aim for flow” and posting-safety advice from this lecture help protect both a trainee’s wellbeing and their professional reputation?

Answers

Reveal answers

1. NZ internet users spend an average 6h32m per day online across all devices, 3h17m of that on mobile phones; TikTok has the highest average monthly time per user among Android apps (21h53m), ahead of Facebook (17h45m) and YouTube (13h39m).
2. Traditional media broadcasts one-way from a single central source to many separate, unconnected recipients; social media is many-to-many, with bidirectional communication between the source and the audience and among audience members themselves, who are also interconnected.
3. To stay up to date with research/best practice, make professional connections, ask questions of experts, contribute to the body of knowledge, influence healthcare conversations, support professional development/build a PLN, promote better health among the public, and become a findable healthcare professional.
4. Following relevant people/institutions/journals/conferences, finding FOAMEd content and podcasts, and using platforms like LinkedIn, X/Bluesky or Symplur hashtags/groups; this can be time-consuming to do well (it can also raise boundary, confidentiality/privacy, and distraction/overwhelm issues).
5. Flow is a focused attentional state of total involvement in a task; for example, it requires commitment to a goal that challenges you and diminishes awareness of time passing (it is also positively associated with happiness/wellbeing and is intrinsically rewarding).
6. Humans cannot multitask; switching between tasks (interrupted focus) carries an attentional cost, so flow, which needs sustained monotasking, is destroyed by interruptions such as phone or social media notifications.
7. The screen inferiority effect is that people take in less when reading from screens than from paper; it is thought to encourage more surface-level/shallow processing and less metacognitive regulation, especially for texts needing deeper understanding or read under time pressure.
8. The group that used ChatGPT first, when later made to rewrite an essay without it, remembered little of their own essay and showed weaker alpha/theta brain waves, suggesting bypassed deep memory processes; the group that wrote brain-only first (then allowed to use ChatGPT) performed well and showed a significant increase in brain connectivity across all EEG frequency bands, suggesting better integration into memory.
9. It means TikTok’s design is especially pushy and low-friction, learns what the user likes and ensures they keep receiving it, and encourages participation through user-generated content, making it more engaging and harder to disengage from than earlier apps.
10. TikTok tic content and tic presentations in neurology clinics both rose sharply during COVID-19; unlike typical tics (mostly facial), TikTok tics were mostly arm movements, averaged 29 tics per minute, were almost all severe/disabling, and frequently included coprolalia and self-injurious behaviour (rare in typical tics); they are believed to represent mass sociogenic illness spreading through a group rather than classic Tourette syndrome.
11. 52% of the top 100 ADHD videos were classified as misleading, 27% as personal experience, and 21% as useful; non-healthcare providers uploaded most of the misleading videos, while healthcare providers uploaded higher-quality, more useful content.
12. Just over a third (35.2%) accessed their personal social media pages more than once per day, with a further 27.8% doing so more than five times per day; 85.2% were aware of the Code of Professional Conduct for Medical Students’ guidelines on social media/internet use.
13. Students who scored high on measures of problematic digital behaviour were more likely to show signs of burnout and depression.
14. Would I say this out loud to a group of patients/peers (or my grandmother)? Am I about to make an offensive comment about another person or colleague? Am I about to make a comment that could be perceived as prejudiced against a person’s race, sexuality, gender, religion or other protected characteristic? Would what I am about to say damage the reputation of the medical profession?
15. Yes, they can be criticised: there is always a balance between freedom of speech/the right to a personal opinion and the public’s expectation of how a doctor should behave, and even when posting as themselves, the public is likely to see them primarily as a doctor.
16. Persuasive app design (e.g. TikTok) works against flow by encouraging constant, low-friction engagement and interruption, which undermines the monotasking flow needs and is linked to the problematic digital behaviour associated with burnout/depression; the lecture’s advice to manage phone/social media use and aim for flow protects wellbeing, while the posting checklist and reminders such as separating personal/professional accounts and reading before posting protect professional reputation, since the public judges a trainee’s online conduct through a professional lens regardless of platform or context.