The use of social media has greatly increased over the past 5 years, with global user numbers for the social networking market leader, Facebook, increasing from 58 million (1) in December 2007 to 955 million (2) in June 2012. The growth of social media is seen by some as the personalization of the World Wide Web, allowing users to connect with one another and share information such as comments, photographs, and videos. There are numerous types of social media and networking sites, including those intended primarily for promoting social connections and interactions (eg, Facebook, www.Facebook. com); publishing short messages (tweets) (eg, Twitter, www.twitter.com); posting videos (eg, YouTube, www. youtube.com); sending instant messages (eg, Windows Live Messenger, www.microsoft.com); and developing professional networks (eg, LinkedIn, www.linkedin.com).
Although extremely popular, (2) there is controversy about students' and professionals' use of social networking sites, particularly in relation to privacy, safety, and inappropriate behavior. Material published online may remain linked to an individual for many years. Thus, potentially inappropriate attitudes and behaviors that users share online with friends through comments, photographs, and other media also may be viewed by parents, academic staff, and current or potential employers. These possibilities highlight the importance of the sites' privacy features, which enable content to be shared with a limited numbers of users. However, even with privacy features enabled, the user is reliant on those who can access their site's content not sharing it with others in a public arena. The failure of users to adequately understand the risks associated with publishing content on social networking sites has led to a number of high-profile disciplinary and criminal cases, including those among healthcare professionals and students. (3,4) Indeed, staff members in some universities have been reported to actively seek out online offenders. (5)
The ability to publish comments to a wide audience has led to flippant statements (eg, making insinuations regarding violent behavior, (6) making racial slurs (7)) being treated with more seriousness than the user intended. While illegal and offensive behavior displayed on social networking sites has direct consequences for the individuals concerned, there are higher expectations and additional responsibilities placed on those who work as, or are training to become, health care professionals. Numerous incidents in which UK health professionals have posted inappropriate material on social networking sites have been reported in the National Health Service in England, including doctors and nurses engaging in unprofessional behavior while on duty, making comments about patients, posting photos taken while on duty, and breaching patient confidentiality. (8,9) Regulators have endeavored to clarify their position with respect to posting on social networking sites in the context of the professional standards that they already have in place. In the United Kingdom, the Nursing and Midwifery Council has published guidance on how to apply the principles of their code of conduct to the use of such sites. (10) The General Medical Council, the body responsible for the regulation of doctors within the United Kingdom, plans to draft specific guidance on the use of social media, while the professional body for doctors, the British Medical Association, published guidance for doctors and medical students in July 2011. (11) The regulators of pharmacy in the United Kingdom, the General Pharmaceutical Council and Pharmaceutical Society of Northern Ireland (PSNI), have yet to provide any specific guidance on the use of social media, although the issue is raised in the context of professional boundaries and learning from disciplinary cases. Similarly, in the United States, the American Pharmacists Association (APhA) Code of Ethics for Pharmacists and the APhA's Academy of Student Pharmacists/American Association of Colleges of Pharmacy Pledge of Professionalism provide general principles on appropriate pharmacist and pharmacy student behavior, but do not specifically apply them to the digital realm. …