Taskforce Report

Professionalism and the Internet in Psychiatry:

What to Teach and How to Teach It
Sandra M. DeJong, M.D., Sheldon Benjamin, M.D., Joan Meyer Anzia, M.D.
Nadyah John, M.D., Robert J. Boland, M.D., James Lomax, M.D.
Anthony Leon Rostain, M.D., M.A.
T
he digital revolution has had a profound impact on
medicine and patient care. Patients have a growing ex-
pectation that they can nd medical information on the web
and discuss it with their physician by e-mail (1). Physicians,
including psychiatrists, are increasingly using blogs and
Twitter to promote their practices (2, 3). The internet itself
is used as a vehicle for therapeutic modalities, even psycho-
therapy (4). Social networking among patients, physicians,
and other friends are blurring boundaries as never before
(5, 6).
The potential clinical, legal, ethical, and professionalism
issues in using the internet and digital media in psychiatry
have been outlined elsewhere, including explicit recom-
mendations for resident education in this area (7). This ar-
ticle focuses on howto teach residents about appropriate use
of the internet.
The evidence of unprofessional online behavior among
physicians and the complexity of the potential issues raised
with internet use in psychiatry suggest that psychiatric resi-
dents, educators, and administrators need explicit teaching
about potential clinical, ethical, and legal pitfalls of internet
use. In 2010, the President of the American Association of
Directors of Psychiatric Residency Training (AADPRT) es-
tablished a Taskforce on Professionalism and the Internet,
charged with reviewing the literature and creating a curric-
ulum to teach psychiatric trainees about online profession-
alism. Participants in a Taskforce-run workshop on this
subject were asked for examples from their own experience
of online professionalism concerns (8), and an outpouring
of vignettes ensued. The Taskforce undertook tocreate a cur-
riculum based on vignettes designed to promote similar
discussion. The principles elicited in these vignettes might
be seen as extensions of well-established principles of pro-
fessionalism (9, 10). Trainees accustomed to continual use
of interactive technologies, however, may overlook bound-
ary and other professionalism issues if they are not made
explicit in training. The curriculum strives to address prin-
ciples, rather than specic technologies, since the latter are
expected to continue to evolve rapidly.
The vignettes in this curriculum (available online at
aadprt.org (11)) are designed for either group discussion
or individual study; they are accompanied by relevant refer-
ences and a teachers guide. The vignettes are organized
around nine issues that may be relevant to various teaching
venues: liability, condentiality, and privacy; psychotherapy
and boundaries; safety issues; mandated reporting; libel;
conicts of interest; academic honesty; netiquette; and
professionalism remediation. We discuss the rst eight of
these topics, using vignettes from the curriculum for illus-
tration. Where vignettes are based on actual cases, all iden-
tifying details are disguised.
Liability
Internet technology has the potential to improve patient
care, but poses new challenges in medical liability. E-mail,
in particular, is increasingly common between patients and
physicians, sometimes improved by protected portals and
encryption systems that safeguard condentiality (1, 12,
13). Residents require training about clinical challenges
posed by online technology. For example, e-mail is limited
by the loss of nonverbal cues, and meanings may be mis-
construed. Communication and diagnostic errors may be
made, emergency situations missed, and physicians may
head down a slippery slope of e-mail exchanges without
Received May 7, 2011; revised September 11, October 22, 2011; accepted
October 27, 2011. From the Dept. of Psychiatry, Cambridge Health Alli-
ance, Harvard Medical School, Cambridge MA; University of Massachu-
setts Medical School; Northwestern Univ. Feinberg School of Medicine;
Brody School of Medicine, East Carolina University; Dept. of Psychiatry
and Human Behavior, Brown University, Providence, RI; Dept. of Psychi-
atry, Baylor College of Medicine, Houston, TX; Dept. of Psychiatry, Univ.
of Pennsylvania, Philadelphia, PA. Correspondence: Dr. Sandra DeJong,
Cambridge Health Alliance; SDeJong@challiance.org
Copyright 2012 Academic Psychiatry
356 http://ap.psychiatryonline.org Academic Psychiatry, 36:5, September-October 2012
setting appropriate limits about when the patient needs to be
seen (11) (Vignette #12). A key issue is response time:
Given 24/7 e-mail access, are physicians responsible for
rapidly responding to e-mails (14)? Consider this clinical
vignette:
A psychiatrist returns from a long weekend away and checks his
e-mail to nd an urgent message from a patient reporting that her
depression is signicantly worse and she is feeling actively suicidal.
The psychiatrist is very upset because he had carefully signed out his
beeper to a colleague and left a message on his ofce voicemail saying
he would be away, and patients in an urgent situation should contact
the covering psychiatrist. The psychiatrist had communicated by
e-mail with the patient on a number of different occasions, but had
always told the patient that e-mail was not the best way to reach himin
urgent situations. The psychiatrist is even more upset when he learns
that the patient did, indeed, make a suicide attempt and has been
hospitalized (11). (Vignette #11)
Such vignettes can be used to teach the importance of
having patients sign a consent form for e-mail commu-
nication that establishes turnaround time for messages,
restriction on non-urgent use, appropriate message head-
ers, privacy and condentiality issues, and permissible
content.
Also, residents need to learn about institutional and legal
standards as they develop, and the fact that electronic
communication is subject to discovery. Once psychiatrists
have established a doctorpatient relationship by providing
online advice to a consenting patient, liability issues may
arisepsychiatrists may be liable if e-mails are not saved
into the record or if response time is not adequate (14).
E-mail is just the beginning: psychiatrists are com-
municating by text and tweet, and new technologies for
interfacing with patients are undoubtedly on the way.
Technology should be used in a boundaried, conden-
tial fashion, with the patients written consent, to support,
rather than to establish or maintain, the doctorpatient
relationship.
Condentiality and Privacy
Violation of patient privacy and condentiality through
social-networking sites such as Facebook and Twitter is
a signicant problem in healthcare settings (7). Numerous
media reports have documented hospital and clinic staff
members posting photographs and identiable information
about patients; in some of these situations, staff are termi-
nated as a consequence (15, 16).
Many hospitals have developed, or are in process of de-
veloping, policies for the use of social-networking sites in
the workplace (17). Medical students, residents, staff, and
attending physicians must be educated about the appropriate
use of such sites. In doing so, medical educators need to
acknowledge that younger physicians use technology as an
integral part of their personal life, as recognized by the
American Medical Association (AMA) in its policy on
Professionalism in the Use of Social Media (18).
Given long work-hours, clinical inexperience, and,
sometimes, lack of personal support, residents may be quick
to express online their thoughts and feelings about work
stresses. They must be trained to be mindful that any di-
vulged information that could lead to the identication of a
patient would be a violation of the Health Insurance Porta-
bility and Accountability Act (HIPAA) (19). Consider the
following example:
Dr. A, a psychiatry resident leaving his on-call shift in the emer-
gency roomat a local hospital, decides to send his friends a Facebook
update. Just nished with a lousy, 24-year-old jerk, Dr. Awrites. A
soldier complaining of pain = addict. Dr. B, who is an emergency
medicine resident in the same local hospital, and Dr. As Facebook
friend, sees the status update on his smart phone just before going in to
see a 24-year-old male patient with a military history who is com-
plaining of pain (11). (Vignette #31)
In a teaching session, residents can note the obvious
HIPAA violation, but also consider the professionalism
breech, and how such a breech may have a negative impact
on the whole profession (20, 21). Residents must learn to
manage their feelings about patients in more appropriate
settings, such as supervision and their own individual
psychotherapy.
The AMA suggests separating professional online in-
formation frompersonal online content (18). Privacy settings
can help to safeguard personal and sensitive information
from the general viewing public. Residents should be
guided to helpful resources like ZDNETs The Denitive
Facebook Lockdown Guide (22) about howto apply good
privacy settings. Also, residents should learn to regu-
larly check search engines like Google, Yahoo, and Bing
to be aware of their web-face and take appropriate
action when necessary to wash it (7, 23). However, as
the AMA policy warns, residents must be careful about
a false sense of security, as privacy settings are not
absolute and that once on the Internet, content is likely
there permanently.
Psychotherapy and Boundaries
Given the rapidity, breadth, intimacy, and potential per-
manence of internet communication, psychotherapy learn-
ers need help in navigating this major shift from traditional
Academic Psychiatry, 36:5, September-October 2012 http://ap.psychiatryonline.org 357
DEJONG ET AL.
communication styles (7, 24). The psychotherapy principles
of neutrality, anonymity, and abstinence may be compro-
mised when a patient accesses trainees postings, which
may date from before their professional education. Unfor-
tunately, such postings may include information that com-
promises professional identity and undermines the patients
comfort in candidly communicating sensitive material,
which is so fundamental to successful psychotherapy (7).
Residents need to anticipate being confronted by patients
regarding online content about their psychiatrist. Dealing
with inaccuracies or indiscretions without adding unhelpful
amounts of self-disclosure (in the service of neutrality and
anonymity) is a difcult clinical problem. Some important
potential situations to consider in a teaching session include:
the impact of a patients discovering the psychiatrists sexual
orientation online; how a psychiatrist with unconscious un-
met emotional needs can lose sight of appropriate boundaries
by engaging in intimate e-mail exchanges with patients; how
a particularly troubled patient can assume a false identity
online to friend and ultimately stalk the psychiatrist. Vi-
gnettes on such topics can be used to stage role-plays (with
residents playing the therapist and patient) that promote open-
ended discussion about confronting and managing these
kinds of clinical dilemmas.
The use of e-mail communication with patients is ex-
tremely complex (25) and requires special attention in
teaching residents. E-mail communication with patients has
been used successfully, including as a way to test the safety
of the treatment relationship (26). But the clinical, ethical,
and liability concerns described above must be considered.
In child and adolescent psychotherapy practice, e-mail and
other technological communication may add a new di-
mension to issues around separation and individuation, or
appropriate parentchild boundaries. For many patients,
written policies or principles regarding electronic commu-
nication will need to be revisited in times of crisis.
Safety Issues and Mandated Reporting
Requirements
When patients or their potential victims appear to be in
danger, we are required to report these unsafe situations to
appropriate authorities. Until recently, such investigations
were based on patient-observation, reporting, and clinical
assessment, as well as direct contact with collateral in-
formants. The availability of personal information online has
opened up entirely new sources of information about patient
behavior to clinicians. Increasingly, psychiatrists are carrying
out information-searches about patients (so-called patient-
targeted googling) (27). Few articles have been published
regarding the extent, circumstances, and reasons used by
clinicians to justify online patient searches (7). The APA
Ethics Committee (2009) offered the following guidelines
(27):
Googling a patient is not necessarily unethical. However, it should be
done only in the interests of promoting the patients care and well-
being and never to satisfy the curiosity or other needs of the psychi-
atrist. Also important to consider is how such information will
inuence treatment and how the clinician will ultimately use this
information.
A pragmatic framework offered by Clinton et al. (28)
suggests that clinicians consider six questions before
searching online for patient information:
1. Why do I want to conduct this search?
2. Would my search advance or compromise the treatment?
3. Should I obtain informed consent fromthe patient prior to
searching?
4. Should I share the results of the search with the patient?
5. Should I document the ndings of the search in the med-
ical record?
6. How do I monitor my motivations and the ongoing risk
benet prole of searching?
The authors provide case-vignettes that can be easily
adapted for teaching purposes. One of them is particularly
compelling because it raises safety and mandatory-reporting
issues. The gist of the case follows:
A 16-year-old girl is seen by a resident in the Psychiatric Emergency
Department for very troubling behaviors (missing school, staying out
past curfew, receiving failing grades), which started after she entered
into a relationship with a 35-year-old man. During the interview, the
resident learns that the patients boyfriend has been taking pro-
vocative pictures of her and posting themon his website. The patients
mother is unaware of the photographs. The resident decides to search
for these pictures online (28).
A useful teaching approach is to hold a debate on the
residents decision, with one side coming up with reasons
justifying the online search and the other advancing argu-
ments against this decision. Here, the thought process, not
a single right answer, is the key.
Potential Libel
Defamation is the communication of false information,
stated as fact, which brings harm to the individual about
whom the information is communicated. Written defama-
tory content, including online content, constitutes libel (29).
Thus, patient-generated material on social-networking sites,
blogs, or physician-rating websites (30) may be considered
358 http://ap.psychiatryonline.org Academic Psychiatry, 36:5, September-October 2012
PROFESSIONALISM AND THE INTERNET
libelous if it is both untrue and harmful to the physician.
Residents need to be aware of web-based content about
them (31); however, residents also need to learn how to
approach the discovery of negative content. Consider the
following example:
An early-career psychiatrist discovers that, on an online physician
rating site, someone has submitted a negative review of the psychi-
atrist, [alleging that] the psychiatrist occasionally violated my civil
rights. The psychiatrist is concerned about the potential impact to his
reputation as he begins practice if this review is available on the
website. . .The psychiatrist considers whether to submit positive
reviews under various pseudonyms, pretending that they are written
by real patients, to create a more favorable impression of the psy-
chiatrist on the website (11). (Vignette #15)
In this case, the single report is unlikely to harmthe young
psychiatrist, and posting pseudonymous reviews will not
improve the psychiatrists ethical position. Rather than
acting out his feelings, the psychiatrist may benet from a
supervisory consultation. Unfortunately, some disgrun-
tled individuals can post false and harmful content online;
residents need to recognize such defamation, and seek
legal counsel and/or the services of a reputation defender
company.
Potential Conicts of Interest
Because psychiatrists often hold various roles at once,
including those of educators, patient advocates, scholars,
researchers, and consultants to industry, they need to be
aware of potential conicts of interest. Roberts and Hoop
(32) dene conict of interest in medicine as a situation in
which a physician has competing roles, relationships, or
interests that could potentially interfere with the ability to
care for patients. In learning about conict of interest in
medicine, psychiatric residents nowmust learn about howit
can apply to online behavior.
A physician may take an online role or express opin-
ions that are not aligned with his or her professional re-
sponsibilities to patients or colleagues. Here are some
examples:

Responding to an online survey or social-networking

site, a physician endorses a particular pharmaceutical com-
pany for which she serves as a speaker.

A resident makes derogatory comments about his cur-

rent hospital service in an online blog.

Amedical student posts his political opinions regarding

an advocacy organization on his Facebook page.
The possibility of online anonymity presents other temp-
tations, as described in the following vignette:
Ajunior faculty member has co-written her rst chapter in a text about
psychotherapy that is edited by a well-known psychiatrist. . .Some
months after publication, the junior faculty member is asked to re-
spond anonymously to a national online survey of faculty members
about recommended textbooks for teaching psychotherapy to resi-
dents. . .The faculty member. . .write[s] a positive review and re-
sounding endorsement of the textbook to which she had contributed. . .
(11) (Vignette #24).
Psychiatric educators can use this vignette to help resi-
dents delineate the clear conict of interest between the
faculty members role as a chapter author and her role in
providing an anonymous online endorsement of the book to
her professional colleagues. Ethics guidelines by pro-
fessional organizations can be referenced (33, 34).
The availability of numerous professional e-mail lists,
websites, and anonymous surveys presents new oppor-
tunities for missteps and poor judgment with regard to
conicts of interest. Recognizing and disclosing poten-
tial conicts so that others are aware of possible bias is the
take-home point.
Academic Issues
Like the clinical setting, the academic setting is both
enhanced and challenged by the digital age. Accessibility
makes the comprehensive research of a subject more ef-
cient than the print medium. Unfortunately, plagiarism is
more efcient as well. Paraphrase plagiarism, in which
a writer copies and then changes a few words from another
authors work and presents it as original, is a common
hazard. One survey of undergraduate students found that
19% occasionally and 10% frequently copied text with-
out attribution (35); another survey of students at 23 different
colleges found that 38% admitted to at least one instance of
paraphrase plagiarism in the past year (36). These decade-old
surveys likely underestimate the problem. Online services
such as The Doctor Job (37) can help residency appli-
cants. Some program directors have resorted to plagiarism-
checkers, such as Turnitin (38).
The internet did not create plagiarism, nor has it neces-
sarily increased the rates (39). One might then assume that
the current policies on academic honesty at academic
institutions are sufcient. However, trainees who have
grown up in an age of le-sharing, web linking, wikis, and
music sampling may nd concepts of ownership, original-
ity, and copyright more difcult to grasp. Consider the
following example:
On reading a students paper, a professor notes a strong resemblance
to a Wikipedia article on the subject, including verbatim quotes used
without attribution. When confronted, the student is perplexed and
Academic Psychiatry, 36:5, September-October 2012 http://ap.psychiatryonline.org 359
DEJONG ET AL.
explains that, as the material is public domain and has no specic
author, it is not plagiarism. Furthermore, she argues that, although she
cut and pasted text from the Wiki, the organization and conclusions
were her own, and thus she was not intellectually dishonest (11).
(Vignette #26)
Although older generations will likely interpret this vi-
gnette as clear-cut plagiarism, younger psychiatrists may be
less convinced, and this attitudinal difference may demon-
strate a fundamental cultural change (40). For example,
when the content of a recently published online novel was
found to include unattributed extended passages from blogs
and other online sources, the young authors defense was
that she represents a new generation of artists who freely
mix and match media to create something new (41). The
novel remains a best-seller and was a literary award nalist.
As the anthropologist Susan D. Blum suggests, the concept
of plagiarism is changing because, in higher education, the
meaning of a text, and notions of the self are changing
around it (42). If this is true, then insisting on adherence to
existing rules of academic honesty may not be sufcient.
Educators must reconsider the philosophy behind academic
honesty and nd ways to teach it in a manner that is relevant
to trainees own experience and values.
Netiquette
Although medical students learn how to interact pro-
fessionally with patients and staff, such lessons on in-
terpersonal and professional etiquette may not cover the
potential pitfalls of electronic communication. Most elec-
tronic communication relies on the written word and visual
image, and does not provide nonverbal cues about the
sender. Thus, details such as the greeting, specic word
choice, and punctuation (including emphasis techniques
such as bold-facing), may have heightened impact and de-
termine how the message is heard, (which may be different
fromthe senders intent). The rapidity of electronic exchange
invites rapid-re responsespausing before responding to
an e-mail or a text can be an important lesson to learn. Fi-
nally, technology provides ways for messages to be quickly
disseminated beyond the initial intended recipient, not al-
ways with that persons knowledge. Learning when to set
a limit on forwarding texts, e-mails, and other online in-
formation is an important skill (43, 44). Here is an example:
A program director (PD) receives an e-mail from a supervisor de-
lineating concerns about a residents performance. The supervisor
makes reference to the residents arrogant manner and narcissistic
need to dominate conversations.. . . The PD. . . forwards the super-
visors e-mail to all seminar leaders and rotation supervisors and asks
for their response (11). (Vignette #19)
This vignette can be used to discuss the inappropriate use
of e-mail that includes condential material, emotionally-
charged language, and personal attack. The PDs decision
to forward the initial e-mail only magnies the problem. In
a teaching session, residents can brainstormas to howthe PD
might have better managed this situation. A key teaching-
point: Technology should never serve to discharge feelings
that are better worked through in supervision or therapy.
Conclusion
The current generation of learners relates to the internet
more as an extension of themselves than as an external re-
source. Interactive technologies have fostered new attitudes
toward privacy and boundaries that must be explicitly
addressed in the process of becoming a physician, particu-
larly in psychiatry. Physicians must carefully construct their
online personae in a manner consistent with long-standing
principles of professionalism. Just as discussions on in-
teraction with industry have helped prepare trainees for
practice realities, thoughtful discussion of online pro-
fessionalism and boundary issues during training will lead
to better decisions by graduates as they establish their
practices. (See Table 1.)
The curriculum suggested in this article represents an
easy-to-implement educational intervention to foster these
discussions. Public perceptions of psychiatry and the eld of
medicine risk being discolored by the online behavior of
members of our profession. It is up to psychiatric educators
to train a newgeneration of psychiatrists to think through the
professionalism issues raised by online technology, in-
cluding technologies not yet invented.
TABLE 1. Recommendations for Teaching About
Professionalism and the Internet
1. Acknowledge and respect different attitudes toward digital
media across generations.
2. Dont assume trainees recognize professionalism issues; make
them explicit.
3. Teach interactively using vignettes familiar to the residents
own experience.
4. Include vignettes that cover the eight topics outlined above:
Liability, Condentiality and Privacy, Psychotherapy and
Boundaries, Safety Issues, Libel, Conicts of Interest,
Academic Issues, and Netiquette.
5. Provide references, including institutional guidelines and
policies, professional codes of ethics, and recommendations
for maintaining a professional online identity.
6. Emphasize overarching principles and concepts, rather than
technological details that are likely to change over time.
360 http://ap.psychiatryonline.org Academic Psychiatry, 36:5, September-October 2012
PROFESSIONALISM AND THE INTERNET
Members of the AADPRT Task Force on Professionalism and
the Internet are Sandra M. DeJong, M.D. (chair), Joan Anzia,
M.D., Sheldon Benjamin, M.D., Robert Boland, M.D., Nadyah
John, M.D., James Lomax, M.D., and Anthony Rostain, M.D.
At the time of submission, the authors reported no competing
interests.
References
1. Baker L, Wagner TH, Singer S, et al: Use of the Internet and
e-mail for healthcare information: results from a national
survey. JAMA 2003; 289:24002406
2. Speller J, Korkosz T: Dr. Jeffs and Dr. Tanyas blog, 2010;
available at http://drjeffanddrtanya.typepad.com; accessed 05/
07/2011
3. Handelman K: ADD-ADHD Blog: The internet blog of Dr.
Kenny Handelman, 2011; available at http://www.addadhd-
blog.com; accessed 05/07/2011
4. Yager J: E-mail as a therapeutic adjunct in the outpatient
treatment of anorexia nervosa: illustrative case material and
discussion of the issues. Int J Eat Disord 2001; 29:125138
5. Yellowlees P, Naz N: The psychiatristpatient relationship
of the future: anytime, anywhere? Harv Rev Psychiatry 2010;
18:96102
6. Fletcher D: Facebook and how its redening privacy. Time
Magazine 2010; 175:3238
7. Gabbard GO, Kassaw KA, Perez-Garcia G: Professional
boundaries in the era of the Internet. Acad Psychiatry 2011; 35:
168174
8. Benjamin S, Anzia J, Boland R, et al: Workshop 2.09Web 2.0
and Psychiatry: Professional and Ethical Issues for Trainees.
American Association of Directors of Psychiatry Residency
Training (AADPRT) Annual Meeting, Orlando FL, March
2010
9. Gabbard GO, Nadelson C: Professional boundaries in the
physicianpatient relationship. JAMA 1995; 273:14451449
10. ABIM Foundation: ACP-ASIM Foundation, European Foun-
dation of Internal Medicine: Medical professionalism in the
new millennium: a physicians charter. Ann Intern Med 2002;
136:243246
11. DeJong S, Benjamin S, Anzia J et al: Curriculum on
Professionalism and the Internet in Psychiatry, 2011; available
at http://www.aadprt.org/vtodocs/professionalism_and_
the_internet/AADPRT_Professionalism_and_the_Internet_
Curriculum.pdf; accessed 05/07/2011
12. Car J, Sheikh A: E-mail consultations in health care, 1: scope
and effectiveness. BMJ 2004; 329:435438
13. Stone J: Communication between physicians and patients in
the era of e-medicine (Perspective column). N Engl J Med
2007; 355:24512454
14. Recupero PR: E-mail and the psychiatristpatient relationship.
J Am Acad Psychiatry Law 2005; 33:465475
15. Hennessy-Fiske M: When Facebook goes to the hospital, pa-
tients may suffer. Los Angeles Times, August 8, 2010; latimes.
com/news/local/la-me-facebook-20100809,0,7484743.story
16. Conaboy C: For doctors, social media a tricky case. The
Boston Globe, April 20, 2011; 279: A1, A14
17. University of Toronto: Guidelines for Appropriate Use of the
Internet, Electronic Networking, and Other Media, 2010;
available at http://www.pgme.utoronto.ca/Assets/PGME
+Digital+Assets/policies/Guidelines+Internet.pdf, accessed
05/07/2011
18. American Medical Association: Professionalism in the use of
social media, AMA.org, 2010; available at http://www.ama-
assn.org/ama/pub/meeting/professionalism-social-media_print.
html; accessed 05/07/2011
19. U.S. Department of Health and Human Services: Health In-
surance Portability and Accountability Act, 1996; available at
http://www.hhs.gov/ocr/privacy; accessed 05/07/2011
20. Chin J: Editorial: Medical professionalism in the internet age.
Ann Acad Med 2010; 38:5
21. Farnan JM, Paro JAM, Higa JT, et al: Commentary: The re-
lationship status of digital media and professionalism: its
complicated. Acad Med 2008; 4:11
22. ZDNET: The Denitive Facebook Lockdown Guide; avail-
able at http://www.zdnet.com/photos/the-denitive-facebook-
lockdown-guide-securing-your-prole-page; accessed 05/07/
2011
23. Banjo S: Washing your web face. Wall Street Journal, Feb
17, 2008; available at http:onlinewsj.com/public/article/
SB120320660446474003.html
24. DeJong S, Anzia J, Benjamin S et al: Blogs, Tweets, E-mails,
and Friending: Teaching About Professionalism and the In-
ternet. Workshop: American Association of Directors of
Psychiatry Residency Training, Austin TX, March 2011
25. Seeman MV, Seeman BS: E-psychiatry: the patientpsychia-
trist relationship in the electronic age. CMAJ 1999; 161:1147
1149
26. Lomax JW, Pargament KI: Seeking Sacred Moments in
Psychotherapy and in Life. Psyche &Geloof [Spirit] 2011; 22:
7990
27. American Psychiatric Association Ethics Committee: Is it
ethical to Google patients? Psychiatr News 2009; 44:11
28. Clinton BK, Silverman BC, Brendel DH: Patient-targeted
googling: the ethics of searching online for patient in-
formation. Harv Rev Psychiatry 2010; 18:103112
29. Van VechtenVeeder: The History and Theory of the Law
of Defamation, Columbia Law Review 1903; 3: 546-573;
available at http://www.jstor.org/stable/1109121; accessed
05/07/2011
30. Rate MDs.com: Find and rate doctors and dentists; available
at http://www.ratemds.com, accessed 05/07/2011
31. Mostaghimi A, Crotty BH, Landon BE: The availability and
nature of physician information on the internet. J Gen Intern
Med 2010; 25:11521156
32. Roberts LW, Hoop JG: Professionalismand Ethics for Mental
Health Professionals: A Q&A Self-Study Guide for Mental
Health Professionals. Arlington, VA, American Psychiatric
Publishing, Inc., 2008
33. American Academy of Child and Adolescent Psychiatry Code
of Ethics: 2009; available at http://www.aacap.org/galleries/
AboutUs/AACAP_Code_of_Ethics.pdf; accessed 05/07/2011
Academic Psychiatry, 36:5, September-October 2012 http://ap.psychiatryonline.org 361
DEJONG ET AL.
34. American Psychiatric Association: The Principles of Medical
Ethics, With Annotations Especially Applicable to Psychiatry,
2010; available at http://www.psych.org/MainMenu/
PsychiatricPractice/Ethics/ResourcesStandards/Principles-
of-Medical-Ethics-2010-Edition.aspx?FT=.pdf; accessed
05/07/2011
35. Scanlon PM, Neumann DR: Internet plagiarism among col-
lege students. J Coll Student Dev 2002; 43:375385
36. McCabe D: Cheating: why students do it and howwe can help
them stop. Am Educ 2001; 25:3843
37. The Doctor Job: 20042010; available at http://www.
thedoctorjob.com; accessed 05/07/2011
38. iParadigms, LLC: Turnitin, 19982011; available at http://
www.turnitin.com; accessed 05/07/2011
39. McCabe DL, Stephens JM: Epidemic as Opportunity: In-
ternet Plagiarism as a Lever for Cultural Change. Teachers
College Record, 2006; ID Number: 12860
40. Gabriel T: Plagiarism Lines Blur for Students in Digital Age.
Wall Street Journal, August 1, 2010; available at http://www.
nytimes.com/2010/08/02/education/02cheat.html?_r=2; accessed
05/07/2011
41. Kulish N: Author, 17, Says Its Mixing, Not Plagiarism.
NewYork Times, February 11, 2010; available at http://www.
nytimes.com/2010/02/12/world/europe/12germany.html, accessed
05/07/2011
42. Rosen C: Its Not Theft, Its Pastiche: College Students Pla-
giarize Routinely, Especially From the Internet. Wall Street
Journal, April 16, 2009; available at http://online.wsj.com/
article/SB123984974506823779.html; accessed 05/07/2011
43. Chan JF: E-mail: A Write It Well Guide: How to Write and
Manage E-Mail in the Workplace. Oakland, CA, Write It Well,
2008
44. Smith LA: Business E-Mail: How to Make it Professional and
Effective. San Anselmo, CA, Writing &Editing at Work, 2002
Call for Papers: Psychiatric Education and Neuroscience
Over the past few decades, psychiatric research has increasingly converged on the importance of neu-
roscience for understanding psychopathology, the mechanisms of current treatments, and avenues for
novel therapeutics. Despite these large scientifc advances, education oI psychiatrists in neuroscience
has lagged signifcantly. This lag may be attributable to numerous Iactors, the result oI which is a psy-
chiatric workforce presently unprepared for understanding these innovations, interfacing with patients
over them, and integrating neuroscientifc advances into their clinical care.
Insights into and attempts to bridge the science-to-training gap, however, have already begun taking
shape. These eIIorts have started on a small scale, but may very importantly inIorm broader eIIorts
by the feld to bring psychiatric practice closer into the Iold oI neuroscience. At the same time, there
are concerns among clinicians that an exclusive focus on neuroscience may diminish the historically
humanistic nature oI psychiatry. To this aim, Academic Psychiatry is creating a special issue of articles
that explore the nature oI the gap, reasons why the training is lagging behind the science, and avenues
Ior bridging this gap in creative ways, while being mindIul to retain the many existing virtues oI clinical
psychiatry.
In keeping with the overall mission of Academic Psychiatry, papers ideally will be evidence- based,
drawing upon data and outcome measures, and/or involving multiple sites. Compre hen sive reviews
and case studies are also welcome. All submissions will be peer reviewed in keeping with the journal`s
policy. Submissions are due by May 1, 2013.
Submissions should be uploaded to ScholarOne Manuscripts (http://mc.manuscriptcentral.com/appi-
ap). Please indicate in the cover letter that the submission is Ior this special issue. For more inIormation,
please visit our Web site at ap.psychiatryonline.org. Please direct questions on the submission process
to Ms. Ann Tennier, Senior Editorial Associate, at 262-346-1461 or acadpsych@gmail.com.
362 http://ap.psychiatryonline.org Academic Psychiatry, 36:5, September-October 2012
PROFESSIONALISM AND THE INTERNET