The survey cited a handful of examples. In one, a student posted identifying patient details on Facebook. Another requested an inappropriate friendship with a patient on the site. Others used profanity, according to the deans.
"The number we found was higher than we expected," said Dr. Katherine Chretien of the Washington, D.C., VA Medical Center, the study's lead author. "And these are the incidents that made it to the attention of the deans. This is the tip of the iceberg."
Yet most deans said their schools didn't yet have policies to help students figure out what's allowed online and what can get them kicked out of medical school.
A quick search of YouTube finds numerous videos posted by medical students, from harmless musical numbers to a prank with what appears to be a dead body. There's no way to tell whether the cadaver prank is real and it wasn't part of the study, but real or staged, it doesn't reflect well on the medical profession, Chretien said.
"I watched it and I definitely cringed," she said. "Disrepect for cadavers is one thing, but filming it and putting it on YouTube is another. It undermines the credibility of our profession."
The study, appearing in Wednesday's Journal of the American Medical Association, found 47 of 78 medical school deans who responded to a survey knew of incidents of online unprofessional conduct. But policies covering the behavior were reported by only 38 percent who answered that question.
The incidents were reported most often by other students or doctors in residency programs, indicating trainees are policing themselves. Most offenders received informal warnings. The deans also reported three dismissals.
Medical students are no different from other young adults, said Anastasia Goodstein, a San Francisco-based marketing expert who tracks youth trends on her Ypulse Web site. The generation that first embraced social networking still considers Facebook merely a way to connect with friends.
"Now they're waking up to the reality of older people and people with authority over them, like deans, seeing their Facebook pages," Goodstein said.
And many young adults don't appreciate that an Internet prank can bounce back years later, said Susan Barnes of the Lab for Social Computing at the Rochester Institute of Technology in Rochester, N.Y.
"Are they going to be able to live it down when they're 50 and a well-known surgeon? Or is it going to come back to haunt them?" Barnes said.
Medical schools should address professionalism online in classes and develop policies for the digital age, Chretien said.
Bawdiness among medical students far precedes the Internet, Chretien acknowledged. The now-defunct Pithotomy Club of Johns Hopkins Medical School, for example, made a tradition of racy skits and songs skewering professors for nearly 100 years.
"In the past, these weren't broadcast on the Internet. Now it's up for public consumption," Chretien said.
The Association of American Medical Colleges helped distribute the survey in the spring. The researchers invited deans of 130 schools to take it, and 78 responded.
More HealthCheck related links: