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To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools.In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies.Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools, the mean full-time equivalent (FTE) support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24 and P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barrier to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84).Wellness programs are widely established at U.S. and Canadian medical schools, and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students' well-being and success.

Criticism, scathing comments, and harassment are becoming more common elements of social media discourse. Recent coordinated public attacks directed at higher education faculty illustrate these troubling trends. In several cases, these attacks have been politically motivated by participants who disagree with a faculty member's statements regarding sensitive subjects. Whereas most high-profile cases have included faculty teaching at the undergraduate level who use social media to promote scholarly discussion, medical school faculty may also be at risk, especially if their scholarly pursuits pertain to politically charged issues (e.g., race and diversity, firearms, vaccinations, the health of transgender populations). In today's digital environment of cellphone recordings, forwarded e-mails, and open-access manuscripts, any faculty member who discusses or engages in scholarship of politically sensitive issues on- or offline may be at risk. In this Invited Commentary, the authors discuss the multifaceted problem of cyberbullying of medical school faculty and provide recommendations to faculty and administrators about how to mitigate and manage these situations.

The social media and medicine landscape is evolving rapidly. Early research, social media policies, and educational efforts focused on risk avoidance, while more current efforts have encouraged reflection and explored opportunities. This trajectory has affirmed physicians' professional commitment to maintaining public trust in the face of new challenges in the digital age. In this Commentary, the authors propose viewing physicians' social media use as a hierarchy of needs, similar to Maslow's psychological theory which posits that more basic levels of needs must be met before higher, aspirational levels can be fully attained. The three levels in the social media in medicine's hierarchy of needs are Security, Reflection, and Discovery. Critical to this model is respecting the essential need for Security in order to move towards Reflection and into Discovery. The social media in medicine hierarchy of needs pyramid rests on a foundation of Public Trust. How physicians as a profession have responded to past--and continue to respond to present and future--social media challenges to professionalism reveals what matters most: maintaining public trust and honoring the physicians' contract with society. A victory for online professionalism would be providing trainees with the tools and guidance needed to ascend to Discovery, while ensuring that their basic social media needs are first met. To do this, physician educators need to continue increasing trainees' awareness through designing relevant curricula, encouraging reflection, and providing positive role modeling and effective mentorship.

To assess faculty perceptions of professional boundaries and trainee-posted content on social networking sites (SNS).In June 2010, the Clerkship Directors in Internal Medicine conducted its annual survey of U.S. and Canadian member institutions. The survey included sections on demographics and social networking. The authors used descriptive statistics and tests of association to analyze the Likert scale responses and qualitatively analyzed the free-text responses.Of 110 institutional members, 82 (75%) responded to the survey. Of the 40 respondents who reported current or past SNS use, 21 (53%) reported receiving a "friend request" from a current student and 25 (63%) from a current resident. Of these, 4 (19%) accepted the student request and 12 (48%) accepted the resident request. Sixty-three of 80 (79%) felt it was inappropriate to send a friend request to a current student, 61 (76%) to accept a current student's request, 42 (53%) to become friends with a current resident, and 61 (81%) to become friends with a current patient. Becoming friends with a former student, former resident, or colleague was perceived as more appropriate. Younger respondents were less likely to deem specific student behaviors inappropriate (odds ratio [OR] 0.18-0.79; adjusted OR 0.12-0.86, controlling for respondents' sex, rank, and SNS use), although none reached statistical significance.Some internal medicine educators are using SNSs and interacting with trainees online. Their perceptions on the appropriateness of social networking behaviors provide some consensus for professional boundaries between faculty and trainees in the digital world.