What You Need to Know About the Infamous #MedBikini Study
Let’s investigate what went wrong and where we can improve and move forward.
Recently there was an explosion of outrage within the Twitter medical community regarding a controversial study that has led some physicians to reassess the concept of professionalism within medicine.
The study, “Prevalence of unprofessional social media content among young vascular surgeons,” was led by researchers at Boston University School of Medicine and was published this year. The purpose of the study was to evaluate the extent of “unprofessional” social media content on vascular surgery trainee’s public accounts.
One of the ways “unprofessionalism” was characterized was if trainees posted public images of themselves on social media in “provocative” poses while wearing bikinis. In response to this particular description of unprofessionalism, many physicians on Twitter responded by posting pictures of themselves in bikinis using the viral hashtag #MedBikini.
However, before jumping into how Twitter reacted, it is critical to first have an understanding of the study itself in order to evaluate the breadth of the issue at hand.
Through an analysis of the ‘#MedBikini study,’ I will examine deeper structural problems that are embedded in the study, specifically around 1) defining medical professionalism, 2) the use of scientific methods to perpetuate oppression, and 3) the ethical treatment of junior medical professionals.
Breaking Down the #MedBikini Study
This study, unfortunately, is rich with examples of what to never do as a researcher. In 2020 this study should humble researchers and physicians who may roll their eyes at the thought of continuous ethics training.
I’m going to break down what I perceived to be the top three problems in this study that the scientific community can actually learn from and immediately begin to address.
Problem #1: What Exactly is Medical Professionalism?
It is deeply ironic that somehow an entire research study about unprofessionalism failed to ever clearly define or conceptualize what it means to be either “professional” or “unprofessional” in medicine.
Due to the concept of unprofessionalism never being formally defined, it was blindly operationalized (measured) in two ways. Any questionable social media content was categorized as either “clearly unprofessional” or “potentially unprofessional.”
Clearly unprofessional content included:
- Images of being visibly intoxicated
- The use of uncensored profanity
- Offensive comments about patients or coworkers
- Health Insurance Portability and Accountability Act (HIPAA) violations
Potentially unprofessional content included:
- Images of the trainee holding alcohol
- Images of the trainee wearing “inappropriate attire” (e.g. “provocative” imagery in bikinis/swimwear, underwear, or Halloween costumes)
- The use of uncensored profanity
- Saying “controversial” political, religious, or social comments (e.g. stances on abortion or gun control)
These mishmashed and highly subjective examples of “unprofessional” behavior continue to avoid the obvious and critical question — what does it really mean to be “professional” in medicine?
Based on the author’s hodgepodge list of “unprofessional” behavior, it appears that a “professional” physician is someone who publicly appears as a perfectly clean-cut one-dimensional character. By these standards, “professional” physicians can express themselves in their off-time, as long as these public expressions prescribe to a deeply conservative 1950s white Anglo-Saxon Protestant (WASP) interpretation of good etiquette and decorum.
It is possible that perhaps the authors never defined “professionalism” in their study because this description would have been transparently centered around white, Western, elitist, heterocentric, neoliberal, and patriarchal norms. A study definitively claiming that hospital employers have the right to police and control employee public expression 24/7 using white patriarchal standards would have likely made the mostly white male audience of vascular surgeons feel uncomfortable.
By not defining their terms, these researchers made more than just a methodological faux pas. By not defining what it means to be “professional,” these researchers were allowed free reign to perpetuate oppressive norms within medicine without making other white male physicians feel uncomfortable with the status quo that continues to unfairly benefit them.
Radically redefining (or better yet abolishing) the concept of medical professionalism using an anti-oppressive lens will require everyone, especially white male physicians, to be uncomfortable. There is no way around it.
Clearly it is not just these particularly controversial vascular surgeons who have systematically gotten away with an unclear definition of medical professionalism. In 2020 the medical community as a whole is long overdue for a serious reimagination of what exactly qualifies as “professional.”
Problem #2: Using ‘Scientific’ Methods to Uphold Oppressive Norms that Have Always Existed in Medicine
The first author of the paper, Dr. Scott Hardouin, and the researcher in charge of correspondence for the article, Dr. Alik Farber, are both white male vascular surgery physicians. In their study, all three of the researchers who determined whether or not the social media content was “unprofessional” were men.
A group of men making morally charged authoritative judgments about who is or is not “professional” should have raised immediate red flags regarding bias and discrimination, but instead, it systematically was approved.
Despite these now obvious issues, this study was approved by the institutional review board (IRB) at Boston University School of Medicine. Not only were these results published in a reputable peer-reviewed scientific journal, the Journal for Vascular Surgery, but this study was also presented at a national conference for the Society for Clinical Vascular Surgery.
The fact that this article survived the scrutiny of an IRB process, a journal peer-review process, and judgment from colleagues at a national conference is a sign of immense systematic failure within vascular surgery as well as the medical research field as a whole.
Some may point out that the data were publicly available, which likely would have resulted in less oversight by the IRB. For this reason, it’s important to remind ourselves of what exactly researchers do, and what we as a scientific community are ethically responsible for throughout the research process.
Researchers breathe life into a neutral observation, like a photo of a physician wearing a bikini on vacation. We transform this otherwise neutral observation into results with meaning.
Whether or not the data were public or private is ultimately irrelevant. It’s the ethical role of researchers, as a scientific community, to expand knowledge while best mitigating any potential harm towards human subjects as well as the greater society.
For these reasons, we cannot merely aim our collective, and possibly naive, disbelief at Dr. Hardouin and his research team. Instead, it’s imperative for physicians and researchers to realize our own roles within these systems, and that these researchers’ actions do not exist within a vacuum.
This study exemplifies how through a façade of ‘science,’ researchers and physicians can plainly uphold and perpetuate oppressive systems and norms that have always existed throughout medicine.
Before we take out our Twitter pitchforks against individual people on the internet, we must come to terms that as researchers and physicians we exist within a well-meaning system with a deeply flawed foundation. It should be no surprise that surgery remains to be a white male-dominated field and that vascular surgery is no exception to this general norm in medicine.
If outraged physicians on Twitter genuinely care about even attempting to create meaningful change within their respective fields, then it will take more than a news cycle to begin addressing the multifaceted ways that professionalism acts as a form of oppression.
Instead of allowing the Twitter outrage to evaporate into passing hashtags and selfies, we need to harness these brief moments of clarity into actualized change for the better.
Problem #3: The Reinforcement of Inappropriate Workplace Boundaries and Unethical Treatment of Trainees
According to the published study, researchers created dummy social media accounts in order to scrape data from trainees’ public profiles. Informed consent for this study was waived by the IRB, which meant that the researchers could collect data from public profiles without the informed consent of the study participants (i.e. the trainees).
The authors justified their research methodology by discussing how junior medical professionals will likely face a similar screening process for unprofessional and unethical behavior while on the job market. Ironically, nowhere within the study did the authors question their own ethical and professional role as senior physicians using data to morally police junior trainee behavior outside of work.
The authors of this study could have evaluated trainee happiness or quality of life, but instead, they chose to cherry-pick online images of young professionals and pathologize normal behavior as “unprofessional.” The only real purpose for senior medical professionals to pathologize and subsequently police trainee behavior outside of work is to establish even more power and control over trainees in their everyday life.
The framing of this study reflects a deeply toxic norm in medicine — that everything you do can be ‘professionally’ criticized and controlled if there are no boundaries between work and other aspects of your life.
It is unethical, hypocritical, and frankly unhealthy, that all public images and messages outside of work are open to such extreme micro-criticisms and highly subjective moral judgment by senior staff members who may very well be doing the same behavior in private.
If medicine is going to seriously grapple with the antiquated concept of professionalism, then the establishment of healthy workplace boundaries and ethical treatment of trainees needs to be evaluated as well.
Moving Forward with #MedBikini
The outrage on Twitter ultimately caused the paper to be retracted and the Journal of Vascular Surgery to make an apology. However, an apology and a paper retraction is the bare minimum that the medical community as a whole can do in response to these deeper issues.
One frustrating aspect of the #MedBikini Twitter trend was that overall physicians did not appear to respond with much deep self-reflection around their own role in this oppressive system, or aim their constructive energy towards the clear structural issues that plagued this study. Physicians on Twitter instead immediately pivoted towards using literal images of women’s bodies as a knee-jerk wholesale solution to structural oppression within medicine.
The problem of medical professionalism is far too complex to be merely met with a rather simplistic solution of posting photos of women’s bodies in bikinis. Simplistic solutions may work well for viral hashtags on Twitter, but they do not suffice for real structural change.
Physicians, particularly those on Twitter, are now left with an option — either let this issue die along with the hashtag or commit to seeing a meaningful change in your own practice or department.