Medical Education e-Professionalism (MEeP) framework; from conception to development

Figures & data

Table 1. Research philosophy and paradigms

Research questions	Ontology	Epistemology	Axiology
To gather information and data, related to suggested e-professionalism.	Knowledge – existing social phenomena. Idealism was applied	Qualitative literature review – interpretative approach	Value – laden
What is the degree, nature (social or educational) and professional use of SNS?	Knowledge – existing social phenomena. Idealism was applied	Reality – a result of human mind, data from stakeholders’ opinion – Interpretivist approach	Value – laden
What are the desired values and behaviors of digital professionalism that are needed for maintaining digital professional identity?	Knowledge – outside the social phenomena. Realism applied	Experts’ opinions – Pragmatist’s approach	Value – free

Figure 1. A structured algorithm of methodological triangulation of scoping review, SNSME survey and Delphi study

SNSME; Social Networking Sites in Medical EducationPRISMA; Preferred Reporting Items for Systematic Reviews and Meta-analyses

Figure 2. A structured layout of the phased emergence of concepts of e-professionalism and their integration towards the MEeP framework

Figure 3. The expected outcomes from a medical professional in the digital era resulting from the triangulation of data from scoping review, SNSME survey and Delphi study

SNSME, Social Networking Sites for Medical Education

Figure 4. The Medical Education e-professionalism (MEeP) framework

Table

#	Searches	Results
S1	Professionalism	209,963
S2	Professional identity	851,518
S3	Professional behaviours	1,586,079
S4	Professional values	1,902,786
S5	Professional ethics	722,966
S6	SNS	1,820,584
S7	Social networking sites	164,903
S8	Twitter	332,511
S9	Facebook	255,642
S10	Healthcare professionals	2,722,521
S11	professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics)	2,394,519
S12	professionalism AND (professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics))	209,959
S13	(SNS) OR (social networking sites) OR Twitter OR facebook	2,160,035
S14	(SNS) AND ((SNS) OR (social networking sites) OR Twitter OR facebook)	2,160,035
S15	(professionalism AND (professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics))) AND ((SNS) AND ((SNS) OR (social networking sites) OR Twitter OR facebook)) AND (healthcare professionals) -	91,368
S16	(professionalism AND (professionalism OR (professional identity) OR (professional behaviors) OR (professional values) OR (professional ethics))) AND ((SNS) AND ((SNS) OR (social networking sites) OR Twitter OR facebook)) AND (healthcare professionals) -	4448

Table

#	Searches	Results
#1	TOPIC: (professionalism) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	6,813
#2	TOPIC: (professional identity) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	4,092
#3	TOPIC: (professional behaviours) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	20,587
#4	TOPIC: (professional ethics) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	7,191
#5	TOPIC: (professional values) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	20,955
#6	TOPIC: (SNS) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	38,891
#7	TOPIC: (social networking sites) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	6,477
#8	TOPIC: (Twitter) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	12,217
#9	TOPIC: (Facebook) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	9,119
#10	TOPIC: (healthcare professionals) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	102,885
#11	#5 OR #4 OR #3 OR #2 OR #1 Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	53,046
#12	#11 AND #1 Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	6,813
#13	#9 OR #8 OR #7 OR #6 Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	52,490
#14	#13 AND #6 Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	38,891
#15	#14 AND #12 AND #10 Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	66
#16	#14 AND #12 AND #10 Refined by: PUBLICATION YEARS: (2020 OR 2017 OR 2019 OR 2016 OR 2018 OR 2015) Indexes = SCI-EXPANDED, CPCI-S Timespan = All years	50

Table

No.	Question	Never	Once a month	Once a week	Once a day	3–5 times a day
1	How often do you use e-mail for sharing information for educational purpose?
2	How often do you use social networking sites (e.g., Facebook, YouTube, Twitter, LinkedIn, WeChat and Flickr) to keep in touch with peers and tutors?
3	How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) to share education-related information?
4	How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) for sharing research, innovations in medicine, and updates in medical field?
5	How often do you read blogs or Wikis for education related information?
6	How often do you contribute to blogs or Wikis to share information, or for dissemination of knowledge?

Table

No.	Question	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
7	Social networking sites help me in collation of educational materials
8	Social networking sites are helpful in collaborative and peer-to-peer learning
9	Social networking sites are useful in developing reading and writing web skills
10	Social networking sites provide opportunity of virtual meeting with other students and tutors
11	Social networking sites help me to communicate with peers about class projects
12	Social networking sites help me to access educational resources
13	Social networking sites help me to retrieve educational references for research
14	Social networking sites facilitate my professional development of learning skills in technology
15	Social networking sites are useful in communicating with classmates about course-related topics
16	I have found social networking sites useful during the pre-exam period when I get an instant answer/explanation from my peer, instead of going through the books
17	I have found social networking sites useful for sharing notes and lectures
18	I have found social networking sites useful for educational purposes
19	Medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes
20	I believe that social networking sites are inappropriate for sharing classroom materials, information, and discussing healthcare related topics
21	Did you receive formal instruction about the use of SNS in medical school?
22	Are you familiar with the SNS policy at this institution?
23	Have you ever closed a personal SNS account for professional reasons?
24	Do you know the current privacy settings of your personal SNS account?
25	Do you think that anybody can search you on your SNS account regardless of your privacy settings?
26	I can permanently delete the content (images/videos/text) I have posted to my SNS account.
27	I have posted content (images/videos/text) on SNS that could be considered unprofessional.
28	I have posted content (images/videos/text) on SNS that I now regret.

The percentages of observed frequencies of responses to statements about the students’ extent of the usage of social networking sites (N = 381)

Table

	Male (n = 137)					Female (n = 244)
	Never	Once a month	Once a week	Once a day	3–5 times a day	Never	Once a month	Once a week	Once a day	3–5 times a day
How often do you use e-mail for sharing information for educational purpose?	12	32.6	21.7	19.6	14.1	8.9	20.1	30.8	19.5	20.7
How often do you use social networking sites (e.g., Facebook, YouTube, Twitter, LinkedIn, WeChat and Flickr) to keep in touch with peers and tutors?	8.7	7.6	5.4	14.1	64.1	10.06	2.96	9.47	21.89	55.62
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) to share education-related information?	22.8	13	21.7	21.7	20.7	21.3	10.6	21.9	22.5	23.7
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) for sharing research, innovations in medicine, and updates in medical field?	30.4	26.1	21.7	9.8	12	36.1	22.5	23	8.9	9.5
How often do you read blogs or Wikis for education related information?	12	20.7	37	14.1	16.3	14.8	20.1	30.8	20.7	13.6
How often do you contribute to blogs or Wikis to share information, or for dissemination of knowledge?	84.8	7.6	4.3	2.2	1.1	82.20	8.30	4.70	3.00	1.80

Table

	Male (n = 137)					Female (n = 244)
	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Social networking sites help me in collation of educational materials	26.0	45.7	15.2	9.8	3.3	34.3	37.3	17.8	6.5	4.1
Social networking sites are helpful in collaborative and peer-to-peer learning	39.1	37.0	15.2	5.4	3.3	41.4	38.5	13.6	5.3	1.2
Social networking sites are useful in developing reading and writing web skills	25.0	46.7	13.0	12.0	3.3	32.0	39.0	15.4	11.2	2.4
Social networking sites provide opportunity of virtual meeting with other students and tutors	52.2	38.0	7.6		2.2	56.2	35.5	4.7	3.0	0.6
Social networking sites help me to communicate with peers about class projects	53.3	32.6	10.8	2.2	1.1	59.8	28.4	5.9	4.1	1.8
Social networking sites help me to access educational resources	39.1	33.7	15.2	8.7	3.3	56.8	26.0	10.1	5.3	1.8
Social networking sites help me to retrieve educational references for research	28.3	34.8	10.9	17.4	8.6	42.6	21.9	17.2	13.6	4.7
Social networking sites facilitate my professional development of learning skills in technology	28.3	37.0	25.0	6.5	3.2	38.5	33.7	17.8	7.7	2.3
Social networking sites are useful in communicating with classmates about course-related topics	53.3	32.6	8.7	2.2	3.2	53.3	31.4	4.7	7.7	2.9
I have found social networking sites useful during the pre-exam period when I get an instant answer/explanation from my peer, instead of going through the books	52.2	29.3	12.0	2.1	4.4	49.1	30.2	9.5	6.5	4.7
I have found social networking sites useful for sharing notes and lectures	58.7	26.1	8.7	4.3	2.2	58.0	23.1	10.6	4.7	3.6
I have found social networking sites useful for educational purposes	41.3	35.9	15.2	4.3	3.3	43.8	36.6	8.9	6.5	4.2
Medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes	16.3	19.6	23.9	21.7	18.5	21.3	23.1	26.0	16.6	13.0
I believe that social networking sites are inappropriate for sharing classroom materials, information, and discussing healthcare related topics	6.5	3.2	19.6	34.8	35.9	5.9	6.5	22.2	32.0	33.4

Table

	Male (n = 137)					Female (n = 244)
	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Did you receive formal instruction about the use of SNS in medical school?	6.5	31.5	15.2	25.0	21.7	11.2	24.8	17.8	30.8	15.4
Are you familiar with the SNS policy at this institution?	10.8	34.8	17.4	26.1	10.9	16.0	29.0	26.0	21.9	7.1
Have you ever closed a personal SNS account for professional reasons?	3.3	12.0	8.6	30.4	45.7	5.9	10.1	5.9	37.3	40.8
Do you know the current privacy settings of your personal SNS account?	45.7	33.6	7.6	9.8	3.3	46.2	32.0	8.7	9.5	3.6
Do you think that anybody can search you on your SNS account regardless of your privacy settings?	19.6	35.9	16.3	18.4	9.8	27.2	35.6	18.9	13.6	4.7
I can permanently delete the content (images/videos/text) I have posted to my SNS account.	18.5	28.4	18.5	15.2	19.6	16.0	18.9	17.8	27.8	19.5
I have posted content (images/videos/text) on SNS that could be considered unprofessional.	2.2	14.1	12.0	29.3	42.4	4.1	4.1	6.5	23.7	61.5
I have posted content (images/videos/text) on SNS that I now regret.	6.5	10.9	14.1	20.7	47.8	3.0	11.8	5.3	28.4	51.5

Table

	Male	Female
	Mean Rank	Mean Rank	Mann-Whitney U	Sig.
How often do you use e-mail for sharing information for educational purpose?	118.46	137.09	6620.50	0.05
How often do you use social networking sites (e.g., Facebook, YouTube, Twitter, LinkedIn, WeChat and Flickr) to keep in touch with peers and tutors?	136.26	127.35	7198.50	0.30
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) to share education-related information?	126.22	132.85	7334.00	0.49
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) for sharing research, innovations in medicine, and updates in medical field?	135.57	127.72	7261.50	0.40
How often do you read blogs or Wikis for education related information?	130.94	129.48	7595.50	0.88
How often do you contribute to blogs or Wikis to share information, or for dissemination of knowledge?	128.71	131.48	7563.50	0.66
Educational use of SNS
Social networking sites help me in collation of educational materials	136.33	128.10	7284.00	0.37
Social networking sites are helpful in collaborative and peer-to-peer learning	134.76	128.20	7301.50	0.47
Social networking sites are useful in developing reading and writing web skills	135.30	128.66	7378.50	0.47
Social networking sites provide opportunity of virtual meeting with other students and tutors	134.60	129.04	7443.00	0.52
Social networking sites help me to communicate with peers about class projects	136.25	128.14	7291.00	0.35
Social networking sites help me to access educational resources	147.13	121.39	6198.00	0.00
Social networking sites help me to retrieve educational references for research	140.49	124.32	6689.00	0.08
Social networking sites facilitate my professional development of learning skills in technology	138.96	125.15	6829.00	0.14
Social networking sites are useful in communicating with classmates about course-related topics	128.67	130.72	7523.00	0.82
I have found social networking sites useful during the pre-exam period when I get an instant answer/explanation from my peer, instead of going through the books	126.19	132.07	7297.00	0.51
I have found social networking sites useful for sharing notes and lectures	127.77	130.44	7441.00	0.76
I have found social networking sites useful for educational purposes	132.19	128.04	7354.00	0.65
Medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes	140.23	123.65	6622.00	0.08
I believe that social networking sites are inappropriate for sharing classroom materials, information, and discussing healthcare related topics	133.70	127.21	7216.50	0.48
Professional use of SNS
Did you receive formal instruction about the use of SNS in medical school?	134.46	129.12	7456.00	0.57
Are you familiar with the SNS policy at this institution?	136.77	127.86	7243.00	0.35
Have you ever closed a personal SNS account for professional reasons?	134.02	128.61	7369.50	0.55
Do you know the current privacy settings of your personal SNS account?	130.88	131.07	7762.50	0.98
Do you think that anybody can search you on your SNS account regardless of your privacy settings?	141.92	125.06	6769.50	0.07
I can permanently delete the content (images/videos/text) I have posted to my SNS account.	121.78	136.02	6925.50	0.14
I have posted content (images/videos/text) on SNS that could be considered unprofessional.	113.20	140.69	6136.00	0.00
I have posted content (images/videos/text) on SNS that I now regret.	124.46	134.56	7172.50	0.26

Table

	18–20	20–23	Above 23
	Mean Rank	Mean Rank	Mean Rank	Chi-Square	Sig
How often do you use e-mail for sharing information for educational purpose?	117.32	144.04	151.95	10.20	0.01
How often do you use social networking sites (e.g., Facebook, YouTube, Twitter, LinkedIn, WeChat and Flickr) to keep in touch with peers and tutors?	136.09	132.67	93.08	10.58	0.01
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) to share education-related information?	139.20	127.40	92.83	10.13	0.01
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) for sharing research, innovations in medicine, and updates in medical field?	135.39	125.05	117.80	2.05	0.36
How often do you read blogs or Wikis for education related information?	132.98	125.14	124.73	0.76	0.68
How often do you contribute to blogs or Wikis to share information, or for dissemination of knowledge?	128.72	131.22	132.75	0.25	0.88
Education use of SNS
Social networking sites help me in collation of educational materials	126.40	129.13	154.27	3.84	0.15
Social networking sites are helpful in collaborative and peer-to-peer learning	124.01	134.43	146.90	3.14	0.21
Social networking sites are useful in developing reading and writing web skills	127.50	127.15	154.50	3.86	0.15
Social networking sites provide opportunity of virtual meeting with other students and tutors	121.44	141.44	143.95	6.18	0.05
Social networking sites help me to communicate with peers about class projects	121.12	136.89	158.25	8.88	0.01
Social networking sites help me to access educational resources	125.22	132.24	146.82	2.59	0.28
Social networking sites help me to retrieve educational references for research	127.05	128.29	144.68	1.54	0.46
Social networking sites facilitate my professional development of learning skills in technology	124.25	131.78	148.55	3.04	0.22
Social networking sites are useful in communicating with classmates about course-related topics	125.29	126.55	158.00	6.11	0.05
I have found social networking sites useful during the pre-exam period when I get an instant answer/explanation from my peer, instead of going through the books	123.56	130.44	155.60	5.47	0.07
I have found social networking sites useful for sharing notes and lectures	128.57	119.20	157.88	7.66	0.02
I have found social networking sites useful for educational purposes	124.19	128.87	152.45	4.14	0.13
Medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes	128.64	131.14	124.80	0.18	0.92
I believe that social networking sites are inappropriate for sharing classroom materials, information, and discussing healthcare related topics	136.41	122.31	111.97	4.03	0.13
Professional use of SNS
Did you receive formal instruction about the use of SNS in medical school?	120.75	142.11	145.47	5.97	0.05
Are you familiar with the SNS policy at this institution?	125.37	141.55	124.55	2.85	0.24
Have you ever closed a personal SNS account for professional reasons?	129.30	133.64	123.18	0.52	0.77
Do you know the current privacy settings of your personal SNS account?	130.99	136.90	110.20	3.24	0.20
Do you think that anybody can search you on your SNS account regardless of your privacy settings?	133.46	126.00	128.68	0.59	0.75
I can permanently delete the content (images/videos/text) I have posted to my SNS account.	118.72	135.45	174.00	14.60	0.00
I have posted content (images/videos/text) on SNS that could be considered unprofessional.	129.02	129.68	140.00	0.67	0.72
I have posted content (images/videos/text) on SNS that I now regret.	136.94	120.15	128.13	3.15	0.21

Table

		F	1	2	3	4	5
		Mean Rank	Mean Rank	Mean Rank	Mean Rank	Mean Rank	Mean Rank	Chi-Square	Sig
	Extent of usage of SNS
How often do you use e-mail for sharing information for educational purpose?		105.20	116.92	107.11	99.81	128.45	121.92	5.08	0.28
How often do you use social networking sites (e.g., Facebook, YouTube, Twitter, LinkedIn, WeChat and Flickr) to keep in touch with peers and tutors?		104.76	118.89	116.74	114.58	109.80	102.76	2.08	0.72
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) to share education-related information?		102.34	115.36	123.77	116.24	99.50	102.12	4.57	0.33
How often do you use social networking sites (i.e., Facebook, YouTube, Twitter, LinkedIn, and Flickr) for sharing research, innovations in medicine, and updates in medical field?		98.05	110.52	115.80	113.83	114.16	112.54	0.21	1.00
How often do you read blogs or Wikis for education related information?		103.26	99.33	120.10	129.21	109.94	104.36	6.60	0.16
How often do you contribute to blogs or Wikis to share information, or for dissemination of knowledge?		101.36	113.79	114.63	108.38	112.16	117.68	1.05	0.90
	Educational use of SNS
Social networking sites help me in collation of educational materials		97.90	100.52	115.91	125.91	117.34	113.42	4.02	0.40
Social networking sites are helpful in collaborative and peer-to-peer learning		102.78	103.31	114.79	120.16	113.81	117.77	2.09	0.72
Social networking sites are useful in developing reading and writing web skills		95.29	91.17	132.10	119.29	120.13	102.49	14.43	0.01
Social networking sites provide opportunity of virtual meeting with other students and tutors		102.80	102.37	115.67	110.55	118.66	126.42	4.19	0.38
Social networking sites help me to communicate with peers about class projects		97.92	103.49	110.21	117.30	115.22	130.18	5.12	0.28
Social networking sites help me to access educational resources		100.25	98.83	116.17	119.04	117.21	119.70	4.03	0.40
Social networking sites help me to retrieve educational references for research		103.37	99.10	108.40	126.91	124.80	117.92	6.18	0.19
Social networking sites facilitate my professional development of learning skills in technology		98.29	93.91	118.18	127.20	120.25	111.68	7.80	0.10
Social networking sites are useful in communicating with classmates about course-related topics		111.45	114.07	114.95	103.28	111.48	122.71	2.22	0.70
I have found social networking sites useful during the pre-exam period when I get an instant answer/explanation from my peer, instead of going through the books		106.91	106.86	109.02	117.50	111.81	127.28	3.17	0.53
I have found social networking sites useful for sharing notes and lectures		103.76	112.23	116.18	104.34	118.78	115.83	1.49	0.83
I have found social networking sites useful for educational purposes		98.30	107.52	116.63	106.05	120.52	115.22	1.72	0.79
Medical students need supervision and guidance for the appropriate use of social networking sites for educational purposes		105.80	92.05	116.34	132.94	123.50	105.66	11.02	0.03
I believe that social networking sites are inappropriate for sharing classroom materials, information, and discussing healthcare related topics		112.80	117.28	110.62	124.80	107.70	103.30	2.95	0.57
	Professional use of SNS
Did you receive formal instruction about the use of SNS in medical school?		107.89	99.36	105.26	121.16	126.73	130.57	8.24	0.08
Are you familiar with the SNS policy at this institution?		108.03	113.63	104.38	112.54	112.92	133.66	5.16	0.27
Have you ever closed a personal SNS account for professional reasons?		99.49	101.60	107.62	130.16	130.33	107.83	8.19	0.09
Do you know the current privacy settings of your personal SNS account?		97.84	109.93	119.02	93.84	103.66	140.68	13.09	0.01
Do you think that anybody can search you on your SNS account regardless of your privacy settings?		112.87	101.29	125.05	105.48	115.44	119.63	5.09	0.28
I can permanently delete the content (images/videos/text) I have posted to my SNS account.		101.73	105.12	117.58	122.13	120.98	105.26	2.90	0.58
I have posted content (images/videos/text) on SNS that could be considered unprofessional.		104.74	107.11	116.85	114.21	120.08	112.96	1.19	0.88
I have posted content (images/videos/text) on SNS that I now regret.		110.80	117.62	111.96	117.33	121.28	103.05	2.10	0.72

Table

		Round 2						Round 3
Theme: 1 Conformity; self-restraint and subordination of one’s own inclinations to the expectations of others
Category		Mode/median	Mean/standard deviation (SD)		Strong consensus %			Mode/median			Mean/standard deviation (SD)		Strong consensus % (Agree/disagree)
Possesses self-control and self-respect, integrity and honest		5.0	4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)			5.0			4.9 ± 0.35		100% agreement (100% strongly Agree)
Conforms and adheres to the medical bodies’ ethical codes, rules and regulations		5.0	4.6 ± 0.52		100% agreement (57% strongly Agree and 43% agree)			5.0			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Theme 2: Benevolence: preserve and enhance welfare of those with whom one is in frequent personal contact
Maintains anonymity and confidentiality of others actions		5.0	4.6 ± 0.52		100% agreement (62.5% strongly Agree and 37.5% agree)			5.0			4.8 ± 0.46		100% agreement (71% strongly Agree and 29% agree)
Says what is for the best of the community, even if it is against his interests		5.0	4.5 ± 0.93		100% agreement (71% strongly Agree and 29% agree)			5.0			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Dedicated, committed, compassionate, empathetic, helpful and thoughtful		5.0	4.6 ± 0.52		100% agreement (57% strongly Agree and 43% agree)			5.0			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Has a genuine interest in others and strives to help and elevate others		4.5	4.4 ± 0.74		86% agreement (43% strongly Agree and 43% agree)			5.0			4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)
Theme 3: Power: status and prestige, control people and resources
Confident, advocates patients right, judicial and fair use of power and authority		4.5	4.4 ± 0.74		86% agreement (43% strongly Agree and 43% agree)			5.0			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Discourages nepotism, religionism, sexism and ageism		4.5	4.5 ± 0.93		100% agreement (71% strongly Agree and 29% agree)			4.5			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Theme 4: Self-direction: autonomous thought and action (idea of agency)
Praxis, straightforward, treat others as he would like to be treated		4.5	4.5 ± 0.53		100% agreement (57% strongly Agree and 43% agree)			4.5			4.5 ± 0.53		100% agreement (50% strongly Agree and 50% agree)
Original, flexible, compliant, and pragmatic		5.0	4.9 ± 0.35		100% agreement (86% strongly Agree and 14% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Positive mindset with an anticipatory attitude, identifies own deficiencies		5.0	4.7 ± 0.46		100% agreement (71% strongly Agree and 29% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Theme 5: Universalism: tolerance and concern for welfare of all others
Advocate of self and other rights thoughtful and helpful		4.0	4.0 ± 1.07		100% agreement (50% strongly Agree and 50% agree)			4.5			4.5 ± 0.53		100% agreement (43% strongly Agree and 57% agree)
Understands diversity, believes in equality and human rights		5.0	4.7 ± 0.46		100% agreement (71% strongly Agree and 29% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Theme 6: Achievement: competitive personal success
Competent, knowledgeable and digitally literate		4.0	4.2 ± 0.71		86% agreement (29% strongly Agree and 57% agree)			5.0			4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)
Theme 7: Honest
Category	Mode/median			Mean/standard deviation (SD)		Strong consensus % (Agree/disagree)				Mode/median		Mean/standard deviation (SD)		Strong consensus % (Agree/disagree)
High moral standards and acts with integrity considering security and privacy issues	4.5			4.5 ± 0.53		100% agreement (43% strongly Agree and 57% agree)				5.0		4.3 ± 0.52		100% agreement (62.5% strongly Agree and 37.5% agree)
Maintain relevant security and patient confidentiality in the digital world while remaining accurate	5.0			4.6 ± 0.52		100% agreement (57% strongly Agree and 43% agree)				5.0		4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Theme 8: Responsible
Non racial, reliable, tolerant, respects beliefs and cultures of others (also respecting conflicting opinions) in the digital world		5.0		4.6 ± 0.52		100% agreement (57% strongly Agree and 43% agree)	5.0					5.0 ± 0.00		100% agreement (100% strongly Agree)
Considers the privacy issues of others before sharing the information and maintains confidentiality, shares information responsibly		5.0		4.7 ± 0.46		100% agreement (71% strongly Agree and 29% agree)	5.0					4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Does not engage in character attacks in digital world		5.0		4.6 ± 0.74		85% agreement (71% strongly Agree and 14% agree)	5.0					4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Use appropriate channel (to whistle blow/complain/challenging policy), responsible for own actions or writings		4.5		4.2 ± 1.03		86% agreement (43% strongly Agree and 43% agree)	5.0					4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)
Can build therapeutic relationship while maintaining the boundary expected of professionals		5.0		4.4 ± 1.06		86% agreement (57% strongly Agree and 29% agree)	5.0					5.0 ± 0.00		100% agreement (100% strongly Agree)
Theme 9: Self-aware
Accepts feedback and criticism, shows good understanding of self and own’s emotions	4.5			4.1 ± 1.36		86% agreement (43% strongly Agree and 43% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Up-to-date knowledge, expertise, competent and self-conscious	4.5			4.1 ± 1.12		72% agreement (43% strongly Agree and 29% agree)			5.0			4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)
Theme 10: Reflective
Continuous reflection and self-improvement	4.5			4.0 ± 1.41		75% agreement (50% strongly Agree and 25% agree)				5.0		4.6 ± 0.52		100% agreement (57% strongly Agree and 43% agree)
Accountable to self and community	4.0			3.4 ± 1.60		62.5% agreement (25% strongly Agree and 37.5% agree)				5.0		4.2 ± 1.39		86% agreement (57% strongly Agree and 29% agree)
Theme 11: Conscientious
Remains calm and self regulated in case of adversity	4.5			4.4 ± 0.74		86% agreement (43% strongly Agree and 43% agree)				4.0		4.4 ± 0.52		100% agreement (37.5% strongly Agree and 62.5% agree)
Job and institution ethics awareness	5.0			4.6 ± 0.52		100% agreement (71% strongly Agree and 29% agree)				5.0		5.0 ± 0.00		100% agreement (100% strongly Agree)
Aware of consequences of his/her sharing	4.5			4.2 ± 1.03		86% agreement (43% strongly Agree and 43% agree)				5.0		4.8 ± 0.71		100% agreement (87.5% strongly Agree and 12.5% agree)
Committed and motivated for self and others improvement	5.0			4.9 ± 0.35		100% agreement (86% strongly Agree and 14% agree)				5.0		4.6 ± 0.52		100% agreement (62.5% strongly Agree and 37.5% agree)
Able to address infobesity by selecting the right and relevant resources with desired level of evidence	5.0			4.5 ± 0.76		86% agreement (57% strongly Agree and 29% agree)				5.0		4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Recognizes boundaries and limitations	4.5			4.5 ± 0.53		100% agreement (43% strongly Agree and 57% agree)				5.0		4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Theme 12: Altruistic
Supports and advocates patients rights	5.0			4.6 ± 0.53		86% agreement (43% strongly Agree and 43% agree)				5.0		4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)
Caring, sensitive, thoughtful and portrays a persona of caring for others	5.0			4.5 ± 0.76		86% agreement (57% strongly Agree and 29% agree)				5.0		5.0 ± 0.00		100% agreement (100% strongly Agree)
Empowers patients, team members and colleagues	5.0			4.5 ± 0.76		86% agreement (57% strongly Agree and 29% agree)				5.0		4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Great regard of profession and clients and fellows	5.0			4.5 ± 0.76		86% agreement (57% strongly Agree and 29% agree)				5.0		4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Theme 13: Communicator
Challenges unprofessional behaviors while maintaining professional and good interpersonal skills	5.0			4.7 ± 0.46		100% agreement (71% strongly Agree and 29% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Brave, distinguished and a good communicator	5.0			4.4 ± 1.41		100% agreement (86% strongly Agree and 14% agree)			5.0			5.0 ± 0.00		100% agreement (100% strongly Agree)
Proactively manages conflict in the online world	4.5			4.0 ± 1.41		72% agreement (43% strongly Agree and 29% agree)			5.0			4.9 ± 0.35		100% agreement (87.5% strongly Agree and 12.5% agree)
Who adheres to professional conduct and shows thoughtfulness towards privileged and accurate communication	4.5			4.2 ± 1.03		86% agreement (43% strongly Agree and 43% agree)			5.0			4.8 ± 0.46		100% agreement (75% strongly Agree and 25% agree)

Table

Framework levels		SNSME Students	Experts
Mission			[–By constantly adhering to values mentioned above and reminding about these virtues at early years of life will definitely help to practice it and then own an identity based on mutual respect, safeguarding the rights of others.] [–An individual who understands the nature of online world. Its not contained by boundaries and borders. Anything can go viral. Yet it’s the interface we will be using and breathing in. so the user needs to be sensitive to cultures, individuals, societies, need of institution he/she belongs. Who knows how to avoid racist, cultural and sexist comments? Digitally literate in terms of nations, nationalities and underprivileged. Understands what goes live and what stays behind. [–A growth in terms of professional aspect which will motivate others rather demotivates,,, the deceptive portrayal has made this generation very vulnerable to others achievements/privileges.] [–The real achievements, I mean achievements should shared which add to their professional development and not the luxuries they enjoy broadcasted.] [–In online communication, uplifts colleagues, empowers patients and doesn’t use any information to make them more vulnerable while display and broadcast information which is correct, accurate and helpful for the patients so they are benefitted and the feel supported.]
Identity	‘Confidentiality and privacy are fundamental expectations of the patient‒physician relationship.’ Manish Garg 2016 “The majority of nursing school deans surveyed were aware of students posting unprofessional content online and at a higher rate than found in studies conducted among medical and pharmacy schools. This suggests that respondents’ greatest concerns are not with students’ immaturity, but rather with students’ professional identities, including patient confidentiality and civility.” Suzanne Marnocha,2015	[–Covid has brought all interactions and activities to the world where tech savvy generation may have access to everything while no oe is watching. Honest, responsible and thorough people are needed] [–It is difficult to separate digital life from the contexts in which new generation navigate key developmental tasks. The process of acquiring identity is complicated.]	[–Mostly professional identity in digital world is blurred as there is only a thin line that can hardly demarcate professional and personal life. Professional development and digital literary can help develop professional identity in the digital world.] [–Does not spread information that may harm others and doesn’t stay behind false identities as nothing is hidden in this online world and can be perpetually traced back due to archives somewhere all the time.] [–A SNS user that considers the privacy issues of others before sharing the information and the consequences of his/her sharing.] [– Considering curiosity PI shall be acquired and created through the use of innovative online ‘forums’ and ‘networking’ resources resulting in internet-based social interaction for teaching and learning. Whereas an idea and optimum ‘balance’ would require to be maintained between real life and the internet world].
Values	‘students believed that maintaining a professional image should not be context specific, many respondents felt that they should not be held to higher standards than the general public’ Jennifer M. Walton 2015 “In the area of information security, prevention always has a lower cost than correction.” DIEGO ADA˜ O FANTI SILVA 2018		[–Applying the rules that he says to himself first and using them. Knowing that he talks to all ages and all types of people at the same time, he needs to adjust what he says to accommodate for that]
Competencies			[–In the face of an age of technological transition without precedent, although we are still unaware of the present and or needed Virtues, yet robots, artificial intelligence, the ‘Internet of Things’ and the many other technological advances on the horizon are going to have a lasting impact.]
Behaviors and environment	‘healthcare professionals not contact patients through Facebook. Both recommend using high privacy settings and becoming familiar with the terms of use on SNS platforms’ Maude Laliberte 2016 ‘Students feel they can “switch off” their professional identity outside the clinical environment and studies have that shown that students can become detached and “disinhibited when they go online” because of a sense of anonymity.’ P. Kenny 2016 “collaboration with peers and colleagues, SNS provides a platform for surgical or medical education Facilitates more efficient communication with and SNS as an effective marketing or advertising tool when used professionally” Xingbo Long 2017	[–A personal rating will be assigned to each digital user which is linked with the complaints against him/her. Each SNS site implements it.] Who challenges unprofessional behavior while maintaining professional and good interpersonal skills	[–Professional behaviors in digital world are largely influenced by a person’s education, training and interpersonal relations.] [–Understands what right and wrong and abides by the rules while no one is watching, knows that any lapse will be recorded and archived which can be later retrieved.] [–Who treat others with respect, does not engage in character attacks and portrays a persona of caring for others while not compromising his morals and values own morals Who adheres to professional conduct and shows thoughtfulness towards privileged and accurate communication] [– A moderator, pacifier and intelligent individual who know how to diffuse the tension while conveying the message]