I cannot believe this is happening. . . .

[Light at end of tunnel]

To be honest, if I were OP, I would go for the whole "I've been framed angle". Because you may have.

Are you SURE you didn't log out?

You think there is a chance OP is being framed, or are you suggesting that as a potential defense?

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[DrfluffyMD]

You think there is a chance OP is being framed, or as you suggesting that as a potential defense?

There is absolutely a chance OP is being framed. It's easy to say "oh I forgot to log off". But if you despise someone, it's easy to steal their password, log in one day, leave that log in active in an obscure computer, and come back for the kill. People often assume they left stuff logged in when it may not be the case.

 

[BoardingDoc]

There is absolutely a chance OP is being framed. It's easy to say "oh I forgot to log off". But if you despise someone, it's easy to steal their password, log in one day, leave that log in active in an obscure computer, and come back for the kill. People often assume they left stuff logged in when it may not be the case.

I feel at this point a random PSA for everyone would be helpful: if you don't have 2FA on your gmail account, you're doing it wrong.

 

[bannie22]

Yep. I get that. And I access my google drive from work all the time. And I could imagine myself making this same error. And I feel bad for the person involved.

But I don't think that changes the situation. The cloud based world we live in has blurred the privacy line, and we're still coming to grips with that. There are plenty of threads here on SDN telling people to sanitize their facebook accounts before applying to school / residency, for fear that something posted there will cause them problems at work. When your private material -- whether on facebook or an open google drive or any other resource -- ends up publicly exposed, it's a big problem if it's NSFW. Perhaps that's unfair, but it's the way it is now.

As mentioned before, details matter. If you left your drive open, someone mucked around in it, found your SDN username, searched your posts, and found an NSFW post, then I would do nothing about that (other than point out that you shouldn't keep your drive open). The person mucking in your stuff is much more in the wrong here, and wouldn't have been exposed to the material if not digging for dirt. If you left your drive open, and there's a folder front and center that says "PORN!!!!11!!!1!!!", someone clicks on it, and then someone standing behind them sees it and reports it, that's a more serious issue.

And let me be clear again, so this doesn't get blown out of proportion. If this happened at my program, we'd investigate to get the details. Assuming it's as described and the resident took ownership of the problem, all that would happen is a serious talk with the resident, perhaps some education about the issue. and a note in their internal file. No one would get fired over this -- it was unintentional and an oversight. My initial post mentioned putting it in their final credentialing paperwork -- I've changed my mind. (See? It happens!).

Any talk of firing someone or anything more draconian than that is only if this is a pattern of behavior, or if material was being stored on work computers or shared using work resources. Or, if the resident doesn't at least accept responsibility for their part of the problem. If they just blame it on the person who mucked around in their drive, they are missing the point -- and then the issue is more about accepting responsibility when a choice you make goes badly, even if it was an honest mistake.

As mentioned above, people need to be very careful with their personal online material while at work. If you have NSFW material there, even more so. Interestingly, there is no way (that I can see) to add a password to a google drive folder, which seems like it could be a nice feature. Password recover couldn't be via Gmail of course -- someone with illicit access to your drive can also access your mail, so that would be dumb.

It is awesome that you are willing to adjust your views during discussion.
Could you please clarify your current position?
If this happened to your resident, what is he/she supposed to admit to?
Being naive and careless in leaving his personal gmail account unattended to?

Anything beyond that remains overkill to me.

If you do agree, then I would like to raise my greatest concern.

Prior to your adjustment, you were ferocious in your belief that the resident had committed a tragic sin, and if he were to had such a discussion with you, would have led to extension of training or dismissal.

Now, you might have adjusted your views slightly, and if this situation were to happen, your might be able to sit down and discuss this with your resident.

But for all the 1000 other program directors out there who have not been in this thread. If their resident was in this position, they would have reacted like you did initially - closed their doors had the resident pleaded much innocence (with some naviety), believed the resident was unable to see his ?flaws, and concluded with a sentence like you did initially.

And that scares me and frustrates me.

 

[NotAProgDirector]

It is awesome that you are willing to adjust your views during discussion.
Could you please clarify your current position?
If this happened to your resident, what is he/she supposed to admit to?
Being naive and careless in leaving his personal gmail account unattended to?

Anything beyond that remains overkill to me.

The resident (or any employee, for that matter) needs to understand that, if they are going to access their private cloud from work, that they really shouldn't have NSFW material there. If they do (and it's totally their right to have it), then they shouldn't be accessing it from work. Or, it needs to be secured. Because as noted multiple times in this thread, mistakes will happen. Someone will forget to log off. Someone will check (or forget to uncheck) the "remember me" box.

They need to understand that material that they find entertaining, others may be offended by. And that allowing access at work to that material, even in error, is a huge problem. They need to accept responsibility, make amends.

If you do agree, then I would like to raise my greatest concern.

Prior to your adjustment, you were ferocious in your belief that the resident had committed a tragic sin, and if he were to had such a discussion with you, would have led to extension of training or dismissal.

Now, you might have adjusted your views slightly, and if this situation were to happen, your might be able to sit down and discuss this with your resident.

But for all the 1000 other program directors out there who have not been in this thread. If their resident was in this position, they would have reacted like you did initially - closed their doors had the resident pleaded much innocence (with some naviety), believed the resident was unable to see his ?flaws, and concluded with a sentence like you did initially.

And that scares me and frustrates me.

I'm not sure what you're referring to. Here's the relevant part of my second post in this thread, where I discuss what I would do:

What would I do in such a situation? First, it might not be my call - HR might decide and leave me no choice. But often I get quite a bit of leeway. If the person initially admitted to the problem and apologized to the people affected (if they knew whom), then I would not fire them nor extend training, as both seem unhelpful and overly draconian. I would require an apology to the person/people affected (forwarded anonymously), would require some sort of ethics / professionalism review (either they would present something to their peers about this topic, or they would take some class / workshop), and it would be included in their credentialing documentation as an event that didn't fit their prior professional performance.

If they tried to hide it / hid behind a lawyer / argued that they were "jipped" and that everyone does this and they just got caught, I would either fire them or extend their training for 3 months. Not for the NSFW event, but for the lack of ownership and insight into the issue.

If the material was offensive enough, termination might be the only option. But that adds a huge amount of subjectivity into the process, hence I'd probably avoid that road, if possible.

The only times I've mentioned termination or extension of training are if the story is more than described in this thread. Or if HR forces my hand -- although in that situation I'd be working with HR to try to prevent that. I thought I was pretty clear about that, but multiple people on this thread seem confused about it. As mentioned already, I probably would not put this in their final documents if it was truly an error. If the resident initially was super defensive and blaming someone else, then after introspection and discussion would have more insight -- then that's fine. Perhaps that's where the confusion is -- I don't care about their initial reaction to all of this. I care that, at the end, they understand the gravity of the situation. The only time this would escalate further (again, assuming the story is complete as told) is if the resident was so resistant to feedback that they continuously doubled down, blamed others, and took no responsibility.

As mentioned, the other element that could get the resident into more trouble would be the character of the material itself. Naked pics of a girlfriend / self / etc -- not that big of a deal. Truly illegal content would be (obviously) an immense problem, your job would be the least of your troubles. And there's a spectrum in between. I think this is a super slippery slope, because it requires a value judgement on the material. Hence why I would try to stay out of that minefield.

 

[NotAProgDirector]

I realize this is a bit OT, but I relatively recently had an issue in the same vein, interested in what others think.

I'm on service working with a medical students. Students use their own, personal computers on our work network. We were doing something on their computer in the EMR, and I needed a web browser window to look something up (a clinical calculator of some sort, if I remember correctly). I saw they already had a window open, so brought it up.

In that window was some sort of medical related information - I think it might have been UpToDate or somesuch. But the banner ads on the side were all seriously NSFW. It wasn't grey zone, it was pure porn. Student apologized profusely, explained that they didn't have a legal account to access the information, so they found this sketchy site that had it but served up these banner ads with it.

I told the student that it was unacceptable. First, even though it wasn't their primary goal to have porn on their computer, it was unacceptable as a side effect of their behavior. Second, accessing private material illegally is, well, illegal. Although I can't say I've never accessed copyrighted material illegally, I don't do so at work on their network. Told him I never wanted to see this again, and that it would end there.

But of course, it didn't. Later in the rotation, saw the same thing. Same explanation when I pointed it out - he couldn't afford to purchase access to the material. This time he told me that he did it at home, then brought his computer to work, forgot to close the window.

And your next move is?

 

[Light at end of tunnel]

I realize this is a bit OT, but I relatively recently had an issue in the same vein, interested in what others think.

I'm on service working with a medical students. Students use their own, personal computers on our work network. We were doing something on their computer in the EMR, and I needed a web browser window to look something up (a clinical calculator of some sort, if I remember correctly). I saw they already had a window open, so brought it up.

In that window was some sort of medical related information - I think it might have been UpToDate or somesuch. But the banner ads on the side were all seriously NSFW. It wasn't grey zone, it was pure porn. Student apologized profusely, explained that they didn't have a legal account to access the information, so they found this sketchy site that had it but served up these banner ads with it.

I told the student that it was unacceptable. First, even though it wasn't their primary goal to have porn on their computer, it was unacceptable as a side effect of their behavior. Second, accessing private material illegally is, well, illegal. Although I can't say I've never accessed copyrighted material illegally, I don't do so at work on their network. Told him I never wanted to see this again, and that it would end there.

But of course, it didn't. Later in the rotation, saw the same thing. Same explanation when I pointed it out - he couldn't afford to purchase access to the material. This time he told me that he did it at home, then brought his computer to work, forgot to close the window.

And your next move is?

Well, aPD, first thank you for giving the individual the benefit of the doubt. I can say that many of us have also likely resorted to such ways of accessing information and for similar reasons.

If this is truly a matter of being able to afford a tool that the individual finds helpful or necessary to succeed, then perhaps offering to assist with more legal access to the same information would clear the matter up?

 

[IM2GI]

I realize this is a bit OT, but I relatively recently had an issue in the same vein, interested in what others think.

I'm on service working with a medical students. Students use their own, personal computers on our work network. We were doing something on their computer in the EMR, and I needed a web browser window to look something up (a clinical calculator of some sort, if I remember correctly). I saw they already had a window open, so brought it up.

In that window was some sort of medical related information - I think it might have been UpToDate or somesuch. But the banner ads on the side were all seriously NSFW. It wasn't grey zone, it was pure porn. Student apologized profusely, explained that they didn't have a legal account to access the information, so they found this sketchy site that had it but served up these banner ads with it.

I told the student that it was unacceptable. First, even though it wasn't their primary goal to have porn on their computer, it was unacceptable as a side effect of their behavior. Second, accessing private material illegally is, well, illegal. Although I can't say I've never accessed copyrighted material illegally, I don't do so at work on their network. Told him I never wanted to see this again, and that it would end there.

But of course, it didn't. Later in the rotation, saw the same thing. Same explanation when I pointed it out - he couldn't afford to purchase access to the material. This time he told me that he did it at home, then brought his computer to work, forgot to close the window.

And your next move is?

Tell him to VPN into the hospital network to access uptodate like everyone else does? Email the articles to himself while at work?

I think the problem from your end is either you do nothing, or it becomes a huge deal. Id tell them they have two strikes, you'll let it go one more time, you see it again he is going to have a major problem.

I tend to be a softie though and don't believe in potentially ruining someones life/career over relatively trivial things in the grand scheme.

 

[rokshana]

Tell him to VPN into the hospital network to access uptodate like everyone else does? Email the articles to himself while at work?

I think the problem from your end is either you do nothing, or it becomes a huge deal. Id tell them they have two strikes, you'll let it go one more time, you see it again he is going to have a major problem.

I tend to be a softie though and don't believe in potentially ruining someones life/career over relatively trivial things in the grand scheme.

once is a mistake, twice is not taking it seriously... they need to be told that IF you let this go with no consequence, then the 3rd time, they will be disciplined with no quarter...to me the best case scenario is that they fail that rotation...worst case is would that there would a question of whether they are allowed to remain in school.

 

[bannie22]

Yes, you are correct, this is bad and could lead to any number of problems for you. So I agree that taking it seriously is critical.

Unfortunately, whether you actually looked at images at work or not is immaterial to the discussion. You left these images out in public. Leaving your google drive open and leaving a computer is just like leaving a folder of pictures lying around at work. Whether you were looking at them doesn't matter. You left them there, and someone else found them. These images shouldn't be at work at all. If you have images like that in your drive, then you shouldn't be logging into it from work computers. I'm not telling you all this to make you feel bad, simply so that you don't make the mistake of trying to explain it this way.

You certainly can get a lawyer. But people often misunderstand what a lawyer can do for you. The advice above that you shouldn't talk to anyone and refer them to your lawyer won't work. You're an employee there. If I'm your PD and I want to talk to you, you talk to me. In my office. Alone, no lawyer. If you refer me to your lawyer, I fire you for not coming to meet with me. You have no legal right to have your lawyer present, nor to force me to deal with them. So, at this point, a lawyer is for advice.

You have a choice to make. One option is to be fully open, admit to what happened, apologize profusely. Chances are, your program will "do something". They might extend your training further. They might require some sort of ethics / professionalism remediation. They might fire you. It's hard to say. Or, you could keep quiet. Don't say anything. See what the investigation actually can find / prove. In that case, if they can't prove anything, you walk away scott free. If they do find the issue, then apologies at that point will be much less effective, and the punishment (might) be greater.

If you actually get fired, then a lawyer is a must. At that point, you want to make sure that they actually followed due process. Do their policies actually allow them to fire you for this? Have they followed all of the appropriate steps? You'll grieve the decision, ask for a fair hearing. But if it comes to this, your entire career is on the line.

One of the hardest parts of this type of process is the timeline. In medicine, we're used to emergencies getting a rapid response and resolution. The legal process is very, very slow. And there's often no clear timeline -- you likely have no idea how long this will take, and when you'll get an answer.

Last, make sure you take care of yourself. This will be very stressful, regardless of the outcome. Make sure you have support through this process.

No worries about disagreements @Light at end of tunnel. This isn't the type of question with a right/wrong answer. Discussion is useful.

Suspension is not necessarily an adverse action. At my institution, if a resident has an incident that suggests a serious problem, they are suspended with pay while the event is investigated. If no concern is found, they are returned to work, get full credit for the time, and no mention is made in their record. If a problem is found, then we proceed with whatever the issue is. A good example would be substance use -- if you show up and I am seriously concerned you are impaired, then you are suspended, removed from work, and get tested in Occ Med. If your test comes back clean, then you get my apologies, back to work, full credit, no issues. Suspension can be an adverse action if it's punitive for some offense. So it depends.

Now it's my turn to disagree, with @bannie22. The OP was not "jipped" nor unlucky. They made a very poor decision. This is a major professionalism violation. They essentially brought NSFW items to work and left them lying around. Sure, maybe they got caught where someone else might have just closed the account and not reported it. But their actions are unacceptable. Perhaps in today's world we are used to having all of our "stuff" in the cloud and instantly accessible. But if you're going to keep a collection of NSFW items, then they can't come to Work. Hence the NSFW.

What would I do in such a situation? First, it might not be my call - HR might decide and leave me no choice. But often I get quite a bit of leeway. If the person initially admitted to the problem and apologized to the people affected (if they knew whom), then I would not fire them nor extend training, as both seem unhelpful and overly draconian. I would require an apology to the person/people affected (forwarded anonymously), would require some sort of ethics / professionalism review (either they would present something to their peers about this topic, or they would take some class / workshop), and it would be included in their credentialing documentation as an event that didn't fit their prior professional performance.

If they tried to hide it / hid behind a lawyer /21950000375304

If the material was offensive enough, termination might be the only option. But that adds a huge amount of subjectivity into the process, hence I'd probably avoid that road, if possible.

That is very odd because this is what you wrote previously.
Which was clearly a response to my initial post that the OP had done nothing wrong except naively left his gmail account open.

So clarify this, if the resident went into your room now that you have had the opportunity to bounce ideas off SDN and told you,

I left my gmail account open accidentally, never intended nor did disseminate any of this material, and some dude after me dug into my files and reported me. This could have obviously happened to anyone on SDN. I cant believe how this happened to me, not only was I unlucky, I am extremely aggrieved and frustrated about the situation.

*PD: I am very angry you left your account open.
Resident: Yes that is my fault.

*PD: You should not have had any NSFW material in this form at work
Resident: No, I do not have the INSIGHT nor PROFESSIONALISM on your scale to comprehend that I must ensure all my cloud drives are squeaky clean. (he does not agree that utilizing his gmail with nsfw material on cloud is an issue)

Does he get an extension or termination?
Because evidently in your first post, you were ready to do either for the lack of insight/professionalism.

 

[IM2GI]

once is a mistake, twice is not taking it seriously... they need to be told that IF you let this go with no consequence, then the 3rd time, they will be disciplined with no quarter...to me the best case scenario is that they fail that rotation...worst case is would that there would a question of whether they are allowed to remain in school.

So what, you fail the kid, and for reason, he had porn ads in his bootleg uptodate? That is a death sentence to a residency/fellowship application.

The person is clearly being an idiot, but I wouldnt ruin their life over it. He needs a very stern talking to without any formal documentation/punishment unless it happens again.

 

[Raryn]

I realize this is a bit OT, but I relatively recently had an issue in the same vein, interested in what others think.

I'm on service working with a medical students. Students use their own, personal computers on our work network. We were doing something on their computer in the EMR, and I needed a web browser window to look something up (a clinical calculator of some sort, if I remember correctly). I saw they already had a window open, so brought it up.

In that window was some sort of medical related information - I think it might have been UpToDate or somesuch. But the banner ads on the side were all seriously NSFW. It wasn't grey zone, it was pure porn. Student apologized profusely, explained that they didn't have a legal account to access the information, so they found this sketchy site that had it but served up these banner ads with it.

I told the student that it was unacceptable. First, even though it wasn't their primary goal to have porn on their computer, it was unacceptable as a side effect of their behavior. Second, accessing private material illegally is, well, illegal. Although I can't say I've never accessed copyrighted material illegally, I don't do so at work on their network. Told him I never wanted to see this again, and that it would end there.

But of course, it didn't. Later in the rotation, saw the same thing. Same explanation when I pointed it out - he couldn't afford to purchase access to the material. This time he told me that he did it at home, then brought his computer to work, forgot to close the window.

And your next move is?

Tell him to install an adblocker and move on.

Then ask the hospital to install sufficient workstations that the medical students don't need to bring their personal devices to work.

 

[NotAProgDirector]

That is very odd because this is what you wrote previously.
Which was clearly a response to my initial post that the OP had done nothing wrong except naively left his gmail account open.

Ahh. I see. "Immaterial to the discussion" is an oversimplification on my part, or a poor choice of words. If the person was actually using / distributing NSFW material at work, then that's obviously much worse. My point was supposed to be that, even if the OP didn't intend to access the material, the fact that they left their account open and someone looked at it is a problem. So it would have been better to say "Even if you didn't plan to access the material and left your account open by mistake, you're still responsible for leaving that material open on a work network"

As for your second bolded statement, I don't see the discordance. If you have NSFW material in a cloud drive, you should not be opening that (even for other material) while at work. Or, at a minimum, the NSFW material should be encrypted / locked / protected.

So clarify this, if the resident went into your room now that you have had the opportunity to bounce ideas off SDN and told you,

I left my gmail account open accidentally, never intended nor did disseminate any of this material, and some dude after me dug into my files and reported me. This could have obviously happened to anyone on SDN. I cant believe how this happened to me, not only was I unlucky, I am extremely aggrieved and frustrated about the situation.

*PD: I am very angry you left your account open.
Resident: Yes that is my fault.

Actually, that's not what I would answer. I'm not angry at all. Neither am I disappointed in their performance. I can completely see how something like this would happen. But I would disagree with the resident that they got "unlucky". I'd explore why they were frustrated, since that's not the emotion I would expect.

*PD: You should not have had any NSFW material in this form at work
Resident: No, I do not have the INSIGHT nor PROFESSIONALISM on your scale to comprehend that I must ensure all my cloud drives are squeaky clean. (he does not agree that utilizing his gmail with nsfw material on cloud is an issue)

Details matter, and we would be having a long discussion about this. I'd explore with the resident why this was a problem, and why they might think it wasn't a problem. We'd review the situation from the other person's viewpoint. I'd point out that perhaps what happened was that person A was mucking in their drive, Person B walked by, saw images, and reported (thinking that they were reporting Person A). And in that case, Person A should also be having a similar conv with their supervisor.

Now, let's say that after a 30 minute discussion the person remains steadfast that they did nothing wrong, that they have the right to log into their google drive anytime and anywhere they want, and that whomever reported them is the only person who is responsible for this mess. They take no responsibility for their role in this. Your quote above actually suggests that they are being sarcastic with me about this -- that this is "my scale", and that their drives need to be "squeeky clean" (which they don't. But if they want to access them from work, either they do or they need to ensure that something like this doesn't happen). In that case, what do I do?

Again, details matter. I know I can't change this person's mind -- nothing I do is going to make any difference in their future behavior in this regard. "Punishment" is not helpful for anyone. But doing nothing is wrong also -- if I was going to be this person's future employer, I'd want to know about this type of attitude. If this was really the very first professionalism issue for this person, I would require some sort of ethics/professionalism remediation (unlikely to be effective, but I'd feel like I have to do something. Maybe a class. Or an online course of some type. Ideally focused on this one specific issue), and it would go into their final documentation. "XYZ happened at the end of their training, seemed out of character as no prior issues were reported. Resident was counseled about this." (I would word it better that this, this is just a poor example). However, I can almost guarantee you that this person would have had multiple similar issues prior -- arguments with nurses, multiple complaints from students, nurses, or other support staff, etc. Someone with no prior history of problems like this would own up to it, apologize, and we'd have moved on. With a history of problems, it now depends upon what we did with the last problem and where we left it. It's less this issue in particular, and the whole pattern of behavior.

And perhaps, that's the focus of our disagreement here. If you present a case of a resident with a minor professionalism issue like this who becomes defensive and blames other people, my clinical and administrative experience instantly jumps to those residents where this is a chronic problem. Because it almost always is. In fact, I can't think of a single situation in my whole career where it isn't. Sure, some people who have no history of professionalism problems run into an unexpected issue -- but they always just address it, apologize, and move on. In fact, most of the time they have already fixed the problem by the time I've heard of it. Just happened -- one of my residents with no issues ended up in a disagreement with security while on call. The resident was COMPLETELY IN THE RIGHT. Security was being ridiculous (to be fair, this was over a new policy that impacted residents on call that was established without contacting my office, so it's not fair to blame the security officer). But the next AM the resident went to the chief resident and the chief of service, reviewed the incident, felt terrible for helping generate a poor situation. He wondered whether maybe he had done something wrong and wanted people to look at the situation with fresh eyes. By the time this bubbled to me, it was already sorted out, all ruffled feathers were smoothed, and all I needed to do was sort out this ridic policy issue. So when you give the the discussion above, I instantly jump to someone with multiple issues and complaints -- because that's the way it usually / always is.

 

[SageRad]

My wife is an employment attorney for a Fortune 500 company. I read the scenario to her.

She said that if this went down as described in the OP, assuming that it is consistent with the precedent of the organization, this would be cause for counseling and minor discipline, not cause for termination. Assuming the employee (resident, in this case) had a good record to date and this is the first offense for this issue, there would not be serious repercussions.

It would be different if he was viewing porn at work and/or left porn open on a computer and walked away. That would be grounds for dismissal. (The OP did not mention porn, but let's assume it is the case.)

She also said that the person who reported that the google/gmail account that was left open and proceeded to search the account would also be subject to counseling and some level of discipline, perhaps greater than the person who left his/her account open, also dependent on precedent for the organization and that individual's previous record. If someone leaves a purse or briefcase on a chair and walks away, it does not give you the right to search through it. The professional thing to do when you see that someone has inadvertently left a personal account open is to log off and move on.

 

[Light at end of tunnel]

My wife is an employment attorney for a Fortune 500 company. I read the scenario to her.

She said that if this went down as described in the OP, assuming that it is consistent with the precedent of the organization, this would be cause for counseling and minor discipline, not cause for termination. Assuming the employee (resident, in this case) had a good record to date and this is the first offense for this issue, there would not be serious repercussions.

It would be different if he was viewing porn at work and/or left porn open on a computer and walked away. That would be grounds for dismissal. (The OP did not mention porn, but let's assume it is the case.)

She also said that the person who reported that the google/gmail account that was left open and proceeded to search the account would also be subject to counseling and some level of discipline, perhaps greater than the person who left his/her account open, also dependent on precedent for the organization and that individual's previous record. If someone leaves a purse or briefcase on a chair and walks away, it does not give you the right to search through it. The professional thing to do when you see that someone has inadvertently left a personal account open is to log off and move on.

Hi SageRad, welcome to the gen residency forum!

 

[IM2GI]

She also said that the person who reported that the google/gmail account that was left open and proceeded to search the account would also be subject to counseling and some level of discipline, perhaps greater than the person who left his/her account open, also dependent on precedent for the organization and that individual's previous record. If someone leaves a purse or briefcase on a chair and walks away, it does not give you the right to search through it. The professional thing to do when you see that someone has inadvertently left a personal account open is to log off and move on.

Agreed. This person went out of their way to dig through OPs account.

 

[bannie22]

My wife is an employment attorney for a Fortune 500 company. I read the scenario to her.

She said that if this went down as described in the OP, assuming that it is consistent with the precedent of the organization, this would be cause for counseling and minor discipline, not cause for termination. Assuming the employee (resident, in this case) had a good record to date and this is the first offense for this issue, there would not be serious repercussions.

It would be different if he was viewing porn at work and/or left porn open on a computer and walked away. That would be grounds for dismissal. (The OP did not mention porn, but let's assume it is the case.)

She also said that the person who reported that the google/gmail account that was left open and proceeded to search the account would also be subject to counseling and some level of discipline, perhaps greater than the person who left his/her account open, also dependent on precedent for the organization and that individual's previous record. If someone leaves a purse or briefcase on a chair and walks away, it does not give you the right to search through it. The professional thing to do when you see that someone has inadvertently left a personal account open is to log off and move on.

I hope that is the case too in this situation.

 

[epsilonprodigy]

I agree that if you find yourself logged in to someone else's email/Dropbox/whatever, the only professional choice is to unclick the remember me box if possible and log out immediately.

I used to be a sexual assault examiner, and some of the images I'd have to use in educational power points were..colorful, to say the least. They certainly would have been called inappropriate if taken out of context by someone looking to cry wolf. This thread should inspire us all to do a safety check on our online clouds.


Sent from my iPhone using SDN mobile

 

[VA Hopeful Dr]

So what, you fail the kid, and for reason, he had porn ads in his bootleg uptodate? That is a death sentence to a residency/fellowship application.

The person is clearly being an idiot, but I wouldnt ruin their life over it. He needs a very stern talking to without any formal documentation/punishment unless it happens again.

Only if they ignore the program director 3 times over the same issue. That is absolutely worthy of harsh punishment

 

[bannie22]

Ahh. I see. "Immaterial to the discussion" is an oversimplification on my part, or a poor choice of words. If the person was actually using / distributing NSFW material at work, then that's obviously much worse. My point was supposed to be that, even if the OP didn't intend to access the material, the fact that they left their account open and someone looked at it is a problem. So it would have been better to say "Even if you didn't plan to access the material and left your account open by mistake, you're still responsible for leaving that material open on a work network"

As for your second bolded statement, I don't see the discordance. If you have NSFW material in a cloud drive, you should not be opening that (even for other material) while at work. Or, at a minimum, the NSFW material should be encrypted / locked / protected.



Actually, that's not what I would answer. I'm not angry at all. Neither am I disappointed in their performance. I can completely see how something like this would happen. But I would disagree with the resident that they got "unlucky". I'd explore why they were frustrated, since that's not the emotion I would expect.



Details matter, and we would be having a long discussion about this. I'd explore with the resident why this was a problem, and why they might think it wasn't a problem. We'd review the situation from the other person's viewpoint. I'd point out that perhaps what happened was that person A was mucking in their drive, Person B walked by, saw images, and reported (thinking that they were reporting Person A). And in that case, Person A should also be having a similar conv with their supervisor.

Now, let's say that after a 30 minute discussion the person remains steadfast that they did nothing wrong, that they have the right to log into their google drive anytime and anywhere they want, and that whomever reported them is the only person who is responsible for this mess. They take no responsibility for their role in this. Your quote above actually suggests that they are being sarcastic with me about this -- that this is "my scale", and that their drives need to be "squeeky clean" (which they don't. But if they want to access them from work, either they do or they need to ensure that something like this doesn't happen). In that case, what do I do?

Again, details matter. I know I can't change this person's mind -- nothing I do is going to make any difference in their future behavior in this regard. "Punishment" is not helpful for anyone. But doing nothing is wrong also -- if I was going to be this person's future employer, I'd want to know about this type of attitude. If this was really the very first professionalism issue for this person, I would require some sort of ethics/professionalism remediation (unlikely to be effective, but I'd feel like I have to do something. Maybe a class. Or an online course of some type. Ideally focused on this one specific issue), and it would go into their final documentation. "XYZ happened at the end of their training, seemed out of character as no prior issues were reported. Resident was counseled about this." (I would word it better that this, this is just a poor example). However, I can almost guarantee you that this person would have had multiple similar issues prior -- arguments with nurses, multiple complaints from students, nurses, or other support staff, etc. Someone with no prior history of problems like this would own up to it, apologize, and we'd have moved on. With a history of problems, it now depends upon what we did with the last problem and where we left it. It's less this issue in particular, and the whole pattern of behavior.

And perhaps, that's the focus of our disagreement here. If you present a case of a resident with a minor professionalism issue like this who becomes defensive and blames other people, my clinical and administrative experience instantly jumps to those residents where this is a chronic problem. Because it almost always is. In fact, I can't think of a single situation in my whole career where it isn't. Sure, some people who have no history of professionalism problems run into an unexpected issue -- but they always just address it, apologize, and move on. In fact, most of the time they have already fixed the problem by the time I've heard of it. Just happened -- one of my residents with no issues ended up in a disagreement with security while on call. The resident was COMPLETELY IN THE RIGHT. Security was being ridiculous (to be fair, this was over a new policy that impacted residents on call that was established without contacting my office, so it's not fair to blame the security officer). But the next AM the resident went to the chief resident and the chief of service, reviewed the incident, felt terrible for helping generate a poor situation. He wondered whether maybe he had done something wrong and wanted people to look at the situation with fresh eyes. By the time this bubbled to me, it was already sorted out, all ruffled feathers were smoothed, and all I needed to do was sort out this ridic policy issue. So when you give the the discussion above, I instantly jump to someone with multiple issues and complaints -- because that's the way it usually / always is.

Thats too bad. It seems that you have certain preconceived notions regarding some of your residents. I prefer our justice system where someone is innocent until proven guilty.
Regardless of whether I were in a position of pwoer, I would continue to empathize for the unfortunate person who had his belongings ransacked and now find himself in a predicament where the repercussions range from a bad letter, extension of training, and even termination.

I can only fault the man for not logging out. I cant bring myself to fault him for anything else. And to be in his current situation, I can only wonder how stressful and life-defining this is.

And no doubt, I agree with the other posters, the medical workplace is very fluid, and you might use multiple computers in a single day unlike other occupations. It would be so easy, to just create a throwaway email, send some NSFW material to someone, open that someone's not-logged-out email, and then report that person.

This witchhunt is just silly. I would say, please dont forget to log out again, and search harder for this rat who obviously did some sneaking around.

 

[dpmd]

Agreed. This person went out of their way to dig through OPs account.

Not sure why this is the assumption. When I open my google drive most of my stuff is not in folders,so there are small pictures corresponding to the files I have in there. None of mine are NSFW but if they were, just going to my drive would show you the first 10 of them immediately. Perhaps that is what happened and the images were shocking enough that the unsuspecting person decided to click in the corner to figure out what pervert left their bestiality scat porn out.

 

[NotAProgDirector]

Thats too bad. It seems that you have certain preconceived notions regarding your residents. I prefer our justice system where someone is innocent until proven guilty.
Regardless of whether I were in a position of pwoer, I would continue to empathize for the unfortunate person who had his belongings ransacked and now find himself in a predicament where the repercussions range from a bad letter, extension of training, and even termination.

I can only fault the man for not logging out. I cant bring myself to fault him for anything else. And to be in his current situation, I can only wonder how stressful and life-defining this is.

And no doubt, I agree with the other posters, the medical workplace is very fluid, and you might use multiple computers in a single day unlike other occupations. It would be so easy, to just create a throwaway email, send some NSFW material to someone, open that someone's not-logged-out email, and then report that person.

This witchhunt is just silly. I would say, please dont forget to log out again, and search harder for this rat who obviously did some sneaking around.

I feel like we are talking around each other.

I don't have preconceived notions. All I'm saying is that an event like this would be taken in context with the resident's past issues/behavior. You seem to think that if you created a throw away account, emailed an NSFW image to someone, opened their account, and looked at it that I would somehow punish them for that. What the heck? We'd investigate, find that it was a single event, figure out what happened, and nothing would come of it except the resident being reminded / warned of logging out their account when they leave a machine.

All I'm saying is:

1. When you're on my work network, if you decide to access your personal accounts you're responsible for what happens to that content if it is shared inappropriately. So either be very careful, don't have objectionable material, or don't access it -- your choice.

2. If something like this does happen, if you accept responsibility and make amends, the end result will not have an impact on your career.

3. If a resident did not accept responsibility, blamed others (who, if they dug through your drive, do deserve some blame. But that's not the issue), and didn't take responsibility, then what happens next depends upon whether this fits a pattern of their behavior in the past. If not, then a warning and a remediation plan is what would happen (and remediation plans are private outside of the institution). If it is a pattern, then it all depends on what's happened beforehand. In my experience, 100% of the time it's a pattern. Perhaps I'm just unlucky.

I think this is the end of this discussion for me. We've all said what we need to say. If we continue to disagree -- well, that's what makes America great.

 

[bannie22]

I feel like we are talking around each other.

I don't have preconceived notions. All I'm saying is that an event like this would be taken in context with the resident's past issues/behavior. You seem to think that if you created a throw away account, emailed an NSFW image to someone, opened their account, and looked at it that I would somehow punish them for that. What the heck? We'd investigate, find that it was a single event, figure out what happened, and nothing would come of it except the resident being reminded / warned of logging out their account when they leave a machine.

All I'm saying is:

1. When you're on my work network, if you decide to access your personal accounts you're responsible for what happens to that content if it is shared inappropriately. So either be very careful, don't have objectionable material, or don't access it -- your choice.

2. If something like this does happen, if you accept responsibility and make amends, the end result will not have an impact on your career.

3. If a resident did not accept responsibility, blamed others (who, if they dug through your drive, do deserve some blame. But that's not the issue), and didn't take responsibility, then what happens next depends upon whether this fits a pattern of their behavior in the past. If not, then a warning and a remediation plan is what would happen (and remediation plans are private outside of the institution). If it is a pattern, then it all depends on what's happened beforehand. In my experience, 100% of the time it's a pattern. Perhaps I'm just unlucky.

To make a final clarification on my position, the resident should be responsible for leaving his account unattended. My understanding from our discussion is that you believe the resident should take responsibility beyond that. Perhaps I have misread or failed to read what you ascertain to be the appropriate level of responsibility within our long discussions, however, at this time your definition of responsibility remains hazy to me.

We will just have to agree to disagree. It was a pleasure.

 

[NotAProgDirector]

To follow up on my other question -- thanks for opinions. I was also torn about what to do. I felt that my first warning should have been sufficient to stop the behavior and that a second warning without some escalation wasn't something I was comfortable with. Clearly the student didn't understand how serious I felt the situation was. At my institution, VPN isn't an option -- although they can log in remotely via citrix, it's buggy and slow. Regardless, I felt it was this student's responsibility to find a solution. Yet, I didn't want to create a situation that brought this student's career to an end -- that seemed wrong also.

So, what I did was walk the student (and their laptop) down to the clerkship director's office. I told the clerkship director that there was a problem, and that I was no longer able to work with this student because I felt their evaluation would be poor enough to seriously impact their grade. I told them that the student would need to explain the situation to the clerkship director, and then they could decide what happened next. I told the student that I would simply say "unable to evaluate" on their evaluation. I also told them not to bother applying to my IM program. I walked out and closed the door.

Feedback from the clerkship director was: Message received, loud and clear. Seemed like a reasonable outcome.

 

[Light at end of tunnel]

To follow up on my other question -- thanks for opinions. I was also torn about what to do. I felt that my first warning should have been sufficient to stop the behavior and that a second warning without some escalation wasn't something I was comfortable with. Clearly the student didn't understand how serious I felt the situation was. At my institution, VPN isn't an option -- although they can log in remotely via citrix, it's buggy and slow. Regardless, I felt it was this student's responsibility to find a solution. Yet, I didn't want to create a situation that brought this student's career to an end -- that seemed wrong also.

So, what I did was walk the student (and their laptop) down to the clerkship director's office. I told the clerkship director that there was a problem, and that I was no longer able to work with this student because I felt their evaluation would be poor enough to seriously impact their grade. I told them that the student would need to explain the situation to the clerkship director, and then they could decide what happened next. I told the student that I would simply say "unable to evaluate" on their evaluation. I also told them not to bother applying to my IM program. I walked out and closed the door.

Feedback from the clerkship director was: Message received, loud and clear. Seemed like a reasonable outcome.

Quite frankly, the one free pass you allowed was more than most would offer. There should not have been a second incident. You gotta draw the line somewhere, and you did.

 

[evilbooyaa]

To follow up on my other question -- thanks for opinions. I was also torn about what to do. I felt that my first warning should have been sufficient to stop the behavior and that a second warning without some escalation wasn't something I was comfortable with. Clearly the student didn't understand how serious I felt the situation was. At my institution, VPN isn't an option -- although they can log in remotely via citrix, it's buggy and slow. Regardless, I felt it was this student's responsibility to find a solution. Yet, I didn't want to create a situation that brought this student's career to an end -- that seemed wrong also.

So, what I did was walk the student (and their laptop) down to the clerkship director's office. I told the clerkship director that there was a problem, and that I was no longer able to work with this student because I felt their evaluation would be poor enough to seriously impact their grade. I told them that the student would need to explain the situation to the clerkship director, and then they could decide what happened next. I told the student that I would simply say "unable to evaluate" on their evaluation. I also told them not to bother applying to my IM program. I walked out and closed the door.

Feedback from the clerkship director was: Message received, loud and clear. Seemed like a reasonable outcome.

Are medical students expected to bring their own devices to the hospital (in clinical scenarios, not counting to study)? If so, why? Why are they being allowed (or expected) to access the EMR on their personal devices? Is that something that is only allowed over the work network, or can they access the EMR from home as well? Why can't they access uptodate (and EMR) on the hospital computers like everybody else?

If they do have to use their own devices, maybe the hospital should offer to set their devices up with UpToDate access? Is it an expectation that students, on rounds, be able to immediately access UpToDate? There's a potential for a systemic issue at play here - obviously the student is still in the wrong, not arguing that, but if the student feels that UpToDate access is critical to his learning and he can't get on a computer at work (which likely has an UpToDate subscription), what are his options?

The illegal access of UpToDate is potentially more problematic to the hospital than anything else. The excuse the second time of "Oops I left it open when I was at home" doesn't fly just like it wouldn't fly if he left actual porn open (even if sound was muted) when he brought his computer to work. There certainly is a possibility there is no systemic issue here, there are enough computers, and this student is just making poor decisions or not understanding the gravity of NSFW material visible in the hospital.

I think you have more restraint than most, and certainly was a reasonable, non-career ending move from your side. Props to you for eliminating your headache while not tanking that student's entire career.

 

[Mad Jack]

I realize this is a bit OT, but I relatively recently had an issue in the same vein, interested in what others think.

I'm on service working with a medical students. Students use their own, personal computers on our work network. We were doing something on their computer in the EMR, and I needed a web browser window to look something up (a clinical calculator of some sort, if I remember correctly). I saw they already had a window open, so brought it up.

In that window was some sort of medical related information - I think it might have been UpToDate or somesuch. But the banner ads on the side were all seriously NSFW. It wasn't grey zone, it was pure porn. Student apologized profusely, explained that they didn't have a legal account to access the information, so they found this sketchy site that had it but served up these banner ads with it.

I told the student that it was unacceptable. First, even though it wasn't their primary goal to have porn on their computer, it was unacceptable as a side effect of their behavior. Second, accessing private material illegally is, well, illegal. Although I can't say I've never accessed copyrighted material illegally, I don't do so at work on their network. Told him I never wanted to see this again, and that it would end there.

But of course, it didn't. Later in the rotation, saw the same thing. Same explanation when I pointed it out - he couldn't afford to purchase access to the material. This time he told me that he did it at home, then brought his computer to work, forgot to close the window.

And your next move is?

Admitting to the flagrant violation of intellectual property rights should be bad enough. I mean, you can't help what banner ads pop up on a given site, that's kind of outside of your control, but to just be like, "yeah, I'm committing a crime, nbd" twice is a huge red flag, and one that puts the hospital's finances at risk since these cases are usually pursued based upon IP not based upon user.

 

[hello1234!]

When I was a student, I wanted uptodate, so I paid for it using my loans. There are student rates.

 

[Mad Jack]

Are medical students expected to bring their own devices to the hospital (in clinical scenarios, not counting to study)? If so, why? Why are they being allowed (or expected) to access the EMR on their personal devices? Is that something that is only allowed over the work network, or can they access the EMR from home as well? Why can't they access uptodate (and EMR) on the hospital computers like everybody else?

If they do have to use their own devices, maybe the hospital should offer to set their devices up with UpToDate access? Is it an expectation that students, on rounds, be able to immediately access UpToDate? There's a potential for a systemic issue at play here - obviously the student is still in the wrong, not arguing that, but if the student feels that UpToDate access is critical to his learning and he can't get on a computer at work (which likely has an UpToDate subscription), what are his options?

The illegal access of UpToDate is potentially more problematic to the hospital than anything else. The excuse the second time of "Oops I left it open when I was at home" doesn't fly just like it wouldn't fly if he left actual porn open (even if sound was muted) when he brought his computer to work. There certainly is a possibility there is no systemic issue here, there are enough computers, and this student is just making poor decisions or not understanding the gravity of NSFW material visible in the hospital.

I think you have more restraint than most, and certainly was a reasonable, non-career ending move from your side. Props to you for eliminating your headache while not tanking that student's entire career.

You can function without UpToDate, it's not like some magical website without which your life is misery. It is nice to have, but the hospital can't just provide him with access- UTD costs six to seven figures for a subscription, and they charge more based upon how many users you want to authorize. If the student feels it is so critical to their learning, they should pay for it. A student subscription is 200 bucks, or 100 if you're an AMSA member, chump change compared to the hundreds of thousands they've already dropped on medical school, and well worth the cost of having not been thrown out of a rotation. If you want the products companies spend enormous amounts of money to produce and update, pay for them, it's not that hard.

 

[bannie22]

Tell him to install an adblocker and move on.

Then ask the hospital to install sufficient workstations that the medical students don't need to bring their personal devices to work.

Didnt notice this side story. But yes I agree with this solution. I am kinda perplexed why PD is constantly accessing the student's computer too. Lol.

I would feel very uncomfortable.

And on the topic of illegal... come on. Some copies of windows at my hospital laptops arent even real! Lol


And in response to aPD, I think you did the best for the student from your position in terms of your values and your standing in the medical community.

I have understood our values are vastly different, and I see this as a situation whereby a student who does not have the financial ability to afford academic references making a dedicated effort to identify sources that he would be able to access, learn, and apply on his clerkship.

I think he made a mistake, which is in carelessness, where he was instructed once by his superior to not have this material in the workplace again. He did not do so out of malice but out of carelessness. If I was in your position, I would warn him ever so much again, and will continue to evaluate him based on his overall performance, nothing drastic such as failure or "cannot be evaluated", but would suggest that he can continue to improve on his attention to detail (or being less careless).

Just my position. But we are different. Thats why you are a program director, and I am a mere SDN user. I do respect that despite your obvious disagreement with his performance, you did not go out of your way to destroy his career.

 

[rokshana]

Didnt notice this side story. But yes I agree with this solution. I am kinda perplexed why PD is constantly accessing the student's computer too. Lol.

I would feel very uncomfortable.

And on the topic of illegal... come on. Some copies of windows at my hospital laptops arent even real! Lol

uh, twice isn't exactly "constant"...and frankly if the 2 times the PD asked to look at the student's computer, well i would image that the student had inappropriate stuff on his computer pretty frequently...pretty stupid on his part.

 

[Light at end of tunnel]

I am a graduating resident, and things have suddenly took a very devastating, unexpected turn. I was logged into my personal gmail account on a work computer, and I forgot to actually log off. A couple days later, another person brought up Google drive on the work computer, and Google already had me logged on. Needless to say, I had some NSFW images and private documents on my drive that the individual saw, and reported me for looking at explicit images while at work (which I never did. I would never open my drive myself at work). Now, IT is investigating, and I have been suspended. I remotely logged out of all of my Google accounts when I found someone had opened my drive, and deleted any unsafe for work images. However, will IT be able to see what was on my Google drive when it was pulled up on the work computer? Can they actually fire me from this accident when I am so close to being done? I'm anxious about losing my career, embarrassed and disappointed. Any thoughts would be appreciated.

OP, if you have some time (no doubt you are preoccupied with other more pressing matters), would you kindly update all of us? Hope you are doing well.

 

[NotAProgDirector]

Our institution has plenty of work computers for people to use. However, it's much more convenient to have your own laptop. We issue laptops to our residents, and all faculty have laptops. So, when on rounds, we can just get work done. Students don't get hospital laptops, they all have their own -- whether issued by their medical school or paid independently, I don't know. They all look the same, so I assume there's some standard involved.

When accessing the hospital system via their laptops, they have full EMR access, and I believe full UTD access also.

I wasn't "snooping" in their laptops. We are all working together in a team room. The student asked me for help putting some orders in. They brought their computer over, the EMR was on the screen. I can't remember what we were doing, but it needed some score calculation -- perhaps a CHA2DS2-VASc score. So I clicked on the web browser on the student's computer. And there it was. Twice. And I didn't end their career. Another warning would likely be ignored again.

Perhaps it wasn't even medical content that they were accessing -- I honestly don't remember. Regardless, it was unacceptable. I was amazed that after being told once, it continued. For sure, all hospital computers have full access to everything, so they had other choices.

 

[TraumaLlamaMD]

Our institution has plenty of work computers for people to use. However, it's much more convenient to have your own laptop. We issue laptops to our residents, and all faculty have laptops. So, when on rounds, we can just get work done. Students don't get hospital laptops, they all have their own -- whether issued by their medical school or paid independently, I don't know. They all look the same, so I assume there's some standard involved.

When accessing the hospital system via their laptops, they have full EMR access, and I believe full UTD access also.

I wasn't "snooping" in their laptops. We are all working together in a team room. The student asked me for help putting some orders in. They brought their computer over, the EMR was on the screen. I can't remember what we were doing, but it needed some score calculation -- perhaps a CHA2DS2-VASc score. So I clicked on the web browser on the student's computer. And there it was. Twice. And I didn't end their career. Another warning would likely be ignored again.

Perhaps it wasn't even medical content that they were accessing -- I honestly don't remember. Regardless, it was unacceptable. I was amazed that after being told once, it continued. For sure, all hospital computers have full access to everything, so they had other choices.

I mean, the other students in the section are clearly able to do their work without broadcasting nude ads across the workroom. And I'm sure they're all not shelling out the dough for a proper subscription to whatever service. Many medical schools provide a logon - I know with Uptodate, at many places, you can register with your school email and get a login for remote access.

 

[doctalaughs]

Oh how things have changed since the days depicted in The House of God.


Sent from my iPhone using SDN mobile

 

[LucidSplash]

If you can access UTD via the institutional computers then you can create an account and get access that will allow you to access it on your phone or your private laptop. You have to log in on the institutional device every so often to maintain the free access, but it's not hard to do this. It is how I have UTD on my phone (app) without paying for it. Either your student was clueless about this or he lied.

 

[nimbus]

I can't believe you're even having this discussion. Who gives a s***!? Program directors are the porn police? Really? Are you going through everybody's devices?

 

[deleted109597]

I can't believe you're even having this discussion. Who gives a s***!? Program directors are the porn police? Really? Are you going through everybody's devices?

Thanks for the driveby, but this is not even close to the situation.

As far as UTDOL, not every hospital pays for it. In fact, none of them in my city do. Thankfully I have legal access through other means, but apparently they're charging a lot for it, or the hospitals are being cheap.

 

[d2305]

I would have given the poor student a subscription to uptodate to keep him out of trouble. It's only $19/month.

 

[evilbooyaa]

You can function without UpToDate, it's not like some magical website without which your life is misery. It is nice to have, but the hospital can't just provide him with access- UTD costs six to seven figures for a subscription, and they charge more based upon how many users you want to authorize. If the student feels it is so critical to their learning, they should pay for it. A student subscription is 200 bucks, or 100 if you're an AMSA member, chump change compared to the hundreds of thousands they've already dropped on medical school, and well worth the cost of having not been thrown out of a rotation. If you want the products companies spend enormous amounts of money to produce and update, pay for them, it's not that hard.

I'm aware, that on my clinical rotations, I could function without up-to-date access at every second of the day. However, it is helpful (more for medical students and early stage residents) to have access to at least sometimes. Hospitals spend a lot of money in a lot of places, and I'm just saying that having a 10-20 rotation of medical student log-ins probably isn't overtly cost prohibitive given how many subscriptions I'm sure the hospital already has.

I certainly accessed UpToDate a few times per week as a student while reading up on patients, but there were enough computers at the hospital to give me that access. I remember the cost was about $179 for 6 months for a student subscription, not something I was enthusiastic about having to budget during medical school. You can use the argument of "Lol you're paying 200k anyways, what's an extra 500 or 1k over your medical school career" if you want, but I don't agree with that mindset to just push costs to students just because you can.

If you can access UTD via the institutional computers then you can create an account and get access that will allow you to access it on your phone or your private laptop. You have to log in on the institutional device every so often to maintain the free access, but it's not hard to do this. It is how I have UTD on my phone (app) without paying for it. Either your student was clueless about this or he lied.

I will say that I was not aware of this possibility whatsoever, even when I accessed UpToDate frequently. Although I only needed access to it at work, so not like I was searching for methods at home.

Our institution has plenty of work computers for people to use. However, it's much more convenient to have your own laptop. We issue laptops to our residents, and all faculty have laptops. So, when on rounds, we can just get work done. Students don't get hospital laptops, they all have their own -- whether issued by their medical school or paid independently, I don't know. They all look the same, so I assume there's some standard involved.

When accessing the hospital system via their laptops, they have full EMR access, and I believe full UTD access also.

I wasn't "snooping" in their laptops. We are all working together in a team room. The student asked me for help putting some orders in. They brought their computer over, the EMR was on the screen. I can't remember what we were doing, but it needed some score calculation -- perhaps a CHA2DS2-VASc score. So I clicked on the web browser on the student's computer. And there it was. Twice. And I didn't end their career. Another warning would likely be ignored again.

Perhaps it wasn't even medical content that they were accessing -- I honestly don't remember. Regardless, it was unacceptable. I was amazed that after being told once, it continued. For sure, all hospital computers have full access to everything, so they had other choices.

So as residents and faculty all have laptops, and therefore medical students are expected to have laptops. If they're on the hospital network on their personal computers, they should have access to UpToDate. If that's the case, then the student made a bad decision. However, if the students don't have UTD access while on the hospital network, how are they supposed to do any reading, since everyone else has hospital-issued laptops which likely give you access.

None of this is to attack you, aPD, but just suggest that there may be somewhat of a systems issue which drove this student to this decision. Still a stupid decision and carelessness on his part to get busted for graphic images, at work, twice.

 

[Mad Jack]

I'm aware, that on my clinical rotations, I could function without up-to-date access at every second of the day. However, it is helpful (more for medical students and early stage residents) to have access to at least sometimes. Hospitals spend a lot of money in a lot of places, and I'm just saying that having a 10-20 rotation of medical student log-ins probably isn't overtly cost prohibitive given how many subscriptions I'm sure the hospital already has.

I certainly accessed UpToDate a few times per week as a student while reading up on patients, but there were enough computers at the hospital to give me that access. I remember the cost was about $179 for 6 months for a student subscription, not something I was enthusiastic about having to budget during medical school. You can use the argument of "Lol you're paying 200k anyways, what's an extra 500 or 1k over your medical school career" if you want, but I don't agree with that mindset to just push costs to students just because you can.



I will say that I was not aware of this possibility whatsoever, even when I accessed UpToDate frequently. Although I only needed access to it at work, so not like I was searching for methods at home.



So as residents and faculty all have laptops, and therefore medical students are expected to have laptops. If they're on the hospital network on their personal computers, they should have access to UpToDate. If that's the case, then the student made a bad decision. However, if the students don't have UTD access while on the hospital network, how are they supposed to do any reading, since everyone else has hospital-issued laptops which likely give you access.

None of this is to attack you, aPD, but just suggest that there may be somewhat of a systems issue which drove this student to this decision. Still a stupid decision and carelessness on his part to get busted for graphic images, at work, twice.

10-20 additional licenses for UTD isn't how it works- licenses are issued per person, so you'd need to buy one for every student rotating through, at the discounted institutional rate of around 400/head, depending on what deal they get. That adds up to $400,000 for a class of 100, hardly chump change, considering many large hospitals actually run in the red. You could hire six new nurses for that amount, or two academic cardiologists...

 

[dpmd]

10-20 additional licenses for UTD isn't how it works- licenses are issued per person, so you'd need to buy one for every student rotating through, at the discounted institutional rate of around 400/head, depending on what deal they get. That adds up to $400,000 for a class of 100, hardly chump change, considering many large hospitals actually run in the red. You could hire six new nurses for that amount, or two academic cardiologists...

Plus it isn't like you need to have access to it. I managed to go through med school and 5 yrs of residency (plus 5 yrs of attending life to date) never once having looked at up to date. And I had institutional access from residency onward (but by that point was used to finding info elsewhere)

 

[TableMD]

I can't imagine the embarrassment related to getting caught with NSFW images at a hospital/clinic. Given the cost associated with medical school, if you need UTD or whatever resource and your school can't help you, just come up with the cash and get it done. To be be caught TWICE by a high level, legit internist like aprogDirector, is unthinkable. I am still a resident and I pay $90 for essential evidence because I think it is a wonderful resource, and in the grand scheme of my debt and salary, it is pocket money (a nice dinner out).

Unreal.

 

[Perrotfish]

To follow up on my other question -- thanks for opinions. I was also torn about what to do. I felt that my first warning should have been sufficient to stop the behavior and that a second warning without some escalation wasn't something I was comfortable with. Clearly the student didn't understand how serious I felt the situation was. At my institution, VPN isn't an option -- although they can log in remotely via citrix, it's buggy and slow. Regardless, I felt it was this student's responsibility to find a solution. Yet, I didn't want to create a situation that brought this student's career to an end -- that seemed wrong also.

An idea for next time: in the military, anytime anything remotely serious happens, the counseling given is 'formal', meaning its not only sit down counseling in an office in a closed door, but that you finish the counseling session by giving them a written summary of your counseling to sign. You make it clear, in writing, that signing the counseling only acknowledges that they received it, not that they are confessing to any accusations in the counseling. You usually end with the plan for what happens next, which can be as simple as 'this is over for now and won't affect your evaluation, but if it happens again...'. If anyone is dimwitted enough not to understand the seriousness of written counseling, well then honestly they're probably too dumb to be in medical school in the first place.

I 100% agree with you that what the student was doing was inappropriate at needed to stop. That being said I got a lot of drive by criticism in medical school, and it was sometimes difficult to figure out what was really annoying/serious for an attending and what was just a target of opportunity. I also had basically no idea who was and wasn't in a position of power on any given rotation. The thing that makes me sympathetic to student is that I really don't know how well you made your particularly drop of criticism stand out from the ocean that we all swam in.

My suggestion is that, if its worth going to the rotation director on the second offense, that means its worth going to formal counseling on the first offense. If its only worth an informal verbal warning on the first offense, you're basically committing yourself to giving the student three strikes before you go to the rotation director.

 

[Perrotfish]

Plus it isn't like you need to have access to it. I managed to go through med school and 5 yrs of residency (plus 5 yrs of attending life to date) never once having looked at up to date. And I had institutional access from residency onward (but by that point was used to finding info elsewhere)

I will never understand how people do this. Uptodate is basically never closed on my computer.

 

[dpmd]

I will never understand how people do this. Uptodate is basically never closed on my computer.

If you never opened it you have no idea what you are missing I guess. Plus I'm a surgeon so I don't think I am the target audience.

 

[SageRad]

10-20 additional licenses for UTD isn't how it works- licenses are issued per person, so you'd need to buy one for every student rotating through, at the discounted institutional rate of around 400/head, depending on what deal they get. That adds up to $400,000 for a class of 100, hardly chump change, considering many large hospitals actually run in the red. You could hire six new nurses for that amount, or two academic cardiologists...

Not to nitpick, but I am coming up with $40,000 ($400/head times 100 students). More relevant, I have poked around in UTD at our hospital and have not found it to be useful for my practice. I would guess that the folks that sell it are making a killing because it appears to be successfully marketed as the Holy Grail of medical knowledge, but from what I can see, there are plenty of other places to get that information. Then again, if the marketing is as successful as it appears to be, the Holy Grail might be self-fulfilling.

 

[wholeheartedly]

10-20 additional licenses for UTD isn't how it works- licenses are issued per person, so you'd need to buy one for every student rotating through, at the discounted institutional rate of around 400/head, depending on what deal they get. That adds up to $400,000 for a class of 100, hardly chump change, considering many large hospitals actually run in the red. You could hire six new nurses for that amount, or two academic cardiologists...

I'm a bit skeptical that this is how it works for institutional type subscriptions. Any institution I've worked at, anyone with access to the hospital computer system had access to UptoDate. Given turnover of staff it wouldn't be sane to issue it per person. Most of our licenses for things like this were issued based on a per computer basis or a certain sized institution fee.

 

[Mad Jack]

Not to nitpick, but I am coming up with $40,000 ($400/head times 100 students). More relevant, I have poked around in UTD at our hospital and have not found it to be useful for my practice. I would guess that the folks that sell it are making a killing because it appears to be successfully marketed as the Holy Grail of medical knowledge, but from what I can see, there are plenty of other places to get that information. Then again, if the marketing is as successful as it appears to be, the Holy Grail might be self-fulfilling.

Eh, you're right, I was tiiiired when I posted that. But 40k is 40k, it's not exactly nothing.

 

[Mad Jack]

I'm a bit skeptical that this is how it works for institutional type subscriptions. Any institution I've worked at, anyone with access to the hospital computer system had access to UptoDate. Given turnover of staff it wouldn't be sane to issue it per person. Most of our licenses for things like this were issued based on a per computer basis or a certain sized institution fee.

You can get per computer subscriptions, but they only are cost effective if you have at least three users per machine (1500/machine/year is the going rate) so many hospitals do it by user. UTD is crazy expensive, the hospital I'm at now literally can't afford it, as an example. I have it through my school, so I'm fine, but when they ran down why they don't use it I was shocked.