Cybercivility in Health Professions Education: A Qualitative Exploration of Perception and Experiences of Postgraduate Medical Students and Faculty

Cybercivility in Health Professions Education: A Qualitative Exploration of Perception and Experiences of Postgraduate Medical Students and Faculty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cybercivility in Health Professions Education: A Qualitative Exploration of Perception and Experiences of Postgraduate Medical Students and Faculty Kiran Imtiaz Khan, Brekhna Jamil, Bushra Mehboob This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7321624/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: In digital environments, anonymity and the absence of body language cues often result in individuals behaving differently, sometimes inappropriately. Given cyberspace’s increasing integration into education, our collective responsibility is to exhibit civil online behaviors, upholding an environment of respect, cooperation, and professionalism. This study aimed to qualitatively explore postgraduate medical students' and faculty’s perceptions of cybercivility and experiences of cyberincivility. Methods: An exploratory qualitative phenomenological study was conducted. Semi-structured Zoom interviews involved a maximum-variation purposive sample of nine faculty members and twelve postgraduate students in Health Professions Education. Recorded sessions were transcribed verbatim. Thematic analysis was done manually following Braun and Clarke's methodology, with codes, subthemes, and themes established from transcripts. Results: Thematic analysis yielded five themes: professional online conduct, cyberincivility manifestations, its negative impact, barriers to cybercivility, and strategies for promoting cybercivility. All interviewees identified challenges in cultivating cybercivility and addressing cyberincivility. Participants proposed strategies to mitigate these challenges and promote civil online conduct. Postgraduate students and faculty shared similar perceptions regarding cybercivility and experiences of cyberincivility. Discussion: While participants recognize the necessity of cybercivility, its implementation is hindered by unclear boundaries, lack of awareness, inadequate training, and the absence of institutional policies. Cyberincivility negatively impacts emotional well-being, professional relationships, and educational outcomes. Promoting a cybercivility culture requires targeted training, clear norms, and institutional support structures. Future research should encompass a variety of health professions and develop quantitative tools for evaluating cybercivility. Cybercivility Cyberbullying Health professional education Dental Education Medical education Postgraduate students Figures Figure 1 Introduction The incorporation of digital technology into educational settings has sparked a revolutionary shift in the delivery of education across various disciplines. Health Professions Education (HPE) has undergone a digital transformation, making online platforms, virtual learning modules, and digital communication tools indispensable for teaching and learning [ 1 ]. These advancements not only create new opportunities but also have the potential to enhance educational experiences significantly. However, they present unique challenges, including the emergence of cyberincivility, which threatens constructive and thoughtful online exchanges essential for effective education [ 2 ]. Cybercivility refers to ethical, responsible, and courteous behavior in digital interactions to maintain a constructive and inclusive online environment. This involves demonstrating empathy, tolerance, and professionalism to foster a secure environment for knowledge acquisition [ 3 ]. Conversely, cyberincivility encompasses behaviors that contravene established standards of respect and ethics online. Within Health Professions Education, these issues may manifest as verbal mistreatment, improper publications, academic breaches, confidentiality violations, and negligent actions like disregarding emails, ambiguous communication, and inadequate feedback from faculty [ 4 ]. Cyberincivility impacts health professions students and educators, leading to adverse consequences for academic achievement, professional growth, and psychological well-being [ 5 ]. Kim, Song, et al., reported that individuals subjected to online incivility frequently describe feelings of distress, anxiety, despair, social isolation, and exhaustion. These outcomes negatively impact their educational experiences and hinder professional development. Additionally, cyberincivility can disrupt learning, strain relationships, and damage mentor-mentee dynamics in health professions [ 6 ]. Numerous studies highlight uncivil online behaviors by students and faculty in Health Professions [ 4 ]. A survey of medical students in Brazil revealed that 60% of the participants engaged in distributing unprofessional material online [ 7 ]. This may be because in-person interactions are typically guided by social norms, body language cues, and immediate feedback, contributing to civility and respectful behavior. However, online, anonymity and the absence of physical consequences often result in different, sometimes impulsive behavior [ 8 ]. Perceptions of suitable online conduct vary across cultures and individuals. What is considered civil in one sociocultural context may differ in another [ 9 ]. The need to learn the "right way" of behaving online warrants investigation of how both learners and faculty members perceive cybercivility. Comprehending these subjective viewpoints can help address challenges in promoting respectful online interactions [ 6 , 9 ]. Existing research on cybercivility in HPE focuses on undergraduate experiences, particularly nursing, leaving postgraduate and faculty perceptions unexplored [ 4 ]. Furthermore, most of the existing research utilizes quantitative methodologies, neglecting qualitative aspects, and considerably centering U.S. populations, limiting exploration of cybercivility in alternative sociocultural contexts where norms of online conduct may vary [ 6 , 9 ]. This study addresses these gaps by exploring how postgraduate medical students and faculty members within a local sociocultural context perceive cybercivility and experience cyberincivility. The study has implications for highlighting awareness levels and drivers of incivility, and can inform interventions to guide respectful behavior and improve healthcare education and patient care outcomes. Methods Study design: The study is a qualitative phenomenological inquiry, best aligned to explore the perceptions and experiences of post-graduate medical students and faculty regarding cybercivility [ 10 ]. Study Settings: The study was conducted in Pakistan at the Khyber Medical University, Peshawar, Riphah International University, Islamabad, and the University of Lahore, Lahore. Sample Size and Selection: Participants included faculty and postgraduate students from Master’s in Health Professions Education programs across three universities selected through a Maximum Variation Purposive sampling [ 11 ]. The study included 21 participants: nine faculty members and 12 postgraduate medical students. Data collection and analysis continued until data saturation was attained, with no new themes emerging in the subsequent interviews. Data collection instrument Following an extensive literature review, semi-structured interview guides were developed to evaluate faculty and postgraduate resident perceptions and experiences of cybercivility and cyberincivility. Five medical education experts reviewed the guides for content and face validity, prompting modifications to reduce repetition, enhance flow, and remove ambiguity (Supplementary file 1: Appendix 1. Semi-structured interview guide for faculty members, Supplementary file 2: Appendix 2. Semi-structured interview guide for postgraduate students). A pilot test was conducted with postgraduate medical students and faculty members to assess clarity and relevance, with interviews lasting 20–40 minutes. Based on feedback, wording, sequence, and follow-up prompts were refined to enhance comprehension and data depth. Data collection After approvals from the ASRB and Ethical Board of Khyber Medical University, institutional permission was obtained from the administration of participating institutions. Eligible participants were identified and approached. Upon expressing interest, they received a participant information sheet, and written consent was obtained. Faculty and students were interviewed via Zoom about their understanding of cybercivility and experiences with cyberincivility. Participants were assigned coded names (R001 to R021) to maintain confidentiality, with detailed participant descriptions only on consent forms. Interviews were recorded on Zoom, transcribed verbatim, and participant anonymity was ensured. Data analysis Recordings from all 21 interviews were stored on a password-protected computer and backed up to Zoom’s cloud, accessible only to the research team. Each file was given an identification number matching the participant code and transcribed verbatim to MS Word. The dataset included nine faculty and 12 postgraduate student transcripts. Using Braun & Clarke’s six-step framework for thematic analysis [ 12 ], transcripts were thoroughly read, initial codes were generated, and then organized into themes. Themes were carefully reviewed, defined, and integrated into a coherent narrative reflecting the data. Ethical considerations The study adhered to the Declaration of Helsinki and followed its ethical guidelines to ensure participants’ anonymity and confidentiality, with data accessible only to the research team. The study received approval from the Advanced Study and Research Board (ASRB) at Khyber Medical University (KMU), Peshawar (ASRB001384/EC/IHPE), in its 155th meeting, and was also approved by the Ethical Board-KMU. (Approval no. 1–12/IHPER/MHPE/KMU/24 − 07) Quality Assurance Validation strategies included a peer-assisted review by medical education specialists to ensure data triangulation, following the Guba Framework to maintain rigor. Credibility was upheld by aligning the research problem, methodology, and analysis, and using purposive sampling for data saturation. Transferability was addressed by conducting the study across three medical institutions in Pakistan, enabling application to similar settings. Reflexivity acknowledged the researcher’s influence, emphasizing transparency and ethical considerations like informed consent and anonymity. Confirmability was ensured through peer triangulation, respondent validation, and thematic analysis per Braun and Clarke [ 12 ]. Dependability was supported by detailing the research design for replication, though exact results may vary in qualitative research. Results Out of 21 participants, 11 were females and 10 were males. The demographic characteristics of participants are given in Tables 1 and 2 . Table 1 Characteristics of Faculty Participants Sr. No. Code Gender Education Position No. of Social Media Accounts Hours Spent using social media/ day Emails received/ day Texts received/day 1 R001 Female MBBS, MPhil Scholar Lecturer 3 Upto 12 > 4 > 50 2 R002 Female MBBS, MHPE Assistant Professor 5 Upto 2 > 25 > 30 3 R003 Male MBBS, DFM, MHPE Assistant Professor 3 Upto 3 > 10 > 50 4 R004 Male MBBS, DHPE, PhD. Associate Professor 1 Upto 1 > 15 > 200 5 R005 Female BDS, MHPE Assistant Professor 3 Upto 5 > 15 > 40 6 R006 Male MBBS, MHPE, PhD Associate Professor 3 Upto 2 > 50 > 15 7 R007 Male MBBS, MHPE, PhD. Professor 3 Upto 1 > 30 > 20 8 R008 Female BDS, MHPE Assistant Professor 3 Upto 3 > 40 > 20 9 R009 Female MBBS, MHPE Assistant Professor 3 Upto 2 > 50 > 30 Table 2 Characteristics of the postgraduate student participants Sr. No. Code Gender Education Year of Postgraduate program No. Of Social Media Accounts Hours spent using social media/day Emails received /day Texts received/day 1 R010 Female BDS, MHPE Scholar 1st Year 5 Upto 4 > 2 > 50 2 R011 Male BDS, MDS, CHPE, MHPE Scholar 2nd Year 3 Upto 8 > 3 > 20 3 R012 Female BDS, MHPE Scholar 1st Year 3 Upto 3 > 3 > 7 4 R013 Male MBBS, FCPS, MHPE Scholar 2nd Year 3 Upto 2 > 5 > 30 5 R014 Male MBBS, FCPS, MHPE Scholar 2nd Year 4 Upto 2 > 35 > 90 6 R015 Female MBBS, MPhil 1st Year 2 Upto 3 > 10 > 30 7 R016 Male BDS, MHPE Scholar 1st Year 4 Upto 5 > 3 > 3 8 R017 Female MBBS, MCPS, FCPS, MHPE Scholar 2nd Year 2 Upto 1 > 20 > 8 9 R018 Male BDS, FCPS, MHPE Scholar 2nd Year 2 Upto 2 > 10 > 35 10 R019 Female BDS, MHPE Scholar 2nd Year 2 Upto 2 > 7 > 35 11 R020 Female BDS, MCPS, MHPE Scholar 1st Year 3 Upto 4 > 3 > 15 12 R021 Male BDS, MHPE Scholar 1st Year 1 Upto 2 > 20 > 200 Initially, data from faculty members and postgraduate students were analyzed separately. During the first cycle of coding, descriptive coding and in vivo coding were done with 231 codes emerging from faculty data and 200 codes from student data, resulting in 431 open codes. In the second round of coding, similar and related codes from the initial open coding phase were merged, and any duplicate codes were removed, resulting in 86 axial codes. These codes were then organized into 21 sub-themes and grouped into five main themes (Supplementary file 3: Appendix 3. Codes, sub-themes and themes). Participants highlighted the importance of professional online conduct, the manifestations of cyberincivility on individuals and institutions, the challenges in promoting civil behavior online, and strategies to encourage cybercivility in Health Professions Education (Table 3 , Fig. 1 ). Table 3 Themes representing the perceptions and experiences of participants regarding cybercivility and cyberincivility Themes Sub-Themes Quotes Professional Online Conduct Professional and Ethical Behavior "Online posts must be very respectful and must follow professional standards." ( R012) Civility in all settings “Sometimes few things may appear uncivil in one context, maybe in a very conservative country like ours, whereas it may not appear bad in a more liberal or secular society. So, there can be these differences as well, contextual and cultural differences, but overall, I think the broad concept of civility remains the same.” (R004) Manifestations Of Cyberincivility Disrespect and Cyberbullying "In an online forum for Oral and Maxillofacial surgeons in Pakistan, the consultants were blatantly bashing women, that women cannot do surgery and that they should not be considered for consultant posts.” (R018) Lack of e-professionalism "Some guys intentionally unbutton their collars, some would be showing off their shoulders, and making sure the light on them makes them look good, showing off basically." (R011) Online Platforms susceptible to cyberincivility “Incidents of cyberincivility can occur everywhere. But mostly on these nonprofessional social apps, Facebook or WhatsApp or TikTok." (R016) Negative Impact of Cyberincivility Poor Personal and Professional Dynamics "Situations escalate from minor issues and lead to explicit animosity." (R009) Emotional Consequences of cyberincivility “If I see someone behaving rudely online, it sticks with me. It builds up a bit of prejudice, and I start seeing them differently." (R013) Psychological Strain "I feel I am not my true self because of fears of being misjudged and discrimination." Deterioration of Public and Institutional Trust "Even though it was just one person lagging, it made the whole department look bad." (R012 ) Barriers to Cybercivility Blurring Of Personal and Professional Boundaries "If you are using the very same profile for personal and professional reasons, then it actually does not remain personal. It is always sort of a professional space for you.” (R014) Online Communication Challenges "They see the comment, and they just interpret and make meaning out of it, and then the thing starts.” (R003) Institutional and Structural Barriers "The policymakers or the institutions are more concerned with face-to-face classes or covering the syllabus... and still, even in the post-COVID era." (R007) Power Dynamics "If I'm a student and I'm facing some person who is in authority, who is my teacher and will be dealing with all my exams, from the fear of retaliation or the fear of that teacher, I won't bring my problem up." (R019) Online Environmental and Behavioral Constraints "The biggest barrier is people's own inability to regulate their behavior." (R021) Ignorance and Digital Illiteracy "People are not even aware of the need to be civil online." (R011) Strategies For Promoting Cybercivility Educational Interventions and Professional Development "Workshops can be conducted in a way where people would come forward with their experiences of cyberbullying and how it affected them; this would work a great deal, in my opinion, when you get to see that the words you post online have actual effects on real people." (R019) Guidelines and Policies "We have to develop clear policies and guidelines both for the students and the faculty. Then we have to reinforce that these are very important and have to be followed." (R020) Personal Responsibility and Accountability "On a personal level, we have to be respectful and create a supportive learning environment, and refrain from using inappropriate language." (R010) Leading by Example "Whatever we say, whatever we do, then we have to role model it. We have to show it. We have to demonstrate it.” (R004) Intentional Disengagement "I just stopped using it. I deleted my account." (R009) Creating a safe and collaborative environment "Groups will be safer if there is one person responsible for regulating group conduct and has authority to control such people, like a teacher in a group. A respectable person whose voice will be heard by all." (R002) Professional Online Conduct The codes ‘Professionalism in online interactions’ and ‘respect and ethical communication’ were the most frequent in this theme. Professional and Ethical behavior was highlighted as a major attribute of cybercivility. Participant R001 emphasized, “I think cybercivility is to be respectful not only with the teachers but students, administrators, and other stakeholders as well.” Many participants stated that civility in all settings is essential, whether online or in person. Faculty and students viewed cybercivility as an extension of one’s personality; with participant R011 articulating, “ If somebody is not a civil person offline, he would not be a civil person online.” Participants highlighted that cybercivility encompasses respect, context-appropriate communication, and using formal, professional language on social media. Manifestations of Cyberincivility Most participants believe disrespect and cyberbullying are prevalent uncivil behaviors online. Participant R004 stated, “I have actually seen colleagues fighting on WhatsApp groups with each other. If you want to fight, you can probably do it in personal messages. Why do you want to tell the world about it? " Participants associated cyberincivility with a lack of e-professionalism . This includes inappropriate behavior, irrelevant content sharing, self-promotion, non-responsiveness, rudeness, poor feedback, unpreparedness, plagiarism, and unprofessional use of social media. Participant R001 described an instance of e-professionalism exhibited by a postgraduate student, stating, "Her presentation was not up to the mark. So, I asked her why it was like that. She replied that she did not have time for it. That upset me a little, and I told her that her behavior was very unprofessional." Participants noted that online platforms susceptible to cyberincivility are not only the less professional social media platforms, but educational and professional platforms are equally prone to online incivility. Negative Impact of Cyberincivility Participants acknowledged the impact of cyberincivility on personal and professional dynamics . Participant R011 stated, “Personal well-being is directly related to professional relationships. So, you see, everything gets messed up if there is such an environment or incident." Participants also mentioned the emotional consequences of cyberincivility , including embarrassment, anxiety, and distress. Cyberincivility can result in psychological strain , manifesting as stress, depression, burnout, and decreased educational engagement. Participant R008 stated, “My colleague had some issues with her assignment, and she was trying to communicate with the facilitator, but he was not responding to her WhatsApp texts and emails, so she failed the assignment, and she became so disheartened that she quit the entire course.” Cyberincivility can also damage a person’s and a profession’s reputation, eroding public and institutional trust . Barriers to Cybercivility Participants identified numerous challenges to promoting cybercivility, including the blurring of personal-professional boundaries and online communication challenges . Participant R016 noted, “Without verbal cues, things often get lost in translation, and the tone can be misinterpreted.” Institutional and structural barriers were highlighted as a major problem. Participant R009 stated, “The biggest challenge is not having an institutional policy, and that is what I have been advocating since the day I joined the University.” Participants shed light on the power dynamics at play in Health Professions Education and identified it as a primary hurdle in the way of addressing cyberincivility. Participant R004 highlighted, “I may have seen accountability, but that accountability is only for the weak and the ones who cannot stand up. I mean, what about the accountability of those who are in power?” Other barriers include online environmental and behavioral constraints, ignorance, and digital illiteracy . Participant R002 said, “People feel that if they are in online space, they are not bound by any code of conduct, and they hide behind this e-curtain.” Strategies for Promoting Cybercivility Participants emphasized the role of educational interventions and professional development in promoting cybercivility. R003 stated, "Cybercivility could be promoted by incorporating it formally into the curriculum and assessments." The preeminent strategy proposed is the establishment of policies and guidelines and the subsequent assurance of their implementation. Personal responsibility and accountability were also highlighted. Participants also suggested leading by example . Participant R011 stated, “If the faculty are being professional, it reflects on the students, and they will be professional." Many participants suggested intentional disengagement from social media and conflict situations to avoid cyberincivility, as R005 articulated, "Sometimes it feels easier to just ignore it to avoid drama." Creating a safe and collaborative online environment was deemed essential, with R017 claiming, "As a comparatively younger generation with more empathy than our seniors, I think the responsibility lies upon us to build an environment which caters to everyone and is respectful to each regardless of age, rank, and gender." Discussion This qualitative study explored postgraduate medical students' and faculty’s perceptions of cybercivility and experiences with cyberincivility, organized into five main themes: professional conduct online, manifestations of cyberincivility, its impact, barriers to cybercivility, and strategies for promoting cybercivility. Most participants viewed respect and professionalism as essential aspects of cybercivility, often interchanging them with e-professionalism. Words like respect, professionalism, etiquette, and courtesy were used as key descriptors for cybercivility. For postgraduate students, cybercivility meant respectful treatment from faculty, timely responses, constructive feedback, and avoiding bullying and mockery. Faculty echoed the significance of confidentiality, professionalism, and relevant online sharing. Both groups noted that cybercivility mirrors civil face-to-face interactions. However, research shows individuals often exhibit more uncivil behavior online, likely due to anonymity and the perceived disconnect from real-world interactions. Participants discussed various online behaviors they deemed uncivil. Postgraduate students identified faculty cyberincivility as rude and derogatory comments, ignoring queries, bullying, and harsh criticism. On the other hand, faculty noted student behaviors like plagiarism, disruption, self-advertising, conflicts, intruding on personal time, and misusing social media. An integrative review of cybercivility in Health Professions Education highlighted similar findings [ 4 ]. While a few participants claimed they had never experienced or witnessed cyberincivility, most postgraduate students and all faculty members reported encountering it. There is substantial literature documenting the high prevalence of cyberincivility in health professions education [ 4 , 13 , 14 ]. Participants recognized that uncivil behaviors arise from unprofessionalism in digital environments and agreed that it is pervasive across all platforms, including professional settings like Zoom, Microsoft Teams, email, and Moodle, and social media sites like Instagram, Facebook, and Twitter. A scoping review conducted in 2021 also confirmed the presence of cyberincivility across these domains [ 15 ]. The widespread occurrence of cyberincivility on these platforms may be attributed to their global usage [ 16 , 17 ]. The emotional and psychological impacts of cyberincivility emerged as another significant theme. Participants reported feeling embarrassment, heartbreak, distress, fear, and anxiety when facing or witnessing cyberincivility. They highlighted that public criticism or negative online content could tarnish reputations and diminish both individual and institutional credibility. Erbil et al. reported similar findings in 2009 [ 18 ]. This is because humans tend to be influenced by the opinions of others. Cyberincivilty was linked to mental health issues such as overthinking, stress, depression, and burnout. It can lead to diminished self-confidence and loss of interest in education and work. Participants also asserted that cyberincivility might erode trust and empathy, resulting in strained interpersonal and professional relationships, which can subsequently reduce job satisfaction. A research study examining the experiences of cyberincivility among Korean nurses revealed that those who suffered emotional distress due to cyberincivility often developed symptoms of depression, leading to a passive approach in patient care [ 6 ]. A study by Chen YY et al. revealed that individuals subjected to verbal and relational bullying in college exhibit markedly diminished health-related quality of life [ 19 ]. Some study participants reported incidences of individuals failing assessments and quitting educational programs because of incidents of online incivility. The results from present and previous studies can be explained by the theory of Humanism and Maslow’s hierarchy of needs. Maslow asserted that to learn, students must experience safety—physically, emotionally, and mentally to learn and thrive without the burden of additional anxieties. Students should feel comfortable posing inquiries or expressing concerns without the apprehension of criticism from the instructor or judgment from their classmates. One primary issue identified in addressing cybercivility is the blurred line between personal and professional boundaries online. Participants stated that uncivil behaviors often arise from contacting individuals outside professional hours or sharing their personal information on professional platforms. A qualitative study reported that nursing students frequently contacted outside of working hours had heightened stress, leading to mental and emotional exhaustion 6 . Miscommunication and misinterpretation due to a lack of verbal cues are also challenges in online spaces, making intentions harder to discern and increasing the likelihood of perceived incivility. Anonymity and a lack of adequate training further contribute to this problem. A major obstacle to cybercivility is the lack of institutional policies or guidelines. Participants noted that the institutions involved lacked specific policies addressing cybercivility despite a significant online component in the curriculum. Previous studies corroborate this finding, showing that few institutions have policies outlining professional behavior in online education settings [ 20 ]. Without clear policies, participants feared reporting cyberincivility due to potential repercussions or hierarchical dynamics, with students in particular fearing academic penalties. This contrasts with a prior study, which found students more inclined to report such incidents [ 4 ]. Faculty members noted they often remained silent on incidents of incivility to avoid unnecessary conflict, especially in the absence of clear institutional support. To promote cybercivility, participants emphasized the need for educational initiatives, policies, and role modelling. Some advocated for including cybercivility education in undergraduate medical programs and offering workshops to raise awareness. These suggestions are consistent with previous studies, which suggest that schools provide resources like websites or counselling services to promote civil online interactions [ 15 , 21 ]. Some participants encouraged intentional disengagement from social media to avoid drama or incivility. Participants also recommended establishing clear guidelines and policies for online behavior, instituting anonymous reporting channels, and providing support systems for those affected by cyberincivility. This study exclusively involved participants from the Master’s in Health Professions Education program, with the majority representing various primary medical specialties. This strategic selection enhanced the diversity of the data but excluded other health professionals like nurses and pharmacists, possibly limiting the generalizability of the findings. Future research could employ larger sample sizes to include a broader range of health professionals/ postgraduate programs to enhance a comprehensive understanding of cybercivility. Additionally, a validated questionnaire specific to cybercivility post-COVID-19 could be developed for quantitative and mixed-methods research. Conclusion This study explored how postgraduate medical students and teachers perceive cybercivility and experience cyberincivility. It emphasizes the importance of respectful, ethical, and professional online behavior. The results show that while participants recognize the need for cybercivility, its implementation is hindered by issues such as unclear personal-professional boundaries, lack of awareness, inadequate training, and the absence of institutional policies. Cyberincivility negatively impacts emotional well-being, professional relationships, and educational outcomes. Promoting a culture of cybercivility requires focused training programs, clear norms, and strong institutional support structures. Future research should encompass a variety of health professions and develop quantitative tools for evaluating cybercivility. Declarations Ethics approval and consent to participate The study received approval from Khyber Medical University Ethics Board (Approval no. 1-12/IHPER/MHPE/KMU/24-07). Informed consent was obtained from each participant through written consent forms, which clearly outlined the purpose of the study and the rights of the participants. Consent for publication Not Applicable. Availability of data and materials Data will be made available by the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Clinical Trial Number: Not Applicable Author Contribution Statement Kiran Imtiaz Khan: Conceived and designed the study; collected, analyzed, and interpreted the data; and contributed to drafting the manuscript. Brekhna Jamil: Supervised the study and analyzed and interpreted the data and reviewed the manuscript; Bushra Mehboob: Analyzed and interpreted the data; and contributed to drafting the manuscript. Data Availability Data will be made available by the corresponding author upon reasonable request. References De Gagne JC. Values clarification exercises to prepare nursing students for artificial intelligence integration. Int J Environ Res Public Health. 2023;20(14):6409. DOI: https://www.mdpi.com/1660-4601/20/14/6409 De Gagne JC, Yamane SS, Conklin JL. Evidence-based strategies to create a culture of cybercivility in health professions education. Nurse Educ. Today 201:.45:138–41. DOI: https://pubmed.ncbi.nlm.nih.gov/27472429/ Bengu PC, Naidy CT, Wibowo R, Eka NGA, Purimahua DI. 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Developing inventory of professional attitude at occupation. J. Hum. Sci.2009;6(1):290-302. DOI: https://www.j-humansciences.com/ojs/index.php/ijhs/article/view/419/346 Chen YY, Huang JH. Precollege and In-College bullying experiences and Health-Related quality of life among college students. Pediatrics 2014;135(1):18–25. DOI: https://doi.org/10.1542/peds.2014-1798 De Gagne JC, Yamane SS, Conklin JL, Chang J, Kang HS. Social media use and cybercivility guidelines in U.S. nursing schools: A review of websites. J Prof Nurs. 2017;34(1):35–41. DOI: https://doi.org/10.1016/j.profnurs.2017.07.006 Clark CM, Werth L, Ahten S. Cyber-bullying and Incivility in the Online Learning Environment, Part 1. Nurse Educ. 2012;37(4):150–6. DOI: https://doi.org/10.1097/nne.0b013e31825a87e5 Additional Declarations No competing interests reported. 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Jamil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACAwYGZmYgDcSMjQc+HIAJMiQQpaXh4AxStIDBYR5itJhLHz5sXLjDjp1/2uGGwzZntiU2sDdvk2DckYZTi2VfWnLyzDPJzBK3ExsO59wAkjzHyiQYz+TgdtgZHuPDvG1Ax4G1fACSEjlmEoxtFXi08H8GaqlnlgdpsQBpkX9DSAsPczJv22FmA5AWBpDDJHhAWnA7zLKHzdiYt+04syFQ8cGeM7eN23jSii0Sz+D2vjkP82Np3rbqZLnb6Q8f/Dh2W7af/fDGGx93JOPUAgMIFWwgIrGBoA4GO1QuIxFaRsEoGAWjYMQAADbSWhWaMSv5AAAAAElFTkSuQmCC","orcid":"","institution":"Khyber Medical University","correspondingAuthor":true,"prefix":"","firstName":"Brekhna","middleName":"","lastName":"Jamil","suffix":""},{"id":521738913,"identity":"1b841bd6-2bb2-4524-bac9-20ec50747d91","order_by":2,"name":"Bushra Mehboob","email":"","orcid":"","institution":"Khyber Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Mehboob","suffix":""}],"badges":[],"createdAt":"2025-08-07 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1","display":"","copyAsset":false,"role":"figure","size":205631,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThematic Map representing the perceptions and experiences of participants regarding cybercivility and incivility\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7321624/v1/b7204ff072d64b61f3aa0077.png"},{"id":104398183,"identity":"2a431a2d-c0df-4edf-956a-2cd8d631a2b8","added_by":"auto","created_at":"2026-03-11 12:00:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1132845,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7321624/v1/7db7b6ba-f72b-4e9e-8d44-836fb8df629b.pdf"},{"id":92478287,"identity":"805eb2e5-3b21-4a8e-9f09-a032417961a8","added_by":"auto","created_at":"2025-09-30 07:28:38","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20103,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7321624/v1/c9e77504dd18c7dc2453065e.docx"},{"id":92478288,"identity":"a5f49239-4623-4178-94db-c8122fe7b96e","added_by":"auto","created_at":"2025-09-30 07:28:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20097,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7321624/v1/8e76a1d6e54fb4f1565d5616.docx"},{"id":92476349,"identity":"72351b3d-5e54-4277-a29f-7ab81cf77bdf","added_by":"auto","created_at":"2025-09-30 07:20:38","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":29853,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7321624/v1/f5d1f683f1700fc0c0089cc1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cybercivility in Health Professions Education: A Qualitative Exploration of Perception and Experiences of Postgraduate Medical Students and Faculty","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incorporation of digital technology into educational settings has sparked a revolutionary shift in the delivery of education across various disciplines. Health Professions Education (HPE) has undergone a digital transformation, making online platforms, virtual learning modules, and digital communication tools indispensable for teaching and learning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These advancements not only create new opportunities but also have the potential to enhance educational experiences significantly. However, they present unique challenges, including the emergence of cyberincivility, which threatens constructive and thoughtful online exchanges essential for effective education [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCybercivility refers to ethical, responsible, and courteous behavior in digital interactions to maintain a constructive and inclusive online environment. This involves demonstrating empathy, tolerance, and professionalism to foster a secure environment for knowledge acquisition [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Conversely, cyberincivility encompasses behaviors that contravene established standards of respect and ethics online. Within Health Professions Education, these issues may manifest as verbal mistreatment, improper publications, academic breaches, confidentiality violations, and negligent actions like disregarding emails, ambiguous communication, and inadequate feedback from faculty [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Cyberincivility impacts health professions students and educators, leading to adverse consequences for academic achievement, professional growth, and psychological well-being [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Kim, Song, et al., reported that individuals subjected to online incivility frequently describe feelings of distress, anxiety, despair, social isolation, and exhaustion. These outcomes negatively impact their educational experiences and hinder professional development. Additionally, cyberincivility can disrupt learning, strain relationships, and damage mentor-mentee dynamics in health professions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNumerous studies highlight uncivil online behaviors by students and faculty in Health Professions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A survey of medical students in Brazil revealed that 60% of the participants engaged in distributing unprofessional material online [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This may be because in-person interactions are typically guided by social norms, body language cues, and immediate feedback, contributing to civility and respectful behavior. However, online, anonymity and the absence of physical consequences often result in different, sometimes impulsive behavior [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePerceptions of suitable online conduct vary across cultures and individuals. What is considered civil in one sociocultural context may differ in another [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The need to learn the \"right way\" of behaving online warrants investigation of how both learners and faculty members perceive cybercivility. Comprehending these subjective viewpoints can help address challenges in promoting respectful online interactions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExisting research on cybercivility in HPE focuses on undergraduate experiences, particularly nursing, leaving postgraduate and faculty perceptions unexplored [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, most of the existing research utilizes quantitative methodologies, neglecting qualitative aspects, and considerably centering U.S. populations, limiting exploration of cybercivility in alternative sociocultural contexts where norms of online conduct may vary [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This study addresses these gaps by exploring how postgraduate medical students and faculty members within a local sociocultural context perceive cybercivility and experience cyberincivility. The study has implications for highlighting awareness levels and drivers of incivility, and can inform interventions to guide respectful behavior and improve healthcare education and patient care outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design:\u003c/p\u003e\u003cp\u003eThe study is a qualitative phenomenological inquiry, best aligned to explore the perceptions and experiences of post-graduate medical students and faculty regarding cybercivility [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudy Settings:\u003c/p\u003e\u003cp\u003eThe study was conducted in Pakistan at the Khyber Medical University, Peshawar, Riphah International University, Islamabad, and the University of Lahore, Lahore.\u003c/p\u003e\u003cp\u003eSample Size and Selection:\u003c/p\u003e\u003cp\u003eParticipants included faculty and postgraduate students from Master’s in Health Professions Education programs across three universities selected through a Maximum Variation Purposive sampling [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The study included 21 participants: nine faculty members and 12 postgraduate medical students. Data collection and analysis continued until data saturation was attained, with no new themes emerging in the subsequent interviews.\u003c/p\u003e\u003cp\u003eData collection instrument\u003c/p\u003e\u003cp\u003eFollowing an extensive literature review, semi-structured interview guides were developed to evaluate faculty and postgraduate resident perceptions and experiences of cybercivility and cyberincivility. Five medical education experts reviewed the guides for content and face validity, prompting modifications to reduce repetition, enhance flow, and remove ambiguity (Supplementary file 1: Appendix 1. Semi-structured interview guide for faculty members, Supplementary file 2: Appendix 2. Semi-structured interview guide for postgraduate students). A pilot test was conducted with postgraduate medical students and faculty members to assess clarity and relevance, with interviews lasting 20–40 minutes. Based on feedback, wording, sequence, and follow-up prompts were refined to enhance comprehension and data depth.\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003e After approvals from the ASRB and Ethical Board of Khyber Medical University, institutional permission was obtained from the administration of participating institutions. Eligible participants were identified and approached. Upon expressing interest, they received a participant information sheet, and written consent was obtained. Faculty and students were interviewed via Zoom about their understanding of cybercivility and experiences with cyberincivility. Participants were assigned coded names (R001 to R021) to maintain confidentiality, with detailed participant descriptions only on consent forms. Interviews were recorded on Zoom, transcribed verbatim, and participant anonymity was ensured.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eRecordings from all 21 interviews were stored on a password-protected computer and backed up to Zoom’s cloud, accessible only to the research team. Each file was given an identification number matching the participant code and transcribed verbatim to MS Word. The dataset included nine faculty and 12 postgraduate student transcripts. Using Braun \u0026amp; Clarke’s six-step framework for thematic analysis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], transcripts were thoroughly read, initial codes were generated, and then organized into themes. Themes were carefully reviewed, defined, and integrated into a coherent narrative reflecting the data.\u003c/p\u003e\u003cp\u003eEthical considerations\u003c/p\u003e\u003cp\u003e The study adhered to the Declaration of Helsinki and followed its ethical guidelines to ensure participants’ anonymity and confidentiality, with data accessible only to the research team. The study received approval from the Advanced Study and Research Board (ASRB) at Khyber Medical University (KMU), Peshawar (ASRB001384/EC/IHPE), in its 155th meeting, and was also approved by the Ethical Board-KMU. (Approval no. 1–12/IHPER/MHPE/KMU/24 − 07)\u003c/p\u003e\u003cp\u003eQuality Assurance\u003c/p\u003e\u003cp\u003e Validation strategies included a peer-assisted review by medical education specialists to ensure data triangulation, following the Guba Framework to maintain rigor. Credibility was upheld by aligning the research problem, methodology, and analysis, and using purposive sampling for data saturation. Transferability was addressed by conducting the study across three medical institutions in Pakistan, enabling application to similar settings. Reflexivity acknowledged the researcher’s influence, emphasizing transparency and ethical considerations like informed consent and anonymity. Confirmability was ensured through peer triangulation, respondent validation, and thematic analysis per Braun and Clarke [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Dependability was supported by detailing the research design for replication, though exact results may vary in qualitative research.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 21 participants, 11 were females and 10 were males. The demographic characteristics of participants are given in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Faculty Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSr. No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePosition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo. of Social Media Accounts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHours Spent using social media/ day\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEmails received/ day\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTexts received/day\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MPhil Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLecturer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MHPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssistant Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, DFM, MHPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssistant Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, DHPE, PhD.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssociate Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssistant Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MHPE, PhD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssociate Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MHPE, PhD.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eProfessor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssistant Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MHPE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssistant Professor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the postgraduate student participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSr. No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYear of Postgraduate program\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo. Of Social Media Accounts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHours spent using social media/day\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEmails received /day\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTexts received/day\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MDS, CHPE, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, FCPS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, FCPS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MPhil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMBBS, MCPS, FCPS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, FCPS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MCPS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBDS, MHPE Scholar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1st Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eUpto 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInitially, data from faculty members and postgraduate students were analyzed separately. During the first cycle of coding, descriptive coding and in vivo coding were done with 231 codes emerging from faculty data and 200 codes from student data, resulting in 431 open codes. In the second round of coding, similar and related codes from the initial open coding phase were merged, and any duplicate codes were removed, resulting in 86 axial codes. These codes were then organized into 21 sub-themes and grouped into five main themes (Supplementary file 3: Appendix 3. Codes, sub-themes and themes). Participants highlighted the importance of professional online conduct, the manifestations of cyberincivility on individuals and institutions, the challenges in promoting civil behavior online, and strategies to encourage cybercivility in Health Professions Education (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes representing the perceptions and experiences of participants regarding cybercivility and cyberincivility\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQuotes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eProfessional Online Conduct\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional and Ethical Behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Online posts must be very respectful and must follow professional standards.\" (\u003c/em\u003e\u003cb\u003eR012)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCivility in all settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes few things may appear uncivil in one context, maybe in a very conservative country like ours, whereas it may not appear bad in a more liberal or secular society. So, there can be these differences as well, contextual and cultural differences, but overall, I think the broad concept of civility remains the same.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(R004)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eManifestations Of Cyberincivility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisrespect and Cyberbullying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"In an online forum for Oral and Maxillofacial surgeons in Pakistan, the consultants were blatantly bashing women, that women cannot do surgery and that they should not be considered for consultant posts.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(R018)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of e-professionalism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Some guys intentionally unbutton their collars, some would be showing off their shoulders, and making sure the light on them makes them look good, showing off basically.\"\u003c/em\u003e \u003cb\u003e(R011)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnline Platforms susceptible to cyberincivility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Incidents of cyberincivility can occur everywhere. But mostly on these nonprofessional social apps, Facebook or WhatsApp or TikTok.\"\u003c/em\u003e \u003cb\u003e(R016)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNegative Impact of Cyberincivility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor Personal and Professional Dynamics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Situations escalate from minor issues and lead to explicit animosity.\"\u003c/em\u003e \u003cb\u003e(R009)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional Consequences of cyberincivility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If I see someone behaving rudely online, it sticks with me. It builds up a bit of prejudice, and I start seeing them differently.\"\u003c/em\u003e \u003cb\u003e(R013)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychological Strain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"I feel I am not my true self because of fears of being misjudged and discrimination.\"\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeterioration of Public and Institutional Trust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Even though it was just one person lagging, it made the whole department look bad.\"\u003c/em\u003e \u003cb\u003e(R012\u003c/b\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eBarriers to Cybercivility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlurring Of Personal and Professional Boundaries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"If you are using the very same profile for personal and professional reasons, then it actually does not remain personal. It is always sort of a professional space for you.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(R014)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnline Communication Challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"They see the comment, and they just interpret and make meaning out of it, and then the thing starts.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(R003)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitutional and Structural Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"The policymakers or the institutions are more concerned with face-to-face classes or covering the syllabus... and still, even in the post-COVID era.\"\u003c/em\u003e \u003cb\u003e(R007)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePower Dynamics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"If I'm a student and I'm facing some person who is in authority, who is my teacher and will be dealing with all my exams, from the fear of retaliation or the fear of that teacher, I won't bring my problem up.\"\u003c/em\u003e \u003cb\u003e(R019)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnline Environmental and Behavioral Constraints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"The biggest barrier is people's own inability to regulate their behavior.\"\u003c/em\u003e \u003cb\u003e(R021)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIgnorance and Digital Illiteracy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"People are not even aware of the need to be civil online.\"\u003c/em\u003e \u003cb\u003e(R011)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eStrategies For Promoting Cybercivility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEducational Interventions and Professional Development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Workshops can be conducted in a way where people would come forward with their experiences of cyberbullying and how it affected them; this would work a great deal, in my opinion, when you get to see that the words you post online have actual effects on real people.\"\u003c/em\u003e \u003cb\u003e(R019)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGuidelines and Policies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"We have to develop clear policies and guidelines both for the students and the faculty. Then we have to reinforce that these are very important and have to be followed.\"\u003c/em\u003e \u003cb\u003e(R020)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonal Responsibility and Accountability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"On a personal level, we have to be respectful and create a supportive learning environment, and refrain from using inappropriate language.\"\u003c/em\u003e \u003cb\u003e(R010)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeading by Example\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Whatever we say, whatever we do, then we have to role model it. We have to show it. We have to demonstrate it.\u0026rdquo;\u003c/em\u003e \u003cb\u003e(R004)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntentional Disengagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"I just stopped using it. I deleted my account.\"\u003c/em\u003e \u003cb\u003e(R009)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCreating a safe and collaborative environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\"Groups will be safer if there is one person responsible for regulating group conduct and has authority to control such people, like a teacher in a group. A respectable person whose voice will be heard by all.\"\u003c/em\u003e \u003cb\u003e(R002)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eProfessional Online Conduct\u003c/p\u003e\u003cp\u003eThe codes \u0026lsquo;Professionalism in online interactions\u0026rsquo; and \u0026lsquo;respect and ethical communication\u0026rsquo; were the most frequent in this theme. \u003cem\u003eProfessional and Ethical behavior\u003c/em\u003e was highlighted as a major attribute of cybercivility. Participant R001 emphasized, \u0026ldquo;I think cybercivility is to be respectful not only with the teachers but students, administrators, and other stakeholders as well.\u0026rdquo; Many participants stated that \u003cem\u003ecivility in all settings\u003c/em\u003e is essential, whether online or in person. Faculty and students viewed cybercivility as an extension of one\u0026rsquo;s personality; with participant R011 articulating, \u003cem\u003e\u0026ldquo;\u003c/em\u003eIf somebody is not a civil person offline, he would not be a civil person online.\u0026rdquo; Participants highlighted that cybercivility encompasses respect, context-appropriate communication, and using formal, professional language on social media.\u003c/p\u003e\u003cp\u003eManifestations of Cyberincivility\u003c/p\u003e\u003cp\u003eMost participants believe \u003cem\u003edisrespect and cyberbullying\u003c/em\u003e are prevalent uncivil behaviors online. Participant R004 stated, \u0026ldquo;I have actually seen colleagues fighting on WhatsApp groups with each other. If you want to fight, you can probably do it in personal messages. Why do you want to tell the world about it? \"\u003c/p\u003e\u003cp\u003eParticipants associated cyberincivility with a \u003cem\u003elack of e-professionalism\u003c/em\u003e. This includes inappropriate behavior, irrelevant content sharing, self-promotion, non-responsiveness, rudeness, poor feedback, unpreparedness, plagiarism, and unprofessional use of social media. Participant R001 described an instance of e-professionalism exhibited by a postgraduate student, stating, \"Her presentation was not up to the mark. So, I asked her why it was like that. She replied that she did not have time for it. That upset me a little, and I told her that her behavior was very unprofessional.\"\u003c/p\u003e\u003cp\u003eParticipants noted that \u003cem\u003eonline platforms susceptible to cyberincivility\u003c/em\u003e are not only the less professional social media platforms, but educational and professional platforms are equally prone to online incivility.\u003c/p\u003e\u003cp\u003eNegative Impact of Cyberincivility\u003c/p\u003e\u003cp\u003eParticipants acknowledged the impact of cyberincivility on \u003cem\u003epersonal and professional dynamics\u003c/em\u003e. Participant R011 stated, \u0026ldquo;Personal well-being is directly related to professional relationships. So, you see, everything gets messed up if there is such an environment or incident.\" Participants also mentioned the \u003cem\u003eemotional consequences of cyberincivility\u003c/em\u003e, including embarrassment, anxiety, and distress. Cyberincivility can result in \u003cem\u003epsychological strain\u003c/em\u003e, manifesting as stress, depression, burnout, and decreased educational engagement. Participant R008 stated, \u0026ldquo;My colleague had some issues with her assignment, and she was trying to communicate with the facilitator, but he was not responding to her WhatsApp texts and emails, so she failed the assignment, and she became so disheartened that she quit the entire course.\u0026rdquo; Cyberincivility can also damage a person\u0026rsquo;s and a profession\u0026rsquo;s reputation, eroding \u003cem\u003epublic and institutional trust\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eBarriers to Cybercivility\u003c/p\u003e\u003cp\u003eParticipants identified numerous challenges to promoting cybercivility, including the \u003cem\u003eblurring of personal-professional boundaries\u003c/em\u003e and \u003cem\u003eonline communication challenges\u003c/em\u003e. Participant R016 noted, \u0026ldquo;Without verbal cues, things often get lost in translation, and the tone can be misinterpreted.\u0026rdquo; \u003cem\u003eInstitutional and structural barriers\u003c/em\u003e were highlighted as a major problem. Participant R009 stated, \u0026ldquo;The biggest challenge is not having an institutional policy, and that is what I have been advocating since the day I joined the University.\u0026rdquo; Participants shed light on the \u003cem\u003epower dynamics\u003c/em\u003e at play in Health Professions Education and identified it as a primary hurdle in the way of addressing cyberincivility. Participant R004 highlighted, \u0026ldquo;I may have seen accountability, but that accountability is only for the weak and the ones who cannot stand up. I mean, what about the accountability of those who are in power?\u0026rdquo; Other barriers include \u003cem\u003eonline environmental and behavioral constraints, ignorance, and digital illiteracy\u003c/em\u003e. Participant R002 said, \u0026ldquo;People feel that if they are in online space, they are not bound by any code of conduct, and they hide behind this e-curtain.\u0026rdquo;\u003c/p\u003e\u003cp\u003eStrategies for Promoting Cybercivility\u003c/p\u003e\u003cp\u003eParticipants emphasized the role of \u003cem\u003eeducational interventions and professional development\u003c/em\u003e in promoting cybercivility. R003 stated, \"Cybercivility could be promoted by incorporating it formally into the curriculum and assessments.\" The preeminent strategy proposed is the establishment of \u003cem\u003epolicies and guidelines\u003c/em\u003e and the subsequent assurance of their implementation. \u003cem\u003ePersonal responsibility and accountability\u003c/em\u003e were also highlighted. Participants also suggested \u003cem\u003eleading by example\u003c/em\u003e. Participant R011 stated, \u0026ldquo;If the faculty are being professional, it reflects on the students, and they will be professional.\" Many participants suggested \u003cem\u003eintentional disengagement\u003c/em\u003e from social media and conflict situations to avoid cyberincivility, as R005 articulated, \"Sometimes it feels easier to just ignore it to avoid drama.\" \u003cem\u003eCreating a safe and collaborative online environment\u003c/em\u003e was deemed essential, with R017 claiming, \"As a comparatively younger generation with more empathy than our seniors, I think the responsibility lies upon us to build an environment which caters to everyone and is respectful to each regardless of age, rank, and gender.\"\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study explored postgraduate medical students' and faculty\u0026rsquo;s perceptions of cybercivility and experiences with cyberincivility, organized into five main themes: professional conduct online, manifestations of cyberincivility, its impact, barriers to cybercivility, and strategies for promoting cybercivility.\u003c/p\u003e\u003cp\u003e Most participants viewed respect and professionalism as essential aspects of cybercivility, often interchanging them with e-professionalism. Words like respect, professionalism, etiquette, and courtesy were used as key descriptors for cybercivility. For postgraduate students, cybercivility meant respectful treatment from faculty, timely responses, constructive feedback, and avoiding bullying and mockery. Faculty echoed the significance of confidentiality, professionalism, and relevant online sharing. Both groups noted that cybercivility mirrors civil face-to-face interactions. However, research shows individuals often exhibit more uncivil behavior online, likely due to anonymity and the perceived disconnect from real-world interactions.\u003c/p\u003e\u003cp\u003e Participants discussed various online behaviors they deemed uncivil. Postgraduate students identified faculty cyberincivility as rude and derogatory comments, ignoring queries, bullying, and harsh criticism. On the other hand, faculty noted student behaviors like plagiarism, disruption, self-advertising, conflicts, intruding on personal time, and misusing social media. An integrative review of cybercivility in Health Professions Education highlighted similar findings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While a few participants claimed they had never experienced or witnessed cyberincivility, most postgraduate students and all faculty members reported encountering it. There is substantial literature documenting the high prevalence of cyberincivility in health professions education [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Participants recognized that uncivil behaviors arise from unprofessionalism in digital environments and agreed that it is pervasive across all platforms, including professional settings like Zoom, Microsoft Teams, email, and Moodle, and social media sites like Instagram, Facebook, and Twitter. A scoping review conducted in 2021 also confirmed the presence of cyberincivility across these domains [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The widespread occurrence of cyberincivility on these platforms may be attributed to their global usage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe emotional and psychological impacts of cyberincivility emerged as another significant theme. Participants reported feeling embarrassment, heartbreak, distress, fear, and anxiety when facing or witnessing cyberincivility. They highlighted that public criticism or negative online content could tarnish reputations and diminish both individual and institutional credibility. Erbil et al. reported similar findings in 2009 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This is because humans tend to be influenced by the opinions of others. Cyberincivilty was linked to mental health issues such as overthinking, stress, depression, and burnout. It can lead to diminished self-confidence and loss of interest in education and work.\u003c/p\u003e\u003cp\u003eParticipants also asserted that cyberincivility might erode trust and empathy, resulting in strained interpersonal and professional relationships, which can subsequently reduce job satisfaction. A research study examining the experiences of cyberincivility among Korean nurses revealed that those who suffered emotional distress due to cyberincivility often developed symptoms of depression, leading to a passive approach in patient care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A study by Chen YY et al. revealed that individuals subjected to verbal and relational bullying in college exhibit markedly diminished health-related quality of life [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Some study participants reported incidences of individuals failing assessments and quitting educational programs because of incidents of online incivility. The results from present and previous studies can be explained by the theory of Humanism and Maslow\u0026rsquo;s hierarchy of needs. Maslow asserted that to learn, students must experience safety\u0026mdash;physically, emotionally, and mentally to learn and thrive without the burden of additional anxieties. Students should feel comfortable posing inquiries or expressing concerns without the apprehension of criticism from the instructor or judgment from their classmates.\u003c/p\u003e\u003cp\u003eOne primary issue identified in addressing cybercivility is the blurred line between personal and professional boundaries online. Participants stated that uncivil behaviors often arise from contacting individuals outside professional hours or sharing their personal information on professional platforms. A qualitative study reported that nursing students frequently contacted outside of working hours had heightened stress, leading to mental and emotional exhaustion\u003csup\u003e6\u003c/sup\u003e. Miscommunication and misinterpretation due to a lack of verbal cues are also challenges in online spaces, making intentions harder to discern and increasing the likelihood of perceived incivility. Anonymity and a lack of adequate training further contribute to this problem.\u003c/p\u003e\u003cp\u003e A major obstacle to cybercivility is the lack of institutional policies or guidelines. Participants noted that the institutions involved lacked specific policies addressing cybercivility despite a significant online component in the curriculum. Previous studies corroborate this finding, showing that few institutions have policies outlining professional behavior in online education settings [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Without clear policies, participants feared reporting cyberincivility due to potential repercussions or hierarchical dynamics, with students in particular fearing academic penalties. This contrasts with a prior study, which found students more inclined to report such incidents [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Faculty members noted they often remained silent on incidents of incivility to avoid unnecessary conflict, especially in the absence of clear institutional support.\u003c/p\u003e\u003cp\u003eTo promote cybercivility, participants emphasized the need for educational initiatives, policies, and role modelling. Some advocated for including cybercivility education in undergraduate medical programs and offering workshops to raise awareness. These suggestions are consistent with previous studies, which suggest that schools provide resources like websites or counselling services to promote civil online interactions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Some participants encouraged intentional disengagement from social media to avoid drama or incivility. Participants also recommended establishing clear guidelines and policies for online behavior, instituting anonymous reporting channels, and providing support systems for those affected by cyberincivility.\u003c/p\u003e\u003cp\u003eThis study exclusively involved participants from the Master\u0026rsquo;s in Health Professions Education program, with the majority representing various primary medical specialties. This strategic selection enhanced the diversity of the data but excluded other health professionals like nurses and pharmacists, possibly limiting the generalizability of the findings. Future research could employ larger sample sizes to include a broader range of health professionals/ postgraduate programs to enhance a comprehensive understanding of cybercivility. Additionally, a validated questionnaire specific to cybercivility post-COVID-19 could be developed for quantitative and mixed-methods research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study explored how postgraduate medical students and teachers perceive cybercivility and experience cyberincivility. It emphasizes the importance of respectful, ethical, and professional online behavior. The results show that while participants recognize the need for cybercivility, its implementation is hindered by issues such as unclear personal-professional boundaries, lack of awareness, inadequate training, and the absence of institutional policies. Cyberincivility negatively impacts emotional well-being, professional relationships, and educational outcomes. Promoting a culture of cybercivility requires focused training programs, clear norms, and strong institutional support structures. Future research should encompass a variety of health professions and develop quantitative tools for evaluating cybercivility.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from Khyber Medical University Ethics Board (Approval no. 1-12/IHPER/MHPE/KMU/24-07). Informed consent was obtained from each participant through written consent forms, which clearly outlined the purpose of the study and the rights of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available by the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical Trial Number:\u003c/em\u003e\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor Contribution Statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKiran Imtiaz Khan:\u003c/strong\u003e Conceived and designed the study; collected, analyzed, and interpreted the data; and contributed to drafting the manuscript. \u003cstrong\u003eBrekhna Jamil:\u003c/strong\u003e Supervised the study and analyzed and interpreted the data and reviewed the manuscript; \u003cstrong\u003eBushra Mehboob:\u003c/strong\u003e Analyzed and interpreted the data; and contributed to drafting the manuscript.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be made available by the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDe Gagne JC. Values clarification exercises to prepare nursing students for artificial intelligence integration. Int J Environ Res Public Health. 2023;20(14):6409. DOI: https://www.mdpi.com/1660-4601/20/14/6409\u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Yamane SS, Conklin JL. Evidence-based strategies to create a culture of cybercivility in health professions education. Nurse Educ. Today 201:.45:138\u0026ndash;41. DOI: https://pubmed.ncbi.nlm.nih.gov/27472429/ \u003c/li\u003e\n\u003cli\u003eBengu PC, Naidy CT, Wibowo R, Eka NGA, Purimahua DI. CYBERCIVILITY IN NURSING EDUCATION: A SYSTEMATIC LITERATURE REVIEW 2023. DOI: https://ojs.uph.edu/index.php/GMHC/article/view/7642\u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Choi M, Ledbetter L, Kang HS, Clark CM. An Integrative Review of Cybercivility in Health Professions Education. Nurse Educ. 2016.:41(5):239\u0026ndash;45. DOI: https://pubmed.ncbi.nlm.nih.gov/27022683/ \u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Koppel PD, Kim SS, Park HK, Rushton S. Pedagogical foundations of cybercivility in health professions education: a scoping review. BMC Med Educ. 2021;21(1). DOI: https://doi.org/10.1186/s12909-021-02507-z\u003c/li\u003e\n\u003cli\u003eKim SS, Song HJ, Lee JJ. Cyberincivility experience of Korean clinical nurses in the workplace: A Qualitative content analysis. Int J Environ Res Public Health. 2020;17(23):9052. DOI: https://pubmed.ncbi.nlm.nih.gov/33291696/ \u003c/li\u003e\n\u003cli\u003eRocha PN, De Castro NAA. Opinions of Students from a Brazilian Medical School Regarding Online Professionalism. J Gen Intern Med. 2014; DOI: https://doi.org/10.1007/s11606-013-2748-y \u003c/li\u003e\n\u003cli\u003eOkdie BM, Guadagno RE, Bernieri FJ, Geers AL, Mclarney-Vesotski AR. Getting to know you: Face-to-face versus online interactions. Comput Hum Behav. 2011 ;27(1):153\u0026ndash;9. DOI: https://doi.org/10.1016/j.chb.2010.07.017 \u003c/li\u003e\n\u003cli\u003eKim SS, Lee JJ, De Gagne JC. Exploration of Cybercivility in Nursing Education using Cross-Country Comparisons. Int J Environ Res Public Health. 2020;17(19):7209. DOI: https://doi.org/10.3390/ijerph17197209 \u003c/li\u003e\n\u003cli\u003eCrotty M. The foundations of social research. Routledge eBooks. 2020. DOI: https://doi.org/10.4324/9781003115700 \u003c/li\u003e\n\u003cli\u003eCreswell JW, Guetterman TC. Educational research: Planning, conducting, and evaluating quantitative and qualitative research. Pearson. One Lake Street, Upper Saddle River, New Jersey 07458; 2024 May 3. \u003c/li\u003e\n\u003cli\u003eClarke V, Braun V. Thematic analysis. J Posit Psychol. 2016;12(3):297\u0026ndash;8. DOI: https://doi.org/10.1080/17439760.2016.1262613 \u003c/li\u003e\n\u003cli\u003eKim J, Scroggins JK, Ledbetter L, De Gagne JC. Cyberincivility among Adolescents: A Systematic Review of Qualitative Evidence. J. Sch. Health. 2024;94(8):754\u0026ndash;67. DOI: https://doi.org/10.1111/josh.13484 \u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Covington K, Conklin JL, Yamane SS, Kim SS. Learning Cybercivility: A Qualitative Needs Assessment of Health Professions students. J. Contin. Educ. Nurs. 2018 ;49(9):425\u0026ndash;31. DOI: https://doi.org/10.3928/00220124-20180813-08 \u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Hall K, Conklin JL, Yamane SS, Roth NW, Chang J, et al. Uncovering cyberincivility among nurses and nursing students on Twitter: A data mining study. Int. J Nurs Stud. 2018; 89:24\u0026ndash;31. DOI: https://doi.org/10.1016/j.ijnurstu.2018.09.009 \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Keeffe GS, Clarke-Pearson K. The impact of social media on children, adolescents, and families. Pediatrics 2011;127(4):800\u0026ndash;4. DOI: https://doi.org/10.1542/peds.2011-0054 \u003c/li\u003e\n\u003cli\u003eWeller K. Trying to understand social media users and usage. Online Inf. Rev. 2016;40(2):256\u0026ndash;64. DOI: https://doi.org/10.1108/oir-09-2015-0299\u003c/li\u003e\n\u003cli\u003eErbil N, Bakır A. Developing inventory of professional attitude at occupation. J. Hum. Sci.2009;6(1):290-302. DOI: https://www.j-humansciences.com/ojs/index.php/ijhs/article/view/419/346 \u003c/li\u003e\n\u003cli\u003eChen YY, Huang JH. Precollege and In-College bullying experiences and Health-Related quality of life among college students. Pediatrics 2014;135(1):18\u0026ndash;25. DOI: https://doi.org/10.1542/peds.2014-1798 \u003c/li\u003e\n\u003cli\u003eDe Gagne JC, Yamane SS, Conklin JL, Chang J, Kang HS. Social media use and cybercivility guidelines in U.S. nursing schools: A review of websites. J Prof Nurs. 2017;34(1):35\u0026ndash;41. DOI: https://doi.org/10.1016/j.profnurs.2017.07.006 \u003c/li\u003e\n\u003cli\u003eClark CM, Werth L, Ahten S. Cyber-bullying and Incivility in the Online Learning Environment, Part 1. Nurse Educ. 2012;37(4):150\u0026ndash;6. DOI: https://doi.org/10.1097/nne.0b013e31825a87e5\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cybercivility, Cyberbullying, Health professional education, Dental Education, Medical education, Postgraduate students","lastPublishedDoi":"10.21203/rs.3.rs-7321624/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7321624/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003e\u003c/em\u003eIn digital environments, anonymity and the absence of body language cues often result in individuals behaving differently, sometimes inappropriately. Given cyberspace’s increasing integration into education, our collective responsibility is to exhibit civil online behaviors, upholding an environment of respect, cooperation, and professionalism.\u003cem\u003e \u003c/em\u003eThis study aimed to qualitatively explore postgraduate medical students' and faculty’s perceptions of cybercivility and experiences of cyberincivility.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u003c/em\u003eAn exploratory qualitative phenomenological study was conducted. Semi-structured Zoom interviews involved a maximum-variation purposive sample of nine faculty members and twelve postgraduate students in Health Professions Education. Recorded sessions were transcribed verbatim. Thematic analysis was done manually following Braun and Clarke's methodology, with codes, subthemes, and themes established from transcripts.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003eThematic analysis yielded five themes: professional online conduct, cyberincivility manifestations, its negative impact, barriers to cybercivility, and strategies for promoting cybercivility. All interviewees identified challenges in cultivating cybercivility and addressing cyberincivility. Participants proposed strategies to mitigate these challenges and promote civil online conduct. Postgraduate students and faculty shared similar perceptions regarding cybercivility and experiences of cyberincivility.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003e\u003c/em\u003eWhile participants recognize the necessity of cybercivility, its implementation is hindered by unclear boundaries, lack of awareness, inadequate training, and the absence of institutional policies. Cyberincivility negatively impacts emotional well-being, professional relationships, and educational outcomes. Promoting a cybercivility culture requires targeted training, clear norms, and institutional support structures. Future research should encompass a variety of health professions and develop quantitative tools for evaluating cybercivility.\u003c/p\u003e","manuscriptTitle":"Cybercivility in Health Professions Education: A Qualitative Exploration of Perception and Experiences of Postgraduate Medical Students and Faculty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:20:33","doi":"10.21203/rs.3.rs-7321624/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"879f4670-e80f-4925-806a-f0a141ca13e3","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T18:39:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:20:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7321624","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7321624","identity":"rs-7321624","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}