"Google is an efficient web resource for identifying specific medical information." Google was more efficient than all other resources for identifying medical information (P less than 0.0001) http://bit.ly/6FXATW
Google Scholar versus PubMed in locating primary literature to answer drug-related questions: no major differences http://bit.ly/8OygYt
Wikipedia is not authoritative and should only be a "supplemental source" of drug information http://bit.ly/7qzZ7k
Does Wikipedia provide evidence-based health care information? http://bit.ly/4WVLHt - No. Who is surprised?
Personality characteristics of Wikipedia members: Introverted women more likely to be members than extroverted women http://bit.ly/8YfrXb
Mobile Websites from Pubmed: Search Abstracts and Find Disease Associations http://bit.ly/7ucyn5 - Works on Kindle too.The mobile MedlinePlus (for consumers) is at m.medlineplus.gov http://bit.ly/6jjkt3
"As you browse the web, it's easy to forget how many people visit the same pages and look for the same information. What if everyone, from a local expert to a renowned doctor, had an easy way of sharing their insights with you about any page on the web? What if you could add your own insights for others who are passing through?
Google Sidewiki allows you to contribute helpful information next to any webpage. Google Sidewiki appears as a browser sidebar, where you can read and write entries along the side of the page."
Here are two examples how doctors add expert insights and comments about websites in Google Sidewiki:
@Scobleizer: "Google Sidewiki is latest attempt by big company to make money off of my content on my blog. I really hate companies that let people put stuff on top of my content without my consent." Google Launches Sidewiki — More Like a Universal Commenting System http://bit.ly/nMwvN
@Laikas, a Dutch medical librarian, took the time to write a long and thoughtful blog post, well-suited for submission to a journal as an editorial: The Trouble with Wikipedia as a Source for Medical Information http://bit.ly/m42zO
She quoted an example which showed that some doctors apparently rely on Wikipedia to the extent they refer to it in medical journal publications - see this Int. J Cardiol. PubMed abstract: http://bit.ly/9wCMO
Lee CH, Teo C, Low AF. Fulminant dengue myocarditis masquerading as acute myocardial infarction. Int J Cardiol. 2009 Aug 21;136(3):e69-71. Epub 2008 Aug 13.
The Heart Institute, National University Hospital Singapore, Singapore. Leechihang@nuh.com.sg
Dengue fever is manifested by a sudden onset of fever (http://en.wikipedia.org/wiki/Fever), with severe headache, myalgias (http://en.wikipedia.org/wiki/Myalgia), arthralgias (http://en.wikipedia.org/wiki/Arthralgia) and characteristic bright red petechia (http://en.wikipedia.org/wiki/Petechia). The exact incidence and pathophysiological mechanism of dengue myocarditis remain obscure, but most of these cases are self-limiting. Fatal dengue myocarditis is a very rare complication of dengue fever. The non-specific symptoms and signs of dengue myocarditis make early diagnosis difficult. A 25-year-old Indian male, suffered from fulminant dengue myocarditis, presented to a our hospital with symptoms and electrocardiographic features mimicking acute myocardial infarction. Unfortunately, the patient succumbed before the dengue serology results were available.
In my opinion, Wikipedia is almost impossible to rely on for medical searches - unless you know the material and just use the text/images for illustrative purposes. One of the many differences between a blog and a medical journal is that, for example, I often reference Wikipedia on the blog, but never in a journal. @FoodAllergyMD asked on Twitter: "If we have come to citing open source, anyone-can-post/edit media, should I be looking for other signs of the apocalypse?"
@Giustini, a Canadian medical librarian, mentioned the well-publicized opinion that "there is nothing wrong starting [a medical search] with Wikipedia but it should never be the last place to search." Humorously, I asked if we should start our medical searches with NYT or WSJ then...
There is even a discussion on FriendFeed which can be summarized as "Is it OK to use Wikipedia citations in Int J Cardiology?" http://bit.ly/14rBuW
I have commented on this topic multiple times in the past (please see the links at the end of this post). In short, medical blogs are not a source of "actionable" medical information. The same principle applies to Wikipedia. You must be treated by an expert - not a "crowd" - as in the "wisdom of crowds" concept used by Wikipedia.
Twitter comments:
@chrisseper: "One way to lose confidence in a doc. Ask a medical question and see the doc go online & find the answer via Wikipedia."
@palmdoc: "Would anyone lose confidence in a Doc who looks up Google? I'd be worried if they don't know how to Google."
@killerswan I'm curious what percentage of actual doctors are a reliable source of actionable information, though...
Study: Junior physician's use of Web 2.0 for information seeking and medical education:
Google and Wikipedia used by 80% and 70% of physicians, respectively http://is.gd/1oQky
Wikipedia is a prominent source of online health information compared to the other online health info providers studied. Wikipedia ranked among first ten results in 71–85% of search engines and medical keywords tested. In search tests, "Wikipedia surpassed MedlinePlus and NHS Direct Online and ranked higher with quality articles" http://bit.ly/39Xq8k
I didn't understand why @Berci spent so much time editing medical articles in Wikipedia. Now I know and it has obviously made an impact.
Also, I have dismissed Wikipedia as a medical resource until so many residents reported using it during the NEJM Horizons conference in October 2008.
Observation: Just look around you in computer section of medical library of any university & see how many students check Wikipedia. Whether we like or not (and I haven't for a long time), medical students use Wikipedia (a lot) http://bit.ly/39Xq8k
Do you think any medical encyclopedia (@medpedia, AskDrWiki) has any sustainable future facing Wikipedia headstart?
Twitter opinions:
@chrisseper: "One way to lose confidence in a doc. Ask a medical question and see the doc go online & find the answer via Wikipedia."
@palmdoc: "Would anyone lose confidence in a Doc who looks up Google? I'd be worried if they don't know how to Google."
Bounceback - a patient who returns to the emergency department with the same complaints shortly after being released
CNS-QNS - Central Nervous System - Quantity Not Sufficient
Code Brown - a faecal incontinence emergency. Often used by nurses and medical technicians requesting help cleaning up an unexpected bowel movement
Code Yellow - a patient who has lost control of his or her bladder
Doc in a Box - a small health-care center, usually with high staff turnover
Hasselhoff - a term for any patient who shows up in the emergency room with an injury for which there is a bizarre explanation. Original Source: Baywatch actor David Hasselhoff, who hit his head on a chandelier while shaving. The broken glass severed four tendons and an artery in his right arm.
Shotgunning - ordering a wide variety of tests in the hope that one will show what's wrong with a patient
References: Medical slang, from Wikipedia, the free encyclopedia.
Should College Students Cite Wikipedia in their Academic Papers? The short answer is "no." Do they use it. You bet.
Wikipedia Tutorial: a guide for students
When I attended the NEJM Horizons conference last October, I was surprised to hear medical students reporting that their colleagues use Wikipedia as a medical reference text. The wiki platform has a place in medical education but Wikipedia does not require any expert knowledge or credentials verification to contribute.
A Wikipedia article is often in the top 5 of Google search results for many queries and the path of least resistance for most searchers is to focus only on the first page of results. This is not a good search (and research) pattern for future physicians, in my opinion.
Dean Giustini posted a good summary of why maintaining a wiki is hard work. The top 5 reasons are listed below along with my comments on how this relates to maintaining a blog. The comments come from my personal experience of keeping up with 3 blogs since 2005.
1. Content creation I use 2 approaches: - comment on medical news stories, journal articles, blog posts and Twitter (this post is an example) - write original posts
Writing blog posts takes time but is an excellent way to keep up with the new developments and to create a personal archive available from any Internet-connected device.
2. Wiki spam Deleting spam comments is part of the blog maintenance. I use Blogger.com word verification and all comments are emailed to me the moment they are posted. In general, spam comments are deleted within a few minutes.
3. Updating entries I often update old posts whenever new information is available. The new links are added at the bottom of the post in the "related reading" section and the date of the update is recorded. Often, I prefer to update an old post rather than write a new one.
4. Authority My blogs clearly list who is responsible for the content and what their credentials are. The readers may decide for themselves whether a particular author is authoritative or not.
5. Minimal use Most visitors to my blogs come from Google, read 1-2 pages and stay only a few seconds. This pattern is the same across most medical blogs that allow open access to their SiteMeter statistics. However, there are quite a few visitors (mostly from .edu domains) who read more than 30-50 pages and stay up to one hour on the site. I work for the second group.
"Along with cardiology colleagues Brian Jefferson, MD, Shane Bailey, MD, and Michael McWilliams, MD, Dr. Civello established AskDrWiki.com, a non-profit, grassroots, physician-run, physician-maintained online community to publish review articles, clinical notes and medical images.
The four cardiologists now are located in different states. Dr. Civello is in Louisiana, Dr. Jefferson is in Tennessee, Dr. McWilliams is in Delaware and Dr. Bailey continues at Cleveland Clinic. AskDr.Wiki.com keeps them in close contact."
Read the full text of the article on Ken Civello's blog: Cleveland Clinic Alumni Magazine on AskDrWiki.com. Ken, Brian and I met several times during the early stages of the wiki and I was very impressed by their enthusiasm and dedication. The site was featured on the front page of the main Cleveland newspaper, The Plain Dealer and I still stay by my quote in the article: "Sites like AskDrWiki will change the way we study and teach medicine."
The eHealth blog linked to Cleveland 2.0 - an initiative begun by Case Western Reserve University to apply Web 2.0 to all kinds of non-profit initiatives in Cleveland.
While checking the links, I found a dental wiki featured by one of the presenters: "Ben Schechter of Case School of Dentistry will comment on migrating content to a wiki platform. He will discuss the evolution of the Case Dentistry clinical manual, its journey from print to its current manifestation, why MediaWiki is the appropriate software, how it is being used, and ways to support editorial review":
The website looks like a useful resource for dental education. I should probably have considered using a wiki rather than Blogger.com when I launched ClinicalCases.org in 2005 but then, again, Blogger is free, easier-to-use and there are no hosting charges or setup.
Mike Cannon-Brookes has a good presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.
He also lists the top 4 wiki enemies: 1. Share drives 2. Email 3. Knowledge management 4. Intranets
The author of both presentations is Patricia Anderson. She is a Head Librarian for the Dentistry Library of the University of Michigan, Ann Arbor and has collected more Web 2.0 presentations on SlideShare.
AskDrWiki is a collaborative encyclopedia started by cardiology fellows at Cleveland Clinic which is expanding rapidly its scope of high quality free content. The project received a lot of coverage from both professional and mainstream media which had the desired effect of bringing more contributors. A wiki is only as good as its contributors and there is definitely a strength in numbers. In addition, the AskDrWiki founders have introduced a rigorous screening process to ensure that only qualified medical professionals can add and edit articles. My application was accepted and I am currently a member of the Editorial Board.
In the recent months, AskDrWiki has expanded its collection of free medical videos and images:
Physicians in training interested in cardiology may find the step-by-step video tutorials of Coronary Angiography and Ventriculography especially valuable.
In summary, AskDrWiki seems to be an exciting medical education project which brings good quality content online (for free) and I am happy to be a small part of it.
Ken Civello, Brian Jefferson and I have presented abstracts about using the wiki for different aspects of medical education at several local, national and international scientific meetings where the posters brought a lot of interest and lively discussion.
Our project Clinical Cases and Images - A Case-Based Curriculum of Clinical Medicine (ClinicalCases.org) was mentioned in the May 2007 issue of StudentBMJ: Trust me; trust me not. The article discusses trustworthiness of online medical information including new Web 2.0 tools such as wikis and blogs.
Dean Giustini, who is one of the best Web 2.0 experts among librarians, was very kind to mention our project in his interview with the author:
"...the main boon of Web 2.0 is how it allows medical practitioners to communicate more effectively with each other. When doctors talk to each other, he says, "The discussions that they have together actually create knowledge-they're continually teaching each other."The technologies of Web 2.0 can allow these conversations to become more fluid, resulting in a "continual process of sharing, information, and repurposing information."Such a process might be facilitated by a wiki, by a medical blog containing clinical information, such as Clinical Cases and Images (http://clinicalcases.blogspot.com), or by a blog recording the thoughts and activities of an individual clinician, such as the popular NHS Blog Doctor (http://nhsblogdoc.blogspot.com)."
The StudentBMJ has a RSS feed with an additional nifty feature: a mash-up box which allows you to create a custom RSS feed from the journal content which fits your search criteria.
David Rothman has assembled a comprehensive list of medical wikis which seems to be growing longer every day. He will need to reorder them in categories soon.
If you click through the entries on the list, you will notice that many wikis are still in early stage with just a few entries. Many of them will not make it and will eventually fade into oblivion. It is a normal process similar to natural selection. The most popular wikis (with most contributors/readers) will survive.
We have discussed several times with the founders of AskDrWiki that the main challenge for a wiki manager is getting people to contribute. Doctors are busy and few of them have time (and desire) to create quality content for free.
Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.
The cleverly named 5th annual Research ShowCASE at Case Western Reserve University features at least 3 presentations on using Web 2.0 technologies in medicine:
I am a co-author along with John Sharp, Ashish Aterja and Neil Mehta from Cleveland Clinic, and Ken Civello and Brian Jefferson from AskDrWiki (which was also started at the Clinic).
As you can see, we pretty much cover a lot of the spectrum of Web 2.0 in medicine with abstracts on blogs and wikis but some unexplored topics still remain: web feeds (RSS/Atom), podcasts, video-sharing sites (YouTube/Google Video), photo-sharing sites (Flickr/Picasa Web), social media (Sermo).
With all the recent coverage that AskDrWiki received from the press, wikis seem to be all the rage, displacing blogs from the top spot in the short attention span of the general media. I think wikis offer much more opportunities for medical education than blogs because by design they are open, multi-author communities. Most blogs are still more or less a "one-man-show." Believe it or not, blogging is becoming old news and seems to have "matured" since 2004. This is confirmed by the Tecnorati's State of the Blogosphere annual report which shows that blog posts per day, the most critical measure as it relates to blogging, slid. Micro Persuasion provides more coverage in As Daily Postings Slide, Blogging Peaks.
Don't get me wrong, I still think that blogs are incredible tools for medical education which are extremely easy to use and can reach millions in a matter of seconds after hitting the "publish" button. If you have doubts, just check my SiteMeter statistics with 1,310,750 page views since 2005. Still, I am becoming more interested in wikis especially since I have discussed their use with AskDrWiki founders. One of the main reasons why we submit abstracts to Research ShowCASE and other national meetings is the goal to make medical educators aware of the exciting opportunities that Web 2.0 technologies offer.
If you are in Cleveland on April 12, please come to join us at Research ShowCASE. You may have the chance to meet some real celebrities - Ken and Brian of AskDrWiki were featured on the front page of the main Cleveland newspaper The Plain Dealer last week.
My presentation on Web 2.0 in Medicine from December 2006.
The Plain Dealer is the major newspaper in Cleveland and we are lucky to have Pulitzer-winning journalists writing for it. I especially enjoy the Friday section which lists many "things to do" for the weekend: festivals, museums, etc.
On Thursday, the front page of The Plain Dealer featured AskDrWiki, a medical wiki created by 4 cardiology fellows at the Cleveland Clinic. I know Ken Civello and Brian Jefferson and I think that they are incredibly bright and have a great future in front of them.
The medical wiki in question has unique, high-quality content, for example, more than 90 free videos of cardiac catheterizations. I can see web sites like AskDrWiki, maintained by experts, becoming competitors to UpToDate and other paid resources. UpToDate is useful but it charges "an arm and a leg" for individual subscriptions. Few companies can compete with free, if the quality is comparable. Look what happened to the once mighty encyclopedia Britannica -- it is gradually becoming irrelevant, out shined by the ever growing Wikipedia.
Medical wikis have several limitations to overcome to be recognized as trustworthy, and we have discussed them many times with Ken and Brian. They have one quality which likens them to Sergey Brin and Larry Page of Google - they attentively listen to requests and advice by users. For example, after David Rothman suggested a tighter control on who can edit the wiki, Ken and Brian introduced registration to insure that only medical professionals are registered as contributors. This is just on of the many problem solutions along the way of making medical wikis mainstream but it is a step in the right direction.
I do stay by my quote in The Plain Dealer article: "Sites like AskDrWiki will change the way we study and teach medicine."
For additional coverage (positive and negative) of AskDrWiki, please check:
Ken, one of AskDrWiki founders, started a blog which he will use to post announcements about the wiki, and most importantly, to ask for feedback from you -- students, physicians, nurses and general readers of medical blogs. Please welcome Ken to the medical blogosphere and Grand Rounds. He definitely has something interesting to say. Featuring interesting EKGs of the week doesn't hurt either.
A wiki is a web site which allows the visitors themselves to easily add, remove, and otherwise edit available content. The most famous wiki-based projects is Wikipedia, the world-largest free encyclopedia with more than 1.5 million English-language articles, which can be edited by anyone. Few studies have explored the effect of this new medium on medical education.
AskDrWiki by Cleveland Clinic Cardiology Fellows Quite a few things have happened since the last time I wrote about AskDrWiki:
- I emailed Dean Giustini about AskDrWiki and he referenced the site in his landmark BMJ editorial How Web 2.0 is changing medicine
- I met the wiki editor, Ken Civello, who is an electrophysiology fellow at the Cleveland Clinic and a really smart guy
- Both Ken and I wrote the abstract "A Wiki-based Web Site as an Educational Tool for Cardiology Fellows" which will be presented at the meeting Medical Education for the 21st Century at the Case Western Reserve University School of Medicine Annual Education Retreat on February 8, 2007. I like this line the best: "The pockets of your lab coat are only so big and what you remembered last month, you may not remember next year. The ability to have access to the "collective online memory" of a fellowship program may help fellows enhance their education, and ultimately, provide better patient care." I will upload the poster here next week.
In the meantime, Ken and his collaborators have added some useful new features to AskDrWiki:
JTF (Just the Facts) Wiki at the University of Michigan JTF (Just the Facts) Wiki is a "Manual for the Interns Online" by medical students and residents at the University of Michigan and Ann Arbor VA Hospitals. The manual was started in 1991 and is in its 13th edition (?!) now. JTF has a well-done procedure section and some good videos of central line placement which I will upload in a separate post.
Summary
I think medical wikis will change the way we study and teach medicine. In the foreseeable future, their role is not in creating "the most authoritative textbook" ever but rather in creating a "collective online memory" for a group of learners. Where these new web tools will lead us in the future, as usual, nobody knows, and this is the beauty of the amazing medium that the Internet is.
Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.
AskDrWiki.com is a medical encyclopedia based on a wiki platform. The authors were one of the first to use YouTube to upload medical videos. Dean Giustini and I discussed this fact a few weeks ago, and he wrote about it in his landmark BMJ editorial How Web 2.0 is changing medicine, linking to AskDrWiki.com.
Ganfyd is another medical Wiki community, created in November 2005 by a group of doctors working in the UK. It is intended to become a large on-line textbook of medicine (source: Wikipedia).
Mike Cannon-Brookes has a nice presentation on Organisational Wiki Adoption on SlideShare (link via DavidRothman.net). This may convince your department or hospital to start a wiki, if you do not already have one.
Wikipedia uses the "wisdom of crowds" concept which postulates that scores of non experts do a better job writing an article than a single expert. It is probably true. Most experts are busy people and do not have time to write, edit and protect from vandals more than one million articles.
Any social media website (and Wikipedia is one of them) has a relatively small number of devoted users who keep the project going and do the bulk of contributions. For Wikipedia, these users are about 500 and they are called administrators. They are in charge of keeping the encyclopedia what is supposed to be -- an encyclopedia -- and not a self-promotion tool.
What happens when administrators disagree with regular contributors? Edit war. There are revisions and versions changed back and forth until sometimes users are even locked-out of "Wikipedia land."
I was reading the Wikipedia article about Polycythemia and since I had an illustrative typical case of secondary polycythemia on ClinicalCases.org, I decided to add it in the "External Links" section at the bottom of the page. That was a well-intentioned and innocent addition, I thought. One of the administrators, JFW, disagreed, called my little effort "advertisement" and deleted the link. We discussed it at the talk page and since I tremendously respect people who take care of the world's largest encyclopedia (for free), I just moved on.
Some people are tougher to deal with though. One hair-transplant surgeon is having fierce fights on his talk page regarding his contributions to Wikipedia which are dubbed by some administrators "commercial" and "promotional." If you have 4-5 minutes, I would recommend reading the whole page to get a feel of what an edit war looks like:
Administrator:
Welcome to Wikipedia. We invite everyone to contribute constructively to our encyclopedia. Take a look at the welcome page if you would like to learn more about contributing. However, unconstructive edits, such as your changes to the Raymond V. Damadian page, are considered vandalism, and if you continue in this manner you may be blocked from editing without further warning. Please stop, and consider improving rather than damaging the hard work of others. Thank you. Talk: Administrator.
Plastic surgeon:
Unconstructive edits, vandalism? nonsense. The page on Raymon V Damadian contains numerous factual errors and much evident confusion about the technology which I was just attempting to correct. I'm and MD PhD who was there when all this stuff was going on. Even published papers in the field and know many of the princopals. See my comments at. Talk:Raymond V. Damadian.
There is (was?) also a Wikipedia page about one of the medical bloggers, Summer Sethi, which was labeled for deletion as a "vanity page":
Strong delete: Wikipedia is not a resume or publication list. There are perhaps thousands of other medical researchers with similar publications, nothing shows why this person is any more notable than them. --Ragib 23:59, 2 September 2006 (UTC)
The Full-body scan article is another example of a disagreement between contributors and administrators.
A fine line
Administrators like JFW and Samir are the backbone of the Clinical Medicine project in Wikipedia. Their job is to keep the vandals and self-promotion types out of the encyclopedia. If you make contributing too difficult though, "regular guys" may just go somewhere else.
Some interesting abstracts from PubMed:
