By Senthil Rajasekaran, MD
Many of our medical students go to such non-peer reviewed online sources to look up unfamiliar clinical terms or topics as Google or Wikipedia. It’s understandable; those sites provide instant information. But non–peer-reviewed online sources like Wikipedia are not (yet) fully trustworthy because anyone can write or edit anything anonymously. As a result, the information can be heavily biased or just anecdotal.
Getting into the habit of accessing those sites may continue beyond medical school into residency and clinical practice. New Scientist cites a report that finds up to half of medical doctors turn to Wikipedia for medical information. It’s important that medical educators intervene early to teach medical students how to access appropriate information.
In this era of technological advances, we must realize that expecting medical students to access information is as important as expecting them to know the information. With constantly changing guidelines and management algorithms, it is impossible for anyone to keep up-to-date with the latest evidence-based literature. And with all of that information available at the touch of our fingers, it isn’t necessary to memorize all the relevant information.
Medical students should gain expertise in using at least few medical apps that are commonly used by physicians to find peer-reviewed information. But simply exposing or familiarizing them with a few apps isn’t enough; we must build new (and better) habits. Build hands-on activities into the curriculum beginning in the first year, helping students become accustomed to using these apps within a clinical context.
Students will be able to perform the tasks multiple times and gain expertise in using these resources before they enter clinical training. This is no substitute for a formal evidence-based medicine course, but is something that can be incorporated into any course. Faculty should create clinical scenarios and challenge students to generate solutions through instant access to information using medical apps.
At Oakland University William Beaumont School of Medicine, we have constructed classroom sessions that require our first-year medical students to install and use three medical apps (e-pocrates, DynaMed, and Micromedex). We generated clinical cases followed by questions regarding drug interaction checks, adverse effect checks, evidence-based decision making (level I, II or III evidence?), cost effective alternative checks, and patient advice. Each of these tasks required students to use one or more of the three apps to find answers. The tasks were time-limited, allowing 30 to 45 seconds for each task.
At the end of the sessions, students gave highly positive feedback about the effectiveness and practicality of this activity. As our students move into their clinical years, our plan is to involve faculty at the clinical clerkships to challenge them with similar tasks at the bedside; students will be able to appreciate the usefulness of such resources in aiding decision-making.
Our students will never be able to know everything, and it is unrealistic for us to expect that they can. I feel strongly that our 21st century doctors need formal training in access to instant information. As the next step, we are working on assessment strategies to assess this specific skill set.