No More Wikipedia! Teaching Medical Students to Access Evidence-Based Information

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.

Senthil-New—Senthil Kumar Rajasekaran is Director, Center for Excellence & Associate Professor at Oakland University William Beaumont School of Medicine. He can be reached at rajaseka@oakland.edu.

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7 Responses to No More Wikipedia! Teaching Medical Students to Access Evidence-Based Information

  1. I can see your concerns are valid but they are not necessarily the only concerns you should have. Have you considered that the resources you cite and expect your students to use among possibly others are actually accurate and relevant? Why do students feel compelled to look elsewhere? Perhaps it’s because they get different points of view, they can now question those whose mission has been to keep them on the straight and narrow. Today, students everywhere, not just in medicine, have many tools and ideas, and if they are “smart” they do ask more questions, something that doctors, as students, historically were not encouraged to do.If you feel threatened by students challenging their peers or others, this is good. No one has all the answers and patients too are quickly realizing their doctors are not fallible. The best you can do as a teacher is to provide, in addition to online resources, a basis for establishing the proper tools to stimulate the curiosity and the empathy needed to become worthy of the respect you want from your patients. Having knowledge is one thing, imparting and using proper judgement and skill takes a lifetime of learning and some get it right and others never do.

  2. Regret that I didn’t pick up the word “fallible”…which should, instead, read as “infallible” or have the word, not removed…i.e. doctors are imperfect.

  3. As a medical student, I truly wish that I had more training in accessing better sources of information than Wikipedia. However, I would say that Wikipedia is often better organized and more transparent about where it gets its information as well as its overall reliability than the lecturers we see in the medical school curriculum. Also, you speak of how it is “impossible to stay up-to-date,” but I would argue that it has never been easier to understand how large sections of the medical community. Before the “era of technological advances,” there did not exist a consensus. There were thoughtful doctors with individual opinions, but that was about it. Opinions are nice, but data-driven, crowd-sourced, iteratively compiled information is usually better (in my opinion, oh the irony).

  4. Senthil Kumar Rajasekaran says:

    Thank you for sharing your thoughts.
    There may be a role for wikipedia and many other open web resources for quick reference and I do not dispute that. But, it is not appropriate when students and physicians turn to such sites for decision making purposes. The purpose of our intervention described in the post was to help students understand that there are evidence based resources available online that can be accessed with the same amount of time and ease as they approach wikipedia or other such resources.
    We have to sadly acknowledge the point in the above post that sometimes, “information in such resources are more reliable than the lecturers we see in the medical school curriculum”. But again, correcting such facts (by the lecturers) is the solution rather than getting into the habit of relying upon such open resources, which are not fully reliable and that does not undergo a stringent peer-review process.

  5. Patricia Franz MD says:

    I think one of the hardest things for medical students, and residents, to understand is that medical knowledge is not absolute, nor is it static. Our recommendations to patients change as medical knowledge advances. How I counsel patients today regarding HRT, for example, is drastically different than how I counseled patients 15 years ago. Because our knowledge about health and disease changes as research is done. My issue with Wikipedia is that the source may or may not be reliable. I have found alot of bad information on Wikipedia. There is not any more accurate information than what a patient can find on the internet themselves. Part of our professional responsibility to our patients, as well as our students, residents and colleagues, is the task of synthesizing the findings of medical studies in a coherent and educated fashion, to then be able to make a recommendation about treatment. If all you ever read is Wikipedia, that ability will never develop.

  6. Pingback: Wikipedia Is King! | Wing Of Zock

  7. Pingback: Defining Learners by the Answers They Need, Not the Questions They Ask | Wing Of Zock

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