 ...one of many candid tweets that get attention on Twitter To browse other articles on a range of HSL topics, see the wiki index.
Introduction
See also Evidence-based web 2.0 and Using web 2.0 tools in health research at UBC
Below are some key articles that form the evidence base regarding the use of web 2.0 tools in medicine. Many are surveys, observational and/or case studies. Prominent medical researchers in this area are from the United Kingdom although there are a few major studies done in the United States. Early investigations deal with the effectiveness of blogs in teaching, networking and using wikis. Newer studies concentrate on Facebook and Twitter, and examining unprofessional behaviour in those spaces.
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- the web facilitates networking and ways to associate with others with similar interests, values and goals
- an online survey was administered to 644 first-year students and 413 graduating students to investigate their media preferences, gauge if they are active on social media, and evaluate how they responded to advertisements
- students were in the following health professions: biotechnology, couple and family therapy, medicine, nursing, occupational therapy, physical therapy, public health, radiologic and imaging sciences, and pharmacy
- students prefer online media as their primary source of information; students use Facebook and Twitter or LinkedIn
- understanding social media has several implications for educating, connecting with and researching health professions students from all stages of their academic careers
- increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in order to maintain confidentiality, honesty and trust in the medical profession. Although physicians use online social networks, blogs, and media sites for personal and professional reasons, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a "dual-citizenship" approach to online social media that separates public and private personae. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary.
- Australian study aims to evaluate how medical students are using Facebook for education. Researchers surveyed 759 medical students at one Melbourne university, and explored the design and conduct of 4 Facebook study groups. 25.5% of students reported using Facebook for education-related reasons and another 50.0% said they were open to doing so. The case studies showed conservative approaches in students' efforts to support their development of medical knowledge and mixed successes. The study authors concluded that Facebook as part of learning and teaching is as much of a challenge for students as it may be for educators.
- study describes how physicians use Twitter, with a specific focus on professionalism. Descriptive characteristics were extracted from pages of self-identified physicians with 500 or more followers in May 2010. Content analysis of 5156 tweets was performed using users’ most recent tweets at time of data extraction. Three authors coded tweets, iteratively refining the coding until κ > 0.78 for all categories or interrater agreement was 100%. One hundred forty-four tweets (3%) were categorized as unprofessional. Thirty-eight tweets (0.7%) represented privacy violations, 33 (0.6%) contained profanity, 14 (0.3%) included sexually explicit material, and 4 (0.1%) included discriminatory statements.
- comparative study of student reflective writings produced either as a (blog) or traditional written (essay) to assess differences in content, depth of reflection and student preferences
- students in internal medicine at two US medical schools in 2008-2009 were quasi-randomly assigned to one of two study arms according to which they were asked to either write a traditional reflective essay and subsequently join in faculty-moderated, small-group discussion (n = 45), or two writings to a faculty group blog and provide one comment on a peer's posts (n = 50).
- examples from a pilot were used to refine coding and determine inter-rater reliability; writing was coded for theme and level of reflection by two blinded authors; coding processes reached inter-rater reliabilities of 91% and 80%, respectively
- student writing addressed seven themes: (i) being humanistic; (ii) professional behaviour; (iii) understanding caregiving relationships; (iv) being a student; (v) clinical learning; (vi) dealing with death and dying, and (vii) the health care system, quality, safety and public health
- distribution was similar across institutions and study arms; level of reflection did not differ between study arms. Post-clerkship surveys showed that student preferences for blogging or essay writing were predicted by experience, with the majority favouring the method they had used.
- our study suggests no significant difference in themes addressed or levels of reflection achieved when students complete a similar assignment via blogging or traditional essay writing; faculty should feel comfortable using blogs for reflective exercises
- Facebook is skyrocketing with 400 million users
- medical centers and residency programs are not immune from the "invasion"
- rapid dissemination of information is possible from status updates, tweets, medical support groups, and clinical communication between patients and providers
- however, new technology opens door for misuse and policies are necessary
- among surgical house staff and faculty, issue has not been addressed previously
- studied use of Facebook in our residency program; of 88 residents and 127 faculty, 56 (64%) and 28 (22%) have pages on Facebook
- 50% are publicly accessible; 31% of publicly accessible pages had work-related comments posted; of these comments, 14% referenced specific patient situations or were related to patient care
- guidelines consistent the Accreditation Council for Graduate Medical Education and American College of Surgeons professionalism are necessary
- studied Facebook activity of residents and fellows; impact of Facebook on doctor–patient relationship
- anonymous questionnaire emailed to 405 residents and fellows at Rouen University Hospital, France, in October 2009
- 202 participants returned questionnaires (50%); 147 (73%) had a Facebook profile; 138 (99%) displayed their real name, 136 (97%) their birthdates, 128 (91%) a personal photograph, 83 (59%) their current university and 76 (55%) their current position.
- default privacy settings were changed by 61% of users, more frequently if they were registered for >1 year (p=0.02).
- if patients requested them as a ‘friend’, 152 (85%) participants would automatically decline request, 26 (15%) would decide on an individual basis and none would automatically accept request
- 88 participants (48%) believed the doctor–patient relationship is altered if patients discover their doctors have a Facebook account
- 139 (76%) considered that it would change if patients had open access to their doctor's profile, independent of content
- residents and fellows frequently use Facebook and display personal information on their profiles
- investigation of how undergraduate medical students use Facebook and identified unprofessional behaviours
- voluntary anonymous online survey was devised by the University of Liverpool and emailed to students
- question topics: use of Facebook, privacy settings, groups relating to course; professional behaviours
- response rate was 31% (n = 56); majority had Facebook account and saw photos they found embarrassing on site
- half of respondents reported they had seen unprofessional behaviour by colleagues on Facebook
- students said they were aware of the UK's General Medical Council (GMC) guidance, but unprofessional behaviour is still seen
- highlights issue of social networking and professionalism amongst medical students
- guidance from the GMC and medical schools is needed to avoid negative impact on professional reputations
- university students are interested and active in supporting their learning by using Facebook, a popular social networking site
- study aimed to add to our understanding of how effectively students are using Facebook
- survey of Facebook use among 759 medical students; explored design and conduct of four Facebook study groups
- 25.5% reported using Facebook for education and 50.0% said they were open to doing so; technological affordances and group dynamics were factors contributing to groups’ mixed success
- cases indicate that Facebook use is a challenge for students and educators
- Chu LF. The role of social networking applications in the medical academic environment. Int Anesthesiol Clin. 2010;48(3):61-82.
- social networking tools allow users to share reports of physician performance: the physician-rating website
- paper describes structure and content of physician-rating websites and assesses extent to which patients might find them valuable
- searched Google for websites that allowed patients to review physicians in the US; included websites that met predetermined criteria, identified common elements and recorded characteristics
- we searched the websites for reviews of a sample of 300 Boston physicians; we analyzed quantitative and narrative reviews; identified 33 physician-rating websites, which contained 190 reviews for 81 physicians
- most reviews were positive (88%). Six percent were negative, and six percent were neutral
- generalists and subspecialists did not differ in number or nature of reviews; we identified narrative reviews that appeared to be written by the physicians themselves
- Physician-rating websites offer patients a way to provide feedback and obtain information about physician performance
- Despite controversy, these sites are used by patients and a majority of reviews appear to be positive
- see Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med. 2008 Oct;23(10):1642-6.
- describes presence of medical schools on social media sites and identifies whether student policies address social media use
- websites of 132 accredited US medical schools were assessed by two investigators for their presence (as of March 31, 2010) on the common social networking and microblogging sites (Facebook and Twitter)
- 100% (n=132) of US medical schools had websites and 95.45% (126/132) had any Facebook presence. 25.76% (34/132) had official medical school pages, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups on Facebook. 10.6% of medical schools (14/132) had Twitter accounts.
- 128 of 132 medical schools (96.97%) had student guidelines or policies publicly available online. 13 of these 128 schools (10.16%) had guidelines/policies explicitly mentioning social media. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible under any circumstances, or mentioned strongly discouraged online behaviors. 53.85% (7/13) encouraged thoughtful and responsible social media use.
- almost all US medical schools have a Facebook presence, yet most do not have policies addressing student social networking behaviour;
- as social media use rises, policy informing appropriate conduct in medical schools lags behind. Established policies at some medical schools can provide a blueprint for others to adopt and adapt.
- study aims to discover whether wikis (collaborative websites) enhance medical students' development of professionalism
- online wiki was made available to four problem-based learning (PBL) groups, involving 32 students
- data collection comprised a small-scale student survey and four focus groups eliciting their views about wiki use, triangulated with facilitator interviews and wiki usage statistics
- several factors affected individual student and group engagement with wikis, such as positive group dynamics. Students shared web links, helping clarify PBL discussions and increase their confidence
- two main benefits of using wikis for the development of professionalism with medical students were revealed
- wikis acted as a shared knowledge base for hard-to-find resources on professionalism; when students reflected on the difference between interacting in wikis and online social spaces, or when they considered whether or not to post a resource that their sense of professionalism emerged.
- examines use of Facebook by young medical graduates, and use of privacy settings
- cross-sectional survey of use of Facebook by recent medical graduates, accessing material available to a wider public
- survey subjects were 338 doctors; total of 220 (65%) graduates had Facebook accounts; 138 (63%) of these had activated their privacy options, restricting their information to ‘Friends’. Of the remaining 82 accounts that were more publicly available, 30 (37%) revealed users’ sexual orientation, 13 (16%) revealed their religious views, 35 (43%) indicated their relationship status, 38 (46%) showed photographs of the users drinking alcohol, eight (10%) showed images of the users intoxicated and 37 (45%) showed photographs of the users engaged in healthy behaviours. A total of 54 (66%) members had used their accounts within the last week, indicating active use.
- young doctors are active members of Facebook; quarter of doctors in our survey did not use privacy options, rendering information they revealed readily available to a wider public
- measures frequency and content of online social networking among 2 cohorts of medical students and residents (2007 and 2009)
- evaluated social networking profiles for 2 cohorts of medical students (n = 528) and residents (n = 712) at the University of Florida in Gainesville
- measures included existence of a profile, whether it was made private, and whether any personally identifiable information was included
- subjective outcomes included photographic content, affiliated social groups, and personal information not generally disclosed in a doctor-patient encounter
- social networking continues to be common among physicians-in-training, with 39.8% of residents and 69.5% of medical students maintaining Facebook accounts
- residents' participation significantly increased (P < .01) when compared to 2007 data. Individuals in 2009 cohort had more “friends” (P < .01), belonged to more “groups” (P < .01), and were more likely to limit public access to their profiles through the use of privacy settings (P < .01) than the individuals in 2007 cohort
- social networking application use by physicians-in-training remains common
- describes the experiences of librarians embedded within clinical teams at the University of Texas MD Anderson Cancer Center
- discusses efforts to enhance communication within their teams using web 2.0 tools
- pros and cons of EndNote Web, Delicious, Connotea, PBWorks, and SharePoint are discussed
- collaboration, Connotea, Delicious, EndNote Web, online reference management
- quotes: Karpinski, Joanna Lynn. Disconnected in a Connected World – Knowledge and Understanding of Web 2.0 Tools at the University of Pennsylvania Medical Center. Medical Reference Services Quarterly 27, no. 1 (Spring 2008).
- Evidence-based practice is the standard paradigm in modern healthcare
- the Internet [and social media] create opportunities in education for healthcare
- University of Brussels initiated a European project called MedSkills in 2004 to create copyright-free reference work of evidence-based information on medical skills for all levels of healthcare professionals (paramedics, nurses and physicians, teachers of medical skills and students)
- created wiki framework to suit different users in ‘cellular’, ‘organ’, ‘body’ and ‘best treatment’ content maps
- up-to-date reporting of social media use helps to monitor its growth and to inform health promotion/communication efforts aiming to effectively utilize social media
- study aims to identify sociodemographic and health-related factors associated with social media consumer users in US
- web 2.0 tools and methods have attracted considerable attention as a means to improve health care delivery
- there is no detailed research describing how Web 2.0 influences physicians' daily clinical practices
- this study examines web 2.0 use by 35 junior physicians in clinical settings to further understand their impact on practices
- Diaries and interviews encompassing 177 days of internet use or 444 search incidents, analyzed via thematic analysis
- 53% of internet visits employed user-generated or Web 2.0 content, with Google and Wikipedia used by 80% and 70% of physicians, respectively.
- web 2.0 represents a profound departure from previous learning and decision processes normally controlled by senior medical staff or medical schools; concern with risks of poor quality information with Web 2.0 and manner in which physicians are using it
- three alternative policy options are identified to manage this risk and improve efficiency
- assesses experience of US medical schools with unprofessional content postings by medical school students
- 60% of US medical schools responded (78/130); 60% (47/78) reported incidents of students posting unprofessional messages
- Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported.
- 45 schools reported an incident and responded to disciplinary actions; 30 gave informal warnings (67%) and 3 reported student dismissal (7%)
- policies that cover student-posted content were reported by 38% (28/73) of deans; 11% (5/46) were actively developing new policies to cover online content. Deans reporting incidents were more likely to have a policy (51% vs 18%; P = .006), believing these issues could be effectively addressed (91% vs 63%; P = .003), and having higher levels of concern (P = .02).
- web 2.0 methods make it easier and less costly to develop decision support; web 2.0 is characterized by open sharing, interactivity and collaboration in online communities
- previous attempts at sharing clinical support content are outside of web 2.0 framework
- authors examine three efforts: Clinfowiki, world-accessible wiki for decision support content; Partners Healthcare eRooms, web-based tools for developing decision support; Epic Systems Corporation's Community Library, repository for sharing decision support content
- authors evaluate potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies
- a case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within organizations
- study examines Web 2.0 use by 35 junior physicians in clinical settings to further understand their impact on medical practice
- diaries and interviews encompassing 177 days of internet use or 444 search incidents, analyzed via thematic analysis
- 53% of internet visits employed user-generated or web 2.0 content, with Google and Wikipedia used by 80% and 70% of physicians, respectively
- web 2.0 is profound departure from previous learning and decision processes normally controlled by senior medical staff or medical schools
- alternative policy options are identified to manage this risk and improve efficiency in Web 2.0’s use.
- translational research focuses on bench-to-bedside information transfer — getting the information from researchers into the hands of clinical decision makers; researchers who manage international collaborations could benefit from increased knowledge and awareness of online collaboration tools to support these projects
- librarians developed curricula targeted at academic researchers focused on online tools to support research
- topics ranged from brainstorming and writing tools (eg. online mindmapping, wikis, Google Docs, Zoho) to online project management (eg. Smartsheet and Huddle) novel communication tools (eg. chat, private chatrooms, Skype, and virtual worlds) and innovative publication and presentation (eg. blogs, open access journals and prepress archives, YouTube and Slideshare).
- social media are tools to support distance collaborations inexpensively while offering benefits of placing selected information in online spaces that facilitate discovery and discussion
- thus supporting the fundamental research processes at the same time as promoting bench-to-bedside information transfer.
- published in January 2009; discussed on blogs
- finding that '45% of medical schools use web 2.0 tools in their curricula'
- what does this mean and how did the authors draw their conclusions?
- criticized for poor study design and statements not based on their results
- study describes redesign of an interprofessional team course for health science students
- theoretical model is hypothesized as a framework for redesign process, consisting of two themes: 1) the increasing trend among post-secondary students to participate in social networking (e.g., Facebook, Second Life) and 2) the need for healthcare educators to provide interprofessional training that results in effective communities of practice and better patient care.
- redesign focused on increasing relevance of course through integration of custom designed technology to facilitate social networking during their interprofessional education.
- students in an educationally structured social networking environment can be guided to join learning communities quickly and access course materials
- research and implementation work is required to effectively develop interprofessional health sciences communities in a combined face-to-face and on-line social networking context
- 212 first year medical students; survey
- 90% med students used instant messaging and social networking sites (70%). No significant difference between males and females;
- blogs are read by 1/5th of med students; small number (8%) write their own.
- 1/5th of men said they used media sharing and contributed to wikis.
- social bookmarking rarely used by either sex.
- medical educators need to recognize potential of social software in medical education.
- essential that med students maintain informality, and privacy of sites.
- major challenge is how to integrate social software into current curricula.
- use of social software among first year medical students is common; social networking sites provide combined features, including instant messaging and blogs, and could be used to develop e-learning.
- Do health librarians have a role to play here? (Dean)
- case study evaluated blog use for a dental course;
- blog set up using free software; set up to get feedback about course;
- instructor posted multiple choice/true/false questions inviting students to publish answers;
- 149 comments were left on blog in response to thirteen posts over three months;
- users considered blog useful; main reason not to use blog? lack of time;
- statistically significant difference existed between students using/those who did not use blogs;
- further research re: blogging, and its potential in dental education is needed.
- Feeney et al (2008):
- This article is an introduction to range of technologies (including social software) for dentists.
- Technology pioneers did not expect to replace person-to-person interaction or communication.
- Whole pedagogies have evolved over past few decades that drive and support appropriate and effective use of technology and media in learning and teaching
- Sandars and Schroter (2007)
- survey; use of/barriers to web 2.0 tools by medical students and medical practitioners
- semi-structured online questions of 3000 medical students and 3000 medical practitioners
- groups had high familiarity, but low use, of podcasts; ownership of digital media players was higher among med students.
- high familiarity, but low use, of other web 2.0 tools except high use of instant messaging and social networking by med students.
- groups stated they were interested in using Web 2.0 in education but there was lack of knowledge about how to use new technologies.
- high awareness of web 2.0 but its potential will only be achieved if there is increased training.
- Bouldin et al (2006):
- Blogs used in reflective journaling exercises in second-professional year of University of Mississippi School of Pharmacy
- To encourage students to reflect on course concepts and apply to environment outside classroom, and assess communication performance.
- Blog entries (2) per week were required for full credit; evaluated at three points during term.
- End of the course, students evaluated the assignment using a 2-page survey instrument.
- Assignment contributed to student learning and increased awareness level for ~40% of class.
- Blogs are useful for reflective journaling; future versions of assignment will benefit from student feedback from this study.
- Boulos et al (2006):
- blogs, wikis and podcasts offer a way to enhance students', clinicians' and patients' learning
- research is needed to determine best ways to integrate tools into existing learning programmes
- must account for different needs of audiences and opportunities of virtual collaboration
- research into novel applications needed to ensure coherent learning experience.
- Zeng et al (2005)
- describes use of course blog in online health information management (HIM) course.
- blog had three purposes (online discussion, digital drop box & class project management tool)
- reports results of after-class survey on using blog as learning tool.
- 55% of students agree that blogging is useful learning tool;
- 50% feel that blog is a good tool for student activities; 60% it can serve as medium for reflective thinking and writing; 60% want to see its application in other courses.
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