Evidence-based web 2.0

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Contents

Introduction

See also Using web 2.0 tools in health research at UBC

"Researchers will continue to make progress in discovering evidence-based principles for the design of e-learning, including new applications of the science of learning to educational games, simulations, and pedagogical agents." — Richard E. Mayer, University of California, USA

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Systematic studies of social software are only beginning to emerge within the medical and health communities. Some early-adopter health librarians have positioned themselves to discuss and critique web 2.0 media (see Booth A. Using evidence in practice: blogs, wikis and podcasts? Health Info LJ 2007; 24: 298–302). However, Andrew Booth suggests that the ephemeral nature of Internet technologies makes them problematic because they over-technicize our work; he also criticizes the "lemming-like tendency [of some health librarians] ...to rush into adoption of ...new, but essentially unproven, delivery mechanism(s) without using the evidence.

That said, this position discounts the importance of experimenting with new technologies. Booth raises the issue of basing decisions to implement social software on better evidence, which is completely defensible. Health librarians should be as knowledgeable about cool tools and social software as possible. But we must be able to assess the usefulness of new information technologies through proper evaluation and contextualization processes - what social software tools are most useful for health professionals? Are physicians different from nurses or pharmacists in their use of web 2.0 tools? If physicians want to begin to explore web 2.0, where should they first be pointed?

Research questions

  • What research or evidence exists that web 2.0 (social software) tools are useful in the context of medicine (or any field)?
    • Some evidence is beginning to emerge in the literature (see below)
  • What is the connection between web 2.0 and teaching? Interdisciplinary practice?
    • Are physicians and health librarians just as likely to use anecdotal reports and intuition as to what is optimum in using web 2.0 tools?
  • What kinds of studies have been done thus far (i.e. surveys, case studies, etc.)?
  • Are there any good studies of the use of social software in medicine? in the area of health librarianship?
  • For physicians new to web 2.0, where is a good place to start (based on the cited evidence)?
  • Do medical school programs expect students to have web 2.0 literacy and digital fluency?
  • Is the effective use of social software mentioned in the context of medical informatics?
  • What are differences between med students who are digital natives and those who can be described as digital immigrants?
  • In terms of belonging to social groups, and social interaction, does web 2.0 have potential health benefits for users?

An early definition

"Evidence-based web 2.0 (EBW2) is the integration of the best available evidence of social software use in promoting effective time and information management skills in the digital age. In addition to alloting time for experimentation, heuristics and 'play', physicians, librarians and information specialists will also want to systematically evaluate EBW2 and build as good an evidence-base as is possible given the future effective application of web 2.0 tools."

What does the medical literature tell us?

In the list below, several articles provide some evidence of the efficacy of web 2.0 tools. These articles are either surveys or case studies. A prominent medical researcher in this area is Dr. Tom Sandars a clinical professor at the University of Leeds (UK). It seems most of the early investigations are in the area of effectiveness of blogs in teaching, networking for health professionals and using wikis.


  • To assess the experience of US medical schools with unprofessional content postings by medical school students
  • Sixty percent 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


  • King S et al (2009) Merging social networking & formal learning to support interprofessional instruction. Med Ed Online
    • 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


  • Sandars et al (2008) - see also 2007 Sandars study below:
    • 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)
  • Tantawi E. (2008):
    • 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 et al (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.

Related articles

The following articles touch on important aspects of the use of technologies in medicine, but are not necessarily focussed on social software.

  • Atreja (2006)
    • health professionals struggle to filter evidence in their fields
    • need solution to facilitate filtering and delivery of information tailored to researchers/ clinicians
    • we propose an evidence-based information and web 2.0 portal to serve as model
  • Eysenbach et al (2004):
    • abundant, unmoderated peer to peer support on the web;
    • research is needed to evaluate conditions and for whom web is supportive
    • how effective are these groups in delivering social support?
  • Casebeer et al (2002):
    • Physician Experience in Internet Use; e-mail - 90%; personal use 86%; lit searching 65%; searching for medical information 53%; professional association updates 33%; accessing on-line journals 45%; continuing medical education 31%; searching for specific patient information 29%; consultation with colleagues 17%
  • Parboosingh et al (2000):
    • "Quoting Brown and Duguid...authors maintain that practitioners develop in 'communities of practice where learning to be a practitioner occurs by practicing with and having access to colleagues. Communities of practice emerge as natural result of individuals working and learning collaboratively in multidisciplinary teams where members are rewarded for sharing information and promoting mutual learning."

Anecdotal arguments for

  • social software and web 2.0 tools have been in use now for several years
  • social software invites participation; collaboration; socialization; experimentation
  • medical journal editor Richard Smith has written about the importance of physicians using the tools of web 2.0
  • My Doctor is Web 2.0. Unqualified Remarks Blog
  • users have tools to engage in construction of their own learning rather than merely absorb content passively
  • content is continually remixed by users; many tools support collaboration, and help those working in teams.
  • shared community spaces are central to what excites young people and contributes to persistence and motivation to learn.

Anecdotal arguments against

  • doctors do not have time
  • takes focus away from F2F meetings with patients, and each other
  • fragmentation of attention
  • Google Is 'Rewiring' Us Alright
  • impact on deep reading, see T. Scott
  • over-technization

Library and private sector reports

Part I

Reports that academic and health librarians need to read are:

Part II

Journal literature

  1. Atreja A. Using Web 2.0 Technologies to Develop a Resource for Evidence Based Medicine. AMIA Annu Symp Proc. 2006;847.
  2. Bonniface L, Green L. Finding a new kind of knowledge on the HeartNET website. Health Info Libr J 2007;24 Suppl 1:67-76.
  3. Bouldin AS, Holmes ER, Fortenberry ML. "Blogging" about course concepts: using technology for reflective journaling in a communications class. Am J Pharm Educ 2006;70(4):84.
  4. Boulos MN, Maramba I, Wheeler. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ. 2006 Aug 15;6:41.
  5. Casebeer L, Bennett N, Kristofco R, Carillo A, Centor R. Physician Internet medical information seeking and on-line continuing education use patterns. J Contin Educ Health Prof 2002; 22 (l): 33-42.
  6. Eysenbach G et al. Health related virtual communities and electronic support groups: systematic review of the effects of online peer-to peer-interactions, BMJ 2004;328:1166.
  7. Feeney L et al. A description of the new technologies used in transforming dental education. Br Dent J. 2008 Jan 12;204(1):19-28. Erratum in: Br Dent J. 2008 Jan 26;204(2):54.
  8. Henderson JV. Comprehensive, technology-based clinical education: The “virtual practicum.” International Journal of Psychiatry in Medicine 1998;28, 41-79.
  9. Kennedy et al. First year students' experiences with technology: are they really digital natives? University of Melbourne Centre for Study of Higher Education. 2006.
  10. Kennedy RS. Weblogs, social software, and the new interactivity on the web. Psychiatric Services 2004;55:247-249.
  11. Kim S, Chung DS. Characteristics of cancer blog users. J Med Libr Assoc. 2007 October; 95(4): 445–450.
  12. Lupien P, Oldham R. The Millenial Mythology: putting suppositions to the test in an academic library. University of Guelph. Computers in Libraries, 2007
  13. McGee JB, Begg M. What medical educators need to know about "Web 2.0". Med Teach. 2008 Mar;30(2):164-9.
  14. McLean R, Richards BH, Wardman JI. The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution? Med J Aust. 2007 Aug 6;187(3):174-7.
  15. Niemi PM. Medical students' professional identity: self-reflection during the preclinical years. Med Educ 1997;31:408-415.
  16. Owen M et al. Social Software and Learning Bristol, Futurelab. 1999
  17. Parboosingh J et al. Evaluating technologies for team learning in health sector workers: a review and synthesis of the literature. Office of Learning Technologies (OLT), CANARIE and Health Canada.
  18. Parboosingh J. Tools to assist physicians to manage their information needs. In: Bruce C , Candy P , eds. Information literacy: models for the future. Wagga Wagga, New South Wales: Charles Stuart University Centre for Information Studies, 2000: 121-136.
  19. Parboosingh J. Continuing education and professional development for hospital doctors and dentists. Med Educ 2000; 34 (6): 421-423.
  20. Potts HW. Is e-health progressing faster than e-health researchers? J Med Internet Res. 2006;8(3):e23 PMID: 17032640
  21. Sandars J, Haythornthwaite C. New horizons in medical education: ecological and Web 2.0 perspectives. Medical Teacher 2007; 29: 307–10.
  22. Sandars J, Schroter S. Web 2.0 technologies for undergraduate and postgraduate medical education: an online survey. Postgrad Med J. 2007 Dec;83(986):759-62.
  23. Sandars J. What is the Net Generation? The challenge for future medical education. Med Teacher 2007;29:85-88
  24. Sandars J. Twelve tips for using blogs and wikis in medical education. Med Teach. 2006 Dec;28(8):680-2.
  25. Sandars J et al. Web 2.0 and social software: the medical student way of e-learning. Medical Teacher 14 February 2008
  26. Tantawi E. Evaluation of a Blog Used in a Dental Terminology Course for First-Year Dental Students. J Dent Educ..2008; 72: 725-735
  27. Wenger E. Supporting communities of practice: a survey of community-oriented technologies. 2002. http://www.ewenger.com/tech/
  28. Zeng X, Harris ST. Blogging in an online health information technology class. Perspect Health Inf Manag. 2005 Sep 29;2:6.
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