IF YOU want to annoy your doctor during your next visit, walk into his or her office and start waving around printouts from Wikipedia. Physicians often complain about these so-called “Internet patients,” the ones who challenge professional expertise with such unverified sources. Our medical school professors recount endless examples, rolling their eyes and telling us to expect these frustrations. It’s an interesting phenomenon to watch, when almost every student in the auditorium is using that website to understand the information.
Whether we’d like to admit it or not, Wikipedia has become a central pillar of medical — and honestly most — education. It’s used everywhere. In lecture, at home, during discussion groups, and even when we’re presenting patients. As physicians-in-training, we use it to look up everything from prescription medications to complicated words. And it provides instant answers in the simplest of forms, through a medium that just makes sense to our generation.
Last week, I informally surveyed my second-year medical school class; among 100 respondents, 89 indicated that Wikipedia was the first resource they consulted when faced with confusing concepts or terms. Seventy-nine said they used it “all the time” and, perhaps most striking, 45 said they thought they would use it for clinical information as physicians. These numbers underlie a near-ubiquitous reliance among medical students on such electronic materials. But does Wikipedia’s lack of credibility pose a problem for the future of American health care? Or is this site the kind of educational resource that medicine has needed for so long?
In my medical school experience, Wikipedia’s anonymous editors have contributed more to my daily learning than peer-reviewed resources or textbooks ever have. Here’s an example. The other day, I was sitting in dermatology class and saw a word that I didn’t understand — telangiectasia. I looked it up on UpToDate, the bible of clinical practice where every sentence is confirmed by academic literature and physician specialists. Greeted by a long list of topics, I clicked on the first option: “hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)”. The word telangiectasia was all over the article, which includes ways to treat this syndrome and its expected clinical presentation. But what does the word mean? Is it a disease? A symptom? I browsed the first three topics, poring through pages with more than 260 combined peer-reviewed citations.
After a couple minutes, I gave up. So I turned to the entry on Wikipedia. The very first sentence states: telangiectasias “are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter.” Well, that was easy.
That’s the promise of Wikipedia in health care — a freely accessible and user-friendly platform through which to explore virtually any subject in medicine. But there’s another side to consider. During our pulmonology block last year, two of my classmates saw an error in the site’s entry for hyperventilation. They fixed the mistake and, as a joke, added “Kenny’s syndrome” as a name for a particular condition. To their surprise, the edit stayed for weeks, and they even found other websites citing my friend as an acid-base disorder. Hence, the opportunity for anyone to edit Wikipedia with minimal regulation has a terrifying capacity to influence the environment for clinicians-in-training. In the worst-case scenario, these inaccuracies could adversely impact the care that patients eventually receive.
These two examples offer contrasting visions for Wikipedia’s future in medical education. The health care community can distance itself from untrustworthy encyclopedias, ignoring the impact these sites can have on the development of physicians. Or it can shape these dynamic resources to help educate medical students — and patients — with the most accurate and clinically relevant information.
It seems that the best path forward would involve strengthening sites like Wikipedia with academic oversight and providing medical students with guidelines for searching information. The realities of patient care will eventually demand more rigorous references; therefore, to encourage students along this transition, we need to reform conventional sources like DynaMed and UpToDate with more attractive interfaces and comprehensible language.
Fortunately, a number of institutions have begun embracing this path. At the University of Minnesota Medical School, the administration has supported a student-run medical wiki through which to distribute materials and concepts from the official curriculum — as of 2011, the site had 1.2 million page views across almost 1,600 articles for students to explore. Founded in 2012, the nonprofit Wiki Project Med Foundation now promotes collaboration among universities and health organizations to improve the quality of medical entries on Wikipedia. In coordination with this group, the University of California, San Francisco School of Medicine recently announced plans to provide course credit to medical students who help edit relevant content on the site.
Outlets like Wikipedia are transforming how our next doctors learn medicine. It’s time we acknowledge the positive role these resources can play in teaching both providers and patients. Only then can we realize the 21st century potential of medical education.