Friday, 5 June 2009

Where do first year medical students look things up?

In the last two days I have spoken to 31 first year medical students about their early clinical attachments in primary and seconday care. I asked them where they looked up unfamiliar clinical topics. These are some of the responses:
  • Wikipedia
  • Google
  • Kumar and Clark
  • Medical dictionary
  • YouTube (especially to find out more about operations)
  • NHS Direct/Choices
  • Oxford Handbook of Clinical Medicine
  • I didn't look anything up.
Wikipedia was definitely the most common choice. Many students said 'I know I shouldn't but....' and then qualified that they used Wikipedia first because it was easy to understand, they felt it was reasonably reliable, and accessible. One student used it to search directly from her phone when on placement.

I was intrigued by one student who was very keen to distinguish 'learning' which was what he did for exams... spotting questions on past papers and reviewing lecture notes... from 'experience', when he would access YouTube or Wikipedia to find out more about something that really interested him. His reluctance to call this learning reminded me of a third year student I spoke to earlier in the year. We were talking about how she would continue learning for the rest of her life. "That's so depressing", she said. In her mind learning was bound up with exams and assessment.

Should we worry about students turning to Wikipedia so often? Which other resources are just as user-friendly and comprehensive?

I think that NHS Choices is a good place to start.

EDIT: Just to make clear, the first year students I am referring to here are in an undergraduate 5 year course. The first few years of the course are pre-clinical but these early clinical attachements are to give them some initial insights into the world of clinical medicine. Some medical schools in the UK have no distinction between the pre-clinical and clinical parts of the course.


  1. I actually am surprised at how often medical students use wikipaedia. This is the first time I've been directly involved in their tutorials which are largely case based with some vinyets and then practice OSCE's. They have had to be actively encouraged to use Cochrane as an alternative. I just wondered how much discussion they have had surrounding good avenues for searching out information.

  2. The issue probably stems from the fact that in most instances, wikipedia pages are the ones that come up first on Google searches - hence you'd need to differenciate students who go to Wiki via Google from those who go straight to Wiki.

    I'm personally a big fan of eMedicine/MedScape, but this is arguably a bit too much for 1st year students. Wikipedia, for all its faults, might be the ideal starting point - provided the article is well referenced, students can be taught to look at, and click through to the references, to read the original sources.

  3. I don't teach medical students; I teach accountants and managers, but the principles are the same (if usually less potentially fatal.)

    I think one of the big advantages of ubiquitous, moderately-reliable information sources like Wikipedia is that we no longer had to teach anyone "facts". Facts have become a public good, rather than a valuable resource for book publishers.

    Because "facts" are everywhere, we educators can focus more on teaching students to treat "facts" with scepticism. That scepticism will help them as much when reading a respected textbook by the world's leading expert as it will when reading Wikipedia or any other source.

    I often go to it in the first instance because, as Pawlu says, many articles are well written and referenced and are a good indicator to other sources, and of course where Wikipedia is wrong, or even silent, it is open to any of us to put that right!

    Indeed, if our students are going to Wikipedia, do we have a duty to help make sure it is right?

  4. As a student, Wikipedia is my quick reference. In most case, I will encounter a lot of technical jargon. However, I will always check for further clarification with the text book or the lecturer.

    But for those who think Wikipedia is a place anyone can put anything, but I believe the amount of good people overcome the bad people.

    Despite that, have you look at the Wikipedia book?

  5. "Should we worry about students turning to Wikipedia so often?"
    You can worry about it all you want, but you can't change it. If you hit them hard enough, you can drive it underground (openness is better). So get in there and ensure that Wikipedia is a good teaching resource.

  6. As educators I think our main responsibility is to teach the kids how to think more than what to think. For online resources then, it's more important to show them how to look for relevant information, evaluate and synthesize it; rather than giving them a list of good, bad or indifferent source websites. The list is never going to be comprehensive and will be instantly out of date as soon as you publish it.

    That's why being web-savvy is so important for education now - assessing the validity of your sources is no longer just about reading the original NEJM article and checking the methodology (although that's important too), it's about understanding how blogs, wikis and UpToDate actually work, and how to weight / balance their influence on your learning.

  7. Hey , everyone. Thanks for your posts.

    @PamDH Cochrane wouldn't be an appropriate alternative to Wikipedia for these students. Cochrane is useful for when you have a focussed question and you want to find out the best evidence. But if you want to find out some background it is not the place to look. I've found myself coming across pages on Wikipedia too recently. I might so a seperate blog post about this.

    @Pawlu I think that most students who access wikipedia do go through Google. If I come across it myself it is through google. The point is that it is one of the 'trusted sources' that they might click on in that first page.
    I agree with you that eMedicine is quite heavy for a first year looking for some brief background to try and make some sense of what they are coming across. It also has the distinct disadvantage that it is from the US. Medicine is not as completely global as we might thing. We use different values and names for tests. We have different ways of organising care. That is also one of the reasons that I am less keen on Wikipedia.
    Some students did say that they went though to the original references on Wikipedia and would have cited them if writing an essay. Thanks for your comment as always.

    @DaveBull Your comment made a lot of sense. I've been looking up what other people say about wikipedia as a way of teaching students to be sceptical of sources today. I think this is probably the way we should approach it. As I said I am quite keen on students to start looking at high quality materials directed at patients for background reading. Some people may be surprised about that as well!

    @Mohd Great to hear from you. Reliability does not worry me a lot. I would just like to find somthing that is just as quick and easy to access as Wikipedia but will be even better for the students.

    @AJC Trying to improve the quality of Wikipedia is too big a task for me! But there are existing resources that are verified and specifically relevant to the UK and I think it would help medical students to make them more aware of them.

    @ColinMitchell These are some great points. @PamDH was wondering how much discussion there is around this with students... well, quite a lot. That is why so many of the students start by saying that they know they have been told it is not reliable etc. When talking to the students I stressed that over the next few years they need to develop skills in establishing how they rate info sources for themselves. New resources will come along all the time.
    What do you think about directing students towards patient directed materials such as NHS choices?

    Thanks again to all.
    As an aside a conversation has started on twitter about whether or nit Wikipedia is an appropriate source to reference in student work. I've started a twitter poll so share what you think:

  8. If I read your tweets right, you use Blackboard? My experience of BB (2003-2005) was entirely negative but now I use Moodle to support learners, and class created Wikis are not only a good professional learning discipline, they can also become a resource for the group.

    Perhaps there could be some kind of Wiki that UK med students can all contribute to, with their tutors notified about who contributes what with marks awarded for contributions that prove a useful foundation for others.

  9. @dave
    I manage OK with Blackboard:) With regards to the wiki you mention- do you mean this as an information resource for students as an alternative to wikipedia? I'm not so big a fan or reinventing the wheel.
    There is a good example of a site started by a student:
    but it hadn't really taken off the last time I checked.

  10. Hello
    This blog was picked up by Chris Dawson at ZDnet, who has his own thoughts on the matter.
    have a read:

  11. Here at Weill Cornell Medical LIbrary we have launched a video campaign to help educate staff and students using Google. The ads are on Youtube:

  12. I just thought I'd let everyone know that Meducation ( has now relaunched and has over 2500 members using it with hundreds of media files, exam questions and more. All for free.

    Check it out!

  13. Perhaps there could be some kind of Wiki that UK med students can all contribute to, with their tutors notified about who contributes what with marks awarded for contributions that prove a useful foundation for others.


  14. I don't know why a lot of people are against using Wikipedia for looking up medical articles. I am a third year medical student, and I have been looking up medical articles on the Wikipedia since I entered medical school, and it's helping me immensely. The language is not too simple as NHS Choices is (NHS is intended for patients and hence uses layman's terminology) nor is it too complex like Medline. It's just right for a medical student. And though anyone can edit Wikipedia, I haven't found many factual errors in medical articles.

  15. Nice post. I think in the US the concern with Wikipedia (or any open document) is that there is the possibility that an entry might have been worked over by a representative of the pharma or device industry, and made the entry not so balanced (I've actually seen some points in the Parkinson's entry which seemed a little biased to one medication, and it made me wonder who entered it). I agree that the best way to make it better is to join in as an editor. I honestly haven't ventured into the Wikipedia editing forum, but maybe I should.

    When I advise students about it, I tell them that Wikipedia is a place to start, but shouldn't be the only place you look. I agree that we should be teaching students how to identify whether the information they are viewing is likely reliable or unreliable. We have UpToDate available through our institution, and I think a lot of students rely pretty heavily on that database. Not being in the NHS, I've not used the NHS Choices, but will check it out.


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