Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008187 on 6 October 2015. Downloaded from Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students? Samy A Azer, Nourah M AlSwaidan, Lama A Alshwairikh, Jumana M AlShammari To cite: Azer SA, ABSTRACT Strengths and limitations of this study AlSwaidan NM, Objective: To evaluate accuracy of content and Alshwairikh LA, et al. readability level of English Wikipedia articles on ▪ Accuracy and readability of Standardised quality and readability tools were cardiovascular diseases, using quality and readability cardiovascular entries on used to answer the research questions. Wikipedia: are they reliable tools. ▪ The study solely focused on 47 adult cardiovas- learning resources Methods: Wikipedia was searched on the 6 October cular diseases and only those entries in the for medical students?. BMJ 2013 for articles on cardiovascular diseases. English language. Open 2015;5:e008187. Using a modified DISCERN (DISCERN is an ▪ The results cannot be generalised to other med- doi:10.1136/bmjopen-2015- instrument widely used in assessing online resources), ically related topics on Wikipedia. 008187 articles were independently scored by three ▪ The work was not blinded. Textbooks are not assessors. The readability was calculated using free from possible errors or differences in their ▸ Prepublication history and Flesch-Kincaid Grade Level. The inter-rater agreement contents. additional material is between evaluators was calculated using the Fleiss κ ▪ Wikipedia is not intended to be used as a text- available. To view please visit scale. book for medical students. the journal (http://dx.doi.org/ Results: This study was based on 47 English 10.1136/bmjopen-2015- Wikipedia entries on cardiovascular diseases. The 008187). DISCERN scores had a median=33 (IQR=6). Four INTRODUCTION Received 14 March 2015 articles (8.5%) were of good quality (DISCERN score 40–50), 39 (83%) moderate (DISCERN 30–39) and 4 With the introduction of integrated medical Revised 7 July 2015 http://bmjopen.bmj.com/ Accepted 16 July 2015 (8.5%) were poor (DISCERN 10–29). Although the curricula and self-directed learning, students entries covered the aetiology and the clinical picture, need to search for their learning issues using there were deficiencies in the pathophysiology of a wide range of learning resources.12These diseases, signs and symptoms, diagnostic approaches changes aim at encouraging active learning and treatment. The number of references varied from 1 and moving away from passive learning to 127 references; 25.9±29.4 (mean±SD). Several or relying on the teacher as the main source problems were identified in the list of references and of information. Student-centred learning citations made in the articles. The readability of articles approaches are particularly recommended in was 14.3±1.7 (mean±SD); consistent with the on September 26, 2021 by guest. Protected copyright. medical schools because of the rapid prolif- readability level for college students. In comparison, 34 Harrison’s Principles of Internal Medicine 18th edition eration of medical information. Therefore, had more tables, less references and no significant medical students need to gain and update difference in number of graphs, images, illustrations or their information continuously, and master readability level. The overall agreement between the the skills on how to search for knowledge evaluators was good (Fleiss κ 0.718 (95% CI 0.57 to rather than limit their learning to lectures or 0.83). the content of a particular textbook.1 Conclusions: The Wikipedia entries are not aimed Owing to the increasing use of social web, at a medical audience and should not be used as a also known as web 2.0, the way information is Department of Medical substitute to recommended medical resources. produced, shared and used has changed.5 Education, Curriculum Course designers and students should be aware Medical students are increasingly relying on Development and Research that Wikipedia entries on cardiovascular diseases Unit, College of Medicine, the Internet and websites such as Google and lack accuracy, predominantly due to errors of King Saud University, Riyadh, Wikipedia in searching for information.2 Saudi Arabia omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed Recently, one study showed that one-third of before they could be considered a supplementary college students use Wikipedia for academic Correspondence to 6 7 Professor Samy A Azer; resource. learning. Guarino et al showed that [email protected] Wikipedia significantly surpassed the Azer SA, et al. BMJ Open 2015;5:e008187. doi:10.1136/bmjopen-2015-008187 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2015-008187 on 6 October 2015. Downloaded from peer-reviewed medical databases as their preferred learn- searched on Wikipedia. These textbooks (box 1) were ing resource. Another study highlighted the increasing selected because they are widely recommended in use of Wikipedia among dental students2 and surgical undergraduate medical courses in most medical schools residents.8 This tendency may be related to the easy and also recommended by regulatory authorities such access. People most often start by searching Google; as the Australian Medical Council in Australia (http:// Wikipedia is usually among the top search results on www.amc.org.au/publications#medicine), the General Google.9 Wikipedia is also well known to most online Medical Council in UK (http://www.gmc-uk.org/ users. Furthermore, Wikipedia is available at any time doctors/plab/23448.asp), and the Royal Colleges such and from anywhere; users only need a computer or a as the College of Physicians and Surgeons of Canada smart phone connected to the Internet to search (https://www.cpsbc.ca/content/exam-preparation), for Wikipedia.5 Other minor advantages for the reliance of examination preparation. They are written by experts students on web-based resources such as Wikipedia may and clinical teachers in different specialties in medi- include: (1) information provided online usually address cine, are regularly updated and reviewed, and were different aspects of an issue and use a range of resources reviewed by scholars in prestigious medical journals to explain it such as images, videos, diagrams and such as the Journal of the American Medical Association, entries,5 and (2) information provided online is more British Medical Journal and The New England Medical – frequently updated than are textbooks.10 These factors Journal.24 27 The aims of using these textbooks were to: may play a role in making students prefer online (1) identify the cardiovascular topics to be evaluated, resources rather than textbooks. and (2) use these textbooks as a reference resource Wikipedia, created in 2001, is a free multilingual during the assessment of the content of the Wikipedia online encyclopedia that provides entries about almost entries. The strategy for searching the five cardiovascu- any topic, and is based on an openly editable lar chapters included: (1) identifying key topics and the model.91112There have been 4 880 039 entries pub- content under each topic, and assessing the emphasis lished up to 28 May 2015 in the English language alone, made, and (2) identifying topics that shared maximum with a total of 36 373 672 pages, and an increase of emphasis across the five chapters. Each evaluator 197 138 articles during the proceeding year.13 14 It is searched these chapters independently and the out- interesting to note here that Wikipedia has created this comes were discussed in a meeting. Topics shared number of entries without any budget or editorial team. among the researchers were further discussed and The reason for the high number of Wikipedia entries is topics covering rare diseases or rare syndromes were that anyone can write an entry (an article); it is entirely not included. In fact, rare diseases included in based on volunteers from different countries, who have Wikipedia were evaluated in an elegant study.9 The worked cooperatively to create, edit and update articles. final list comprised 47 Wikipedia entries covering issues Interestingly, searching for information by using a commonly included in undergraduate medical pro- http://bmjopen.bmj.com/ search engine such as Google or Yahoo has shown grammes. Another source for identifying the 47 topics Wikipedia appearing in the first 10 results.9 As of May was the author’s long experience in medical school cur- 2015, the number of views worldwide was over 453.10 ricula at the University of Sydney and University of million,15 and the number of medical and health-related Melbourne in Australia as well as other detailed curric- articles was over 33 000 entries.13 14 ula for undergraduate medical schools such as curricu- Although a good number of research publications lum verification reports (University of California— examined the reliability of Wikipedia: (1) as an educa- San Francisco School of Medicine; http://www.aamc. tional resource for patients,16 nursing students,17 clinical org/download/363632/data/sampleverifreprtucsf.pdf). on September 26, 2021 by guest. Protected copyright. pharmacy education,18 drug information19 and veterin- ary medicine,20 and (2) for gathering information on gastrointestinal and liver diseases,21 respiratory diseases22 Box 1 Medical textbooks used as a reference in evaluat- and the nervous system,23 there have been no studies ing Wikipedia articles fi examining the scienti c accuracy and readability level of Andreoli TE, Benjamin IJ, Griggs RC, et al. Andreoli and the Wikipedia entries on cardiovascular diseases, and Carpenter’s Cecil Essentials of Medicine, 8th Edition. Philadelphia: whether the entries can be a reliable learning resource Saunders, 2010. for medical students. Therefore, the aim of this study Colledge NR, Walker BR, Ralston SH. Davidson’s Principles & was to assess the scientific accuracy of the Wikipedia Practice of Medicine, 21st Edition. Edinburgh: Elsevier, Churchill entries on cardiovascular diseases and whether they can Livingstone, 2010.