The paper reviewed here is ‘Junior Physician’s Use of Web 2.0 for Information Seeking and Medical Education: A Qualitative Study’ by Benjamin Hughes and colleagues. The authors use a qualitative approach in order to characterise the use of Web 2.0 technology by 35 junior physicians and the conclusion of the abstract reads that
‘Results indicate that 53% of internet visits employed user-generated or Web 2.0 content with Google and Wikipedia used by 80% and 70% of physician, respectively‘
‘Despite awareness of information credibility risks with Web 2.0 content, it has a role in information seeking for both clinical decisions and medical education‘
In interpreting these results, it is necessary to see firstly how the physician’s were sampled and their characteristics. The researchers chose graduates of a London Medical school and employed stratified sampling to ensure doctors were chose from a variety of specialities. Those that were chosen were either Foundation Year 2 or ST1. The authors suggest that this group would have a ‘Generation Y attitude towards the internet’. The term apparently refers to people born after 1975 and who are more comfortable with the internet than their parents (I’m not sure how valid this term is as there will no doubt be many factors that determine how a person interacts with the internet which could feasibly reverse the aforementioned relationship).
The researchers use three approaches to investigate the attitudes of the participants to Web 2.0 technology – questionnaires, a semi-structured interview and the use of a diary. Thus over a period of at least 5 days, the participants would keep a diary of their use of the internet including ‘the perception of whether they had used open or user-generated content versus sites where immeidate user contributions were not allowed’. I would argue that such questions have the potential to influence the behaviour of the participants. If a participant was keeping a diary for five days, they would surely be aware of the user generated content issues as they were using the internet. It is possible (although it would need empirical support) that if the participant was focusing on this issue during diary completion, this might influence in some way their tendency to seek user generated content. Perhaps a retrospective diary might avoid this possibility although this would create other drawbacks. The interviews were completed after the diary and here I would argue that the order should have been reversed. Thus a questionnaire prior to the diary filling would have avoided the risk of further bias secondary to the issues raised in the diary. I wasn’t able to find a definition of Web 2.0 nor a reference to Health 2.0 or Medicine 2.0 although both the latter terms have been assessed using a grounded theory approach.
A particular strength of the study was the use of 2 coders for the data that was acquired with a strong correlation in the marking as well as multiple data sources for triangulation (although noting the limitation above). 89% of the physicians used 1 or more ‘Web 2.0 tool in their medical practice’. In terms of other themes that were explored, this methodological approach provided quite rich data. An emergent theme was that Web 2.0 resources were utilised for background reading with one phyisican reporting being able to rapidly cross-reference one source with another. With closed questions (e.g. specific treatment questions), ‘best-evidence tools’ were used. There were further interesting comments about how Web 2.0 tool use was impacting on clinical practice. One physician defended the use of Web 2.0 technology by physicians, arguing that confirming information using such technology, while giving the appearance of a lack of knowledge should be more encouraging as it signals a checking strategy. Another theme that emerged was that physicians wanted more access to Web 2.0 tools at their workplace commenting that such sites were usually blocked at the workplace.
In conclusion, this is a study with a small sample size which is suitable for the qualitative aspects of the study. However for the quantitative aspects reported in the abstract, there would be benefits to larger replication studies. The results of this study lead to further interesting questions. We are seeing a marked cultural shift. A parallel question historically might be – what difference did Television and Radio make to the way doctors practiced or learnt (if any)? Should the use of sites with lower standards of evidence that the ‘best evidence’ tools be a cause for concern? I would argue that it depends on the use of the information. Physician’s interpret information – it is part of a doctor’s role. The internet and Web 2.0 technology has thrown up a massive amount of information sources and various tools for accessing this information. The assessment of the quality of information is a necessary skill in various kinds of decision making. Thus the question should be asked ‘should we completely ignore low quality information sources’. The results from this study suggest that some doctors at least, triangulate their use of perceived low quality data sources – a sensible strategy for making use of this easily accessible information. It will be interesting to see in the not too distant future how a generation of ‘cloud computing‘ physicians practice (although it remains to be seen if that technology emerges successfully).
Hughes B, Joshi I, Lemonde H and Wareham J. Junior Physician’s Use of Web 2.0 for Information Seeking and Medical Education: A Qualitative Study’. International Journal of Medical Informatics. 78. 2009. 645-655.
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