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In dieser Rubrik legen wir den Fokus einmal nicht auf Suchvorgänge, um eigene Wissenslücken zu füllen; Ärzte suchen auch,

um Patientenwissen zu rekonstruieren

dem Patienten etwas besser erklären zu können

um ihm ausgedruckt etwas mitgeben zu können oder eine Quelle empfehlen zu können

dem Patienten, der mit einer selbstrecherchierten Diagnose oder Therapie kommt, zu begründen, warum sein Vorschlag nicht gut ist

Daher sollten Ärzte das Angebot an Informationsquellen kennen, die sie ihren Patienten empfehlen können. Hier einige Vorschläge:

Cochrane kompakt (auf deutsch); dank einer Nationallizenz ist übrigens die ganze Cochrane Library in der Schweiz Open Access; viele Reviews enthalten am Ende ein Plain Language Summary.

JAMA Patient Page (Beispiel)

gesundheitsinformation.de (Patientenportal des deutschen Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen IQWiG – werbefrei und evidenzbasiert)

UpToDate Patienteninformation

Fact boxes, Beispiel AOK

EBM in Buchform für Patienten erklärt: Testing Treatments

Eine neue Bertelsmann-Studie (2018) hat ergeben: Die wenigsten Patienten kennen solche Angebote. Den höchsten Bekanntheitsgrad unter den Patienten haben gemäß der Studie (S. 6) die Quellen Wikipedia, Apotheken-Umschau.de und NetDoktor.de.

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66% der Bevölkerung (D) googeln Gesundheitsthemen

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66% der Bevölkerung (D) googeln Gesundheitsthemen

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gemäß Befragung des deutschen Bundesamts für Statistik (2018) – bei den Frauen sind es sogar 75%

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Statistik
Die Deutschen shoppen online gerne und schreiben Mails - doch auch Gesundheitsthemen liegen hoch im Kurs, wie das Statistische Bundesamt belegt. Dabei unterscheiden sich die Interessen der Geschlechter voneinander.
© AndSus / stock.adobe.com

WIESBADEN. Gesundheitsthemen treiben die deutschen Internetnutzer um: Zwei von drei Usern nutzen das World Wide Web, um über Gesundheitsthemen zu recherchieren, so das Statistische Bundesamt (Destatis).

Die Suche nach Gesundheitsinformationen ist damit die dritthäufigste Onlineaktivität der Deutschen, sagt Destatis in seiner „Befragung über die private Nutzung von Informations- und Kommunikationstechnologien" (IKT-Erhebung).

Platz eins belegt die Suche nach Waren und Dienstleistungen für private Zwecke: 91 % der Nutzer gaben diese Tätigkeit an. Am zweithäufigsten war die Kommunikation über E-Mails (89 %). Ähnlich beliebt wie Gesundheitsthemen-Recherche sind das Anschauen von Videos (64 %), Online-Banking (59 %) und soziale Netzwerke (56 %). Mehr als jeder Zweite führt auch (Video-)Telefonate online (siehe nachfolgende Grafik).

Verschiedenes Nutzungsverhalten

Je nach Alter setzten die Nutzer unterschiedliche Online-Schwerpunkte - das spiegelt sich auch bei der Gesundheitssuche wider. Am häufigsten waren die 25- bis 44-Jährigen auf der Suche nach Gesundheitsinformationen: Mehr als drei Viertel gaben dies an, bei den älteren Gruppen lag der Wert leicht darunter.

Bei den Jugendlichen und jungen Erwachsenen suchten jeder Zweite nach Gesundheitsthemen, bei Kindern zwischen 10 und 15 Jahren waren es nur 17 Prozent (siehe nachfolgende Tabellen). Frauen benutzen Dr. Google etwas häufiger als dies Männer tun (75 versus 58 %).

Jeder Siebte gab zudem an, schon einmal online einen Arzttermin vereinbart zu haben. Bei den 25- bis 44-Jährigen war es sogar jeder Fünfte.

Destatis hat die repräsentative Umfrage letztes Jahr durchgeführt: 12.000 Haushalte wurden dafür befragt. (ajo)

Weitere Beiträge aus diesem Themenbereich

Die Newsletter der Ärzte Zeitung

Lesen Sie alles wichtige aus den Bereichen Medizin, Gesundheitspolitik und Praxis und Wirtschaft.

NEU als Themen abonnierbar: Frauengesundheit und Kindergesundheit

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Die Deutschen shoppen online gerne und schreiben Mails - doch auch Gesundheitsthemen liegen hoch im Kurs, wie das Statistische Bundesamt belegt. Dabei unterscheiden sich die Interessen der Geschlechter voneinander. © AndSus / stock.adobe.com WIESBADEN. Gesundheitsthemen treiben die deutschen Internetnutzer um: Zwei von drei Usern nutzen das World Wide Web, um über Gesundheitsthemen zu recherchieren, so das Statistische Bundesamt (Destatis).

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Manche Ärzte gehen den Weg, dass sie selbst Erklär-Videos für ihre Patienten erstellen, damit diese gut informiert sind.

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Herzlich willkommen auf deinediagnose.de !

Auf dieser Seite möchten wir dir anhand von Videos erklären, was deine eigenen medizinischen Diagnosen bedeuten. Wir helfen dir schwierige Erkrankungen aus dem Krankenhaus oder aus der Praxis zu verstehen.

Wer sind wir?

Seit mehreren Jahren arbeiten wir als Ärzte in verschiedenen Krankenhäusern und unterschiedlichen Fachbereichen. Dort haben wir die Erfahrungen gemacht, dass zu wenig Zeit für wiederholte Erklärungen bleibt. Leider bleibt der Patient dann manchmal alleine mit der Frage: Was bedeutet meine Diagnose?

Was bietet diese Seite?

Hier kannst du dich mit deinen Fragen aus der Medizin in Ruhe näher beschäftigen. Wir möchten, dass du zum nächsten Termin bei deinem Arzt besser über deine eigene Gesundheit informiert bist. So kannst du das Gespräch mehr auf das lenken, was für dich wichtig ist. Wir möchten euch helfen, bereits entdeckte Krankheiten und gestellte Diagnosen besser zu verstehen. Man kann sich selber und seiner Gesundheit nur helfen, wenn man die Entstehung der eigenen Erkrankungen begreift.

Was bietet diese Seite nicht?

Beachte, dass wir mit dieser Seite nicht einen einzigen Besuch bei deinem Arzt ersetzen wollen. Wir können und werden keine Ferndiagnose anhand von beschriebenen Beschwerden (=Symptomen) stellen. Dies braucht ein Gespräch mit eurem behandelnden Arzt, eine körperliche Untersuchung und manchmal noch weitere Untersuchungen. Dies können wir mit unserer Seite nicht übernehmen.

Wie funktioniert diese Seite?

In verschiedenen Videos werden dir hier Krankheiten und häufige Diagnosen erklärt. Du kannst die Themen z.B. anhand einer Liste auswählen. Die Krankheiten sind nach dem jeweiligen Facharzt sortiert, der diese Erkrankungen behandelt. Außerdem gibt es rechts auf der Video-Seite eine Such-Funktion. Nutze diese um nach den gesuchten Diagnosen zu suchen. Gib hier z.B. eine Diagnose aus deinem Arztbrief ein, die du nicht verstehst und schaue, ob wir hierzu schon ein Video anbieten.

Deine Mithilfe ist gefragt!

Deine Hilfe ist aber auch gefragt, damit wir den Inhalt besser an deine Fragen anpassen können. Wenn du Vorschläge hast zu Themen bezüglich Krankheit, Operation, Verletzung und Entzündung, schreib uns eine E-Mail. Die Themen können alle wichtigen Organe betreffen (wie zum Beispiel Herz, Gehirn, Knochen, Leber, Lunge, Augen, Nase, Ohren, Magen-/ Darm-Trakt, Haut). Wenn du Worte oder Erklärungen nicht verstehst, sag uns Bescheid. Wir werden dann versuchen die Videos zu verbessern. Medizin ist nicht schwer. Man muss sich nur Mühe geben, in einfachen Worten darüber zu sprechen.
zu den Videos

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Auf dieser Seite möchten wir dir anhand von Videos erklären, was deine eigenen medizinischen Diagnosen bedeuten. Wir helfen dir schwierige Erkrankungen aus dem Krankenhaus oder aus der Praxis zu verstehen. Wer sind wir? Seit mehreren Jahren arbeiten wir als Ärzte in verschiedenen Krankenhäusern und unterschiedlichen Fachbereichen.

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Point-of-care-Informationssuche findet unter Zeitdruck statt. Wie viel Zeit haben / nehmen sich Ärzte für Informationssuche?

Aktivität:
Was ist Ihre Meinung: Wie viel Prozent seiner Arbeitszeit sollte ein Assistenzarzt an einem Schweizer Unispital an einem durchschnittlichen Arbeitstag (Tagesschicht) verwenden, um med. Informationen nachzuschauen, die die klinische Versorgung seiner Patienten verbessern helfen? 1% – 5% – 15%?

Dank der Lausanner Beobachtungsstudie wissen wir, wie viel es tatsächlich ist – lesen Sie selbst nach (in der Tabelle unter "Literature review").

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Tipps für effiziente Suchstrategie in PubMed, um klinische Fragen zu beantworten 

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Tipps für effiziente Suchstrategie in PubMed, um klinische Fragen zu beantworten 

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PIC-Schema

narrow clinical queries Filter

je nach Ergebnis anpassen

ausführlich in Agoritsas et al. (2012)

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Es gibt Symptom-check-Tools für Patienten, z.B.:

Isabel

webmd.com

In der Schweiz arbeiten u.a. die Krankenkassen an solchen Angeboten, die sie z.B. als Apps ihren Kunden zur Verfügung stellen und damit unnötige Arztbesuche zu verhindern versuchen (NZZ-Bericht).

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Versicherte, die sich krank fühlen, sollen sich via Smartphone medizinisch beraten lassen können. Die Krankenversicherung Swica hofft, die Zahl von Patienten zu reduzieren, die vorschnell einen Arzt aufsuchen.

Unklare Symptome verunsichern viele Patientinnen und Patienten - und veranlassen sie unter Umständen, vorschnell den Hausarzt oder ein Spital aufzusuchen. Die Krankenkasse Swica will nun Gegensteuer geben und bringt eine Smartphone-App auf den Markt. Sie soll die Nutzer mit einem sogenannten Symptom-Check darin unterstützen, bei medizinischen Problemen das weitere Vorgehen zu bestimmen. Leidet jemand beispielsweise unter Ohrenschmerzen, wird das Problem anhand einfacher Fragen eingegrenzt und via App eine Empfehlung für die nötigen Schritte abgegeben - beispielsweise vorerst abzuwarten, einen Arzt zu konsultieren oder gar die Notfallstation aufzusuchen.

Swissmedic involviert

Pikant: Bei der App handelt es sich um ein Medizinprodukt, für das gemäss gesetzlichen Vorgaben höhere Anforderungen gelten. So muss Swica nachweisen, dass die App den versprochenen medizinischen Nutzen tatsächlich erbringt und die angegebenen Leistungsmerkmale erfüllt werden. Auch dürfen für die Nutzer keine Gefahren bestehen. Das schweizerische Heilmittelinstitut Swissmedic ist in das Verfahren involviert. Die App, die unter dem Namen Benecura auf den Markt kommt, untersteht gemäss der entsprechenden Verordnung einer Meldepflicht. Nach Auskunft eines Sprechers von Swissmedic existieren hierzulande bis jetzt erst wenige Apps, die von dieser Meldepflicht betroffen sind. Laut Swica-Sprecherin Silvia Schnidrig handelt es sich sogar um die erste Symptom-Check-App einer Schweizer Krankenkasse, die als Medizinprodukt konzipiert ist.

Die Lancierung der App zeigt, wie die Digitalisierung im Gesundheitswesen inzwischen auch im Consumer-Bereich unaufhaltsam Fahrt aufnimmt. Geht es dabei auch um medizinische Informationen, erweist sich der Datenschutz als besonders vordringlich. Nach Angaben von Schnidrig speichert die App die Daten jedoch verschlüsselt in einem Dossier. Dieses könne nur von der versicherten Person eingesehen werden. Nur sie kann die Daten der versicherungseigenen Gesundheitsberatung zugänglich machen. Auch der Eidgenössische Datenschutzbeauftragte habe deshalb keine Bedenken geäussert. Die via App erhobenen Informationen unterliegen ausserdem der ärztlichen Schweigepflicht. Eine Verknüpfung dieser medizinischen Daten mit der Police des Versicherungsnehmers wäre damit unzulässig.

Datenschutz bleibt gewahrt

Die App soll unter anderem mithelfen, unnötige Gesundheitskosten einzudämmen: "Verschiedentlich haben uns Leistungserbringer angesprochen, dass sie eine Zunahme von durch Google-Suchen verunsicherten Patienten in ihrer Praxis feststellen, die eigentlich keine Behandlung benötigen", erklärt Schnidrig. Patienten sollen sich deshalb auf diesem Weg schnell und zuverlässig selber informieren können.

Unlängst hat auch die Krankenkasse Helsana eine App auf den Markt gebracht, die Anreize für mehr Eigenverantwortung setzen will. Die Helsana-App soll Versicherte zu einem gesunden Lebensstil motivieren, indem diese für sportliche Aktivitäten Bonuszahlungen erhalten. Auch Helsana erklärt, keine Gesundheits- und Vitaldaten (Schritte, Puls, Kalorien) zu sammeln. "Diese Daten werden ausschliesslich zur Bonifizierung der Aktivitäten bearbeitet", erklärt Stefan Heini, Leiter der Medienstelle, auf Anfrage. Die Versicherung erhalte von der App der Nutzer einzig eine Aussage dazu - also beispielsweise ob jemand tatsächlich Sport getrieben habe.

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Eine App soll verhindern, dass Patienten nach eigener Google-Recherche zum Arzt rennen | NZZ

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Versicherte, die sich krank fühlen, sollen sich via Smartphone medizinisch beraten lassen können. Die Krankenversicherung Swica hofft, die Zahl von Patienten zu reduzieren, die vorschnell einen Arzt aufsuchen. Unklare Symptome verunsichern viele Patientinnen und Patienten - und veranlassen sie unter Umständen, vorschnell den Hausarzt oder ein Spital aufzusuchen.

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RefHunter-Manual: bietet standardisierte Beschreibungen der einzelnen Datenbanken
auch in dieser Tabelle werden Infos zu den wichtigen Datenbanken gesammelt

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RefHunter - Manual zur Literaturrecherche in Fachdatenbanken

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Herzlich Willkommen bei RefHunter, dem Manual zur Literaturrecherche in Fachdatenbanken aus dem Themenbereich Gesundheit.

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Cooper et al. (2018) vergleichen eine Reihe von Anleitungen, Handreichungen sowie Forschungsliteratur und arbeiten den gemeinsamen Nenner heraus: 8 key stages des Suchprozesses für Systematic Reviews.

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Auch wenn Sie selbst momentan noch nicht als Autoren im medizinischen Publikationsbetrieb agieren – so "konsumieren" Sie doch die Produkte dieses Betriebs. Daher ist es sinnvoll, die Mechanismen und Probleme dieses Wissenschafts- und Publikationsmarktes kritisch zu reflektieren. Unter dieser Rubrik finden Sie einige ausgewählte Problematiken …

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Diskussion um Fake Science und Predatory journals

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Diskussion um Fake Science und Predatory journals

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2018 gab es eine von deutschen Investigativjournalisten lancierte Debatte über das Problem der von Fake Science (vgl. NDR-Dossier).
Hintergrund: Die Open-Access-Bewegung fordert freien Zugriff auf Publikationen. Doch die Verlage haben darauf reagiert und neue Business-Modelle entwickelt. Statt von den Lesern verlangen sie jetzt häufig von den Autoren Publikationsgebühren.
Das neue System hat auch dubiose Anbieter auf dem Zeitschriftenmarkt möglich gemacht: Sie streichen die Publikationsgebühren ein, bieten aber keine seriöse Zeitschrift mit Qualitätskontrolle an (sog. predatory journals). Die Folge: Der Zeitschriftenmarkt wird überschwemmt mit schlechter Forschung, die z.T. sogar mit öffentlichen Mitteln gefördert wird.
In der Schweiz hatte vor der Diskussion in Deutschland schon die NZZ am Sonntag recherchiert.
In der Ärztezeitung Swiss Medical Weekly hatte es auch eine Auseinandersetzung um Open Access gegeben:

Hagner-Artikel in Swiss Medical Weekly 2018

Antwort

Gegenantwort

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Klassisches Beispiel für Interessenkonflikte: Studie von Barnes/Bero (1998): Autoren mit Bezug zur Tabak-Industrie sehen Passivrauchen als weniger schädlich an.
Aktuelle Publikation: Einfluss von Süßigkeiten- und Süßgetränke-Industrie auf zahnmedizinische Forschung: Kearns/Bero (2019)
Literatur zur Vertiefung:

Interessenkonflikte, Korruption und Compliance im Gesundheitswesen

Buch: Interessenskonflikte in der Medizin

studentische Initiative, u.a. mit Interviews zu Interessenkonflikten

Ausgewählte Themen:

Eine Studie hat am Beispiel des Standard-Lehrwerks Harrison's Principles of Internal Medicine gezeigt: Einzelne Autoren haben hohe Zahlungen aus der Pharma-Industrie und für Patente erhalten. Im Unterschied zu Zeitschriften-Artikeln, wo die Offenlegung von Interessenkonflikten inzwischen Standard ist, besteht bei Lehrbüchern bisher wenig Bewusstsein für die Problematik.

Wie viel die Selbstdeklaration von Interessenkonflikten manchmal wert ist, zeigt der Fall eines führenden deutschen Kardiologen, der im Rahmen der Paradise-Papers-Recherchen ans Licht kam: Er hat über die Vorteile von Stents publiziert, u.a. 2005 in der Fachzeitschrift Circulation. Er ließ sich in Veröffentlichungen eines singapurischen Stent-Herstellers zitieren und lobte die Vorteile dieses Herstellers. Vom gleichen Hersteller nahm er eine großzügige Aktienoption an. Im Circulation-Paper gab er dennoch keine Interessenkonflikte an, obwohl die Zeitschrift zu dieser Zeit die verpflichtende Offenlegung von Interessenkonfliten ihrer Autoren bereits eingeführt hatte.

Solche Negativbeispiele haben zu einem Bewusstseinswandel geführt, der sich Initiativen niederschlägt wie:

MEZIS – Mein Essen zahl ich selbst

Ärzte-Plattformen, die auf Unabhängigkeit Wert legen wie z.B. Deximed

dem HON-Code, als unabhängige Zertifizierung für Gesundheitsseiten im Internet

Beispiel für eine HON-zertifizierte Schweizer Seite: tellmed.ch

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Problematik des Peer-Review-Systems: Das Peer Review ist nach wie vor ein entscheidender Schritt im Publikationszyklus. Dabei ist Peer Review seit langem umstritten: "The main criticisms are that it is ineffective; unreliable; poor at detecting errors; offering too much scope for bias, particular in single- blind form; providing scope for reviewer misconduct; and that it is slow, delaying publication unnecessarily" (STM-Report 2015: 47).

Es gibt neuere Ansätze, Peer review zu verbessern wie Open Peer review oder Post-publication peer review. Vgl. im STM-Report 2015: 45–52).

Um den Publikationsprozess zu beschleunigen, gibt es auch Preprints. Über Vor- und Nachteile von Prep ist allerdings eine Debatte entstanden.

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Ein Teil der begonnenen Studien wird nie publiziert. Das führt zu einem publication bias und hat schwerwiegende Implikationen: Antes/Blümle/Lang (2014: 44) nennen mit Blick auf unveröffentlichte RCTs als Folgen

eine falsche Wissensbasis

Betrug an Teilnehmern und

Verschwendung

Für die Schweiz hat kürzlich SRF Puls zu der Thematik recherchiert, hat die Publikationen der Universitätsspitäler vergleichen und berichtet, wie man in Basel das Problem angeht.

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Es gibt Medical Students Journals (vgl. Al-Busaidi 2016): dort kann man als Stud. ein Paper einreichen. Die Idee ist, dass man schon während des Studiums praktische Erfahrungen mit dem Publikationszyklus macht.

Es gibt auch Initiativen, dass Studien in Verantwortung von Studierenden gestartet werden mit dem Ziel, dass man schon als Studierende/r den Wissenschaftsbetrieb aktiv kennenlernt. Diesen Weg geht man zum Beispiel in Heidelberg bei dieser Studie.

In der britischen Datenbank ProjectPal werden Projekte ausgeschrieben – so kommen forschungsinteressierte Studierende mit Projektleitern zusammen und können in den akademischen Prozess einsteigen.

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Damarell/Tiemann (2015) haben sich angeschaut, wie Kliniker im Bereich Palliative Care PubMed benutzen und welche Fehler sie dabei machen.
Zum Beispiel: Sieht man sich nicht in der Search detail box an, was PubMed mit der Eingabe macht, kann Folgendes passieren: Wenn man end of life eingibt, macht PubMed daraus:

end[All Fields] AND (‘life’[MeSH Terms] OR ‘life’[All Fields])

‘life’[MeSH Terms] hat aber die Unterkategorie Beginning of Human Life – man hat also Treffer, die das Gegenteil dessen beinhalten, was man sucht.

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Aktivität: Wiederholen Sie die Evidenzhierarchie – schreiben Sie die verschiedenen Studientypen in eine Pyramide.

Eine Erweiterung der Evidenz-Pyramide für Studientypen stellt das 5S-Modell von R. Haynes dar, das die Pyramide um die EBM-Quellen erweitert; vgl. z.B. diese Darstellung.

In den Users' Guides (Guyatt et al. 2015: Kap. 5) findet sich dieser Ansatz ebenfalls – dort wird vereinfacht als EBM Resources eine dreiteilige Pyramide verwendet:

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monatliche Podcast-Serie von JAMAevidence (auch über iTunes), darin u.a.:

Finding the Evidence: Interview With Dr Ann McKibbon

The 5As of the Health Information Cycle: Interview With Dr Robert Hayward

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Finding the Evidence: Interview With Dr Ann McKibbon

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Finding the Evidence: Interview With Dr Ann McKibbon

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Prorok et al. (2012) haben 10 EBM-Summaries hinsichtlich der Kriterien

Aktualität

Breite der Abdeckung

Qualität der Informationen

beurteilt.
Ihr Ergebnis (Tabelle 3): Keine einzelne Quelle ist Spitzenreiter über alle Kriterien hinweg. UpToDate rangiert in dieser Studie – trotz seines Titels – hinsichtlich Aktualität nur im Mittelfeld, ist aber hinsichtlich Breite und Qualität sehr gut.

(auch beschrieben in den Users' Guides Kap. 5)

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The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey

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To evaluate the quality of evidence reporting, breadth of coverage, and timeliness of content updating of 10 selected online medical texts.Each text w...

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Tools und Infos auf der Seite des Centre for Evidence-Based Medicine

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EBM tools for the five stages of Evidence-Based Medicine

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Duran-Nelson et al. (2013) haben in ihrer Befragung amerikanischer Assistenzärzte herausgefunden (vgl. ihre Figure 2): V.a. Geschwindigkeit des Zugriffs, Vertrauenswürdigkeit und mobile Verwendung sind bestimmende Faktoren für die Wahl einer Informationsquelle.
UpToDate punktet bei Geschwindigkeit und Vertrauenswürdigkeit. Aber auch der gute alte Pocket Guide in der Kitteltasche ("Herold" & Co.) erzielt sehr gute Ergebnisse.

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O‘Carroll et al. (2015) haben untersucht, welche Quellen ihre Medizinstudenten bevorzugt benutzen: Neben UpToDate werden Google und Wikipedia häufig genutzt.

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Original Paper

¹ Dalhousie University, Halifax, NS, Canada

² Division of Pediatric Neurology, Dalhousie University, Halifax, NS, Canada

*these authors contributed equally

Corresponding Author

Corresponding Author:

Aoife Marie O'Carroll, MD, FRCPC

Dalhousie University

Division of Pediatric Neurology, IWK Health Centre, Children's Site, 8th Floor

5850-5980 University Avenue, PO Box 9700

Halifax, NS,

Canada

Phone: 1 902 470 8475

Fax:1 902 470 8486

Email:

ABSTRACT

Background: Medical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important.

Objective: To describe medical students' current pattern of health information resource use and characterize their experience of instruction on information search and appraisal.

Methods: We conducted a cross-sectional web-based survey of students registered in the four-year MD Program at Dalhousie University (Halifax, Nova Scotia, and Saint John, New Brunswick, sites), Canada. We collected self-reported data on information-seeking behavior, instruction, and evaluation of resources in the context of their medical education. Data were analyzed using descriptive statistics.

Results: Surveys were returned by 213 of 462 eligible students (46.1%). Most respondents (165/204, 80.9%) recalled receiving formal instruction regarding information searches, but this seldom included nontraditional tools such as Google (23/107, 11.1%), Wikipedia, or social media. In their daily practice, however, they reported heavy use of these tools, as well as EBM summaries. Accessibility, understandability, and overall usefulness were common features of highly used resources. Students identified challenges managing information and/or resource overload and source accessibility.

Conclusions: Medical students receive instruction primarily on searching and assessing primary medical literature. In their daily practice, however, they rely heavily on nontraditional tools as well as EBM summaries. Attention to appropriate use and appraisal of nontraditional sources might enhance the current EBM curriculum.

JMIR Medical Education 2015;1(1):e4

doi:10.2196/mededu.4267

Citation

Please cite as:

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KEYWORDS

Introduction

The information landscape is expanding rapidly, in large part due to the advent and evolution of the Internet. In the developed world, widespread access to the Internet along with intuitive and user-friendly search tools have made information on a vast range of topics available within moments. Some tools have gained such ubiquity as to become part of common parlance: "Google" is now a dictionary-approved verb [].

Medicine has seen a similar trend, and the volume of information is not unequivocally helpful to practice. Authors have previously cited the challenges of staying up to date on a multitude of articles [] and guidelines []; today, even the tools to access evidence proliferate. Whereas evidence-based medicine (EBM) developed as an approach to manage the challenge of translating primary evidence into clinical practice, the field has evolved to define increasingly sophisticated approaches to the body of literature as a whole. Indeed, some authors suggest that information management training may be as important as instruction on searching the primary literature [,].

Instruction in EBM is variable, however, and whether it affects long-term behaviors is uncertain [-]. The realities of daily work can present barriers to evidence-based practice, which is often perceived as a time- and effort-intensive pursuit [-]. Moreover, access to primary medical literature, summaries, and clinical support tools often comes with costly subscription fees.

These challenges make the user-friendly, freely accessible tools that are useful for general purpose inquiries appealing. Indeed, studies of medical trainees and practicing physicians support the popularity of general purpose tools for clinical or academic queries [,,]. Notwithstanding concerns regarding reliability, some evidence suggests that general resources such as Google can be effective in answering clinical questions [-].

If these issues are important for the future of medicine, we need to understand how information-seeking behaviors develop. Medical school lays foundations of knowledge and behavior patterns. Students' active engagement in participatory knowledge building is critical to this process, and thus information acquisition and use have central importance. Students turn to information sources to build background knowledge and will subsequently develop increasingly patient-specific questions and searches. As clinical encounters lead them to continually integrate this knowledge, they gradually build mental maps that enable automatic processing for quick clinical decision making []. Meanwhile, however, they must recognize the ongoing need to engage with information sources: to update their mental maps and to supplement when prior knowledge is absent or insufficient []. Their medical education must therefore prepare them as managers of information as well as experts in human health.

Previous studies that focused on medical students in the developed world have considered the use of specific resources [-] or technology [-]. Others have reported on experimental educational interventions [-]. With the current study, we sought a holistic characterization of the information-seeking behaviors of a medical student cohort in the context of an existing formal EBM curriculum.

We surveyed students enrolled in a medical doctorate training program regarding their use of Internet resources for medical information and the instruction they have received in EBM and information management. We hypothesized that this group would report high use of general purpose resources with minimal instruction in the use or interpretation of such resources.

The primary objective of this study was to define students' current patterns of resource use. We also sought to characterize student experiences of current informatics instruction. Lastly, we began an inquiry into student valuations of various resources for medical information.

Methods

Survey Instrument

We developed a web-based survey to assess student information-seeking behavior, formal instruction on information searches, and evaluation of sources of health information. The survey was developed based on a review of relevant published literature and pretested with a convenience sample of ten medical students. The final survey contained 20 questions, predominantly requiring yes/no or rating scale responses; one question required a numeric estimate, one asked students to list their five most-used resources, and two were open-ended. Questions regarding resource use were based on recall of the previous seven days. The list of survey questions is included in .

Participant Recruitment

All students registered in the Dalhousie University 4-year medical doctorate program, at either the Halifax or the Saint John site, were considered eligible for participation in the survey. At the time of the survey, there were 462 registered students. We considered students in years 1 and 2 preclinical and those in years 3 and 4 clinical because the first two years are classroom-based while the third and fourth years take place predominantly within clinical settings.

The survey was published online using the Opinio 6 survey platform (ObjectPlanet, Inc) and remained open for two weeks. Two of the study authors (AO and EW) made in-class announcements to each student cohort, and invitation and reminder emails were sent to eligible students.

Data Analysis

The survey responses were exported from the survey platform into Excel (Microsoft Corp). Data were analyzed using descriptive statistics, computed by hand. Frequencies were reported as percentages. Where appropriate, 95% confidence intervals were calculated using the .cii command with exact binomial confidence intervals using STATA version 12.1 (StataCorp LP). No correction was made for multiple statistical testing.

One question asked respondents to list their five most-used resources from the previous seven days. We assessed response frequency, and used Wordle [] to generate a graphical representation of this data in which type size reflects frequency of occurrence.

Selected data were subsequently graphed using R (The R Foundation). In keeping with a paper presented at the 2011 Joint Statistical Meeting [], these Likert data were presented graphically, using diverging stacked bar charts across information sources.

Open-ended questions were analyzed qualitatively for themes by AO. Responses were read and common themes identified; on second reading, responses were categorized into thematic groups. Responses that reflected more than one theme were included in each relevant thematic group.

Ethics

The study was formally reviewed and approved by the IWK Health Centre Research Ethics Board. We also received approval from the Dalhousie Undergraduate Medical Education Curriculum Committee.

Results

Participant Recruitment

Of 462 students invited to respond, 213 (46.1%) provided evaluable responses. Two-thirds of closed-ended questions received response rates of 42.0% or above (193 or more students), and all but one question had responses from at least 39.0% (180 students). Ten students accessed the survey but did not provide any responses; these were considered to be nonrespondents and were not included in the response rate figures.

Study Participants

Of the respondents, 56.6% (120/212) were female and 42.0% (89/212) were male; 3 preferred not to answer this question. Preclinical and clinical training levels received comparable representation (110/212, 51.9%, and 102/212, 48.1%, respectively). Roughly half (109/207, 52.7%) had prior experience as contributors to peer-reviewed literature, while relatively few (35/207, 16.9%) had posted information online for the public.

Instruction on Information Searching

While 80.9% (165/204; 95% CI 74.8%-86%) of respondents recalled receiving formal instruction on searching for health information, 67.1% (139/207; 95% CI 60.3%-73.5%) also recalled being discouraged from using certain resources. Education regarding bibliographic databases (eg, PubMed) was common (162/206, 78.6%; 95% CI 72.4%-84.0%), whereas respondents seldom had instruction regarding general purpose Internet sources. Only 11.1% (23/207; 95% CI 7.2%-16.2%) reported teaching regarding the general search engine Google, and fewer had education on Wikipedia (a free, online, open-content encyclopedia) or social media. Although self-rated competence in finding information showed some variability, a strong majority (184/207, 88.9%; 95% CI 83.8%-92.8%) felt their skills were good or better.

Pattern of Resource Use

We considered a resource to be heavily used if a student reported use 4 or more times in the previous 7 days (, ). Most respondents use Google on a daily basis (154/202, 76.2%; 95% CI 69.8%-81.9%), and very few reported using the search engine on fewer than 4 of the prior 7 days (13/202, 6.4%; 95% CI 3.5%-10.8%). Wikipedia, UpToDate (a subscription-only, evidence-based summary source), and personal/provided notes were also heavily used. In contrast, few respondents (28/199, 14.1%; 95% CI, 9.6%-19.7%) had used bibliographic databases on at least 4 days, and just over one-third (68/199, 34.2%; 95% CI, 27.6%-41.2%) had not used such sources at all in the previous week.

Comparison of preclinical- and clinical-level respondents revealed two prominent differences: clinical-level respondents reported less frequent use of bibliographic databases ( P<.001) and more frequent use of UpToDate ( P<.001) ().

Of note, these results were somewhat different from respondents' self-generated lists of most used resources. Here, UpToDate was the most-listed single reference, while Google and Wikipedia were the next most commonly cited resources ().

‎
Table 1. Preclinical and clinical student use of resources during the previous 7 days.
View this table

‎
Figure 1. Student self-reported use of resources in the previous 7 days.
View this figure

‎
Figure 2. Student-identified top resources from the previous 7 days.
View this figure

Values and Reasons for Using Sources

Whereas students valued the general purpose resources Google and Wikipedia highly for their accessibility, understandability, and usefulness, they gave PubMed and other bibliographic databases stronger ratings for accuracy and trustworthiness. As a representative EBM summary, UpToDate appeared to bridge this gap: it received high ratings across values although many students noted elsewhere that access to this resource was limited by cost and lack of an institutional subscription ().

Students identified key factors in their impressions of a source's trustworthiness: recognition of factual errors in a reference and reputation among mentors and peers, as well as being specifically counseled to use or avoid a reference.

‎
Figure 3. Student evaluations of specified resources.
View this figure

Self-Identified Needs and Abilities

Students offered valuable insights in their responses to open-ended questions, and several themes emerged. Many spoke of being overwhelmed by the number of available and/or suggested resources as well as by the density of information in these sources; respondents repeatedly reported a need for more basic information and for managing information/source overload. They requested faculty- and/or peer-generated resource recommendations, although some noted that current lists added to a sense of overload. Perhaps in response to this challenge, several requested increased and longitudinally integrated instruction on searching for information and often highlighted a desire to learn how to approach nontraditional, or general purpose, Internet sources. Finally, resource accessibility presented an additional, practical barrier to finding useful information. Respondents commonly identified a need for freer access, including at the point of care; they cited lack of universal Internet access, inconvenience of multiple sign-ins, and subscription-based access as barriers.

Discussion

Dalhousie University Medical School Curriculum

Our survey assessed patterns of information resource use among students in the undergraduate MD program at Dalhousie University. Students in the program must have an undergraduate degree; some have additional study or work experience. The school has two campuses (Halifax, Nova Scotia, and Saint John, New Brunswick); the sites share a uniform curriculum, and many lectures are videoconferenced. All students have remote access to Dalhousie University library electronic resources throughout their training.

The medical school follows a 4-year curriculum. Two classroom-based preclerkship years aim to provide a foundation of knowledge and basic skills. A two-year clerkship follows, spent mostly in clinical settings.

A concentrated series of lectures on EBM are delivered at the beginning of year one. On a recent syllabus, seven hours during that unit were devoted to aspects of EBM, including five hours on question formulation and searching for evidence. Lecture notes refer to a standard hierarchy of preappraised evidence and discuss how and when to use various resources [Robin Parker, Sources of evidence, 10 September 2012, Dalhousie University, Canada].

Information management and EBM continue to receive attention at various points after this introductory unit. Weekly sessions during the first two years address evidence search and appraisal and other topics (ethics, law, population health, and professionalism). The formal curriculum is more limited during the clinical years, and much of the planned teaching time addresses clinical skills; training objectives continue to refer to critical use and appraisal of evidence.

Students have access to an array of resources and resource guides. They receive reference recommendations for each unit, and notes and links are posted on general and course-specific websites. The library website houses subject guides for each course and clinical rotation, including guides to search strategies for PubMed and Cochrane Library, a subscription-based set of medical and healthcare databases.

Principal Findings

Behavior Diverges From Formal Instruction

In this survey, most students recalled having received formal instruction on health information searches during their training, most of which concerned traditional information sources such as PubMed or other bibliographic databases. Although students commonly reported being discouraged from using certain resources and seldom recalled instruction in the use of general purpose search resources (such as Google), they reported Google as the most frequently used in their actual practice. The contrast between self-reported formal instruction and practice may have several explanations. Medical education takes place on multiple levels: while the formal curriculum transmits intentional and explicit instruction, informal and hidden curricula operate through experience, interactions, and role modeling []. A substantial body of literature avers the importance of these latter curricula on the emerging professional and ethical identities of the students. Our respondents likewise rated reputation among peers and mentors as an important factor in their valuation of information sources. Informal curricula may well influence learning behaviors as much as they do ethical ones. If so, given the high rates of general purpose and preappraised resource use among medical residents and qualified physicians [,,]-students' chief mentors during training-it is not surprising that these students should so frequently use such resources. Moreover, increased informal, experiential interaction with these mentors during the clinical training years would be expected to result in increased use of role-modeled resources.

Changing Patterns of Resource Use

Students in their clinical years used Google heavily but reported increased use of UpToDate and less reference to bibliographic databases compared to their preclinical peers. With the shift to a clinical setting, students' information needs change: they require more patient-oriented information, whereas preclinical students must accumulate basic knowledge of physiology and disease. As well, the real-world, clinical setting demands increased search efficiency, often making review of individual studies impractical []. Such needs may have influenced the students in this study and have spurred an industry of preappraised, summarized information sources (including UpToDate). Although criticized for variable design and timeliness [,], preappraised summaries have proven superior to primary literature searches in some cases [,] and are commonly considered an important part of evidence-based practice [].

Access to EBM summaries may have been a contributing factor to the seniority-related variation in resource use. Anecdotally, several students told us that they purchase or share subscriptions to resources, including UpToDate, upon entering clerkship. While our university does not hold a license for UpToDate-the EBM summary most frequently named by students-some clinical settings do.

Meanwhile, the fact that students less commonly named evidence summaries to which our university does offer access is significant. It may reflect the strength of peer and mentor influences. It could also speak to the problem of information resource overload. Excess information may lead to errors of omission in the clinical context [,]: with such a large variety and volume of resources, information may be lost. One medical librarian's observation that "students may not have an accurate picture of the access they're entitled to" [personal communication by Kathleen Gadd, 9 March 2015] lends support to this possibility.

Resource Selection: A Balance of Needs

The values respondents attributed to various information sources identify ease of understanding and accessibility as common features among the more heavily used resources. Meanwhile, their comments highlight challenges navigating a surplus of information and managing source accessibility. Their practice appears to reflect a trade-off between accessibility/digestibility and accuracy: students appear to believe the balance of benefit lies with summary sources, whether medical or general purpose.

Such calculations constitute a satisficing approach to searching and source selection. Faced with practical limits on obtaining and analyzing a large volume of relevant data, individuals select what they perceive to be a good enough option [-]-for example, selecting Google or UpToDate to locate a piece of needed information instead of conducting a thorough literature review. The concern, of course, is whether students are equipped to know and choose what is actually good enough. Can they appraise the source and the information,adequately to determine whether it meets minimum standards? An optimistic view would hold that this is the case. On the other hand, given the lack of instruction on use and appraisal of their most-used sources, we might question the bases for their strategies and consider the risks of uncritical information seeking.

Student Self-Assessment

A strong majority of respondents rated their information seeking skills as good or better-this despite reporting information search practices that diverged from the formal instruction they had received. Perhaps this is because they achieve good results with their current search practices. It is worth noting, however, the limits inherent to self-assessment. Individual self-rating bears little relation to actual competence, and most students overestimate their performance; this is demonstrable among medical students, among others [-]. Individuals who believe they have adequate skills are unlikely to seek remediation, whether or not they are truly competent. Furthermore, the students in this survey reported feeling overwhelmed by the information landscape; we know medical professionals consistently choose CME activities that address interests and skills rather than weaknesses and can surmise that medical student behavior is likely similar. It seems unlikely that these students will independently seek out ways to improve their skills, now or possibly even into their careers. If there is a better approach to seeking information, medical educators must offer active guidance.

Study Limitations

Our study has limitations. We conducted the survey at a single medical school. The response rate was lower than desired. Our response rate appears comparable, however, to that achieved by previous online surveys addressing technology and information management in medicine [-,].

Our survey relied on self-reported behaviors, which are known to be subject to social desirability bias. External observation of behavior, however, is not feasible for the current inquiry. A daily diary approach might have offered greater accuracy but at a further cost to the response rate. We asked respondents to report practices from the preceding 7 days as a strategy to obtain more accurate self-reported data than a more general inquiry. Despite this, the difference seen between the frequencies of use reported for different resources and respondents' self-generated lists of most-used resources suggested the possibility of bias in some questions. We would, however, have expected social desirability bias to skew results away from non-traditional, general-purpose sources-instead we saw quite a dramatic favoring of such resources over bibliographic databases.

Our survey obtained a cross-sectional assessment, with reference to behavior during the preceding seven days. It is possible that student behavior differed from usual practice during the week prior to the survey, rendering nonrepresentative results. In an effort to limit this possibility, we discussed survey timing with the Dalhousie Undergraduate Medical Education Curriculum Committee and student leaders and selected survey dates that fell during the routine session, avoiding examination or recess periods.

Conclusions

No tool is optimal for every purpose. Students need to gain skills and familiarity assessing primary literature, but they also must learn to find useful, practical information efficiently. They need to recognize what tool will best serve a given purpose-whether this is getting an overview of a common condition or physiologic process or assessing effectiveness of alternate medical therapies-and to appreciate the limitations inherent to that tool. Thus, whereas current formal instruction on information searching neither reflects nor appears to alter,student behavior, consideration should be given to instruction on information management and appraisal in general. Medical education that includes use and appraisal of primary literature, summary sources, and even general purpose resources might more effectively equip students in their pursuit of lifelong learning.

Acknowledgments

This study was unfunded. AO is a subspecialty resident physician at the IWK Health Centre/Dalhousie University. EW is a third-year medical student at Dalhousie University. KEG and JD are staff physicians at the IWK Health Centre and faculty members with the Department of Pediatrics, Dalhousie University. AO contributed to the study's conception, survey design, data acquisition, analysis, and interpretation; and wrote the manuscript. EW contributed to survey design and implementation and manuscript review. JD and KEG offered supervision to the project and advised regarding study design, data interpretation and statistical analysis, and manuscript review. AO and KEG had full access to all the data in the study, conducted, and take responsibility for the integrity of the data and the accuracy of the data analysis.

We appreciate support received from other members of Dalhousie University. Poh Chua (Information Technology Services, Dalhousie University) gave technical support. Sylvia Bartlett and Carolyn Pelham (Dalhousie Undergraduate Medical Education administration) and Leo Fares (Dalhousie Medical Student Society President 2013-14) helped to coordinate the survey. Alicia Eakins (UGME Administrator, Dalhousie University) provided curriculum information. Librarians at Dalhousie and its affiliated health care centers gave information on resource availability: Patrick Ellis (Associate University Librarian Resources; Head, W.K. Kellogg Health Sciences Library, Dalhousie University), Jackie Phinney (Information Services Librarian, Dalhousie Medicine NB), Darlene Chapman (Manager, Library and Audiovisual Services, IWK Health Centre, Halifax, NS), Kathleen Gadd (Librarian, Horizon Health Network, NB), and Katie McLean (Librarian Educator; Vice-President of Maritime Health Libraries Association, Capital District Health Authority, NS).

Conflicts of Interest

None declared.
‎
‎
Abbreviations

Edited by G Eysenbach; submitted 21.01.15; peer-reviewed by L Maggio, A Shaughnessy; comments to author 03.03.15; revised version received 06.04.15; accepted 02.05.15; published 29.06.15

©Aoife Marie O'Carroll, Erin Patricia Westby, Joseph Dooley, Kevin E Gordon. Originally published in JMIR Medical Education (http://mededu.jmir.org), 29.06.2015.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on http://mededu.jmir.org/, as well as this copyright and license information must be included.

ABSTRACT

Background: Medical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important.

Objective: To describe medical students' current pattern of health information resource use and characterize their experience of instruction on information search and appraisal.

Methods: We conducted a cross-sectional web-based survey of students registered in the four-year MD Program at Dalhousie University (Halifax, Nova Scotia, and Saint John, New Brunswick, sites), Canada. We collected self-reported data on information-seeking behavior, instruction, and evaluation of resources in the context of their medical education. Data were analyzed using descriptive statistics.

Results: Surveys were returned by 213 of 462 eligible students (46.1%). Most respondents (165/204, 80.9%) recalled receiving formal instruction regarding information searches, but this seldom included nontraditional tools such as Google (23/107, 11.1%), Wikipedia, or social media. In their daily practice, however, they reported heavy use of these tools, as well as EBM summaries. Accessibility, understandability, and overall usefulness were common features of highly used resources. Students identified challenges managing information and/or resource overload and source accessibility.

Conclusions: Medical students receive instruction primarily on searching and assessing primary medical literature. In their daily practice, however, they rely heavily on nontraditional tools as well as EBM summaries. Attention to appropriate use and appraisal of nontraditional sources might enhance the current EBM curriculum.

JMIR Medical Education 2015;1(1):e4

doi:10.2196/mededu.4267

Citation

Please cite as:

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KEYWORDS

Introduction

The information landscape is expanding rapidly, in large part due to the advent and evolution of the Internet. In the developed world, widespread access to the Internet along with intuitive and user-friendly search tools have made information on a vast range of topics available within moments. Some tools have gained such ubiquity as to become part of common parlance: "Google" is now a dictionary-approved verb [].

Medicine has seen a similar trend, and the volume of information is not unequivocally helpful to practice. Authors have previously cited the challenges of staying up to date on a multitude of articles [] and guidelines []; today, even the tools to access evidence proliferate. Whereas evidence-based medicine (EBM) developed as an approach to manage the challenge of translating primary evidence into clinical practice, the field has evolved to define increasingly sophisticated approaches to the body of literature as a whole. Indeed, some authors suggest that information management training may be as important as instruction on searching the primary literature [,].

Instruction in EBM is variable, however, and whether it affects long-term behaviors is uncertain [-]. The realities of daily work can present barriers to evidence-based practice, which is often perceived as a time- and effort-intensive pursuit [-]. Moreover, access to primary medical literature, summaries, and clinical support tools often comes with costly subscription fees.

These challenges make the user-friendly, freely accessible tools that are useful for general purpose inquiries appealing. Indeed, studies of medical trainees and practicing physicians support the popularity of general purpose tools for clinical or academic queries [,,]. Notwithstanding concerns regarding reliability, some evidence suggests that general resources such as Google can be effective in answering clinical questions [-].

If these issues are important for the future of medicine, we need to understand how information-seeking behaviors develop. Medical school lays foundations of knowledge and behavior patterns. Students' active engagement in participatory knowledge building is critical to this process, and thus information acquisition and use have central importance. Students turn to information sources to build background knowledge and will subsequently develop increasingly patient-specific questions and searches. As clinical encounters lead them to continually integrate this knowledge, they gradually build mental maps that enable automatic processing for quick clinical decision making []. Meanwhile, however, they must recognize the ongoing need to engage with information sources: to update their mental maps and to supplement when prior knowledge is absent or insufficient []. Their medical education must therefore prepare them as managers of information as well as experts in human health.

Previous studies that focused on medical students in the developed world have considered the use of specific resources [-] or technology [-]. Others have reported on experimental educational interventions [-]. With the current study, we sought a holistic characterization of the information-seeking behaviors of a medical student cohort in the context of an existing formal EBM curriculum.

We surveyed students enrolled in a medical doctorate training program regarding their use of Internet resources for medical information and the instruction they have received in EBM and information management. We hypothesized that this group would report high use of general purpose resources with minimal instruction in the use or interpretation of such resources.

The primary objective of this study was to define students' current patterns of resource use. We also sought to characterize student experiences of current informatics instruction. Lastly, we began an inquiry into student valuations of various resources for medical information.

Methods

Survey Instrument

We developed a web-based survey to assess student information-seeking behavior, formal instruction on information searches, and evaluation of sources of health information. The survey was developed based on a review of relevant published literature and pretested with a convenience sample of ten medical students. The final survey contained 20 questions, predominantly requiring yes/no or rating scale responses; one question required a numeric estimate, one asked students to list their five most-used resources, and two were open-ended. Questions regarding resource use were based on recall of the previous seven days. The list of survey questions is included in .

Participant Recruitment

All students registered in the Dalhousie University 4-year medical doctorate program, at either the Halifax or the Saint John site, were considered eligible for participation in the survey. At the time of the survey, there were 462 registered students. We considered students in years 1 and 2 preclinical and those in years 3 and 4 clinical because the first two years are classroom-based while the third and fourth years take place predominantly within clinical settings.

The survey was published online using the Opinio 6 survey platform (ObjectPlanet, Inc) and remained open for two weeks. Two of the study authors (AO and EW) made in-class announcements to each student cohort, and invitation and reminder emails were sent to eligible students.

Data Analysis

The survey responses were exported from the survey platform into Excel (Microsoft Corp). Data were analyzed using descriptive statistics, computed by hand. Frequencies were reported as percentages. Where appropriate, 95% confidence intervals were calculated using the .cii command with exact binomial confidence intervals using STATA version 12.1 (StataCorp LP). No correction was made for multiple statistical testing.

One question asked respondents to list their five most-used resources from the previous seven days. We assessed response frequency, and used Wordle [] to generate a graphical representation of this data in which type size reflects frequency of occurrence.

Selected data were subsequently graphed using R (The R Foundation). In keeping with a paper presented at the 2011 Joint Statistical Meeting [], these Likert data were presented graphically, using diverging stacked bar charts across information sources.

Open-ended questions were analyzed qualitatively for themes by AO. Responses were read and common themes identified; on second reading, responses were categorized into thematic groups. Responses that reflected more than one theme were included in each relevant thematic group.

Ethics

The study was formally reviewed and approved by the IWK Health Centre Research Ethics Board. We also received approval from the Dalhousie Undergraduate Medical Education Curriculum Committee.

Results

Participant Recruitment

Of 462 students invited to respond, 213 (46.1%) provided evaluable responses. Two-thirds of closed-ended questions received response rates of 42.0% or above (193 or more students), and all but one question had responses from at least 39.0% (180 students). Ten students accessed the survey but did not provide any responses; these were considered to be nonrespondents and were not included in the response rate figures.

Study Participants

Of the respondents, 56.6% (120/212) were female and 42.0% (89/212) were male; 3 preferred not to answer this question. Preclinical and clinical training levels received comparable representation (110/212, 51.9%, and 102/212, 48.1%, respectively). Roughly half (109/207, 52.7%) had prior experience as contributors to peer-reviewed literature, while relatively few (35/207, 16.9%) had posted information online for the public.

Instruction on Information Searching

While 80.9% (165/204; 95% CI 74.8%-86%) of respondents recalled receiving formal instruction on searching for health information, 67.1% (139/207; 95% CI 60.3%-73.5%) also recalled being discouraged from using certain resources. Education regarding bibliographic databases (eg, PubMed) was common (162/206, 78.6%; 95% CI 72.4%-84.0%), whereas respondents seldom had instruction regarding general purpose Internet sources. Only 11.1% (23/207; 95% CI 7.2%-16.2%) reported teaching regarding the general search engine Google, and fewer had education on Wikipedia (a free, online, open-content encyclopedia) or social media. Although self-rated competence in finding information showed some variability, a strong majority (184/207, 88.9%; 95% CI 83.8%-92.8%) felt their skills were good or better.

Pattern of Resource Use

We considered a resource to be heavily used if a student reported use 4 or more times in the previous 7 days (, ). Most respondents use Google on a daily basis (154/202, 76.2%; 95% CI 69.8%-81.9%), and very few reported using the search engine on fewer than 4 of the prior 7 days (13/202, 6.4%; 95% CI 3.5%-10.8%). Wikipedia, UpToDate (a subscription-only, evidence-based summary source), and personal/provided notes were also heavily used. In contrast, few respondents (28/199, 14.1%; 95% CI, 9.6%-19.7%) had used bibliographic databases on at least 4 days, and just over one-third (68/199, 34.2%; 95% CI, 27.6%-41.2%) had not used such sources at all in the previous week.

Comparison of preclinical- and clinical-level respondents revealed two prominent differences: clinical-level respondents reported less frequent use of bibliographic databases ( P<.001) and more frequent use of UpToDate ( P<.001) ().

Of note, these results were somewhat different from respondents' self-generated lists of most used resources. Here, UpToDate was the most-listed single reference, while Google and Wikipedia were the next most commonly cited resources ().

‎
Table 1. Preclinical and clinical student use of resources during the previous 7 days.
View this table

‎
Figure 1. Student self-reported use of resources in the previous 7 days.
View this figure

‎
Figure 2. Student-identified top resources from the previous 7 days.
View this figure

Values and Reasons for Using Sources

Whereas students valued the general purpose resources Google and Wikipedia highly for their accessibility, understandability, and usefulness, they gave PubMed and other bibliographic databases stronger ratings for accuracy and trustworthiness. As a representative EBM summary, UpToDate appeared to bridge this gap: it received high ratings across values although many students noted elsewhere that access to this resource was limited by cost and lack of an institutional subscription ().

Students identified key factors in their impressions of a source's trustworthiness: recognition of factual errors in a reference and reputation among mentors and peers, as well as being specifically counseled to use or avoid a reference.

‎
Figure 3. Student evaluations of specified resources.
View this figure

Self-Identified Needs and Abilities

Students offered valuable insights in their responses to open-ended questions, and several themes emerged. Many spoke of being overwhelmed by the number of available and/or suggested resources as well as by the density of information in these sources; respondents repeatedly reported a need for more basic information and for managing information/source overload. They requested faculty- and/or peer-generated resource recommendations, although some noted that current lists added to a sense of overload. Perhaps in response to this challenge, several requested increased and longitudinally integrated instruction on searching for information and often highlighted a desire to learn how to approach nontraditional, or general purpose, Internet sources. Finally, resource accessibility presented an additional, practical barrier to finding useful information. Respondents commonly identified a need for freer access, including at the point of care; they cited lack of universal Internet access, inconvenience of multiple sign-ins, and subscription-based access as barriers.

Discussion

Dalhousie University Medical School Curriculum

Our survey assessed patterns of information resource use among students in the undergraduate MD program at Dalhousie University. Students in the program must have an undergraduate degree; some have additional study or work experience. The school has two campuses (Halifax, Nova Scotia, and Saint John, New Brunswick); the sites share a uniform curriculum, and many lectures are videoconferenced. All students have remote access to Dalhousie University library electronic resources throughout their training.

The medical school follows a 4-year curriculum. Two classroom-based preclerkship years aim to provide a foundation of knowledge and basic skills. A two-year clerkship follows, spent mostly in clinical settings.

A concentrated series of lectures on EBM are delivered at the beginning of year one. On a recent syllabus, seven hours during that unit were devoted to aspects of EBM, including five hours on question formulation and searching for evidence. Lecture notes refer to a standard hierarchy of preappraised evidence and discuss how and when to use various resources [Robin Parker, Sources of evidence, 10 September 2012, Dalhousie University, Canada].

Information management and EBM continue to receive attention at various points after this introductory unit. Weekly sessions during the first two years address evidence search and appraisal and other topics (ethics, law, population health, and professionalism). The formal curriculum is more limited during the clinical years, and much of the planned teaching time addresses clinical skills; training objectives continue to refer to critical use and appraisal of evidence.

Students have access to an array of resources and resource guides. They receive reference recommendations for each unit, and notes and links are posted on general and course-specific websites. The library website houses subject guides for each course and clinical rotation, including guides to search strategies for PubMed and Cochrane Library, a subscription-based set of medical and healthcare databases.

Principal Findings

Behavior Diverges From Formal Instruction

In this survey, most students recalled having received formal instruction on health information searches during their training, most of which concerned traditional information sources such as PubMed or other bibliographic databases. Although students commonly reported being discouraged from using certain resources and seldom recalled instruction in the use of general purpose search resources (such as Google), they reported Google as the most frequently used in their actual practice. The contrast between self-reported formal instruction and practice may have several explanations. Medical education takes place on multiple levels: while the formal curriculum transmits intentional and explicit instruction, informal and hidden curricula operate through experience, interactions, and role modeling []. A substantial body of literature avers the importance of these latter curricula on the emerging professional and ethical identities of the students. Our respondents likewise rated reputation among peers and mentors as an important factor in their valuation of information sources. Informal curricula may well influence learning behaviors as much as they do ethical ones. If so, given the high rates of general purpose and preappraised resource use among medical residents and qualified physicians [,,]-students' chief mentors during training-it is not surprising that these students should so frequently use such resources. Moreover, increased informal, experiential interaction with these mentors during the clinical training years would be expected to result in increased use of role-modeled resources.

Changing Patterns of Resource Use

Students in their clinical years used Google heavily but reported increased use of UpToDate and less reference to bibliographic databases compared to their preclinical peers. With the shift to a clinical setting, students' information needs change: they require more patient-oriented information, whereas preclinical students must accumulate basic knowledge of physiology and disease. As well, the real-world, clinical setting demands increased search efficiency, often making review of individual studies impractical []. Such needs may have influenced the students in this study and have spurred an industry of preappraised, summarized information sources (including UpToDate). Although criticized for variable design and timeliness [,], preappraised summaries have proven superior to primary literature searches in some cases [,] and are commonly considered an important part of evidence-based practice [].

Access to EBM summaries may have been a contributing factor to the seniority-related variation in resource use. Anecdotally, several students told us that they purchase or share subscriptions to resources, including UpToDate, upon entering clerkship. While our university does not hold a license for UpToDate-the EBM summary most frequently named by students-some clinical settings do.

Meanwhile, the fact that students less commonly named evidence summaries to which our university does offer access is significant. It may reflect the strength of peer and mentor influences. It could also speak to the problem of information resource overload. Excess information may lead to errors of omission in the clinical context [,]: with such a large variety and volume of resources, information may be lost. One medical librarian's observation that "students may not have an accurate picture of the access they're entitled to" [personal communication by Kathleen Gadd, 9 March 2015] lends support to this possibility.

Resource Selection: A Balance of Needs

The values respondents attributed to various information sources identify ease of understanding and accessibility as common features among the more heavily used resources. Meanwhile, their comments highlight challenges navigating a surplus of information and managing source accessibility. Their practice appears to reflect a trade-off between accessibility/digestibility and accuracy: students appear to believe the balance of benefit lies with summary sources, whether medical or general purpose.

Such calculations constitute a satisficing approach to searching and source selection. Faced with practical limits on obtaining and analyzing a large volume of relevant data, individuals select what they perceive to be a good enough option [-]-for example, selecting Google or UpToDate to locate a piece of needed information instead of conducting a thorough literature review. The concern, of course, is whether students are equipped to know and choose what is actually good enough. Can they appraise the source and the information,adequately to determine whether it meets minimum standards? An optimistic view would hold that this is the case. On the other hand, given the lack of instruction on use and appraisal of their most-used sources, we might question the bases for their strategies and consider the risks of uncritical information seeking.

Student Self-Assessment

A strong majority of respondents rated their information seeking skills as good or better-this despite reporting information search practices that diverged from the formal instruction they had received. Perhaps this is because they achieve good results with their current search practices. It is worth noting, however, the limits inherent to self-assessment. Individual self-rating bears little relation to actual competence, and most students overestimate their performance; this is demonstrable among medical students, among others [-]. Individuals who believe they have adequate skills are unlikely to seek remediation, whether or not they are truly competent. Furthermore, the students in this survey reported feeling overwhelmed by the information landscape; we know medical professionals consistently choose CME activities that address interests and skills rather than weaknesses and can surmise that medical student behavior is likely similar. It seems unlikely that these students will independently seek out ways to improve their skills, now or possibly even into their careers. If there is a better approach to seeking information, medical educators must offer active guidance.

Study Limitations

Our study has limitations. We conducted the survey at a single medical school. The response rate was lower than desired. Our response rate appears comparable, however, to that achieved by previous online surveys addressing technology and information management in medicine [-,].

Our survey relied on self-reported behaviors, which are known to be subject to social desirability bias. External observation of behavior, however, is not feasible for the current inquiry. A daily diary approach might have offered greater accuracy but at a further cost to the response rate. We asked respondents to report practices from the preceding 7 days as a strategy to obtain more accurate self-reported data than a more general inquiry. Despite this, the difference seen between the frequencies of use reported for different resources and respondents' self-generated lists of most-used resources suggested the possibility of bias in some questions. We would, however, have expected social desirability bias to skew results away from non-traditional, general-purpose sources-instead we saw quite a dramatic favoring of such resources over bibliographic databases.

Our survey obtained a cross-sectional assessment, with reference to behavior during the preceding seven days. It is possible that student behavior differed from usual practice during the week prior to the survey, rendering nonrepresentative results. In an effort to limit this possibility, we discussed survey timing with the Dalhousie Undergraduate Medical Education Curriculum Committee and student leaders and selected survey dates that fell during the routine session, avoiding examination or recess periods.

Conclusions

No tool is optimal for every purpose. Students need to gain skills and familiarity assessing primary literature, but they also must learn to find useful, practical information efficiently. They need to recognize what tool will best serve a given purpose-whether this is getting an overview of a common condition or physiologic process or assessing effectiveness of alternate medical therapies-and to appreciate the limitations inherent to that tool. Thus, whereas current formal instruction on information searching neither reflects nor appears to alter,student behavior, consideration should be given to instruction on information management and appraisal in general. Medical education that includes use and appraisal of primary literature, summary sources, and even general purpose resources might more effectively equip students in their pursuit of lifelong learning.

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Information-Seeking Behaviors of Medical Students: A Cross-Sectional Web-Based Survey

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Original Paper 1 Dalhousie University, Halifax, NS, Canada 2 Division of Pediatric Neurology, Dalhousie University, Halifax, NS, Canada *these authors contributed equally Corresponding Author Aoife Marie O'Carroll, MD, FRCPC Dalhousie University Division of Pediatric Neurology, IWK Health Centre, Children's Site, 8th Floor 5850-5980 University Avenue, PO Box 9700 Halifax, NS, Canada Phone: 1 902 470 8475 Fax:1 902 470 8486 Email: Background: Medical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important.

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Schweiz: https://www.guidelines.fmh.ch/index.cfm?l=1

USA: https://www.guideline.gov

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Statt in einzelnen Datenbanken bieten Meta-Suchmaschinen die Suche gleichzeitig in mehreren Datenbanken. Beispiele:

http://plus.mcmaster.ca/ACCESSSS/Default.aspx?Page=1

https://www.tripdatabase.com

http://sumsearch.org

https://www.epistemonikos.org

https://www.livivo.de/

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Auf Literaturverwaltungsprogramme (EndNote etc.) können wir in med.info.pro nicht eingehen – dafür stehen Ihnen die separaten Schulungen über https://fortbildung.unibas.ch zur Verfügung. Auch im Wissenschaftsmonat gibt es Schulungen.
Wenn Sie Literaturverwaltungssoftware vergleichen wollen, gibt es Vergleichsseiten wie: www.library.ethz.ch/content/download/2459/63547/file/Literaturverwaltung.pdf.
S. auch den Beitrag im Beast-Blog zu Zotero.

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EndNote für MedizinerInnen | Fortbildung

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Erstellen von Bibliographien Importieren von Rechercheresultaten Recherchen mit EndNote Formatieren von Bibliographien Einfügen von Zitaten in Texte Verwalten der eigenen PDF-Dokumente Datenaustausch mit EndNote Web

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Aktivität: Nutzen Sie fachbezogene soziale Netzwerke (ResearchGate etc.)? Welche? Was sind Ihre Erfahrungen?

Weitere Beispiele für Netzwerke:
https://www.medscape.com
US: https://www.doximity.com

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“Open Data” ermöglicht die Reproduktion von Resultaten. Außerdem weisen die Befürworter von Data sharing auf eine ethische Verpflichtung hin, vgl. z.B. hier: "The International Committee of Medical Journal Editors (ICMJE) believes there is an ethical obligation to responsibly share data generated by interventional clinical trials because trial participants have put themselves at risk."

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Zur Wichtigkeit, sich bezüglich den medizinischen Fortschritten auf dem Laufenden zu halten:

Aktivität: Was denken Sie, wann sind Ärzte am besten: wenn sie jung sind (unter 40) oder wenn sie älter sind?

Für amerikanische Spitalärzte haben Tsugawa et al. (2017) diese Frage anhand dieser Outcomes für über 65-jährige Akutpatienten untersucht:

Sterblichkeitsrate 30 Tage nach der Einweisung

erneute Einweisung innerhalb 30 Tagen nach der Entlassung

Behandlungskosten

Ihr Ergebnis: Die Sterblichkeitsrate ist bei unter 40-jährigen Ärzten tiefer als unter älteren Ärzten. Als mögliche Erklärung für diesen Befund nennen die Autoren (S. 7): Ältere Ärzte, die weiter von der Ausbildung entfernt sind, greifen evtl. auf Fachwissen zurück, das nicht up-to-date ist, und sie setzen neu erprobte Behandlungsmethoden seltener ein. Wenn diese Hypothese zutrifft, kommt dem Informationsverhalten und lifelong learning der Ärzte eine große Bedeutung zu.

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E-Mail-Alerts sind eine gute Möglichkeit, um über neue Publikationen auf dem Laufenden zu bleiben. Praktisch alle Journals, Portale und auch Datenbanken wie PubMed bieten diesen kostenlosen Service an.

Aktivität: Richten Sie sich einige E-Mail-Alerts bei Journals ein, die Sie interessieren! Richten Sie sich auch einen Alert bei PubMed ein. Dafür müssen Sie einen MyNSBI-Account erstellen. Details hier.

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Wie werden wir in 10, in 20, in 50 Jahren Informationen suchen? Einige Denk-Anregungen:

Werden klinische decision-support-Systeme wie das von Roche lancierte Navify den Ärzten in Zukunft die Suche abnehmen und automatisch die Daten des individuellen Patienten mit der Gesamtheit der vorhandenen Daten (Stichwort big data / data mining) abgleichen?

Z.B. spricht der Roche-Diagnostik-Chef Roland Diggelmann von "Apps, die beim Erstbefund eines Patienten Informationen aus der medizinischen Literatur oder die Orte bereitstellen, an denen passende klinische Studien laufen" (lesen Sie das ganze Interview hier).

Oder wird es dabei bleiben, dass Informationssuche von Menschen gemacht wird, werden sich aber alternative Such-Ansätze durchsetzen? Eine solche Alternative stellt der sog. objektivierte Ansatz (entwickelt am IQWiG) dar.

Was denken Sie?

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Smith: The trouble with medical journals (2006)

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Video im Rahmen dieses englischen Tutorials (für Login nach "Play" mit "Continue" weiterklicken)

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Leserumfrage Medizinische Fachpresse 2017 bei 2550 Ärzten

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Übersicht zur Literatursuche in der Medizindidaktik 

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Übersicht zur Literatursuche in der Medizindidaktik 

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A beginner’s guide to the literature search in medical education

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Ärzte können ihren Patienten nicht nur geeignete Informationsquellen empfehlen; sie können sie auch selbst befähigen, Gesundheitsinformationen richtig einzuordnen und misstrauisch gegenüber falschen Versprechungen zu sein. Einen solchen Ansatz verfolgt das Konzept der kritischen Gesundheitskompetenz.

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Helgesson et al. (2018)

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Fake News in Social Media zu Prostatakrebs

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Fake News in Social Media zu Prostatakrebs

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Ärztezeitung, bezogen auf Artikel

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ausführliche Aufstellung und Unterscheidung diverser Unterarten in Sutton et al. (2019)

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Corresponding Author

E-mail address: a.sutton@sheffield.ac.uk

@antheasutton
https://orcid.org/0000-0003-2449-2516
School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK

Correspondence: Anthea Sutton, Health Economics and Decision Science (HEDS), ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. E‐mail:
a.sutton@sheffield.ac.uk Search for more papers by this author
First published:

Abstract

Background and objectives

The last decade has witnessed increased recognition of the value of literature reviews for advancing understanding and decision making. This has been accompanied by an expansion in the range of methodological approaches and types of review. However, there remains uncertainty over definitions and search requirements beyond those for the 'traditional' systematic review. This study aims to characterise health related reviews by type and to provide recommendations on appropriate methods of information retrieval based on the available guidance.

Methods

A list of review types was generated from published typologies and categorised into 'families' based on their common features. Guidance on information retrieval for each review type was identified by searching pubmed, medline and Google Scholar, supplemented by scrutinising websites of review producing organisations.

Results

Forty‐eight review types were identified and categorised into seven families. Published guidance reveals increasing specification of methods for information retrieval; however, much of it remains generic with many review types lacking explicit requirements for the identification of evidence.

Conclusions

Defining review types and utilising appropriate search methods remain challenging. By familiarising themselves with a range of review methodologies and associated search methods, information specialists will be better equipped to select suitable approaches for future projects.

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Meeting the review family: exploring review types and associated information retrieval requirements

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Corresponding Author E-mail address: a.sutton@sheffield.ac.uk @antheasutton https://orcid.org/0000-0003-2449-2516 School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK Correspondence: Anthea Sutton, Health Economics and Decision Science (HEDS), ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.

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Verbreitung von falschen Informationen über Social Media

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Verbreitung von falschen Informationen über Social Media

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Die Autoren Edwards/Roland 2019 aus der Notfallmedizin haben versehentlich eine fehlerhafte Darstellung über Social Media verbreitet. Sie untersuchen, wie sich der Fehler verbreitet hat oder korrigiert wurde.

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predatory journals: wie bewusst sind sich Wissenschaftler der Problematik?

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predatory journals: wie bewusst sind sich Wissenschaftler der Problematik?

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Abstract

Objective

The purpose of predatory open access (OA) journals is primarily to make a profit rather than to disseminate quality, peer-reviewed research. Publishing in these journals could negatively impact faculty reputation, promotion, and tenure, yet many still choose to do so. Therefore, the authors investigated faculty knowledge and attitudes regarding predatory OA journals.

Methods

A twenty-item questionnaire containing both quantitative and qualitative items was developed and piloted. All university and medical school faculty were invited to participate. The survey included knowledge questions that assessed respondents' ability to identify predatory OA journals and attitudinal questions about such journals. Chi-square tests were used to detect differences between university and medical faculty.

Results

A total of 183 faculty completed the survey: 63% were university and 37% were medical faculty. Nearly one-quarter (23%) had not previously heard of the term "predatory OA journal." Most (87%) reported feeling very confident or confident in their ability to assess journal quality, but only 60% correctly identified a journal as predatory, when given a journal in their field to assess. Chi-square tests revealed that university faculty were more likely to correctly identify a predatory OA journal ( p=0.0006) and have higher self-reported confidence in assessing journal quality, compared with medical faculty ( p=0.0391).

Conclusions

Survey results show that faculty recognize predatory OA journals as a problem. These attitudes plus the knowledge gaps identified in this study will be used to develop targeted educational interventions for faculty in all disciplines at our university.

INTRODUCTION

Open access (OA) publishing allows free, unlimited online access to scholarly literature without the paywalls associated with traditional publishing models [ 1]. Legitimate OA journals uphold rigorous peer review, allow authors to retain copyright, and have been shown to increase an author's visibility [ 2, 3]. However, an unanticipated effect of this model has been the emergence of predatory OA journals that "exist for the sole purpose of profit, not the dissemination of high-quality research findings and furtherance of knowledge" [ 4]. These journals attempt to entice authors into paying an article processing fee and never publish the article or publish the article rapidly without quality peer review. This practice significantly impacts the quality of research being published and could have detrimental implications for authors, their institutions, and their fields [ 5- 8].

To date, most of the literature on predatory OA journals has been opinion-based (editorials, commentaries, news items, and so on), aimed at raising awareness of and cautioning against publishing in predatory OA journals [ 5, 9- 14]. Numerous investigations of faculty attitudes regarding OA in general have been published [ 15- 20], many revealing a general skepticism toward legitimate OA journals [ 16, 17, 20- 22]. Only a handful of investigations have focused on predatory OA journals specifically, often assessing faculty attitudes [ 7, 8, 23- 25]; fewer still have tested faculty knowledge of predatory OA journals directly [ 7, 23]. Libraries currently do and will continue to play a pivotal role in educating users about predatory OA journals [ 4, 26]. Therefore, it is important to understand faculty's baseline knowledge of and attitudes toward predatory OA journals.

Since 2016, the Oakland University William Beaumont School of Medicine Library (OUWB Medical Library) has spearheaded initiatives to raise awareness of predatory OA journals among faculty and students. Specifically, these journals have been discussed in faculty development sessions about publishing and journal selection, in the medical school curriculum as part of the required research program, and in three dedicated sessions on predatory OA journals during Oakland University Libraries' (OU Libraries') annual OA Week events. In addition, the OUWB Medical Library tracks institutional scholarship and has noted several instances of faculty publishing in questionable or known predatory OA journals.

Recently, OU Libraries included assessing faculty knowledge of predatory OA journals as a top priority in their strategic plan. As a result, librarians from the university and medical school libraries collaborated to conduct an educational needs assessment to investigate and compare current knowledge of and attitudes toward predatory OA journals among university and medical school faculty. Our research questions were:

1. What gaps, if any, exist in faculty members' knowledge of predatory OA journals, including the ability to identify one?

2. What are faculty attitudes regarding predatory OA journals?

The results of this project will be instrumental in tailoring faculty development sessions at the university that address identified knowledge gaps and attitudes and may provide a framework for other libraries to perform similar assessments at their own institutions.

METHODS

As no previous surveys have been published to date on predatory OA journals specifically, the authors developed a twenty-item Qualtrics (Qualtrics XM, Provo, UT, USA) questionnaire ( supplemental Appendix A). The survey included both quantitative and qualitative items and was divided into several sections:

demographic items including status as a university or medical school faculty member, rank, department, field of study, and total number of career publications

previous training on predatory OA journals

knowledge of predatory OA journals including assessing respondents' ability to: (1) distinguish between characteristics of predatory and legitimate OA journals and (2) identify a predatory OA journal when asked to review the website of one in their field; we selected four predatory OA journals in various fields that had a polished appearance to encourage a thorough evaluation

attitudes about predatory OA journals, including confidence in identifying predatory OA journals and the importance of discussing such journals at institutional and professional levels

previous experiences with predatory OA journals

resources used to assess journal quality

how libraries can assist with assessing journal quality

Prior to institutional review board (IRB) review, the survey was pilot-tested by 9 faculty members and revised. This study was deemed exempt by the Oakland University IRB. Respondents needed to be current (full- or part-time) or emeritus faculty members at Oakland University or OUWB School of Medicine to be eligible for the study. The screening questions to determine eligibility were required, but respondents could elect to skip any subsequent questions.

All eligible university (n=1,669) and medical school (n=1,425) faculty were invited to participate in the study via emails through university email discussion lists in early February 2019. The emails were sent to university faculty via the Oakland University Provost's Office and to medical faculty via the OUWB Office of Faculty Affairs. A reminder email was sent in late March 2019, and the survey was closed at the end of April 2019. Descriptive statistics were used to summarize the data, and comparisons between groups were analyzed using chi-square tests. A p-value <0.05 was considered statistically significant. All data analysis was completed using SAS 9.4 (SAS Institute, Cary, NC, USA).

RESULTS

A total of 220 responses were collected. Of these, 34 were removed because respondents did not proceed beyond the screening questions, and 3 were removed because the respondents were not faculty members. Therefore, a total of 183 faculty members completed the survey, representing an overall response rate of 5.9%.

Demographics

As all survey questions were optional, 17 respondents elected not to respond to the demographic questions. Of the respondents, 37.4% (n=62/166) were medical school faculty and 62.7% (n=104/166) were university faculty. The majority of respondents held rank as associate professors (36.3%), followed by assistant professors (26.9%), and professors (16.9%). For university faculty, the largest number of respondents came from social and behavioral science disciplines (32.0%), followed by the sciences (15.5%), humanities (14.6%), and business (9.7%), with all university schools and colleges represented. For medical school faculty, basic science faculty accounted for the most respondents (24.6%), followed by internal medicine (13.1%), with small numbers from various clinical departments including emergency medicine, family medicine, orthopedic surgery, pediatrics, radiation oncology, and surgery. Supplemental Appendix B provides a complete breakdown of respondents by rank and department.

Most respondents had published between 11 and 20 peer-reviewed publications in their academic careers (21.7%; n=36), closely followed by 0-5 (20.5%; n=34) publications ().

Previous training on predatory open access (OA) journals

Only a few respondents (13.3%, n=22) reported receiving training on predatory OA journals. shows the type of training reported by respondents.

Table 1

Library workshop at Oakland University (OU) or Oakland University William Beaumont School of Medicine Library (OUWB)

14

Library workshop at another institution

7

Professional conference

6

Workshop in their department

4

Knowledge of predatory OA journals

To answer the first research question, all 183 respondents were asked questions to assess their knowledge (or lack thereof) of predatory OA journals. When respondents were asked if they had previously heard of the term "predatory OA journal," most (70.5%, n=129) reported "yes," but a substantial portion reported "no" (23.0%, n=42) or "unsure" (6.6%, n=12). One respondent commented, "Wow, I had never heard of predatory [OA] journals so I am glad that this survey called the issue to my attention."

When participants were asked to review a series of OA journal characteristics and identify which ones they associated with legitimate OA journals, predatory OA journals, both, neither, or unsure, several trends emerged (). Most respondents correctly identified that legitimate OA journals can be indexed in major databases (85.8%; n=151/176), but only about half identified a journal being listed in the Directory of Open Access Journals (DOAJ) (49.7%; n=88/177) as a characteristic of this type of journal. As for characteristics of predatory OA journals, some respondents correctly identified 2 characteristics: rapid acceptance of articles (62.5%; n=110/176) and rapid publication of articles (56.5%; n=100/177). Only half of respondents correctly identified being free to read online (51.1%; n=89/174) as a characteristic of both legitimate and predatory OA journals. There were a number of characteristics that faculty were unsure about:

journal being listed in the DOAJ (28.8%; n=51/173)

article processing fee seems low (28.9%; n=50/173)

requirement of transfer of copyright prior to publication (25.4%; n=45/176)

an International Standard Serial Number (ISSN) (25.6%; n=45/176)

Many of these characteristics could be associated with either legitimate or predatory OA journals. Therefore, responding "both" for these questions indicated an understanding that these characteristics were not absolute indicators of legitimacy.

When comparing university faculty to medical faculty responses to these journal characteristics, some statistically significant differences were found. For "rapid acceptance of articles," a larger proportion of medical faculty (35.5%) than university faculty (18.3%) stated that this was a characteristic of a legitimate OA journal (χ ²(1)=6.19, p=0.0129). There was no significant difference in responses to "rapid publication of articles" between groups ( p>0.05). For "presence of physical mailing address" on the journal website, a larger proportion of medical faculty (82.3%) than university faculty (60.6%) stated that this was a characteristic of a legitimate OA journal (χ ²(1)=8.49, p=0.0036). However, a larger proportion of medical faculty (33.9%) than university faculty (15.4%) stated this same characteristic was associated with a predatory OA journal (χ ²(1)=7.66, p=0.0056). For "journal has low impact factor," a larger proportion of medical faculty (74.2%) than university faculty (48.1%) stated that this was a characteristic of a predatory OA journal (χ ²(1)=10.86, p=0.0010). Furthermore, for "listed in the Directory of Open Access Journals," a larger proportion of university faculty (6.7%) than medical faculty (0) believed that being listed in the DOAJ was a characteristic of neither type of OA journal (χ ²( 1)= 4.36, p=0.0369).

Assessment of the quality of an OA journal

Respondents were asked which of 5 broad disciplinary fields (arts, humanities, medicine and health sciences, sciences, or social and behavioral sciences) they felt most comfortable with in assessing the quality of a journal. They were then asked to assess the website of an actual predatory OA journal in their chosen fields and to give their opinion on whether it was a predatory or legitimate OA journal. In total, only 60.0% (n=103/172) correctly identified the journal as predatory, with 15.1% (n=26/172) incorrectly determining it was legitimate, and 25.0% (n=43/172) indicating they were unsure. A significantly larger proportion of university faculty (69.2%) than medical faculty (43.6%) correctly identified the journal as predatory (χ ²(1)=14.88, p=0.0006). Faculty who self-identified (in the demographics section) as being in the social and behavioral sciences discipline were the only discipline significantly more likely to correctly identify the journal as predatory (χ ²(2)=6.24, p=0.0442).

There were no significant differences ( p>0.05) in faculty members' ability to identify the predatory OA journal based on their rank, previous training, or publication history. There were also no significant differences ( p>0.05) among the 4 predatory OA journals used in the survey in terms of faculty correctly identifying the journal as predatory. Faculty who selected to assess the journal used for both the humanities and social sciences categories had the greatest success at identifying it as predatory, 75.0% (n=15/20) and 70.6% (n=36/51), respectively; the sciences journal at 60.7% (n=17/28) and medicine and health sciences journal at 48.6% (n=34/170) followed. Only 2 respondents selected to assess the arts journal, with 50.0% success (n=1/2) in correctly identifying it as predatory.

When respondents were asked to give at least two reasons why they believed the journal was predatory or legitimate, common themes emerged. Reasons for identifying it as predatory included promise of rapid review and/or publication, journal scope too broad, information about the editorial board missing, and only Bitcoin accepted as payment. Reasons for identifying it as legitimate included presence of an ISSN, peer review process described, digital object identifiers (DOIs) for articles, impact factor listed on website, editorial board named, and legitimate appearance of website.

Previous experience with predatory OA journals

The majority of respondents had some previous experience with predatory OA journals (). When comparing university and medical faculty, the only significant finding was that medical faculty were more likely to have been asked to serve on the editorial board of a predatory OA journal (61.3%) than university faculty (42.3%; χ ²(1)=6.00, p=0.0180).

Table 2

Experience with predatory OA journals

n (total=183)

%

Asked to publish in a predatory OA journal

133

72.6%

Asked to serve on an editorial board

83

45.4%

Receive unsolicited email solicitations a few times per month

71

38.8%

Asked to serve as a peer reviewer

56

30.6%

Receive unsolicited email solicitations a few times per week

37

20.2%

When asked if they had previously published in a predatory OA journal, 7 of the 169 respondents who answered this question said "yes," and 11 were "unsure." The top reasons given for publishing in a predatory OA journal (multiple choices allowed) were: not aware of it being a predatory OA journal (n=10), could not get article published elsewhere (n=6), and option for rapid acceptance and/or publication (n=6).

Attitudes about predatory OA journals

To answer the second research question, respondents were asked a series of Likert scale questions (). When presented with the statement, "I feel confident in my ability to assess journal quality," 86.9% (n=139/160) of faculty strongly agreed or agreed. When given the statement, "I believe promotion and tenure review committees should be concerned about predatory OA journals," 95.0% (n=152/160) strongly agreed or agreed. In addition, 93.3% (n=153/164) strongly agreed or agreed with the statement "My field/profession should be concerned about predatory OA journals." In the final open-ended question, several respondents shared concerns and thoughts about journal quality considerations in the promotion and tenure process:

"I think tenure and promotion committees should have to assess (or have the candidate assess) journal status."

"This is an important issue for academic integrity, merit pay, and promotion & tenure decisions."

"Given the increasing importance of number of publications published for tenure, it becomes more likely that desperate junior faculty will succumb to predatory [OA] journals. Frankly, that is becoming more of an issue across all faculty levels."

In addition, several comments emerged about the importance of discussing predatory OA journals with students:

"I think it is important to teach students, as well as faculty, about these journals. Although some students' awareness of varying quality in publications is excellent, many still assume that if it looks like a reputable, scholarly source, it is."

"Having a module to train graduate students on how to identify predatory [OA] journals would be fantastic!"

"Training in this area should be part of the curriculum for all medical students, residents, and fellows."

"I appreciate knowing that such journals exist and will look closely when advising my students."

After being asked these Likert scale questions, respondents were asked to describe, in an open-ended format, why they did or did not feel confident in their ability to judge journal quality. Of those who were confident, their answers coalesced around several themes: knowing the reputable journals in their field, knowing which resources to use to assess journal quality, researching a journal prior to submission, and having previous training or consultations with librarians. Conversely, respondents who were not confident in their ability to assess journal quality cited several recurring themes: sophistication of many predatory OA journals, lack of experience or education, mistrust in the OA model in general, and the sheer number of OA journals. In fact, three respondents specifically commented in the final open-ended question about their fears of this phenomenon:

"This is a bit of a scary issue because many predatory [OA] journals seem legitimate."

"I think this is a big issue that frankly scares me and has the potential to undermine our legitimacy as researchers."

"Predatory [OA] journals are scary things."

There were no significant differences in self-reported confidence in assessing journal quality based on faculty rank, previous training, publication history, or discipline. However, a larger proportion of university faculty (90.7%) than medical faculty (79.3%) reported higher self-confidence in their ability to assess journal quality (χ ²(3)=8.36, p=0.0391). Of the respondents who strongly agreed or agreed (n=139) with the statement, "I feel confident in my ability to assess journal quality," 66.0% were able to correctly identify a predatory OA journal in their fields, compared to 60.0% of all respondents. Of the respondents who strongly disagreed or agreed with the statement (n=21), 38.1% were able to correctly identify a predatory OA journal in their fields.

Resources used to identify journal quality

Respondents were asked to select what resources they used to help assess the quality of journals when looking to publish their work. Of the 165 responses, the 3 highest reported resources were colleagues (76.4%; n=126); Google or another search engine (54.5%; n=90); and a professional email discussion list, blog, or website (42.4%; n=70). Some also used librarians (38.8%; n=64) or consulted the library's website (19.4%; n=32).

How libraries can assist faculty in assessing journal quality

When asked what OU Libraries could do to assist them, faculty were interested in a checklist (70.9%; n=112/158); information on the libraries' website (65.2%; n=103/158); workshops or training (46.2%; n=73/158); or individual consultations (27.4%; n=43/157) (). A larger proportion of university faculty (85.3%) than medical faculty (62.9%) stated that their colleagues were a resource for assessing journal quality (χ ²(1)=10.86, p=0.0010). In addition, several respondents in open-ended comments noted the aid of librarians: "I have found the OU librarians invaluable in assessing the legitimacy of online journals" and "The Library staff has been very helpful to me!" Ten respondents did not think the OU Libraries could be helpful in this area.

DISCUSSION

Predatory OA journals are a pervasive issue across all of academia. However, to date, most of the published literature on predatory OA journals has been editorial in nature rather than methodical investigations [ 5, 9- 14]. Previous studies have focused on faculty attitudes regarding OA journals in general [ 15- 18], with only a handful studying predatory OA journals specifically [ 7, 19, 23- 25]. This study assessed cross-disciplinary university and medical faculty members' ability to identify predatory OA journals and sought to understand their attitudes and previous experiences with these journals.

Previous investigations into a particular group's familiarity with predatory OA journals took different methodological approaches: talking to authors who had previously published in a predatory OA journal [ 23, 24], assessing the influence of predatory OA journals on clinical care [ 7, 8], or evaluating an educational intervention for early career researchers [ 25]. A study by Christopher and Young in 2015 that assessed veterinary and medical authors' (students, residents, and faculty) knowledge of predatory OA journals before attending a scientific writing workshop found that only 23.0% of respondents were aware of the term "predatory OA journal," and when asked in an open-ended response to define "predatory OA journal," most participants associated it with poor quality rather than truly predatory practices [ 19]. The current study builds on Christopher and Young's results by directly assessing faculty's identification of the particular characteristics of legitimate versus predatory OA journals. Although a larger proportion of faculty (70.5%) in this study had heard of the term, many thought that some characteristics of the OA publishing model were, in fact, indicators of predatory OA journals, such as charging article processing fees.

We had anticipated that faculty would exhibit some knowledge gaps regarding predatory OA journals. However, we were surprised by the extent of these knowledge gaps, as only 60.0% of faculty were able to correctly identify a journal as predatory. Therefore, there was a mismatch between ability and self-reported confidence, as 86.9% of faculty reported that they strongly agreed or agreed with the statement, "I feel confident in my ability to assess journal quality." Thus, these findings suggested that many faculty members continued to demonstrate gaps in knowledge about the OA publishing model, a phenomenon that has been widely reported in the literature [ 16, 17, 20- 22]. Faculty respondents in this survey also indicated an overall lack of trust in the OA publishing model. One of the comments was particularly striking and illustrates ongoing confusion about the OA model:

"If the work cannot be published in a legitimate journal, it shouldn't be published. I don't understand faculty who do not understand that paying to publish is not consistent with the values and traditions of the academy."

Two other recent studies investigated reasons why authors decided to publish in predatory OA journals: one through a survey [ 23] and the other through in-depth interviews [ 24]. Both found that authors self-reported similar reasons, including lack of awareness that the journal was predatory, pressure to publish, lack of confidence in their ability to publish in a high-quality journal, and lack of research experience [ 23, 24]. Though only a small portion of respondents admitted to publishing in a predatory OA journal in the current study, our results are consistent with these previous findings.

Based on earlier educational efforts at our university, we hypothesized that faculty in the sciences, including medicine and health sciences, would be more likely to correctly identify a sample predatory OA journal. However, we found that faculty in social and behavioral science disciplines were significantly more likely to correctly identify a predatory OA journal, with no other significant differences related to discipline, demonstrating that education and awareness of predatory OA journals needs to reach faculty in all disciplines.

Our respondents appeared to agree with this need, as 91.6% (n=153) strongly agreed or agreed with the statement, "I believe my field should be concerned about predatory OA journals." In addition, there were no significant associations between faculty members' ability to correctly identify a journal as predatory and their rank, publication history, or previous training. This finding supported those of a survey on OA publishing conducted at our institution in 2014, which concluded that predictions about faculty opinions on, use of, and publishing in OA journals could not be made based on age, rank, or seniority [ 15]. However, we found that university faculty were significantly more likely to report being more confident than medical faculty, which was interesting considering that most of the libraries' educational activities about OA journals to date have been offered directly to medical school faculty at OUWB. This, again, points to the need to target educational efforts at faculty at all levels and disciplines and provides additional motivation for librarians to advocate for their role in education about predatory OA journals.

One of the major takeaways from the survey was the need for our 2 libraries to publicize and advocate for our educational role in this area and become recognized as a reputable resource to answer questions related to predatory OA journals. Unsurprisingly, most faculty reported colleagues (76.4%) and Google or another search engine (54.5%) as their top 2 sources when investigating journals in which to publish. Only 38.8% reported asking a librarian, and only 19.4% had consulted the library's website.

However, it was clear that faculty were seeking help and more information about predatory OA journals, with most reporting wanting a checklist to assess journal quality (70.9%), followed by information on the library website (65.2%). Many also wanted the option of individual consultations and educational workshops for themselves and their students. Based on these results, we plan to create web pages dedicated solely to predatory OA journals on both the university and medical library websites, develop a series of trainings and workshops targeting all departments on campus, and more widely disseminate our locally developed journal authenticity checklist that is currently available on the OU Libraries' website. In addition, linking to other freely available journal quality checklists, such as Think. Check. Submit and a recently published checklist by Blas et al. [ 27], would be beneficial for enhancing faculty skills in assessing journals [ 5].

In designing the survey, we made a conscious decision to not include predatory journal or publisher lists, because Beall's List is no longer active and Cabell's is not in the libraries' budget. Furthermore, our libraries' educational efforts have focused on developing critical thinking skills in appraising journal quality and legitimacy, which aligns with the Association for College & Research Libraries' Framework for Information Literacy for Higher Education [ 28]. Other institutions could elect to add one or more of these lists to the survey, depending on their current subscriptions. As an initial step, we created an executive summary describing the project, major results, and future plans that was disseminated with permission from the provost's office, medical school, and library administration to various stakeholders on campus, including library faculty liaisons, all medical school department chairs, the university research office, graduate office, and university research committee.

Limitations

This study does have some limitations. First, the overall response rate of 5.9% was low, which was not unexpected. In the future, if university policy allows, incentives could be considered to increase the response rate. As faculty self-selected to participate in the survey, some selection bias might also be present, favoring those with a preexisting interest in or knowledge of the topic. However, most schools, colleges, and clinical departments were represented, and we had sufficient responses to conduct statistical analysis. Although the data might be representative and generalizable on a greater scale, a larger sample size and response rate could reveal additional differences. Second, we decided that the scope of this project would be on faculty knowledge and attitudes about predatory OA journals, so students and medical residents were excluded. Future studies could repeat the survey with a student or resident population to provide additional insights.

Publishing, knowingly or unknowingly, in a predatory OA journal can have serious implications for authors: it can affect their reputations as scholars, impact their ability to submit to other journals, and diminish the quality of their work. Some institutions assess the quality of journals that faculty choose to publish in and may use this as one criterion for hiring, promotion, and retention. Understanding faculty's current knowledge levels is essential in developing targeted educational campaigns and professional development. By directly assessing faculty knowledge of such journals and their ability to identify them, in addition to their attitudes, this study provides a clearer understanding of the topic in this particular population. Overall, predictions could not be made about faculty knowledge or attitudes based on rank, discipline, publication history, or previous training about predatory OA journals. However, most faculty were interested in librarians' help in selecting legitimate OA journals to publish in, providing an impetus for OU Libraries to promote their role in this process and tailor their educational initiatives to these needs.

Stephanie M. Swanberg, MSI, AHIP, ude.dnalkao@grebnaws, https://orcid.org/0000-0003-0553-8339, Associate Professor and Information Literacy & eLearning Librarian, Medical Library, Oakland University William Beaumont School of Medicine, Rochester, MI

Joanna Thielen, MSI, MS*, ude.hcimu@eleihtej, http://orcid.org/0000-0002-2983-5402, Biomedical Engineering Librarian, Art, Architecture & Engineering Library, University of Michigan, Ann Arbor, MI

Nancy Bulgarelli, MSLS, ude.dnalkao@leraglub, Associate Professor and Director, Medical Library, Oakland University William Beaumont School of Medicine, Rochester, MI

ACKNOWLEDGMENTS

The authors thank Patrick Karabon, MS, for his assistance with statistical analysis of the data and the faculty who pilot tested our survey.

REFERENCES

17. Cusker J, Rauh AE. A survey of physical sciences, engineering and mathematics faculty regarding author fees in open access journals. Issues Sci Tech Libr. 2014 Fall;78:1. doi: 10.5062/F4VH5KTQ. [[ CrossRef] Google Scholar]

22. Woszczynski AB, Whitman ME. Perspectives on open access opportunities for IS research publication: potential benefits for researchers, educators, and students. J Inf Syst Educ. 2016;27(4):259-76. [ Google Scholar]

27. Blas N, Rele S, Kennedy MR. The development of the journal evaluation tool to evaluate the credibility of publication venues. J Librariansh Schol Commun. 2019;7(1) doi: 10.7710/2162-3309.2250. [[ CrossRef] Google Scholar]

# data[].attributes.attachment_link.title
Faculty knowledge and attitudes regarding predatory open access journals: a needs assessment study

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The purpose of predatory open access (OA) journals is primarily to make a profit rather than to disseminate quality, peer-reviewed research. Publishing in these journals could negatively impact faculty reputation, promotion, and tenure, yet many still choose to do so. Therefore, the authors investigated faculty knowledge and attitudes regarding predatory OA journals.