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January 13, 2007. Can we trust Dr. Google?. The importance of teaching student doctors how to evaluate medical websites. Geoffrey Talmon, M.D. University of Nebraska Medical Center. A scenario…. Learning issue: Describe the Schilling Test. The way it was…. The way it is now….

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Can we trust Dr. Google?


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    1. January 13, 2007 Can we trust Dr. Google? The importance of teaching student doctors how to evaluate medical websites Geoffrey Talmon, M.D. University of Nebraska Medical Center

    2. A scenario… Learning issue: Describe the Schilling Test

    3. The way it was…

    4. The way it is now…

    5. The way it is now…

    6. Another scenario… “Doctor, I found this website that says that weasel saliva will cure my prostate cancer. What do you think?

    7. The Internet has revolutionized information exchange • Depth and breadth of available information is staggering • The WWW is increasing in use, influence, and cultural importance

    8. The Internet in medicine: statistics • WWW debuted in 1993 • In 2005, 1 billion people worldwide • In 2004, 202,000,000 Americans used the Internet (72%) • 112% increase from 2000 • 66% use the Web daily Pew Survey, 2007

    9. The Internet as a medical information source • Access to support/discussion groups, primary literature, society websites, etc. • Growth in health resources • In 2000: 100,000 medical websites BMJ 2000; 321:136 • 2007 “medical websites” Google search: > 2,000,000,000 results • Online health ad spending: $662 M in 2010 • 79% of Americans use the WWW to find health information, the majority utilizing search engines (Google=55%) Wall Street Journal 3/21/2006

    10. The Internet as a medical information source

    11. The Internet as a medical information source

    12. The Internet as a medical information source: caveats • Audience of websites varies • Patients/relatives to specialists • Complexity of information and language varies • Sponsorship (agenda) varies and disclosure not universal • Professional societies • Drug companies • Patient groups • Special interest groups

    13. The Internet as a medical information source: caveats • No systematic means to remove outdated content • Web search engines not discriminatory • No systematic peer review of content (the “wikipedia syndrome”) • 2000: ~50% of content was reviewed by experts • 4-89% of information was “inaccurate” or “misleading” • Worst in nutrition, best in cancer • Worst in “private sector”, best in societies’ JAMA 2002; 287:2691-2700

    14. How health information on the web will impact student doctors • Primary medical resource • Evaluation of patients’ information

    15. The Internet as a primary m medical resource • Little data to quantify or characterize medical student/resident Internet use • 88% of 18-29 year-olds use the internet regularly • >80% of college students own a computer Pew Survey, 2006 • 94% of clinicians use the Internet with 81% using it at least several times per week • Personal experience: the WWW is ubiquitous • WebMD, eMedicine, UpToDate, pathologyoutlines.com, etc… • Access to online journals/texts • WWW searches

    16. The Internet as a primary medical resource • Advantages: • Fast, convenient, inexpensive, easy to use • Wide variety of information from multiple sources accessible • Disadvantages: • Requires additional evaluation of content (“academic vigilance”) • Limit of research to material available online • Decrease in variety of sources used? • Digital plagarism

    17. Patients and the Internet • 77% of consumers research health topics before and after seeing a physician • 54% discuss their findings • 64% get information from sites intended for professionals • 43% use WWW to seek second opinions • Online health information is trusted by public second only to that from clinicians • Average user looks for health related information 3x/wk HON survey, 2004-5

    18. Patients and the Internet Health Affairs, Nov/Dec 2000

    19. Patients and the Internet

    20. What should educators do? • Understand that the Internet has and will continue to impact health care • Recognize the degree of current Internet use by students/residents • Foster conscientious use through teaching student doctors how to evaluate websites

    21. Preparing student doctors for the Internet Age • Abundant experience with teaching the evaluation of primary/review literature • Web-based materials engender additional issues • Student doctors should be just as conversant in these as study design and selection of statistical methods • Medical research curricula should include these points • Learners and educators should encourage the empiric evaluation of all web-based materials

    22. Evaluating medical websites • Additional criteria for evaluating websites: • 1. Audience • Intended audience should be clearly identified • 2. Accuracy • Cite the source(s) of published information • 3. Sponsorship/financial disclosure • Identify host organizations and funding sources • 4. Transparency • Identities/qualifications of authors, editor(s)/reviewers, and webmaster with accurate contact information • 5. Currency • Date created and/or last updated

    23. Resources • Published guidelines for evaluating sites • Johns Hopkins University • Net.TUTOR • “The Good, the Bad, and the Ugly…” • Published guidelines for evaluating health-related websites • AMA Guidelines for medical and health information sites on the Internet (2000)

    24. Resources

    25. Resources • Health on the Net Foundation (www.hon.ch) • Non-governmental foundation in EU with published code of conduct for web publishing of health information (HONcode) • Accredits health websites • Downloadable toolbar • checks accreditation status of sites • Searches accredited sites

    26. Resources

    27. Resources

    28. Resources • WRAPIN (www.wrapin.org) • Project of HON • Searches only “approved” websites • Searchable by keywords

    29. Resources

    30. Resources Arch Path Lab Med 2005;129: 742-6

    31. Summary • The Internet has and will continue to be an important method of obtaining medical information for patients and clinicians • The Web is currently being heavily used by the public and student doctors • Medical education needs to recognize the importance of the evaluation of health-related websites and the information they contain • Published guidelines and useful web-based tools are currently in existence to aid educators

    32. Questions?