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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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slide1

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
A scenario…

Learning issue: Describe the Schilling Test

another scenario
Another scenario…

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

slide7
The Internet has revolutionized information exchange
  • Depth and breadth of available information is staggering
  • The WWW is increasing in use, influence, and cultural importance
the internet in medicine statistics
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

the internet as a medical information source
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

the internet as a medical information source caveats
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
the internet as a medical information source caveats13
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  • No systematic means to remove outdated content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

how health information on the web will impact student doctors
How health information on the web will impact student doctors
  • Primary medical resource
  • Evaluation of patients’ information
the internet as a primary m medical resource
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
the internet as a primary medical resource
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
patients and the internet
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

patients and the internet18
Patients and the Internet

Health Affairs, Nov/Dec 2000

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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
preparing student doctors for the internet age
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
evaluating medical websites
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
resources
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)
resources25
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
resources28
Resources
  • WRAPIN (www.wrapin.org)
    • Project of HON
    • Searches only “approved” websites
    • Searchable by keywords
resources30
Resources

Arch Path Lab Med 2005;129: 742-6

summary
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