{"id":37047,"date":"2013-06-13T08:00:48","date_gmt":"2013-06-13T12:00:48","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=37047"},"modified":"2013-06-13T16:46:53","modified_gmt":"2013-06-13T20:46:53","slug":"a-wiki-world-for-physicians","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/06\/13\/a-wiki-world-for-physicians\/","title":{"rendered":"A Wiki World for Physicians"},"content":{"rendered":"

CardioExchange\u2019s John Ryan<\/b> interviews Harvard Medical School professor C. Michael Gibson<\/b>, founder and editor-in-chief of <\/i>WikiDoc.org<\/i><\/a>, a \u201cliving textbook of medicine\u201d online.<\/i><\/p>\n

Ryan: <\/i><\/b>Why did you create WikiDoc?<\/b><\/b><\/p>\n

Gibson:<\/i><\/b> Innovation increases as free and open access to information grows.\u00a0Our mission statement is that \u201cHealthcare is enriched when medical information flows freely.\u201d\u00a0Traditional textbooks, typically in paper format, are often outdated before they are printed.\u00a0At best they permit one-way flow of information, with no opportunity for bidirectional exchanges, comments, or reader participation.<\/p>\n

Access to traditional print educational content is limited to those who can afford to buy it.\u00a0The copyrighted material is owned by the publisher and cannot be broadly disseminated or repurposed. Many people now view access to medical information as a right.\u00a0Although free online content is available, nearly all accessible sites (including society websites) are supported by pharmaceutical and device companies (an exception is the National Library of Medicine).<\/p>\n

In late 2005, I created WikiDoc as a free, open-access website that allows an international community of healthcare professionals to \u201cco-create\u201d webpages without requiring that they be familiar with HTML or computer programming. Rather than top-down creation and one-way delivery of content, it is a bottom-up, grassroots, participatory community with bidirectional flow of information. Instead of a vertical organizational structure at a single academic institution, our horizontal structure of co-creation (which we also call \u201ccollective genius,\u201d \u201cpeering,\u201d or \u201conline collectivism\u201d) has engaged 7082 authors worldwide who have contributed to 200,458 chapters (with 26,625 freely downloadable images) that have been edited 768,180 times.<\/p>\n

Our reader-supported site has no funding from pharmaceutical or device companies \u2014 and no advertisements. Instead of being copyrighted, the content is legally protected as \u201ccopyleft,\u201d which safeguards against control by any individual and ensures free access forever.\u00a0Visitors can copy, modify, and redistribute the information for their own purposes, as long as the new version grants the same freedoms to others and acknowledges the source or authors of the original content (e.g., parts of this sentence came from WikiDoc).<\/p>\n

Our content is increasingly multilingual and organized into \u201cmicrochapters\u201d that display well on mobile devices, which many healthcare providers in the developing world can access despite being unable to afford print textbooks. The physician and patient content for a given topic are linked together.\u00a0An overview page is written at the level of a medical student, and the microchapters are written at the level of a subspecialist.\u00a0There is bidirectional flow of content with Wikipedia, although WikiDoc is targeted at physicians, whereas Wikipedia aims to reach a general readership.\u00a0Several years ago we launched a sister site, WikiPatient<\/a>, whose 1200 chapters of content are written at a fifth- to eighth-grade reading level.<\/p>\n

About 20 full-time volunteer physicians in Boston curate the content.\u00a0We meet every morning at 8:30 to set our goals, and again at 4:30 that afternoon to review our progress and address questions.\u00a0These amazingly dedicated volunteers (our deputy editors-in-chief) labor along with me at night and on weekends. The content is served on Amazon Right Scale, which can recruit an expandable number of servers to scale up as traffic increases. Last month, in 46 hours, the site was visited 4.7 million times (about 2.5 million times daily or 896 million times a year).<\/p>\n

Ryan:<\/i><\/b> How do you ensure accuracy on WikiDoc?<\/b><\/p>\n

Gibson:<\/i><\/b> Traditional textbooks represent the views of highly selected authors. Content on a collaboratively authored site tends to be less biased, as it is based on consensus rather than any individual\u2019s point of view.\u00a0A discussion page allows a community of writers to openly vet WikiDoc content so that a consensus can be reached.\u00a0Consensus does have its limitations, lest we forget that the \u201cwisdom of the crowd\u201d once perpetuated the view that the earth was flat and the sun revolved around it.\u00a0Indeed, it was not until \u201ccontent experts\u201d like Copernicus, Galileo, and their predecessors were given a voice that the scientific paradigm shifted.\u00a0Thus, experts have a critical role in moderating the wisdom of the crowd, and our goal is to crowdsource experts. Collaborative authoring on Wikipedia has been shown to be as accurate as Encyclopedia Britannica<\/i> content or information in a Nature<\/i> article.<\/p>\n

Authors must register via a system that requires a \u201ccaptcha\u201d to verify they are human, and a team member also reviews their credentials. Prior versions of webpages are stored, and a page can be instantly reverted to any of its previous states if vandalism occurs.\u00a0WikiDoc authors can choose to be alerted by email when changes are made to a topic that interests them. Only approved users who request permission are allowed to edit drug pages.<\/p>\n

Ryan:<\/i><\/b> How have patients responded to the site?<\/b><\/p>\n

Gibson:<\/i><\/b> Some 57% of patents use the internet to obtain medical information.\u00a0In the past, doctors were trusted providers who delivered paternalistic, proscriptive information to largely uninformed patients.\u00a0Guidelines and checklists have represented a great advance, but they tend to deliver one-size-fits-all healthcare. Doctors must now earn the trust of increasingly knowledgeable patients through open dialogue and conversation.\u00a0Patients now want more-personalized medicine, tailored to both their genome and their envirome (their environmental risk factors). WikiDoc content allows patients to become better-educated consumers of healthcare.\u00a0For many years, I posted my phone number online, and calls from patients who desired education were some of the highlights of my career.<\/p>\n

Ryan:<\/i><\/b> What is the future of WikiDoc?<\/b><\/p>\n

Gibson:<\/i><\/b> My son is spearheading the creation of board review questions at Harvard Medical School.\u00a0We are working toward a process of \u201cmicro-CME\u201d or \u201cCME on the fly\u201d as physicians access or create content.\u00a0We hope to provide free content for integration into electronic medical records as part of the health information technology revolution. We have a variety of artificial intelligence initiatives underway and welcome all who would like to get involved. Just email me at charlesmichaelgibson@gmail.com<\/a>.<\/p>\n

Have you used WikiDoc? What are your thoughts about this online venture?<\/b><\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

CardioExchange\u2019s John Ryan interviews Harvard Medical School professor C. Michael Gibson, founder and editor-in-chief of WikiDoc.org, a \u201cliving textbook of medicine\u201d online. Ryan: Why did you create WikiDoc? Gibson: Innovation increases as free and open access to information grows.\u00a0Our mission statement is that \u201cHealthcare is enriched when medical information flows freely.\u201d\u00a0Traditional textbooks, typically in paper […]<\/p>\n","protected":false},"author":748,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[1842,1771,1841],"class_list":["post-37047","post","type-post","status-publish","format-standard","hentry","category-general","tag-medical-information","tag-online-behavior","tag-textbooks"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37047","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/748"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=37047"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37047\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=37047"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=37047"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=37047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}