gms | German Medical Science

GMS Journal for Medical Education

Gesellschaft für Medizinische Ausbildung (GMA)

ISSN 2366-5017

Blogging Medical Students: A Qualitative Analysis

research article medicine

GMS Z Med Ausbild 2013;30(1):Doc9

doi: 10.3205/zma000852, urn:nbn:de:0183-zma0008525

This is the original version of the article.
The translated version can be found at: http://www.egms.de/de/journals/zma/2013-30/zma000852.shtml

Received: May 30, 2012
Revised: September 7, 2012
Accepted: October 2, 2012
Published: February 21, 2013

© 2013 Pinilla et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Abstract

Purpose: Blogging is an increasingly popular method of sharing and reflecting on experiences of medical students in the World Wide Web with a potentially global learning community. The authors are not aware of studies that specifically examined blogs by medical students and thus for the first time investigated the type of experiences and impressions that emerged from these blogs with relevance for medical students and medical educators.

Method: This was a qualitative study. Initially 75 blogs were identified. 33 blogs with a total of 1228 English and 337 German blog entries met the inclusion criteria and were analyzed. We started with line-by-line coding and switched to focused coding using constant comparative analysis to create a categorical framework for blogs.

Results: Medical students use blogs to write and reflect about a large variety of issues related to medical school. Major emerging themes included the preparation for written and oral high-stakes exams, experiences during clinical rotations, dealing with distressing situations during medical school, and social life of students beyond medical school.

Conclusions: Our findings suggest that blogs are a potentially useful tool for medical students to reflect on their experiences during medical school as well as for medical educators to better understand how students perceive their time in medical school. The educational benefit of blogging might even be increased if trained medical educators would help to facilitate meaningful and targeted discussions emerging from blog entries and comment on students’ learning challenges with the chance to reach a large community of learners.

Keywords: Blogging, medical student, qualitative, undergraduate, medical education


First author

Contributed equally: Severin Pinilla and Ludwig T. Weckbach


Introduction

Use of Web 2.0 has become an increasingly important part of education. Collaborative creation of content and interaction for the purpose of sharing information are key features of Web 2.0 applications [1]. The fact that only little technological knowledge is needed and applications are often free of charge makes Web 2.0 applications accessible to a wide audience [2]. The term Web 2.0 includes several different online applications that are believed to be supportive of learning, for instance wikis, blogs or podcasts [3]. However, of all Web 2.0 applications blogs are by far the most widely and intensively discussed online tools in the literature [1].

Blogs are online diaries or journals consisting of “frequently modified web pages in which dated entries are listed in reverse chronological sequence” [4] which are maintained by solitary or multiple authors and which can be used for public or private purposes. The entries contain graphics, sounds and videos as well as descriptions of events or highly subjective, reflecting thoughts, opinions and preferences [5]. Blogs used in the educational setting provide a platform for critical reflection and peer interaction in learning processes [2] and enable students to strengthen their analytical thinking critically [5].

Despite extensive research on blogs in education in general, literature on blogs in the context of medical education is rare. Up to date, blogs are used by a significant number of medical students around the world. Reflections, experiences and descriptions posted in blogs of medical students could potentially be of great value for improvements in medical education. In this qualitative study we analyzed the topics of medical student blogs and shed light on the potential use of blogs for medical students and educators based on emerging themes.


Methods

In this study we used a grounded theory [6] approach to analyze blogs in the World Wide Web in May 2012, written by individuals who identified themselves as medical students. Initially, the online search engine ‘Google’ (http://www.google.com) was used to find relevant blogs. German and English blogs were included in this analysis. We used the search queries ‘medical student blog’, ‘medicine student blog’, and ‘medical studies blog‘ to identify English blogs, and ‘medizin student blog’, ‘medizinstudent blog’, ‘medizin blog’ to identify German blogs. More blogs were added to our list by following the referenced medical student blogs on the initially identified web pages. The inclusion criteria for active blogs were based on previously published work [7]. We limited our analysis to blogs with a minimal activity of four blog entries on average during the last year and to entries posted on or after 06/01/2011 to ensure actuality of posts. Micro-blogs (limited number of characters per entry) or discussion forums were not included. Consequently blogs were characterized by gender of blogger, language and blog activity, and assigned to the level of medical school according to the first entry posted (see Table 1 [Tab. 1]) if according information was provided.

Each included blog entry was then read, translated if necessary and coded. Emerging themes were categorized (see Table 2 [Tab. 2]). Iterative thematic analysis informed the ongoing generation of categories, themes and subthemes [8]. The developing framework was constantly challenged and the potential use of blogs for medical students and educators were discussed until all members agreed on final interpretation and no new themes emerged.

Microsoft Excel and Word were used to organize the data. We analyzed a total of 33 blogs that met our inclusion criteria and analysis was stopped after thematic saturation had been reached.


Results

Our final coding framework is shown in Table 2 [Tab. 2] and is organized around two main categories: Medical school and social life. Additional themes and subthemes emerged in each category, including preparation for standardized tests, clinical rotations, emotional distress related to medical school, perception of specific curricular elements, perception of interaction with peer students, career planning, research activities, motivation for studying medicine, and sharing factual knowledge. In the main category social life, emerging themes were role of social support, social events, voluntary work, religion and sports.

Medical school

Our data suggest that students consistently use blogs to reflect on how to prepare for standardized high-stakes tests, various aspects related to clinical rotations, and the emotional distress that students are facing during medical school.

One of the more frequently discussed topics is related to oral and written exams, and specifically to high-stakes exams like the USMLE or German medical state examination. Students describe how they prepare for exams, where they found helpful information, what kind of studying techniques they used like making lists “of everything from autoimmune bodies to cranial nerves”, and which of those worked best for them. Often they comment on how they handle “the information fire hydrant” before exams and how they plan and coordinate their studying time using specific web tools like Skype or “Google Plus Hangout [...] and [...] go over the material [...] following a strict study schedule” with peer students. Blogging students differed in how much they commented on their personal learning strategies or experiences, however tended to emphasize the importance of collaborating with peers and ignoring “the voice that tells you to be competitive”.

Many students wrote on their experiences in clinical settings and the transition from studying medicine to actually putting that “into practice and influence someone’s life”. Across blogs from different medical educational systems the first clinical experiences seemed to be important for students in terms of showing them why “it is worth studying” and their learning motivation:

“All you get is scores as feedback about how you’re doing [in preclinical years of medical school], and I don’t rock tests. Not now. I spent a lot of time feeling really sub-par. Now that it’s third year, turns out I’m not so bad with actual patients. I also find it so much easier to learn now that I see it benefiting real people.” (English blog, 3rd year medical student)

Student blogs also included perceptions of interacting with or observing more senior medical students and health care professionals. Both positive experiences regarding role models in the clinical context as well as negative observations were frequently discussed in many blogs. As an example, one blogger mentioned the impressions she got during a clinical rotation regarding working attitude:

“I have been buffered and shocked by the rampant negativity that oozes through the hospital walls. People seem to even take pride in their ability to bemoan their situation... By far the most common conversation in a hospital involves complaining.” (English blog, 4th year medical student)

Students often reflected on emotionally distressing experiences in medical school either related to realizing “that patients die” during clinical rotations or the “fear of not being good enough” academically and failing to meet the standards of a qualified physician.

Social life

The second broad category in the analyzed blogs encompassed the social and personal life above and beyond medical school of medical students. Emerging themes in this category included the role of social support systems during medical school, social events, physical activities, and personal religious views.

Students consistently reflected on the importance of social relationships with their spouses, friends, family members or peer students. For one student the essential ways of failing out of medical school were “to A) never study, or B) not have a support system”. In the majority of blogs students either commented on how they enjoyed “spending a whole day with [...] family” or how they were “frustrated” and questioned their choice of career when their social lives were compromised over a given time period because of again spending another “whole Saturday and Sunday afternoon” working in a lab or “studying for exams” and not being able to participate in family meetings or friends’ birthdays. Another student wrote that specifically during preparation for high-stake exams, she preferred to socialize with peer students, who were preparing for the same exam:

“[...] I don’t seem to be able to hang out with people, who are not in my situation right now. This might be wrong, because distraction actually is good, but somehow I can’t stand anymore to explain how I feel right now. It is just easier, when the other person understands this without words, because she is feeling the same way.” (German blog, 6th year medical student)

Some students described their experiences during various social events, voluntary work, physical exercise, and the perceived role of god for their medical career to balance their learning effort and time spent in medical school.


Discussion

Our results show that blogs of medical students represent a rich source for qualitative information about various experiences related to medical school across medical educational systems, as well as social life of students beyond medical school. In the following paragraphs we focus on discussing the potential use and limitations of blogs for medical undergraduate training based on the most frequently discussed themes in our data.

Potential use for medical students and medical educators

Medical students shared views, experiences and insights regarding preparation for high-stakes exams. This information could be of great value for other medical students preparing for those exams in terms of providing them with a wide range of different learning strategies for their respective learning plans. Medical educators on the other hand could use this information to identify learning challenges emerging during the preparation for exams and subsequently offer targeted help to overcome those.

Experiences of clinical rotations were also widely described in blogs of medical students. Especially interactions with other health care professionals and patients were mentioned in a majority of blog entries, providing information on difficulties but also successful learning experiences including emotional aspects during clinical rotations. Hence, knowing about challenges that others have experienced could help peer medical students with coping more effectively when encountering problems during clinical rotations. Furthermore medical educators could use clerkship-specific blogs to identify barriers to an effective learning experience during clinical rotations.

Several blog entries revealed emotional distress during medical school. Blogs seem to be valuable for gathering information about negative emotions and fear regarding to medical school taking in consideration that such issues tend to be concealed during interpersonal conversations. Fear of academic failure has been found to be a serious concern in blogs of medical students and could potentially impede successful learning or affect professional progress [9]. Knowing about potential sources of fear of failure and providing students with a defined space, like blogs, to discuss those might be an effective way to support students.

Sharing information is a key feature of blogs [1] but still needs further qualitative and quantitative evaluation in the field of medical education regarding effectiveness and acceptance by medical students and medical educators. Blogs might be even more effective and useful when being embedded in a portfolio of social media to support students’ learning by sharing of course-related documents or participating in targeted and subject-specific discussions. Each of these social media components would also need to be evaluated individually in the respective context.

Limitations and opportunities of blogs

One limitation of using these blogs as source of information is the relatively unstructured or seemingly random way that individual bloggers write about their experiences. Blogs also strongly differ regarding the depthness of reflections on the above-mentioned issues. This might make it difficult and time consuming for readers to find relevant information for their personal interests. Previously published work has shown that use of technology does not support learning when used in an unplanned manner [2].

A second limitation for evaluating the usefulness of blogs is lack of information on how many individuals actually read a given blog. Our impression was that rather few blog entries received comments from other readers. A central learning opportunity however lies within the possibility to discuss reflections with a theoretically global learning community through interactive blogging rather than solitary blogging [5].

It might be possible to facilitate this process by providing specifically designated platforms for medical students to share their experiences, integrating blogs in curricular designs and encouraging medical educators to comment on students’ blogs [10]. This could potentially facilitate more in-depth reflection and increase the benefit for other blog readers. For instance, such platforms were started at Loma Linda University School of Medicine in 2011 (http://ilusm.wordpress.com/) and at University of Ottawa [11]. Such longitudinal qualitative data that consistently reflect a student’s voice also provide an opportunity to investigate how different experiences affect the epistemological system of a medical student.

Moreover, it was not always a direct way that led to medical student blogs, but a rather laborious task to find relevant blogs in the first place. Providing links on an easily identifiable platform to relevant blogs might also increase interaction of readers and bloggers.

Finally, we gained the impression that specifically elements of what is often referred to as the ‘hidden curriculum’ become visible in blogs and thus could be used as an additional rich source for evaluating teaching elements and clinical experiences. Evaluation offices however would need to dedicate administrative and scientific resources to offer and use this source and inform subsequent quantitative investigations for curricular adjustments. Although English and German blogs of medical students did not differ regarding overall emerging themes we got the impression that themes related to work-life balance were more present in English blogs than in German blogs, whereas experiences related to research activities were more present in German blogs. This is likely due to differences in the respective medical education systems.


Conclusion

Medical students use blogs to reflect on a large variety of experiences and learning aspects during medical school as well as personal social experiences above and beyond medical school. Therefore blogs seem to be a feasible way to help students reflect on their experiences in various stages of their undergraduate medical training and share them with a geographically independent learning community. Although we did not see frequent comments and discussions resulting from blog entries, we suggest that mentors or clinical teachers could use blogs for formative feedback and support peer learning through guiding and prompting their students regarding metacognitive processes around their learning experiences.

Furthermore medical educators could benefit from these blogs by using them to identify emerging perceptions of both explicit and implicit curricular elements and consequently inform educational innovations at their respective institutions.

Considering the similarity of themes and categories emerging from German and English blogs, an even broader range of blog applications across international medical education systems becomes imaginable. Specifically exchange programs for medical students could benefit from structured and purposefully implemented blogging components for continuous improvement and sharing of experiences between students.


Acknowledgement

We would like to thank Dr. Vanessa Fong and Maya Weilundemo at the Harvard Graduate School of Education for their outstanding introduction to qualitative research methods.


Competing interests

The authors declare that they have no competing interests.


References

1.
Baxter GJ, Connolly, TM, Stansfield MH, Gould C, Tsvetkova N, Kusheva R, Stoimenova B, Penkova R, Legurska M, Dimitrova N. Understanding the Pedagogy Web 2.0 Supports: The Presentation of a Web 2.0 Pedagogical Model. Proceedings of International Conference on European Transnational Education (ICEUTE); 20-21 October 2011; Salamanca, Spain.
2.
Boulos MN, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Med Educ. 2006;6:41. DOI: 10.1186/1472-6920-6-41 External link
3.
Hanson C, Thackeray R, Barnes M, Neiger B, McIntyre E. Integrating Web 2.0 in Health Education Preparation and Practice. Am J Health Educ. 2008;39(3):157-166.
4.
Herring SC, Scheidt LA, Bonus S, Wright E. Weblogs as a bridging genre. Inform Technol People. 2005;18(2):142-171. DOI: 10.1108/09593840510601513 External link
5.
Yang C, Chang YS. Assessing the Effects of Interactive Blogging on Student Attitudes towards Peer Interaction, Learning Motivation, and Academic Achievements. J Com Assist Learn. 2012;28(2):126-135. DOI: 10.1111/j.1365-2729.2011.00423.x External link
6.
Lingard L, Albert M, Levinson W. Grounded theory, mixed methods, and action research. BMJ. 2008;337:a567. DOI: 10.1136/bmj.39602.690162.47 External link
7.
Cain J, Dillon G. Analysis of pharmacy-centric blogs: Types, discourse themes, and issues. J Am Pharm Assoc. 2010;50(6):714-719. DOI: 10.1331/JAPhA.2010.10025 External link
8.
Denzin NK, Lincoln Y. The Landscape of Qualitative Research. Third Edition. Thousand Oaks (CA): SAGE Publications; 2007.
9.
Olmesdahl PJ. The establishment of student needs: an important internal factor affecting course outcome. Med Teach. 1999;21(2):174-179. DOI: 10.1080/01421599979824 External link
10.
Hanson K. Blog enabled peer-to-peer learning. J Dent Hyg. 2011;85(1):6-12.
11.
Hall P, Byszewski A, Sutherland S, Stodel EJ. Developing a Sustainable Electronic Portfolio (ePortfolio) Program That Fosters Reflective Practice and Incorporates CanMEDS Competencies Into the Undergraduate Medical Curriculum. Acad Med. 2012;87(6):744-751. DOI: 10.1097/ACM.0b013e318253dacd External link
12.
Frank J. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicains and Surgeons of Canada; 2005.