gms | German Medical Science

Web-based media are essential for today’s information and communication channels. The rapid development of the World Wide Web has produced “Web 2.0”. The term “Web 2.0” was originated by Tim O’Reilly (2005) (http://www.oreillynet.com/oreilly/tim/). He describes Web 2.0 as “architecture and participation”. In contrast to Web 1.0, which is accessible via static websites comprising content that is only altered when the responsible person allows changes, the technology and tools of Web 2.0 allows for active participation. The new technology wants engagement from many users. This includes users with little to no technical understanding, who are able to easily generate their own content and thereby add their own information and opinions. Users support each other without input from the industry [1]. The resulting groups are known as networks or communities. Social Media bundles the platforms and networks that make social interaction in the Internet possible. Users exchange experiences and opinions via social media and evaluate each other. Several of the main Web 2.0 tools are presented in the following [2]:

• Blogs: These are electronic diaries that are maintained as websites. Entries, comments and notes are ordered chronologically. Topics are specified by the author. Additional users, also known as bloggers, are able to add input on these topics. A blog ends when the author decides to end it; otherwise it runs on endlessly. Examples are Blogger (http://www.blogger.com) or Typepad (http://www.typepad.com).
• Twitter: This is an application for microblogging. Registered users can enter their own text messages with a maximum of 140 characters. These messages will be displayed to all users who follow this user. Interactions are possible, too: other users can answer a post, and discussions can be created. It is often used to inform a specific group of people about current events (http://www.twitter.com).
• Instant messaging: This makes real-time communication between two or more participants possible. It mostly occurs in written form consisting of short messages (chats), but can also be supported with audiovisual features, for example Skype (http://www.skype.com).
• Podcasting: These are audiovisual files, including videos, that are created by individual authors and are then available to all users online.
• Wikis: These are similar to blogs, but other users are allowed to edit the text on the website. In this case, a shared document is created in which many users can participate, the most famous example being Wikipedia (http://www.wikipedia.org).
• Media sharing: For this, visual media are uploaded and stored on a website, for example Flickr (http://www.flickr.com) for photos and YouTube (http://www.youtube.com) for videos. The media can then be shared, evaluated and communicated with others.
• Social networking sites: These sites present the opportunity to create personalised profiles and friend lists. Blogs, photos, music, videos, thoughts and opinions can be communicated here. This information can be designated as “private” and is then available to only a defined group of users referred to as “invited friends”. If this limitation is not set, the contents of the website are open to the public and are therefore visible and shareable by all the users of that particular networking site. The most well-known example of this is Facebook (http://www.facebook.com).

These tools and communication technologies are used by students, instructors and patients in multiple ways to gain information and to communicate [3], [4], [5], [6], [7], [8], [9]. Therefore, these tools should also be assimilated into the education of future doctors. Universities that integrate these technologies into teaching have been able to show that their students are more motivated and discuss issues in a more lively fashion [1], [8], [10]. Communication in small group projects outside of the university is made easier and more effective [10]. What other experiences have been gained regarding this? How do we integrate the new media into medical education in Germany? The current version of the Medical Licensure Act specifies in §1 paragraph 1 [11], “The education should impart fundamental knowledge, abilities, and skills in all specialities that are necessary for comprehensive health care of the public.”...“On the basis of current research, it should impart fundamental knowledge of the influence of family, society and the environment on health, the organisation of public health, and coping with the sequelae of disease...” Thus, the inclusion of Web 2.0 tools and social media takes into account the changes to communication and information channels and conveys the necessary skills.

The following systematic literature review guided by the question: For which forms of teaching and learning are social media and Web 2.0 tools used in current medical education?

A systematic literature review based on the research question was conducted on 1 May 2012, using PubMed. In the search query: 16 terms (MeSH) related to the term “medical”, 43 terms (MeSH) related to the term “education” and 51 terms (MeSH) related to the term “social media” were used. By connecting these terms, 1245 results were obtained. This was reduced to 84 results after applying the limiting factors and the appropriate inclusion and exclusion criteria (see Figure 1 [Fig. 1]). One limiting factor was a publication date range that included the last five years, which, due to the rapid development in this area, was used to further restrict results. In the subsequent examination of the abstracts, articles dealing with health care provision, and educating and informing the patient were excluded. The remaining publications were evaluated in their full-text form. At this point, two additional articles were excluded. One was related to training librarians, and the other was about the Greek post-secondary education system. Therefore, 20 articles were examined in detail.

19 publications were related to the education in England, New Zealand, Australia and the USA [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Only one German publication was identified [21]. 12 of the 20 articles were from the USA [3], [5], [6], [7], [9], [12], [13], [14], [15], [16], [19], [20]. The designs were divided into articles on use and primary literature for the studies conducted, both of which were strongly represented. In the literature from the first 2 years (2007/2008), general user behaviour was described [1], [2], [3], [4], [12], [13], and requirements derived from the use of new media in medical education were proposed. The publications in 2009 begin to put thought into negative effects of using social media in the educational context [5], [14]. These critical discussions continue in the following years (2010/2011) [7], [8], [9], [10], [15], [16], [18], [19], [21], [20]. Studies appear on the use of concrete Web 2.0 tools in special teaching and learning forms, for example in problem-oriented learning [10]. The tools for medical education most often described in the literature are displayed in Figure 2 [Fig. 2]:

The details of the individual tools are described in the following:

The use of social networking [1], [2], [5], [8], [10], [17], [20] enables students to make contact with instructors via well-known channels. It motivates them to start discussions with instructors, ask questions and share their own thoughts. Many students notice that they have more confidence to make this contact via the Internet rather than in person [20]. Social networking enables interaction between students and instructors as well with as with other faculties. In this way, information can be forwarded quickly, and projects can be set up and worked on together in small groups [1]. Podcasts [1], [3], [5], [8], [15], [21] are used to follow up on lectures or to catch up on missed lectures. Using lecture slides to catch up means that only the most important elements of a lecture are available. By using podcasts, the entire context of the lecture can be captured, and the contents can be appropriately integrated [8]. Moreover, a positive effect was shown when students learned practical skills. In this case, the students had the opportunity to review the skills via podcasts after the lecture [21]. Blogs [1], [2], [3], [5], [6], [13] can also be used similarly to wikis, as an on-going but reflective diary in which important experiences are noted [1]. The instructors hand out their material via wikis [1], [3], [5], [6], [10], [18], where the students can immediately access them and have the opportunity to enter into an interactive discussion directly with the instructor. The advantages of using wikis have also been shown during the preparation of POL discussions [10]. The use of wikis and blogs deepens the students’ learning. Moreover, they read more critically and are forced to do more analytical thinking and clear writing [18]. The use of steaming video via YouTube [5], [6], [13], [19] has been present for a longer time due to the integration of e-learning units. The collaborative creation of video streams was evaluated very positively by students [19]. Students evaluated the use of Twitter [6], [16], [19] and Skype [19] for the corresponding lesson as having high qualitatively value.

A presentation of the different results can be seen in Table 1, attachment[Attach. 1].

The literature search shows that Social ;edia and Web 2.0 tools are increasingly included in medical education. This is proven by the increasing number of studies in the literature since 2010. In parallel to the introduction of Social Media and Web 2.0 tools, the implementation of the Medical Licensure Act also took place in Germany. With the establishment of their own curriculum, the introduction of work in small groups, and classes that overlapped faculties, the resources of the universities were exhausted in many places. Due to the implementation of the new teaching and examination forms, added e-learning programs have been integrated into teaching. Consequently, it would make sense to assimilate the relevant social media and Web 2.0 tools into education in German faculties as a next step. However, this should not happen without reflection on the results from England and the USA [22], [23], [24]; these provide insights into which tools make sense for use in teaching and what measures should be introduced in order to mitigate the described deficits [25], [26], [27].

In the following, suggestions for integrating the tools most often described in the literature into medical education are presented.

Podcasts: These were most often mentioned in the literature in conjunction with following up on lectures. This learning phase carries the expectation of intrinsic, high motivation on the part of the students, which may not be directly relevant to the examination. The use of podcasts significantly increases the motivation to follow up on lectures [1], [3], [15], [21]. In current discussions surrounding family-friendly studies, new education concepts are required. These should “...enable independence and flexibility time-wise, for example e-learning and recording lectures, and compensation possibilities for examination achievements and lectures where one is required to be present...” [28]. Podcasts are made for this sort of use.

Blogs and wikis: These enable quick exchanges between instructors and students [6]. The students interact beyond class time. They see themselves as “active” learners and not as “passive” consumers of instructional material. The students read more critically and are bound to more analytical thinking and clear writing [18]. Additionally, students can use blogs as an electronic log book, for example during a practical year. Via wikis, collaborative topic areas can be worked on.

YouTube: Through the use of video streams in teaching, for example during lectures, content can be made clearer. The timely use of short video streams increases the attention of students during the lecture and supports the introduction of skills or the description of behavioural patterns. A new challenge still open is the creation of videos streams by the students themselves [6], [19]. In addition to the class’ core content, social skills are also practised in this way, for example working and communicating in a team.

Social networking: Because the communicative aspect is the most frequently presented result in the literature, it should be more comprehensively discussed. The inclusion of communication and information usage via social networking is a good preparation for the work world, which is becoming more and more global and networked; it is exactly these tools that future physicians must use and master.

The current generation of students has grown up with high acquisition of technical skills [7]. The accompanying altered communication, which can be quicker, more spontaneous and used everywhere, also has an effect on the behaviour and expectations of the students regarding the instruction and the instructors. The permanent availability and ‘reachability’, the expectation of a direct answer, feedback or similar reaction also affects the relationship between the lecturers and students. This access simplifies communication, which is no longer tied to rigid office hours, but is also carries the dangers inherent in permanent availability.

Communication between students, for example over Facebook, helps in the organisation and preparation of project meetings at a time when the increasing use of project-oriented learned demands more networking of students with each other. This is on top of the dismal availability of study areas, which frequently offers students few opportunities for appropriate work within the faculty. Social networking can provide an avenue for information exchange with other group members, and contact with tutors can be maintained [8].

The students must be prepared during their education for the altered communication between doctor and patient. Patients also communicate via the Internet and are very networked. They inform themselves about their own symptoms, diagnoses, and therapies, or do research before an up-coming inpatient stay. Frequently, information on doctors is requested, especially before a patient’s first contact. Students must be sensitive to this new behaviour. Relevant skills regarding communicating with “Internet-informed” patients as well as communicating via the Internet should be conveyed to them. In addition, students must also be shown how to protect their own privacy so that they can prevent unintentional access to their personal information by patients.

It can be shown that as a general consequence to teaching, new training tasks resulting from the revealed weakness and open questions are becoming apparent with the uptake of these new tools in teaching. Related to this is the often recited demand for rules and guidelines for the handling of social media and Web 2.0. Additionally, it must also be clarified who tests the quality of the information made available, and who references the steady stream of posts added.

Within the learning environment, the students, who have a limitless reach to knowledge, must filter the content. It must be regulated who takes responsibility for the generated teaching and study material, when everyone has the possibility to make study content available. What happens if students perform poorly in an examination and then attribute this to false information in the web-based study materials? Frequently, a university Intranet is required, which provides the students with a protected framework and limits the access [13]. This offer is rejected by many students, who feel controlled by it [10]. Connected to this, the question as to who will look after this Intranet in terms of the teaching material remains unanswered.

In general it can be stated that the integration of Web 2.0 and social media represents the current form of self-determined learning. It stimulates reflection and obligates students to be active in constructing knowledge [3]. Moreover, students learn communication and teamwork skills, which are necessary for both social and professional contexts.

The introduction of technologies into teaching presents a new challenge to university faculties. This form of teaching requires accompanying lessons that point out the consequences of using social media and Web 2.0 tools and provide knowledge and skills in this regard. Only in this way can students be adequately prepared. Additionally, there is a need for ongoing research that evaluates learning and teaching behaviours and evaluates how successful learning is.

The authors declare that they have no competing interests.