Do Medical Students Assess the Credibility of Online or Downloadable Medical Reference Resources?

Introduction

Medical reference resources have changed significantly within the past decade. Whilst the content itself may continue its natural evolution as new knowledge becomes available the access to that knowledge has been altered through the availability and ubiquity of mobile technology. These devices have changed the learning environment by providing access to a large amount of information not only at fixed geographical locations but at anyplace and at anytime. (Martin & Ertzberger, 2013) This access to large amounts of knowledge on one hand can be seen as an undeniably rich source of information but it also raises concerns about the accuracy of that information and how we decide which resources to trust. Medical Undergraduates have traditionally been instructed on the merits of Evidence Based Medicine and critical appraisal of medical literature. This instruction is however designed to address issues in a considered, systematic approach that is not time critical. It was not designed to assess the credibility of information accessed within the clinical environment for example at the bedside or within a patient consultation. The rapid change in access to resources, perhaps for the first time, has seen educational institutions reacting to changes in the learning environment which have been outwith their control. It is essential therefore that students, as practitioners of the future, develop digital literacy skills that reflect the environment in which they will be practising.

There have been initiatives within healthcare to address these concerns and provide access to reliable and trustworthy resources. Many of these initiatives dating from the initial development of the internet are no longer in existence but some have survived. The DISCERN project produced a questionnaire as a validated and reliable way of assessing the quality of written information on treatment choices for a health problem. This was however created primarily to assess the quality of information related to treatment options rather than medical reference resources and indeed significantly predates the mobile era. The Health on the Net Foundation has sought to provide certification for health resources as having met their code of practice for published resources and have sought to address the issue by building search engines to filter resources that are deemed unreliable. These projects have sought to act as gatekeepers of knowledge and continue to have relevance today but again were never designed to be used within the truly mobile environment.

Healthcare professionals and particularly those in training need to critically evaluate online resources for credibility, reasonableness and accuracy. This has been strongly advised by researchers and leaders in higher education, with students being expected to note and appropriately interpret the multiple characteristics of a source or application (app). (Barzila, 2012; Brem et al, 2001; Johnson & Kaye, 2000; Rouet, 2006, Wallace et al, 2001; Wiley et al, 2009) A number of studies have shown that students of all ages often do not evaluate the trustworthiness of their sources and find it difficult to apply any form of website evaluation criteria. (Brem et al, 2001; Hoffman et al, 2003; Kuiper et al, 2005; Wallace et al, 2001; Wiley et al, 2009) These studies indicate that students have a tendency to look at unreliable source characteristics such as layout, visual cues and surface relevance with one study noting that spontaneous skills such as seeking of scientific evidence and corroboration is rarely employed by these individuals. (Wiley et al, 2009)