SAN FRANCISCO, CALIFORNIA - When the online encyclopedia Wikipedia came on the scene in January 2001, it initially was met with skepticism. How could an article jointly edited by anonymous volunteers be trusted?
But through the years, Wikipedia evolved – becoming one of the most widely used medical references in the world, mainly because it is not edited by just anyone. And last year, the University of California, San Francisco School of Medicine became the first American institution to offer a course on how to edit the nonprofit website’s medical content.
Dr. Amin Azzam, who leads the month-long course on WikiProject Medicine, says he wants his students to go to Wikipedia, identify gaps in information and update entries using their own knowledge and credible medical resources.
"What I hope to do in helping them with this elective is to appreciate that the global system of Wikipedia is a system," said Azzam, a health sciences associate clinical professor. "Since Wikipedia is the fifth, sixth, or seventh most heavily trafficked Web page on the planet consistently, and since that’s where people go for medical information, perhaps our students can see themselves as citizens of the global, health information-seeking community and make a difference that way.”
That's one reason fourth-year medical student Raquel Kronen enrolled. While she has an extensive medical background, her writing skills are not as developed.
"Those are really different things. In order to be a good Wikipedia editor, you actually need both," she said. "You have to be able to know your information, transcribe your information in a way that’s appropriate for the general public, and then, really, write in a clear fashion."
Understanding Wiki style
Students spend most of the course on their own, doing research and writing. But first, they attend two intensive workshops to learn how to write for Wikipedia’s medical project, WikiProject Medicine.
Wiki has a style guide for its articles. It calls for a maximum of 23 words per sentence, a four-sentence lead paragraph, and no contractions. The language must be understandable by someone reading at the sixth-grade level. Because the articles are translated into 100 other languages, the writing must be kept simple.
WikiProject Medicine has 32,000 health-related pages, ranked by importance and quality. Azzam's students generally choose a topic from among the 100 lowest ranked to research and improve. Students in the first two sessions updated articles on cirrhosis, hepatitis, diabetes, white blood cells, and race and health.
One of the highest-ranked pages, on Ebola, has been viewed more than 17 million times. James Heilman cut back his hours as a Canadian emergency-room doctor to devote more time to updating the page. Ten or 12 others work with him. Heilman is one of few editors whose name is known; Wikipedia's volunteer contributing editors generally are kept anonymous.
Kronen, who wants to be an obstetrician-gynecologist, chose post-partum depression as her topic – partly because her best friend, who just had a baby, suffered with it. The medical student started with what she described as a pretty well-developed article.
"A lot of what needed to be done on this article was clarity for the everyday user: changing some of the terminology to be more accessible, putting the ideas in a context that was easier to understand for someone without a medical background," Kronen said.
Halfway through the class, she was well into the research stage.
"I’m reading through all that literature and I’m trying to decide what’s useful to put on the Wikipedia page and what isn’t useful to put on the Wikipedia page," she said. She kept in mind, "What would my best friend want to know?"
Dispensing with medical jargon
On the last day of the course, the students gathered to share their experiences. They were generally happy with the outcomes of their work, but some had some experienced problems – especially in presenting complex medical information to a lay audience.
Dora Friedman had that trouble in explaining premature rupture of membranes, in which a pregnant woman’s water breaks before she goes into labor.
"When we’re fourth year in our medical training, we’ve really become immersed in the medical language," she explained.
Ali Zaadi researched amyloidios, a rare disease in which proteins in the body misfold, causing harmful deposits. He’d like to see a two-pronged approach to coverage, envisioning a Wikipedia page with "a more medicalized article of this topic and a lay article topic."
Kronen said she’ll continue to use Wikipedia, both as a source and as a way to spread information she learns as a doctor.
Promoting information sharing
Kronen learned in class that Wikipedia is partnering with cellphone companies in the developing world to give some 360 million users free access to its pages.
"Being able to give someone in rural Africa the information I know as a UCSF medical student in one of the most urban and privileged societies probably in the world – that ability to outreach is just phenomenal," she said. "That’s larger of an impact than I will ever have with my own two hands as a surgeon in the future."
Azzam sees WikiProject Medicine as a way for medical professionals to give back to society. Editing for the online encyclopedia should be taught in every medical school, he said.
"Nothing would make me happier than copy-cat improvements to our elective," he said. "I'd be thrilled if every med school, if every health professional school on the planet actually had electives like this, or even requirements like this in their curricula, because I believe this is a social good we should be doing."
While Azzam has come to trust Wikipedia’s health information, and is turning out students who can increase its reliability, he still cautions that it is best to verify information with other sources, including doctors.