This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
Wikis may give clinician communities the opportunity to build knowledge relevant to their practice. The only previous study reviewing a set of health-related wikis, without specification of purpose or audience, globally showed a poor reliability.
Our aim was to review medical wiki websites dedicated to clinical practices.
We used Google in ten languages, PubMed, Embase, Lilacs, and Web of Science to identify websites. The review included wiki sites, accessible and operating, having a topic relevant for clinical medicine, targeting physicians or medical students. Wikis were described according to their purposes, platform, management, information framework, contributions, content, and activity. Purposes were classified as “encyclopedic” or “non-encyclopedic”. The information framework quality was assessed based on the Health On the Net (HONcode) principles for collaborative websites, with additional criteria related to users’ transparency and editorial policy. From a sample of five articles per wikis, we assessed the readability using the Flesch test and compared articles according to the wikis’ main purpose. Annual editorial activities were estimated using the Google engine.
Among 25 wikis included, 11 aimed at building an encyclopedia, five a textbook, three lessons, two oncology protocols, one a single article, and three at reporting clinical cases. Sixteen wikis were specialized with specific themes or disciplines. Fifteen wikis were using MediaWiki software as-is, three were hosted by online wiki farms, and seven were purpose-built. Except for one MediaWiki-based site, only purpose-built platforms managed detailed user disclosures. The owners were ten organizations, six individuals, four private companies, two universities, two scientific societies, and one unknown. Among 21 open communities, 10 required users’ credentials to give editing rights. The median information framework quality score was 6 out of 16 (range 0-15). Beyond this score, only one wiki had standardized peer-reviews. Physicians contributed to 22 wikis, medical learners to nine, and lay persons to four. Among 116 sampled articles, those from encyclopedic wikis had more videos, pictures, and external resources, whereas others had more posology details and better readability. The median creation year was 2007 (1997-2011), the median number of content pages was 620.5 (3-98,039), the median of revisions per article was 17.7 (3.6-180.5) and 0.015 of talk pages per article (0-0.42). Five wikis were particularly active, whereas six were declining. Two wikis have been discontinued after the completion of the study.
The 25 medical wikis we studied present various limitations in their format, management, and collaborative features. Professional medical wikis may be improved by using clinical cases, developing more detailed transparency and editorial policies, and involving postgraduate and continuing medical education learners.
Access to information is a daily concern for clinicians, especially in general practice where the expertise field is particularly wide. Clinicians have to apply evidence-based knowledge as far as possible to manage varied and complex medical issues [
Wikis are websites characterized by a collaborative edition between users. A “wiki” is a type of content managing system differing from others in that the content is created without any defined owner [
The recent review of the literature about wikis and collaborative writing applications in health care by Archambault et al broadly explored use patterns, quality of information, and knowledge translation interests, and brought out a need for primary research on these applications [
Our study aimed at systematically reviewing medical wikis dedicated to clinical practices according to their purposes, platform, management, information framework, contributions, content, and activity.
In October 2011, we performed Google queries searching for the phrase “list of medical wikis” translated in the 10 most spoken languages on the Internet (English, Chinese, Spanish, Japanese, French, Portuguese, German, Arabic, Russian, and Korean), using the Google translation tool when necessary [
Second, we searched PubMed and Web of Science (using “wiki” AND [“medic*” OR “clinic*”]) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) (using “wiki”) in full texts for articles published until September 2012. Every open-access abstract and open access article was read, coupled with Web searches when necessary, in order to identify any potentially relevant URL (
Finally, we included any other potentially relevant URL retrieved through Web extra-browsing or expert advice, until September 2012. One author (AB) made all data extractions of the screening.
Websites were included if they were (1) accessible from a public Internet protocol address; (2) operating a wiki tool, defining a “wiki” as “a type of content managing system (CMS) used for collaborative edition, where the content is created without any defined owner” [
The inclusion and exclusion was done by 2 authors (AB and LL), and disagreements were solved by discussion.
All data collections from the included sites were performed in October and November 2012. The main language interface of each wiki, that is, the one having the biggest amount of content, was used as a reference to collect data. No direct contact to sites’ administrators was undertaken. The data retrieval was done by 1 author (AB), and their assessments were performed by 2 authors (AB and LL). Disagreements were solved by discussion.
Wikis’ main purposes were described on the basis of sites’ disclosures. Defining the term “encyclopedic” as a comprehensive reference work within a knowledge field [
Platforms were described according to software, user data, ergonomics, and clinically relevant utilities, by systematically browsing sites and using their functionalities.
Management was described on the basis of sites’ disclosures and technical characteristics. The access for editing was systematically tested anonymously and after login whenever registration was possible. A user community was defined as “closed” when the editing rights accreditation was not publicly opened. The registration process was defined as “automated” when filling out a form triggered the login access, and “on credentials” when some personal information had to be first checked. In case of hierarchy between registered users, those having special rights were consistently named “super-users”, and their nomination procedure and specific roles were described. We named “administrators” those super-users having enlarged rights such as deleting or massively editing content, assigning or removing rights to users, blocking pages, blocking users, etc.
The Health On the Net ethical code of conduct (HONcode), as adapted for collaborative websites, was used as a reference to perform the information framework quality assessment [
The 16 information framework quality criteria.
Screened criteriaa | Operational definitionb | ||
|
|||
|
1 | Identity (p2) | Indication of the entity that owns the information presented on the website (o1). |
|
2 | Contact details (p6) | The webmaster or other official can be contacted. The presence of email address, telephone, fax, or online form (o2). |
|
3 | Funding (p7) | The presence of a disclosure about owner’s funding. |
|
4 | Conflicts of interest (p7) | The presence of a disclosure about owner’s conflicts of interest. |
|
|||
|
5 | Medical advisory statement (p2) | The presence of a statement about the value of the medical content displayed on the website. |
|
6 | Users privacy policy (p3) | The presence of a disclosure about the management of the users’ personal information. |
|
7 | Advertising policy (p8) | The presence of a disclosure about the advertising displayed (or not) in the website. |
|
|||
|
8 | Review policy (p1) | The presence of a claim of use of an editorial review process or the listing of an editorial review committee or medical advisory board (o3). |
|
9 | Patients data protection rule (p3) | The presence of a rule for using patients’ data. |
|
10 | Information referencing rule (p4) | The presence of a rule for referencing information. |
|
11 | True statement rule (p5) | The presence of a rule for editing with honesty. |
|
12 | Content organization rule | The presence of a rule for organizing the content. |
|
|||
|
13 | Editing users’ identity | The presence of the disclosure of the identity, mandatory for every editing user. |
|
14 | Editing users’ credentials | The presence of the disclosure of the authority and qualification (o4), mandatory for every editing user. |
|
15 | Editing users’ conflicts of interest | The presence of the disclosure of eventual conflicts of interest, mandatory for every editing user. |
|
16 | Administrators’ identity | The presence of the disclosure of the identity, mandatory for every administrator. |
aCriteria referring to the HONcode principles [
bOperational definitions validated by Bernstam et al [
Physicians were considered as contributors by default, except when they were not targeted in the audience. The contributions of medical learners (students or physicians) were described based on educational objectives, or when mentioned in super-users’ credentials. Lay persons’ contributions were described according to the registration requirements. The presence of clinical case reports was systematically searched by querying sites with the key word “case”. Any content reporting some clinical materials issued from users’ practice was considered.
This part of the study aimed at describing the characteristics of the contents and assessing their readability. However, the scientific value of contents in itself was not assessed. From each wiki, we selected a sample of the 5 most revised articles. Articles were included if they had a clinically relevant topic and were written in the main language of the wiki. In sites where the numbers of revisions were not available, we subjectively selected the most finalized articles. We described characteristics related to content (presence of pictures, videos, diagrams, posology details, evidence levels and external resources, and numbers of words and references per article) and data related to edition (numbers of revisions and authors per article, and related talks). The sampled articles were assessed with Flesch’s reading ease test adapted to each language and performed with automated hyphenation [
Wikis’ global activities were described on the basis of available data from sites (absolute numbers of content pages, revisions, and talk pages). Displayed numbers of users were considered globally inaccurate since we suspected tens of false user registrations across several sites, presumably due to vandalism attacks. In order to estimate annual activity, content pages were counted according to their last edition date by performing empty queries on Google, filtered on each URL, and for each year since the wiki’s creation. A recent editorial rate was estimated by reporting the number of pages last edited in the 365 previous days to that edited since creation. Rates higher than 50% were considered as “very high”, and rates lower than 10% were considered as “very low”. A recent editorial trend was estimated by reporting the number of pages last edited in the 365 previous days to that last edited in the 365 days before. Trends higher than 300% were considered as “sharply increasing” and trends lower than 33% as “sharply decreasing”.
The Google search yielded 341 pages, including 27 linking to some potentially relevant URLs. After extraction and removing duplicates, 141 URLs were collected (
Site screening, exclusion, and inclusion flow diagram.
Of the 176 collected URLs, 31 met the inclusion criteria. Six of them became inoperative during the study. Finally, 25 wikis were retained for analysis [
The main languages were English (19 wikis), German (3), French (2), and Chinese (1), and four wikis had a second language interface. The purpose was encyclopedic for 11 wikis, including one also aiming at reporting clinical cases. Among the 14 wikis having a non-encyclopedic purpose, five aimed at editing a textbook, three medical lessons, two oncology protocols, one a single focused article, and three at reporting clinical cases, including one also displaying a textbook-like wiki area. Whereas 16 wikis were specialized to specific themes or disciplines, nine were not. Physicians were explicitly targeted by 22 wikis, medical learners by 18, and lay persons by five (
Wikis’ purposes.
Wiki | Language | Main purpose(s) | Target audience | ||
|
|||||
|
|
Medpedia [ |
English | Medical encyclopedia | Physicians, Learners, Laypeople |
|
|
Ganfyd [ |
English | Medical knowledge base | Physicians |
|
|
AskDrWiki [ |
English | Medicine | Physicians, Learners |
|
|
DocCheck Flexikon [ |
German, English | Medical lexicon | Physicians |
|
|
Toxipedia [ |
English, Spanish | Toxicology encyclopedia | Physicians, Learners |
|
|
EyeWiki [ |
English | Ophthalmology encyclopedia | Physicians, Learners |
|
|
Radiopaedia [ |
English | Radiology encyclopedia & clinical case reports | Physicians |
|
|
Wikiecho [ |
English | Echography encyclopedia | Physicians |
|
|
wikiRadiography [ |
English | Radiography resource | Physicians |
|
|
Pathowiki [ |
German | Pathology encyclopedia | Physicians, Learners |
|
Pathpedia [ |
English | Pathology wikibook | Physicians, Learners, Laypeople | |
|
|||||
|
|
|
|
|
|
|
|
WikiDoc [ |
English | Medical textbook | Physicians, Learners, Laypeople |
|
|
WardWiki [ |
English | Junior doctors help | Physicians, Learners |
|
|
WikEM [ |
English | Emergency Medicine point of care reference | Physicians, Learners |
|
|
Open Anesthesia [ |
English | Anesthesia textbook & critical care manual | Physicians, Learners |
|
|
ECGpedia [ |
English, Dutch | ECG textbook & tutorial | Physicians, Learners |
|
|
|
|
|
|
|
|
MedRevise [ |
English | Medical course revision | Learners |
|
|
Mediwiki.fr [ |
French | Medical course revision | Learners |
|
|
Wikia Biomedwiki [ |
German | Bio-medical learning aid | Physicians, Learners |
|
|
|
|
|
|
|
|
Oncologik [ |
French | Oncology protocols | Physicians |
|
|
OncoWiki [ |
English | Oncology regimens | Physicians |
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
English | Second line oral therapy in type 2 diabetes | Physicians, Learners, Laypeople | |
|
|
|
|
|
|
|
|
Dermpedia [ |
English | Dermatology knowledge and experience sharing | Physicians, Learners |
|
|
Orthochina [ |
Chinese, English | Orthopedic clinical cases | Physicians, Learners, Laypeople |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
English | Radiology clinical cases | Learners |
MediaWiki in its native form was supporting 15 sites. Three sites were hosted by online “wiki farms”, that are ready-to-use multifunctional platforms [
Wikis’ platform.
Wiki | Software | Purpose-built | User disclosures management | Relevant utilitiesa | ||
|
||||||
|
|
Medpedia [ |
MediaWiki | ✓ | ✓ |
|
|
|
Ganfyd [ |
MediaWiki |
|
|
Bibl. links |
|
|
AskDrWiki [ |
MediaWiki |
|
|
|
|
|
DocCheck Flexikon [ |
MediaWiki | ✓ | ✓ |
|
|
|
Toxipedia [ |
Other | ✓ | ✓ |
|
|
|
EyeWiki [ |
MediaWiki |
|
|
|
|
|
Radiopaedia [ |
Other | ✓ | ✓ | Imaging + semantics |
|
|
Wikiecho [ |
MediaWiki |
|
|
|
|
|
wikiRadiography [ |
Online wiki farm |
|
|
|
|
|
Pathowiki [ |
MediaWiki |
|
|
|
|
|
Pathpedia [ |
Other | ✓ | ✓ |
|
|
||||||
|
|
|
|
|
|
|
|
|
WikiDoc [ |
MediaWiki |
|
|
Bibl. links + semantics |
|
|
WardWiki [ |
MediaWiki |
|
|
|
|
|
WikEM [ |
MediaWiki |
|
✓ |
|
|
|
Open Anesthesia [ |
MediaWiki |
|
|
|
|
|
ECGpedia [ |
MediaWiki |
|
|
|
|
|
|
|
|
|
|
|
|
MedRevise [ |
MediaWiki |
|
|
|
|
|
Mediwiki.fr [ |
MediaWiki |
|
|
|
|
|
Wikia Biomedwiki [ |
Online wiki farm |
|
|
|
|
|
|
|
|
|
|
|
|
Oncologik [ |
MediaWiki |
|
|
Bibl. links |
|
|
OncoWiki [ |
MediaWiki |
|
|
|
|
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
MediaWiki |
|
|
|
|
|
|
|
|
|
|
|
|
|
Dermpedia [ |
Other | ✓ | ✓ |
|
|
|
Orthochina [ |
Other | ✓ | ✓ | Imaging |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
Online wiki farm |
|
|
|
aBibl. links=automatized links to external resources (PubMed, Cochrane, etc); Semantics=key words management; Imaging=medical imaging facilities.
Sites’ owners were non-profit organizations (n=10), individuals (n=6), private companies (n=4), scientific societies (n=2) or universities (n=2), and one could not be identified. Six wikis restricted access to their talk pages and users’ profile areas, and one wiki restricted access to its articles. Two wikis allowed any visitor to edit without registering. Registration was automated in 11 wikis, based upon credentials in 10, and limited to a closed community in four. A hierarchy between registered users existed in 14 wikis, among which three restricted the edition (or the validation of edition proposals) to super-users only. Super-users could be organized in “editorial boards” (n=9), responsible for the whole content, in “lead authors” (n=4), responsible for some articles, or in “moderators” (n=2), responding on call. Super-users were nominated without any explicit procedure in 10 wikis, subjectively in consideration of users’ credentials or activity in two wikis, and following a systematic procedure based on a score or a vote in two wikis. Super-users were divided in more than two types of roles in four wikis (
Wikis’ management.
Wiki | Governancea | Edit right accreditation | Authoring structure | Super-users nomination | >2 super-user roles | ||
|
|||||||
|
|
Medpedia [ |
Universities | Super-uservonly | Lead authoring | On credentialsb + on scorec |
|
|
|
Ganfyd [ |
NPO | On credentialsb | None | - |
|
|
|
AskDrWiki [ |
NPO | Super-user only | Lead authoring | On credentials | ✓ |
|
|
DocCheck Flexikon [ |
PC | (any visitor) | None | - |
|
|
|
Toxipedia [ |
NPO | Automated | Editorial board | N/A |
|
|
|
EyeWiki [ |
SS | On credentials | Editorial board | N/A |
|
|
|
Radiopaedia [ |
PC | Automated | Editorial board | N/A |
|
|
|
Wikiecho [ |
NPO | Automated | Editorial board | N/A |
|
|
|
wikiRadiography [ |
Individuals | Automated | Moderators | N/A |
|
|
|
Pathowiki [ |
University | On credentials | None | - |
|
|
|
Pathpedia [ |
PC | Automated | Editorial board | N/A |
|
|
|||||||
|
|
|
|
|
|
|
|
|
|
WikiDoc [ |
NPO | On credentials | Editorial board | N/A | ✓ |
|
|
WardWiki [ |
N/A | Closed | - | - |
|
|
|
WikEM [ |
NPO | Automated | Editorial board | On credentials + editorial activity | ✓ |
|
|
Open Anesthesia [ |
SS | Automated | Editorial board | N/A |
|
|
|
ECGpedia [ |
NPO | On credentials | Lead authoring | N/A |
|
|
|
|
|
|
|
|
|
|
|
MedRevise [ |
Individuals | On credentials | None | - |
|
|
|
Mediwiki.fr [ |
Individuals | On credentials | None | - |
|
|
|
Wikia Biomedwiki [ |
Individual | (any visitor) | None | - |
|
|
|
|
|
|
|
|
|
|
|
Oncologik [ |
NPO | Closed | - | - |
|
|
|
OncoWiki [ |
Individual | Closed | - | - |
|
|
|
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
NPO | Automated | None | - |
|
|
|
|
|
|
|
|
|
|
|
|
Dermpedia [ |
PC | Automated | Editorial board + lead authoring | N/A |
|
|
|
Orthochina [ |
NPO | Super-user only | Moderators + editorial board | Automated + on scored + vote | ✓ |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
Individual | Closed | - | - |
|
aNPO=non-profit organization; PC=private company; SS=scientific society
bProof of credentials required.
cScore based on forum contributions and edit proposals.
dScore based on a multiple choice test and forum contributions.
The owner’s identity was displayed on 19 wikis, its contact details on 21, its funding sources on 14, and its potential conflicts of interest on seven. A medical advisory statement was displayed on 17 wikis, a policy for users’ privacy on 17, and a policy about advertising on 10. A review policy was displayed on 10 wikis, a rule for the protection of patients’ data on 11, a rule for referencing information on nine, a rule for delivering true information on 11, and a rule for organizing content on five. The editing users’ identity was systematically displayed on nine wikis, their credentials on seven, their potential conflicts of interest on two, and the administrators’ identity was systematically displayed on three wikis, which were all made by students [
Wikis’ information framework quality assessment.
Wiki | Owner disclosures (n=4) | Disclaimers (n=3) | Editorial policy (n=5) | User disclosures (n=4) | Total (n=16) | ||
|
|||||||
|
|
Medpedia [ |
4 | 3 | 5 | 3 | 15 |
|
|
Ganfyd [ |
3 | 2 | 2 | 0 | 7 |
|
|
AskDrWiki [ |
4 | 1 | 2 | 0 | 7 |
|
|
DocCheck Flexikon [ |
3 | 2 | 0 | 0 | 5 |
|
|
Toxipedia [ |
4 | 3 | 3 | 3 | 13 |
|
|
EyeWiki [ |
4 | 3 | 3 | 0 | 10 |
|
|
Radiopaedia [ |
4 | 3 | 4 | 2 | 13 |
|
|
Wikiecho [ |
2 | 2 | 1 | 0 | 5 |
|
|
wikiRadiography [ |
0 | 2 | 0 | 0 | 2 |
|
|
Pathowiki [ |
3 | 2 | 3 | 0 | 8 |
|
Pathpedia [ |
4 | 2 | 3 | 2 | 11 | |
|
|||||||
|
|
|
|
|
|
|
|
|
|
WikiDoc [ |
4 | 3 | 5 | 0 | 12 |
|
|
WardWiki [ |
0 | 2 | 3 | 0 | 5 |
|
|
WikEM [ |
2 | 1 | 0 | 3 | 6 |
|
|
Open Anesthesia [ |
3 | 0 | 2 | 0 | 5 |
|
|
ECGpedia [ |
3 | 2 | 2 | 0 | 7 |
|
|
|
|
|
|
|
|
|
|
MedRevise [ |
3 | 2 | 2 | 1 | 8 |
|
|
Mediwiki.fr [ |
2 | 1 | 1 | 1 | 5 |
|
|
Wikia Biomedwiki [ |
0 | 2 | 0 | 0 | 2 |
|
|
|
|
|
|
|
|
|
|
Oncologik [ |
2 | 0 | 1 | 1 | 4 |
|
|
OncoWiki [ |
1 | 1 | 0 | 0 | 2 |
|
|
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
0 | 0 | 0 | 0 | 0 | |
|
|
|
|
|
|
|
|
|
|
Dermpedia [ |
3 | 2 | 2 | 2 | 9 |
|
|
Orthochina [ |
1 | 2 | 1 | 2 | 6 |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
2 | 1 | 1 | 1 | 5 |
Physicians were considered as contributors by default in all wikis except the three made by and for students [
Wikis’ contributions.
Wiki | Lay people | Learnersa | Formal educational goal | Clinical case reports | ||
|
||||||
|
|
Medpedia [ |
|
|
|
✓ |
|
|
Ganfyd [ |
|
|
|
|
|
|
AskDrWiki [ |
|
|
|
|
|
|
DocCheck Flexikon [ |
Free edition |
|
|
|
|
|
Toxipedia [ |
Registered only |
|
|
|
|
|
EyeWiki [ |
|
|
|
|
|
|
Radiopaedia [ |
|
|
|
✓ |
|
|
Wikiecho [ |
|
|
|
|
|
|
wikiRadiography [ |
|
|
|
✓ |
|
|
Pathowiki [ |
|
PG |
|
✓ |
|
Pathpedia [ |
|
|
|||
|
||||||
|
|
|
|
|
|
|
|
|
WikiDoc [ |
|
|
|
✓ |
|
|
WardWiki [ |
|
|
|
|
|
|
WikEM [ |
|
PG | ✓ |
|
|
|
Open Anesthesia [ |
|
PG | ✓ |
|
|
|
ECGpedia [ |
|
PG |
|
✓ |
|
|
|
|
|
|
|
|
|
MedRevise [ |
|
UG |
|
✓ |
|
|
Mediwiki.fr [ |
|
UG + PG |
|
|
|
|
Wikia Biomedwiki [ |
Free edition | UG |
|
|
|
|
|
|
|
|
|
|
|
Oncologik [ |
|
|
|
|
|
|
OncoWiki [ |
|
|
|
|
|
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
Registered only |
|
|
||
|
|
|
|
|
|
|
|
|
Dermpedia [ |
|
|
|
✓ |
|
|
Orthochina [ |
|
CME | ✓ | ✓ |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
|
PG | ✓ | ✓ |
aUG=undergraduate, PG=postgraduate, CME=practicing physicians in continuing medical education.
As only one wiki displayed a single article and another did not allow access to its relevant content, 116 articles were sampled, including 58 most revised and 58 most finalized. Numbers of authors were not available for five encyclopedic articles. Numbers of revisions and of authors were not available for five non-encyclopedic articles. Pictures, videos, and external resources were more frequent in articles from encyclopedic wikis. Posology details were more frequent in articles from non-encyclopedic wikis (
Features of content, of edition, and readability of articles according to wiki purpose (N=116 articles).
Wiki purpose | Encyclopedic (n=55) | Non-encyclopedic (n=61) |
|
|
|
n (%) or median (min-max) | n (%) or median (min-max) |
|
|
|
||||
|
Pictures, n (%) | 33 (60.0) | 23 (37.7) | .025 |
|
Videos, n (%) | 7 (12.7) | 0 (0.0) | .004 |
|
Diagrams, n (%) | 3 (5.5) | 8 (13.1) | .211 |
|
Posology, n (%) | 5 (9.1) | 24 (39.3) | < .001 |
|
Evidence levels, n (%) | 0 (0.0) | 2 (3.3) | .497 |
|
External resources, n (%) | 33 (60.0) | 21 (34.4) | .009 |
|
References, median (min-max) | 3 (0-87) | 2 (0-105) | .400 |
|
Words, median (min-max) | 1248 (94-4945) | 654 (38-16265) | .353 |
|
||||
|
Revisions | 40 (2-261) | 40.5 (2-516) | .953 |
|
Authors | 3 (1-34) | 3 (1-6) | .067 |
|
Talks | 0 (0-24) | 0 (0-2) | .099 |
|
||||
|
Flesch’s reading ease score | 26.1 (-11.4-50.6) (college graduate) | 33.9 (-55.5-87.6) (college) | .041 |
Wikis had been created between 1997 and 2011 (median year: 2007). Content pages per wiki varied from 3 to 98,039 (median 620.5), revisions per content page from 3.6 to 180.5 (median 17.7), and talk pages per content page from 0 to 0.42 (median 0.015). Among five particularly active wikis, three had a high previous year editorial rate and three a sharply increasing editorial trend. Among six wikis almost unused, six had a low previous year editorial rate, and three a sharply decreasing editorial trend. The activity of one wiki having a sharply increasing trend upon a very low previous editorial rate was not interpreted (
Wikis’ activities.
Wiki | Year of creation | Content pages | Revisions / content pages | Talk pages / content pages | 2011-12 editorial ratea,b, % | 2010-12 editorial trenda,c | ||
|
||||||||
|
|
Medpedia [ |
2002 | 4000 | 85.3 | 0.02 | 36 | → |
|
|
Ganfyd [ |
2005 | 7979 | 6.7 | 0.14 | 18 | → |
|
|
AskDrWiki [ |
2006 | 1406 | 4.8 | < 0.01 | 4 | → |
|
|
DocCheck Flexikon [ |
2002 | 18,017 | 8.5 | 0.02 | 73 | ↗ |
|
|
Toxipedia [ |
2006 | 1910a | N/A | N/A | 34 | → |
|
|
EyeWiki [ |
2010 | 142 | 79.2 | 0.20 | 41 | → |
|
|
Radiopaedia [ |
2005 | 5131 | N/A | N/A | 44 | → |
|
|
Wikiecho [ |
2007 | N/A | N/A | N/A | N/A | N/A |
|
|
wikiRadiography [ |
2006 | 1730a | N/A | N/A | 10 | ↘ |
|
|
Pathowiki [ |
2010 | 425 | 11 | < 0.01 | 27 | → |
|
|
Pathpedia [ |
2006 | N/A | N/A | N/A | 0 | N/A |
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
WikiDoc [ |
2006 | 98,039 | 6.7 | < 0.01 | 38 | ↗ |
|
|
WardWiki [ |
2010 | 324 | 11.4 | 0 | 0 | ↘ |
|
|
WikEM [ |
2010 | 126 | N/A | 0.01 | 64 | → |
|
|
Open Anesthesia [ |
2008 | 1023 | N/A | 0.02 | 60 | → |
|
|
ECGpedia [ |
2006 | 1241 | 17.7 | 0.02 | 16 | → |
|
|
|
|
|
|
|
|
|
|
|
MedRevise [ |
2008 | 597 | 21.8 | 0.01 | 8 | → |
|
|
Mediwiki.fr [ |
2008 | 216 | 29.4 | 0.02 | 32 | ↗ |
|
|
Wikia Biomedwiki [ |
2006 | 75 | 36.0 | 0.02 | 4 | ↗ |
|
|
|
|
|
|
|
|
|
|
|
Oncologik [ |
2011 | 152 | 180.5 | 0.42 | 48 | → |
|
|
OncoWiki [ |
2011 | 112 | 3.6 | 0.01 | N/A | N/A |
|
|
|
|
|
|
|
|
|
|
Open Medicine Live Wiki [ |
2011 | 3 | 29.0 | 0 | 0 | ↘ | |
|
|
|
|
|
|
|
|
|
|
|
Dermpedia [ |
2008 | 601 | N/A | N/A | 18 | → |
|
|
Orthochina [ |
1997 | N/A | N/A | N/A | N/A | N/A |
|
|
UCLA Radiology Residents Pediatric Imaging [ |
2008 | 640 | N/A | 0 | 17 | → |
aEstimated with Google.
b[Last year edited pages]/[total pages]: >50%=high rate; <10%=low rate
c[Last year edited pages ]/[year before edited pages]: ↗=sharply increasing trend (>300 %); ↘=sharply decreasing trend (<33 %); →=stable trend.
From this international review, we identified 25 medical wikis dedicated to clinical practices. The majority were in English and four were bilingual. They had various purposes, dominated by encyclopedic perspectives (44%), and most were specialized (64%). The MediaWiki software was commonly used (68%), often in its native form (60%). Site owners were mostly non-profit organizations (40%) and individuals (24%); only two were universities. While practicing physicians were major contributors (88%), medical learners (36%) and lay persons (16%) sometimes contributed.
Cross-reading our results, the relevancy for clinicians of the medical wikis can be discussed according to four information properties: accuracy, readability, reliability, and currency. Accuracy may be impaired in wikis not displaying a review policy (60%) and in those not delivering rules for organizing content (80%) [
Our review may not have been exhaustive as the Google search was restricted to lists of medical wikis and several sites reported in the health literature were not accessible. Furthermore, the Web 2.0 field is rapidly changing, and some new medical wikis may have emerged since October 2012. Re-browsing the lists of medical wikis used in this study, we found only one relevant wiki after the inclusion period: the Australian Cancer Guidelines Wiki [
Among the tools available for assessing the quality of health information on websites, none is currently validated and none is fitted either to wikis or to a professional audience [
The relevancy of low readability scores, corresponding to college and higher, is arguable since medical doctors have
To check the validity of the estimation of annual editorial activities using Google, we measured the agreement between the number of content pages declared on the site and the corresponding estimate from the Google search engine, for 20 wikis. Although there was a strong agreement (Spearman correlation coefficient=.88,
Our results suggest that no medical wiki meets all four information properties needed by clinicians. The encyclopedic format does not seem to fit in terms of both accuracy and readability. However, whatever the wikis’ purposes, the organization of contents is often unclear, apart from very focused purposes such as oncology protocols, where the knowledge granularity is adapted to a particular audience [
Reliability is widely, and sometimes critically, impaired by lack of management. Although authoring transparency requires both technical and policy supports [
In most wikis, weak and poorly collaborative activity jeopardizes content updates. The talk pages, when available, are exceptionally used, and the discussion threads included in forums or social networks are not directly connected to content pages [
Users’ regulation in wikis is complex since the lower the control of their editors, the higher their growth [
Although multi-authoring requires a thorough organization [
While the HONcode principle about the authoritativeness of the information protects the moderators’ privacy by allowing their anonymity [
Among eight medical wikis including learners’ contributions, five include spontaneous undergraduate or postgraduate students’ contributions. The three others have a formal educational goal, targeting postgraduate students or practicing physicians in continuous medical education [
The 25 medical wikis reviewed present various limitations in their format, management, and collaborative features. Encyclopedic wikis have less accurate and readable content. Reliability is widely impaired by lack of transparency. Currency is commonly jeopardized by low editorial activity. Professional medical wikis may be improved by using clinical cases, developing more detailed transparency and editorial policies, and involving postgraduate and continuing medical education learners.
Google search.
Literature search.
Site exclusions and inclusions.
Content Managing System
Health On the Net code of ethics
Health Summit Working Group Information Quality tool
Medical Subject Headings
Uniform Resource Locator
We would like to thank Ewa Dobrogowska-Schlebusch for sharing her original work; Meik Michalke for improving the koRpus package of the R cran project; Martin Wedderburn for providing English editorial help; and Patrick M Archambault and Tom H Van de Belt for their valuable external review. We are grateful to the College of teaching general practitioners of Lyon (CLGE) to have supported this work.
None declared.