Use of Wikis in advanced pharmacy practice experiences.
To the Editor: Most clinicians have been exposed to, or are aware of, the existence of Wikipedia, the world's most popular wiki project. The online encyclopedia Wikipedia offers the advantage of an open-access library of information that can be authored or edited with little delay by anyone with Internet access.1 Alternatively, wikis (and their accompanying software programs) may serve as a useful tool in health sciences education and research. A wiki can serve as an “expert pharmacy community” in an online format, fully supported through a collaborative effort by its members. Utilization of wiki technology specifically for pharmacy-related education is limited and its use in pharmacy education has not been well documented. Mirk et al presented information on pharmacy students’ prior experience with wikis, but their opinions on their use and impact in a pharmacy education setting are unknown.6 At the South Carolina College of Pharmacy on the campus of the University of South Carolina (SCCP-USC), 3 faculty members utilize wiki technology during advanced pharmacy practice experiences (APPE). 
 
Online tools for advancing education and training in health sciences have been used for over a decade, although use of wikis is a more recent development.2 Ciesielka described the use of a community wiki in nursing education at Clarion University.3 The students far exceeded course expectations and continued to contribute to the wiki even after grades were assigned. Students were given substantial autonomy and responded positively to the experience, suggesting it greatly facilitated teamwork and allowed them to “see the big picture.”3 Incorporation of wikis into medical education has also been documented in a gross anatomy course at the Mayo Medical School.4 Given an anatomical outcome, students were instructed to utilize a wiki to design a clinically relevant case. Pre- and post-assessments demonstrated a significant increase in students’ confidence in identifying appropriate diagnostic procedures, discerning differential diagnoses and potential treatments, and delivering an oral presentation of the clinical case.4 
 
The use of wikis in health sciences expands beyond education into the research arena, as biology databases have begun to utilize wiki technology.5 In conjunction with his biologics company, Knewco, Barend Mons has launched a Web site, www.wikiprofessional.org, with the goal of creating a single, interlinked, biomedical database supporting vital research in genetic and protein modeling for many scientists. The use of wikis may be embraced soon by publishing companies seeking a move to an online format. A wiki format offers the advantage of continuous online group editing done in real time, minimizing inherent delays and costs. 
 
Over the past year, 3 faculty members at SCCP-USC have used wikis to enhance the student experience during APPEs, but student opinions on their use are unknown. These wikis were setup through Google Wikis (http://www.google.com/sites/), a free online service. Students participate in a 4- week APPE in an acute care setting focused in internal medicine/infectious diseases, critical care, and/or hematology/oncology. The students create and use wiki entries to answer daily questions that arise during interdisciplinary rounds or stemming from patient-specific and evidence-based care decisions. Additionally, disease-state reviews are created by the students to provide comprehensive information on key topics. In situations where information on the wiki related to a topic already exists, students are asked to review, edit, and expand on the work of their peers. The initial use of wikis required some Web site creation and design, but following that, entries have been exclusively student created. Since using wikis is new to many students, we provide some initial instruction on the types and expectations for content as well as training in “how to” of the Web site. During the first few days of the APPE, students are somewhat reluctant to add entries to the wiki, but reminders to add specific information are well-received. However, once the students are comfortable with the wiki site, they are eager to add new and update existing information. 
 
Thirty students have utilized the wiki over the past 9 months, with 4 students using wikis on multiple APPEs. In order to assess the impact of the wiki on student learning and overall perception, a survey was administered with answers based on a 5-point Likert scale (1=strongly agree; 5=strongly disagree), with additional space for comments. 
 
The survey was administered anonymously online using SurveyMonkey (surveymonkey.com). All students using wikis on APPEs were invited to participate, with 16 students responding to the survey (response rate = 61.5%). Overall, opinions on the survey were positive with greater than 90% of respondents either strongly agreeing or agreeing that wikis helped reinforce concepts and ideas and that they enjoyed working with wikis while on APPEs. Many students (approximately 70%, 11/16) believed that the use of wikis helped create a sense of collegiality and strengthened professional relationships with peers. In addition, a question aimed at gauging students’ interest in using wikis in other areas of pharmacy education had a favorable response with approximately 90% of students strongly agreeing or agreeing that they would like to see wikis and other online tools employed in other areas of pharmacy education. Students gave generally favorable responses to questions gauging their attitudes towards using previously written wiki entries to help review APPE concepts and assessing how the wiki helped them reflect on clerkship concepts. 
 
Student comments regarding the use of wikis detailed how they were enjoyable and helped enhance concept understanding. One student reported that they “enjoyed working on pages for the wiki. [They] felt like they were a good tool to use to help reinforce concepts introduced during the rotation, especially in thinking critically to break the concept down into palatable pieces…” Another student stated that, “the wiki forced [them] to put concepts into [their] own words, and as a result enhanced understanding.” 
 
Critics of wikis have commented that open access leads to the possibility of inaccuracies in user contributions. In the medical arena, this could involve potential hazards leading to patient harm. An analysis of online content in Wikipedia compared to Encyclopedia Britannica found little difference in overall accuracy.7 At SCCP, faculty members serve as editors for the APPE wikis. Whenever activity occurs on the wiki, a post is made on the announcement page allowing preceptors and students to follow any edits or updates. Currently, our wikis are only available to students as contributors who have been or are currently enrolled in the APPE. This helps to alleviate copyright and liability concerns and controlling for unknown additions to the wiki pages. Our overall experiences with wikis have been positive, and we feel that they provide an opportunity for students to practice critical thinking and writing skills and promote professional collegiality. 
 
We have found the use of wikis to be a useful tool in experiential education, and student responses indicate that they may be helpful in other areas of pharmacy education. Incorporation of wiki technology into didactic elective courses is also being researched and evaluated by the same faculty members. These data will be forthcoming in a future publication. 
 
 
April D. Miller, PharmD 
 
P. Brandon Bookstaver, PharmD 
 
LeAnn B. Norris, PharmD 
 
South Carolina College of Pharmacy-University of South Carolina