segunda-feira, 28 de janeiro de 2013

Saúde Baseada em Evidências

 Saúde baseada em evidências

Portal Saúde Baseada em Evidências   

Criado pelo Ministério da Saúde em parceria com a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes/MEC), o Portal Saúde Baseada em Evidências reitera o compromisso do governo brasileiro de aprimorar o exercício dos trabalhadores da saúde democratizando as condições de acesso, nas suas áreas de atuação, a conteúdos cientificamente fundamentados na perspectiva de melhor atender à população.
Fornecer acesso rápido ao conhecimento científico por meio de publicações atuais e sistematicamente revisadas. As informações, providas de evidências científicas, são utilizadas para apoiar a prática clínica, como também a tomada de decisão para a gestão em saúde e qualificação do cuidado, auxiliando assim os profissionais da saúde.

Os conteúdos estão disponíveis para os profissionais de saúde vinculados ao respectivo Conselho Profissional. Terão acesso à pesquisa os profissionais das áreas de Biologia, Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia e Terapia Ocupacional, Fonoaudiologia, Medicina, Medicina Veterinária, Nutrição, Odontologia, Psicologia e Serviço Social.

Bases Editoriais

Para acessar o site e um vídeo instrucional sobre o cadastramento gratuito , clique aqui.

sexta-feira, 25 de janeiro de 2013

Comunidade de práticas

Why You Should Build a Community of Learners in Your School

High-Impact Leadership for High-Impact Schools: The Actions That Matter MostThis tip discusses how school leaders can build a strong learning-focused environment in their district or school. High-Impact Leadership for High-Impact Schools: The Actions That Matter Most, by Pamela Salazar, presents specific knowledge and practical strategies for school leaders to reach high standards of excellence.

Strong learning-focused communities offer professional support and provide learning opportunities and mutual accountability for improving instruction. Principals must build a work culture that promotes collaboration, knowledge sharing, and collective responsibility for improving teaching and learning.

High-Impact Leaders Ask:
  1. When do teachers come together to talk about teaching and learning?
  2. What are the expectations for teachers to continue their professional development?
  3. Have we established a culture of questioning and inquiry?
  4. Is professional development site-specific and aligned with the needs assessment and goals of the school?
  5. Do teachers use assessment results to drive instructional decisions on an ongoing basis?
  6. Do teachers have opportunities for looking at student work?
  7. Do we see ourselves as a community of learners that can continuously improve through collaboration, assessment of results, and reflection?
A high-impact school is a community of practice in which learning, experimentation, and reflection are the norm. There is a sense of common purpose based on a collective understanding of the community served by the school and the staff’s capacity to work together toward this common purpose. Everyone works together to assure that diverse voices and beliefs are heard and that consensus truly results in what is good for the whole school and every student.
High-impact schools are professional learning communities engaged in assessing and improving instructional practice. These schools are equipped to meet the needs of individual students and to accelerate the pace of learning. They do this through a high level of communication about a variety of issues after establishing opportunities for collaboration. These schools value the exploration and improvement of teaching. They recognize and support innovative efforts that contribute to creating a positive climate and culture in the school. Collaborative work forms the backbone for developing an aligned educational experience and expands a school’s vision and boundaries by involving more people in essenHow to Advocate Building a Community of Learners in Your School >> Eye On Educationtial processes related to student achievement and school improvement.

High-impact leaders are proactive. They build a supportive learning environment that is healthy and intellectually stimulating. They create an environment characterized by a high level of professional practice paired with a high level of student engagement in the construction of new knowledge. Students feel respected and connected and they are engaged in learning. Instruction is personalized to increase student contact with teachers. Professional development supports collaboration and collegial accountability.
The high-impact school dedicates itself to developing everyone’s potential talents, centering its attention on learning. It continuously seeks more effective ways to enhance student achievement through careful design and evaluation of programs, teaching, and learning environments. The school and staff both demonstrate an enthusiastic commitment to organizational and personal learning as the route to continuous improvement. Seeing itself as a community of learners that can continuously improve through collaboration, assessment of results, and reflection, the school designs practical means for gauging its students’ and its own progress toward clearly identified goals.

quarta-feira, 23 de janeiro de 2013

Apps para Estudantes de Medicina

10 Useful iPhone Apps For Medical Students

The great thing about smartphones today is that there’s an app for everything. In Apple’s ecosystem, you’ll find hundreds of thousands of apps. From the mundane to the wonderful, there’s something for everyone.
As you can see from the title, this post is about medical students who need apps that help them get through the day!

If you’re a med student struggling to get your grades up, just grab your iPhone and take a look at these apps:
Medscape Mobile is one of the best apps you can get. It’s an encyclopedia, filled with thousands of articles about everything related to medicine. They also have pictures and an extensive database about diseases.
For those who have a notebook with formulas written inside, you can throw it away! All you need is MedCalc. It’s very easy to use and it has plenty of formulas and does everything a usual calculator can do, such as converting units.
You can sort the formulas by categories, and the app costs just $0.99.
Simply put, this app allows you to search for all the eponyms you need. The app is free and there’s a description for each eponym.
Just like having a medical encyclopedia beside you is handy, so is an encyclopedia about pharmaceuticals. The Micromedex app provides a complete database of Canadian and US drugs. It has all the description you need such as the instructions and side effects.
This app is very popular among the medical field because it also provides a detailed list of drug references. It has thousands of prescription drugs with the proper administration instructions and a host of other features, such as a pill identifier and calculations too.
This app contains radiology presentations. It has everything you need, such as captions for easier understanding. You can view the data by categories and best of all, the app is free!
The app is pricey, selling for 17.99 bucks. However, the price is justified since the app is also used for doctors, not just med students. It has a 3D design where you can view the human heart in any angle you like.
This app was made by the American College of Cardiology Foundation. Basically, it’s a walking encyclopedia of ACC textbooks. It also includes a TTE/TEE Tool with a database of echocardiography. This app is also free like the others.
This dental app is for those who want more than what the Little Dental Drug Book Provides. This app costs 300 dollars! It provides full access to Lexi – Comp’s library of resources. It has everything you need to diagnose patients for treatment.
It features colored pictures and detailed paragraphs.
As indicated, this app is for students who are specializing in dermatology. It’s not really an app that helps you get through the day. This app is more of a reviewer. You’ll find 229 multiple choice questions that are all about real life cases. It’ll definitely help you because you can track your answers and they’re all explained really well.
These apps are very comprehensive. Even the free apps are worth looking at. If you’re a med student practicing dentistry or some other field, the iTunes App Store has everything you need.
So go grab your iPhone, download the apps you need, and go help a patient!

terça-feira, 22 de janeiro de 2013

Ensino de Anatomia

el país

Ser médico sin tocar un cadáver

Miles de licenciados en Medicina no han practicado nunca con un muerto

La disección ha perdido peso académico en favor de las nuevas tecnologías

Estudiantes de Medicina en una sala de disección de la Universidad Complutense. / Carlos Rosillo

Miles de estudiantes de Medicina salen de las aulas españolas sin haber hecho prácticas reales de anatomía, es decir, disección de cadáveres, una disciplina que se estudia en los dos primeros años de la carrera, a pesar de que nunca como ahora se habían recibido tantos cuerpos donados a las universidades para este uso. Un estudio publicado recientemente en Holanda revela que un 6% de los errores graves que se producen en enfermos hospitalizados se deben principalmente a causas humanas, entre ellas el poco conocimiento y la mala transferencia de la información. La revista científica americana Clinical Anatomy contaba a principios de siglo hasta 80.000 muertes evitables al año en las mesas de quirófano. Y un número no desdeñable de ellas, decía, pueden atribuirse a la incompetencia en los conocimientos anatómicos necesarios por falta de una formación académica rigurosa.
 La Anatomía se sigue impartiendo en las facultades de Medicina, pero tuvo días más felices. En los años cuarenta era la estrella, con la Fisiología, pero otras disciplinas le fueron arañando terreno: la Biología, Genética, Histología, Bioquímica... En la actualidad, hay facultades que imparten 60 horas y otras que llegan a 200.
Nadie discute la importancia de la anatomía en la formación médica, pero hay un fenomenal debate abierto sobre las formas de impartirla. A un lado, los que defienden la disección de cadáveres; en la otra esquina, los que creen que el famoso óleo de Rembrandt bien puede suplirse ya por las nuevas tecnologías. Y en medio, matices variopintos.
"No hay tiempo para disecar", dice un catedrático de Anatomía
En todo caso, ya hay muchas facultades donde los alumnos apenas asoman la nariz por las salas de disección. “No tenemos tiempo y no siempre los profesores están preparados para eso. Nuestros alumnos pasan por la sala, ven el cadáver... no hay tiempo para disecar”, argumenta el catedrático de Anatomía Manuel Rosetti. Él defiende las nuevas tecnologías: “El licenciado, cuando va a enfrentar una patología no puede abrir la cabeza, pero tiene otras herramientas, las resonancias, el TAC. Hay que adecuarse a ello”, afirma. Aunque reconoce su impresión cuando, siendo alumno, entró por primera vez a una sala de disección: “Yo creía que el útero era grandísimo y se me grabó para siempre su pequeño tamaño. Es cierto que el 3D carece de valor si, además, no se ve in situ. Pero sí, puede ser verdad que cientos de alumnos salen sin ver cadáveres ahora”. Y lo achaca en su universidad a las costumbres sociales de los andaluces: “Cádiz tiene problemas para recibir cuerpos donados. Es una circunstancia social”, asegura.
En Granada, una de las más prestigiosas facultades de Medicina, la práctica con cadáveres “ha disminuido mucho y es una pena, porque las personas donan el cuerpo y podríamos utilizarlo”, se queja el decano, Indalecio Sánchez. Opina que “las nuevas técnicas son magníficas, pero no pueden sustituir una buena lección de anatomía. Con la disección se ve la realidad, hay diferencias con un cuerpo vivo, pero se aproxima”, dice. Cree que estas prácticas han ido a menos “porque se han incorporado a las aulas especialistas en anatomía que no son médicos. Es falso que no haya médicos que quieran dar estas clases. Falla la selección del profesorado”, asegura, y sabe que sus palabras generan polémica.
Acérrimo defensor de la disección de cadáveres en las aulas es también José Ramón Sañudo, catedrático de Anatomía de la Complutense. “En el resto de países de nuestro entorno, Alemania, Reino Unido, siempre ha estado muy vinculada a la medicina generalista y a la cirugía. La importancia de impartir anatomía con cadáveres es que la normalidad de la anatomía es, precisamente, su variabilidad. Cada cuerpo es distinto, hay cientos de detalles que se pueden encontrar y estudiar. Además, la sala de disección te enseña la muerte, son valores importantes para un futuro médico. Eso no se ve en 2D ni en 3D”, replica Sañudo, en cuyo departamento la práctica con cadáveres tiene gran peso y disponen de cuerpos para un buen desempeño del alumnado. Cree que este trabajo en las aulas es importante para los cirujanos y para los médicos generalistas.
"El encuentro con estos cuerpos tiene una dimensión ética", sostiene Zarco.
A ver qué opinan. Arturo Soriano es catedrático de Patología Quirúrgica en La Laguna y presidente de la Asociación Española de Cirujanos. Quiere mantenerse en un “virtuoso término medio”, dice. “Los cadáveres son importantes, claro, yo recordaré toda la vida mis experiencias en las salas de disección como estudiante: el tórax, el abdomen, pero también lo son las nuevas tecnologías, que permiten ver un hígado por dentro con más detalle que haciéndolo filetes. Pero claro que es útil para un cirujano, yo me acerco a la postura clásica, a las prácticas con cadáveres, pero quizá no al 100%, como cuando yo era estudiante. Defendería, desde luego, una mínima práctica con cadáveres, en traumatología es básico, por ejemplo. Pero ahora también hay simuladores estupendos”, asegura.
Julio Zarco, que ha sido presidente de la Sociedad Española de Medicina de Familia, cree que la anatomía se enseña “como a principios del siglo pasado. Y eso no sirve para un médico clínico, hay que relacionarla con la patología y la fisiología, pero se imparte como si lo que tuvieran que hacer en el futuro fuera diseccionar cadáveres”, afirma. Zarco no desdeña las nuevas tecnologías, pero cree que “el encuentro con el cadáver tiene una dimensión anatómica real y una carga ética y vivencial para el alumno y en la actualidad se está rehuyendo ese encuentro. Si todavía hay quien enseña anatomía en la pizarra. Los alumnos ven pocos cuerpos, ni vivos ni muertos. El estudiante antes pasaba consulta con los residentes mayores, por ejemplo, eso también se está perdiendo y mucho”.

Cuerpo completo, 6.000 dólares

La formación y reciclaje permanentes de los médicos y cirujanos requiere a menudo cursos muy especializados en los que es necesario manipular cuerpos sin vida. Los organizan las sociedades médicas, pero se encargan de ello en las facultades: es una forma de conseguir recursos económicos. Pero no sirven para ello cadáveres preparados para la disección; los necesitan “en fresco”. Los hacen traer de Estados Unidos, porque en España no siempre se dan las condiciones requeridas. “Precisan estar conservados a 80 grados bajo cero y no tenemos instalaciones para ello”, explica José Ramón Sañudo, catedrático de Anatomía de la Complutense.
Los cuerpos llegan al aeropuerto y se paga por uno completo 6.000 dólares (4.500 euros), pero también se compran por partes, en función de las necesidades de los especialistas. La cirugía plástica, por ejemplo, requiere entrenamientos de este tipo, y así se organizan. “Pero también son útiles para otorrinos, traumatólogos, ortopedistas. Organizamos unos 15 al año, y es un dinero que revierte en el departamento”, explica Sañudo.
En otros países, como en Reino Unido, de estos cursos prácticos se encargan los Reales Colegios de Cirugía u organismos mixtos entre las sociedades científicas y las universidades, como ocurre en el centro de Europa.
Estos institutos son similares a las sociedades médicas españolas, pero estas organizan sobre todo cursos eminentemente teóricos. “Deberían incorporar prácticas para los especialistas, como hacen en los países de nuestro entorno. Su ventaja es que es una formación del profesional al profesional”, explica José Ramón Sañudo.

domingo, 13 de janeiro de 2013

U.S. Health in International Perspective 

US health disadvantage likely has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions. National wealth needs to be spent wisely to promote a healthy population. 

The report "US Health in International Perspective: Shorter Lives, Poorer Health" finds that Americans live shorter and less healthy lives than people in other high-income nations and explores possible reasons for this disadvantage. In this video, Steven Woolf, the chair of the committee that wrote the report, explains its major findings.


quarta-feira, 9 de janeiro de 2013

Habilidades clínicas

YouTube as a Platform for Publishing Clinical Skills Training Videos

Topps, David MD; Helmer, Joyce EdD; Ellaway, Rachel PhD



The means to share educational materials have grown considerably over the years, especially with the multitude of Internet channels available to educators. This article describes an innovative use of YouTube as a publishing platform for clinical educational materials.
The authors posted online a series of short videos for teaching clinical procedures anticipating that they would be widely used. The project Web site attracted little traffic, alternatives were considered, and YouTube was selected for exploration as a publication channel. YouTube's analytics tools were used to assess uptake, and viewer comments were reviewed for specific feedback in support of evaluating and improving the materials posted.
The uptake was much increased with 1.75 million views logged in the first 33 months. Viewer feedback, although limited, proved useful. In addition to improving uptake, this approach also relinquishes control over how materials are presented and how the analytics are generated. Open and anonymous access also limits relationships with end users.
In summary, YouTube was found to provide many advantages over self-publication, particularly in terms of technical simplification, increased audience, discoverability, and analytics. In contrast to the transitory interest seen in most YouTube content, the channel has seen sustained popularity. YouTube's broadcast model diffused aspects of the relationship between educators and their learners, thereby limiting its use for more focused activities, such as continuing medical education.

(C) 2012 Association of American Medical Colleges

* To read a  .pdf copy of this article, click here.

terça-feira, 8 de janeiro de 2013

Avaliação do Ensino Superior

Veja - Capa

MEC merece vivas pela avaliação do ensino superior. E puxões de orelha

Em artigo da edição de VEJA desta semana, o colunista analisa o sistema federal de acompanhamento de instituições e cursos

Claudio de Moura Castro

Saiu a nova avaliação do ensino superior. Vários vivas para o MEC, mas, também, puxões de orelha. Ambos merecidos. Vivas pela consolidação de um sistema ousado, único no mundo e combatido pelas hostes do atraso, inclusive dentro do MEC. É um sobrevivente, sofreu escoriações, mas também teve reparos. Todos ficam sabendo quem é quem: ele mata a onça e mostra o pau. Desta vez, a justiça é mais cega: puxões de orelha também para os cursos fracos da rede pública. E por que não? Outro avanço: a “dosimetria” das penalidades é graduada, leve para alguns e truculenta para os grandes pecadores. Até aqui, maravilha. O problema é ser muito fácil derrapar nos meandros da teoria estatística. O maior enguiço é no entendimento errado da curva descoberta pelo matemático Gauss. Como muitos fenômenos estatísticos se distribuem na forma de um sino, na avaliação é comum e correto dispor os dados na curva e dar notas a cada um de acordo com o ponto dela em que estejam. Quem ficou na cauda direita ganha a nota máxima. Vai a mínima para os da cauda esquerda.

"O MEC não pode dizer que os cursos
 com piores notas são ruins, nem se pioraram. 
Mas pode considerá-los sob suspeição"

Mas é preciso saber o que não dizem os resultados. Imaginemos que o MEC tivesse sob sua tutela as dez melhores universidades do mundo. Sendo a melhor, Harvard ganharia 5. E seria dada nota 2 para Berkeley, pois é a penúltima. O MEC iria proibi-la de fazer vestibular. Mas, vejam só, Berkeley é a melhor universidade pública do mundo! Onde está o erro? Muito simples, está na diferença entre ruim e pior. Pior é um relativo, ruim um absoluto. Berkeley é pior do que oito, mas é excelente. Nossa avaliação não permite dizer se é ruim ou boa, apenas compara cursos. Quem acertou menos ganha nota pior. São fracos só na comparação com os outros. E, pela regra, a proporção com nota ruim será sempre a mesma. Sabemos quais são os nossos piores cursos. Mas, para saber se são ruins, precisaríamos definir o que os graduados de cada área devem dominar minimamente. O exame da OAB é concebido assim (em que pese sua pouca transparência). Mas nas provas do Enade isso jamais foi feito, pois um grupo de professores redige as questões pela sua cabeça. Vejam o dilema: nas licenciaturas de matemática, as médias de acerto são baixíssimas. Só que não sabemos se os cursos são fracos, se os alunos são despreparados ou se quem formulou as questões tinha expectativas irrealistas. Pela mesma razão, ao contrário da Prova Brasil, os testes não são comparáveis de ano a ano. Portanto, não podemos dizer se algum curso melhorou, sabemos apenas se passou na frente de outros. No curto prazo, essas limitações das provas são incontornáveis. Portanto, o MEC não pode dizer que os cursos com piores notas são ruins, nem se pioraram, como vem fazendo. Mas pode e deve considerá-los sob suspeição, justificando uma investigação individualizada.
Thinstock/Digital Vision
(Thinstock/Digital Vision)

Um tropeço desnecessário é o uso de um indicador composto, somando o que o graduado sabe (o Enade) com o número de doutores e mestres, a proporção em tempo integral e a opinião dos alunos sobre assuntos que desconhecem. O argumento é muito simples: os alunos aprenderam? Tiraram boas notas na prova? Então, o curso é bom. Se consegue resultados sem doutores, qual é o problema? Na verdade, não há correlação entre tais indicadores e o que os alunos aprendem. O que o indicador composto (IGC) faz é tão somente penalizar aqueles cursos privados cujos alunos aprendem o mesmo mas não têm recursos para pagar doutores em tempo integral (cuja contribuição é incerta).
Por último, há uma diferença essencial entre o que o aluno sai sabendo e o que o curso forneceu para a sua formação (o chamado valor adicionado). Sabe-se que 80% do desempenho no Enade é estatisticamente explicado pelo que o aluno já sabia ao entrar no superior. Se o MEC quer punir cursos fracos — e deve fazê-lo —, cabe puxar as orelhas daqueles cujos alunos sabem menos porque eram fracos ao entrar? Ou dos cursos em que os alunos aprenderam pouco? Não são os mesmos! Esses breves comentários não fazem justiça à complexidade técnica do assunto. A avaliação é um instrumento precioso e é feita com boa técnica. O ensaio apenas alerta para os perigos de que ela seja mal-usada.

segunda-feira, 7 de janeiro de 2013

Educação à Distância

Melhores universidades do mundo oferecem cursos gratuitos pela internet


O professor Walter Sinnott-Armstrong, da Universidade Duke (EUA), fez uma aposta: se um terço dos alunos que começaram a assistir a suas aulas na semana passada chegar ao fim do curso, ele vai raspar e doar o cabelo a uma instituição que faz perucas para pessoas com câncer.
Baixa autoestima? Não. Apenas realismo: o curso do professor tem 166.872 estudantes. As aulas são dadas no site Coursera, que reúne 207 disciplinas de 33 universidades dos EUA, da Europa, da Ásia e do Oriente Médio --tudo de graça.

Onde quer que esteja, o aluno precisa só de um computador e de conexão banda larga. Depois de se cadastrar, assiste às aulas em vídeo, lê textos e resolve provas. No fim, recebe um certificado.
O Coursera é a maior, mas não a única iniciativa do tipo. Das dez melhores universidades do mundo segundo o ranking Times Higher Education, todas têm conteúdo gratuito on-line. Delas, seis têm disciplinas inteiras.
O site reúne a Universidade Harvard, o MIT (Instituto de Tecnologia de Massachusetts), a Universidade da Califórnia em Berkeley e a Universidade do Texas com esse mesmo propósito.
A ideia de boa educação superior ao alcance de todos ganhou corpo em 2012 com o conceito de Mooc, sigla que em inglês significa "cursos abertos on-line em massa".
Também entra nesse grupo o iTunes U, iniciativa da Apple que permite baixar, no iTunes, palestras e seminários universitários, de graça. 

"A principal diferença entre os meus alunos da universidade e os on-line é a independência", diz Sinnott-Armstrong à Folha, por telefone. "Como minha disciplina na web possui um fórum, sinto que posso sentar e apenas vê-los se ajudarem."
Estudioso da epistemologia, ramo da filosofia que investiga a origem e a natureza do conhecimento, ele oferece a disciplina Pense Novamente: Como Raciocinar e Argumentar, a maior em número de alunos no Coursera, lançado em abril.
As universidades americanas não foram as únicas a abrir seus cursos na internet. Escolher aulas oferecidas por instituições de outras partes do mundo é, também, uma forma de ter contato com as respectivas culturas.
A Escola Federal Politécnica de Lausanne (Suíça), presente no Coursera, oferece uma disciplina completa em francês.
Outro exemplo é a disciplina Uma Nova História para uma Nova China, oferecida em inglês pela Universidade de Hong Kong.
No iTunes U, cinco instituições lusas, incluindo a renomada Universidade de Coimbra, têm vídeos de palestras e seminários em português. 

Nas maiores plataformas de Mooc que existem atualmente, há prevalência de cursos das carreiras de exatas. Vários fatores podem explicar esse fenômeno.
"Estudantes de exatas têm naturalmente mais contato com línguas estrangeiras", diz Pollyana Mustaro, doutora em educação pela USP. Com aulas em inglês, estar acostumado ao idioma é essencial, argumenta.
Já Sinnott-Armstrong especula três motivos para haver mais cursos de exatas.
Primeiro, alunos de áreas como ciência da computação estão mais acostumados ao uso de tecnologia. Segundo, é mais fácil aplicar provas on-line com respostas mensuráveis que pedir textos ao aluno, situação comum em humanas. Terceiro, vários cursos de humanas se baseiam em debates em sala de aula.

sexta-feira, 4 de janeiro de 2013

Informação em Saúde

Online encyclopedia provides free health info for all
Within a decade, Wikipedia has become one of the most popular health-content web sites in the world. James Heilman talks to Fiona Fleck about how the once free-wheeling website is moving closer to a formal publication model.

Q: How have the health and medical articles evolved since Wikipedia was established?
A: Wikipedia was started in 2001 by a group of volunteers interested in sharing knowledge and had some health-care content from the start. The medical side of things was more formally organized in 2004, when internist Dr Jacob Wolff, who is based in the United Kingdom, started Wikiproject Medicine. I joined the project in 2007. Wikipedia is trying to summarize all human knowledge, which includes health knowledge. Most topics are covered and, if one is not, users can create it – as long as they provide suitable references. Wikipedia’s medical and health content is driven by its editors and what they are interested in.

Q: How did you become so involved in editing health-care content?
A: We work hard to ensure that Wikipedia’s content is accurate and up to date. With the open editing platform, we can donate as much or as little time as we like, and we encourage other volunteers to join us. I personally became involved when I found some poor quality content and realized that I, myself, could fix it. Later on, when I realized what a key source of public health information Wikipedia had become, I became even more involved.

Q: What have you and your colleagues built up in these eight years in terms of health-care content?
A: Wikipedia’s health-care content is made up of about 25 000 articles in English and this content is viewed about 200 million times a month. The articles range from a few hundred to more than 10 000 words in length. Wikipedia is currently the most used online health-care resource globally, as measured by page view and by unique visitors, and is used extensively by professionals and the lay public alike. It is the web site most used by medical students except for Google and it is consulted by most practising physicians in the developed world.

Q: You have amassed a vast body of work that is clearly useful, but you yourselves admit that the quality is “hit and miss.” What are you doing to address this?
A: We have several efforts to improve the quality of the content. As part of one of those, we have selected 80 articles in English, each covering core health or medical topics, and we are working to raise these up to a professional standard. This work is followed by a semi-formal peer review by volunteers – so far we have completed 20 articles – and, finally, translation into as many other languages as possible in collaboration with Translators Without Borders. We have already begun translation into more than 30 languages and hope that we can eventually translate this content into all of the 285 languages in which Wikipedia exists. Some of our 80 core articles are also going through a more formal peer-review process via Open Medicine, our open-access journal partner. This means that some of the content will be indexed in PubMed and there will be opportunities for the authors to get formal recognition. If put together as a textbook, these 80 articles, would run to about 2000 pages. While Wikipedia contains much content supported by the Cochrane Collaboration, we are developing a mechanism to update this in a timely fashion. Several editors are also working to persuade more health-care professionals to join us in our efforts.

Q: How did you select these 80 core topics?
A: We rank our articles by quality and importance. We have four levels of importance − low, middle, high and top importance − and there are criteria for each category. For an article to be of top importance, the content must be of global interest, covering a health condition that causes high morbidity and/or mortality. We are currently working to improve the quality of these 80 articles of top importance, to eventually give them “good article” status. That means they must undergo a semi-formal peer review and pass certain quality criteria involving accuracy, scope and referencing.

Q: What’s the difference between Wikipedia and other encyclopedias? What is its added value, apart from being free and online?
A: One of the benefits of Wikipedia is that it’s easy to access and update. Print-based encyclopedias are often years out of date and can take a long time to correct. Some online resources have excessive advertising and there are reasonable concerns that this can introduce bias into their articles. Other online sources charge membership fees. And, of course, no resource is available in as many languages as Wikipedia.

Q: Have you ever considered taking advertising?
A: Many claim that they can maintain neutrality in editorial content while running advertisements, but we doubt whether this is possible and we don’t want to take that risk. Many people rightly recognize the effect of advertising and this is one reason why we are so widely read.

Q: You mentioned the importance of good references, what is your policy on these?
A: Before 2007, references were recommended but not strictly required. Since then, there has been a push to increase referencing. Those of us who deal with medical subject matter prefer secondary over primary sources because reviews, insofar as they summarize the primary literature, provide a more comprehensive understanding of a given topic than primary sources. They are, therefore, more in tune with our efforts to portray the most current state of knowledge on a topic. As an encyclopedia written by contributors, most of whom are anonymous, Wikipedia is now extremely densely referenced. Added text must stand entirely on its sources rather than on the expertise of the contributor. Thus, it is very much an evidence-based effort.

Q: How do you do due diligence on anonymous contributors?
A: There are arguments in favour of and against the anonymity of Wikipedia editors. Some feel that no one should use his or her real identity because the idea is to create an encyclopedia based exclusively on sources. Even when people do use their real names, we, as an organization, have no method for verifying that contributors are who they say they are. A few years ago, an editor claimed he was a religious studies professor. It turned out to be a fabrication. We have nearly 18 million registered editors and many more anonymous ones. We do not have the resources to verify each one’s identity and prefer to concentrate our efforts on writing an encyclopedia. Text, thus, must be supported by creditable references. We, as a community, keep track of changes and look out for conflicts of interest. We have a dedicated group of trusted volunteers with the ability to block or ban people who cause problems. We also have mechanisms to determine from what institution some people are editing and to analyse their edits. A few years ago we caught several pharmaceutical companies removing content discussing concerns about their products.

Q: Have you identified other attempts to manipulate the contents of Wikipedia?
A: Yes, an employee from Savient Pharmaceuticals tried to create an article on “refractory chronic gout.” Savient Pharmaceuticals manufactures pegloticase, an intravenous medication for the treatment of this condition. The community of editors felt that the topic did not merit being treated separately from “gout” and so the article on “refractory chronic gout” was deleted and its readers were redirected to the article on gout. All Wikipedia contributors need to support what they add with creditable sources. This example shows that if references for a new disease or condition are not supported by reliable secondary sources, then the article in question will be deleted.

Q: Does all content that is backed by strong evidence merit inclusion?
A: We have policy and guidelines on this as well. What we include is ultimately based on consensus, attained through discussion on the article’s “talk page.” We have found that the number of people who want to contribute positively is far greater than those who wish to contribute nefariously. We allow everyone to edit and we assume everybody has good intentions until they prove us wrong, in which case we take preventive measures by blocking the offending party’s IP address or restricting the editing of an article to established editors. Someone once said “Wikipedia doesn’t work in theory, it only works in practice” and it’s true. Wikipedia is based on the philosophy that the majority of people have good intentions.

Q: Not every one reads in English, how are you addressing that?
A: As mentioned, we are working on a collaborative effort with Translators Without Borders to translate 80 priority English-language articles into as many other languages as possible. As this content is on Wikipedia, it is freely accessible to people who have access to the internet via a computer or a cell phone. Within this project we are concentrating on content that is of particular importance to those in the developing world and on translating it into the languages people speak in those countries. We have entered into agreements with several cell phone companies, who have agreed to allow browsing of Wikipedia content without data charges to all of their customers in Africa, the Middle East, South-East Asia and eastern Europe. Once fully rolled out, this will be of benefit to more than 200 million people. As of October 2012, rollout had started in 10 countries and is set to continue through 2012 and 2013. We are also beginning to create spoken versions of the articles, in English and other languages. English is currently the main language on Wikipedia, with more than four million articles, and is followed by German, French and Dutch each with more than one million articles.

Q: In which developing countries do you have contributors and who are they?
A: Wikipedia has contributors from all over the world. Anyone with internet access can potentially get involved. The Wikipedia Foundation is working with universities in Egypt to improve our Arabic language content. An office has recently been opened in India to get more people involved there. Many countries or regions have national chapters – we are up to 39 – that promote the Wikimedia movement locally.

Q: Tell us more about the Wikipedia Foundation.
A: The Wikimedia project is supported entirely by donations from the general public. Money is raised through an annual fundraising event every November. The organization runs on a very small budget. In 2011, the budget was about US$ 20 million and had come from more than one million individuals. This money primarily goes towards paying for band width, keeping the servers running, and improving the underlying software. The development and maintenance of the content itself is done entirely by volunteers.