Is Medical Education Ready for Universal Open Access to Research?

Given the potential benefits of open access for, among other things, increasing the reliance on evidence-based medicine and engaging patients in informed decision-making, it is not too early to consider the implications for medical education.

As teachers and educational researchers, our contribution to such considerations has been to study the points and basis of access for physicians and the public. For example, would physicians have the time and interest to access biomedical literature if it was fully open access? In one study, 336 physicians were provided free access to the literature through Stanford University libraries for a year.⁴  While two-thirds of the participants did not access a research article over that year (with some attributing this to a lack of reminders or promotion of the service), one-third viewed 1 article a week, on average, for purposes that ranged from assisting with clinical care to educating fellow physicians. Some reported withdrawal symptoms when the access ended; others informed us of how, prior to this study, they had been deterred from consulting research by encountering a paywall. The results suggested that physicians need to be informed of their growing access to research, and guidance on how to skillfully and effectively use this access should be added to their training. Building expectations of access to this work will support its realization, while providing guidance on its use will result in better medical education and better informed medical practices.

The news media will also play a key role in this new access, with health journalists quickly providing links to new breakthrough medical studies, which are now increasingly available to readers.⁵  This means that research is going to become a greater part of a physician's daily life. New research findings currently have a growing presence on Twitter and Facebook.⁶  Even for those who do their best to avoid social media, in 2030 there will be enhanced access, whether through physician interactions with patients and their families or with other health care professionals. These future changes highlight the need to prepare physicians to play an informed and critical role and to take advantage of open access to new developments in medicine and medical education.

Then there is Wikipedia. While some may shudder, it is notable that since 2004, the WikiProject Medicine group, led by James Heilman, MD (username: Doc James), has devoted itself to ensuring that the encyclopedia's entries on health and medical issues are well structured and have referenced sources.⁷  A growing proportion of the literature that these entries cite is freely available. Some Wikipedia health-related entries may receive negative reviews,⁸  and others are assessed positively,⁹  but the evidence of Wikipedia use by medical students, residents, and physicians is unequivocal.^10–12 

Given the value of Wikipedia to physicians, one approach to improving its educational contribution will be to provide physicians with the means to learn more about this resource. Our own work has focused on understanding how to foster a gateway approach to professionals' use of Wikipedia by encouraging them to delve into the cited sources.¹³  And some medical education courses introduce students to the editing and critical appraisal of Wikipedia health articles.^14,15  The goal is to further develop this public resource as a shared health benefit, while giving students a sense of how new medical knowledge is built through the accumulation and review of new studies. This approach has the added bonus of increasing students' familiarity with the structure and nature of the increasingly available biomedical literature that may benefit their patients.

In 2030, physicians will also be more conversant with federal initiatives such as ClinicalTrials.gov, which allows physicians and the public to learn about, and potentially qualify to participate in, randomized clinical trials. One can track the various stages of a trial, as well as follow up on published study results.

In 2030, medical educators will also be more familiar with publicly accessible resources for use in clinical learning environments. For example, MedEdPORTAL, an online journal sponsored by the Association of American Medical Colleges, provides open access to hundreds of ready-to-implement teaching and assessment articles. Additionally, for their own professional development, physicians will be conversant with the FOAM (Free Open Access Medical education) movement and its tagline: “Medical education for anyone, anywhere, anytime.” It provides a wealth of freely available content in the form of blogs, podcasts, text documents, and tweets.¹⁶  Currently, there is a movement to translate this information into synthetic and evaluative podcasts, such as KeyLIME; these formats may become the main source of information for medical trainees and physicians in 2030.¹⁷ 

In becoming conversant with this research literature and its varying forms, physicians will need to develop an understanding of its nature and structure, from PubMed indexing to the National Center for Biotechnology Information Bookshelf, from systematic reviews to meta-analysis. With the opening up of the research literature and universal access for physicians, trainees, and patients, new forms of learning and new points of inquiry and reflection will become available. We can imagine that by 2030 medical trainees and their educators will be keenly engaged with a new level of public discourse about—and support for—new medical developments and sources of evidence-based practices. In our role as educators, we see this as both an opportunity and responsibility. We are inspired in this work by the potential gains in health care, health understanding, and health education to be achieved as biomedical research, and other forms of research and scholarship, become a greater part of the public sphere.