With the proliferation of online medical information, educators and students alike struggle to discern the legitimacy of “e-health” sources.1 Wikipedia, a crowdsourced online encyclopedia, is frequently utilized as a “starting [point] for locating information” despite its perceived lower quality and reliability compared with peer-reviewed sources.2 In fact, 94% of medical students surveyed in 2012 reported using Wikipedia, describing its articles as “easy to access…and understand.”3

Addressing concerns from health professors less familiar with digital resources, Jennifer Meka, PhD, of the Penn State College of Medicine in Hershey, Pennsylvania, developed a framework for incorporating online content into medical education.4

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Marc Prensky coined the terms “digital natives” and “digital immigrants” to describe individuals who were born into the “digital era” and individuals who were not, respectively.5 To properly educate, Mr Prensky asserts, educators must “learn to communicate [with] their students” who are digital natives.5 That is, educators must accommodate and regulate students’ use of online materials.

Wikipedia, as a crowdsourced website, is vulnerable to serious errors and thus should be navigated with care. Several studies have investigated the accuracy of Wikipedia. A 2005 study published in Nature compared the accuracy of scientific articles in Wikipedia with those in Encyclopedia Birtannica.6 However, an additional review conducted in 2011 found “mixed results.”6  

Even so, medical entries on Wikipedia remain a leading resource, amassing 4.88 billion crowdsourced pageviews in 2013 alone.7 In addition, 1 study even suggested that Wikipedia “[complements]…the traditional journal system,” in that scientific articles referenced by Wikipedia receive more citations.8 It is clear that despite reservations about scientific accuracy, Wikipedia is frequently utilized by medical students and may even influence the medical research community itself.

As such, researchers developed the Technological Pedagogical Content Knowledge (TPACK) framework to guide educators in “[teaching] effectively with technology.”9 TPACK expands on the teachings of Lee Shulman, who emphasized the necessity of “contextual understanding”10 for educators; in this case, medical professors must be aware that medical learning now occurs in the digital era.

Per TPACK, educators must demonstrate 3 primary forms of knowledge: content knowledge, pedagogical knowledge, and technological knowledge. Through effective utilization of the TPACK framework, educators provide an “optimal learning experience” for digital natives by teaching students to be discerning about online resources. Under TPACK, content knowledge and pedagogical knowledge each reflect standard tenets of teaching; content knowledge comprises understanding of “concepts, theories, ideas” and understanding of their acquisition.11 In a  similar fashion, pedagogical knowledge refers to the understanding of the “materials, programs, and resources” that comprise the curriculum.11 As an addendum, the investigators have added technological knowledge, an understanding of how to productively utilize information technology.9 Educators must understand their students’ preferences and needs, specifically the widespread use of Wikipedia and similar sources. By becoming educated on the same online resources utilized by students, educators can effectively provide guidelines and assistance.

Educators must teach students to effectively weigh evidence and make educated decisions, be they in the clinic or performing a resource scan on Wikipedia. Open communication regarding the reliability of these sources is paramount to a proper medical education in the digital era.


  1. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20.
  2. Judd T, Kennedy G. Expediency-based practice? Medical students’ reliance on Google and Wikipedia for biomedical inquiries. Br J Educ Technol. 2011;42(2):351-360.
  3. Allahwala UK, Nadkarni A, Sebaratnam DF. Wikipedia use amongst medical students—new insights into the digital revolution. Med Teach. 2012:35(4):337.
  4. Meka J, Vigliotti A. Should crowdsourced, unvetted content on Wikipedia be used in health sciences teaching and learning? AMA J Ethics. 2018;20(11):E1033-1040
  5. Prensky M. Digital natives, digital immigrants. On Horiz. 2001;9(5):1-6.
  6. Giles J. Internet encyclopaedias go head to head. Nature. 2005;438(7070):900-901.
  7. Heilman JM, West AG. Wikipedia and medicine: quantifying readership, editors, and the significance of natural language. J Med Internet Res. 2015;17(3):e62.
  8. Thompson N, Douglas H. Science is shaped by Wikipedia: evidence from a randomized control trial. MIT Sloan School of Management research paper 5238-17. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3039505. Published September 20, 2017. Updated February 19, 2018. Accessed December 3, 2018.
  9. Koehler M. TPACK explained [What is TPACK? tab on TPACK website]. http://tpack.org/. Published September 24, 2012. Accessed December 3, 2018.
  10. Shulman LS. Knowledge and teaching: foundations of the new reform. Harv Educ Rev. 1987;57(1):1-21.
  11. Koehler MJ, Mishra P. What is technological pedagogical content knowledge? Contemp Issues Technol Teach Educ. 2009;9(1):60-70.