# WikiJournal Preprints/Use of Wikipedia at university as a resource of active health teaching methodology and scientific dissemination

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## Article information

Authors: Maria Julia Gobbi Volpe  , Eliene Silva Araujo  , Maria Julia Ferreira Cardoso  , Alexandre Alberto Pascotto Montilha  , Hector Gabriel Corrale Matos  , Katia de Freitas Alvarenga  , Lilian Cássia Bórnia Jacob
* ↑ Univertiy of São Paulo, Bauru, Brazil
* ↑ Federal University of Rio Grande do Norte, Natal, Brazil
* ↑ University of São Paulo, Bauru, Brazil
* ↑ University of São Paulo, Bauru, Brazil
* ↑ University of São Paulo, Bauru, Brazil
* ↑ University of São Paulo, Bauru, Brazil
* ↑ University of São Paulo, Bauru, Brazil
* ↑ mariajuliavolpe@usp.br

## Introduction

Launched on January 15, 2001, Wikipedia is a free, collaborative, and multilingual encyclopedia managed by the Wikimedia Foundation. It advocates for global empowerment and participation in creating educational content available online under open commons licenses and in the public domain, with the goal of promoting widespread sharing. Given that the platform is the largest and most popular general reference work on the internet, it presents the possibility of being adopted in university education. By using Wikipedia to create content grounded in scientific evidence, students engage in an active and participatory teaching methodology, positioning themselves as active agents in their own learning process. They feel empowered with certain knowledge, allowing them to develop a sense of identity and pass it on to others.
The active approach involves greater engagement, dedication, and, consequently, responsibility from students in the process of knowledge construction. It also encourages collective work through access to an expanded discussion environment. This leads to improved comprehension of the explored content, as well as the development of communication skills, which are essential for healthcare professionals. Furthermore, the platform is widely consulted, with its information accessed by millions of users, particularly in the fields of science and health, by both the general public and professionals in these areas.
As health-related topics receive significant and growing attention in online searches, these resources can be leveraged to reach the public. In this context, the democratization of scientific knowledge comes into focus, allowing it to reach diverse segments of the population and empowering them, as information becomes accessible for societal use. Scientific literacy is recognized as a tool for improving quality of life. Consequently, scientific dissemination is increasingly viewed as both a tool and a social movement, fostering citizenship and enhancing the health of diverse groups. Thus, the overarching objective was to analyze scientific production between 2015 and 2020 regarding Wikipedia as a tool for active teaching methodologies in health and scientific dissemination.

## Materials and Methods

A scoping review was conducted in September 2020. This type of literature synthesis is designed to analyze different types of studies and summarize the available evidence on a topic of interest. The review was structured into the following steps: (i) formulation of the guiding question and research objective; (ii) identification of studies based on the adopted research methodology; (iii) selection of studies using inclusion criteria; (iv) analysis and grouping of data; (v) synthesis of results through a qualitative evaluation of the themes in the articles, based on the research objective and question; and (vi) presentation of results through thematic analysis. The literature review was conducted using the databases available on the CAPES Journals Portal (Coordination for the Improvement of Higher Education Personnel), PubMed/MEDLINE, LILACS (Latin American and Caribbean Health Sciences Literature), and SciELO. The protocol for this review was registered on the Open Science Framework based on the proposal How to write a scoping review protocol: Guidance and template. Any methodological changes during the study will be updated on the Open Science Framework platform.
The search was guided by the following research questions: a) "What are the applications and benefits of Wikipedia in universities as a resource for active methodology in the health field?" and b) "What is Wikipedia's contribution to scientific dissemination in health?" The research questions were developed using the Population, Concept, and Context (PCC) strategy: P - population (Wikipedia in universities and Wikipedia in the health field); C - concept (contribution, application, and benefits); C - context (active methodology and scientific dissemination). In the next step, descriptors were identified using MeSH (Medical Subject Headings) and DeCS (Health Sciences Descriptors) and structured into the search strategy: “Wikipedia” AND (“Wikipedia” AND (“university” OR “health” OR “education”)). The article selection process was based on the following inclusion criteria: free full-text articles (Open Access); articles published between 2015 and 2020; and studies available in Portuguese, French, German, English, and Spanish. Duplicate references were analyzed and excluded. Subsequently, the titles and abstracts of the articles were reviewed based on the criteria and guiding questions. The articles included in the review were then grouped according to the guiding questions defined in the research scope, considering the objective and outcomes of each article. The Rayyan review software (Qatar Computing Research Institute), and the Google Sheets tool for systematizing the review process, with manual verification performed later.
A total of 1,318 articles were retrieved from the databases and added to the review software, and a total of 742 articles published between 2015 and 2020 were included, followed by the inclusion of 526 texts in English, Portuguese, and Spanish. This resulted in 386 articles selected for full reading by the authors based on the guiding questions of the literature review. The full reading of the selected studies led to the inclusion of 12 articles, which were then added to the literature review (Figure 1).

## Results and Discussion

Twelve articles were included in the literature review, with eight articles answering the question "What is the application and benefits of Wikipedia in universities as an active learning resource in the health field?" and four articles answering the question "What is Wikipedia's contribution to scientific dissemination?". The categorization of the articles was based on the research questions established, as presented in Table 1 and Table 2, regarding the title, publication year, objective, and outcome of the articles.
Table 1: Outcomes related to the guiding question: What is the application and benefits of Wikipedia in universities as an active learning resource in the health field? :
| | Wikipedia Education Program in higher education settings |
| Objective | Present a comparative view of the efforts and results achieved by the Wikipedia Education Program, working with higher education institutions, identifying challenges and similar solutions in implementing Wikipedia projects in academic settings. |
| Outcomes | Feedback was received from the professor and the Wikipedia community. This led to an increase in the number of students who re-edited their assignments. Wikipedia can be a resource for critical assessment and content improvement, enabling students to assess consensus, generate constructive feedback, and collaborate based on reliable sources. It forms new generations of networked learners. Furthermore, students reported greater motivation to engage in formative assessment activities when their contributions receive measurable exposure, knowing the real and quantifiable audience. |
| Wikipedia as a reference information source: evaluation and perspectives ||
| Objective | What supports the acceptance of Wikipedia in forums such as elite scientific journals? |
| Outcomes | Editing Wikipedia is an excellent way to fulfill public participation responsibilities and share knowledge. The use of Wikipedia in the university classroom is encouraged by several authors. |
| Uses, perceptions, and evaluations of Wikipedia by university professors ||
| Objective | To understand the uses, perceptions, and evaluations of Wikipedia through a survey of university professors, developing a typology and usage profiles of the tool. |
| Outcomes | There are advantages to using Wikipedia in academic activities at the university, particularly in teaching. As an educational resource, collaborative work stands out. Through article editing, it contributes to writing skills, analysis, and academic performance. |
| Improving the Quality of Consumer Health Information on Wikipedia: Case Series ||
| Objective | Enhance Wikipedia's health pages using current high-quality research findings and track the persistence of these edits and the number of page views after the changes to evaluate the initiative's impact. |
| Outcomes | Taking on the role of Wikipedia editor required students to gather and synthesize current, evidence-based information, promoting learning. |
| Pharmacy students can improve access to quality medicines information by editing Wikipedia articles ||
| Objective | Expand the traditional approach of pharmacy training programs by requiring students to improve medication information pages on Wikipedia. |
| Outcomes | Editing Wikipedia allows students to demonstrate their skills in research and in conveying information about medications. Through this experience, students come to view the platform in a more informed and critical way. |
| Wikipedia as a gateway to biomedical research: The relative distribution and use of citations in the English Wikipedia ||
| Objective | Establish benchmark parameters for the relative distribution and click-through rate of citations—as indicated by the presence of a Digital Object Identifier (DOI)—on Wikipedia, with a focus on medical citations. |
| Outcomes | The introduction of continuous teaching strategies in undergraduate and medical and health education should address the value of consulting citations as a tool to enhance learning. For example, at the University of California, San Francisco, the School of Medicine offers training for students to edit and critically evaluate Wikipedia. |
| The 5th ISCB Wikipedia Competition: Coming to a Classroom Near You? ||
| Objective | Show the 5th International Society for Computational Biology competition on Wikipedia. |
| Outcomes | The use of competitions in courses, involving contributions to Wikipedia in the classroom, was considered a success. Unlike traditional classes, by contributing to Wikipedia, students' work becomes available to the public and future researchers. The competition also provides an opportunity to develop effective communication skills with diverse audiences and to work effectively as part of a team. |
| Why Medical Schools Should Embrace Wikipedia: Final-Year Medical Student Contributions to Wikipedia Articles for Academic Credit at One School ||
| Objective | Assess the impact of edits made by fourth-year medical students on Wikipedia content, as well as the effects of the course on both the participants and the readers of the articles selected by the students. |
| Outcomes | The students reported challenges in addressing the general public and the professional medical audience. They found the collaborative nature of the work to be a challenge, as it often required a willingness to re-edit; however, these challenges were mitigated by the perception of the usefulness and potential global significance of their contributions. Additionally, they developed their skills as health educators and completed the course with an expanded understanding of their professional responsibilities. They gained practical experience in explaining health information in an accessible manner to the general public, which they found rewarding. |
Table 2: Outcomes related to the guiding question: What is Wikipedia's contribution to scientific dissemination? :
| The Most Influential Medical Journals According to Wikipedia: Quantitative Analysis ||
| Objective | Determine the ranking of the most cited journals based on their representation in English-language medical pages on Wikipedia. Assess the number of days between the publication of journal articles and their citation on the platform (information dissemination). |
| Outcomes | The time between the publication of a journal article and its mention on Wikipedia has decreased substantially since the platform's inception. Evidence of "presentism" (a preference for citing recently published articles) was found. High-impact traditional medical and multidisciplinary journals were highly cited by Wikipedia, suggesting that Wikipedia's medical articles have solid foundations. This allows the inclusion of general science and health journals and serves as an alternative, if not more reliable, measure of a journal's impact on public knowledge, based on decisions made by the self-governing, peer-production community. |
| Wikipedia and medicine: quantifying readership, editors, and the significance of natural language ||
| Objective | Quantify the production and consumption of medical content on Wikipedia across four dimensions: 1. Articles and bytes; 2. Citations supporting the content; 3. Analysis of medical readers compared to other health websites; 4. Characteristics of medical contributors to Wikipedia. |
| Outcomes | By the end of 2013, Wikipedia's medical content encompassed over 155,000 articles and 1 billion bytes of text in more than 255 languages (or 1016 MB), representing a 10.19% increase from the previous year (922 MB). The content was supported by over 950,000 references from journals respected by the scientific community. Health articles were viewed more than 4.9 billion times annually on non-mobile devices (with inclusive estimates for mobile devices reaching 6.5 billion). This makes it one of the most viewed medical resources in the world. Since 2010, the number of academic articles in health sciences citing Wikipedia has increased substantially. |
| Improving the Quality of Consumer Health Information on Wikipedia: Case Series ||
| Objective | To improve Wikipedia health pages by incorporating high-quality, up-to-date research findings and monitoring the persistence of these edits along with the number of page views to evaluate the initiative's impact. |
| Outcomes | The reach and potential of the Internet to improve the health of individuals and populations should be recognized by healthcare professionals as a tool for enhancing the quality and equity of healthcare services. Wikipedia facilitates the dissemination of a large volume of high-quality information to broad segments of the population. Wikipedia's standards require the inclusion of citations, a practice that other health information sources on the internet do not always follow. The Wikipedia model can streamline the translation of research into practice. |
| Pharmacy students can improve access to quality medicines information by editing Wikipedia articles ||
| Objective | Expand the traditional approach of pharmacy training programs by engaging students in improving medication information pages published on Wikipedia. |
| Outcomes | Wikipedia is frequently used by students, healthcare professionals, and patients to quickly access information and enables the sharing of medical knowledge in a way that is accessible to the public. Encouraging students to improve health content on Wikipedia not only benefits the users of the pages but also helps the students develop skills in communicating information to the public. |

### Application and benefits of Wikipedia in universities as an active learning resource in the health field

There is agreement that Wikipedia can be used in universities as an active learning resource in the health field through student edits to entries. This strategy allows for the development of research skills, writing, analysis, and improved academic performance through collaborative work as part of a team, and by exploring the practice of consensus. Furthermore, this exercise can introduce students to or expand their experience with the practice of peer review in an amplified, public review process. The work encourages the collection and synthesis of the most relevant current information for subsequent editing, thereby promoting learning on the subject . The platform's updating requires critical evaluation in the selection of sources, data, and changes to previous edits. This also fosters a sense of agency, where greater motivation is achieved through fulfilling social participation responsibilities, coupled with the sense of utility and importance provided by sharing knowledge with communities lacking access to other validated sources of information. The gratification reported by students in this and other formative assessment activities is attributed to measurable reach to a real audience. Not only, does the professor provide feedback to students, but also the entire Wikipedia community, leading to expanded feedback that encourages constant revisions of their work. Additionally, from concrete experiences, there is effective development of communication skills with diverse groups, ranging from the general population to the medical/professional community. In this context, editing allows students to explore and develop skills as health educators, gaining an enhanced understanding of their professional roles. Unlike traditional classes, encouraging contributions to Wikipedia means advancing in favor of current modernity and creating active, engaged, networked learners.

### Contribution of Wikipedia to scientific dissemination

The literature has highlighted the extensive reach and potential of Wikipedia as one of the top five online information sources. The medical content available on Wikipedia grew by 10.2% from 2012 to the end of 2013, with over 155,000 articles, 1 billion bytes of textual content in more than 255 languages, supported by more than 950,000 references, and over 4.9 billion views annually from computers—estimated to reach 6.5 billion when including mobile devices. As such, Wikipedia has become one of the most accessed medical resources worldwide. Increasingly, traditional scientific journals formally reference the platform, and since 2010, there has been a significant rise in citations of the encyclopedia in academic articles within the health sciences field. Additionally, the reverse is observed, as Wikipedia uses references from the most respected journals. The distinctiveness of Wikipedia compared to most other available online health information sources lies in its requirement for the inclusion of citations. These citations from high-impact medical and multidisciplinary journals also demonstrate a considerable reduction in the time between the publication of an article and its inclusion on Wikipedia. Given its broad grounding, these factors suggest that health articles in the encyclopedia correspond to quality content with solid foundations. Furthermore, they constitute an important resource for enhancing the visibility of major journals in the public domain through peer production.

### Recognition by the scientific community

The recognition of Wikipedia’s contribution to knowledge dissemination can also be observed through its inclusion in the analysis of new bibliometric indicators, which aim to address the gaps of the traditional "impact factor." The traditional impact factor has several limitations, one of which is that articles published in high-impact journals but receiving few citations benefit from the quality of more cited articles, potentially leading to a misjudgment of the relevance and quality of the work. New metrics measure the individual impact of a scientific article through the number of citations that encompass social networks in their search, in addition to accounting for traditional sources. The mention of an article in a Wikipedia entry is included and counted in the impact assessment of new systems. These systems allow researchers to discover the reach of studies on the web, at a time when increasingly, these informal social media platforms facilitate and accelerate information exchange in the academic world. It is important to note, however, that the quality and relevance of the coverage of scientific topics in Wikipedia entries may be directly or indirectly influenced by the level of involvement of area specialists. The expansion and improvement of articles in a given field or subject generally lead to an increase in views. Retaining teachers and students as active collaborators on the platform could solidify this mechanism of scientific dissemination. WikiProjects exist to facilitate contact between members of the existing community with common interests, increasing the adoption rate of new collaborators. The English Wikipedia contains nearly 2,000 WikiProjects (around 800 active), and approximately 30 of them are in the field of health. In English Wikipedia, the articles that are part of the Medicine WikiProject (the largest WikiProject in the health field) are generally more comprehensive, have a greater number of references, a higher citation index, and receive more visits when compared to articles in the rest of Wikipedia. Furthermore, readers of these pages tend to show higher engagement with the content when compared to readers of other articles, spending more time on the pages before clicking on references and checking footnotes more frequently. Thus, it is understood that Wikipedia is a strong ally in the dissemination of a vast amount of high-level knowledge to substantial segments of the population, with current and meaningful information for the public. In fact, encouraging students to improve content on Wikipedia not only benefits them individually but also contributes to the broad scientific dissemination to society.

## Conclusion

The reviewed literature allowed for answering the guiding questions of this study, demonstrating benefits for the development of academic, professional, and personal skills resulting from the incorporation of Wikipedia as an active and participatory methodological resource in health courses. Thus, these findings suggest the encouragement of editing practice on the platform, aiming at expanding learning and fulfilling social responsibilities in health education or communication. Consequently, these activities contribute to making one of the most read and accessible sources of information in the world even more accurate and comprehensive in the field, disseminating relevant knowledge supported by scientific publications to millions of people.
Acknowledgements
Acknowledgment to the São Paulo Research Foundation (FAPESP) for funding grant No. 2021/06902-2 - Wikipedia Education Program as active teaching methodology and crowdsourcing tool in hearing health.

### Competing interests

The authors declare no conflict of interest.