Web 2.0, Library 2.0, Physician Learning 2.0
Authors: Thomas J. Liesegang
Journal: Ophthalmology (2007)

Initially, the Internet was a static structure with passive viewers, similar to newspapers, radio, and television. With the development of broadband connections, a major evolution took place in the way people entertain themselves, interact, and learn. Scientific communications have been enhanced as well by multimedia content and wider availability to researching physicians and interested public. Web 2.0, coined by O’Reilly (Tim O’Reilly, O’Reilly Radar blog, comment posted October 1, 2005) et al, refers to this second generation of dynamic Internet-based services and communication tools that emphasize the active or interactive online collaboration, contributing, and sharing among users in an “architecture of participation.”1O’Reilly T. What is Web 2.0: design patterns and business models for the next generation of software. Available at: http://www.oreillynet.com/pub/a/oreilly/tim/news/2005/09/30/what-is-web-20.html. Accessed May 16, 2007.Google Scholar, 2Wikipedia encyclopedia. Web 2.0. Available at: http://en.wikipedia.org/wiki/Web_2.0. Accessed May 16, 2007.Google Scholar Some features of Web 2.0 will be defined and the impact on medicine explored as the profession adapts to using these tools for education and patient care. Typically, new software releases are indicated by a version number, with full releases bearing whole numbers, such as 2.0, and partial releases possessing fractional parts, such as 2.3. Web 2.0 is not just an upgrade but a conglomeration of technologies, ideas, and approaches that represent a new way of interacting online.3Notess G.R. The terrible twos: Web 2.0, Library 2.0, and more.Online [serial online]. 2006; 30 (Available at: http://www.infotoday.com/online/may06/OnTheNet.shtml. Accessed May 16, 2007.): 40-42Google Scholar Under Web 2.0, single authority, ownership, and control are yielded to a group or community.4Giustini D. How Web 2.0 is changing medicine.BMJ. 2006; 333: 1283-1284Crossref PubMed Scopus (237) Google Scholar O’Reilly further explains these and other principles behind Web 2.0, such as “the Web as platform,” “harnessing collective intelligence,” and “rich user experiences” in his essay “What is Web 2.0.”1O’Reilly T. What is Web 2.0: design patterns and business models for the next generation of software. Available at: http://www.oreillynet.com/pub/a/oreilly/tim/news/2005/09/30/what-is-web-20.html. Accessed May 16, 2007.Google Scholar Web 2.0 technologies, termed collaborationware or collective intelligence1O’Reilly T. What is Web 2.0: design patterns and business models for the next generation of software. Available at: http://www.oreillynet.com/pub/a/oreilly/tim/news/2005/09/30/what-is-web-20.html. Accessed May 16, 2007.Google Scholar (Tim O’Reilly, O’Reilly Radar blog, comment posted October 1, 2005), are intelligent ways to share knowledge; Web 2.0 can be used to generate and distribute knowledge in the educational context via several venues such as Really Simple Syndication (RSS), wikis, audiocasts (podcasts), videocasts (vodcasts), Web logs (blogs), and search tools such as Google. Really Simple Syndication is a Web feed that constantly scans the Web and provides links to content in which one has indicated an interest or requested a periodic update (e.g., tables of contents). Doctors are using RSS feeds from medical aggregators such as MedWorm (MedWorm.com) on mobile devices such as iPods and Blackberries to scan research in the office or hospital.4Giustini D. How Web 2.0 is changing medicine.BMJ. 2006; 333: 1283-1284Crossref PubMed Scopus (237) Google Scholar Wikis—from the Hawaiian wiki, to hurry, swift—are collaborative Web sites whose content is open and can be written and edited by anyone who has access to it. A prominent example is Wikipedia, which presently has more than 1 million articles, increasing daily. Similarly, Ganfyd.org and AskDrWiki.com are online collaborative medical references edited by medical professionals and invited nonmedical experts.5AMNews. Dolan PL. Physician wikis: do-it-yourself textbooks. Available at: http://www.ama-assn.org/amednews/2007/05/07/bil20507.htm. Accessed May 16, 2007.Google Scholar Lists of medical wikis are available (http://www.davidrothman.net/list-of-medical-wikis). Podcasts and vodcasts are repositories of audio and video materials, respectively, for an audience who want to hear or view the content when and where they choose. Podcasts are already being used in medical school curricula; other examples include New England Journal of Medicine podcasts and Johns Hopkins Medicine podcasts. Blogs are Web pages that contain a series of entries by an individual or a group, presented in chronological order, and may contain text, links, photographs, and video and audio files. About 1.2 million blogs are posted each day6TechLearning. Jakes D. Professional development and Web 2.0. Available at: http://techlearning.com/showArticle.php?articleID=196604381. Accessed May 16, 2007.Google Scholar; there are many active medical blogs. Photoblogs and other social networking sites (MySpace, Facebook, YouTube) are being used for active social communication. About 55% of Americans between the ages of 12 and 17 use social networking sites for communication.7TechLearning. McLester S. Web 2.0: a guide for educators. Available at: http://www.techlearning.com/showArticle.php?articleID=196604380. Accessed May 16, 2007.Google Scholar Each person gets his or her own space to create a personal profile and connect with friends and the online community. These same platforms can be used to create metadata of digital resources for medical purposes. Mashups are hybrids in which several elements of Web 2.0, including these platforms, are combined to provide enhanced information; this holds great potential for education.8Maness J.M. Library 2.0 theory: Web 2.0 and its implications for libraries.Webology [serial online]. 2006; 3 (Available at: http://www.webology.ir/2006/v3n2/a25.html. Accessed May 16, 2007.)Google Scholar In addition to small text or visual contributions to the Web in various places, entire books can be written by amateurs, distributed, and read on the Web at minimal cost and without a traditional publisher. Web searching, topic blogs, or RSS feeds can alert potential readers to these resources.9Habib M.C. Toward Academic Library 2.0: development and application of a Library 2.0 methodology [master’s thesis]. University of North Carolina, Chapel Hill, NC2006Google Scholar Perhaps the most recognized and utilized portion of Web 2. 0 is extensive and robust search mechanisms, such as Google, used frequently for medical information by patients and physicians alike.10MacColl J. Google challenges for academic libraries.Ariadne [serial online]. 2006; 46 (Available at: http://www.ariadne.ac.uk/issue46/maccoll. Accessed May 15, 2007.)Google Scholar Google has effective indexing that permits a depth of search, although it does not necessarily provide a judicious search mechanism or the scope that authoritative medical bibliographic tools possess.10MacColl J. Google challenges for academic libraries.Ariadne [serial online]. 2006; 46 (Available at: http://www.ariadne.ac.uk/issue46/maccoll. Accessed May 15, 2007.)Google Scholar Some of the major libraries of the world (Stanford, Michigan, Harvard, New York Public Library, Oxford) have become collaborators with Google in digitizing major literary works, though not all academicians agree with these endeavors due to copyright concerns.10MacColl J. Google challenges for academic libraries.Ariadne [serial online]. 2006; 46 (Available at: http://www.ariadne.ac.uk/issue46/maccoll. Accessed May 15, 2007.)Google Scholar The business model for access to these literary works may include an online rental fee, which is counter to the open access initiative and expectations of the Google-using public. Google certainly is affordable and fairly comprehensive and, with its multilanguage versions, has been a boon to many developing countries. Google Scholar is an academically oriented search tool that provides coverage of journals, reports, meeting proceedings, e-theses, and dissertations10MacColl J. Google challenges for academic libraries.Ariadne [serial online]. 2006; 46 (Available at: http://www.ariadne.ac.uk/issue46/maccoll. Accessed May 15, 2007.)Google Scholar and is now frequently used by physicians as well as the more sophisticated public. In one study, use of Google search devices proved as effective as a PubMed search.11Tang H. Ng J.H. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study.BMJ. 2006; 333: 1143-1145Crossref PubMed Scopus (301) Google Scholar Conversely, the search mechanism used by Google Scholar is not precise, not totally revealed, and not amenable to search by subject, as it rather relies on keywords or phrases, just as Google does.10MacColl J. Google challenges for academic libraries.Ariadne [serial online]. 2006; 46 (Available at: http://www.ariadne.ac.uk/issue46/maccoll. Accessed May 15, 2007.)Google Scholar Therefore, physicians are discouraged from using Google Scholar as the sole source. Part of the success of Web 2.0 is the relief from the continual purchase of new software, because most of the programs and processes in Web 2.0 are open source and contained within the Internet programs, so they are easily available to all with Internet access. “Transparent technology” requires less technical skill on the part of the user.12Wheeler S. Kelly P. Gale K. The influence of online problem based learning on teachers’ professional practice and identity.ALT-J. 2005; 13 (http://www.informaworld.com/smpp/content∼content=a713990957∼db=all. Accessed May 16, 2007.): 125-137Crossref Google Scholar, 13Boulos M.N. Maramba I. Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education.BMC Med Educ. 2006; 6 (Available at http://www.biomedcentral.com/1472-6920/6/41. Accessed May 16, 2007.): 41Crossref PubMed Scopus (758) Google Scholar Wikis, blogs, and podcasts have the potential to enhance students’, clinicians’, and patients’ learning experiences compared with traditional teaching. Web 2.0 has a more robust platform to share knowledge and requires significantly more engagement and collaboration by the learner in these digital learning environments.14Romani J.C. Learning 2.0..Global Leapfrog Educ [serial online]. 2006; 1 (Available at: http://www.leapfroginstitute.org/journal/index.php/gle/article/view/2/2. Accessed May 16, 2007.): 7-14Google Scholar Because participation requires active cognitive reflection and construction (and competition), the experience is enriched exponentially as more people and communities become involved in generating the information. In Web 2.0, it is the users who add value and expand the value of the venue, enhancing the initial knowledge base. An advantage of these technologies is that they are available when and where the user is available (just-in-time learning). Any learning device, however, is not effective unless there is sufficient content to cover the topic or to stimulate the student. In medicine, it is imperative that the content of Web 2.0 be accurate, reliable, robust, participatory, stimulating, and monitored and protective of patient privacy issues. At this point, the use and evaluation of information in the health field is not as robust as in other areas (e.g., politics). How will medical libraries adapt? Present library resources (Library 1.0) are defined by title or subject and organized by the publishers; they exist in fragmented silos with librarians as gatekeepers rather than related to user need. This makes much of the content somewhat hidden, like a treasure to be found only with a thoughtful search assisted by a skilled librarian.15Miller P. Web 2.0: building the new library.Ariadne [serial online]. 2005; 45 (Available at: http://www.ariadne.ac.uk/issue45/miller/intro.html. Accessed May 16, 2007.)Google Scholar Library 2.0 is a direct and peripheral effect of Web 2.0.9Habib M.C. Toward Academic Library 2.0: development and application of a Library 2.0 methodology [master’s thesis]. University of North Carolina, Chapel Hill, NC2006Google Scholar Miller suggests several principles of Web 2.0, including the freeing and innovative use of data, the building of virtual applications by drawing from the present applications and data, and the participatory role of the user in whatever format the user wants to work or share.16Miller P. Coming together around Library 2.0: a focus for discussion and a call to arms.D-Lib Mag [serial online]. 2006; 12 (Available at: http://dlib.org/dlib/april06/miller/04miller.html. Accessed May 17, 2007.)Google Scholar The focus switches from the content that the library holds to the needs of the end user, who presumably might enhance the data and information. Under this system, Miller emphasizes that trust is needed that all will use the data and content appropriately.15Miller P. Web 2.0: building the new library.Ariadne [serial online]. 2005; 45 (Available at: http://www.ariadne.ac.uk/issue45/miller/intro.html. Accessed May 16, 2007.)Google Scholar Library 2.0 is a mashup of wikis, streaming media, blogs, content aggregators, instant messaging, and social networks.8Maness J.M. Library 2.0 theory: Web 2.0 and its implications for libraries.Webology [serial online]. 2006; 3 (Available at: http://www.webology.ir/2006/v3n2/a25.html. Accessed May 16, 2007.)Google Scholar Maness posits 4 attributes of Library 2.0: it is user centered, involves a multimedia experience, is socially rich, and is communally innovative.8Maness J.M. Library 2.0 theory: Web 2.0 and its implications for libraries.Webology [serial online]. 2006; 3 (Available at: http://www.webology.ir/2006/v3n2/a25.html. Accessed May 16, 2007.)Google Scholar He further states that “Library 2.0 is not about searching, but finding; not about access, but sharing. Library 2.0 recognizes that human beings do not seek and utilize information as individuals, but as communities.”8Maness J.M. Library 2.0 theory: Web 2.0 and its implications for libraries.Webology [serial online]. 2006; 3 (Available at: http://www.webology.ir/2006/v3n2/a25.html. Accessed May 16, 2007.)Google Scholar In addition to providing their standard services, libraries will adapt to assisting individuals with their expertise and content; become more visible and accessible; share resources with other libraries; and be more relevant providers of information, including expertise in the use of Web 2.0 products.16Miller P. Coming together around Library 2.0: a focus for discussion and a call to arms.D-Lib Mag [serial online]. 2006; 12 (Available at: http://dlib.org/dlib/april06/miller/04miller.html. Accessed May 17, 2007.)Google Scholar If libraries do not have these characteristics, their users will find other more responsive and relevant sources of information, even if the quality of information might be somewhat inferior.16Miller P. Coming together around Library 2.0: a focus for discussion and a call to arms.D-Lib Mag [serial online]. 2006; 12 (Available at: http://dlib.org/dlib/april06/miller/04miller.html. Accessed May 17, 2007.)Google Scholar How will medical journals adapt?17Nature Medicine 2.0.Nat Med. 2007; 13 (Available at: http://www.nature.com/nm/journal/v13/n1/pdf/nm0107-1.pdf. Accessed May 16, 2007.): 1Crossref PubMed Scopus (1) Google Scholar The Internet has already changed the business models for journals to fewer print subscriptions and a shift to institutional online subscriptions and access to journal Web sites by physicians as well as the public through PubMed, Google Scholar, blogs, and other RSS feeds. One year after its introduction, Google Scholar brought more readers to journal Web sites than PubMed.18Giustini D. How Google is changing medicine.BMJ. 2005; 331: 1487-1488Crossref PubMed Scopus (89) Google Scholar In the future, the download of articles by the public may be a dominant source of income for publishers of scientific journals. The availability of medical wikis may provide enough collective knowledge that serves as good and timely overviews of medical topics such that reviews in journals and some textbooks may no longer be necessary, especially because textbooks are not timely.17Nature Medicine 2.0.Nat Med. 2007; 13 (Available at: http://www.nature.com/nm/journal/v13/n1/pdf/nm0107-1.pdf. Accessed May 16, 2007.): 1Crossref PubMed Scopus (1) Google Scholar The authority of experts who previously wrote comprehensive reviews could be replaced by the collective knowledge of many, perhaps more clever and competing individuals.17Nature Medicine 2.0.Nat Med. 2007; 13 (Available at: http://www.nature.com/nm/journal/v13/n1/pdf/nm0107-1.pdf. Accessed May 16, 2007.): 1Crossref PubMed Scopus (1) Google Scholar An editorial in Nature Medicine argues that high profile excellent branded journals will continue to thrive because they provide information filtered by the experts, but that some journals may not be able to compete with Web 2.0 sources.17Nature Medicine 2.0.Nat Med. 2007; 13 (Available at: http://www.nature.com/nm/journal/v13/n1/pdf/nm0107-1.pdf. Accessed May 16, 2007.): 1Crossref PubMed Scopus (1) Google Scholar Even the high-impact journals, however, need to adapt to the Web 2.0 presence and continue to explore business models in this age of demand for open access. Certainly Web 2.0 has increased the expectation of more transparency and openness in medical publishing.4Giustini D. How Web 2.0 is changing medicine.BMJ. 2006; 333: 1283-1284Crossref PubMed Scopus (237) Google Scholar How will medical education adapt? Some have begun to analyze the change in medical education as a result of Web 2.0.13Boulos M.N. Maramba I. Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education.BMC Med Educ. 2006; 6 (Available at http://www.biomedcentral.com/1472-6920/6/41. Accessed May 16, 2007.): 41Crossref PubMed Scopus (758) Google Scholar, 14Romani J.C. Learning 2.0..Global Leapfrog Educ [serial online]. 2006; 1 (Available at: http://www.leapfroginstitute.org/journal/index.php/gle/article/view/2/2. Accessed May 16, 2007.): 7-14Google Scholar Encouraging the initiation of medical wikipedias, Giustini writes, “The more we use, share, and exchange information on the Web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.”4Giustini D. How Web 2.0 is changing medicine.BMJ. 2006; 333: 1283-1284Crossref PubMed Scopus (237) Google Scholar The dynamic interactive environment of Web 2.0 challenges critical thinking because many individuals (perhaps unknown to each other but nonetheless collaborating) are contributing to and impacting an important area, our health care.19Karkalis G.I. Koutsouris D.D. E-health and the Web 2.0. itab2006.2006Google Scholar Open access to journals is another part of this fabric of knowledge enhancement that is still being probed.20Liesegang T.J. Schachat A.P. Albert D.M. The Open Access initiative in scientific and biomedical publishing: fourth in the series on editorship.Am J Ophthalmol. 2005; 139: 156-167Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Clearly, libraries, journals, medical educators, and medical societies must master their approach to these Web 2.0 applications because they are already an integral part of the daily life of many, including physicians. And Web 3.0 is already on the way.21Victoria University of Wellington. Leung A. What is Web 2.0 and what could be Web 3.0? Available at: http://www.mcs.vuw.ac.nz/∼aleung/seminarBrief.pdf. Accessed May 16, 2007.Google Scholar, 22Jensen M. The new metrics of scholarly authority.Chron High Educ. 2007; 53 (Available at: http://chronicle.com/free/v53/i41/41b00601.htm. Accessed July 10, 2007.): B6Google Scholar