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Have medical journals missed the Web 2.0 roller coaster?

2012; Wiley; Volume: 24; Issue: 3 Linguagem: Inglês

10.1111/j.1742-6723.2012.01570.x

1742-6731

Andrew Buck,

Health Literacy and Information Accessibility

Access for clinicians to medical information has never been easier or faster, with the specialty of emergency medicine leading the world in the online dissemination of information to its practitioners. This has allowed those training in and practising emergency medicine to stay abreast of their field with relatively little effort. Australasian emergency physicians are among those pioneering online medical education and the use of social media. Three years ago in this journal Cadogan provided an in-depth synopsis of many of the available Web 2.0 resources that could be of use to medical professionals, and their potential utility and popularity within the rapidly growing Australasian and international emergency medicine community. Unfortunately, it appears that his call to 'get with the times' has fallen on deaf ears in the medical journal publishing world.1 Medical journals in general have been slow to adapt to the online paradigm, with few really using the vast array of social media and Web 2.0 tools for distributing journal content. Modern online business and marketing models are also scarce within the journal publishing world. Although some emergency medicine journals have adopted a range of Web 2.0 tools, such as supplemental content in online articles, real-time comments and forums, social media plug-ins, videos, podcasts and more (e.g. Annals of Emergency Medicine, Academic Emergency Medicine and the Emergency Medicine Journal), others (such as Resuscitation, the American Journal of Emergency Medicine, Canadian Journal of Emergency Medicine and this journal Emergency Medicine Australasia) have shown no signs of modernising their content. The latter journals, for instance, simply provide digitised versions of their print articles, and charge significant fees for non-subscribers to purchase individual items. Meanwhile, there is discussion around the utility of social media for scientists and researchers, as many are interested in Web 2.0 tools that will help them 'do science' rather than 'talk about science'. Some feel that journals should be helping develop these tools, for example data gathering and analysis, rather than simply promoting published material.2 Several issues have arisen as a result of the way in which modern medical information is created and the speed at which it can be accessed and distributed, particularly in the field of emergency medicine. These have direct implications for the particular niche of medical journal publishing and social media, and are discussed below. A major challenge related to social media and medical journals is the conflict between the widespread and growing support for free access to medical information by clinicians, against the need for publishers of medical journals to maintain an effective business model and maintain a profit. On the whole, medical journals seem slow to adopt the contemporary culture and methods of online distribution of information, and few, if any, are adapting to modern online business or marketing models. These might include the 'freemium' model (majority of content provided for free, premium content available at a price), alternative revenue streams (database mining, iPhoneTM[Apple, Cupertino, CA, USA] applications, advertising, niche marketing) and novel information distribution (videos, podcasts, iPadTM[Apple] or other e-book reader functionality, forums, blogs, social media applications). There are currently numerous competing free, and several paid online educational resources for emergency physicians, which leave medical journals in a precarious position. Failure to adapt to the modern information paradigm might relegate them to a redundant position, especially given the additional growing popularity of open-access journals which have adopted the 'author pays' rather than 'user pays' paradigm to make content universally available at no cost. One of the key tenets of social media is the engagement of consumers, and catering to the wants and needs of the various communities that use a particular product. Without addressing this free versus paid issue, as well as coming up with novel ways to provide consumers with useful content while maintaining an effective business model, there is little value in medical journals, including Emergency Medicine Australasia, pursuing a social media presence. What is clear is that the current production mode of medical journals, with slow approval and publishing times, infrequent distribution of hard copies to subscribers, negligible engagement with consumers, no functional online presence and no clear brand presence needs to change to meet the expectations of current and future generations of clinicians. Progress for medical journals will necessitate 'loosening the grip' on journal information, as well as introducing new methods of distributing information as a trade-off for gaining more users and increasing engagement. Given how few journals are pursuing this type of model, there is certainly scope for Emergency Medicine Australasia to participate in this evolution of the online delivery of medical journal content. Medical staff now have too much information made available to them yet cannot find the information they need when they want it – the so-called 'information paradox'.3 Information overload is experienced by many in the emergency medicine arena. With so many free online resources now available, I frequently hear colleagues at all levels say they are overwhelmed by choice, and find it hard to know which sources they should use and can trust. Clinicians also prefer information sources that 'add value'. This means summaries that provide synthesis and interpretation of literature findings. When faced with a need to know a certain medical fact, clinicians want relevant, concise, authoritative, searchable information from a credible source. Currently, the Australasian College for Emergency Medicine (ACEM) provides no online learning material designed specifically for trainees, and still recommends hard copy textbooks as references for the Primary and Fellowship exams. This places trainees and educators in a conundrum as to where they should source information. It is likely that blogs, podcasts and textbooks alike are all now the commonest sources of information for emergency medicine practitioners, with Emergency Medicine Australasia and other similar journals being a source of relatively little directly useful exam or clinical practice information. Yet, Emergency Medicine Australasia is in a unique position to take advantage of this conundrum. As a 'College endorsed' source, there is an opportunity to engage users, especially trainees, as a credible, authoritative resource, while being careful to not add to the information overload. However, simply placing more journal content online, or even increasing the amount of journal content full-text 'freeview' without social media interactivity or a clear 'value-add' with more summaries, expert comments or analysis, would be futile. Scientific papers are increasingly being critiqued publicly in blogs, TwitterTM (Twitter, San Francisco, CA, USA) and other social media outlets within hours of their publication. Although this might have the potential benefit of rapidly weeding out poor-quality research, it is proving a daunting area for researchers whose work is in the firing line. This is particularly so when unchecked and often unqualified criticism brings their work into potentially unjustified disrepute. Some journals struggle with anonymous and vexatious online comments, and need to carefully oversee and edit their discussion areas. Some solutions to this are coming from the general science community with resources, such as the Faculty of 1000 (F1000), which is a peer-nominated faculty of reviewers who identify and evaluate the most important articles in biology and medical research publications (see http://f1000.com/), and The Third Reviewer, an online journal club that provides a forum for scientists to share opinions about recently published research (see http://thirdreviewer.com/). These centralised, independent, collaborative projects help to moderate the online discussion of scientific papers, and remove much of the onus of policing comments from the journals. Other online reference managers and academic social networks, including Mendeley (http://www.mendeley.com/), CiteULike (http://www.citeulike.org/) and Zotero (http://www.zotero.org/), are aimed at helping users gather and share scientific literature. In the future new ways of assessing an article's impact are likely, with the development of metrics programs that analyse all of the online activity generated by individual articles, as well as the more traditional academic scrutiny simply based on journal article citations. Richard Smith, the Editor of the British Medical Journal from 1991 to 2004, commented on the future of medical journals in an online presentation, and suggested that although no one can predict the future, that medical journals will become paper and electronic, they will be multimedia and will include raw data and the software used to interpret them, will be 'live documents', and act as forums for debate, and will need to concentrate on meeting the needs of their readers as a community rather than authors, as well as maintaining the usual features, such as education, debate, reviews and news.4 The format of articles and how they are written also needs to change to meet the demands of the Generation Y (Millennials) and Generation Z (Internet Generation) users, who purport to have short attention spans, learn more from audio/visual content than print, and prefer poignant summaries over long-winded articles. It is not only these generations that have low tolerance for digitally inept content. Studies into the future of libraries show that those research behaviour traits that are commonly associated with younger users – impatience in search and navigation and zero tolerance for any delay in satisfying their information needs – are now becoming the norm for all age groups, from younger pupils and undergraduates to professors.5 Social media is an ideal avenue to fulfil the information needs of the various groups that use medical journal content, and so journals need to start adapting to this new information age. Given the low level of social media presence, universities, academics, researchers and medical specialty colleges, including ACEM, need to address this desire for increased medical journal social media content. However, for current and future ACEM trainees and Fellows (FACEMs), this might be overshadowed by the diverse overall range of interest, input and capability of the various related players (see Fig. 1). The social media paradigm. ACEM, Australasian College for Emergency Medicine; EMA, Emergency Medicine Australasia; FACEMs, Fellows of the Australasian College for Emergency Medicine; SM, social media. Credit should be given to ACEM for taking the first tentative steps into embracing TwitterTM and FacebookTM (Facebook, Menlo Park, CA, USA). However, the content must be engaging and serve some greater educational purpose (rather than, for example, posting of random links with no description on TwitterTM, and simple photos of College meetings on FacebookTM). No doubt, this will be improved by a more focused approach by ACEM, who this year are undertaking a major IT restructure involving a number of the College's systems and processes that include a new website and the migration to the SharePointTM 2010 platform (MicrosoftTM, Redmond, WA, USA).6 One must question the rationale for medical journals failing to adapt to the online market, when the benefits of social media are so clear and while the appetite for information from the medical community is so high. Some would argue that in the business world companies do not so much have a choice whether or not they use social media, but rather the choice is now how well they do it. Rather than being afraid of failure, modern companies need to 'fail fast, fail better and fail forward', as not taking any action in this arena relegates a company, especially one with information as its main commodity, to a non-competitive position.7 The potential benefits to educational institutions, such as ACEM, or a journal, such as Emergency Medicine Australasia, of establishing well designed social media practices that are targeted and responsive to the needs of their users are enormous, and if done well, will likely create significant positive outcomes not just to the aforementioned organisations, but more importantly to their members and readers, and most of all to their patients. However, belatedly, ACEM and Emergency Medicine Australasia need to climb on board the Web 2.0 roller coaster and indeed take the ride that Cadogan foreshadowed.1 AB is the administrator of http://www.edexam.com.au, a free website that supplies information and resources for the ACEM Fellowship Exam. He posts regularly on Twitter: @edexam.