”I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.—Modern Hippocratic Oath, Lasagna, 1964
- WikiMSK (wikimsk.org) was founded in June 2020 by myself, Jeremy Steinberg, leveraging on the knowledge gained over the years in software development and systems administration.
- The aim of this wiki is to produce an accurate, readable, reliable, accessible, and up-to-date repository of knowledge for the practice of Musculoskeletal Medicine in New Zealand.
- Rather than a dropbox style "document dump," (although it can be used that way) the aim is to have individually written articles that discuss key MSK topics (with references), a la the white papers but for the modern era, and modern doctors.
- Most content is open access, except for the training portal (read below). Being open stands in contrast to other Musculoskeletal resources which exist in knowledge silos.
- Content is based off Musculoskeletal Medicine textbooks, journal articles, uptodate.com articles, regional pathways, other online resources, and exemplary NZAMM member presentations (with permission when required if not paraphrasing).
- Only NZAMM members are eligible for accounts, and account creation is managed by the administrator.
- I am happy to give personal tutorials on how to use the wiki, or live demonstrations. There is also a full user guide.
- I recognise that this is an ambitious project but in a couple of years I predict that it will be something that the association will be proud of.
- The wiki is free. It runs on secure opensource software on a local Auckland secure server.
- Backups are done automatically every day for free, and offsite copies are held.
- There is no added cost for each additional user.
- If the website became too large then a server upgrade may be required, this would be at a cost of around $30 a month. The current server storage capacity is ~15GB
- The software is MediaWiki, and has been customised to suit the purposes of the goals of WikIMSK. MediaWiki is the software used by Wikipedia.
- I have done several hours of research on website hierarchy, drawing from many medical and non-medical wikis that I thought were exemplary, as well as drawing from the literature on wiki construction and maintenance in medical education.
- Articles may be on any Musculoskeletal Medicine topic. I will use Lateral Elbow Tendinopathy as an example. But they can also be on procedures, examination, concepts, specific papers, or anything.
- Articles are placed into one or more Categories to allow ease of browsing and search. Lateral Elbow Tendinopathy is is the Elbow and Forearm Category, as well as the Tendinopathies Category.
- Categories are placed into Portals. The Elbow and Forearm Category is placed into the Topics by region portal, The Tendinopathies Category is placed into the Topics by concept portal
- A dropbox or onenote type product only allows you to place a particular file in one particular folder. A wiki allows the file to be in as many areas as you want. This makes content discovery much more natural.
- The software works as "write it once," using something called templates. The example article takes information from a template that has the differential diagnosis of ankle pain. In this way multiple articles can integrate this information and you only have to write it once.
The full list of portals are below:
Most portals are fairly self-explanatory.
- Regions: Articles categorised by body region
- Concepts: Articles categorised by concept
- Procedures: Articles categorised by procedure
- DDX: Differential diagnosis checklists.
- Cases: Case history section. Problem based learning is an effective modern education method.
- EBQ: Evidence based questions. This is an area for the systematic analysis of key MSK papers.
- Links: Useful external resources
- Training: The only closed off section of the website, specifically for trainees.
- Any article can be made private. It can be locked to one users, or a group of users.
- The Training Portal has content mainly around exam preparation and access is only allowed for NZAMM trainees and fellows. This section can be used for many purposes. For example storing links to recorded zoom lectures, or uploading material where permission has only been granted for NZAMM members to access.
- The table below outlines the privileges of each user type
- See also: WikiMSK:Peer Review Process
Articles go through quality improvement stages:
- Stub: basically a dump of information or limited information. Indicated by a quarter circle at the top right of the article ◔
- Partial. Most of the structure and content is present. Indicated by a half circle ◒
- Complete. Thought to be complete but not peer reviewed. Indicated by a three quarter circle ◕
- Peer reviewed. Indicates that the article has been peer reviewed by a fellow or other relevant expert. Indicated by a full green circle, and says the reviewer and date of review if you hover over the icon, as well as a box at the top of the article ⬤
Every change to an article is saved in the history section of the article which makes peer review much simpler.
With nonmainstream topics a warning can be placed at the top of an article.
Advantages and Disadvantages
Rasmusen summarised the potential benefits and drawbacks to the use of a wiki in medical education, and is summarised below. There are many examples of the successful use of wikis in undergraduate and postgraduate medical education.
|Knowledge Construction||Setup and Preparation|
|Collaborative Learning||Acceptability and Engagement|
|Social Learning||Challenges to Collaboration|
|Engagement and Ownership||Need for Oversight|
|Peer Feedback||Issues relating to Hierarchy|
There are many other advantages to a wiki. Some of them:
- Free open access (except for training portal), helping other professionals in particular GPs
- Integration of multimedia tools like the Quiz software, videos, and more.
- Infinitely customisable, especially as I am systems administrator, software developer, editor, and writer.
- Designed to be quick to access information when required at work.
- The software has been around since 2002. It is very robust and very easy to find out how to do basically anything you want.
- It is basically impossible to break anything. Changes can be easily reverted.
- Powerful search. For example it searches within articles.
- Designed to be printable, either to paper or to PDF.
There are already wikis for Physiotherapy, Orthopaedic Surgery, Radiology, and Emergency Medicine, but this is the first for Musculoskeletal Medicine. There are also HealthPathways but there are only a limited number of Musculoskeletal Medicine articles, they are written for primary care only, and are not open access.
- An optional core module for training. In my view, many of the learning objectives of the Musculoskeletal Medicine Training program are covered by becoming involved with WikiMSK in writing and reviewing articles. You can track user involvement via a scoring system. The WikEM emergency medicine wiki provides up to 20 hours of credit for involvement in their wiki as an EM trainee. They count 0.5 points as equivalent to one hour, see here.
- The following are on the wish-list and require hiring a professional mediawiki developer and therefore donations.
- Install Citoid, a program that automatically generates reference data from a DOI, ISBN, PMID, or URL.
- Build a central dashboard for easier monitoring of the peer review process of articles like what eyewiki have done.
- Hire a professional develop to build an MRI image viewer so the user can scroll through the scan like what radiopaedia have done.
- Development of an Android and iOS mobile app
- In the event of a very large donation, then building something akin to the human diagnosis project but within WikiMSK in the case histories portal.
- The following requires an upgraded server
- Installing cirrus search, a more powerful search engine
- Possibly required with Citoid (see above)
- File:WikiMSK Presentation.pptx - presentation on wikimsk
- Rasmussen A, Lewis M, White J. The application of wiki technology in medical education.Med Teach. 2013;35(2):109-114. doi:10.3109/0142159X.2012.733838.