2010; 32: 824–829

Developing professionalism through the use ofwikis: A study with first-year undergraduatemedical students

TUNDE VARGA-ATKINS1, PETER DANGERFIELD1 & DAVID BRIGDEN2

1University of Liverpool, UK, 2Bangor University, UK

Abstract

Aim: Learning about professionalism occurs through collaboration, with peer groups being important sources of support for

students [Sandars J, Homer M, Pell G, Croker T. 2008. Web 2.0 and social software: The medical student way of e-learning.

Med Teach 14:1–5. Accessed 2008 February 14]. This study aimed to discover whether the use of wikis (collaborative websites)

could enhance medical students’ development of professionalism.

Methods: An online wiki was made available to four problem-based learning (PBL) groups, involving 32 students. Data collection

comprised a small-scale student survey and four focus groups eliciting their views about wiki use, triangulated with facilitator

interviews and wiki usage statistics.

Results: Several factors affected individual student and group engagement with wikis, such as positive group dynamics. Students

shared web links, helping clarify PBL discussions and increase their confidence.

Conclusions: Two main benefits of using wikis for the development of professionalism with medical students were revealed.

First, wikis acted as a shared knowledge base for hard-to-find resources on professionalism. Second, it was precisely when

students reflected on the difference between interacting in wikis and their online social spaces, or when they considered whether

or not to post a resource that their sense of professionalism emerged.

Introduction

The development of professionalism is important in the

current UK healthcare context. The University of Liverpool

follows the General Medical Council (GMC 2001, 2003, 2008)

professional standards, relating to professionalism both as a

practising doctor as well as an undergraduate student in a

longitudinal theme followed throughout the course

(Professional and Personal Development, PPD). This refers,

in this article, to individuals possessing the knowledge and

skills that enable them to join the medical profession as well as

demonstrating a high standard of work ethics, behaviour and

attitude. Olckers et al. (2007) identify three areas of develop-

ment of professional, namely, emphatic, knowledgeable and

reflection. Wagner et al. (2007) further argue that this is ‘about

the acquisition of a new identity in life – an identity as a doctor,

a medical professional, with all the rights and responsibilities

that that entails’. Coulehan (2005) highlights three identity

types that professionals can display (technical, non-reflective,

compassionate and responsive). In this sense, the developing

professional identity is a social identity as the ways others see

the developing professional, intertwined with other aspects of

identity (‘the private notion of who they are’; Watson 2002).

The public and the private aspects of identity, inform one

another as both develop and emerge through interactions with

others (Watson 2002).

This process can be problematic, illustrated by reports of

medical students who post unprofessional content on social

networking sites, not being aware that their online posts can

reflect negatively on their professionalism (Chretien et al.

2009). However, because web2.0 technologies, such as social

Practice points

. Wikis can be used as a knowledge base for students

working in groups to share web resources and links

related to professional development.

. Wikis can create an online space which engages

students in reflecting on and assessing the value and

quality of resources they find before sharing them with

others.

. Face-to-face group cohesion was a central factor in

making a wiki work well.

. Students were not always aware of the purpose of wikis.

Examples of online tools which clinical staffs use in their

practice could be demonstrated to students to make the

potential benefit of such tools more explicit to students.

. Students find an empty wiki daunting and they prefer to

work in their small groups, at least initially. So any future

wiki uses should consider how students perceive the

online wiki group space in terms of privacy and access.

Correspondence: T. Varga-Atkins, Centre for Lifelong Learning, University of Liverpool, Liverpool, L69 3GW, UK. Tel: 151 794 1342; fax: 151 794

2512; email: tva@liverpool.ac.uk

824 ISSN 0142–159X print/ISSN 1466–187X online/10/100824–6 � 2010 Informa UK Ltd.

DOI: 10.3109/01421591003686245

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networking sites (e.g. Facebook1), media-sharing sites (e.g.

YouTube2), wikis, blogs and podcasts employ the power of

interaction, socialisation and peer collaboration in both private

and public spheres, they have the potential to contribute to

identity formation processes.

Studies indicate that over 90% of today’s students use social

networking and about 50% are users of blogs and wikis (JISC/

IPSOS MORI 2008). Whilst steady growth in the use of these

tools in the last 2 years has occurred (Kennedy et al. 2008),

studies also show that students are more likely to employ them

in their social interactions and are less aware of their

educational potential (Boulos et al. 2006; Trinder et al. 2008).

Furthermore, peer groups are important sources of learning for

students (Sandars et al. 2008).

Wikis are collaborative websites, created and maintained

by groups of people with specific interests. Wikis aim to create

a shared resource through online contributions of their

members. They can be public (e.g. Wikipedia3) or private to

a group of individuals, and offer different read/write privi-

leges.4 In contrast to blogs, which are individual journal

entries, wikis are essentially peer collaborations, also true of

social networking sites. However, wikis arise from a group’s

common need to build a shared resource, whilst social

networking sites are about the interactions between individ-

uals rather than about the end product.

These characteristics, combined with the argument that

learning about professionalism is based on socialisation and

interactions (Cruess & Cruess 2006), gave the authors the idea

to trial the use of wikis with undergraduate students in order to

see whether they can benefit student learning in this area.

Wikis have been effectively used in other disciplines, e.g. civil

engineering and computing (Nicol et al. 2005; Doolan 2006;

Rick & Guzdial 2006) and authors have reported their potential

for medical education (Sandars 2006). The value in enhancing

undergraduate and postgraduate education has been amply

demonstrated with the success of the AnatoWiki,5 which

started as a class project by two US institutions and now it gets

10,000 visitors every month. It includes recorded lectures,

discussions, videos of surgical procedures and case studies.

Philip et al. (2008) also described a novel way of using this

wiki: with students having to work backwards to build up a

patient case starting from a disease diagnosis.

This study explored the practical implementations and

benefits of using Wiki tools within the medical curriculum by

posing the research question: To what extent can the use of

wikis enhance student learning in the development of

students’ professionalism?

Context of the study

The study was conducted at the University of Liverpool, UK,

where medical students acquire the knowledge-base of the

‘core curriculum’ through problem-based learning (PBL)

groups. Each semester is divided into 2-week modules

around a case-based PBL scenario. During their first PBL

session, students identify a set of learning objectives, with one

set specifically focussed on personal and professional devel-

opment. Students research objectives consulting various

resources, some available through the university’s virtual

learning environment (Blackboard). In subsequent PBL ses-

sions, students integrate their prior and new knowledge by

sharing learning within their PBL groups.

Methods

Four PBL groups agreed to participate in the study, involving

32 first-year undergraduate students. The wiki tool within

Blackboard (called TeamsLX) was used with eight wikis being

created, one for each module per group. The group wikis

remained private to the PBL group and their facilitator; no

contributions could be accessed by other students.

Students used their wikis to share resources or ask

questions relating to the learning objectives on professional

development within the two learning scenarios covering

conception and birth. Set objectives included, for instance,

the roles of the health visitor or the difference between privacy

and confidentiality. The set objectives differed from group to

group.

A questionnaire gathered qualitative feedback about stu-

dents’ use of the wiki in relation to professionalism. Eight

questionnaires were returned giving a 25% response rate.

A focus group session collected more detail about the use of

wikis. The eight students participating in this focus group were

predominantly from one group. To minimise bias, a further

three focus groups were arranged, one for each of the

remaining groups, in which 24 students participated.

All focus groups were recorded and transcribed with the

consent of participants. The qualitative questionnaire data and

the focus groups were coded using thematic analysis to

identify 8 themes and 23 sub-themes. The majority of themes

were looked for in the data, based on the author’s previous

e-learning research experiences (e.g. students online behav-

iour, perceptions of professionalism, benefits and issues of

wiki use, technical/usability issues and recommendations).

Once these themes were identified, the majority of sub-themes

were allowed to emerge from the data. The themes and sub-

themes were analysed and refined by the other authors to

ensure their validity and that there were no other hidden sub/

themes present. Triangulation of data sources was used to

extend the understanding of student data and confidence in

reported findings by consulting online usage statistics as well

as interviewing the groups’ PBL facilitators. Thus, where

students reported benefits or issues that influenced their wiki

use, patterns of online usage were observed (whether they

used the wikis to a great, lesser extent or not at all) and

compared with student responses. This yielded clues as to the

factors which played a part in student engagement. The PBL

facilitator interviews gave information about the face-to-face

group dynamics and other student characteristics/behaviour

(e.g. technological skills), which seemed to affect wiki

engagement, and which would not have been possible to

collect from other sources.

Results

The emerging and identified themes were: the learning

context, i.e. how students collaborated with their peers; how

students engaged with the wikis; what benefits wikis brought

Developing professionalism through the use of wikis

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to their learning; the teaching and learning issues; and finally,

the technical issues which influenced the students’ engage-

ment with wikis. These will be reported in turn.

Learning context

Students found the PBL groups both educationally and socially

important. Between their on-campus sessions, some students

collaborated through informal chats, instant messaging, tele-

phone, email and online social networks (mainly via

Facebook). Students preferred to keep their social and

university ‘work’ spaces separate and preferred to do work

within the institutionally provided spaces:

I would be more likely to put things on that [wiki]

. . . because it is work. On Facebook, I just want to

check what other people are up to or talk to other

people. (Focus Group 1)

Student engagement

Different students engaged with the wikis differently: some

posted contributions concerning professionalism, some only

viewed others’ posts and some did not log on at all. Certain

groups were more active than others. Students also reported

that prior to the wiki pilot, they tended to share resources

incidentally through their online social networking sites.

Participants were more likely to post web links rather than

type up content in the wiki (example of the latter is shown in

Figure 1).

Benefits of wikis

When their peers came across a good resource on profession-

alism, students found it beneficial to share it, preventing others

from having to waste time trying to locate the information. This

was all the more appreciated as professionalism is hard to find

resources on. (Focus Group 3).

Some students also thought that the online wiki contribu-

tions made between their PBL sessions helped clarify their

face-to-face PBL discussions. By being able to see their peers’

contributions before coming to the next session, they also felt

more confident about their learning and their ability to achieve

their set learning objectives.

Students wanted to appear ‘professional’ when contributing

to the wiki and were concerned with the quality of their posts.

They did not want to be seen ‘wrong’ or ‘stupid’. This made

them reflect that they interacted differently in different spaces,

such as online versus face-to-face, or in their private sites,

as opposed to the more ‘formal’ wiki space:

When you are online, you tend to be a lot more

informal than face to face. Basically you have to

develop . . . communication in a professional way.

(Focus Group 1)

Teaching and learning issues

There were a number of issues which influenced students’

engagement with the wikis. Because the online group area

was located in an institutionally provided web space, some

students felt that they were being ‘monitored’ by staff (even

though they were not), which inhibited their contributions.

These students tended to discuss their learning objectives and

resources in their social space on Facebook. Private, small-

group based wikis rather than wikis for the whole year were

more welcomed by students as they felt they could share in a

safe, trusted environment and so not worry about the quality of

their contributions.

Figure 1. A student contribution to the group’s wiki: The role of the health visitor.

T. Varga-Atkins et al.

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Groups which worked well face-to-face tended to engage

more with wikis. Many students did not want or dare to

contribute to an empty wiki: you don’t want to be the first

person that starts (Focus group 1). Students welcomed the idea

of contributing to wikis which already had resources on

professionalism; this was less daunting for them.

However, students also saw the advantage of a large whole-

year wiki, with more students being able to contribute more

resources.

Technical issues

The simple design and the interface of the chosen wiki tool did

put off some students; they found the tool too ‘plain’ or

‘boring’. They preferred the interface of Facebook as it also

provided them with a summary of recent activities. This alert

function was lacking in the wiki. Students preferred a hands-

on training into the use of wikis rather than the provided

guide.

Discussion

Findings point to two main ways in which wikis can enhance

students’ learning about professionalism. First, wikis can act as

a shared knowledge-base for students to collate their identified

resources relating to professionalism in one, accessible place.

Having this shared knowledge-base online allowed students to

continue their learning in-between their face-to-face sessions.

This also made them better prepared and more confident in

their learning. This confirms that peer feedback is an important

aspect in students’ learning and identity forming (Niemi 1997).

Students perceived the quality of postings a major issue, i.e.

whether and how they could tell that their own or other

people’s contributions are good enough. McGee and Begg

(2008) argue that future physicians need to be adept at

locating, synthesising information from a variety of sources.

What this project demonstrated was that, when students are

engaged as collaborators in a wiki, they tend to reflect more on

the quality of located and researched information than when

just shared informally. This suggests that using tools, such as

wikis, have the potential to develop the information literacy

skills, contributing to students’ development as professionals.

Promoting reflection was also observed by Nicol et al. (2005)

who used wikis with engineering students to communicate

their team designs to other students. Wikis and blogs have also

shown to contribute to the development of students’ digital

literacy skills (Chan & Cmor 2009), such as how to commu-

nicate with other professionals online in a suitable manner,

which is an important aspect of professionalism. Doolan

(2006), for instance, used wikis with computing students to

develop competencies, which will help them to learn how to

communicate effectively online as future computer profes-

sionals. Through role play and group work, students work in

teams and simulate client communications through a wiki

platform.

Second, the study established that there was a role for wikis

in enhancing students’ professionalism in a wider sense.

If current medical education is about developing a profes-

sional identity (Wagner et al. 2007), introducing students to the

institutional online wiki space allowed them to experiment

with different identities (Livingstone 2002). Participants viewed

themselves as ‘students’ in their own social networking spaces,

whilst they saw themselves as ‘professionals’ in the wiki space.

Consequentially, students felt that they had to act accordingly

and think about the quality of their contributions. As students

felt awkward having to communicate professionally in their

otherwise informal peer group. This brought their identity to

the fore. But it is because of these reflections about identity

that the merits of their collaboration were realised.

The implication was that one of the roles of the online wiki

space was its potential to help develop students’ professional

identity. The more formal wiki space allowed students to

occupy different spaces (the private and the public) and

interact within them. By being ‘who they are’ in their private

network spaces, and by exploring ‘what others may think of

me’ (Watson 2002) when in the formal wiki space, allowed

them to connect and contrast the two. This offered an

opportunity to promote their reflection and sense of develop-

ing professional identity. Reports on medical students’ inap-

propriate, unprofessional behaviour on online social

networking sites (Chretien et al. 2007) suggests that this

identity-forming process is often problematic (i.e. not all

students are aware that their ‘private’ social networking sites

can be ‘public’ and so their online behaviour can be

unprofessional). However, the fact that students did not

always readily see the advantage that a formal online

collaborative environment may have brought suggested that

examples where students would have to act professionally

online (such as becoming members of online forums) could

increase their engagement.

Already existing open access medical wikis can not only

benefit students in their direct searches for medical informa-

tion, but also demonstrate the social responsiveness of medical

professionalism in action (Swick 2000; Olckers et al. 2007),

where ‘medical work can be seen as a contribution to the

public good’ (Frankford et al. 2000). Ganfyd6 and AskDrWiki7

are examples of publicly accessible wikis (but to which only

medical professionals can contribute), which make medical

knowledge available for anyone. This ‘wiki way of life’, the

ethos of openness and sharing for the public good, can be

used to impress these qualities on student awareness.

Student engagement seemed to be influenced by other

factors. Small group environment, being provided with pre-

loaded and quality assured resources in the wiki, confidence in

one own’s information skills and positive group dynamics

were conducive to engagement. Whilst lack of motivation, lack

of hands-on instruction, an unattractive user-interface and the

lack of an alert function hindered students from contributing to

the wiki. These findings indicated the importance that students

placed on trust. Without the feeling confident in their own

abilities and of being in a trusted environment with good

relationships with peers, students reported less online engage-

ment. This, in turn, meant that their postings were less likely to

be reciprocated. Developing trust, therefore, seemed to be key

in promoting online contributions as well as motivating

students to respond to one another’s postings.

Although the study was small scale, data collected also shed

light on how this technology can be used across a whole-year

Developing professionalism through the use of wikis

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group of some 300 students. Clearly, creating 37 group wikis

for each learning scenario would pose a number of manage-

rial, teaching and learning and support issues. For brevity,

these issues are summarised in Table 1, as the full project

report provides them in more detail (Dangerfield & Varga-

Atkins 2009).

One of the most important considerations of scalability was

about access and privacy. Students expressed contrasting

needs in this regard. Many welcomed private, small-group

based wikis as these ensured a trusted environment for their

sharing of resources. However, students also appreciated that

a whole-year group wiki would be beneficial in increasing the

amount of potential resources contained in it. We recommend

further research into how this tension can be managed. The

ability of judging the quality of resources linked to student

confidence. When students were more confident, they were

more likely to be willing to post in the wikis. The importance

of quality assurance suggested that further research could

explore the role of a person who would act as a wiki

moderator. The selected wiki tool lacked in functions, the

appropriateness of other wiki tools, as well as web2.0 tools

which have similar functions could be the subject of a further

study. One such technology, social bookmarking seems

appropriate. Social bookmarking helps students to store web

links (bookmarks) in their online accounts which they can

organise with tags; they can swap and view their social

networks’ bookmarks and web links, as well as view book-

marks of people who have saved the same web links as they

did. This study’s students mainly saved web links, and not

typed up resources. Social bookmarking, harnessing all the

‘social’/networking aspect of social networking sites, could

offer new avenues for learning and collaboration.

Conclusions

This study explored whether and how web2.0 technologies, in

particular wikis can enhance students’ learning of profession-

alism in a PBL context. The results of the study showed both

direct and indirect benefits of using wikis with medical

students in developing their professional identities. Wikis

acted as a useful shared resource which helped students

learning about professionalism. By offering a more formal wiki

space, as opposed to the private social networking sites, wikis

contributed indirectly to the development of their professional

identity. This article also identified a number of issues which

influenced student engagement and which any practical

implementation needs to consider. The small scale of the

study may be a potential limitation of this research, but at the

same time it yielded data in a relatively under-researched area

suggesting that the next step needs to look at scalability whilst

also responding to student needs for a trusted, small-group

environment.

Acknowledgements

This project was funded by the Centre for Excellence in

Teaching and Learning for the Development of

Professionalism, Medical Education, University of Liverpool.

We would also like to acknowledge the contributions of Steve

McKinnell (Director of the e-Learning Support Unit, Faculty of

Medicine), Martin Ralph (Learning Technology Coordinator,

Faculty of Medicine), Nick Bunyan (Learning Technology

Developer, Centre for Lifelong Learning), David Williams (PBL

facilitator) and all those MBChB students who contributed to

the study.

Declaration of interest: The authors report no conflicts of

interest. The authors alone are responsible for the content and

writing of this article.

Notes on contributors

TUNDE VARGA-ATKINS, MA, MSc, is a Learning Technology developer

and researcher at the Centre for Lifelong Learning, University of Liverpool.

Her research interests include professional development and technology-

enhanced learning.

PETER DANGERFIELD, MD, MBChB, FHEA, is the Year 1 director on the

MBChB programme at the Faculty of Medicine, University of Liverpool, and

is a professor at the School of Health, Staffordshire University. His research

interests include curriculum design, assessment and careers and profes-

sional development.

DAVID BRIGDEN M.Ed., B.Ed (Hons) Cert Ed (Dist), C. Biol, F.I.Biol, FLS,

FHEA, is Deputy Head of the School of Medical Sciences and Director of

Education, Teaching and Learning at Bangor University, North Wales, UK.

He is also Professor of Professional Development and Life Long Learning in

the Learning Enhancement and Professional Development Unit at the

University of Bolton and previously worked as Regional Adviser for

Postgraduate Medical and Dental Education, Mersey Deanery, Liverpool.

His research interests include professional development, lifelong learning,

teaching and learning facilitation.

Notes1. http://www.facebook.com

2. http://www.youtube.com

3. http://wikipedia.org

4. For a publicly available medical wiki, see for instance

Ganfyd (http://www.ganfyd.org). Anyone can view the entries

but only registered medical professionals can edit the site.

5. http://anatowiki.wetpaint.com (last accessed 2009

December 7).

6. http://www.ganfyd.org (last accessed 2009 December 7).

7. http://askdrwiki.com (last accessed 2009 December 7).

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Wiki lifecycle Can future students read/write in the wiki?

Wiki functionality What functions does the wiki tool have?

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6/14

For

pers

onal

use

onl

y.