JBJS | The Internet as a Communication Tool for Academic Orthopaedic Surgery Departments in the United States

The Journal of Bone & Joint Surgery, Volume 83, Issue 7

Articles | July 01, 2001

The Internet as a Communication Tool for Academic Orthopaedic Surgery Departments in the United States

Tamara D. Rozental, MD; Jess H. Lonner, MD; Selene G. Parekh, MD, MBA

Investigation performed at the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Tamara D. Rozental, MD
Jess H. Lonner, MD Selene G. Parekh, MD, MBA
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104. E-mail address for T.D. Rozental: trozental@att.net. E-mail address for S.G. Parekh: avataars@yahoo.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone & Joint Surgery. 2001; 83:987-991

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Abstract

Background: The Internet’s appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based health-care companies have proliferated, and many medical centers have established individual web sites. The purpose of the present study was to evaluate academic orthopaedic surgery departments in the United States with respect to Internet visibility and content.

Methods: We reviewed existing web sites for the 154 departments or divisions of orthopaedic surgery currently accredited for resident education by the Accreditation Council for Graduate Medical Education. The study sample consisted of the 113 departments that had a web page listed in the FREIDA (Fellowship and Residency Electronic Interactive Database) database. Each web site was assessed with regard to its informational value in the categories of clinical services, resident education, and physician recruitment. In addition, three commonly employed browsing engines were used to search for individual web sites and to determine their ease of accessibility.

Results: In the category of clinical services, sixty-five (57.5%) of the 113 sites provided faculty listings and forty-nine (43.4%) provided office telephone numbers and locations. Only thirteen sites provided information on common orthopaedic conditions, and five had links to other patient-education sites. In the category of resident education, twenty-four sites (21.2%) had online academic schedules, but only two provided access to complete conferences or teaching files. In the category of physician recruitment, ninety-one provided a description of their residency program and fifty-four had information on the application process, but only twenty-six web pages offered detailed departmental statistics. In terms of accessibility, fifty-three programs (46.9%) were identified by one of three popular search engines, seventeen (15%) were identified by more than one search engine, and two (1.8%) were identified by all three.

Conclusions: Academic orthopaedic surgery departments in the United States underutilize the Internet as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access with use of popular search engines. Thus, academic orthopaedic surgery departments in the United States are missing a valuable opportunity to promote awareness of their institutions and to become educational resources for the community.

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Introduction

Introduction | Materials and Methods | Results | Discussion | References

The Internet was first conceived in the early 1960s by the United States Department of Defense to facilitate communication within the academic community. Over the last decade, the availability of affordable computers, standardized programming language, and commercially available web browsers has led to a dramatic increase in the Internet’s popularity. Surveys conducted by Internet marketing and research organizations recently estimated that 40% of the United States population accesses the Internet^1,2.

Accounting for approximately 14% of the gross domestic product, the health-care industry has not been immune to the Internet’s expansion. There are currently more than 20,000 health-care-related web sites, with an additional 1500 sites created monthly³. A recent telephone survey indicated that more than twenty-two million adults in the United States use the Internet to access health-related information, and surveys completed by patients of physicians in private practice revealed that up to 50% of patients use the Internet to retrieve health and medical information^4,5. Furthermore, recent studies on the quality of disseminated medical information have demonstrated that most of it is substandard and that the majority is supplied by commercial web sites⁶.

Many academic medical centers have already made use of the Internet’s capabilities and have created individual web pages geared toward patient and physician education. These web sites, characterized as content-based, provide descriptions of available clinical services as well as information on common diseases and conditions. Several organizations, such as the American Academy of Orthopaedic Surgeons, also use the Internet as an important resource to promote student and resident education^5,7-11. The purpose of the present study was to review the available web pages of academic orthopaedic surgery departments in the United States and to rate their informational value with respect to clinical services, resident education, and physician recruitment.

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Fig. 1:: Information provided by the web pages of orthopaedic surgery departments with regard to clinical services.

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Fig. 2:: Information provided by the web pages of orthopaedic surgery departments with regard to resident education.

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Fig. 3:: Information provided by the web pages of orthopaedic surgery departments with regard to physician recruitment. ERAS = Electronic Residency Application Service.

Materials and Methods

Introduction | Materials and Methods | Results | Discussion | References

The American Medical Association currently maintains the Fellowship and Residency Electronic Interactive Database (FREIDA at http://www.ama-assn. org/cgi-bin/freida/freida.cgi), which registers all accredited orthopaedic programs. Listed in this database are the mailing addresses and existing web-page addresses for individual departments. The 154 departments or divisions of orthopaedic surgery currently accredited by the Accreditation Council for Graduate Medical Education, as identified by FREIDA, were included in this study.

Web-Site Evaluation

Individual web sites were accessed and evaluated according to the following criteria.

Clinical Services

We noted whether the web site provided faculty listings, office telephone numbers, e-mail addresses, schedules of office hours, and practical information (such as maps or directions to the facility, provider insurance data, and the ability to schedule appointments online). We also noted whether web sites provided information on common orthopaedic conditions, offered links to other patient-education sites, or allowed patients to submit questions by e-mail.

Resident Education

Web sites were evaluated with regard to their completeness in providing academic schedules, links to major orthopaedic societies and journals, rotation and/or call schedules, electronic evaluation forms, online teaching files (such as weekly case reports), and access to conferences online. The listing of departmental research interests and the ability to access abstracts or publications online were also reviewed.

Recruitment

Evaluation criteria included the presence of a program description, a list of current residents, hospital statistics (such as numbers of admissions and surgical cases), and information on the admissions process, including a detailed interview schedule. We also searched for lists of fellowships and jobs obtained by recent alumni.

The date of the last update was noted in order to evaluate the currency of the information.

Web-Site Accessibility

To evaluate the accessibility of the departmental orthopaedic pages, we selected the three most frequently employed search engines at the time that this study was performed: Yahoo (www.yahoo.com), AltaVista (www.altavista.com), and Excite (www.excite.com)¹². The key words "orthopaedic surgery" and "orthopedic surgery" and the name of each individual medical center were searched. The first fifty results, or "hits," identified by each search engine were examined for the presence of individual departmental web pages. Since some academic medical centers make use of an Intranet so that access to information is limited to identified users, we also evaluated each web site for the presence of password-protected areas.

Results

Introduction | Materials and Methods | Results | Discussion | References

Our study sample consisted of 154 orthopaedic surgery programs currently accredited by the American Council of Graduate Medical Education. One hundred and thirteen (73.4%) of the programs had web pages listed on the FREIDA database. The remaining forty-one (26.6%) were not known to possess an individual web page. The 113 existing web pages constituted our final sample and were evaluated for their informational value with respect to clinical services, resident education, and physician recruitment information.

In the category of clinical services, sixty-five web sites (57.5%) provided faculty listings, fifty-three (46.9%) listed office telephone numbers, and forty-nine (43.4%) supplied office locations. Thirty-seven sites (32.7%) provided the clinicians’ e-mail addresses. Very few sites provided practical information for patients: thirty-three (29.2%) provided directions to hospital facilities, seven (6.2%) listed detailed schedules of office hours, and three (2.7%) listed provider insurance information. At four sites (3.5%), it was possible to schedule appointments online. With regard to patient education, thirteen sites (11.5%) listed information on common orthopaedic conditions, but only five (4.4%) provided links to other patient-education resources. Seventeen sites (15%) allowed patients to submit questions to providers by e-mail (Fig. 1).

In most cases, the information provided for resident education was extremely limited. Twenty-four sites (21.2%) listed their academic schedules online. Thirty (26.5%) had links to major orthopaedic societies, and eleven (9.7%) provided links to major journals and publications. Very few sites offered access to complete online conferences (two sites) or teaching files (two sites). Although the titles of departmental research projects were often listed (forty-four sites; 38.9%), online abstracts were seldom provided (thirteen sites; 11.5%). Few web sites (six; 5.3%) posted resident rotation and call schedules, and only one web site (0.8%) provided rotation evaluation forms for faculty and residents (Fig. 2). Two web sites had password-protected links to a departmental Intranet, which may have provided links to these data for authorized users.

Almost all departmental web sites (ninety-one; 80.5%) supplied a basic program description, and many (fifty-one; 45.1%) provided lists of current residents for recruitment purposes. Seventy-four (65.5%) provided links to the Electronic Residency Application Service, and fifty-four (47.8%) had detailed descriptions of the application review process as well as online interview schedules. Only thirteen sites (11.5%) listed program alumni and their contact information. Twenty-six (23%) offered departmental or hospital statistics, such as number of beds, case logs, and number of orthopaedic admissions (Fig. 3).

Twenty-four web sites (21.2%) posted the date on which their page had been last updated. The mean time between the last update and the date of our review was 4.5 months (range, zero to fourteen months).

Only fifty-three program sites (46.9%) were identified by one of the three search engines. Seventeen sites (15%) were identified by more than one search engine, and only two (1.8%) were identified by all three search engines.

Discussion

Introduction | Materials and Methods | Results | Discussion | References

In the new millennium, the Internet has rapidly become the dominant medium for sharing information and conducting worldwide transactions. In the United States, the Internet has already surpassed newspapers and magazines in annual per capita media consumption¹³.

The World Wide Web provides easy access to the Internet and is commonly used as an information resource by both patients and physicians. At the present time, only 11.5% of the web sites for orthopaedic surgery departments are using the Internet to provide fundamental information on common orthopaedic conditions and treatment options. In addition, although several sites provide directions to their facilities, few list insurance information, provide detailed office-hour schedules, or allow patients to schedule appointments online.

Despite its demonstrated educational potential^14-17, the Internet is also underutilized with respect to teaching and instruction of orthopaedic residents. Only two programs post teaching cases or conferences online, and few provide detailed descriptions of departmental research projects, although such information could promote interdepartmental cooperation. Web sites listing rotation and call schedules were rare, as were those fostering an exchange of information between faculty and house staff. Although this type of information can pose a risk to patient and physician confidentiality, it can substantially improve communication between attending and resident physicians and should be made available in password-protected areas. Similarly, with <25% of sites displaying departmental statistics or positions obtained by recent alumni, we believe that orthopaedic departments are not making full use of the World Wide Web to recruit young physicians.

Accessibility and accuracy of information are important factors to consider in the evaluation of the effectiveness of any medium of communication. Our study revealed that existing web sites for departments of orthopaedic surgery in the United States are often difficult to identify with popular search engines. Less than one-half of the web sites were located by one search engine, and only two were identified by all three. Twenty-four sites posted the date on which their page had been last updated, and several web sites had not been updated for more than six months. Because of the rapidly evolving nature of the Internet, web-site addresses frequently change. To provide accurate information and to maintain their appeal to individual consumers, sites must be updated on a regular basis.

A recent report revealed that, unlike other industries, the health-care market has been slow to integrate into the information superhighway¹⁸. The reasons for this include concerns with regard to patient security and confidentiality, physician liability, and reliability of information. Another recent study showed that although 98% of patients under the age of fifty considered information on the Internet to be reliable and trustworthy, 29% of patients over the age of fifty had serious concerns with regard to confidentiality⁵. Thus, as noted in a report by the National Academy of Sciences, public policy that addresses issues of liability, privacy, and security standards needs to be drafted in order to fully integrate the health-care industry onto the Internet¹⁸. Economic impediments may also exist; the costs of creating and maintaining a web site can be prohibitive for individual departments and residency programs.

There were limitations to our study and thus several areas for future exploration. For example, although we reviewed the availability of information pertaining to clinical services, resident education, and physician recruitment, we did not evaluate the quality of the information provided. Rather than determine the overall value of individual sites, we chose to assess each site’s level of completeness. Second, we used three popular search engines to determine web-site accessibility. Although these search engines were those most commonly employed by Internet users at the time of the study, it is possible that people conducting searches related to orthopaedic surgery utilize other, more specific search tools. Finally, two web sites that we reviewed had password-protected areas that restricted access to specific links and limited a full review of the available information.

In conclusion, our study showed that academic orthopaedic surgery departments in the United States vastly underutilize the Internet, both as a marketing tool and as a means of enhancing patient and physician education. We demonstrated that the web pages of orthopaedic departments are not readily accessible and do not provide all of the information necessary to maximize the value of their sites. In an era when monetary allocations are intensely scrutinized, the duration of physician-patient encounters are reduced, and patients resort to the Internet for a substantial percentage of their information, orthopaedic surgeons are missing an important opportunity to provide high-quality, cost-effective, and accessible information to the community.

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