Using The Internet To Study Psychiatry
Dr Justin Marley, Specialist Registrar in Old Age Psychiatry, Mental Health Department, Rotherham District General Hospital, Moorgate Road, Rotherham, S60 2UD.
Aims and Method: Internet resources for studying psychiatry were grouped into four domains: text, audio, video and software. For each domain a search was made of relevant journal articles and internet resources. Results: Articles and internet resources were identified and summarised. Clinical Implications: Freely accessible evidence-based guidelines are identified in a number of clinical areas. Resources for improving clinical skills and supporting decision-making are identified.
The internet is an elaborate global network of computers that allow people access to a range of resources including information, social networking, trading and real-time communication. The internet has evolved rapidly and the advent of new software applications and other resources offer psychiatrists numerous and novel opportunities for the study of their discipline. The World Wide Web forms an important part of the internet and is a set of pages linked to each other by hypertexts which can be clicked on with a mouse to reach the linked page. Whilst the use of computer-based technology in psychiatric education has a small evidence base there are a few studies showing superiority over traditional education methods (1). The diversity and number of educational resources on the internet means that there should be sufficient material to match individual learning needs. This articles focuses on text-based, audio, video and software resources for studying psychiatry using the internet.
There are a vast number of text-based resources on the internet the most accessible of which are located on the World Wide Web. Text content is usually accessed from websites by means of a web-browser, although text information can be received in the form of e-mails, RSS feeds or can even be sent to mobile devices.
There are a number of websites relevant to psychiatry (2)(3)(4). The Royal College of Psychiatrists website (5) has many helpful resources contained within ten sections. The training section contains guidance for basic and higher specialist training as well as online CPD learning modules. Within the publications section there are reports from the college executive committee, the majority of which can be downloaded without charge in portable document format (PDF). There are also links to online college journals, an area for ordering college books and journals as well as links to external journals. The events section contains details of upcoming educational events with links to relevant websites. The Department of Health website (6) has seven sections including health care, social care and publications. Within the social care section in particular there are a number of topics pertinent to psychiatry including capacity, 'mental health and social care' and vulnerable adults. The reader can download digital documents including legislation and service development guidance.
The NICE website (7) contains completed guidelines across psychiatry. The site contains both full and summary guidelines as downloadable PDF's. At the time of writing there were fourteen completed guidelines available in mental health including depression, anxiety, schizophrenia and dementia. The British Association of Psychopharmacology (BAPP) is one of the largest national psychopharmacology associations in the world and the website (8) features courses and events as well as digitalised consensus statements and newsletters which can be freely downloaded. The British Association for Counselling and Psychotherapy (9) has a website with links to relevant external sites, a downloadable ethical framework for practising counsellors and psychotherapists, upcoming events, and a link to the journal 'Therapy Today'. The British Association of Psychotherapists website (10) contains information on courses, code of ethics, events and details of supervision and links to other psychoanalytic psychotherapy organisations. Psychotherapy internet resources are covered in more detail elsewhere (11, 12). The British Psychological Society has a website with numerous sections, some of which require membership (13). There are links to the British Psychological Society Blogspot as well as news updates.
The National Library of Health is a combination of national and local 'knowledge' services partly delivered through the internet (14). The stated intention for the NLH is that it will be 'the best, most trusted health related knowledge service in the world'. The NLH requires authorisation via an Athens password (available to NHS employees) for access to core features. Amongst these are a collection of more than 400 e-books with an emphasis on psychiatry and Proquest which allows access to over 1500 full-text journals. In this sense, the NLH provides access to the ‘deep web’, a term used to describe a significant part of the internet which requires authorisation for access and which is ‘hidden’ from standard search engines. Wikipedia is an online free encyclopedia that is supported by donations and lists over 2 million articles in English as well as other languages (15). As articles are contributed to by users, and there is a loose peer review process (within the group contributing to the article), Wikipedia has a number of interesting properties. Articles are updated rapidly and it is not unusual to see new advances being added to articles on the day that this information becomes publicly available. Articles where there are disputes may be locked until there is a resolution whilst potential bias is labelled explicitly. The quality of the articles is variable and as with any encyclopedia, utility is specific to the reader. A particular strength of Wikipedia lies in allowing a rapid overview of a subject which can be very useful given the breadth of subject areas covered within psychiatry. Typically the articles link to relevant external websites. Other useful websites include those of the World Psychiatric Association (16), the Institute of Psychiatry (17), the Whole Brain Atlas (18), Medscape (19), e-medicine (20), the Directory of Open Access Journals (21) and the Cochrane Library (22). Medical and science journals invariably have an internet presence and can be easily located using search engines.
Discussion groups contain members with similar interests who communicate via e-mail and can be particularly useful for highly specialised interests. There are many psychiatry discussion groups (4) and a useful starting point is JISCmail (23)
RSS is an acronym for Really Simple Syndication and refers to the process of making updates to websites available in a format which can be utilised by tailored software. The updates can be text-based as well as in other formats and are variable in their quality. RSS feeds can be pulled together using aggregator software. This software allows you to view the RSS feeds from different websites in a single window, allowing a regularly updated overview of disparate information sources. This saves valuable time as the user has no need for multiple visits to the websites. Many journals including the British Journal of Psychiatry have RSS feeds.
A Blog is a site where information is chronologically ordered and may be text based or use other media formats. There are various blogs by psychiatrists which are regularly updated and these can be located using specialised search engines such as Technorati (24). Blogs can be a useful supplementary means of keeping up-to-date in psychiatry.
The internet facilitates access to audio data that can be used for studying and together with video offers a very different experience to books. However audio files are typically much larger than text files and can therefore be more costly for websites to host and can take much longer for the user to download. There are two types of audio resources which are particularly useful - podcasts and audiobooks.
Podcasts are audio files (or video files) that can be streamed over the internet or downloaded for later use and psychiatry podcasts are increasing in popularity (25). There are an abundance of podcasts available and this increased choice means that individual needs are likely to be met. Podcasts can be listened to on mobile audio devices making it possible to combine activities thereby making more efficient use of time.
There are various projects that provide books for free online in an audio format and examples include Learn out Loud (26) and Audiobooks For Free (27). Books that are free to download are typically ones in which the copyright has expired in which case the books will be from many decades or even centuries ago, although various universities offer free courses also. However more recent books are released commercially and as well as Audio Books For Free, sites such as Amazon (28) or Audible (29) will offer a wide variety of downloadable books or CD's for a price.
Video resources offer another means for studying psychiatry. Some of the CME modules discussed previously are in video format.
Film and Television
The relationship between films and psychiatry has an established literature and there are a number of documented methods for studying psychiatry using this medium. Firstly fictional psychiatrists or therapists can be identified as role models or otherwise (30). Secondly interpretations can be made of the characters development or behaviour using appropriate models (30). Thirdly appropriate segments can be selected for performing a crude mental state examination which can then inform a differential diagnosis (31). Fourthly, films can also be used to examine cultural issues (32). The internet has a number of resources which facilitate the selection of film material. The internet archive (33) offers freely downloadable material including films that have lapsed into the public domain. Nevertheless if the reader is intending to show clips of films for educational purpose, they should take steps to ensure that their material is indeed in the public domain as there is complex legislation surrounding the performance of film clips. Internet films clubs such as ‘I Love film’ (34) offer a large selection of films and television series for rental through the post. Television series allow a more detailed exploration of characters and themes. The same approach for studying psychiatry in film can be applied to television series and the BBC make their own shows available online using proprietary iPlayer software, for a limited period after the initial screening (35).
There are a number of video-sharing websites which allow users to upload and share video clips that they have created. YouTube is perhaps the most well known of these sites (36). Entering the term 'psychiatry' in the YouTube search engine produced a number of clips with an anti-psychiatry emphasis. However the term 'psychopharmacology' produced a number of documentary-type clips and interviews of interest. Entering the names of different illnesses results in clips of people with those illnesses discussing their experiences which has the potential to offer valuable insights. Video-sharing websites contain a wealth of information and no doubt many resources for studying psychiatry will be identified as these sites develop and become better characterised.
Searchable databases of medical article abstracts can be extremely useful in education, research and clinical work. Perhaps the best known medical database is Medline which is derived from the Index Medicus, an indexed list of journal articles first developed in 1863 (37). The American National Library of Medicine's PubMed is perhaps the best known interface for accessing Medline (along with other databases), whilst ProQuest has the advantage that direct links can be made to a large set of full text journals. Search engines are an indispensible form of software used to locate information on web pages. The most popular is Google (38). The user enters keywords of interest in the search query and can refine the search terms to narrow the search. The search engine will return web pages of relevance. A more detailed discussion of search engines is to be found elsewhere (12). One criticism has been that the quality of information can be variable. The Intute search engine is described as focusing on returning high quality results (39). Metasearch engines return searches from multiple search engines a popular example being info.com (40). There are also specific search engines for books, images, video, blogs and the deep web. Reference management software is designed to manage references and the rudiments of their use are outlined elsewhere (41). There are a number of freely available reference managers on the internet including JabRef (42) and BibSonomy (43) the latter being web-based and allowing references to be shared.
Declaration of Interest
The author has a psychiatry blog.
The author would like to acknowledge the Librarians at Rotherham District General Hospital Library for their help in obtaining articles.
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Copyright PrioryLodge Education Limited 2008
First Published September 2008