Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism.

Using wikis to promote
the personal and professional development of
undergraduate medical students:
a report for the CETL in Developing Professionalism

February 2009

This project has been funded by the CETL Fellowships funding at the CETL in Developing
Professionalism, University of Liverpool. Website: http://www.liv.ac.uk/cetl

Project leader: Dr Peter Dangerfield

spine92@liverpool.ac.uk
School of Medical Education
University of Liverpool, Sherrington Buildings, Ashton Street
Liverpool L69 3GE
Phone: 44 (0) 151 794 5502

Project researcher: Tünde Varga-Atkins

tva@liverpool.ac.uk
Educational Development, Centre for Lifelong Learning
University of Liverpool, 128 Mount Pleasant, Liverpool L69 3GW
Phone: 44 (0) 151 794 1180

With contributions from:

Dr David Brigden, PBL facilitator

Nick Bunyan, Learning Technologist

Dr Steve McKinnell, PBL facilitator

Martin Ralph, Blackboard and Learning Technology Coordinator

Dr David Williams, PBL facilitator

Cover design: Robin Sellers

Wiki logo design: Paul Duvall

Acknowledgements: We would like to thank the contributions of all those
2007/08 first-year undergraduate MBCHB students at the University of Liverpool who took
part in this pilot and offered their own time to give feedback.

Please cite this report as:

Dangerfield, P; Varga-Atkins, T with contributions from Bunyan, N; McKinnell, S; Ralph, M;
Brigden, D and Williams D (2009) Using wikis to promote the personal and professional
development of undergraduate medical students: a report for the CETL in Developing
Professionalism. Liverpool: University of Liverpool.

Using wikis to promote the personal and professional development of UG medical students

Executive Summary ...................................................................................................................................... 7
Key terms and abbreviations ...................................................................................................................... 10
1. Introduction: professionalism and web2.0 technologies ..................................................................... 11
1.1 Originality ......................................................................................................................................... 13
1.2 Scope and limitations of the report ................................................................................................... 13
1.3 Report structure ............................................................................................................................... 13
2. Aims ................................................................................................................................................... 14
3. Methodology ...................................................................................................................................... 14
4. Findings: the learning context ............................................................................................................. 16
4.1 Student engagement in the wikis ...................................................................................................... 18
5. The benefits of using wikis for students’ development of professionalism .......................................... 21
5. 1 Wikis as a shared resource and knowledge-base .............................................................................. 22
5.2 Wikis as online spaces for developing identity as a professional ........................................................ 24
6. Teaching & learning, technical and managerial issues of using wikis.................................................... 27
6.1 Teaching and learning issues ............................................................................................................. 27
6.2 Technical issues ................................................................................................................................ 32
6.3 Managerial issues ............................................................................................................................. 33
7. Project summary and outcomes.......................................................................................................... 38
7.1 Project summary ............................................................................................................................... 38
7.2 Project outcomes .............................................................................................................................. 39
8. Conclusion and recommendations ...................................................................................................... 43
8.1 Recommendations for the development of professionalism.............................................................. 43
8.2 Recommendations for the future implementation of wikis ............................................................... 43
8.3 Further research ............................................................................................................................... 44
9. Project impact .................................................................................................................................... 45
References ................................................................................................................................................. 46

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Executive Summary
Introduction
The purpose of the study was to introduce wikis in a problem-based learning context and explore
how this web2.0 technology may be used to enhance medical students’ learning in a blended
environment, especially relating to their development of professionalism.

Aims
The research questions were:
to what extent the use of wikis can enhance student learning in the area of students’
personal and professional development;
what are the facilitators and barriers to student learning in professional and personal
development, in particular, those associated with the use of such technology?

Methods
The use of wikis was piloted with four first-year problem-based learning groups (32 medical
students) at the University of Liverpool. The study took an interpretivist approach gathering
qualitative data in the form of focus groups and a small-scale survey on the perceptions of the
participants as to their self-assessed impact of the pilot on their personal and professional
development. Triangulation of methods involved both students, as well as their facilitators, in the
data collection, combined with online system statistics. Transcripts of the focus group sessions were
analysed using thematic content analysis.

Findings
The problem-based learning (PBL) groups were an important part of students’ learning, both
academically and socially.
Students displayed a range of collaboration patterns in-between PBL sessions, including
offline and online modes such as informal chatting, using online social networks, email and
phone calls.
Students demonstrated a range of engagement patterns in the wiki, some posted
contributions, some only viewed others’ posts and some did not log on at all.
Students most frequently posted web links to the wikis.

Benefits
There were two main ways in which wikis were beneficial to medical students’ learning in a problem-
based learning context:
Wikis acted as a shared resource and knowledge-base with students being able to share
their identified learning resources which answered their identified learning objectives on
personal and professional development in-between their face-to-face sessions.
Wikis promoted students’ development as a reflective professional by having to think
about the quality of resources that they contributed to the shared wiki space. This
reflection, in turn, then had the benefit of creating an online identity, which promoted
students’ sense of developing professionalism through interacting in a more formal,
online space.

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Facilitators and barriers
Facilitators and barriers which influenced student engagement with the wikis have been identified
as:
Those students who were more aware of what the purpose of wikis was, were more likely to
engage with them.
The trusted, safe environment of private, small-group wikis was seen more conducive to
student participation than large-group wikis, as students claimed to be more confident in
making postings to a private wiki.
Positive group dynamics were an important indicator for students’ engagement. Members of
effective groups were more likely to share their resources both face-to-face and online.
As no one wanted to be the first to post in a wiki, a wiki pre-populated with some resources
and links on personal and professional development was seen as encouraging to students.
Confidence in one’s own information skills facilitated engagement. Where students were
unsure about the reliability or the quality of the resource they found, they were less likely to
post it.
Some students found their current methods of learning ‘good enough’. They lacked
motivation to use wikis in order to share their learning.
A number of students found the wiki tool’s interface as ‘plain’ and ‘boring’, especially in
comparison with online networking sites such as Facebook. This directly hindered their
engagement.
More importantly, the lack of alert-function in the examined wiki tool meant that students
were not notified when new postings were made in their group wiki. This made it more
difficult for students to engage; students were used to the comfort of their online social
networking sites (Facebook) alerting them about group member activities.
Hands-on demonstration of the wiki tool was preferred to written guidance.
The history function of the wiki was less known to students. This knowledge may have
helped those less confident in making contributions when they were unsure about the
quality of resources to be posted.

Scalability
The report highlighted a number of issues with regards to scalability of the pilot. These included:
Access and privacy: who has read/write access to the wiki?
The remit of the wiki: what is the remit of contributions?
Wiki lifecycle: can future students use the wiki and its contributions?
Wiki functionality: what functions does the tool have?
Support needs and resources: how to balance benefits versus support needs?

Recommendations
A set of recommendations on the future implementation of similar projects included:
Making pre-loaded resources on professionalism available in the wikis, where possible,
quality-assured by staff.
Introducing the various purposes of wikis to students (from sharing resources to
discussion/questions forum) and negotiate their use based on their preferences as
awareness of purpose seemed to increase engagement.

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Drawing attention of students to how participation in online collaborative spaces may be
relevant in their future career, e.g. by introducing them to other online professional spaces
and showing them examples of practitioners communicating online.
Considering other wiki tools which have an alert system, a user-friendly interface and flexible
access-rights functionality.
Considering a two-level wiki which consists of small private group areas and a joint year-
group area.
Creating a trusting environment to overcome the issue of student confidence when posting
to the wiki.

Further research
The study has also identified further areas of research including:

The benefits and issues that may arise when the pilot is scaled up to a whole year group;
the benefits and issues that may arise when students use wikis over successive academic
years in the form of a long-term study;
the role of the moderator in the wiki;
the appropriateness of other tools which may serve a similar purpose to wikis (e.g. social
bookmarking).

Project impact
The study has contributed to the scarce evidence-base on the use of web2.0 technologies in medical
education and identified both practical issues for the future implementation of similar projects as
well as further areas for research.

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Key terms and abbreviations

Key terms

Problem-based learning Problem-based learning in this report refers to a student-centred
method of learning in which students collaboratively solve problems,
identify their learning objectives, seek and evaluate relevant learning
resources and reflect on their experiences.

Professionalism Defining professionalism would be the remit of a whole project. Thus
without attempting to offer a finite definition, professionalism will be
used to refer here to the individual who possesses the knowledge and
skills that enables them to join the medical profession as well as a high
standard of work ethics, behaviour and attitude. One essential
characteristic of a ‘professional’ is their ability to reflect on their own
learning, attitudes and behaviour.

Web2.0 tools/technologies Second generation web (or web2.0) tools or technologies are
user-centred tools based around collaboration and sharing. Examples
include multimedia sharing sites (YouTube, Flickr), social networking
sites (Facebook), wikis and blogs etc.

Wikis Wikis are web2.0 tools; they are public or private websites that allow
the non-technical user, or groups of users, to write, edit and update web
content easily. Wikipedia is one example of a public wiki.

Abbreviations
CETL Centre for Excellence in Teaching and Learning

ICT Information and Communication Technologies

PBL Problem-Based Learning

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1. Introduction: professionalism and web2.0 technologies
This chapter introduces today’s healthcare context and the role of professionalism, describes what
web2.0 technologies, especially wikis, are – together with the rationale for the study which tests the
use of wikis in the development of professionalism with medical students. It describes the originality
of the study, its limitations and the report structure.

how this web2.0 technology may be used to enhance medical students’ learning in a blended
environment, especially relating to students’ development of professionalism.

Professionalism has an important role in the current healthcare context. Today’s medical students
not only need to acquire knowledge and skills but also develop professional attitudes and behaviour
(GMC 2001, 2003), and so acquiring a new identity as a doctor or medical professional (Wagner et al
2007). Practising professionals are increasingly employing and relying on technologies that share
patient information, interacting with institutional computer systems, seeking information or
participating in online communities for their own professional development. Recent years have also
seen a greater emphasis on collaboration in the UK healthcare system, with healthcare being
delivered through practitioners working in teams with their own and other professions. These
changes towards the importance of collaboration have been taking place in parallel with the advent
of a new group of technologies, also called as ‘web2.0’ tools (Figure 1).

Figure 1 Examples and characteristics of web2.0 tools

‘Web2.0’, or ‘second generation’ tools:
are highly collaborative;
are easy-to-use;
users do not need to have technical expertise or web design skills;
include social networking sites (e.g. Facebook, MySPace), wikis (e.g. Wikipedia), blogs (web
diaries), social bookmarking (e.g. del.icio.us) etc.

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Wikis, the technology used in this study, are one example of web2.0 tools. Wikis are collaborative
websites. They allow a public or a private group to collaborate on web content, documents and
multimedia resources and build up a shared resource to which all the group members can
contribute. An important feature of a wiki is its history function, which displays users’ contributions
in chronological order, with an option to revert to previous versions, if necessary. All these features
make wikis a potentially useful tool for student learning.

The rationale for this study was to pilot the use of a particular web2.0 technology, wikis, in medical
education. The characteristics of medical undergraduate students, the curricular context of problem-
based learning and the nature of wikis all converged to this end. Various current research dealing
with today’s generation of students (also called the ‘NetGeneration’) has found that students rely
heavily on the web and information technologies both in their studies and, even more so, in their
social lives (Conole et al 2006). A recent survey revealed that over ninety percent of students use
social networking and about fifty percent are users of blogs and wikis (JISC/IPSOS MORI 2008). That
online social interactions take central place in students’ lives has been shown by other studies too
(see e.g. Sandars and Morrison 2008). This is further evidenced by the growth in the use of these
web2.0 tools in the last two years (Kennedy et al 2008).

The problem-based context in which this study was introduced is based around students negotiating
their own learning objectives, needing to draw on their information literacy skills in locating,
synthesising and evaluating resources to fulfil these objectives. Students then integrate these with
their prior knowledge and share their understandings within their problem-based learning groups.
Learning about professionalism (at least at the location of the study, the University of Liverpool) is
one explicit strand of these identifiable learning objectives. As Cruess and Cruess (2006) argue, much
of learning about professionalism is based on socialisation and interactions with the peer group
being an important source of learning for these students (Sandars and Morrison 2008). The
principles of interactions, socialisation and peer collaboration are essential characteristics of web2.0
technologies. Studies have also shown that students are more likely to employ these tools in their
social interactions and are less aware of their potential for their studies (Trinder et al 2008; Boulos et
al 2006).

How wikis may benefit students’ learning has been described by other studies. One such study
argues that the collaborative nature of wikis, i.e. that students can edit and comment on pages
created by others, facilitates group work in an online environment (Doolan 2007) and these peer
contributions help students by ‘regulating one another’s learning through online technologies’
(Boulos et al 2006). Learning about professionalism requires students to think critically, reflect, make
links and structure their ideas. Studies have found that the asynchronous nature of the tool as well
as its organically growing structure, which students need to manage, can be linked to increased
reflectivity (Nicol et al 2005). In the context of this study focusing on students’ learning about
professionalism, students would not only see where others are up to in their own thinking through
their wiki contributions, but how others develop theirs, jointly constructing their understandings
around themes of professionalism. Thus, introducing web2.0/wiki technology in a problem-based
learning context seemed pertinent in exploiting the collaborative potential of this online tool, as well
as responding to the cultural gap between students’ and their educational institution’s use of
web2.0 technologies (Trinder et al 2008). In particular, McGee and Begg (2008) recognised the

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possibilities offered by wikis for students to add information and materials relevant to their own
learning aims to small group wikis and hence to contribute to their learning.

1.1 Originality
Although the use of wikis is getting more and more widespread in teaching and learning, their use
has been mainly reported from disciplines other than medical education (such as architecture,
engineering, media etc.) (e.g. Rick and Guzdial 2006). The originality of the proposed study was due
to the lack of research evidence available from within medical education on the use of wikis. The
study aimed to close this gap. It aimed to combine the strengths of this technology for the pedagogic
context in medical education and make available the valuable lessons learned not just about how ICT
can enhance student learning, but how such methods can be effectively designed and delivered to
students. Whilst the project offered insights into the use of wikis in a medical PBL context, other
disciplines which also use PBL may also benefit from this approach.

1.2 Scope and limitations of the report
This report aims to capture the outcomes of introducing the use of wikis in a first year medical
context. It reports on an innovative and experimental pilot during which a range of data was
collected and analysed to ensure the rigour of findings. Nonetheless, the report and its findings are
constrained to some extent by limitations such as the small scale of the pilot as well as the relatively
short timescale in which it was conducted. In this sense, the hope is that this study has been able to
illuminate the various opportunities and issues that can, and have, arisen through the introduction
of such innovative technologies. Whilst the authors are also mindful that the technology employed is
constantly evolving.

1.3 Report structure
The remaining chapters of the report is organised as follows:

Chapter 2 – describes the aims of the study;
Chapter 3 – introduces the methodology;
Chapter 4 – elaborates the learning context;
Chapter 5 – summarises the benefits of using wikis in student learning on professionalism;
Chapter 6 – details the various teaching and learning, technical and managerial issues of
the implementation, with special reference to the scalability of the pilot;
Chapter 7 – summarises and discusses the project findings;
Chapter 8 – concludes the study with recommendations; and finally,
Chapter 9 – highlights project outcomes.

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2. Aims
The research questions of the project were:

• to what extent the use of wikis can enhance student learning in the area of students’
personal and professional development;

• what are the facilitators and barriers to student learning in professional and personal
development, in particular, those associated with the use of such technology?

3. Methodology
The use of wikis was piloted at one institution, the University of Liverpool, where problem-based
learning (PBL) sessions provide the main vehicle for medical students to acquire the knowledge-base
of the ‘core curriculum’. Students each week had to identify a set of learning objectives from their
problem-based scenario related to personal and professional development (PPD), which they then
needed to research.

Figure 2 A problem-based learning session - identifying learning objectives

The study was carried out with ethical approval from the University. Four PBL groups involving 32
first-year medical students were selected on the basis of the facilitators volunteering to take part.
Once the facilitators’ and the groups’ approvals were received, a group-wiki was set up for each
group on the aspects of personal and professional development for each PBL scenario under
discussion.1

The wiki tool used for the project was TeamsLX, the tool available in the institutional virtual learning
environment, Blackboard. Each student was introduced to the project at the first PBL session in the
second semester. They all received a printed guide describing how they could use and interact with
the tool. One wiki was set up for each module and group so that only the group’s members and the
facilitators could access the wiki. Students used the wikis to share resources or ask questions relating
to these learning objectives on professional development (they also had the option to relate them to
the other strands of objectives such as ‘structure and function’ etc.).
1
Each two-week module is based around an imaginary clinical scenario, from which the PBL group derives
learning objectives. From each scenario, students are expected to identify learning objectives under the four
curricular themes - Structure and Function (SF); Individuals, Groups and Society (IGS); Population Perspective
(PP); and Professional and Personal Development (PPD).

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Each wiki was pre-structured but students were informed that they could develop their own
structure should they wish to. Due to the short timescale of the pilot, the use of wikis involved a
discrete medical learning scenario (from conception to birth) spanning a four-week period in their
second semester (Feb-April 2008). This meant that two wikis per group were set up initially. As the
wiki pilot was extended for a further three modules until May 2008, a further three wikis were
created for each group.

With such a small, exploratory study it was important to look, not for immediate changes in
students’ assessed performance, but at their views, attitudes and behaviours about their own
learning experience. Hence the study took an interpretivist approach using qualitative data to inform
developments in the use of the tool as well as collect perceptions of the participants as to their self-
assessed impact of the pilot on their personal and professional development. Tutors’ perceptions as
to the professionalism-related learning outcomes of students were also collected and compared
with those of students.

Triangulation of methods ensured that research findings were checked against one another by
involving both students and tutors in the data collection, combined with system statistics on the use
of the tools (such as access and student contributions). Each participating student was given a brief
questionnaire at one of the PBL sessions with a confidential return envelope. Altogether eight
questionnaires were returned (25% response rate). A focus group session, with a free-lunch
incentive, was arranged at which students could return the questionnaires and discuss their project
experiences. Eight students took part in the focus group, predominantly from one PBL group. This
may have showed some bias in that the participants were amongst the keenest who also worked
well as a group (see Section 6.1 on group work and sharing).

In order to boost data collection and minimise this bias, the other groups were also followed up and
three further, brief, focus groups were set up with the participating student groups in March/April
2008. A follow-up focus group with two of the groups were arranged at the end of May 2008 so that
student reflections could be gained after a more extended period of wiki use from the participating
students. Interviews were also conducted with two of the three tutors who facilitated the
participating PBL groups in order to gain their perspectives on the student learning experience and
project outcomes.

The focus group sessions were transcribed. These transcripts and the qualitative survey data were all
analysed using thematic content analysis. Frequency tables of the survey data were also prepared.
Being mindful of the limited response rate and potential bias in representation, this small-scale
quantitative data has therefore only been used as illustrative of student experiences in the project
complementing the qualitative analysis.

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4. Findings: the learning context
This chapter contextualises the research findings by describing students’ learning patterns
and perceptions of professionalism and concludes with the project findings in terms of how
students engaged with, and interacted in, the wikis made available to them.

It was important for the research to locate students’ experiences with this new technology by
placing it in the context of their overall learning experience. Therefore, the study gathered data on
students’ learning patterns within the problem-based learning context, which also included their
online behaviour within and outside the course requirements. Since the purpose of the study was to
look at how the use of web2.0 technologies may enhance students’ learning on professionalism,
students’ perceptions of professionalism were also elicited. Finally, online observation of how the
different student groups engaged with their wiki is summarised. All these contextual data served as
the basis for the discussion and analysis of project outcomes in subsequent chapters. The students’
learning experience is considered first.

With regard to the first-year students who took part in the pilot study, the problem-based (PBL)
learning group to which they belonged, seemed to be an important part of their learning experience.
Not only educationally, but through the social bonds, friendships that they have made were
important in providing a safe, trusted learning environment where their confidence as university
students and would-be-professionals grew. Students frequently mentioned that these peer-group
interactions were particularly useful at the initial stages of their course when they were ‘feeling their
way’ around the university, “double-check*ing+ yourself with the group as you go along” (Focus
Group 3).

Students also talked about developing various strategies and patterns of learning in the first
semester, which helped them with the shift from school to university. These included working out
which resources were useful to consult, including resources in the institution’s virtual learning
environment, Blackboard:

“It’s like you know *that+ for S+F *structure and function+ you use this textbook, for PPD
[personal and professional development] you use that textbook, use the internet for this,
then you do that and it’s just getting … your efficient habits.” Focus Group 3

As far as collaboration between the problem-based learning sessions was concerned, students’
behaviour tended to vary. Some collaborated in various forms with one another, whilst others did
not necessarily draw on members of the group. Those who collaborated tended to do so via face-to-
face and online methods, the latter including social networking, email, telephone and instant
messaging. Sharing resources, such as web links and books, were predominantly an unplanned and
incidental aspect of these personal interactions, both face-to-face and online (McGee and Begg
2008).

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Figure 3 Students' range of learning patterns in-between PBL sessions

One way that students interacted and shared resources online was setting up online social
networking groups in Facebook2 for their PBL group; this was particularly the case in the first
semester when social bonds were forming. Out of the four PBL groups in the second semester, when
the pilot was conducted, only one formed an online social network on Facebook for their group. A
recurrent theme was how students differentiated between their social and academic (“work”) lives
and did not like the two to get mixed up with one another:

“if with PBL when you are sharing information, you are just sharing it. But if it’s
*VLE/wiki+ like, it seems like it’s work!”

Confirming the findings of other studies (e.g. Trinder et al 2008), this study’s students also preferred
to keep their social and academic spheres separate. They preferred to interact socially in their
unmonitored, informal online social networks and conduct their academic learning – anything
“work-related” – in the institutionally provided space of the virtual learning environment:

“I would be more likely to put things on that [wiki] or look at [the wiki] the same time as
going on VITAL to check my emails 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)

As far as students’ ICT (information and communications technology) context was concerned, most
students claimed that they were relatively confident with ICT and most had their own PCs or laptops.

Students’ perceptions of professionalism were also elicited in the study. The small-scale survey data
showed that students claimed to understand the concept of professionalism in general and in
medicine, and understood what personal and professional development was. They also viewed the
problem-based learning process positively in that it raised their awareness of professional
development and, in the majority, their interest in ethical issues. Focus-group discussions elaborated
the picture of their perceptions. When asked about what professionalism meant to them, students
responded with a few typical answers such as: “careers. What’s the role of GPs. Job descriptions.”
2
http://www.facebook.com

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This response indicated a narrow view of professionalism, i.e. the boundaries of job roles and career
paths. Other students had a more formed, complex view of professionalism (Jha et al 2006), such as:

“Professionalism is the process of tackling daily activities in a serious manner alongside
the application of the related principles, laws and ethics of the profession.” (survey
response).

In one instance, a student articulated:

“Professionalism is not something you can learn over the internet. It’s a social skill. It’s a
lifestyle.” (Focus Group 1)

These different perceptions of professionalism could be attributed to the different strategies that
students employed in their learning about professionalism. Those students who mainly identified
professionalism with the learning objectives related to personal and professional development,
which tended to be job roles, seemed more likely to have a more narrow interpretation of it. Whilst
other students, who associated professionalism with other aspects of their medical career such as
attitudes, behaviour and interactions had a more developed, holistic view of it.

Key points – Findings: the learning context

The problem-based learning (PBL) groups were an important part of students’ learning, both
academically and socially.
Students displayed a range of collaboration patterns in-between PBL sessions, including
offline and online modes such as informal chatting, using online social networks, email and
phone calls.
Students preferred to keep their social and work spaces separate. Therefore, when it came
to ‘doing work’, they did not want this to encroach in their private online social networking
spaces; they were happy to work in the institutionally provided wikis and virtual learning
environment.
Students demonstrated a range of perceptions with regards to professionalism, from seeing
professionalism as purely concerned with job roles, through to more developed
understandings.

What follows next is a description of project findings with regards to how students engaged in the
wikis which were set up for them on a voluntary basis.

4.1 Student engagement in the wikis
A private wiki was set up for each problem-based learning group for each of the two modules, which
spanned four weeks (Figure 4).

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Figure 4 The group wikis set up for each module in Blackboard (TeamsLX wiki)

This was then extended on an optional basis to include a further three modules (for a further six
weeks). Students were provided with a ‘how-to guide’ on using the wikis, but interestingly, they
tended to find out how the wiki worked on a basis of trial-and-error. Due to the short lead-in time
available in the pilot, it was not possible to do a hands-on demonstration for each group. Some
students found wikis easy to use, whilst other students did not find them as straightforward. There
were also a number of students who initially did not see the purpose of using the wiki for their
learning. Students displayed a variety of attitudes in terms of their interactions in the wiki. Some
posted items by editing their group’s wiki pages, some only viewed others’ interactions and there
were students who had not logged on to the wiki at all. The four groups differed in the extent of
their wiki participation, with some groups being more active than others. In terms of the posted
material in the wikis, web links were the most frequently contributed items (Figure 5).

Figure 5 A student contribution to the group wiki – a web reference on professional roles

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Students also posted book references. In one case, when a student felt that he was struggling with
one learning objective, he posted a question to the others in the group. In another instance, a whole
section on the role of the health visitor was posted (Figure 6).

Figure 6 A student contribution to the group’s wiki: the role of the Health visitor

Despite the short lead-in time and duration of the pilot, students engaged with the wiki and edited
the wiki pages with their contributions. In terms of the wiki structure, the pilot phase set out a page
structure which students could follow (i.e. they only had to edit the pages with their contributions
rather than having to create their own pages afresh). Some students followed this structure and
some created their own new pages. After the initial focus group session at which the wiki structure
was further discussed with the participating students and slightly re-organised for the subsequent
modules, there was a tendency for these students to use the pre-set structure. This suggested the
usefulness of a negotiation process between students (and/or the facilitator) about the wiki
structure. Students had a better understanding of how they were to structure their contributions
and grow the wiki pages in a logical fashion.

Key points – Findings: student engagement in the wikis

Students tended to get to know how the wiki worked on a trial-and-error basis.
Students demonstrated a range of engagement patterns in the wiki, some posted
contributions, some only viewed others’ posts and some did not log on at all.
Students more frequently posted web links rather than typed-up content to the wikis.
Some PBL groups were more active than others in the wiki.
Involving students in negotiations about the structure and purpose of the wiki enhanced
students’ understanding of how they could make better use of the wiki for their learning.

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5. The benefits of using wikis for students’ development of
professionalism
This chapter summarises the way in which wikis can enhance student learning on
professionalism. Findings point to two main ways in which this can happen. Firstly, wikis can
act as a shared knowledge-base and resource for students’ learning about professionalism
by way of helping them to collate useful links and resources which answer their identified
learning objectives on personal and professional development. Secondly, interaction in the
more formal wiki space can promote reflection and the development of the online identity
of medical trainee students.

Chapter 4 discussed students’ perceptions of professionalism and the two main strands in which
students engaged with it in their learning. At a more direct level, students identified discreet
learning objectives related to personal and professional development for each of their problem-
based learning scenarios and attempted to fulfil these objectives during and between their PBL
sessions. At a more indirect level, students’ PBL discussions, as well as other curricular activities,
contributed to and promoted their development as future medical professionals. On the basis of this
study’s findings, two main areas of benefits have emerged in relation to these two ways of students’
learning about professionalism.

Firstly, wikis helped students in finding, compiling, evaluating and sharing resources related to their
learning objectives on professionalism. That is: wikis acted as a useful collaborative learning
resource and knowledge-base. Secondly, it was demonstrated by the study that the online wiki
spaces could have a role in enhancing students’ development of professionalism in a wider sense.
One theme that emerged in relation to students’ use of wikis was how wikis could promote
students’ development as reflective practitioners, i.e. by having to think about the quality of
resources that they contribute to the shared wiki space. Linked to this theme, another important
finding indicated that by students separating their online social and academic spaces, they become
concerned with how they act as individuals in both spheres, as a ‘student’ in the former, and as a
‘professional’ in the latter. This reflection, in turn, then has the benefit of creating an online identity,
which promotes students’ sense of developing professionalism. Figure 7 summarises these two main
benefits as they emerged during the research. The following two sections take each benefit in turn,
to discuss them in detail.

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Figure 7 The two main benefits of using wikis to enhance medical students' learning about
professionalism

Key points – Benefits of wikis:

The two main areas of using wikis in student learning on professionalism were shown to be:
o Wikis can act as a shared resource and knowledge-base. They allow students to
share their identified learning resources with one another in –between their face-to-
face sessions.
o Wikis can act as online spaces for developing students’ identity as a professional and
their development as reflective professionals.

5. 1 Wikis as a shared resource and knowledge-base
One of the main benefits that students reported concerned their ability to share resources on their
identified learning objectives in-between their PBL sessions. When other students found a relevant
resource on the area of personal and professional development and posted it to the wiki, the whole
group was able to see it online. Sharing links in this way helped students study the relevant learning
objectives. Some students found these links especially useful when they had seemed to waste a lot
of time and effort on identifying resources for the given learning objective. This benefit was all the
more welcome as students found personal and professional development to be the least well
provided for out of the four strands associated with their problem-based learning scenarios:

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“Professionalism is hard to find resources on, so ... it’s quite useful to share them.”
(Focus Group 3)

The small-scale survey responses also signalled a positive attitude from students who accessed or
contributed to the wiki. They reported an enhanced understanding of personal and professional
development, they said that they shared more resources as a result of the wiki and that it improved
collaboration within the group. To a lesser extent, these students also agreed that wikis contributed
to their professional development and enhanced the PBL process. This was confirmed in the focus
groups with one student suggesting that resources put up in the wiki by other students helped clarify
their problem-based learning discussions:

“*X+ put references on for certain pieces of information, which made it a lot easier to
understand what she was talking about in PBL.” (Focus Group 1)

Another student commented that if they were unable to find a resource on professional learning to
put in the wiki then it may be an indicator that their learning objective needed amending, which
they could do in the wiki without waiting until the next problem-based learning session. Some
students also found this method of sharing better than their previous methods which were emailing
and texting one another. In another student’s view, wikis had the potential to display different
perspectives on the same issue, which they saw as a useful characteristic, especially when it came to
discussing more complex professional issues:

“If there is a very difficult question, or one that you can only see one way, you can put it
up to see how other people approach it in different perspectives” (Focus Group 2)

In Chapter 4, the importance of the PBL group in creating a positive peer environment for students’
learning was highlighted. Wikis were seen to benefit students in this sense too. Students considered
the use of the wiki as a potential medium which, being located in their PBL group, strengthened
group cohesion and opportunities for positive peer feedback. This was due to being able to see how
others progress in searching for and thinking about the identified learning objectives online in-
between sessions. Students commented on feeling a lack of confidence especially in the early period
of their arrival to university. They saw these wiki interactions in-between sessions as potentially
beneficial in increasing their confidence in their own ability to achieve their set learning objectives.

Key points – Benefits of wikis when acting as a shared resource and knowledge-base
Wikis helped students to share resources with one another in-between their face-to-face
sessions. This is particularly useful as professionalism seemed to be an area where resources
were difficult to locate.
Wikis helped clarify PBL discussions.
By being able to check one another’s wiki contributions online, students felt more confident
about their learning.

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5.2 Wikis as online spaces for developing identity as a professional
The previous section demonstrated the benefits of using wikis in relation to the particular learning
objectives. Before describing another major area of benefits arising from the use of wikis, it is
necessary to highlight two aspects of professionalism, at least as the concept was interpreted by the
author of this research study. This interpretation viewed the essential characteristic of a
‘professional’ as their ability to reflect on their own learning, attitudes and behaviour. Further, that
the development into a ‘professional’ was very much concerned with a reflection on what it meant
to be a professional, i.e. a sense of emerging professional identity. What emerged from this study
was that wikis were seen as beneficial related to both of these aspects. Thus, the fact that wikis
promoted students’ reflection and sense of identity-formation demonstrated their potential for
students’ development of professionalism. How these benefits materialised are discussed below.

Towards becoming reflective
Using wikis helped students reflect on their learning. When talking about the problem-based
learning objectives in personal and professional development, students’ reported their main source
of information to be the internet. They cited websites – such as the General Medical Council, the
National Health Service and the Department of Health – as useful sources for finding out information
to complete their learning objectives. Some drew on family and friends for information. However,
because students engaged in locating resources via the internet, the issue of the difficulty in judging
the quality of internet resources emerged:

“Things like group discussion I think help to tie in everything we have been learning ‘cos
on the internet you get so many different resources give slightly different opinions on
professionalism.” (Focus Group 3)

Students found it hard to evaluate whether the internet resource was good quality and reliable. As a
result of these expressed uncertainties, some students were more hesitant to contribute the
resource they found to the group wiki. Students did not want to be seen to ‘be wrong’ in front of
others by posting up an unreliable web resource.3 As opposed to the informal social networking
space where these fears were not present, the fact that students felt faculty members could see
what they had posted, meant that they were less confident in contributing to the wiki space in case
the resource was not of high quality. These comments demonstrated a developing sense of
professionalism, exactly because students realised the importance of the quality and reliability of
resources in their learning as trainee medical professionals. These tentative attitudes expressed by
students when consulting the internet for resources on professionalism therefore at the same time
indicated that they were becoming more reflective. McGee and Begg (2008) similarly argue that in
the current technological environment, information literacy skills are requisite skills in higher
education where “future physicians need to be adept at locating and synthesising info from a variety
of sources”. The project then demonstrated how these information literacy skills could be promoted
through the use of wikis, and how these contributions could promote students’ becoming more
reflective professionals.

3
Students also listed a range of other sources which they draw on to develop their professionalism during
their course such as their communication skills module or clinical practice; and the importance of interaction
and real-life settings – however, the discussion of these is outside the remit for now.

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Developing identity through online wiki spaces
As one student commented, this web2.0 type technology “introduced *her+ to a new way of
learning”. Although she also commented that due to the short time-scale of the pilot, its full benefits
were not yet explored or were not evident to her, this student saw that through the use of wikis,
trainee students could learn how to interact online. What emerged from this and other students’
views was a way in which online wiki spaces could contribute to the promotion of professional
identity. How this may take place is discussed below.

As Wagner asserts, part of medical education is about acquiring a new identity as a doctor and
medical professional (Wagner et al 2007). Whilst Hilton and Slotnick (2005) describe this
development in relation to the communities of practice model in which the young trainee attempts
to copy the behaviour of their more experienced and senior professional with whom they come in
contact. These stages of identity-forming were observable during the wiki pilot as well. That some
students expressed a need for a staff member to offer their expertise in helping them to monitor the
quality of wiki contributions suggested exactly this: they wanted to rely on and copy their behaviour
until they were confident enough in their own. Similarly, not wanting to be seen to ‘be wrong’ in
front of staff members – when students were aware that faculty members may have monitored their
wiki contributions, even if they did not, – also suggested a sense of forming professional identity,
manifested online.

The role of technologies, especially that of web2.0, in developing students’ identity has been
discussed by others too. Sefton-Green (2004) for instance describes how through their participation
in online social networks, students become used to negotiating a range of identities, which then
helps them to explore their identity. Similarly to this, Collis and Moonen argue that:

“the many different kinds of communication, representation and collaboration tools
collectively referred to as web2.0 that are now being used by learners of all ages and
levels outside formal education requirements are making fast inroads because they offer
effective ways to be heard, to connect, to find and share, and to build identity” (quoted
in Trinder et al 2008)

With particular reference to medical students, the stage of students presenting themselves to their
peers and receiving feedback is an important part of their professional development (Niemi 1997).
The various technologies offer a platform for students to develop their self-identity (Sandars 2008
quoting Livingstone 2002). As was seen in Section 4 on learning context, the pilot’s students did
make extensive use of informal, online social networking to interact with one another in, and
beyond, their peer group. These interactions took place in a trusted, informal environment where
students could be themselves: ‘students’. They talked about the freedom of making mistakes and no
one observing them or making judgements as to their competence. As soon as they entered the
realm of the wikis, which were seen to be set up by their course instructors, and to which facilitators
also had access, their behaviour changed, they took on a different, ‘professional’ identity. This was
an identity which they identified as ‘work’ and with being a professional medical trainee. In this
sphere, rules of engagement changed and students were keen to be seen acting as ‘professionals’
when it came to their wiki contributions:

“When you are online, you tend to be a lot more informal than face to face. Basically
you like have to develop to [do] communication in a professional way. I guess that kind

25


of makes me reluctant to use this wiki thing, because we are just used to informal
chatting. I wouldn’t be [acting] professional with these people [referring to PBL group]. I
am not saying that [group laughs], but I wouldn’t like to try to give up that kind
demeanour, just like a friend to a friend. “ Focus Group 1

That both the informal social networking and the wiki contributions were acted out in the same peer
group has caused some tension in relation to this identity:

“Why would we be writing professionally as like really formal to [one another]? We are
not like esteemed colleagues [laughs- all participants laugh+.” Focus Group 1

The above perception demonstrates that students were aware of an innate need to act
professionally in the wiki. However, they found it difficult to adjust and act professionally in the
same peer group with which they interacted informally in their private online spaces. The above
perception also highlighted some lack of awareness as to the benefits of ‘being professional’ online,
i.e. that these online interactions may have another aspect of developing skills which the student
would be able to employ in their future career as a medical professional. Thus, although the benefit
of using wikis demonstrated a potential in students’ identity-formation as professionals, by way of
contrasting their informal and formal online learning spaces, this potential may need further
highlighting to students.

Key points – Benefits of wikis when acting as online spaces for identity development

Wikis can help students become more reflective practitioners as they are ‘forced’ to
evaluate the resources before they share them.
Students identified the wiki spaces (as provided by the institution) with ‘work’ which also
meant that they interacted differently in their informal, private online spaces as opposed to
the wikis.
Students wanted to appear ‘professional’ when contributing to the wiki and were concerned
with the quality of their contributions and not wanting to be seen ‘wrong’ or ‘stupid’.
These different interactions showed how online wiki spaces can help develop students’
professional identity.
The merits of acting professionally online were not always evident to students, suggesting
that these need to be explicitly highlighted to them.

The fact that not all students experienced these above benefits to the same extent draws attention
to the various issues that influenced student engagement as well as the outcomes of the wiki pilot.
These issues are discussed in the next chapter.

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6. Teaching & learning, technical and managerial issues of using
wikis
This chapter describes the various teaching & learning, technical and managerial issues
which influenced students’ engagement with wikis. The main identified teaching and
learning issues included wiki awareness, privacy, group work and sharing, the
‘populatedness’ of the wiki, reliability, motivation and professional identity. Whilst
managerial issues predominantly concerned the scalability of the pilot.

The previous chapter highlighted the main benefits of using wikis as evidenced from this research.
The student survey, the focus group discussions together with the observation of online wiki
interactions gathered a number of issues related to student engagement. Some of these issues were
general teaching and learning issues, some of these were related to the use of wikis as a web2.0
technology or specific to the particular wiki tool (TeamsLX) used in the pilot and finally, some
concerned the way wikis were set up and managed. These issues are grouped and discussed in the
next three sections: teaching and learning, technical and managerial.

6.1 Teaching and learning issues
First, the teaching and learning issues are considered, including those educational issues that
influenced the perceived effects of learning benefits of wiki use either from the instructors’ or
students’ points of view. These included awareness of the wiki technology, privacy, group work and
sharing, the ‘populatedness’ of the wiki, concerns of reliability, gains in professional identity and lack
of student motivation. These will be explored below.

Wiki awareness
Studies concerned with today’s generation of young students have claimed that there is a
widespread awareness between students of new types of technologies such as social networking,
blogging and wikis (see Prensky 2001). Recent studies, however, found that students’ degree of
familiarity differed when it came to the different types of web2.0 technologies. Whilst students
extensively used online social networking (e.g. 91%), they were both less familiar with and
comfortable using wikis and blogs for instance (52%) (JISC/IPSOS MORI 2008). It is interesting to note
that while many students use Wikipedia for researching their studies, a high proportion of them are
not aware of what a wiki is or how to use it (JISC/IPSOS MORI 2008). This finding was confirmed by
the current study. It appeared during focus group discussions that before the pilot started, students
had not been aware of what wikis were or had not used them before. One student, when prompted
about Wikipedia being similar to the wiki, exclaimed with surprise: “Is that a form of the wiki?” Once
students were equipped with the knowledge as to the purpose of the group wikis (whether it was
resource sharing or discussions around the learning objectives) and how they could be used for their
learning, they seemed to value wikis more. This confirmed another finding from related e-learning
studies, i.e. that students, although familiar with web2.0 technologies for their social purposes, do
not necessarily see the educational value in them without further structure and guidance from their
educator (Trinder et al 2008). The findings of this research study confirmed that students were less
aware of the wikis than the abovementioned studies suggested. Students’ learning curve was
greater than with other, more familiar types of web2.0 technologies, such as social networking tools
or even blogs. These point to the need for careful scaffolding when introducing students to this

27


technology, both in terms of an introduction to the tool as well as how they will be used in their
studies.

As mentioned above, those students who took part in a discussion at one of the focus groups as to
the nature and structure of wikis, did show an increased engagement with the tool after the focus
group session.

Key points – Wiki awareness

Students demonstrated less awareness of wikis as a technology than expected on the basis
of previous studies.
The more students were aware of what wikis were, the more likely they were to be engaged
with them.

Privacy
Many students contrasted their interactions in the institutionally provided group wikis with that of
their own private social networking tools. As mentioned before in Chapter 4 on learning context,
students predominantly used Facebook for their own social purposes, although also commented
that in Facebook they discussed their learning or sharing resources on an ad-hoc basis. They
associated this online social networking space with safety and comfort where they did not have to
worry about having to appear professional, they could be themselves, students:

“you feel more free to express yourself” (Focus Group 1)

Because the institutional wiki was set up for the students by the medical faculty, they associated this
space as one that was being ‘monitored’ and therefore not private; even though only their groups
and their facilitator could access it and there was no intention of the faculty monitoring their
contributions. Purely because of where the wiki space was located (i.e. within the institutional VLE),
students felt that they were in a different environment over which they had no control. The effect of
this perception was that students were less motivated to contribute to the wiki, or at least that they
had to make more purposeful judgments as to when to contribute or not, more so than they would
have made in their private social networks.

If students identified their online Facebook networks with privacy and their wiki space with a ‘public’
space, there was another dimension of this dichotomy: the separation of social and work spheres,
respectively:

“Facebook is primarily a way of communicating with friends. Whereas the Wiki is a way
of communicating things that you’ve found that are relevant to work. So *pause+ it’s
seen as something that’s work not something that’s social so you’re less tempted to use
it.” (Focus Group 3)

The fact that students saw the wiki space as “work” did tend to affect their engagement with wikis;
though this occurred differently in the case of different students. Some appreciated the separate
work space and preferred working in the wiki, whilst others preferred to stay in their social Facebook
space. This polarised behaviour was also observed in the JISC/IPSOS MORI study concerning the use

28


of wikis (2008). In line with other studies (Sandars et al 2008), students also highlighted that it would
not be a solution to move the institutional web space to their preferred online networking space as
they would not use it:

“I think if you do add it [wiki] to a social site then no one will use the social thing
because they will think the faculty are watching or checking all what they are all doing.”
(Focus Group 1)

The characteristics of the wiki space then, in which students shared their learning within their peer
group, whether it was seen as an informal/social/private place or whether a formal/work/public
space affected students’ interactions. The solution, on the basis of student comments and as
Sandars et al (2008) also suggested, was not necessarily moving one space into the other, but
looking at managing control and ownership within the institutionally set-up wiki space. Many
students commented that they preferred small-group based wikis, in which access was restricted to
their eight-person PBL group. This offered them a trusted and safe environment in which they felt
confident making contributions, as opposed to having to contribute to large wikis to which the
whole year group had access.

Key points – Privacy

Students who liked the separation between their online work and social spaces, tended to
appreciate and use the wiki space more for their learning.
When students found the wiki space too ‘public’ for their interactions, they were less likely
to see the benefits of this space for their learning and so, they preferred to keep their
discussions about the problem-based learning objectives within their own private
(online/offline spaces).
Private, small-group based wikis were welcomed by students. This was because their known
problem-based group ensured a trusted, safe environment where they did not need to
worry about the quality of their contributions and how they were seen by other group
members.

Group work and sharing
Group work and willingness to share resources with others were issues which emerged during the
introduction of wikis. As seen in Chapter 4, different PBL groups engaged with the wiki at varying
levels, some being more active than others. In one instance, although students accessed the wiki,
the group did not contribute to it at all. Facilitators suggested that some groups worked better
together as a group than others, with the more cohesive groups being more active online as well.
Reticence to share resources, albeit on a small scale, was also a reason why those less willing to
engage in the wikis did not contribute to it. Cultural differences went some way to explain this
student attitude, though as students themselves said, it only characterised a small proportion of
students. These issues related to group dynamics though not specifically relevant to the use of
web2.0 technologies per se, were nevertheless important pedagogical aspects of the learning
context which influenced student engagement.

29


Key points – Group work and sharing

Positive group dynamics were an important indicator for students’ engagement. Groups
which worked well together in face-to-face sessions were more likely to share resources
with one another online.
Cultural issues related to sharing, i.e. students being reticent to share their learning with
others, were also found to act as a barrier to engagement, though this concerned only a few
individuals.

‘Populatedness’
One optimal condition that students saw for using wiki in their PBL context was when the wiki was
already populated with items such as web or other resources. An empty wiki was daunting for them.
They did not want to be the first to contribute:

“I think everyone hesitates to put something in it at the moment. You don’t want to be
the first person that starts …” (Focus Group 1)

The ‘populatedness’ of the wiki was linked to levels of sharing and access. Students appreciated that
whilst a small, peer-group based wiki had advantages in terms of privacy, it also meant a limited
amount in terms of the volume of postings (with a maximum of eight members being able to post to
the wiki). Students felt that a wiki available to the wider student group – for instance to the whole
year – though losing in privacy, would allow a greater number of contributions to the benefit of all
member students.

‘Populatedness’ of the wiki was not just a quantitative issue. Students also expressed the view that
they would have liked to have access to a wiki which was already populated by resources related to
professionalism and checked by staff members. This would not only have initialised their
contributions but would have offered them a guide as to what they should be learning and guiding
them in terms of selecting the ‘right’ kind of information for their study. This finding coincided with
that of Cruess and Cruess (2006) who also identified institutional support including adequate
resources important for students’ development of professionalism. That said it also signals a tension
between the problem-based learning approach where part of the learning is to find, evaluate and
use information and resources.

To summarise, whether resources already existed in the wiki, either by peer members or faculty
staff, influenced students’ confidence in posting contributions to the wiki. A tension between the
preference for a private, trusted wiki space between the issue of ‘populatedness’ was also
discovered during the pilot, which was linked to the extent of member access (small group versus
large group).

Key points – ‘Populatedness’

The lack of pre-existing resources in the wiki, the lack of ‘populatedness’, was daunting for
students. Many did not want to be the first to contribute.
Students welcomed the idea of contributing to wikis which were already populated by
resources on professionalism and which were quality assured by staff.

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Students saw whole year-group wikis as having advantages as these large wikis would have
potentially contained more resources to choose from for their learning about
professionalism. However, this caused a tension between their previously expressed
preference for private, small-group based wikis.

Reliability
As already discussed in relation to the benefits of wikis to student learning in chapter 5, students in
their reflections about their wiki engagement expressed a concern as to the quality of postings of
their wiki contributions. A number of students commented that they did not want to be seen to be
posting ‘wrong’ or irrelevant content. Apart from the reliability of resources being linked to issues of
professionalism such as identity and confidence, this student concern had a pedagogical impact as
well. These comments brought up the issue of the need for monitoring and editorship in the wiki.
Some students conveyed the view that they would have liked staff members to act as monitors over
their own and their peers’ contributions, as they were better judges of the quality of resources. They
found the lack of quality-assured materials, especially in the area of personal and professional
development a difficulty, given that this area was the most difficult to find resources on. There was
also some discussion about what should happen to the postings that were deemed not to be right –
whether they were to be deleted or to be commented upon and evaluated. One student observed
that as different groups had defined different learning objectives for the same learning scenario, one
resource may be relevant for one group and not to the other.

Key points – Reliability

In their reflections on wiki engagement, students expressed a concern as to the reliability of
the resources contributed to the wiki.
Students did not want to be seen ‘wrong’ when posting to the wiki.
Where students had more confidence in their information literacy skills, they were more
likely to share resources within the wiki.
Students found the lack of quality-assured materials by staff members and professionals a
difficulty in their learning about personal and professional development.
They welcomed the idea of having a staff member who would monitor the quality of
contributions.

Professional identity
Chapter 5 highlighted that the use of wikis promoted students’ development of professionalism by
making them reflect on the way they interacted in different online spaces. This was achieved by
juxtaposing their interactions in the formal wiki and informal social networking spaces. However,
not all students were aware of this indirect benefit, i.e. that interacting online and discussing
professional issues with their peers through wikis could lead to an appreciation of what role similar
online spaces may play in their future career. For instance, they did not draw a connection between
their own wiki use and that medical professionals may draw on similar online communities of
practice in their careers for their own personal and professional development.

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Key points – Professional identity

Not all students appreciated, or were aware of, the benefits that interacting in more formal
online spaces, such as wikis, could bring to their future professional career and
development.

Motivation
As far as student motivation was concerned, there were a number of students who did not engage in
using wikis for their problem-based learning studies. There were a number of possible reasons for
this. Some students stated that their “current methods are good enough”, meaning that the way
they discussed their learning and shared resources between sessions, e.g. via email, text and face-to-
face, were suitable methods. The other main educational reason for being less engaged was due to
students being strategic learners. If students did not see the immediate benefits of wikis for their
exams, they did not feel the need to be engaged (McGee and Begg 2008). What transpired from the
focus group discussions was that the majority of students still favoured making their own paper-
based notes (though some students did some of this on their laptops) which they brought to the
next session. This meant that students who did engage in the wiki were more motivated to share
links with one another rather than typing up content for others to see.

Key points – Motivation

Some students found their current methods of learning about professionalism ‘good
enough’ (which could be either offline or online, individual or peer methods); they lacked
motivation for using the institutionally provided wikis.
This was linked to the voluntary nature of wikis - their use was not aligned to any
assessment tasks; students being strategic learners did not feel compelled to use the wikis
for their learning.

Motivation to use wikis for their studies was also linked to technical issues, which are discussed in
the next section.

6.2 Technical issues
The technical issues that influenced students’ perceptions as to the benefits of using wikis for their
learning included two main aspects: issues of usability (such as the interface and functions of the
wiki tool) and training & support needs.

Usability
As for usability, where students expressed more negative views of the wiki, these tended to relate to
its interface (the chosen tool was the the TeamsLX wiki in the institutional learning environment,
Blackboard). These comments were typically like: the wiki was “too boring”, “plain” and
“uninteresting”. In many instances students compared the wiki tool to that of Facebook, with the
latter being the preferred option for its user-friendly, colourful and engaging interface. This was true
for the functionalities that both offered. Students liked the fact that Facebook was activity-centric
and that it notified them of recent activities. Similar alerts were not available in the TeamsLX wiki,

32


i.e. if the wiki was updated, students were not notified of this. They actively had to log in and scroll
through each page to see whether there were any new changes. Some students also struggled with
navigating round the wiki.

Training and support needs
The importance of hands-on learning and getting familiar with the structure of the wiki in face-to-
face sessions was also confirmed. Due to the short lead-in time available for the set-up of the pilot, it
was not possible to conduct a face-to-face training session and this was commented on by students.
The written guide, although helpful in some cases, was not satisfactory in guiding them as to what
they could do in the wiki. This was because those more confident with ICT were happy to experiment
with the wiki on a trial-and-error basis, whilst those less confident did not draw on the guide either.

Students were not too aware of the history function of the wiki; this was shown by their concern of
potentially making mistakes in the wiki or posting something wrong, not realising that the option of
deleting or amending contributions was one of the main aspects of wikis. Had they been aware of
this functionality, the knowledge that their posting could be reverted could have helped their
confidence in making contributions to the wiki.

What these technical issues pointed to was the importance of alerts when using wikis in similar
group contexts as well as the value of making the wiki appealing, perhaps through the use of images
and colours. Having the need for a face-to-face training session in which the purpose, structure and
navigation of wikis were explained to and discussed with students was in strong evidence on the
basis of student accounts.

Key points – Technical issues

Usability
Students’ engagement was negatively influenced by the design and interface of the wiki tool.
Students preferred the interface of Facebook to that of the wiki tool piloted (Teams LX) as
they found it easier to use and more friendly and colourful.
Students had to actively log in to the wiki and check each page one-by-one to see whether
anything has been added. This lack of functionality with regards to alerts, otherwise a central
function of web2.0 tools such as Facebook, was also a major impediment for student
engagement.
Training and support needs
Not having a dedicated face-to-face session had the effect of some students not logging on
at all, due to a lack of ICT confidence.
Students preferred a hands-on introduction to the wikis as opposed to reading a written
guide.
The history function of the wiki was less well known to students.

6.3 Managerial issues
There were a number of considerations which pointed beyond the technical capabilities of the
chosen wiki tool. These concerned the set-up and management of the wikis. This section therefore
discusses how these managerial decisions impacted on the achieved learning benefits of wikis. Given

33


the pilot, small-scale nature of the study, it was important to consider any issues within the research
with a view of what would happen when the pilot is scaled up, in this instance, with the introduction
of wikis to the whole first-year group. Therefore this section first discusses any managerial issues
that the introduction of wikis brought about during the pilot, which were access, privacy, remit and
navigation.

As the pilot was conducted in the context of problem-based learning groups, it was decided to
restrict access to the wikis to the eight-member PBL group. The group’s facilitator and the
researchers on the project also had access to the wiki. Students liked this privacy:

“One thing about that PPD thing [wiki] which was good was the fact that it is private
and other groups can’t see what we have written.” Focus Group 1

Although students also commented that in this privacy set-up they could be losing out due to not
seeing other groups’ contributions:

“But I also think it’s a disadvantage as well because sometimes being able to see with
the PBL learning objectives, being able to see what other people have written is
beneficial as well.” Focus Group 1

Further, it was decided that for each problem-based learning scenario a new wiki would be created;
this meant to make it easier for students to relate resources to their identified learning objectives
for that module (as opposed to creating an overall wiki for instance for the duration of the pilot). In
this set-up however, the potential for the wiki’s remit to act as a cumulative resource over the
lifetime of the student, or even just the year, was muted.

To match this remit at the module level (the two weekly-learning scenario), the wiki was linked to
the relevant module in Blackboard, i.e. students had to click at least four clicks to access it within the
hierarchical navigation.

All these managerial decisions (small group vs large group access; privacy; remit; and location in
terms of navigation – see Table 1) influenced student contributions to the wiki.

Table 1 Managerial considerations of the wiki setup
Managerial Details
considerations
Access Who has access to the wiki? Small or large group?
Privacy Is the wiki open to others Private (members-only) or public (non-
who are not members? members have read access) wiki?
Remit What is the remit of the Is it linked to the module or
wiki? cumulatively to more modules over
the years?
Location/Navigation Where is the wiki located? Can students click into it at the top
level or do they need to navigate
through various levels of hierarchy to
access it?

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It is not yet clear without further researching other wiki tools whether these managerial decisions
could be consolidated in other wiki tools by enhanced functionality or whether they are decisions
that need to be made on the basis of weighing up the advantages and disadvantages of each option.

Issues for scalability of the pilot
The small-scale pilot also offered an opportunity to consider the managerial issues with regards to
its scalability, i.e. implementing the use of wikis in PBL groups across a whole year (with some 300
medical students). These need to be taken into account alongside the above mentioned managerial
considerations. The identified issues mainly concern:

access to the wiki - whether only a small (e.g. problem-based learning group) or the whole-
year group has access to it and whether non-members can read wiki contributions or not;

its setup in relation to the remit of the wiki - i.e. what is the boundary of the wiki– is it just
for discussing the relevant problem-based learning scenario or does it follow a broader
purpose to record students’ learning;

the lifecycle of the wiki - whether and how students access/interact with it in subsequent
years;

Some of the solutions to the issues may be directly determined by the available functions of the
chosen wiki tool. Whether or not both institutionally or externally available tools can be chosen will
be determined by the institution. So what follows is a consideration of these various managerial
issues as mentioned above, highlighting what potential solutions would need to be taken into
account for the success of up-scaling the pilot to a whole medical year-group.

Issue 1: Access and privacy: who has read/write access to the wiki?
Issue description: On the one hand, students preferred to share their learning online in their familiar
peer groups. This meant that they liked the fact that the wikis were only accessible to their own
group. Another reason for this was the recognition that one group’s learning objectives would not
necessarily be the same for other groups and they would not have the same purpose/resources to
identify. On the other hand, students realised that wikis open to the whole year group would yield
more contributions in terms of resources, purely because they would be coming from a significantly
larger group.

The solution needs to consider: a wiki structure that offers different levels of access. This could
potentially mean a two-level wiki, which a) has discrete private group areas for students to discuss
their own learning objectives and ask questions which they may not want to ask in front of the
whole group and b) a joint year-group area for the whole year. This latter could consist of resources
which were found to be of good quality by the small groups, as well as questions which the small
problem-based groups are finding hard to answer or finding it difficult to find resources on.

Issue 2: The remit of the wiki: what is the remit of contributions?
Issue description = during the pilot, wikis were set up for each discrete learning scenario. This remit
is not necessarily reflecting the iterative nature of the medical curriculum. Wikis could also be set up
which would span a wider remit, beyond the learning scenarios. The first solution poses problems in
terms of searchability. Students at their later stages of their training would need find information in
a potentially high number of wikis. The latter cumulative-wiki solution would present issues of

35


growth and structure, i.e. how information could be structured in the wiki so that students could
organically and logically be able to grow their wikis during their training. One issue, and this may be
particular to the institution where wikis were piloted, was that the problem-based learning groups
change each semester so any group-related wikis would need to deal with this extra complexity.

The solution needs to consider: whether wikis at the learning scenario level are useful for student
learning (mini-wikis) or whether wikis would need to serve a wider cumulative purpose. Again, could
this tool consolidate these opposing purposes?

Issue 3: Wiki lifecycle: can future students use the wiki and its contributions?
Issue description: the wiki pilot was conducted within a semester of students’ training for 2-5
discrete learning scenarios. The question arises as to what would happen to wikis in their
subsequent years of training as well as these wikis relationship to the new in-take of first year
students. If the wiki pilot continues, will students be able to easily access and find information in
their past wikis? Would the new first-year students be able to benefit from the contributions made
by previous first-year peers?

The solution needs to consider: how this accumulation of knowledge is managed: whether it is
managed in one wiki or across several wikis (linked to the previous issue of wiki remit). For instance,
whether wiki contributions could be accessed and re-used by students in the following years. There
may not be an easy solution. Different alternatives such as opening up wikis or perhaps exporting
wiki pages may need to be considered.

Issue 4: Wiki functionality: what functions does the tool have?
Issue description: the chosen wiki tool for the pilot had various constraints in terms of its
technological capabilities. One of the main limitations was that the tool did not have an alert
function. Students also found the interface less engaging.

The solution needs to consider: other wiki tools which may be external, third party tools.
Institutional constraints may play a part in whether this choice is openly available. Given that the
main purpose for students to use wikis was sharing links to resources rather than sharing content,
other tools such as social bookmarking systems could also be considered.

Issue 5: Support needs and resources: how to balance benefits versus support needs?
Issue description: there are about 35 problem-based groups in a medical year at the pilot institution.
If wikis were set up for each of these (or even if a joint group wiki was set up with different access
areas), the process of setting up these groups would require significant support and set-up time.

The solution needs to consider: the large-scale nature of benefits of using wikis and measure them
against these resource needs.

It is true that with regards to scalability more questions than answers emerged as a result of the
pilot. These questions are important in identifying the issues that would need to be considered when
scaling up the pilot to a whole year group. It was also possible however to make some practical
recommendations as to future implementations for the use of wikis in medical education, especially
relating to the development of professionalism. These are expressed in the section 8.

36


Key points – Managerial issues

Five issues were identified which need to be considered when scaling up the pilot. These were:
Access and privacy: wiki access, whether creating small or big group wikis influences student
engagement with benefits and disadvantages in the case of both. A potential solution could
be considered which offers different levels of access.
Wiki remit: the implementation needs to consider whether wikis at the learning scenario
level are useful for student learning (mini-wikis) or whether wikis would need to serve a
wider cumulative purpose.
Wiki lifecycle: the longevity of wiki usefulness surfaced as a managerial issue, i.e. whether
wikis are created for a discreet learning period or whether they can provide a more
cumulative resource base for students.
Wiki functionality: given the functional restrictions of the wiki tool, future implementations
need to consider other available tools, subject to institutional constraints. It could even be
that other web2.0, such as social bookmarking, tools could also facilitate the sharing of
resources on professionalism.
Support needs vs benefits: implementation of the wiki project, if carried out similarly to the
pilot, would require significant support and set-up time which needs to be measured against
the expected benefits of using wikis for enhancing student learning.

37


7. Project summary and outcomes
This chapter summarises the study and the outcomes of the project.

7.1 Project summary
how this web2.0 technology may be used to enhance first-year medical students’ learning in a
blended environment, especially relating to their development of professionalism. Group-based
wikis were set up for the duration of the pilot associated with a particular learning scenario. This
meant that students were able to share and discuss resources online related to their identified
learning objectives as a group.

During the pilot phase, all four groups had the opportunity to access and use the wikis for their
study. Student interactions in the wiki, based on online observations as well as focus group
comments, differed not just from group to group but also on an individual basis. Some groups, and
some individuals, were more active than others. Some students contributed to the wiki, whilst
others just viewed it, and again others did not log on at all. Students tended to experiment with the
wikis on a trial-and-error basis rather than reading any support material.

Data were collected in the form of a small scale survey and focus groups discussions. Through this, it
was possible to gather information about the learning context of the participating students as well
as to locate the benefits that students experienced when using wikis for their learning about
professionalism.

The learning context of these first-year students involved the importance of students’ peer group
(both the immediate problem-based learning group and beyond) in their learning. These students
were also at an important point of development as university students, formulating and developing
their learning strategies appropriate to the university environment and requirements. These
strategies included the selection of online resources for their study. It was also a phase when they
were growing in confidence as learners, supported by the feedback of their facilitators and peers.
The social bonds which they created were an important part of this, with an indication that some of
this social interaction happened within their online social networking groups outside the
institutional environment.

As far as the development of professionalism was concerned, students demonstrated a range of
perceptions from the concrete ‘professionalism is about job roles’ to more complex views which
amalgamated professional attitudes with duty of care obligations through to associating
professionalism with ‘a lifestyle’. Most students used the internet for discovering resources for
fulfilling their learning objectives related to professionalism. Students identified professionalism as
an area that was least provided for by the institution as well as an area which was hard to find
information about. All these perceptions pointed to the need for having access to resources,
especially web resources, on professionalism. Students’ concern about not just trusting any resource
pointed to a sense of their developing identity as a reflective practitioner who was concerned with
the quality and relevance of the resources. Students identified that they needed the skills of being
able to search, evaluate and synthesise resources in order to be able to post to the wikis; skills which
they associated with senior professionals and staff members. Indirectly then this was a stage in

38

Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism.

Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism.

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Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism.