In the dynamic and rapidly advancing modern technological landscape, the role of digital learning tools in medical education is an emerging area of study. Although much has been written about online resources and learning in medical education, there is a lack of studies on physician’s role in the development of these digital tools. This paper describes the creation of a pilot psychiatric educational website, and relevant considerations about the present and future role of physician-developed Web technology in medical education.

Medical students and residents are increasingly relying on Web technologies as their primary educational resources. A recent survey of fourth-year medical students found that on a daily basis, for educational purposes, 76% used Google searches, 83% used Wikipedia, 57% used UpToDate, and only 8% used bibliographic databases. [1]. Another survey study of residents of psychiatry revealed that the majority of respondents relied on online resources instead of textbooks, with the most utilized website being UpToDate, closely followed by Wikipedia and PubMed [2].

The variables driving the preference for and selection of online educational resources are multifold. Although there are numerous novel and effective uses of technology in medical education including gamification [3], feedback dashboards [4], social media [5], and virtual reality [6], websites remain the most frequently utilized digital resource. The high rate of use of Wikipedia and similar resources suggests that medical trainees are relying in part on user-created content for their education. Furthermore, in a recent survey of pediatric residents about preferences for educational website functions, 100% of respondents wanted pictures, 93.2% interactivity, 88.9% digital videos, 88.6% links to articles and research, and 86.4% graphics and animation [7]. These reports suggest that medical trainees value the interactive and multimedia potential of Web-based educational resources for learning and understanding their subject materials.

Modern Web technology now offers a novel opportunity for medical educators and trainees to not only be consumers of educational websites, but also participate in their creation. Technology has evolved to make the development of custom websites affordable, feasible, and educationally valuable. Understanding the process of developing digital technologies for medical and psychiatric education provides an opportunity for physician educators to leverage technology to better engage learners around relevant and quality content. A firsthand narrative describing the construction of a novel educational website for psychiatry trainees, PsychOnCall, provides a lens through which one can understand the current barriers, capabilities, and future opportunities for physicians in integrating technology development and teaching.

The value of understanding the creation and development of websites is best understood and framed in the context of advances in medical education theory. Adult learning theory, which highlights the active role of the learners’ aspirations, as applied to residents of psychiatry suggests they are motivated more by personal interests and clinical relevance of topics than by training requirements [8]. The flipped classroom model, in which residents learn foundational material on their own and then use didactic time to discuss or apply such knowledge, encourages active learning and self-discovery of knowledge [9]. In the same vein, while a website may classically be seen as source of knowledge for learning, in the flipped classroom model it can also serve as a source of knowledge through creating content. Using Web technology, collaboration and active learning are no longer limited to just physical space, and several successful educational websites, such as that of the Kahn Academy, have been developed to realize this potential. However, there currently does not exist any widely available psychiatry-specific resource.

When it comes to training faculties and trainees, the competency of technologically minded individuals varies significantly, just as the case with wide range in competency in clinical knowledge and research literacy among these individuals. The creation and maintenance of a Web-based educational tool with clinically sound educational material can potentially serve as a venue to merge bidirectional teaching and learning in all 3 realms, namely, technology, clinical knowledge, and research literacy. More technologically minded trainees could educate and engage faculty members on the use and benefits of technology through this endeavor, while faculty members can educate and engage the trainees in systematically reviewing the quality of clinical material to be used for the website. The latter thereby reinforcing the cliché “Do not believe everything you read on the Internet.” It could also foster discussions on ways in which different learners learn and how to optimize the use of technology to benefit multiple learning styles. This endeavor may also help identify trainees and faculties who may benefit from or be interested in further training in biomedical and clinical informatics, which is a growing field in medicine.

Thus, it seems that advances in technology and educational theory offer the opportunity for medical trainees and training programs to play an active role in the creation of an educational website that is visually appealing, dynamic, and interactive, where both teachers and trainees can learn from each other. Our goal was not to build that website but to rather explore the process to provide a pilot experience for an eventual large-scale project recognizing the value in understanding the development of educational technologies [10]. While we discuss the process of constructing our single specific website, PsychOnCall, we believe that the process of creating this website could provide valuable generalized lessons regarding both the opportunities and barriers that any resident, clerkship director, or program director will likely face when trying to build their own educational website.

While building our pilot website we focused on exploring the potentials of Web technology to enhance general medical as well as psychiatric education and the understanding of the process necessary to construct such a website. Online educational websites remain a nascent field and there are many exciting avenues for such to develop along. Although there are technological barriers to implementation, we believe that these barriers will continue to diminish and that the true barrier at this point is the design, translation, and validation of core psychiatric concepts presented on the page and their conversion into interactive and visual formats.

Rather than be flooded by a sea of websites, medical as well as psychiatric educators now have the opportunity to develop their own online resources as a hub of education. While the creation of websites is not novel, the increased reliance on them by trainees and the increased ease of creating them is novel and important. Using Web technology, now at a point where trainees can create websites as in our example, technology is no longer only a medium for educational knowledge but also a tool to be planned, developed, and learned.

While the potentials of digital learning to provide personalized adaptive or collaborative learning have been widely discussed and defined [12], actually implementing such in clinical education has been less well documented. Considering technology itself as a tool to be learned by medical trainees has been even less discussed. As we demonstrated, the actual creation of such a website even with a social/collaborative component is technically feasible and easily constructed. The challenge now is observing and understanding how trainees may actually use such a website and how various learning theories translate into an online reality. Medical and psychiatric educators now have the opportunity to conduct such studies and gather actual user data.

However, in order for such to succeed there should be several well-established processes before construction of any actual website. Understanding how content will be created and who will review and approve it are barriers that will likely become of increasing importance. Likewise, understanding how such content will be updated is another important consideration. A potential solution grounded in adult learning theory and the open classroom model is that trainees will provide the content and actively review the quality of the material with faculty as a shared process, which would simultaneously promote education in research literacy. However, the actual implementation of such remains unproven.

Despite the increasing prevalence of website use in medical education and psychiatry, much also remains unknown and unproven. While our paper does not present any user or subject data, our goal here is to not the highlight the merits or faults of any one unique website but rather consider the motivations and processes around creating such tools. Although there continues to be newer technologies, for example, virtual reality headsets and smart watches, websites currently remain the core technology that medical trainees continue to rely on. A better understanding of their use and the process of their creation is the important first step for medical education to better understand and utilize technology for teaching.

Although creating such processes will not be a simple task, starting to think of solutions now is important in ensuring that psychiatric educators will be able to influence the design and implementation of online educational resources. Following the recommendations of the Working Group on the 2011 conference “A 2020 Vision of Faculty Development Across the Medical Education Continuum,” we agree that technology should be used to supplement but not replace face-to-face experience, that medical schools should allocate a variety of resources and support, and that national organizations should provide funding and leadership [13]. While it is impossible to define that tipping point where the investment and necessary resources decrease and the potential educational benefit increases, perhaps psychiatric education is now at that very tipping point with the future of online educational resources in motion. At one point in time, 16 years ago to be exact, it was noted that “software [for residency administration] will require both a financial and time investment before there can be dividends” [11] and today we would argue that online educational websites today are at that same crossroads.