ABSTRACT
Objective: To describe the process of the development
and implementation of a clinical education wiki site
at a chiropractic college, and students’ satisfaction and
experience using this site.
Methods: The information technology department and
faculty members created the design, layout, navigation,
and a list of procedures to go on the site. To evaluate the
students’ perception and experience using the wiki site,
an institutional review board (IRB) approved anonymous
classroom survey for student cohorts in each year of the
chiropractic program (3rd, 5th, 6th, and 8th terms out of
10 terms) was conducted.
Results: The student survey revealed that 92% reported
using the wiki site since its creation, 95% rated their
overall satisfaction using the site as very satised or
satised, 81% found the site to be user-friendly, and 90%
agreed that the site improved their overall educational
experience.
Conclusion: The development and implementation of
a clinical education wiki site at a chiropractic college
is a process that requires the collaboration of faculty,
administration, students, and information technology
professionals. The use of a wiki site is an encouraging
approach for improving the educational programs at a
chiropractic college. The results of the student survey
reveal that most students nd the wiki site helpful and
easy to use.(J Contemporary Chiropr 2022;5:145-149)
Key Indexing Terms: Chiropractic; Medical Education;
Wikis
INTRODUCTION
Web 2.0 technology is the current evolution of the
internet, allowing users to actively engage, create,
and distribute information instead of just receiving
information (as in Web 1.0 technology). Examples are
social media sites such as YouTube, Facebook, LinkedIn,
Wikipedia, Blogs, podcasts, and online shopping sites
like Amazon and eBay.
Ward Cunningham created the rst wiki software
in 1994. The term “wiki” comes from the Hawaiian
phrase, “wiki wiki” which means “quick”. (1) Literature
shows that many groups have used wikis, including
corporations, (2) all levels of education, and in medical
and nursing education. (3) Wiki sites are used to prepare
research publications, improve teaching and learning, to
enable professional development, and produce project
management tools. (4- 6) Healthcare professionals use
wikis to collaborate, create, and disseminate knowledge.
(7)
New publishing models, such as blogs and wikis,
continue to inuence educational practices by gradually
replacing print manuals that can be continually updated
and provided on-demand. Wiki sites are collaboratively
authored, searchable documents. (2) They are extremely
easy to use and edit, requiring minimal technical skills,
low costs, and minimal maintenance. (6,9) For educators,
wikis can be a way to provide a public forum for students
as well as an engaging site for student assignments and
expression. (10) According to Leuf et al., a wiki site is
the ultimate collaborative tool for a group of users on
a global scale. (11) Students in this generation have
grown up using the internet and most students spend a
signicant portion of their lives using various internet-
based technologies accessible through various devices.
(12)
In 2011, our chiropractic college made the decision
to develop an online clinical education manual to be
available to all chiropractic students and faculty at the
college. The objective of this paper is to describe the
process of the development and implementation of a
clinical education wiki site at a chiropractic college, and
students’ satisfaction and experience using this site.
METHODS
Key faculty are tasked by the dean to develop a clinical
education wiki site for students and faculty at the college,
with the assistance of the information technology
department (IT). The purpose of this wiki site is to
J Contemp Chiropr 2022, Volume 5
DEVELOPMENT AND IMPLEMENTATION
OF AN ON-DEMAND WIKI SITE FOR
TEACHING AT A CHIROPRACTIC COLLEGE
Paul Wanlass, DC, CSCS, CSPN
1
, Rhiannon Hutton, DC, MOAM
1
Journal of
Contemporary
Chiropractic
JCC
1
Southern California University of Health Sciences, Whitter, CA
Wiki Site and Teaching
Wanlass and Hutton
145
J Contemp Chiropr 2022, Volume 5
Wiki Site and Teaching
Wanlass and Hutton
support the students’ education in the classroom and
in the clinic. The university information technology
(IT) department creates a working group comprised of
faculty and IT members. The representative from the IT
department determines the necessary resources to achieve
this task, including the software, computer hardware and
network equipment, camera equipment, and the space
needed to lm.
Our software criteria include:
1. Low-cost software that allows hosting videos,
pictures, text, links, and references
2. Software compatible with the operating system
software on the college’s server
3. Software allowing faculty to easily edit and
update the pages to keep the content current
The criteria for the computer hardware and network
equipment includes:
1. Identifying the available storage space on the
current college server(s) for a new website
2. Evaluating the current network infrastructure
including the wired and wireless internet and
intranet to ensure all students and faculty would
be able to view the wiki site both on and
off campus
The criteria for the camera equipment includes:
1. Purchase a high-denition video camera with
high-quality sound and the ability to take high-
denition still pictures
2. An adjustable tripod
The criteria for the space includes:
1. A dedicated space on campus to lm all videos
over a 2-to-3-year period
2. A sound insulated room
3. Direct lighting
4. A chiropractic table, exercise equipment, and
various cushions, balance boards, and towels
5. The room should have a background that is
pleasing to the eye and will remain uniform for
all videos
Faculty members that are content experts in their area
of instruction create the design, layout, navigation, and
a list of procedures to go on the site. During the research
to nd the best software for this project, the working
group learned that wiki software uses Common Gateway
Interface (CGI) script and Hypertext Preprocessor (PHP)
programming to provide an interface between the web
server and the wiki software to generate web content. The
wiki software allows edits, keeps track of edits, contains
a list of authorized users and administrators, allows
redirects from one page to another, and allows searches.
The site Administrator must be able to write CGI scripts
and use PHP programming (a type of programming
language different than Hyper Text Markup Language
(HTML) used by most websites).
The working group chose one faculty member with
computer programming and web development experience
to be the Administrator of the wiki site. The Administrator
is responsible for creating the site navigation, lming,
uploading the videos and pictures to the site, using CGI
and PHP to create links on each page, adding the written
content on each page, and corresponding with the IT
department to convert each video to multiple le formats
to ensure they could be viewed on PC, Mac, and mobile
devices. Student actor-volunteers sign a written informed
consent granting the chiropractic college a non-exclusive,
non-terminable, royalty-free license to use and display
their name, image, likeness, picture, voice, and video
image. Student volunteers and graduates also help with
written content, proofreading and editing the pages. The
site Administrator conducts a nal review and approval
of all wiki site pages.
The working group develops a 2-phase plan for
implementation. In phase I, we create videos, pictures,
and content for all procedures taught in the diagnosis
and chiropractic procedures courses. Phase II links
these procedures with common clinical conditions,
and evidence-guided care pathways developed by our
university.
To evaluate the students’ perception and experience
using the wiki site, an institutional review board (IRB)
approved anonymous classroom survey for student
cohorts in each year of the chiropractic program (3rd,
5th, 6th, and 8th terms out of 10 terms) was conducted.
The authors used The Statistical Package for the Social
Sciences (SPSS) software to analyze the data descriptively
using percentages.
RESULTS
After considering the above criteria, the IT department
installed the wiki software on the school server,
purchased a video camera, and reserved an existing
video room on campus. Phase I of the wiki site started
in 2011 and was completed in September 2013. The goal
is to offer students online videos to supplement their
classroom and laboratory education in areas of physical
examination, neurological and orthopedic testing. It
also includes adjustive techniques, soft tissue therapy,
146
palpation, and rehabilitative care. The site is organized
by body region such as cervical, thoracic, lumbar,
pelvis, upper extremity, and lower extremities. There
are additional categories for physiological therapeutics,
vascular tests, neurological tests, specialized chiropractic
procedures such as instrument assisted adjusting, and
review materials. As of June 2022, there are 2,742 total
pages (all pages in the wiki including video, photo, and
text content pages, and redirects to other pages on the
site), 1,240 content pages, and 1,183 videos and 982
pictures. Additionally, each page contains step by step
instructions for all the procedures including references.
The main page of the wiki site has a search box. The user
can type in a key word or even speak into a mobile device
or microphone to search the entire site. The site has had
a total of 2,866,189 visitors since 2011. This includes
the creation of each page with multiple edits plus new
visitors.
Phase II will consist of the common clinical conditions.
This would include the requisite history and exam
procedures along with related diagnostic tests as needed.
After a literature review, the working group estimates
there will be between 40 and 50 common clinical
conditions. These conditions will link to evidence-
guided care pathways, outcome assessments, diagnostic
guidelines, and all related procedures already on the
wiki site. The site design will allow students to navigate
quickly between these conditions.
After one year of use, students were surveyed to
determine their level of use and satisfaction with the
wiki site. A cohort of students from 3rd, 5th, 6th, and
8th term out of 10 terms were chosen for the survey
because they had completed the courses both before and
after implementation of the wiki site. The results are in
Table 1.
DISCUSSION
Wiki sites are easy to implement, edit, and maintain,
and provide a way for many people to collaborate on
a specic topic. For example, Neuhaus et al. examined
the impact of wiki-based clinical practice guidelines
and found that it enables iterative, ongoing, and
interactive development and revision processes and
provides a cost-effective, efcient methodology and
transparent assessment of the available evidence. (13)
Brulet completed a systematic review of 25 medical wikis
dedicated to clinical practice in 2015 and found that only
two were being used at universities. (14) Archambault
reviewed wikis and collaborative writing applications
in health care and found 23 surveys about wiki use in
healthcare, their impact as knowledge translation (KT)
tools, and the factors that affect their use. The authors
concluded that future research should study the effects
of using embedded media such as pictures and audio
and video recordings within collaborative writing
application (CWA’s) such as wiki sites. (15) Taveira-
Gomes et al. completed a systematic review of computer-
based learning (CBL) technologies using multi-media
and text in medical education and concluded that future
research should focus on implementing reusable software
platforms for specic learning contexts, tracking online
activity, and creating a more student-centered model
within the computer-based learning platform. (16) Our
wiki site records detailed statistics on viewer usage, and
page edits.
Rasmussen studied the application of wiki technology in
medical education in 2013 and concluded that with proper
planning and instructional design, wiki technology can
be usefully employed in medical education. (17) Wiki
sites stimulate collaborative learning in online health
science courses for nursing according to Zitzelsberger.
(18) Cabrera et al. found that wikis are particularly useful
in the creation and management of asynchronous and
multi-author knowledge dissemination, collaborative
learning, and social interaction in graduate medical
education. (19)
The results from our survey suggest that students use
the wiki site on a regular basis and agree that it plays
an important role in their educational program. All
health care educational institutions should consider
implementing a wiki site to support student learning.
Wiki sites are used to distribute medical information
and in the educational setting. We did not nd literature
describing the use of a wiki site to support student
learning at a chiropractic college.
J Contemp Chiropr 2022, Volume 5
147
Wiki Site and Teaching
Wanlass and Hutton
Table 1.
Students
Number of Students 178
Gender 61% (Male)
39% (Female)
Reported Using the Wiki Site 92%
Wiki Site Usage 34% (Few times/month)
29% (Few times/trimester)
15% (Few times/week)
11% (Once a week)
3% (Daily)
Overall Satisfaction With e SCU Wiki
Site
95% (Agreed)
Overall Educational Experience Improved 90% (Agreed)
Website Was User- Friendly 81% (Agreed)
Descriptions Including e Procedures,
Indications And Contraindications Are
Well Dened In Site
79% (Agreed)
Supporting Pictures Are Helpful 86% (Agreed)
Videos Are Helpful 91% (Agreed)
Overall, students were satised with the wiki site. The site
helps them review the materials taught in class as well as
prepare for examinations. The information is centralized
in a single site and is accessible at any time and from any
place with internet service. The navigation structure of
the site makes it easy for the students to move from one
topic to another.
From an administrative standpoint, the wiki site is
maintained by designated faculty with minimal workload
on the IT department. The content, videos, pictures,
and references are easily updated. A log of changes and
statistics for the entire site are also easily accessible to the
site Administrator. The site can also be used by faculty,
alumni, and private practice doctors to review and to
complete their continuing education.
Limitations
No prior references exist to cite as a comparison to our
wiki site, and little literature exists regarding online
education within the Complementary Alternative
Medicine (CAM) spectrum.
CONCLUSION
The development and implementation of wiki site at
a chiropractic college is a process that requires the
collaboration of faculty, administration, students, and
information technology professionals. The use of a
wiki site is an encouraging approach for improving the
educational programs at a chiropractic college. Once
Phase II is completed, analysis will be conducted to
determine the characteristics of students who received
the greatest benet from the wiki site, and whether the
wiki site has improved student learning. The results of
the student survey reveal that most students nd the wiki
site helpful and easy to use.
ACKNOWLEDGMENTS
The authors thank Kevin Rose, D.C., M.P.H. for
the statistical analysis of the blinded data, Michael
Sackett, DC, MS, DABCO for his leadership during the
implementation of the site, Anupama KizhakkeVeettil,
BAMS (Ayu), MAOM, PhD for her assistance with
the literature search, the information technology
department, student volunteers, and the many faculty
who have contributed to the videos and pictures on the
site.
REFERENCES
1. Wikipedia: The free encyclopedia (Internet).
Wikipedia. Available from: https://en. wikipedia.
org/wiki/Wiki
2. Majchrzak A, Wagner C, Yates D. Corporate
wiki users: results of a survey. In: Proceedings
of the 2006 international symposium on Wikis
- WikiSym ’06. Odense, Denmark: ACM Press;
2006:99. Available from: http://portal.acm.org/
citation.cfm?doid=1149453.1149472
3. List of medical wikis - Health++. Available from:
http://www.healthplusplus.com/wiki/List_of_
medical_wikis
4. Varga-Atkins T, Dangereld P, Brigden D.
Developing professionalism through the use
of wikis: a study with rst-year undergraduate
medical students. Med Teach 2010;32(10):824–
829. Available from: http://www.tandfonline.com/
doi/full/10.3109/01421591003686245
5. Ebersbach A, Glaser M, Heigl R, Dueck G. Wiki:
web collaboration. Berlin; New York: Springer;
2006:383
6. Boulos MNK, Maramba I, Wheeler S. Wikis, blogs,
and podcasts: a new generation of web-based
tools for virtual collaborative clinical practice and
education. BMC Med Educ 2006;6(1):41. Available
from: https://bmcmededuc.biomedcentral.com/
articles/10.1186/1472-6920-6-41
7. Archambault PM, van de Belt TH, Grajales III
FJ, Faber MJ, Kuziemsky CE, Gagnon S, et al.
Wikis and collaborative writing applications in
health care: a scoping review. J Med Internet Res
2013;15(10):e210. Available from: http://www.
jmir.org/2013/10/e210/
8. Parker K, Chao J. Wiki as a teaching tool. 2007.
Available from: https://www.informingscience.
org/Publications/3131
9. Chirikov I, Semenova T, Maloshonok N, Bettinger
E, Kizilcec RF. Online education platforms
scale college STEM instruction with equivalent
learning outcomes at lower cost. Sci Adv
2020;6(15):eaay5324. Available from: https://
www.science.org/doi/10.1126/sciadv.aay5324
10. Maddox S. Conuence, Tech Comm, Chocolate:
a wiki as platform extraordinaire for technical
communication. 1st. ed. Laguna Hills, Calif: XML
Press; 2012:477 (Social media series)
11. Leuf B, Cunningham W. The wiki way: quick
collaboration on the web. Boston: Addison-
Wesley; 2001:435
148
Wiki Site and Teaching
Wanlass and Hutton
J Contemp Chiropr 2022, Volume 5
12. Payne L. Using a wiki to support sustainability
literacy. Innov Teach Learn Inf Comp Sci
2009;8(1):45–52. Available from: https://
ww w.tandfonline.com/doi/full/10.11120/
ital.2009.08010045
13. Neuhaus SJ, Thomas D, Desai J, Vuletich C,
von Dincklage J, Olver I. Wiki-based clinical
practice guidelines for the management of adult
onset sarcoma: a new paradigm in sarcoma
evidence. Sarcoma 2015;2015:1–6. Available
from: http://www.hindawi.com/journals/
sarcoma/2015/614179/
14. Brulet A, Llorca G, Letrilliart L. Medical wikis
dedicated to clinical practice: a systematic review.
J Med Internet Res 2015;17(2):e48. Available from:
http://www.jmir.org/16/2/e48/
15. Archambault PM, Légaré F, Lavoie A, Gagnon
MP, Lapointe J, St-Jacques S, et al. Healthcare
professionals’ intentions to use wiki-based
reminders to promote best practices in trauma
care: a survey protocol. Implementation
Sci 2010;5(1):45. Available from: http://
implementationscience.biomedcentral.com/
articles/10.1186/1748-5908-5-45
16. Taveira-Gomes T, Ferreira P, Taveira-Gomes I,
Severo M, Ferreira MA. What are we looking for in
computer-based learning interventions in medical
education? A systematic review. J Med Internet Res
2016;18(8):e204. Available from: http://www.jmir.
org/2016/8/e204/
17. Rasmussen A, Lewis M, White J. The application
of wiki technology in medical education. Med
Teach 2013;35(2):109–114. Available from: http://
www.tandfonline.com/doi/full/10.3109/014215
9X.2012.733838
18. Zitzelsberger H, Campbell KA, Service D, Sanchez
O. Using wikis to stimulate collaborative learning
in two online health sciences courses. J Nurs
Educ 2015;54(6):352–355. Available from: https://
journals.healio.com/doi/10.3928/01484834-
20150515-08
19. Cabrera D, Cooney R. Wikis: using collaborative
platforms in graduate medical education. J
Grad Med Educ 2016;8(1):99–100. Available
from: https://meridian.allenpress.com/jgme/
article/8/1/99/201035/Wikis-Using-Collaborative-
Platforms-in-Graduate
J Contemp Chiropr 2022, Volume 5
149
Wiki Site and Teaching
Wanlass and Hutton
