PTU - Polskie Towarzystwo Urologiczne

Internet in education of urologists and andrologists
Artykuł opublikowany w Urologii Polskiej 2008/61/2.


Igor Shaderkin - Krasnodar, Russia, Aleksander Shulyak - Lviv, Ukraine

Today the Internet penetrated in every part of modern life. Bill Gates in his monograph “Business at the speed of thought” wrote “… with the introduction of Internet in the life of a person to answer the question how much earns the specialist of this or that sphere, it will be enough to ask: “what is his education?” [1]. First of all it is due to the fact that the Internet wipes off the borders of space, of time, of language and the social borders. Today a man, who is familiar with Internet technologies, can freely communicate on-line with his colleagues, create associations not only for spending free time, but for conducting business, scientific work and education.

Taking into consideration that in the whole world modern technologies of professional education system changed from the principle “education for the whole life” to the principle “education through the whole life”, such an idea as continuing medical education is used very actively. That is why nowadays receiving new quickly changing information in time is urgent as never before.

More and more doctors prefer to find sources of knowledge in the Internet [2]. And it is reasonable. The emergence of new printed publications, especially full-size scientific books, remains behind in time from emergence of current information in global net. Prices for subscription of periodical printed publications remain rather high.

The World Health Organization conducted a research in 2003 and discovered that in 75 poor countries of the world 56% of Medical Institutions did not have an access to academic medical journals over the last 5 years. That is why it is especially pertinent to use the Internet for continuing education in developing countries and regions, which are far from Educational Medical Centers [3].

The Internet wipes the borders between states and nations, and judging from this it becomes evident that Russia remains behind other countries. Our gap in Internet-technologies is not exclusion. United States of America is the doubtless and indisputable leader in the development of global network, on its territory emerged the Internet itself. Then go European countries. But, recently in our country a positive tendency was exhibited, and nowadays the Internet in Russia is developing very rapidly. Everything that is happening to the World Wide Wed in Russia has already happened to it in developed countries. And we should not reject this great experience, but pay attention to their important accumulations in this sphere.

The Internet is great source of valuable information. But one should know how to find this information. In this context the Internet can be compared to a big city, where there is everything from libraries that contain world masterpieces to stalls that contain tabloids. That is why any work in the Internet begins with searching necessary information. From this point of view we will try to characterize briefly the sources of information in the Internet, but we do not pretend to give full explanation of them.

To begin with it should be said that information in different languages will be different. If the Internet wipes off the borders, it means that a user has an access to all national sources. The most common language of the Internet is English. The most valuable information and the greatest amount of it is in English. According to the sources, where one can find this information, it can be divided into several chapters.

Extensive research databases

MedLine is one of the largest and most famous scientific databases. It is supported by the American National Medical Library of the National Institute of Health. It contains abstracts almost of all periodical scientific printed and electronic publications since 1950 to nowadays. It is nearly 15000000 journal articles from nearly 5000 journals. The access to this database can be received with the help of several Internet resources. The best variant to do it is to use the site of National Medical Library of America by visiting PubMed. From this website one can make an unlimited number of requests using intuitively understandable language, which syntax, by the way, is very rich and allows very complicated enquires. It is free of charge and does not need any registration. The base for this language is Boolean algebra. This Internet service provides a great set of abilities not only for searching but for saving its results, making further work easier. All information in MadLine database is in English. The sites of Cochrane Collaboration also contain a great amount of information, based on principles of evidentiary medicine.

Cochrane Collaboration is not only collection of information; it is Medical Scientific Association, which deals not only with selection of data, but also defines its scientific value, using the principles of evidentiary medicine. Greater part of full-text information is closed for unregistered users. There is a number of other sources, which allow to find scientific medical information in the Internet, but in most cases they are based on these databases.

For the initial search one can use special search servers, which are similar to search servers as Google, Yahoo, Yandex and others. Search on these servers is called vertical search, the search, which is limited by certain subject area, in our case it is “medicine”, “urology”, “andrology” (Table I). At all these sites the information is searched in Englishspeaking sector of the Internet. In the Russian-speaking sector of the Internet one vertical search server in the chapter “Urology and Andrology” should be noted, it is the site – urology researcher (

To find these sites different mechanisms are used: databases of global search servers, abstracts databases. Some of them have their spiders (programs, which indexes information that was found at the medical sites), and also use a combination of these technologies. So, after finding the necessary information, reading the title of the article and its abstract it is possible, using suggested reference, to find its origin. In this regard it is possible to define the next chapter of Internet information.

Network representation of scientific printed and electronic publications

In reality there are a lot of sources of information, but we will speak only about those, which are purposeful scientific medical resources. First of all, periodical printed publications – magazines are of a great scientific and practical interest. Almost all representative publishing houses have electronic versions of printed publications, which are published at the same time and do not remain behind printed versions according to the date of publishing. Table II presents a short list of the most popular periodical publishing houses that concern urology and andrology and are available in the Internet.

The access to information at many of the resources listed in Table 2 is chargeable. Mostly it concerns Internet representatives of printed publishers. Sometimes, with a view to advertise it is possible to receive some magazine fascicles and/ or some articles free of charge. But, even Russian specialists can afford to subscribe electronic versions of magazines. Some scientific associations that are the owners of these magazines give a reduction for interested specialists from Russia. Such a reduction can be given at the site of European Association of Urologists ( Mane scientific and educational institutions have free access to this information.

As the rule, full electronic versions are contained in convenient pdf format. These files can be “downloaded” on your computer and printed almost in the same way this article was presented in the magazine. From this point of view html-versions (it is the look of all the Internet sites) are much worse, because they contain a lot of unnecessary information.

The site UroToday also should be paid attention. It contains a lot of useful full-text information for urologists and andrologists, which is updated every day. The site is always kept up to date. But, the main part of information is available in English. The information of electronic publications is very valuable, and the confidence is provided by scientific associations, which are the editors and moderators of these editions. A good example is given by Professional Association of Andrologists in Russia (PAAR), which gives an opportunity to become familiar with some articles of its regular printed publication “Urology and Genital Surgery” and announcements of the publication at the site Also Russian Society of Oncologists ( gives Internet users a possibility to read some articles from the magazine “Oncology” and subscribe for its printed version free of charge at the site ( One can find the list of articles, published in the magazine “Urology” at the site of the Institute of Scientific Research of Urology (

Electronic representative offices of professional urological and andrological associations

The information, available at sites of professional urological and andrological associations and also scientific-educational institutions and medical centers should be paid much attention. North America (USA and Canada) and Europe are well represented in the Internet Legislators of fashion in the sphere electronic of Urology (e - urology) are: • The American Association of Urologists - and http://www. • The European Association of Urologists - http://www. • There are quite enough of andrology resources in the Internet: • American Society of Andrologists - http://www.andrologysociety. com/ • The American Society of Reproductive Medicine - http:// • European Society of Sexual Medicine - • European Society of Reproduction and Embryology - • British Scientific Society of Andrologists - http://www. • British Society of Sexual Medicine - Also at these sites one can find useful information about educational and scientific work of these centers. Table 3 presents a short list of educational-scientific institutions. The plenty of highly specialized directions in urology, which are also widely represented in the Internet, is impressive (Table 4).

There is a great amount of information at these sites even for people who are not members of these organizations. First of all the recommendations of associations regarding management of a patient are of a special value. As the rule they are available for free “downloading”. Full-text scientific articles, the information regarding past and forthcoming conferences are of a great interest. If you are a member of professional association, you receive a great support at these large sites. You receive an access to different and very valuable information.

For such distant and big countries as Russia, Ukraine, Byelorussia Internet representatives of leading urology and andrology associations are very important from the educational point of view. In this case with low prizes the speed of data delivery is indisputably higher. Russian scientific urological associations also have their sites, which are listed in the table 5. The full list of professional Russian-speaking sources of urology one can find at the site html.

But one should be very careful with the information received in the Internet

Availability and simplicity of Internet technologies give a rise to great number of sites that contain a little amount of information; it is so-called “Internet-noise”. This is the noise of a big city.

Nowadays every user for a reasonable sum of money can get any virtual area, where he can easily create and place his pages and open a site in every place of the world (USA, China, Russia, Iran and others). With a help of few simple methods it is possibly to define reliable source of information. We will try to name some of them.

A. Domein name of a site, which contains the information. • The site, which has a domein name of a second level, is more reliable then the site, placed as the domein of third or higher level in the area that is free of charge. For example, domein name of the American Urological Association (http:// is better then domein name of the site, placed in free of charge area like (http:// is a protocol, according to which the site works, it is not interested for ordinary user, www is a definer of a global net, auanet is the domain of a second level, org is a domain of the first level, it can not be registered free of charge).

• It is a good sign if a site is placed at the national domain of the first level. For Russia it is “ru”, for Byelorussia it is “by”. But domeins org, com, net, edu are common domains, where different useful sites can be placed. • It is very positive if the name of a site reflects its context. For example the site of American Urological Association auanet. org shows that “aua” is an abbreviation of AUA (American Urological Association), and “net” means a representation of American Urological Association in the Internet.

This information is not obligatory, but if it is present, the site becomes more reliable. B. It is a positive feature, if a site contains the information about its authors. Anonymous author is one of the signs, which should put a user on his guard, because an honest author has nothing to hide. It is very good to have a separate page for this. This page should contain a return address; it is preferable to have not only e-mail. Many authors of sites are not ashamed to put their photos, what makes the user trust this site more C. It is also very nice to have information concerning policy of safety and rules of using the site. D. Site without grammatical errors is a good tone and a sign that the information on the site is being tested. Usability of a site (it is a number of programme and design decisions, which make the usage of a site convenient) also is a sign of professionalism. But inconvenient site is not always bad site.
E. Electronic article you are reading at a site should contain • The title • Date of publication (date of publication at the site; it is one of the important parameters, because the documents can live in the network for a long time and titles like “Modern questions in curing and diagnosing… ” can be not appropriate if the article was published 10 years ago)
• Authors • Origin This list can be enlarged and detailed.

Search and examination of information in the Internet for self education is one of the most frequent, convenient and popular ways of continuing medical education. Internet technologies in education go much further than the usual static presentation of information. The peculiarity of these technologies allows not only providing textual information, but also multimedia data, organizing interactive communication, which makes the information richer. Using the principle of a feedback gives a possibility to get distance education.

According to many authors the usage of on-line learning and videoconferencing improves access of doctors to qualified continuing education [4], shows better results for self education, and at the same time the programme on the basis is less expensive [5,6,7,8]. If to look at the hierarchy of the effectiveness of various methods of learning in medicine, it becomes clear that on-line training is on the first place (level).
• Level 1 - interactive clinical training
• Level 2 (a) - interactive training in the classroom
• Level 2 (b) – didactic clinical training
• Level 3 – didactic training in the classroom or standard training [7,9].

With the emergence of affordable high-speed links the Internet provides an increasingly effective environment for interactive learning. This interactive training web-based technology allows a doctor to examine complex information in the absence of restrictions in time and venue of education and allows the student to set for himself the pace and depth of the material studied [7,9].

The 27th of August, 2001 RF Ministry of Health and Russian Academy of Medical Sciences produced the Order No 344/76 “The concept of telemedicine technology development in Russian Federation and the plan of its realization.” The document states that the distance education used during preparation of postgraduate medical staff has a number of advantages over the traditional system of raising skills level. The needs of practical health care system in educational services are met more fully, the flexibility of postgraduate education system for practitioner, the economic effectiveness, high quality of education, ability to attract professionals from various regions of the country as teachers, as well as practical opportunities for postgraduate practitioner to get continuing education without moving somewhere or leaving a place of work. Taking into consideration the huge territory of the country and the presence of a large number of very remote regions, this type of education would allow much more doctors and nurses to regular training.

If to touch the technology of distant education briefly, it is possible to identify some key points.
1. Registration and application for taking an interactive training course.
2. Process of education, which may consist of several ways of learning the material.
a. Distant receiving of training materials and studying outside the global networks (it is so-called off-line mode). Electronic versions of programs a trainee can receive by e-mail or download from other sources Internet and run them on his computer without connecting with the global network.
b. Examination of the material on-line, ie being at the site, which provides material for education. Not only common static information (text, graphics, etc.) is used, but training in connection with the training program, installed on the remote computer, also is conducted.
c. Teleconferences are a direct connection with the teacher. One can use text link (forums, chat, etc.), an audio or video conferences. Videoconference is the most effective, and, therefore, is the most valuable, if to speak about education, but it is quite expensive, because it requires high-speed Internet channels.
3. Summarizing of education. Summarizing of education can be discrete, ie after learning one topic and passing it successfully a student can begin to study the next part of the programme. At the end of the whole course one should pass a final exam. It can be passed: a. on-line, b. or teachers and students meet face-to-face.

A great variety of continuing medical education using Internet technologies is presented in North America. Thus the American Urological Association conducts continuing education courses, which can be taken on not only by the members of the association, but by urologists from other countries (http://www. Subject certification courses regarding the problems of urology are held at the site (http://www.medscape. com/urology/cme). And courses can be taken on not only by doctors, but also by nurses.

European Urological Association conducts continuing medical education, part of which could be accomplished with the use of the Internet technologies of distance education. The site site. is devoted entirely to this issue. There are not so many educational Internet centres in Russia; especially those centres, which would conduct the education of andrologists and urologists.

The bright example of distance education is the “Internetcentre of distance education for doctors”, whish is sponsored by the Smolensk Department of Clinical Pharmacology GMA (FAC) and the Smolensk Research Institute of Antimicrobial Chemotherapy GMA (IAC) ( ). At the same site one can find a list of documents that regulate the usage of Distant Education - normreg.shtml.

The Department of Urology in Rostov LGU (Head Professor Kohan MI) is conducting face-to-face and in absentia thematic courses in the sphere of urology very successfully. In absentia part of these courses is conducted on-line, for the classroom part a user comes to the department and passes the final exam there (

Such a system of medical education allows the listeners not to leave their place of work for a long time, helps to increase the number of participants, makes the work of teachers easier and reduces the real cost of courses[5,6,7,8].

The rapid development of information and communication technologies and their active usage in practice reduces the price of the hardware, connections and software significantly. It makes an interactive on-line education available. That is why in the near future we can hope that such training programs on the basis of the institutions, leading departments and major clinical centres, which train the specialists in urology and andrology, will emerge in Russia. You can also expect the emergence of new professional Russian-speaking sources of information, which will deal with urology and andrology.


  1. Бил Гейтс. «Бизнес со скоростью мысли». ЭКСМО-ПРЕСС, 2001 г. (51-52
  2. стр.)
  3. Nylenna M, Aasland OG: Doctors learning habits: CME activities among Norwegian physicians over the last decade. BMC Med Educ 2007, 8-7, 10.
  4. Geissbuhler A, Bagayoko CO, Ly O: The RAFT network: 5 years of distance continuing medical education and tele-consultations over the Internet in French-speaking Africa. Int J Med Inform. 2007, 76 (5-6), 351-356.
  5. KarlinskyH, Dunn C, Clifford B et al: Workplace injury management: using new technology to deliver and evaluate physician continuing medical education. J Occup Rehabil 2006, 16 (4), 719-730.
  6. Short LM, Zita J, John MH: A community-based trial of an online intimate partner violence CME program. Am J Prev Med 2006, 30 (2), 181-185.
  7. Fordis M, King JE, Ballantyne ChM et al: Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial. JAMA. 2005, 9, 1043-1051.
  8. Wutoh R, Boren SA, Balas EA: eLearning: a review of Internet-based continuing medical education. J Contin Educ Health Prof. 2004, 1, 20-30.
  9. Schilling K, Wiecha J, Deepika P, Souad K: An interactive web-based curriculum on evidence-based medicine: design and effectiveness. Fam Med. 2006, 38 (2), 126-132.
  10. Khan KS, Coomarasamy A: A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine. BMC Med Educ. 2006, 15, 6, 59.

adres autorów

Igor Shaderkin
Boguna 6\6
Ukraine, 79013