Internet information seeking and use by Medical Students of Nnamdi Azikiwe University , Nigeria .

Every form of information resource needed to support academics is available on the Internet both retrospective and current. The research determined information seeking and use of the Internet by medical students of the College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria. Data was collected using a questionnaire. Sample was 161 clinical students in 400 to 600 levels of study. Result shows that Internet was used daily by 72% of the respondents. Internet was used mainly to search for medical information (82%), social media communication, (77.6%) and for course assignments (62.2%). There is low use of academic resources such as online databases, e-journals, e-books and library websites to find information. The most frequently used website is Wikipedia (30.4%). This is followed by Medscape (25.5%) and PubMed (20.5%). Lack of Internet access (81.3%) was a barrier to the effective use of the Internet by the medical students. Other barriers identified by the respondents include: restriction of important information for payment (78.3%) and too many results returned for search (70.8%). The study concluded that Medical librarians have a role in improving students’ use of educational resources on the Internet through an extensive and curriculum based information literacy programme. 
 
   
 
 Keywords: Internet use, medical students, medical education, information seeking behaviour.


INTRODUCTION
Students are at great advantage in the twenty first century in their academic endeavours because of the Internet which is proving to be an incomparable information resource for learning and research.Every form of information resource needed to support academics is available on the Internet both retrospective and current.For medical students, many of the tools that support and transmit medical education and health research are now available online.There are e-book, e-journals, subject databases, academic and professional websites with numerous educational resources.Jadoon et al. (2011) described the Internet as an important learning tool in medical education by providing access to latest evidence anytime and anywhere.It is especially useful for students from developing countries helping them to keep abreast of ever expanding knowledge bridging the gap resulting from scarcity of resources.Geissbuhler and Boyer (2006) also noted that as a collaborative work tool, the use of the Internet is now essential for biomedical research and for the development of health systems.Advanced information retrieval technologies integrating scattered databases give new meaning to knowledge management Apart from creating easy availability of information resources that support education, the Internet as a digital object is a tool that has enriched the learning experience by giving new forms of access to information.As a multimedia education resource, students are benefiting from the wide range of interactive objects offered by the materials in the Internet.Chowdhury (1999) noted that the multimedia and hypermedia features have made the Internet particularly suitable for distant learning and self education.Computeraided instruction packages and 'virtual' universities, etc., have opened new possibilities in the teaching and research environments throughout the globe.
Social media platforms and networking on the Internet is also a tool for exchange of ideas and knowledge sharing by students.World Federation for Medical Education (WFME), 1998 recognizes the potentials of computers and Internet in medical education.They noted that the computer with its capacity for managing information and linking is the most powerful tool for processing medical knowledge and opens new avenues to the teaching and learning process.It is also a knowledge sharing tool which through linking local networks allow institutions to collaborate worldwide and exchange teaching materials and ideas.
With these resources easily available online, students can now find information to solve a learning or research problem on any topic and improve their knowledge.They can also do their assignments with ease.This makes the Internet a great tool for education and research.

Medical Students Use of the Internet
Despite the fact that the Internet is a rich information resource that can support medical education, internationally, many reports show that medical students predominantly use the Internet for non medical and educational purposes such as social media, email and surfing.Lal et al. (2006) in a research on Internet use among medical students and residents of a medical college of North India ranked medical students use of the Internet as e-mail surfing, chatting, entertainment and education.Ghabili and Alizadeh (2008) in a study of computer and Internet use among 320 Iranian medical students reported that connection to the Internet by the students was largely for non-scientific purposes.A third used it for recreational purposes.The researchers suggested that curriculum supervisors and medical trainers should revise the current medical curriculum by adding courses in computer skills or search skills to current educational programmes.Maroof et al. (2012) assessed how medical students were using the computer and Internet and found that the main use of the Internet was for communication (58.5%) and entertainment, that is, downloading movies and games (46.3%).Report by Kumar (2012) on application of information and communication technology by medical students in Chandigarh, India showed that 65.95% of the students use the Internet for scanning the available literature, while 63.82% use it for the purposes of sending and receiving e-mail.34.04% use it for online chatting with their friends.Kommula and Kusneniwar (2013) found that 64.9 % Medical Students of Mediciti Institute of Medical Sciences, Andhra Pradesh, India have an account in social networking sites like Facebook and Orkut.However, over half the students 56.7% have no knowledge about medical education websites.The study concluded that training in computing skills and information regarding medical education websites are required to enable better utilization of digital resources by medical students.Similarly, in the study by Chathoth et al. (2013) on Internet behaviour pattern in undergraduate medical students in Mangalore, the most common purpose for Internet use was found to be social networking (97.8%), followed closely by e-mailing (87.8%).
However, some studies show predominant use of the Internet by medical students for academic and research purposes.Jadoon et al. (2011) evaluated Internet access and utilization by medical students in Lahore, Pakistan; and reported that about two third of the students (61.0%) use Internet for both academic and professional activities.Akporido (2014) studied Medical Students Use of Internet in College of Health Sciences, Delta State University, Abraka, Nigeria and found that all respondents (100%) use the Internet for email and research.
Nnamdi Azikiwe University is a Federal Government owned tertiary institution situated in Anambra State, Nigeria.Though researches on the use of the Internet by medical students have been carried out in many institutions in several countries, little is known about its use by medical students in this institution.The Internet is now an undisputable tool in medical education and health practice.It is imperative to find out how this group of students are maximally utilizing the tool that has potentials to enrich their learning experience as well as build their knowledge base.Data collected will provide an insight into the information seeking behaviour of the students on the internet and possibly establish gaps and barriers that need to be addressed so that the students can effectively use the Internet in their studies.

Objectives
The main purpose of the study was to determine the

Research questions
The following research questions guided the study:

METHOD
The survey research method was used for this study.The study was carried out in the Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus.The research focused on clinical students of the faculty on 400 to 600 level.Data was collected using the questionnaire instrument.The Questionnaires (α = .846)were distributed to the medical students in their various classrooms and in the medical library.Two hundred copies of the questionnaire were distributed, a total of 161(80.5%)usable questionnaires were collected.Results were analyzed using simple percent and mean score.Analysis was done using SPSS version 17.

RESULTS
Respondents' demography is shown in Table There is no access from the faculty and Library.This is expected because the Internet facility of the College is currently not functional.On frequency of use, Internet was used daily by 116(72%) of the respondents.It was used two to three times a week by 29 (18%) of the respondents.5 (3.1%) never use the Internet to search for information.

The most satisfactory information resource used for search
The students were asked to indicate which information resource gives the most satisfaction when searching for information.Result is shown in Table 3.The table shows that majority 121(74.5%) of the respondents indicated that the Internet gives them the most satisfaction when searching for information.37 (23%) prefer print books and journals.Only 4 (2.5%) considered CD-ROM as the most satisfactory information resource.

Activities on the internet
Respondents were asked to rate the frequency of various

Most consulted websites for academic studies
Respondent were asked to list three websites they consult most frequently for academic studies.Result in Table 5 shows that the most frequently consulted website by the students is Wikipedia.This is followed by Medscape/E-medicine and PubMed.

Access to e-books in medicine through the Internet
Respondents were requested to indicate subjects to which they have downloaded e-books for study.The result is shown in Table 6.Table 6 shows that the most downloaded subjects by the students are Internal Medicine 34 (21.1%),Pathology 27 (16.8%)and Pharmacology 25(15.5%).Anaesthesiology 15 (9.3%) is the least downloaded subject.

Benefit of the Internet to Academic studies
Respondents were asked to indicate the benefits of the Internet to their academic studies.
Results in Table 7 shows that large majority indicated that easy access to information (81.3%), faster access to information (83.2%), access to current information (79.5%) and access to wider range of information (78.9%) are the benefits of the Internet to their academic work.

Barriers to using the Internet
Respondents were asked to indicate barriers to the use of the Internet for academic studies.The Result is shown in Table 8.As shown in the table, the major barrier to use of the Internet for academic purposes is lack of Internet access (81.3%).Other barriers include restriction of important information for payment (78.3%) and too many results returned for my search (70.8%).

DISCUSSION
The research determined pattern of information seeking and use of the Internet by medical students of Nnamdi Azikiwe University.Results show that 88.2% have access to the Internet.Internet was used daily by 72% of the respondents and this access is mainly through their smart phones.This pattern of use is consistent with the findings of Aggarwal et al. (2015) where 78.57% of the medical students use Internet daily and majority access the internet through their phones.This appears to show increasing preference and shift in sources of access to hand held devices.The rate of use is however higher than that of Singh et al. (2013) where only 51.2% respondents used it daily.The students were asked to indicate their level of Internet search skill which is very essential for them to access educational and research resources on the Internet.80.2% gave a high rating of their Internet search skills as proficient, and very proficient.The Internet was highly rated by the medical students as an information resource.It gives majority of the students the most satisfaction when searching for information with 74.5% of the respondents preferring the Internet compared to 23% that prefer print books and journals.This percentage of preference for the Internet is higher than that found by Unnikrishnan et al. (2008) where 42% of the respondents prefer the Internet and 24% textbooks.This is not unexpected considering the wide diffusion of the Internet in the past five years.
On Internet activities, percentage score shows that the Internet is highly used by the respondents for searching for medical information (82%), social media communication, (77.6%) course assignment (62.2%) and sending and receiving e-mail (57.2%).This pattern of use is different from earlier findings (Parashar and Bansalm, 2012;Ghabili and Alizadeh, 2008) which showed that the main use of the Internet was for recreation, communication and entertainment.Notably, the Internet is highly used for medical information and course assignment, but there is low use of online databases, e-journals, e-books and library websites.This implies that students may not be accessing quality information from the subject databases specifically developed for the purpose.Kommula and Kusneniwar (2013) also reported that 56.7% of the students have no knowledge about medical education websites.For Jadoon et al (2011) it was only 34% that posses the knowledge.They researchers noted that there is under utilization of the potential of Internet resources to augment learning.Increase in awareness, availability of requisite facilities and training in computing skills are required to enable better utilization of digital resources by medical students.
Textbooks are major information resource for students.Many of the core medical texts are now available in eformat and are accessible through the Internet either for free download or on payment.82 (50.9%) indicate downloading their medical text through the Internet.Internal Medicine 34 (21.1%),Pathology 27 (16.8%)and Pharmacology 25(15.5%)are the most downloaded subjects by the students.Anaesthesiology 15 (9.3%) was the least.Though the percentage of downloading for the medical subjects is small, it shows a growing awareness and acceptance of the e-book format.
The major barrier to the use of the Internet for the medical students was lack of Internet access (81.3%).This is not unexpected because the Internet facility in the College is currently not functional so students source for their own Internet services.This is an important issue that needs to be rectified to ease the problem and costs these students face in accessing the Internet for their education.Another barrier raised by the students is on subscription based publications which deny access to important information they need on the Internet (78.3).This is an issue because many quality journals and textbooks are subscription based and available for purchase with foreign currency.Many of the students may not afford the cost.A percentage of the students also indicated that too many results are returned for search (70.8%).This may be the result of poor information search skills.Good information search skill may help the students to filter search results for precision.
The study established that the medical students of the institution use the Internet for academic purposes not just for social networking.This is a good development; however this needs to be channelled to the use of academic and subject bibliographic databases relevant to medical education.Medical librarians in the institution have a role to create awareness as well as impart skills that are needed to harness quality medical information resources on the Internet.Therefore there is need for a well organized information literacy programme that will empower the students to use the Internet effectively in their education.

Conclusion
For learning and research in today's academic world, the Internet has brought lots of information resources that fully support the acquisition of knowledge.Results of the research show that even though the medical students use the Internet highly to access medical and research information, there is low use of quality information resources such as online subject databases, e-books, e-journals and library websites.They need to be aware of these resources in order to utilize them.Medical librarians have a role in improving students' use of educational resources on the Internet through an extensive and curriculum based information literacy programme.This is highly needed considering the growing concern on the quality of information on the open net.
n=161 pattern of use of the Internet by the medical students of Nnamdi Azikiwe University.Specifically, the research determined:1.Frequency of use of internet 2. Internet search skills of the medical students 3. Activities on the Internet 4. The most consulted websites for academic studies 5. Subject pattern of e-book access through the Internet 6.The benefits of the Internet to the medical students' academic career 7. Barriers encountered by the medical students in accessing the Internet for academics

Table 2 .
Access to the Internet.
* Response not mutually exclusive.

Table 3 .
The most satisfactory information resource used for search.

Table 4 .
Rate of use of the Internet for activities.

Table 5 .
Three most consulted websites for academic studies.

Table 6 .
Respondents' Downloading of E-books through the Internet by Subjects.

Table 7 .
Benefits of the Internet to Respondents' Academic Studies.

Table 8 .
Barriers to using the Internet.