Objectives According to the survey conducted by Pew Research Center in 2013, over half of US adults search medical information online and half of them share their findings with their physicians. Merck Manuals surveyed 240 primary care physicians in October 2018 and ninety-seven percent said patients come into the office with misinformation. Nearly eighty percent of respondents said the availability of medical information online has made patients more likely to question their diagnoses or recommendations. The objective of this training session was to advance digital native medical students’ information fluency to address online health misinformation encountered during patient interactions and improve patients’ outcomes.

Method An 80-minute information fluency session was given to all incoming MD and PA students during their first quarter as part of the Practice of Medicine curriculum. Before starting the session, we asked students how they accessed and appraised health information. We showed students a popular online post about the safety of marijuana compared to alcohol and tobacco and asked them to evaluate the credibility of the post. Through interactive lectures and case discussions, students learned and practiced the following skills:

1. Apply various evaluation schemes to appraise online health information systematically and efficiently.

2. Conduct a comprehensive PubMed search to locate evidence to support or refute online health information.

3. Evaluate retrieved scholarly materials using CEBM's critical appraisal tools.

4. Reflect on how they can combat online health misinformation as healthcare providers.

Students re-evaluated the same post and voted the credibility score again near the end of the session.

Results Students voted the three best information resources for finding trustworthy health information. A total of 186 votes were received. PubMed (33%), Google Scholar (25%), and medical libraries (15%) were the top three choices. Healthcare providers (12%) were ranked fourth. Search engines and printed references were ranked equally fifth (5%). Social media and friends or family members were equally low on ranking (1%). Fifty students also shared the criteria used for evaluating online health information. Twenty-four respondents listed the credibility, accuracy, and trustworthiness of references cited to support the online information as key criteria. Thirteen students included the authors’ qualifications and affiliation as other key criteria. Objectivity and tones of the online posts were also listed. Ninety percent of students were able to rate a highly-shared inaccurate health post as low-credible (58%) and non-credible (32%). It increased to ninety-two percent and non-credible responses were up to fifty-five percent after the training.

Conclusions After this interactive information fluency session, students increased their awareness of the extent and impact of online health misinformation on patient care and physician-patient interactions. The knowledge of various evaluation schemes helps them to appraise online health information brought in by their patients critically, objectively, systematically and efficiently in just a few minutes. Our polling result supported that most medical and physician assistants students have basic literature search skills using free resources, like PubMed and medical libraries, to locate reliable health information. By providing more in-depth training in PubMed search and CEBM’s critical appraisal tools, the students can share their knowledge and experience with patients and other healthcare colleagues to identify and combat online health misinformation. Based on students’ feedbacks, our next step is to provide a series of online short practice cases for students to reinforce their appraisal and PubMed search skills during their pre-clerkship and clerkship training.