title: Effectiveness of YouTube as a Source of Medical Information on Heart Transplantation.
abstract: BACKGROUND
  In this digital era, there is a growing tendency to use the popular Internet site YouTube as a new electronic-learning (e-learning) means for continuing medical education. Heart transplantation (HTx) remains the most viable option for patients with end-stage heart failure or severe coronary artery disease. There are plenty of freely accessible YouTube videos providing medical information about HTx.
  
  
  OBJECTIVE
  The aim of the present study is to determine the effectiveness of YouTube as an e-learning source on HTx.
  
  
  METHODS
  In order to carry out this study, YouTube was searched for videos uploaded containing surgical-related information using the four keywords: (1) "heart transplantation", (2) "cardiac transplantation", (3) "heart transplantation operation", and (4) "cardiac transplantation operation". Only videos in English (with comments or subtitles in English language) were included. Two experienced cardiac surgeons watched each video (N=1800) and classified them as useful, misleading, or recipients videos based on the HTx-relevant information. The kappa statistic was used to measure interobserver variability. Data was analyzed according to six types of YouTube characteristics including "total viewership", "duration", "source", "days since upload", "scores" given by the viewers, and specialized information contents of the videos.
  
  
  RESULTS
  A total of 342/1800 (19.00%) videos had relevant information about HTx. Of these 342 videos, 215 (62.8%) videos had useful information about specialized knowledge, 7/342 (2.0%) were found to be misleading, and 120/342 (35.1%) only concerned recipients' individual issues. Useful videos had 56.09% of total viewership share (2,175,845/3,878,890), whereas misleading had 35.47% (1,375,673/3,878,890). Independent user channel videos accounted for a smaller proportion (19% in total numbers) but might have a wider impact on Web viewers, with the highest mean views/day (mean 39, SD 107) among four kinds of channels to distribute HTx-related information.
  
  
  CONCLUSIONS
  YouTube videos on HTx benefit medical professionals by providing a substantial amount of information. However, it is a time-consuming course to find high-quality videos. More authoritative videos by trusted sources should be posted for dissemination of reliable information. With an improvement of ranking system and content providers in future, YouTube, as a freely accessible outlet, will help to meet the huge informational needs of medical staffs and promote medical education on HTx.
authors.affiliation: Division of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: He-Ming
authors.initials: HM
authors.lastname: Chen
authors.forename: Zhong-Kai
authors.initials: ZK
authors.lastname: Hu
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Zheng
authors.forename: Zhao-Shun
authors.initials: ZS
authors.lastname: Yuan
authors.forename: Zhao-Bin
authors.initials: ZB
authors.lastname: Xu
authors.forename: Ling-Qing
authors.initials: LQ
authors.lastname: Yuan
authors.forename: Vinicio A De Jesus
authors.initials: VA
authors.lastname: Perez
authors.forename: Ke
authors.initials: K
authors.lastname: Yuan
authors.forename: Mark
authors.initials: M
authors.lastname: Orcholski
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Liao
keywords: Internet; YouTube; e-learning; heart transplantation; medical informatics; online videos