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Residents’ patient-specific clinical questions: opportunities for evidence-based learning.

Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents’ patient-specific clinical questions: opportunities for evidence-based learning. Acad Med. 2005 Jan;80(1):51-6.

A study at the University of Colorado examined how answering patient-specific clinical questions affected residents’ patient care decisions. Internal medicine residents were asked to formulate a clinical question and use evidence-based learning guidelines to answer them. Results from the study show that:

  • UpToDate was the most frequently used information source by residents.

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Randomized trial for answers to clinical questions: Evaluating a pre-appraised versus a MEDLINE search tool.

Patel MR, Schardt CM, Sanders LL, Keitz SA. Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol. J Med Libr Assoc. 2006 Oct;94(4):382-7

A study at the Department of Medicine at Duke University Medical Center concluded that medical libraries need to provide both MEDLINE and pre-appraised resources such as UpToDate for answers to the largest proportion of clinical questions.

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Evidence-based library and information practice

Farrell A, Evidence Based Library and Information Practice 2008, 3:2

A survey study at the Memorial University of Newfoundland, Canada, found that UpToDate was able to provide information for the greatest number of clinical questions compared with other evidence-based information tools evaluated.

  • UpToDate was rated easy to use and informative.

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Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed.

Hoogendam A, Stalenhoef AFH, de Vries Robbé PF, Overbeke AJ, Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed. J Med Internet Res 2008;10(4):e29.

An observational study from the Netherlands evaluated 2986 patient-related questions asked by 70 physicians. Available information resources included PubMed, UpToDate, Harrison’s Online and a drug database. The authors concluded that “Based on our data, there is no reason to start searching on a lower level of the evidence-based pyramid for any major medical topic but it is sensible to use UpToDate as the primary information resource.”

  • UpToDate was used most often (78% of questions), and questions were significantly more likely to be answered by UpToDate than PubMed regardless of the topic of the search.

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Searching for medical information online: A survey of Canadian nephrologists.

Shariff SZ, Bejaimal SA, Sontrop JM, Iansavichus AV, Weir MA, Haynes RB, Speechley MR, Thind A, Garg AX. J Nephrol. 2011 Nov-Dec;24(6):723-32. doi: 10.5301/JN.2011.6373.

In this cross-sectional study (2008 to 2010), a random sample of Canadian nephrologists completed a survey of their online search practices. Respondents were queried on their searching preferences, practices, and use of 9 online information sources.

  • Nephrologists used a variety of online sources to retrieve information on patient treatment including UpToDate (92%), PubMed (89%), Google (76%) and Ovid MEDLINE (55%).
  • Community-based nephrologists were more likely to consult UpToDate first (91%), while academic nephrologists were divided between UpToDate (58%) and PubMed (41%).
  • When searching bibliographic resources such as PubMed, 80% of nephrologists scan a maximum of 40 citations (the equivalent of 2 search pages in PubMed). Searching practices did not differ by age, sex or years in practice.

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Psychiatry residents’ use of educational websites: A pilot survey study

Torous J, Franzan J, O’Connor R, Mathew I, Keshavan M, Kitts R, Boland R. Psychiatry Residents’ Use of Educational Websites: A Pilot Survey Study. Acad Psychiatry 2015. DOI 10.1007/s40596-015-0335-8.

Results indicate that psychiatry residents at the study site rely more on online educational resources than traditional printed resources such as textbooks. Residents reported using online resources in nearly all aspects of training, ranging from reading at home to working in the emergency department, inpatient unit, outpatient clinic, and consult service. UpToDate, PubMed, and Wikipedia were the three most utilized resources by residents and reflect the varied nature of the resources available to residents today.

UpToDate, a secondary source, was the most utilized resource, and residents gave it the highest rating for trustworthiness of recommendations. PubMed, a primary source, received the highest rating as source of personal learning but a lower ranking as a source of clinical decision-making in comparison to UpToDate.

graphic from research study

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Temporal trends in accessing online medical information

Lott JP, Roy B, Venkatesh AK (2014), Temporal trends in accessing online medical information. J. Hosp. Med., 9: 525–526. doi: 10.1002/jhm.2211.

Since January 2004, relative search interest associated with UpToDate has increased steadily, whereas web-based queries for other sources of online medical information have declined (Figure 1).

Relative search interest in UpToDate has, on average, exceeded that of JAMA, NEJM, and PDR since approximately July 2011 (Figure 1), whereas PubMed has been associated with the greatest, albeit diminishing, relative search interest.

Linear regression yielded the following significant (P < 0.001) coefficients of trend for UpToDate (coefficient = 0.010), JAMA (coefficient = −0.012), NEJM (coefficient = −0.030), PDR (coefficient = −0.020), and PubMed (coefficient = −0.011). Every coefficient differed significantly from each other (P < 0.001).

Figure 1:

graphic from research study

Google Search trends for online medical information. Temporal trends in relative Google search query interest by online medical resource, 2004 to 2013. Abbreviations: JAMA, Journal of the American Medical Association; NEJM, New England Journal of Medicine; PDR, Physicians’ Desk Reference.

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Using clinician’s search query data to monitor influenza epidemics

Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. Using clinician’s search query data to monitor influenza epidemics. Clin Infect Dis. (2014) 59 (10): 1446-1450 first published online August 12, 2014 doi:10.1093/cid/ciu647.

Search query information from a clinician’s database, UpToDate, is shown to timely predict influenza epidemics in the United States.

Study results show that digital disease surveillance tools based on experts’ databases may be able to provide an alternative, reliable, and stable signal for accurate predictions of flu outbreaks.

graphic from research study

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Medical students’ use of information resources: Is the digital age dawning?

Peterson MW, Rowat J, Kreiter C, Mandel J. Medical students’ use of information resources: is the digital age dawning? Acad Med. 2004 79(1):89-95.

Investigators at the University of Iowa monitored the use of UpToDate by second-year students as they transitioned to their clinical years. Students rapidly adopted UpToDate. By the end of their third year:

  • More than 85% of medical students identified electronic sources as their primary resource for medical information (UpToDate 53%, MDConsult 33%). UpToDate was preferred significantly more often than other resources.
  • They used electronic information resources daily and required less than 15 minutes to answer most of their clinical questions.

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Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations

Lai CJ, Aagaard E, Brandenburg S, Nadkarni M, Wei HG, Baron R., Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations. J Gen Intern Med. 2006 May;21(5):486-9.

Of online sources, 98% of residents reported using UpToDate regularly, 44% used literature search, and 35% used Google.com or other search engines.

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The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties

Leff B, Harper GM, The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties. Acad Med. 2006 May;81(5):489-94.

Among medical students at Johns Hopkins, UpToDate was the most commonly used reading source and was rated as the most useful.

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An evaluation of five bedside information products using a user-centered, task-oriented approach

Campbell R, Ash J. An evaluation of five bedside information products using a user-centered, task-oriented approach. J Med Libr Assoc 2006 Oct; 94(4):435-41, e206-7.

  • Participants successfully answered more clinical questions with UpToDate than with any of the other resource (P < 0.0001).
  • In response to the question, “Overall, did this database satisfy your needs?,’ UpToDate ranked significantly higher than all other resources (P = 0.006). UpToDate also ranked significantly higher on ease of use (P < 0.0001).
  • Most users (76%) ranked UpToDate to be the best product while none rated it the worst.

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Answering physicians’ clinical questions: Obstacles and potential solutions

Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.

A study of generalist physicians in Iowa investigated the obstacles preventing physicians from answering their patient care questions. Physicians asked 5.5 questions per half-day but pursued answers to just 55% of them. Of the 55% of questions pursued, UpToDate was used the most (41%) out of over 10 information resources consulted during the study. Other resources on the list included Epocrates (25%), MICROMEDEX (15%), and the Sanford Guide to Antimicrobial Therapy (14%).

  • The typical primary care physician has approximately 11 questions a day. While they pursue answers to 55% of questions, only 40% get answered.
  • Answering all questions would change up to 5 management decisions per day.
  • The most common reason for not pursuing an answer was that they doubted that an answer existed.

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