MEDLINE training for medical students integrated into the clinical curriculum

Can emergency medicine residents reliably use the internet to answer clinical questions?

INTRODUCTION

The study objective was to determine the accuracy of answers to clinical questions by emergency medicine (EM) residents conducting Internet searches by using Google. Emergency physicians commonly turn to outside resources to answer clinical questions that arise in the emergency department (ED). Internet access in the ED has supplanted textbooks for references because it is perceived as being more up to date. Although Google is the most widely used general Internet search engine, it is not medically oriented and merely provides links to other sources. Users must judge the reliability of the information obtained on the links. We frequently observed EM faculty and residents using Google rather than medicine-specific databases to seek answers to clinical questions.

METHODS

Two EM faculties developed a clinically oriented test for residents to take without the use of any outside aid. They were instructed to answer each question only if they were confident enough of their answer to implement it in a patient-care situation. Questions marked as unsure or answered incorrectly were used to construct a second test for each subject. On the second test, they were instructed to use Google as a resource to find links that contained answers.

RESULTS

Thirty-three residents participated. The means for the initial test were 32% correct, 28% incorrect, and 40% unsure. On the Google test, the mean for correct answers was 59%; 33% of answers were incorrect and 8% were unsure.

CONCLUSION

EM residents' ability to answer clinical questions correctly by using Web sites from Google searches was poor. More concerning was that unsure answers decreased, whereas incorrect answers increased. The Internet appears to have given the residents a false sense of security in their answers. Innovations, such as Internet access in the ED, should be studied carefully before being accepted as reliable tools for teaching clinical decision making.

Comparing the self-described searching knowledge of first-year medical and dental students before and after a MEDLINE class

Do students need MEDLINE instruction? Do self-described knowledge and search skills match actual ability? To address these questions, librarians developed an assessment tool, a self-administered pre-test/post-test of eighteen skills and concepts taught in the MEDLINE class. By their own assessment, 70% or more of the medical and dental students learned something about each concept taught during the workshop. The study convinced faculty and students that the MEDLINE class is necessary. Librarians and associated faculty agree that the class is important and should continue to be mandatory.

Information skills training: a systematic review of the literature

The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty-seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. Further research is needed in a number of areas.