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Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study

Kataoka K, Nishizaki Y, Shimizu T, Yamamoto Y, Shikino K, Nojima M, Nagasaki K, Fukui S, Nishiguchi S, Katayama K, Kurihara M, Ueda R, Kobayashi H, Tokuda Y. Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study. JMIR Med Educ 2024;10:e52207.

This study collected data from more than 3,000 residents training at 215 teaching hospitals in Japan.

  • Residents in hospitals with higher frequency of UpToDate use had higher scores on a standardized training examination compared with those in hospitals with lower UpToDate use (mean score 26.9 versus 26.2, p = 0.009). The correlation persisted after adjusting for multiple individual and hospital-level variables related to the educational environment.
  • These findings support the value of access to UpToDate as part of a comprehensive medical education program.

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Mobile app use by medical students and residents in the clinical setting: an exploratory study

Fournier K. Mobile app use by medical students and residents in the clinical setting: an exploratory study. J Can Health Libr Assoc. 2022 Apr 1;43(1):3-11. doi: 10.29173/jchla29562. PMID: 35950082; PMCID: PMC9359684.

In this survey of senior medical students and residents at the University of Ottowa, UpToDate was by far the preferred and most used medical app, despite the fact that the library did not offer it to users (but did offer other clinical decision support resources including Dynamed):

  • For clinical decision support, UpToDate was a preferred app for 76%, versus MDCalc (20%), Spectrum (16%), Medscape (10%)...Lexicomp and Dynamed (6%).
  • For drug information, UpToDate and Lexicomp (combined) were preferred apps for 56%, and all others were <10% (Micromedex 1%).
  • For being helpful on 5-point Likert scale, UpToDate scored 4.6, Lexicomp 4, and DynaMed 3.1.

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Knowledge-seeking behaviors of pre-interns and early career doctors in Sri Lanka: A cross-sectional study

Chaturaka Rodrigo, Sachith Maduranga, Milinda Withana, Deepika Fernando and Senaka Rajapakse. BMC Research Notes 2015, 8:610 doi:10.1186/s13104-015-1600-3.

  • UpToDate is one of the most frequently used online resources to obtain general medical information.
  • Early career doctors prefer UpToDate.

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Factors associated with medical knowledge acquisition during internal medicine residency

McDonald FS, Zeger SL, Kolars JC. Factors associated with medical knowledge acquisition during internal medicine residency. J Gen Intern Med. 2007 Apr 28.

A study of internal medicine residents at the Mayo Clinic examined the impact of learning habits such as conference attendance and use of an electronic knowledge resource (UpToDate) on medical knowledge acquisition as measured by the Internal Medicine In-training Examination (IM-ITE). The IM-ITE assesses the medical knowledge of internal medicine residents during their three-year training program; scores increase with each year of residency reflecting the acquisition of medical knowledge during residency. Performance on the examination correlates with subsequent performance on the American Board of Internal Medicine Certification Examination. The authors correlated how much UpToDate was used by each resident (based upon usage logs) with IM-ITE scores. Using UpToDate for 20 minutes a day was associated with a comparable increase in IM-ITE scores as an entire year of residency. The model was fully adjusted and considered known covariates associated with performance on the IM-ITE, suggesting that use of UpToDate was an independent predictor of performance. A similar degree of benefit was also detected for regular conference attendance. The authors also cited a survey of 18,000 residents in which UpToDate was the most commonly used clinical resource for clinical information. These data (as well as previous studies involving UpToDate) suggest that it has an important role in medical education and in acquisition of medical knowledge.

  • Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.

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How residents and interns utilize and perceive the personal digital assistant and UpToDate

Phua J, Lim TK. How residents and interns utilize and perceive the personal digital assistant and UpToDate. BMC Medical Education 2008, 8:39. doi:10.1186/1472-6920-8-39.

A survey study at National University Hospital in Singapore found that after 5 months of use 60% of respondents reported that UpToDate led to a change in patient management and 95% would recommend UpToDate to a colleague.

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A multi-institutional survey of internal medicine residents’ learning habits

Edson RS, Beckman TJ, West CP, Aronowitz PB, Badgett RG, Feldstein DA, Henderson MC, Kolars JC, McDonald FS. A multi-institutional survey of internal medicine residents’ learning habits. Med Teach. 2010;32(9):773-5.

95% reported UpToDate was the most effective resource for learning. 90% reported that UpToDate was their first choice for answering clinical questions.

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Resource utilization patterns of third-year medical students

Cooper AL, Elnicki DM. Resource utilization patterns of third-year medical students. Clin Teach. 2011 Mar;8(1):43-7.

Most students used UpToDate to prepare for attending physician rounds and to admit patients (64% and 67%, respectively), but not for exam preparation.

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Relationship of electronic medical knowledge resource use and practice characteristics with internal medicine maintenance of certification examination scores

Darcy A. Reed, MD, MPH, Colin P. West, MD, PhD, Eric S. Holmboe, MD, Andrew J. Halvorsen, MS, Rebecca S. Lipner, PhD, Carola Jacobs, BA, and Furman S. McDonald, MD, MPH. Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores. J Gen Intern Med. 2012 Feb.

Maintenance of certification (MOC) examination performance is associated with quality of care. A study at the Mayo Clinic aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine.

  • Use of UpToDate was associated with improved scores on Internal Medicine Maintenance of Certification Examinations (IM-MOCE).

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Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

Kinoshita K, Tsugawa Y, Shimizu T, Tanoue Y, Konishi R, Nishizaki Y, Shiojiri T, Tokuda Y. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan. International Journal of General Medicine 2015:8.

The authors conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE).

  • Residents with four or five times per month of emergency department (ED) duties exhibited the highest mean scores compared to those with greater or fewer ED duties.
  • Those with the largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge.
  • Hospitals with the greater UpToDate topic viewing showed a significantly greater mean score.

Appropriate ED workload, inpatient caseload, and use of evidence-based electronic resources were associated with greater clinical knowledge of residents.

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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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