Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan.
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan.
JMIR Med Educ. 2024 May 30;10:e52207. doi: 10.2196/52207.
The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire.
We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores.
This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019.
The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001).
The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.
在日本，教育成果与教学医院中使用基于网络的临床知识支持系统之间的关系尚不清楚。由于使用了自我报告的问卷，之前关于这个主题的研究可能受到了回忆偏差的影响。
我们旨在探讨教学医院使用 Wolters Kluwer UpToDate 临床知识支持系统与住院医师一般医学培训考试（GM-ITE）成绩之间的关系。在这项研究中，我们客观地评估了 UpToDate 医院使用日志总数与 GM-ITE 分数之间的关系。
这是一项全国性的横断面研究，包括在 2020 学年参加考试的住院医师 1 年级和 2 年级的学员。从已发表的网页中获取医院层面的信息，而 Wolters Kluwer 则提供了 UpToDate 医院使用日志。我们评估了 UpToDate 医院使用日志总数与住院医师 GM-ITE 分数之间的关系。我们分析了 2017 年至 2019 年期间至少有 5 名 GM-ITE 考生和医院使用资源日志数据的 215 所教学医院。
该研究人群包括来自 215 所至少有 5 名 GM-ITE 考生和 2017 年至 2019 年期间基于网络的资源使用日志数据的教学医院的 3013 名住院医师。高使用率医院的住院医师 GM-ITE 得分明显高于低使用率医院的住院医师（平均 26.9，标准差 2.0 与平均 26.2，标准差 2.3；P=.009；Cohen d=0.35，95%CI 0.08-0.62）。GM-ITE 分数与医院使用日志总数呈显著正相关（Pearson r=0.28；P<.001）。多水平分析显示，日志总数除以医院医生人数与 GM-ITE 分数之间呈正相关（估计系数=0.36，95%CI 0.14-0.59；P=.001）。
研究结果表明，住院医师通过 UpToDate 发展临床推理能力与 GM-ITE 高分相关。因此，更高的 UpToDate 使用量可能会促使高使用率医院的医生和住院医师增加实施循证医学的力度，从而获得更高的教育成果。
