Abstract
Objective: To determine whether the addition of Quick Medical Reference (QMR) to usual educational tools improves an intern’s performance in managing clinical cases that test diagnostic and investigative skills.
Design: Randomized, controlled, single-blinded crossover study.
Setting: Tertiary care teaching hospital.
Subjects: Comprehensive medical interns who are proficient in the use of QMR.
Intervention: A total of 16 interns trained in the use of QMR were randomized to work up a total of six diagnostically challenging cases, three using medical textbooks plus access to QMR and three using textbooks and no access to QMR.
Measurements: The interns provided their solutions to the cases, which consisted of the differential diagnosis and investigations. They were scored by comparing their answers with the consensus answers provided by subspecialty consultants. For each intern, the difference in mean total scores with and without QMR was calculated.Results: The mean difference in total scores was 7.2% benefit (p<0.05, 95% CI=0.05 to 14.4) using QMR. The beneficial difference was driven mainly by improvement in diagnostic scores, with the mean difference being 11.6% (p=0.01, 95% CI=2.4 to 20.8). Regression analysis showed that the more difficult the case, the greater the benefit of QMR.
Conclusions: Quick Medical Reference may be a useful adjunct to interns in formulating diagnostic strategies for difficult clinical cases. However, since optimal conditions were chosen for QMR benefit in this study design, the small benefit in test scores must be weighed against the time required to teach QMR to interns.
Similar content being viewed by others
References
Haynes RB, Sackett DL, Tugwell P. Problems in the handling of clinical and research evidence by medical practitioners. Arch Intern Med. 1984;143:1971–5.
Miller RA, Masarie FE, Myers JD. Quick Medical Reference for diagnostic assistance. MD Comput. 1986;3:.34–48.
Shortliffe EH. Medical expert systems—knowledge tools for physicians. West J Med. 1986;145:830–9.
Bankowitz RA, McNeil MA, Challinor SM, Parker RC, Kapoor WN, Miller RA. A computer-assisted medical diagnostic consultation service. Ann Intern Med. 1989;110:824–32.
Blomqvist N. On the relation between change and initial value. J Am Stat Assoc. 1977;72:746–7.
Yates F, Cochran WG. The analysis of groups of experiments. J Agricult Sci. 1938;28:556–80.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York: New York Academic Press, 1969.
Ott L. An Introduction to Statistical Methods and Data Analysis. Boston: Duxbury Press, 1984; 132.
Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;103:596–9.
Jones TV, Gerrity MS, Earp J. Written case simulations: do they predict physician’s behaviour? J Clin Epidemiol. 1990;43:805–12.
Rethans JJ, Boven van CPA. Simulated patients in general practice: a different look at the consultation. Br Med J. 1987;294:809–12.
Rethans JJ, Leeuwen VY, Drop R, Strumans F. Competence and performance: two different concepts in the assessment of quality of medical care. Fam Pract. 1990;7:168–74.
Author information
Authors and Affiliations
Additional information
Dr. Detsky is supported by a National Health Research Investigator Award from Health and Welfare Canada, #6606-4697-48.
Reprints are not available.
Rights and permissions
About this article
Cite this article
Bacchus, C.M., Quinton, C., O’Rourke, K. et al. A randomized crossover trial of quick medical reference (QMR) as a teaching tool for medical interns. J Gen Intern Med 9, 616–621 (1994). https://doi.org/10.1007/BF02600304
Issue Date:
DOI: https://doi.org/10.1007/BF02600304