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Real-time EBM: From Bed Board to Keyboard and Back

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

To practice Evidence-Based Medicine (EBM), physicians must quickly retrieve evidence to inform medical decisions. Internal Medicine (IM) residents receive little formal education in electronic database searching, and have identified poor searching skills as a barrier to practicing EBM.

Objective

To design and implement a database searching tutorial for IM residents on inpatient rotations and to evaluate its impact on residents’ skill and comfort searching MEDLINE and filtered EBM resources.

Design

Randomized controlled trial. Residents randomized to the searching tutorial met for up to 6 1-hour small group sessions to search for answers to questions about current hospitalized patients.

Participants

Second- and 3rd-year IM residents.

Measurements

Residents in both groups completed an Objective Structured Searching Evaluation (OSSE), searching for primary evidence to answer 5 clinical questions. OSSE outcomes were the number of successful searches, search times, and techniques utilized. Participants also completed self-assessment surveys measuring frequency and comfort using EBM databases.

Results

During the OSSE, residents who participated in the intervention utilized more searching techniques overall (p < .01) and used PubMed’s Clinical Queries more often (p < .001) than control residents. Searching “success” and time per completed search did not differ between groups. Compared with controls, intervention residents reported greater comfort using MEDLINE (p < .05) and the Cochrane Library (p < .05) on post-intervention surveys. The groups did not differ in comfort using ACP Journal Club, or in self-reported frequency of use of any databases.

Conclusions

An inpatient EBM searching tutorial improved searching techniques of IM residents and resulted in increased comfort with MEDLINE and the Cochrane Library, but did not impact overall searching success.

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Acknowledgments

Dr. Stark was supported by grants from the Empire Clinical Research Investigator Program, New York State Department of Health and U.S. Department of Health and Human Services, Health Resources and Services Administration CFDA 93-895.

The authors thank the EBM Task Force of the SGIM for making their survey tool available to our group.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA

    Rachel Stark MD, MPH

  2. Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Ira M. Helenius MD, MPH, Ian Kronish MD, MPH & Deborah Korenstein MD

  3. Gustave L. and Janet W. Levy Library, Mount Sinai School of Medicine, New York, NY, USA

    Laura M. Schimming MLS

  4. Graduate School of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY, USA

    Nogusa Takahara MD

  5. Mount Sinai Medical Center, New York, NY, USA

    Deborah Korenstein MD

Authors
  1. Rachel Stark MD, MPH
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  2. Ira M. Helenius MD, MPH
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  3. Laura M. Schimming MLS
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  4. Nogusa Takahara MD
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  5. Ian Kronish MD, MPH
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  6. Deborah Korenstein MD
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Corresponding author

Correspondence to Deborah Korenstein MD.

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Stark, R., Helenius, I.M., Schimming, L.M. et al. Real-time EBM: From Bed Board to Keyboard and Back. J GEN INTERN MED 22, 1656–1660 (2007). https://doi.org/10.1007/s11606-007-0387-x

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  • DOI: https://doi.org/10.1007/s11606-007-0387-x

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