JMIR Publications

ABSTRACT

Background:

The relationship between educational outcomes and the use of online clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study in this regard could have been affected by recall bias because of using a self-reported questionnaire survey.

Objective:

Therefore, we aimed to explore the relationship between the use of the 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 hospital usage logs in UpToDate and the GM-ITE scores.

Methods:

This nationwide cross-sectional study included postgraduate year 1–2 residents who had taken the examination in the academic year 2020. Hospital-level information was obtained from published WEB pages, and hospital usage logs of UpToDate were provided by Wolters Kluwer. We evaluated the relationship between the total number of hospital usage logs in UpToDate and residents’ GM-ITE scores. We analyzed 215 teaching hospitals with at least five GM-ITE examinees and hospital usage logs from 2017 to 2019.

Results:

The study population consisted of 3,013 residents (39.2%) from 215 teaching hospitals (36.2%) with at least five GM-ITE examinees and online resource usage log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (26.9 ± 2.0 vs. 26.2 ± 2.3, p=0.009, Cohen’s d, 0.35; 95% confidence interval, 0.08–0.62). The GM-ITE score was significantly correlated with the total number of hospital usage logs (Pearson’s r=0.28, p < 0.001). Multi-level analysis revealed a positive association between the total logs divided by the number of hospital physicians and the GM-ITE score (estimated coefficient, 0.36; 95% confidence interval, 0.14–0.59; p = 0.001).

Conclusions:

The findings suggest that that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, the higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, advancing educational outcomes.