Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among...

Area of Science:

• Medical Education
• Clinical Informatics
• Health Services Research

Background:

• The impact of web-based clinical knowledge support systems on educational outcomes in Japanese teaching hospitals is not well understood.
• Previous research may have been limited by recall bias due to self-reported data.

Purpose of the Study:

• To investigate the association between the utilization of the Wolters Kluwer UpToDate system and residents' General Medicine In-Training Examination (GM-ITE) scores in Japanese teaching hospitals.
• To objectively assess the relationship between UpToDate usage logs and GM-ITE performance.

Main Methods:

• A nationwide cross-sectional study involving postgraduate year 1 and 2 residents who took the 2020 GM-ITE.
• Data on hospital-level information and UpToDate hospital use logs (2017-2019) were collected.
• Analysis included 215 teaching hospitals with sufficient resident and usage data.

Main Results:

• Residents in hospitals with high UpToDate usage demonstrated significantly higher GM-ITE scores compared to those in low-usage hospitals (mean 26.9 vs. 26.2, P=.009).
• A significant positive correlation was found between total hospital UpToDate use logs and GM-ITE scores (Pearson r=0.28, P<.001).
• Multilevel analysis indicated a positive association between normalized UpToDate usage (logs per physician) and GM-ITE scores (coefficient=0.36, P=.001).

Conclusions:

• Increased use of UpToDate in teaching hospitals is associated with improved resident educational outcomes, as measured by GM-ITE scores.
• Higher UpToDate utilization may facilitate the adoption of evidence-based medicine, potentially enhancing clinical reasoning and educational performance.