循证医学主题综述知识系统UpToDate研究分析

利用信息技术和数据库技术提供的知识管理服务是医学知识服务的重要模式,构建专业的医学知识服务系统、搭建知识服务平台,是有效实施医学知识服务的重要手段。循证医学专题综述知识系统,已经成为国外提供医学知识服务的重要形式之一,出现了诸如UpToDate、DynaMed、BMJC1inicalEvidence、MDConsult等一批高质量的医学知识系统。以UpToDate知识系统为例,从知识系统的框架结构、系统功能、系统特色和评价研究等方面详细介绍了国外循证医学主题综述知识系统的发展现状,为国内医学知识服务平台和知识系统的开发提供参考和借鉴。     

基于UpToDate数据库的住院医师创伤急救规范化培训课程设计

创伤急救是临床医疗体系的重要环节。然而,由于传统医学教育中关于创伤急救教学的不足,导致有些低年资住院医师其创伤急救能力通常不能满足临床需求。基于UpToDate数据库的住院医师创伤急救规范化培训课程基于循证医学原则,通过结合临床实际病例,不仅可调动学员的学习积极性和学习兴趣,同时能保障临床案例设计的系统性及临床教学的同质化,能为住院医师的创伤急救培训提供新的平台。此外,利用UpToDate数据库在创伤急救教学的同时穿插医患沟通的内容,有助于加强住院医师的医学人文教育。     

Utilization and uptake of the UpToDate clinical decision support tool at the Makerere University College of Health Sciences (MakCHS), Uganda

BackgroundThe use of point-of-care, evidence-based tools is becoming increasingly popular. They can provide easy-touse, high-quality information which is regularly updated and has been shown to improve clinical outcomes. Integrating such tools into clinical practice is an important component of improving the quality of health care. However, because such tools are rarely used in resource-limited settings, there is limited research on uptake especially among medical students.ObjectiveThis paper explores the uptake of one such tool, Up-To-Date, when provided free of cost at a medical school in Africa.MethodsIn partnership with the Better Evidence at Ariadne Labs free access to UpToDate was granted through the MakCHS IP address. On-site librarians facilitated training sessions and spread awareness of the tool. Usage data was aggregated, based on log ins and content views, presented and analyzed using Excel tables and graphs.ResultsThe data shows evidence of meaningful usage, with 43,043 log ins and 15,591 registrations between August 2019 and August 2020. The most common topics viewed were in obstetrics and gynecology, pediatrics, drug information, and infectious diseases. Access occurred mainly through the mobile phone app.ConclusionFindings show usage by various user categories, but with inconsistent uptake and low usage. Librarians can draw upon these results to encourage institutions to support uptake of point-of-care tools in clinical practice.     

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, −0.2% (95%CI −0.36%, −0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.