What residents can show attendings about online search

Alisa Duran-Nelson, MD, was in a resident clinic with an intern about two years ago when a question came up about the treatment of a disease. The resident recalled seeing a relevant study on the issue and said he was going to look it up on Google Scholar.

“I had never heard of Google Scholar before,” said Dr. Duran-Nelson, who considers herself tech-savvy and pretty knowledgeable about search tools.

She suggested pulling up the article on PubMed but the resident bet her he could access it more quickly using Google Scholar. Sitting side-by-side on computers, they decided to see who could find it first.

“Sure enough, he ends up pulling the article up within about 10 seconds, and I had just started putting in my [medical search] headings in PubMed. I was just blown away by this,” she said. She wondered what other resources she didn’t know about. She also wondered how often residents were using Google for medical questions.

What resulted was a study looking at what resources residents use and why. The findings, published in the June issue of Academic Medicine, indicated that residents could teach attending physicians a thing or two when it comes to searching the Internet. Residents not only were utilizing tools some attending physicians don’t know about, but they also were thoughtful about the way they used those tools.

Dr. Duran-Nelson and fellow researchers from the University of Minnesota Medical School surveyed 167 residents on their search methods. They found that electronic resources were used frequently. The tools enlisted most often at the point of care on a daily basis were UpToDate, a clinical decision support resource written by physicians and owned by Wolters Kluwer Health, utilized by 85% of residents; and Google, employed by 63%.

The primary drivers associated with choosing a tool were speed, trust and portability. Dr. Duran-Nelson said that when it came to Google, students used it because it was fast, even though they might not have a high trust in what it found. But she also noticed that different situations called for different tools.

Cameron Decker, MD, a third-year emergency medicine resident at the Texas Medical Center in Houston, compares his use of some search tools to the checklist pilots go through before takeoff. (Dr. Decker is a pilot as well as a physician.) It’s not that he doesn’t know the answer, but sometimes he needs a quick validation that a certain dosage is appropriate or that he has considered everything he needs to. So he pulls out a quick reference guide on his phone, much like he would use his pilot’s checklist before flying. When it’s not urgent and he has time to sit down and read, he’ll use a tool such as UpToDate to look for clinical studies.

Jim Beattie, a medical librarian at the University of Minnesota Medical School and a co-author of the study, said attending and faculty physicians could learn a lot from residents.

“We learn to use tools, and if they work for us, we continue to use them, and it’s often difficult to learn new ones,” Beattie said. “There’s a learning curve, so we stick with what we know.” He experienced this himself when a resident taught him how to use Google Scholar in a way he never had before — to generate a differential diagnosis.

How residents use Google

Going into the research, Dr. Duran-Nelson said she was a little concerned with the frequency at which residents turned to Google. She learned that residents are very different from faculty physicians in the amount of time they spend researching a question. She cited other studies that found residents spend an average of two minutes researching a question compared with faculty members, who spend between five and 10 minutes. Therefore, residents are drawn to tools that get the best information in the least amount of time.

Beattie said that although sites like Google and Wikipedia are good at producing information quickly, they have a stigma within the medical profession associated with their use because of the unreliability of what comes up compared with a scholarly search. But he and Dr. Duran-Nelson agreed that residents do not have a problem vetting information. And while Google might not be the best place to end a search, it often is a good place to start.

Their research found that 68% of residents use Google regularly. Of those, 75% use it to help them locate a trusted website they have used before, and 71% use it to find general information about a topic or disease. But when searching for diagnostic strategies from a journal, 44% went to Google Scholar; 44% said they used Google Scholar to search for the most current treatment in a journal; and 38% use it to search for a specific paper they have seen before. However, many were unfamiliar with Google Scholar.

Knowing tips and tricks to finding the best information quickly are good skills to have, experts agree. Beattie said physicians often start a search with many constraints, the biggest being time.

Residents often are aware of these new search strategies because of educational sessions or lectures by medical librarians. Attending physicians could benefit from some of that same training, said Priscilla Stephenson, chair-elect of the Hospital Libraries Section of the Medical Library Assn. “We’ve got so many neat tools,” she said.

But more experienced physicians might be unaware of them. Stephenson said medical librarians are starting to do presentations during grand rounds or small group sessions to try to educate all doctors on tools that are available. “But it’s hard to get on the agenda.”

There’s definitely value in residents “teaching the teacher,” Stephenson said.

Dr. Decker said he fully expects that when he is an established attending physician working with young residents, he’ll be the one learning about new tech tools to help him in his job.

“You’re going to have these resources that are available on your smartphone, or whatever we have 10 years from now,” he said.