title: Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol.
abstract: OBJECTIVE
  The paper compares the speed, validity, and applicability of two different protocols for searching the primary medical literature.
  
  
  METHODS
  A randomized trial involving medicine residents was performed.
  
  
  METHODS
  An inpatient general medicine rotation was used.
  
  
  METHODS
  Thirty-two internal medicine residents were block randomized into four groups of eight.
  
  
  METHODS
  Success rate of each search protocol was measured by perceived search time, number of questions answered, and proportion of articles that were applicable and valid.
  
  
  RESULTS
  Residents randomized to the MEDLINE-first (protocol A) group searched 120 questions, and residents randomized to the MEDLINE-last (protocol B) searched 133 questions. In protocol A, 104 answers (86.7%) and, in protocol B, 117 answers (88%) were found to clinical questions. In protocol A, residents reported that 26 (25.2%) of the answers were obtained quickly or rated as "fast" (<5 minutes) as opposed to 55 (51.9%) in protocol B, (P = 0.0004). A subset of questions and articles (n = 79) were reviewed by faculty who found that both protocols identified similar numbers of answer articles that addressed the questions and were felt to be valid using critical appraisal criteria.
  
  
  CONCLUSIONS
  For resident-generated clinical questions, both protocols produced a similarly high percentage of applicable and valid articles. The MEDLINE-last search protocol was perceived to be faster. However, in the MEDLINE-last protocol, a significant portion of questions (23%) still required searching MEDLINE to find an answer.
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA. manesh.patel@duke.edu
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Connie M
authors.initials: CM
authors.lastname: Schardt
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Keitz
mesh_terms: D003200:Computer User Training; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D006801:Humans; D007255:Information Services; D016247:Information Storage and Retrieval / Q000379:methods*; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D016239:MEDLINE