title: Speed and accuracy of a point of care web-based knowledge resource for clinicians: a controlled crossover trial.
abstract: BACKGROUND
  Effective knowledge translation at the point of care requires that clinicians quickly find correct answers to clinical questions, and that they have appropriate confidence in their answers. Web-based knowledge resources can facilitate this process.
  
  
  OBJECTIVE
  The objective of our study was to evaluate a novel Web-based knowledge resource in comparison with other available Web-based resources, using outcomes of accuracy, time, and confidence.
  
  
  METHODS
  We conducted a controlled, crossover trial involving 59 practicing clinicians. Each participant answered questions related to two clinical scenarios. For one scenario, participants used a locally developed Web-based resource, and for the second scenario, they used other self-selected Web-based resources. The local knowledge resource ("AskMayoExpert") was designed to provide very concise evidence-based answers to commonly asked clinical questions. Outcomes included time to a correct response with at least 80% confidence (primary outcome), accuracy, time, and confidence.
  
  
  RESULTS
  Answers were more often accurate when using the local resource than when using other Web-based resources, with odds ratio 6.2 (95% CI 2.6-14.5; P<.001) when averaged across scenarios. Time to find an answer was faster, and confidence in that answer was consistently higher, for the local resource (P<.001). Overconfidence was also less frequent with the local resource. In a time-to-event analysis, the chance of responding correctly with at least 80% confidence was 2.5 times greater when using the local resource than with other resources (95% CI 1.6-3.8; P<.001).
  
  
  CONCLUSIONS
  Clinicians using a Web-based knowledge resource designed to provide quick, concise answers at the point of care found answers with greater accuracy and confidence than when using other self-selected Web-based resources. Further study to improve the design and implementation of knowledge resources may improve point of care learning.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States. cook.david33@mayo.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
authors.forename: Jane A
authors.initials: JA
authors.lastname: Linderbaum
authors.forename: Dale
authors.initials: D
authors.lastname: Zwart
authors.forename: Farrell J
authors.initials: FJ
authors.lastname: Lloyd
keywords: Web-based learning; clinical decision support; educational technology; health information technology; medical education