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PubMed2003

Spinal cord injury computer-assisted instruction for medical students.

OBJECTIVE: To determine if a computer-assisted instruction program would improve fourth-year medical students' knowledge base related to spinal cord injury, as determined by pretest and posttest scores. DESIGN: A multimedia computer-assisted instruction program was developed and offered on a volunteer basis to an entire class of fourth-year medical students (n = 168). Effectiveness of the instructional content was evaluated with pretests and posttests, and overall user satisfaction with the module was assessed with the courseware evaluation. RESULTS: The responses yielded 83 sets of completed pretest and posttest pairs and 80 sets of fully completed courseware evaluations. Mean posttest score was significantly higher than the mean pretest score (pretest, 6.65 +/- 1.44, vs. posttest, 7.36 +/- 1.38; df = 82, t = -4.74, P < 0.001). Courseware evaluations yielded positive ratings in all areas, including applicability and usability. CONCLUSIONS: The significantly increased posttest scores suggest that the students left the program with an expanded knowledge base in the content areas of spinal cord injury medicine covered in the computer-assisted instruction program.

Clinical Competence↗
PubMed1994

Evaluation of a caregiver education program: home oxygen therapy for infants.

OBJECTIVE: To evaluate the effectiveness of a structured education program for increasing caregiver knowledge of infants discharged on home oxygen therapy. DESIGN: The study used a one-group pretest-posttest design with recruitment of subjects between May 1988 and May 1989. SETTING/PARTICIPANTS: All subjects were primary caregivers of infants with bronchopulmonary dysplasia who were discharged from a tertiary-care center. Eighteen caregivers of 10 infants entered and completed the study. INTERVENTIONS: The education program included a booklet, videotape, and practical session. A pretest was administered immediately before the caregiver entered the program, and a posttest was administered immediately after caregiver completion of the program. A delayed posttest was administered 6 weeks after the infant's discharge from the hospital. MAIN OUTCOME MEASURE: The difference between the mean scores on the pretest and posttest. RESULTS: Posttest scores were significantly higher than pretest scores (t = 4.22; p < .01). CONCLUSION: The significant difference between the pretest and posttest scores was due to the education program. The effects of history and maturation on posttest scores were minimal.

Adult↗
PubMed2002

The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review.

OBJECTIVE: The aim of this study was to determine the pretest probability of organic GI disease and the accuracy of diagnostic tests for organic GI disease in patients who meet symptom-based criteria for irritable bowel syndrome (IBS). METHODS: After a comprehensive literature search for studies examining the accuracy of diagnostic tests for organic GI disease among patients who meet symptom-based criteria for IBS, two independent observers qualitatively assessed the methodology of selected studies and extracted data. Data on the pretest probability of organic GI disease in this population and the accuracy of currently recommended diagnostic tests were converted to descriptive tables. RESULTS: Among patients meeting symptom-based criteria for IBS, the pretest probability of inflammatory bowel disease, colorectal cancer, or infectious diarrhea is less than 1%. Currently recommended diagnostic tests rarely identify organic GI disease in patients fulfilling symptom-based criteria for IBS. However, the pretest probability of celiac disease in patients meeting symptom-based criteria for IBS was 10 times higher than the prevalence of celiac disease in the general population. CONCLUSIONS: There is insufficient evidence to recommend the routine performance of a standardized battery of diagnostic tests in patients who meet symptom-based criteria for IBS. Based upon the increased pretest probability of celiac disease, routine performance of serological tests for celiac disease may be useful in this patient population, though additional study is needed in this area.

Autoantibodies↗
PubMed2005

Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism.

OBJECTIVES: To assess the likelihood ratios of diagnostic strategies for pulmonary embolism and to determine their clinical application according to pretest probability. DATA SOURCES: Medline, Embase, and Pascal Biomed and manual search for articles published from January 1990 to September 2003. STUDY SELECTION: Studies that evaluated diagnostic tests for confirmation or exclusion of pulmonary embolism. DATA EXTRACTED: Positive likelihood ratios for strategies that confirmed a diagnosis of pulmonary embolism and negative likelihood ratios for diagnostic strategies that excluded a diagnosis of pulmonary embolism. DATA SYNTHESIS: 48 of 1012 articles were included. Positive likelihood ratios for diagnostic tests were: high probability ventilation perfusion lung scan 18.3 (95% confidence interval 10.3 to 32.5), spiral computed tomography 24.1 (12.4 to 46.7), and ultrasonography of leg veins 16.2 (5.6 to 46.7). In patients with a moderate or high pretest probability, these findings are associated with a greater than 85% post-test probability of pulmonary embolism. Negative likelihood ratios were: normal or near normal appearance on lung scan 0.05 (0.03 to 0.10), a negative result on spiral computed tomography along with a negative result on ultrasonography 0.04 (0.03 to 0.06), and a d-dimer concentration < 500 mug/l measured by quantitative enzyme linked immunosorbent assay 0.08 (0.04 to 0.18). In patients with a low or moderate pretest probability, these findings were associated with a post-test probability of pulmonary embolism below 5%. Spiral computed tomography alone, a low probability ventilation perfusion lung scan, magnetic resonance angiography, a quantitative latex d-dimer test, and haemagglutination d-dimers had higher negative likelihood ratios and can therefore only exclude pulmonary embolism in patients with a low pretest probability. CONCLUSIONS: The accuracy of tests for suspected pulmonary embolism varies greatly, but it is possible to estimate the range of pretest probabilities over which each test or strategy can confirm or rule out pulmonary embolism.

Echocardiography↗
PubMed2000

Diagnostic testing for coagulopathies in patients with ischemic stroke.

BACKGROUND: Hypercoagulable states are a recognized, albeit uncommon, etiology of ischemic stroke. It is unclear how often the results of specialized coagulation tests affect management. Using data compiled from a systematic review of available studies, we employed quantitative methodology to assess the diagnostic yield of coagulation tests for identification of coagulopathies in ischemic stroke patients. SUMMARY OF REVIEW: We performed a MEDLINE search to identify controlled studies published during 1966-1999 that reported the prevalence of deficiencies of protein C, protein S, antithrombin III, plasminogen, activated protein C resistance (APCR)/factor V Leiden mutation (FVL), anticardiolipin antibodies (ACL), or lupus anticoagulant (LA) in patients with ischemic stroke. The cumulative prevalence rates (pretest probabilities) and positive likelihood ratios for all studies and for those including only patients aged </=50 years were used to calculate posttest probabilities for each coagulopathy, reflecting diagnostic yield. The cumulative pretest probabilities of coagulation defects in ischemic stroke patients are as follows: LA, 3% (8% for those aged </=50 years); ACL, 17% (21% for those aged </=50 years); APCR/FVL, 7% (11% for those aged </=50 years); and prothrombin mutation, 4.5% (5.7% for those aged </=50 years). The posttest probabilities of ACL, LA, and APCR increased with increasing pretest probability, the specificity of the tests, and features of the patients' history and clinical presentation. CONCLUSIONS: The pretest probabilities of coagulation defects in ischemic stroke patients are low. The diagnostic yield of coagulation tests may be increased by using tests with the highest specificities and by targeting patients with clinical or historical features that increase pretest probability. Consideration of these data might lead to more rational ordering of tests and an associated cost savings.

Adolescent↗
PubMedDate not supplied

What white blood cell count should prompt antibiotic treatment in a febrile child? Tutorial on the importance of disease likelihood to the interpretation of diagnostic tests.

Most diagnostic tests are not dichotomous (negative or positive) but, rather, have a range of possible results (very negative to very positive). If the pretest probability of disease is high, the test result that prompts treatment should be any value that is even mildly positive. If the pretest probability of disease is low, the test result needed to justify treatment should be very positive. Simple decision rules that fix the cutpoint separating positive from negative test results do not take into account the individual patient's pretest probability of disease. Allowing the cutpoint to change with the pretest probability of disease increases the value of the test. This is primarily an issue when the pretest probability of disease varies widely between patients and depends on characteristics that are not measured by the test. It remains an issue for decision rules based on multiple test results if these rules fail to account for important determinants of patient-specific risk. This tutorial demonstrates how the value of a diagnostic test depends on the ability to vary the cutpoint, using as an example the white blood cell count in febrile children at risk for bacteremia.

Anti-Bacterial Agents↗
PubMed1998

Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome.

ResMed Autoset (AS) is a simplified diagnosis system for obstructive sleep apnoea/hypopnoea syndrome (OSAS) based on the respiratory flow/time relationship by pressure variation measured through simple nasal prongs. A multicentre prospective trial was used to compare AS and polysomnography (PSG) for diagnosing 95 patients, with suspected OSAS. Physicians gave a pretest probability of the patient having OSAS. The apnoea/hypopnoea index (AHI) was compared between the two methods of diagnosis for the whole population and for subgroups according to the pretest probability. Twenty-four patients had AHI < 15 events x h(-1) on PSG and 19 AHI 15-30, and 52 patients had AHI > or = 30. Correlation between AHI assessed by AS and PSG was r=0.87 for total sleep time (TST), p<0.0001. A Bland and Altman plot gave an agreement between the two methods of +/-40%. For a threshold of AHI > or = 15 events x h(-1) to diagnose OSAS, AS has a sensitivity of 92%, specificity of 79%, positive predictive value of 93% and negative predictive value of 76%. With a pretest probability > or = 80%, sensitivity and positive predictive value were 98 and 100% respectively. Of six false negative, four had a high pretest probability (> 80%) or Epworth score > or = 10. Using these parameters as a criterion for proceeding to PSG after a negative AS study would mean that two apnoeic patients (AHI 20 and 17 events x h(-1) by PSG) would escape detection. The Autoset is useful for the detection of obstructive sleep apnoea but with high pretest probability and a negative Autoset result polysomnography should be performed.

Adult↗
PubMed2004

The use of a dissected bovine heart to teach cardiac sonography.

OBJECTIVES: To create and test a dissected bovine heart model (BHM) to facilitate the interpretation of cardiac sonography (CS). METHODS: After a pretest and an instructional video on CS, emergency physicians (EPs) were randomized into two groups. Group 1 viewed two-dimensional (2D) anatomic pictures of human hearts. Group 2 examined the BHM and the same anatomic pictures as group 1. The EPs retook the pretest. The differences between the raw pretest and posttest scores of the groups were compared with an unpaired Student's t-test. Multiple linear regression was used to adjust for confounding by variation in education and initial test scores. EPs with previous experience in CS were excluded from the analysis. RESULTS: Thirty-five participants met the inclusion criteria, 16 in group 1 and 19 in group 2. The groups were well balanced with respect to postgraduate year training. The EPs in group 1 had a higher average pretest score of 11.6 versus 8.1 in group 2. Compared with the pretest scores, the average improvements in group 1 and group 2 were 7.6 and 11.3 points, respectively. Group 2 improved an average of 3.7 points (95% confidence interval [95% CI] = 0.7 to 6.7; p = 0.016) more than group 1. After adjusting for confounding by the difference in initial scores, group 2 improved 1.8 (95% CI = -1.1 to 4.8; p = 0.22) more points on average than group 1. CONCLUSIONS: A dissected bovine heart model did not significantly improve the ability of EPs to label structures on static ultrasounds over inspection of static-labeled anatomic pictures alone.

Animals↗
PubMed2002

Development and evaluation of the Kids Count Farm Safety Lesson.

The Kids Count Farm Safety Lesson was delivered to nearly 2,000 fifth-grade students in 15 rural schools in Hillsborough County, Florida. The lesson covered animal, machinery, water, and general safety topics applicable to farming in Florida. A staggered pretest-posttest study design was followed whereby five schools received a multiple-choice pretest and posttest and the remainder of the schools (N = 10) received the posttest only. Results of the study showed a significant increase in the mean number of correct answers on the posttests compared to the pretests. There was no significant difference in the mean number of correct answers of those students who received the pretest and those students who had not, eliminating a "pretest" effect. This study fills an important gap in the literature by evaluating a farm safety curriculum offered in the elementary school setting. It also included migrant schoolchildren in the study population. It is strongly recommended that agricultural safety information be included into the health education curriculum of these elementary schools.

Accidents, Occupational↗
PubMed1999

Failure to confirm the Rauscher and Shaw description of recovery of the Mozart effect.

The Mozart effect is an increase in spatial reasoning scores detected immediately after listening to the first movement of a Mozart piano sonata. Rauscher and Shaw (1998) suggested that failure to produce a Mozart effect could arise from carryover effects of a spatial reasoning pretest which may interfere with the effect of listening to Mozart. They cited an unpublished study in which a verbal distractor was inserted between the pretest and listening condition, and the manipulation produced the recovery of a Mozart effect. This experiment attempted to confirm the unpublished study. 206 college students were exposed to one of three sequences, pretest-Verbal distractor material-Mozart, pretest-Mozart-Verbal distractor material, and pretest-Verbal distractor material. An immediate posttest indicated no significant difference on solution of paper folding and cutting items among the three groups. The results do not support Rauscher and Shaw (1998). Our negative results are consistent with prior failures in other laboratories to produce a Mozart effect.

Attention↗
PubMed1986

External factors that affect grades in graduate physiology.

Data from 251 students over 11 yr were used to evaluate factors affecting the final grade in a graduate animal anatomy and physiology course. Background information obtained on the first class day included major, major professor, degree(s) and location(s) of matriculation, and participation in science courses. A pretest was administered to identify each student's background. Final numerical grade was influenced by major, degree, College where bachelor's degree was obtained, and gender. Students from fisheries and wildlife had higher final numerical grade than other majors. Undergraduates scored lower than master's or doctoral students. Students from small colleges and foreign institutions obtained lower final numerical grades than students from agricultural universities and major colleges. Females had higher final grades (81.3 +/- 1.7) than males (79.6 +/- 1.7). Pretest score was indicative of final grade and was affected by degree, college of bachelor's degree, year, and organic chemistry. Master's students had pretest scores 6.1 higher than bachelor's students; students with organic chemistry scored higher than students with none, and foreign students score lowest of all groups by college of bachelor's degree. Change in score from pretest to final grade was affected by major, degree, gender, and pretest score. The student's background in biochemistry, cell physiology, and organic chemistry and motivation can affect success in graduate physiology and anatomy.

Anatomy↗
PubMed1990

Infection control programmed instruction: an alternative to classroom instruction in baccalaureate nursing education.

The purpose of this study was to determine whether self-managed learning in the form of a programmed unit of instruction (PUI) in the basic principles of infection control is an acceptable alternative to a standard lecture format for teaching infection control to nursing students. A sample of 108 subjects was selected from third-year baccalaureate nursing students at two universities. The subjects were randomly assigned to two groups. The experimental group was given the pretest, the PUI (treatment), the post-test, and a Likert scale opinionnaire of the PUI. The control group was pretested and presented the same content in a lecture format, then post-tested. A pretest-post-test control group design was used for data analysis and a one-way analysis of covariance was performed on the post-test means of the groups. Analysis of covariance (ANCOVA) was applied to the post-test means of the groups, with pretest scores and educational setting as covariates. Results indicate that nursing students who complete an infection control PUI score higher on post-tests than those who attend a lecture (p less than .001), regardless of pretest scores and educational setting. Subjects using the PUI also preferred this format and found the content manageable.

Cross Infection↗
PubMed2003

Training in pathology informatics: implementation at the University of Pittsburgh.

CONTEXT: Pathology informatics is generally recognized as an important component of pathology training, but the scope, form, and goals of informatics training vary substantially between pathology residency programs. The Training and Education Committee of the Association for Pathology Informatics (API TEC) has developed a standard set of knowledge and skills objectives that are recommended for inclusion in pathology informatics training and may serve to standardize and formalize training programs in this area. OBJECTIVE: The University of Pittsburgh (Pittsburgh, Pa) core rotation in pathology informatics includes most of these goals and is offered as an implementation model for pathology informatics training. DESIGN: The core rotation in pathology informatics is a 3-week, full-time rotation including didactic sessions and hands-on laboratories. Topics include general desktop computing and the Internet, but the primary focus of the rotation is vocabulary and concepts related to enterprise and pathology information systems, pathology practice, and research. The total contact time is 63 hours, and a total of 19 faculty and staff contribute. Pretests and posttests are given at the start and end of the rotation. Performance and course evaluation data were collected for 3 years (a total of 21 residents). RESULTS: The rotation implements 84% of the knowledge objectives and 94% of the skills objectives recommended by the API TEC. Residents scored an average of about 20% on the pretest and about 70% on the posttest for an average increase during the course of 50%. Posttest scores did not correlate with pretest scores or self-assessed computer skill level. The size of the pretest/posttest difference correlated negatively with the pretest scores and self-assessed computing skill level. CONCLUSIONS: Pretest scores were generally low regardless of whether residents were familiar with desktop computing and productivity applications, indicating that even residents who are computer "savvy" have limited knowledge of pathology informatics topics. Posttest scores showed that all residents' knowledge increased substantially during the course and that residents who were computing novices were not disadvantaged. In fact, novices tended to have higher pretest/posttest differences, indicating that the rotation effectively supported initially less knowledgeable residents in "catching up" to their peers and achieving an appropriate competency level. This rotation provides a formal training model that implements the API TEC recommendations with demonstrated success.

Clinical Competence↗
PubMed2003

A diagnostic strategy involving a quantitative latex D-dimer assay reliably excludes deep venous thrombosis.

BACKGROUND: Because clinical diagnosis is inaccurate, objective testing is usually considered necessary when patients present with suspected deep venous thrombosis (DVT). OBJECTIVE: To determine whether a negative result on a quantitative latex D dimer assay eliminates the need for further investigation in patients with a low or moderate pretest probability of DVT. DESIGN: Prospective cohort study. SETTING: Three tertiary care hospitals in Canada. PATIENTS: 556 consecutive outpatients with suspected first DVT. INTERVENTION: Patients were categorized as having a low, moderate, or high pretest probability of DVT and then underwent D-dimer testing. Patients with low or moderate pretest probability and a negative D-dimer result had no further diagnostic testing and received no anticoagulant therapy. Serial compression ultrasonography was performed in all other patients. Patients who did not receive a diagnosis of DVT were followed for symptomatic venous thromboembolism. MEASUREMENTS: Objectively confirmed symptomatic venous thromboembolic events during 3 months of follow-up. RESULTS: 283 patients (51%) had low or moderate pretest probability and a negative D-dimer result. One of these patients had DVT during follow-up (negative likelihood ratio, 0.05 [CI, 0.01 to 0.23]). The negative likelihood ratio of the d -dimer test in all patients was 0.03 (CI, 0.01 to 0.16). CONCLUSION: A negative result on a quantitative latex d -dimer assay safely eliminates the need for further testing in patients with low or moderate pretest probability of DVT.

Fibrin Fibrinogen Degradation Products↗
PubMed2000

The rapid diagnosis of smear-negative pulmonary tuberculosis: a cost-effectiveness analysis.

OBJECTIVE: The prompt diagnosis of smear-negative pulmonary tuberculosis (PTB) is a clinical challenge. It may be achieved by a number of tests which have varying accuracies, costs and degrees of invasiveness. The objective of this study was to compare the cost-effectiveness of clinical judgement (empirical), the Roche Cobas amplicor assay for Mycobacterium tuberculosis (amplicor), acid-fast staining of bronchoalveolar lavage specimens (BAL), nucleic acid amplification tests of bronchoalveloar lavage specimens for M. tuberculosis (BAL + NAA), computed tomography (CT) and amplicor assay followed by BAL. METHODOLOGY: The range of predictive values of the various strategies were derived from published data and a new study of 441 consecutive adult patients with suspected smear-negative PTB prospectively stratified into three pretest risk groups: low, intermediate and high. The cost-effectiveness was evaluated with a decision tree model (DATA software). RESULTS: The incidence of PTB was 5.7% (4% culture positive) for the whole group, 95% in the high-risk group, 0.9% in the low-risk group and 3.4% in the intermediate-risk group. The sensitivity of the empirical approach was 49% and of the amplicor assay was 44%. Patient outcomes were expressed as life expectancy for the base case of a 58-year-old man with a pretest probability of 5.7%. At this low pretest risk the differences in life expectancies between tests was < 0.1 years and the empirical approach incurred the lowest cost. Sensitivity analysis at increasing pretest risks showed better life expectancies (approximately 1 years) for CT scan and test combinations than empirical and amplicor for additional costs of US$243-US$309. Bronchoalveolar lavage had the worst overall cost-effectiveness. CONCLUSIONS: We conclude that the pretest risk of active PTB was a key determinant of test utility; that the AMPLICOR assay was comparable to clinical judgement; that BAL was the least useful test; and that with increasing risks, CT scan and test combinations performed better. Further studies are needed to better define patients with intermediate risk for PTB and to directly compare the cost-effectiveness of more sensitive nucleic acid amplification tests such as the enhanced Gen Probe, CT scan and test combinations/sequences in these patients.

Bacteriological Techniques↗
PubMed2002

Hands-on is better than look-on: condom use.

OBJECTIVES: To compare knowledge about condoms, attitude towards condom use and skill in condom application between the experimental group who received hands-on and the control group who had look-on demonstrations of condom application onto the penile model of third year male primary vocational students. METHOD: Self administered questionnaire was used to collect data about knowledge and attitude. Skill was separately evaluated by a skill evaluation form. Pretest and posttest of knowledge, attitude and skill were done separately at 2 week intervals in the same subjects. The pretest and posttest scores were expressed as the mean and standard deviation. Statistic analysis used unpaired t-test for comparing scores between the two groups using SPSS. RESULTS: Comparison of pretest with pretest, posttest with posttest and the different mean score of posttest with pretest between the two groups of knowledge and attitude about condoms were not significantly different in both groups but the skill in condom application score was significantly different (p-value < 0.001). However, the skill score increased in the experimental group more than in the control group. CONCLUSIONS: This study suggested that condom application skill increased with the hands-on than look-on instructional model. It was concluded that hands-on should be used to improve skill to prevent condom user failure and nonuse.

Adolescent↗
PubMed2004

Effect of an HIV counseling and testing program on AIDS-related knowledge and practices in tuberculosis clinics in Abidjan, Côte d'Ivoire.

SETTING: Two out-patient tuberculosis treatment centers, Abidjan, Côte d'Ivoire. OBJECTIVE: To assess the effect of a human immunodeficiency virus (HIV) counseling and testing program on acquired immune-deficiency syndrome (AIDS) related knowledge and behaviors among persons with newly diagnosed tuberculosis. DESIGN: Since 1994, patients with newly diagnosed tuberculosis have received individual or group HIV pretest counseling, informed consent, free HIV testing for those who consent, and post test counseling. From January 1995 through August 1996 in Abidjan's two largest tuberculosis clinics, knowledge and beliefs about HIV/AIDS were assessed before and immediately after the group pretest sessions, and again 4 months later. RESULTS: Prior to pretest counseling, 68.9% and 68.0% of the 559 enrolled subjects could correctly identify five modes of HIV transmission and five modes of HIV prevention. These proportions increased significantly immediately after pretest counseling (90.0%, 86.6%, respectively), and remained higher 4 months later (83.7%, 87.7%) (all P < 0.01). Among men, consistent condom use during the preceding 4 months with a partner who was not a commercial sex worker increased from 9.9% at enrollment to 23.6% at the 4-month visit (P = 0.001), but not for women (6.3% vs. 9.5%, P = 0.40). CONCLUSIONS: An HIV pretest counseling program conducted in an out-patient tuberculosis clinic was well accepted, and significantly increased the level of HIV/AIDS knowledge and, among men, self-reported condom use.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Experiential curriculum improves medical students' ability to answer clinical questions using the internet.

BACKGROUND AND OBJECTIVES: Teaching about evidence-based medicine (EBM) is widespread, yet physicians still use rapid references preferentially over EBM techniques such as literature searching and appraisal of original research. The Internet now provides rapid access to preappraised evidence. We provided clinically integrated teaching of using the Internet to answer clinical questions for third-year medical students and assessed the change in their search skills. METHODS: The curriculum included two 90-minute computer lab sessions with teaching of search skills related to clinical questions. Immediately before the first and after the second session, students recorded sites searched, time needed for searching, and answers found for three standardized questions. Pretest and posttest questions were matched and reversed with each block. RESULTS: Eighty-six students completed pretests and posttests. For two questions about conventional medical care, posttest answer quality was significantly higher, and posttest search times were significantly shorter, by 1.6 minutes for question 1 (mean pretest search time 6.3 minutes, mean posttest search time 4.7 minutes) and 1.9 minutes for question 2 (mean pretest search time 8 minutes, mean posttest search time 6.1 minutes). For a question about herbal medicine, results were similar, but there were smaller differences that did not reach statistical significance. Students used or found significantly fewer sites on the posttest than on the pretest to find answers for all three question types (absolute difference=0.3 sites for each question). CONCLUSIONS Introducing students to useful Web sites, practicing answering clinical questions, and integrating this process with clinical rotation experiences can reduce the effort that students need to find answers and improve the quality of answers they find.

Biomedical Research↗