abstract: 'BACKGROUND: Investing in continued medical education strengthens

  surgical systems. This study assessed the effectiveness of an

  evidence-based practice (EBP) tutorial and access to UpToDate (UTD) to

  improve EBP and understand how and why providers practice using

  evidence.STUDY DESIGN: This is a mixed-methods, implementation study at

  9 public hospitals in Peru consisting of a didactic session for surgeons

  on EBP and Google Translate and support of applications for UTD access.

  Change in clinical knowledge scores (CKS), access and use of UTD, and

  impact of language pre-and postintervention were measured. Qualitative

  interviews uncovered rea-sons for these changes.RESULTS: Intervention

  participants had lower CKS at follow-up compared with baseline (odds

  ratio {[}OR] of higher score 0.41 {[}0.18,0.98]; p = 0.044), and this

  effect was modified (p = 0.003) to the extent that the reverse was true

  for control participants (OR 2.30 {[}1.13,4.71]; p = 0.022).

  Participants with 1 to 20 years of experience had significantly improved

  CKS compared with students/residents (1 to 10 years: OR 4.5 {[}1.1,18];

  11 to 20 years: OR 4.9 {[}1.4,17]); there was no evidence of a different

  CKS between providers with > 20 years of experience compared with

  students/residents (OR 1.3 {[}0.5,3.7]). Administrative disconnect,

  usability, motivation, edu-cation, time, resources, and age influenced

  point-of-care medical information systems impact on knowledge and EBP.

  Participants reporting low English proficiency translated medical

  literature mostly used Google Translate. Those with low/no English

  reading proficiency had higher odds of reporting a negative impact on

  research than those with working (p = 0.007) or professional (p < 0.001)

  proficiency.CONCLUSIONS: Providing education on EBP, free UTD access,

  and translation solutions did not correlate with increased CKS due to

  complex barriers to using point-of-care medical information systems. (J

  Am Coll Surg 2023;236:484-494. (c) 2022 The Author(s). Published by

  Wolters Kluwer Health, Inc. on behalf of the American College of

  Surgeons. This is an open-access article distributed under the terms of

  the Creative Commons Attribution-Non Commercial-No Derivatives License

  4.0 {[}CCBY-NC-ND], where it is permissible to download and share the

  work provided it is properly cited. The work cannot be changed in any

  way or used commer-cially without permission from the journal.)'
affiliation: 'Noble, H (Corresponding Author), 22 S Greene St, Baltimore, MD 21231
  USA.

  Noble, Helen, Univ Washington, Northern Pacific Global Hlth Fogarty Int Program,
  Seattle, WA USA.

  Senturia, Kirsten, Univ Washington, Dept Hlth Serv, Seattle, WA USA.

  Ordonez, Willy Jesus Neumann; Checa, David Ortega, Soc Cirujanos Gen Peru, Lima,
  Peru.

  Wong, Gabriela Zavala, Univ Peruana Cayetano Heredia, Med Sch, Lima, Peru.

  Rodriguez, Manuel J., Univ Peruana Cayetano Heredia, Dept Surg, Lima, Peru.

  Checa, David Ortega, Hosp Rebagliati, Dept Surg, Lima, Peru.

  Warne, Maria; LaGrone, Lacey Nicole, Univ Colorado Hlth, Med Ctr Rockies, Dept Surg,
  Loveland, CO USA.

  Jin, Ying; Peterson, Ryan, Univ Colorado, Anschutz Med Campus, Aurora, CO USA.'
author: Noble, Helen and Ordonez, Willy Jesus Neumann and Wong, Gabriela Zavala and
  Rodriguez, Manuel J. and Checa, David Ortega and Warne, Maria and Senturia, Kirsten
  and Jin, Ying and Peterson, Ryan and LaGrone, Lacey Nicole
author-email: Helen.Noble@umm.edu
author_list:
- family: Noble
  given: Helen
- family: Ordonez
  given: Willy Jesus Neumann
- family: Wong
  given: Gabriela Zavala
- family: Rodriguez
  given: Manuel J.
- family: Checa
  given: David Ortega
- family: Warne
  given: Maria
- family: Senturia
  given: Kirsten
- family: Jin
  given: Ying
- family: Peterson
  given: Ryan
- family: LaGrone
  given: Lacey Nicole
da: '2023-09-28'
doi: 10.1097/XCS.0000000000000530
eissn: 1879-1190
files: []
issn: 1072-7515
journal: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
keywords-plus: COST-EFFECTIVENESS; QUALITY
language: English
month: MAR
number: '3'
number-of-cited-references: '53'
pages: 484-494
papis_id: 8064d11b8f86e6b9cee512dce504f3b6
ref: Noble2023doesaccess
times-cited: '0'
title: Does Access to Point-of-Care Medical Information Improve Trauma and General
  Surgeons' Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with
  Random Assignment
type: article
unique-id: WOS:000968088900007
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '236'
web-of-science-categories: Surgery
year: '2023'