Are internet searches a reliable source of information for answering residents' clinical questions in the emergency room

Emergency Department (ED) residents perceived Internet resources to be reliable and regularly searched the Internet to answer clinical questions in the ED. A single blinded prospective study was conducted to determine if Emergency Medicine residents (EMR) working in a teaching hospital could accurately answer clinical questions, such as those that routinely occur in an ED, using only Google. Thirty-three EMR completed the study. A demographic questionnaire was completed by each participant to provide a self-assessment of their search skills and confidence in searching. Residents were given a written PreTest consisting of 71 questions and instructed to answer the questions without outside resources, and if they were confident the information was suitable for patient care. Those questions that the EMR were unsure of, or had answered incorrectly on the PreTest were used to create a Google® Test. On the pretest 32% of the questions that the residents answered were correct, while 28% were incorrect. The residents were unsure of 40% of the questions that they responded to. By contrast on the Google® Test 59% of the residents' responses were correct, 33% were incorrect and the residents were unsure of 8% of their answers. The percent of unsure answers dropped significantly when the residents searched Google®. In the controlled environment of a library computer laboratory residents searched only Google® and resulting web resources to answer the remaining questions. The search history was captured using USA Proxy software. Search logs are being analyzed to understand search strategies used, to create a profile of each resident's searching behavior, and to assess the usefulness of websites visited. The data collected are being correlated with the residents' self-assessment of confidence in searching, and with the number of correct, incorrect and unsure answers submitted as a result of searching Google. The goal was to understand why 33% of the residents' answers were incorrect. Thus far there appears to be a correlation between the resident's self-assessment of confidence in searching, as reported on the demographic questionnaire and the number of correct answers found when they searched only Google. The results of the study indicated that while EMR often retrieved inaccurate information using Google® they believed the information was reliable enough to use in patient care. These findings have major implications for medical practice and patient safety. Providing Internet access in the ED should be carefully reviewed because it may not be a reliable tool for teaching and clinical decision-making by EMR.