Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial

Background The explosion of biomedical information has led to an ‘information paradox’—the volume of biomedical information available has made it increasingly difficult to find relevant information when needed. It is thus increasingly critical for physicians to acquire a working knowledge of biomedical informatics. Aim To evaluate four search tools commonly used to answer clinical questions, in terms of accuracy, speed, and user confidence. Methods From December 2008 to June 2009, medical students, resident physicians, and attending physicians at the authors9 institution were asked to answer a set of four anaesthesia and/or critical care based clinical questions, within 5 min, using Google, Ovid, PubMed, or UpToDate (only one search tool per question). At the end of each search, participants rated their results on a four point confidence scale. One to 3 weeks after answering the initial four questions, users were randomised to one of the four search tools, and asked to answer eight questions, four of which were repeated. The primary outcome was defined as a correct answer with the highest level of confidence. Results Google was the most popular search tool. Users of Google and UpToDate were more likely than users of PubMed to answer questions correctly. Subjects had the most confidence in UpToDate. Searches with Google and UpToDate were faster than searches with PubMed or Ovid. Conclusion Non-Medline based search tools are not inferior to Medline based search tools for purposes of answering evidence based anaesthesia and critical care questions.