The Better Evidence program at Ariadne Labs has been leading research to better understand the impact that an evidence-based clinical resource can have on front line care.

Some of our most recent research:

Better evidence: prospective cohort study assessing the utility of an evidence-based clinical resource at the University of Rwanda

Partners: Ariadne Labs, Brigham and Women’s Hospital, Harvard University, Muhimbili University of Health and Allied Sciences, College of Medicine and Health Sciences, University of Rwanda

Study Results: BMJ Open, “Better evidence: prospective cohort study assessing the utility of an evidence-based clinical resource at the University of Rwanda,” August 2019

In American medical schools, a historical focus on memorization is giving way to knowing how to find information, synthesize it and apply it clinically. Evidence-based clinical resources (EBCRs) have the potential to help clinicians improve diagnostic and therapeutic accuracy. However, many EBCRs are subscription based, and their cost is prohibitive for most clinicians and trainees in low-income and middle-income countries. In the first study to link usage of online educational resources to performance in medical school examinations in Africa, medical students and faculty at the University of Rwanda were offered free access to UpToDate, a leading evidence-based clinical resource. The impact was assessed through two student surveys and their grades.

What did we learn?

  • Over 92 percent of Rwandan medical students have an internet-ready device, capable of accessing UpToDate, but the $299 price tag of a subscription is very costly in a country that spent $52 per capita on healthcare in 2014.
  • In 2014, the paper authors were able to form an agreement with Wolters Kluwer, the UpToDate parent company, to provide free subscriptions to medical students in Sub-Saharan Africa. Fifty-six percent of the 980 medical students and 29 percent of the faculty invited to enroll did so. About 88 percent of eligible final year students enrolled.
  • Researchers were also able to precisely track online usage of UpToDate; enrolled final year students viewed on average 1.24 cases per day and continued to use UpToDate after graduating.
  • After UpToDate access was granted, average grades of exams of the Rwandan graduating medical students – in internal medicine, pediatrics, obstetrics and gynecology and surgery – rose from 68 to 75 and students reported decreased use of Wikipedia.

Overall, the findings suggest that removing the subscription cost barrier can generate an uptake of EBCR use among East African medical students and, subsequently, better exam grades. The researchers caution, however, that while UpToDate may have helped students prepare for their exams more efficiently and increase their knowledge base, it is also possible that the exams in 2016 and 2017 were easier than those of years past or that the students were independently academically superior to the previous classes. Future research might explore other EBCRs and features that impact uptake and utility.