• Helen Noble, OrdoñezWilly Jesús NeumannWJNSociedad de Cirujanos Generales del Perú, Lima, Perú (Ordoñez, Ortega Checa)., Zavala WongGabrielaGMedical School (Zavala Wong), Universidad Peruana Cayetano Heredia, Lima, Perú., Manuel J Rodríguez, Ortega ChecaDavidDSociedad de Cirujanos Generales del Perú, Lima, Perú (Ordoñez, Ortega Checa).Department of Surgery, Hospital Rebagliati, Lima, Perú (Ortega Checa)., Maria Warne, Kirsten Senturia, Ying Jin, Ryan Peterson, and Nicole LaGroneLaceyLDepartment of Surgery, University of Colorado Health, Medical Center of the Rockies, Loveland, CO (Warne, LaGrone)..
• From the Northern Pacific Global Health Fogarty International Program (Noble).
• J. Am. Coll. Surg. 2023 Mar 1; 236 (3): 484494484-494.

BackgroundInvesting 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 DesignThis 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 reasons for these changes.ResultsIntervention 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, education, 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.ConclusionsProviding 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.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons.

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