When today's medical students graduate, they will conduct patient encounters using multiple technology-enhanced decision support systems. Current medical student training in ambulatory settings may not prepare students for this type of practice. Students often learn from physicians who generate few (0.01 to 0.8) clinical questions per patient encounter and infrequently use information technology to answer clinical questions at the point of care [1–3] Clinicians have previously reported that answering clinical questions is too time consuming to be practical during clinical sessions[4, 5] However, that situation is changing. Improved information management tools, including personal digital assistants (PDAs) and Internet capable wireless computers, now allow rapid access to Web-based clinical information in ambulatory settings.
Medical students must develop information management skills as a routine, integral part of the ambulatory patient encounter. Information management skills include: asking and refining clinical questions; accessing, retrieving, integrating and applying information into a clinical situation; and managing the doctor/patient/technology interface. Managing information at the point of care requires different skills than traditional evidence-based medicine (EBM) as taught in most medical schools  In traditional EBM, the learner develops a clinical question, performs a literature search, selects and appraises an appropriate research study, and draws conclusions. The EBM process usually occurs remotely from the patient encounter and requires time, the ability to understand the source literature, and critical appraisal skills.
While EBM skills are important for medical learners, many clinical questions can be answered at the point of care without critical appraisal. For example, using an electronic drug database in a PDA to investigate potential drug interactions is information access and retrieval. Modifying the patient's medications to adjust for interactions is information integration and application. The learner accesses an information source he/she deems reliable, and finds the answer in approximately 20 seconds during the office visit.
Few studies have investigated students' ability to manage information in clinical settings. In a study by Bergus and colleagues, fourth year medical students evaluated a standardized patient (SP), then read an article about a diagnostic test relevant to the patient's presentation. Most students appraised the article correctly, but few could apply the information to the individual patient In contrast, Webershock and colleagues demonstrated that, following an EBM seminar, third-year students could both appraise an article and integrate that information into a paper case Davidson and colleagues conducted a more complex skills assessment by having SPs ask a question of third year medical students. Students then formulated a clinical question, performed a Medline search, selected and appraised a journal article and transmitted results to the patient. Students did well in this applied EBM exercise, averaging 3.7–4.0 on a scale of 1 (poor) to 5 (superior) for each task as evaluated by faculty and librarians In summary, after a non-clinical EBM course, graduating students demonstrated EBM knowledge but had difficulty applying EBM information in the clinical setting. However, third year students applied EBM skills adequately to a paper case and standardized patient encounter given structured directions and sufficient time
A 2005 literature search yielded no previous studies investigating students' abilities to access, retrieve, integrate and apply information in real time patient encounters. In this study, we investigated whether case-based discussions with information management exercises improved students' information management skills as evaluated on a standardized patient case. We compared (1) intervention and control groups on two different clerkships and (2) first and third groups from both clerkships in academic year 2005–6.