The Users’ Guides to the Medical Literature Interactive website (www.usersguides.org) is an online resource with the stated goal of putting the “clinician in charge of the single most powerful resource in medicine,” the medical literature. To achieve this goal, the resource has used the Users’ Guides to the Medical Literature textbook (previously reviewed in ACP Journal Club¹ and also available at www.acpjc.org/Content/136/2/Issue/ACPJC-2002-136-2-A14.htm) to develop interactive online materials designed to aid in understanding and teaching evidence-based medicine. Its target audience is “any clinician who wishes to understand the medical literature.”

Users’ Guides to the Medical Literature Interactive website.

Designed and edited by Robert Hayward, the website is managed by the Centre for Health Evidence (www.cche.net) in collaboration with the Evidence-based Medicine Working Group and the editors and publishers of JAMA and the Archives journals. Anyone who purchases a copy of the Users’ Guide to the Medical Literature textbook receives a free 60 day trial of the website. Subscribers to JAMA and the Archives journals also receive access.

Once you log onto the website, the initial screen shows you the Navigator (table of contents) adjacent to the text material. The Navigator can be closed to make the whole screen available for the text, but we preferred to keep it open to move easily from section to section within the website. The Navigator can be organised in several ways. The default method of organisation is similar to that of the textbook and is divided into 2 parts. Part 1 provides an excellent review of evidence-based medicine basics, and Part 2 is a superb reference for those teaching evidence-based medicine or wanting to “practice evidence-based medicine at a more sophisticated level.” You can also reorganise the Navigator into Validity, Results, and Applicability sections.

The text provided on the website is well written and easy to understand. The organisation of materials is intuitive, and we particularly liked the use of clinical examples. You can review the materials by using the search option or by browsing and reading individual sections. We did not find the search option to be user friendly. You can also download the PDF version of each chapter for printing or transferring to your personal digital assistant.

The main strength of the website is its ease of interaction. For example, the Workpad screen can be opened beside the text screen. The Workpad offers an array of functions ranging from note taking to evidence-based medicine tips. The functions available in the Workpad differ according to section. The Workpad in the Diagnostic Tests section includes calculators for constructing 2 × 2 tables and calculating likelihood ratios, sensitivity, and specificity that you can use while reading the text or download to your personal digital assistant. It also provides an online interactive likelihood ratio nomogram and critical appraisal worksheets.

We found the extra tools available in the Diagnostic Tests section very useful, but unfortunately such tools were missing in most other sections. We were left wanting calculators for the number needed to treat in the Therapy section and a tool to calculate quality adjusted life years in the Economic Analysis section. The Workpads in these sections for taking notes and providing summary guides, definitions, and tips are fun but not as useful as those in the Diagnostic Tests section. Furthermore, we found that we could not save our work as we moved from one chapter to another.

References are dealt with in an amazing way. Not only are references provided in traditional bibliographies, but a link to the entire reference also pops up and you are often able to link directly to PubMed. The only way to make this more useful would be to have an export option into a reference manager system.

We found that the site worked well with Internet Explorer 5.0 but was less functional (no Workpad) and prone to glitches when viewed with Netscape. Some people may find this site easy to use immediately, but others may require a modest time investment to realise all of its benefits.

When we were asked to tackle this review, our initial thought was “not another book on evidence-based medicine.” However, we were pleasantly surprised to discover that this resource is not just another evidence-based medicine book. It builds on the Users’ Guides to the Medical Literature textbook and provides many useful tools. This website is a rare example of an online resource that takes advantage of the capabilities of online interaction. With some online books you are left asking, “What did I gain over a paper book?” but this is certainly not the case with the Users’ Guides to the Medical Literature Interactive website.