GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study

Abstract

Background: To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient's preferences and the physician's clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations. Methods: We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software. Results: GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor's experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning. Conclusions: Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning.

Online training in evidence-based medicine and research methods for GP Registrars: a mixed-methods evaluation of engagement and impact

“…Research on interventions for GP supervisors to facilitate and encourage the practice of EBM by their registrars could also be bene cial. Given that discussion sessions between registrars and supervisors are an opportunity for registrars to learn, collaborative learning discussions can be utilised for development and translation of EBM skills into practice while creating a safe, equal and collaborative environment between registrars and supervisor (39). A previous study reported that this approach was useful for promoting EBM (39).…”

Learning Conversations with Trainees: An Undervalued but Useful EBM Learning Opportunity for Clinical Supervisors

“…Within the broader research project to which this study belongs, 19,24 we selected 22 supervisors and their trainees for maximum variation between September 2016 and April 2017 by giving promotional talks and distributing information leaflets during formal educational sessions at the GP training institutes in Antwerp and Ghent (Belgium) and Utrecht (the Netherlands). 25 Since recruitment was more difficult in the Netherlands, convenience sampling was used there.…”

“…A previous study (part of the larger research project to which this study belongs) showed that trainees indeed see these conversations as an opportunity for EBM learning in which they might discuss the supervisor’s experience and the specific local context in light of what the evidence recommends. 19 However, it is unclear whether supervisors see these conversations as an opportunity to learn EBM from their trainee as well. This study explores how supervisors currently perceive their own EBM learning in learning conversations with their trainee.…”

Examining drivers of self‐harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework

“…GPs experience training about mental health which includes awareness of evidence‐based guidelines (Royal College of General Practitioners, 2019 ); however, acquiring knowledge about self‐harm and the self‐harm guidelines is not a mandatory part of core GP training. Systematic review evidence suggests that prior clinical experiences, including the uptake of further training, also influence GPs’ use of guidelines (Zwolsman et al, 2012 ); trainee GPs encounter more clinical uncertainty (Chatterjee et al, 2017 ; Welink et al, 2020 ) and consult guidelines more readily than experienced GPs who are confident making decisions based upon their expertise (Francke et al, 2008 ; Harris et al, 2014 ; Patel et al, 2001 ; Van Dijk et al, 2010 ). There is a mounting patient safety rationale to ensure evidence‐based guidelines for self‐harm are implemented (Carr et al, 2016 ).…”