Why Do Residents Fail to Answer Their Clinical Questions? A Qualitative Study of Barriers to Practicing Evidence-Based Medicine

Green, Michael L.; Ruff, Tanya R.

doi:10.1097/00001888-200502000-00016

Cited by 183 publications

(147 citation statements)

References 25 publications

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“…21,27,28 Our findings do not support the suggestion that use of these compendia may actually be detrimental to the acquisition of medical knowledge. 29 Although seemingly intuitive, prior studies investigating the association between conference attendance and test performance have shown no effect.…”

Section: Discussioncontrasting

confidence: 92%

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

2007

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BACKGROUND: Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition.OBJECTIVE: To examine associations of learning habits on medical knowledge acquisition. MEASUREMENTS: Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS:When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p<.001).In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p<.001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p=.008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, −0.2% (95%CI −0.36%, −0.042%; p=.01), and graduation from a US medical school, score decrease compared to international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p=.03). CONCLUSIONS:Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.

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Section: Discussioncontrasting

confidence: 92%

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

2007

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“…12 Our sample size is consistent with other published qualitative studies. [13][14][15][16][17] The authors reviewed all excerpts related to each theme and agreed upon the representative quotes that would be presented in the Results section. In order to protect the privacy of our informants, descriptive details about the quoted informants are not provided.…”

Section: Discussionmentioning

confidence: 99%

Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Perspective

et al. 2012

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BACKGROUND: Philanthropic contributions to academic medical centers from grateful patients support research, patient care, education, and capital projects. The goal of this study was to identify the ethical concerns associated with philanthropic gifts from grateful patients. METHODS: A qualitative study design was selected. Investigators conducted in-depth semi-structured interviews with 20 Department of Medicine physicians at Johns Hopkins who were identified by Development Office staff as experienced and successful in this realm-those having relationships with multiple patients who have made philanthropic contributions. Interview transcripts were independently coded by two investigators. Content analysis identified several themes related to ethical concerns. RESULTS: Eighteen informants (90 %) were Associate Professors or Professors; two (10 %) were females. Four thematic domains emerged related to ethical concerns associated with philanthropy from grateful patients: (i) impact of gift on the doctor-patient relationship; (ii) gift acquisition considered beyond the physician's professional role; (iii) justice and fairness; and (iv) vulnerability of patients. Despite acknowledging at least one of the aforementioned concerns, eleven physician informants (55 %) expressed the view that there were no ethical issues involved with grateful patient philanthropy. CONCLUSIONS: In this paper, we report that physicians involved in grateful patient philanthropy are aware of, and in some cases troubled by, the ethical concerns related to this activity. Further studies could examine how best to prepare faculty for the challenges that may accompany these gifts so as to help them maintain expected professional and ethical standards when accepting grateful patient philanthropy.

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“…Although Green and Ruff [6] found over 10 years ago that health care professionals were not aware of resources available to them, medical students graduating now face such a wide range of resources that it is perhaps clear to them that it is to their advantage to look into the reliable resources offered at the university.…”

Section: Using Information Resourcesmentioning

confidence: 99%

“…Dorsch et al [5] concluded that medical graduates who were trained in their undergraduate program "retained EBM skills in residency and maintained a positive attitude about the importance of applying EBM principles to patient care." However, Green and Ruff [6] found that health care professionals were having difficulties formulating clinical questions and translating them into effective searches. A few years later, Cullen et al [7] observed that junior doctors rated their skills higher than assigned by the study raters.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Long-Term Impact of a Curriculum-Integrated Medical Information Literacy Program

Maranda

Harding

Kinderman

2016

J Can Health Libr Assoc

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Introduction: Medical libraries have long provided educational programs to support evidence-based practice. Medical students at Queen's University, Kingston, Ontario, participate in a curriculum-integrated information literacy program during the first two years of medical school. Do they retain, improve, or forget the skills? Do they continue to use the library resources during clerkship? Did they encounter barriers to prevent them from using the resources? Methods: A short survey was administered to 99 students at the end of medical school. The survey included questions about medical students' attitudes and behaviours, their use of information resources, and their medical information literacy knowledge. Some of the knowledge questions were compared to pre-and post-tests that the same class completed in first year. Results: Fifty-three students completed the survey. The students rated their abilities very highly but there was only a weak positive relationship with the knowledge scores. Information resources were well used, both for clinical questions and to complete the mini-scholar exercises. Discussion: Medical students feel better prepared to answer clinical questions and their skills improved or remained the same for the content that could be compared between first and fourth year. Different resources were used for day-to day information needs and for the completion of the minischolar exercises. The results will inform changes to the Medical Information Literacy program at Queen's University. The librarians will explore some of the barriers to access to ensure that future students can use information resources with more ease while away from campus.

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Why Do Residents Fail to Answer Their Clinical Questions? A Qualitative Study of Barriers to Practicing Evidence-Based Medicine

Cited by 183 publications

References 25 publications

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Perspective

Evaluation of the Long-Term Impact of a Curriculum-Integrated Medical Information Literacy Program

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