Answering questions at the point of care: Do residents practice EBM or manage information sources?

被引:48
作者
McCord, Gary
Smucker, William D.
Selius, Brian A.
Hannan, Scott
Davidson, Elliot
Schrop, Susan Labuda
Rao, Vinod
Albrecht, Paula
机构
[1] Northeastern Ohio Univ Coll Med & Pharm, Dept Family Med, Rootstown, OH 44272 USA
[2] Akron City Hosp, Summa Hlth Syst, Akron, OH USA
[3] St Elizabeth Hosp, Med Ctr, Youngstown, OH 44501 USA
[4] Aultman Hosp, Canton, OH USA
[5] Akron Gen Ctr Family Med, Akron, OH USA
关键词
D O I
10.1097/ACM.0b013e3180307fed
中图分类号
G40 [教育学];
学科分类号
040101 ; 120403 ;
摘要
Purpose To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training. Method In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source. the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA. Results Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource. Conclusions The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.
引用
收藏
页码:298 / 303
页数:6
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