Medical Education Research: A New Role for Practice-Based Research Networks William J. Cairney, PhD AACOM Annual Meeting Panel June 23, 2006

How Family Practice Residents learn and apply new medical information William J. Cairney, PhD Joel Dickerman, DO Jeremy C. Saunders, MPP Kristiann L. Saunders, MPA

Background ► Despite the wealth of evidence-based medical literature that is now readily available to clinicians, adoption of this information, particularly practice guidelines, has been poor. The purpose of this study was to investigate how Family practice residents acquire and apply new medical information in clinical practice

Methods ► Qualitative study involving a series of focus groups performed at family practice residency programs. Focus groups were 45 – 60 minutes in duration. Residents were invited to participate by open invitation. Questions presented to residents were presented through a PowerPoint presentation, and were designed to present open-ended questions eliciting resident response. All sessions were recorded, with results tabulated by Hampshire House Consulting.

Methods: Focus group questions ► Four basic categorical questions were presented, each with sub-questions to help elicit resident responses ► #1 Where do you look to find new information?  What do you find most available?  What do you find most useful?  What do you find most authoritative?

Methods: Focus group questions ► #2 How much time do you spend acquiring new information?  Do you think it’s enough?  Do you think your time is effectively used?  Do you integrate what you have found? Assuming you want to integrate your newly acquired information...

Methods: Focus group questions ► #3 How do you apply new knowledge in your practice?  E.g. from… ► Continuing medical education ► Family practice journals ► the Internet  Give an example of something you have done or changed recently based on new knowledge?

Methods: Focus group questions ► Knowledge->Practice: Do you do an adequate job?  How would you personally measure an “adequate job”?  What prevents you from better integrating new knowledge?  If you had more resources or more time, what would you do to integrate new research into your practice?

Results: Focus group respondents ► In all 70 residents participated in 7 total focus groups ► Focus group size ranged from 5-15 participants

Results: Question #1 ► Where do you look to find new information?  Internet: Up to Date *, Medscape, MD Consult*, general Google searches  Colleagues/Faculty/Specialists: Either direct contact in clinic, or will call  Journals: Review articles  CME: Scheduled lectures, CME by pharmaceutical reps * Depends on availability

Results: Question #2 ► How much time do you spend acquiring new information?  Always learning  Dedicated time ranges from 1-10 hours per week, but depends on definition ► More if you count point-of-care learning, less if you count dedicated learning time outside of clinic time  Never enough time  Family practice very challenging – so broad  Most effective use of time is learning at point of care  Information integrated if done at point of care  Information more readily integrated if demonstrated by colleague

Results: Question #3 ► How do you apply new knowledge in your practice?  More likely to apply if colleague presents information (either at bedside or in CME)  At point of care or in follow-up visit  Specific examples of application: Screening for hip dysplasia, Use of Riboflavin in headaches, Pap protocols, Hepatitis A vaccination indications, beta- blockers in pre-surgical patients with cardiac disease, current antibiotics for meningitis.

Results: Question #4 ► Knowledge->Practice: Do you do an adequate job? How would you personally measure an “adequate job”?  Faculty evaluations  Colleague feedback  Patient response  Patient satisfaction

Results: Question #4 (con’t) ► Knowledge->Practice: Do you do an adequate job? What prevents you from better integrating new knowledge?  Lack of time  Skepticism/conflicting guidelines/lack of specialty adoption  Other administrative duties  Established beliefs and habits

Results: Question #4 (con’t) ► Knowledge->Practice: Do you do an adequate job? If you had more resources or more time, what would you do to integrate new research into your practice?  EMR/point of care guidelines  Distilled, easy to use guidelines  Dedicated staff or individual that could provide point of care distilled evidence-based medicine

Conclusions ► Family practice residents acquire new information primarily from the internet, colleagues, and lectures. ► Residents feel point-of-care learning is the most effective means of retaining information. ► Residents apply new medical information when it directly relates to a patient medical issue. Application of new knowledge occurs more readily when it is supported by a colleague or mentor.

Conclusions ► Residents receive feedback on the use of new medical information through formal evaluation, reinforcement through colleague actions, patient results, and patient satisfaction ► Obstacles to implementing new knowledge include lack of point-of-care resources, lack of time, other administrative duties, skepticism of new knowledge, and established habits. ► More convenient, distilled resources, more time to research patient questions, and dedicated staff versed in evidence-based medicine would improve application of new knowledge