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

Medical Education Medical Education Research: A New Role Research: A New Role

for Practice-Based for Practice-Based Research NetworksResearch Networks

William J. Cairney, PhDWilliam J. Cairney, PhD

AACOM Annual Meeting PanelAACOM Annual Meeting Panel

June 23, 2006June 23, 2006

How Family Practice How Family Practice Residents learn and Residents learn and apply new medical apply new medical

informationinformation

William J. Cairney, PhDWilliam J. Cairney, PhDJoel Dickerman, DOJoel Dickerman, DO

Jeremy C. Saunders, MPPJeremy C. Saunders, MPPKristiann L. Saunders, MPAKristiann L. Saunders, MPA

BackgroundBackground

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

MethodsMethods

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

Methods: Focus group questionsMethods: Focus group questions

►Four basic categorical questions were Four basic categorical questions were presented, each with sub-questions to presented, each with sub-questions to help elicit resident responseshelp elicit resident responses

►#1 Where do #1 Where do you you look to find new look to find new information?information? What do you find most available?What do you find most available? What do you find most useful?What do you find most useful? What do you find most authoritative?What do you find most authoritative?


►#2 #2 How much time do How much time do youyou spend acquiring spend acquiring new information?new information? Do you think it’s enough?Do you think it’s enough? Do you think your time is effectively used?Do you think your time is effectively used? Do you integrate what you have found? Do you integrate what you have found?

Assuming you want to integrate your Assuming you want to integrate your newly acquired information...newly acquired information...


►#3 #3 How do How do you you apply new knowledge in apply new knowledge in youryour practice? practice? E.g. from…E.g. from…

►Continuing medical educationContinuing medical education►Family practice journalsFamily practice journals►the Internetthe Internet

Give an example of something you have Give an example of something you have done or changed recently based on new done or changed recently based on new knowledge?knowledge?


► Knowledge->Practice: Do Knowledge->Practice: Do you you do an adequate job?do an adequate job?

How would you personally measure an How would you personally measure an “adequate job”?“adequate job”?

What prevents you from better integrating What prevents you from better integrating new knowledge?new knowledge?

If you had more resources or more time, If you had more resources or more time, what would you do to integrate new what would you do to integrate new research into your practice?research into your practice?

Results: Focus group Results: Focus group respondentsrespondents

► In all 70 residents participated in 7 In all 70 residents participated in 7 total focus groupstotal focus groups

►Focus group size ranged from 5-15 Focus group size ranged from 5-15 participantsparticipants

Results: Question #1Results: Question #1

►Where do Where do you you look to find new look to find new information?information? Internet: Up to Date *, Medscape, MD Internet: Up to Date *, Medscape, MD

Consult*, general Google searchesConsult*, general Google searches Colleagues/Faculty/Specialists: Either Colleagues/Faculty/Specialists: Either

direct contact in clinic, or will call direct contact in clinic, or will call Journals: Review articlesJournals: Review articles CME: Scheduled lectures, CME by CME: Scheduled lectures, CME by

pharmaceutical repspharmaceutical reps* Depends on availability* Depends on availability


► How much time do How much time do youyou spend acquiring new spend acquiring new information?information? Always learningAlways learning Dedicated time ranges from 1-10 hours per week, but Dedicated time ranges from 1-10 hours per week, but

depends on definitiondepends on definition► More if you count point-of-care learning, less if you count dedicated More if you count point-of-care learning, less if you count dedicated

learning time outside of clinic timelearning time outside of clinic time

Never enough time Never enough time Family practice very challenging – so broadFamily practice very challenging – so broad Most effective use of time is learning at point of careMost effective use of time is learning at point of care Information integrated if done at point of careInformation integrated if done at point of care Information more readily integrated if demonstrated by Information more readily integrated if demonstrated by

colleaguecolleague


► How do How do you you apply new knowledge in apply new knowledge in youryour practice?practice? More likely to apply if colleague presents More likely to apply if colleague presents

information (either at bedside or in CME)information (either at bedside or in CME) At point of care or in follow-up visitAt point of care or in follow-up visit Specific examples of application: Screening for Specific examples of application: Screening for

hip dysplasia, Use of Riboflavin in headaches, hip dysplasia, Use of Riboflavin in headaches, Pap protocols, Hepatitis A vaccination Pap protocols, Hepatitis A vaccination indications, beta-blockers in pre-surgical indications, beta-blockers in pre-surgical patients with cardiac disease, current patients with cardiac disease, current antibiotics for meningitis.antibiotics for meningitis.


► Knowledge->Practice: Do Knowledge->Practice: Do you you do an adequate job? do an adequate job?

How would you personally measure an How would you personally measure an “adequate job”?“adequate job”? Faculty evaluationsFaculty evaluations Colleague feedbackColleague feedback Patient responsePatient response Patient satisfactionPatient satisfaction

Results: Question #4 (con’t)Results: Question #4 (con’t)


What prevents you from better What prevents you from better integrating new knowledge?integrating new knowledge? Lack of timeLack of time Skepticism/conflicting guidelines/lack of Skepticism/conflicting guidelines/lack of

specialty adoptionspecialty adoption Other administrative dutiesOther administrative duties Established beliefs and habitsEstablished beliefs and habits

Results: Question #4 (con’t)Results: Question #4 (con’t)


If you had more resources or more If you had more resources or more time, what would you do to integrate time, what would you do to integrate new research into your practice?new research into your practice? EMR/point of care guidelines EMR/point of care guidelines Distilled, easy to use guidelinesDistilled, easy to use guidelines Dedicated staff or individual that could Dedicated staff or individual that could

provide point of care distilled evidence-provide point of care distilled evidence-based medicinebased medicine

ConclusionsConclusions

►Family practice residents acquire new Family practice residents acquire new information primarily from the internet, information primarily from the internet, colleagues, and lectures. colleagues, and lectures.

►Residents feel point-of-care learning is the Residents feel point-of-care learning is the most effective means of retaining most effective means of retaining information.information.

►Residents apply new medical information Residents apply new medical information when it directly relates to a patient medical when it directly relates to a patient medical issue. Application of new knowledge occurs issue. Application of new knowledge occurs more readily when it is supported by a more readily when it is supported by a colleague or mentor.colleague or mentor.

ConclusionsConclusions

► Residents receive feedback on the use of new Residents receive feedback on the use of new medical information through formal evaluation, medical information through formal evaluation, reinforcement through colleague actions, reinforcement through colleague actions, patient results, and patient satisfactionpatient results, and patient satisfaction

►Obstacles to implementing new knowledge Obstacles to implementing new knowledge include lack of point-of-care resources, lack of include lack of point-of-care resources, lack of time, other administrative duties, skepticism of time, other administrative duties, skepticism of new knowledge, and established habits.new knowledge, and established habits.

►More convenient, distilled resources, more time More convenient, distilled resources, more time to research patient questions, and dedicated to research patient questions, and dedicated staff versed in evidence-based medicine would staff versed in evidence-based medicine would improve application of new knowledgeimprove application of new knowledge

Documents

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