Green M. — Yale University
Siddharta R, Holmboe ES. — American Board of Internal Medicine
Presented: Society of General Internal Medicine Annual Meeting, April 2013
Background: Physicians frequently encounter clinical questions at the point of care (POC), which represent opportunities for learning, immediate application of new knowledge and longer term performance improvement. An understanding of these POC learning episodes would inform continuing medical education programs, electronic information resources, evidence-based practice training and reflective practice. Previous studies of POC learning have been confined to small numbers of physicians in limited geographic areas.
Methods: The sample was internists enrolled in the ABIM Maintenance of Certification (MOC) program that registered for and entered at least one question in the ABIM Point-of-Care Clinical Question Module between November 2010 and December 2012. To complete this Web-based module, internists documented the characteristics, information seeking, learning, practice impact and barriers of at least 20 point-of-care clinical questions.
Results: Four hundred seventy-two internists entered at least one clinical question (224 completed the module, 188 are currently working on it, and 60 cancelled). Among those who completed the module, 197 (88%) spent more than 30 hours per week in patient care activities, 66 (28%) were generalists, and 108 (48%) worked in academic settings. The internists documented 5,187 POC learning episodes over periods ranging from 1 to 19 months. The episodes most commonly were stimulated by direct patient care in the ambulatory setting, with or without a trainee (57%); involved cardiovascular disease (21%) or gastroenterology (14%) content; represented foreground questions (58%); and concerned therapy (55%) or diagnosis (14%) questions. The internists spent a median of 30 minutes looking up medical information, most often sometime after the clinical encounter (61%); using a median of two resources; and most commonly consulting UpToDate® (25%) and articles retrieved via PubMed (17%). The internists planned to change their practice based on 40% of the point-of-care learning episodes. Among the remainder, they reported that the information supported their current practice (47%), they required more information before making a change (9%), or the practice change was not feasible (3%). Internists encountered barriers during 11% of the learning episodes, including limited access to information resources (17%), uncertainty about the sufficiency of the information initially obtained (13%), difficulty searching information resources (11%) and difficulty appraising the validity or usefulness of the information (8%).
Conclusions: Using a novel Web-based portfolio for MOC, internists report POC learning episodes that most commonly occur in the ambulatory setting, involve cardiovascular disease or gastroenterology content and concern questions of therapy and diagnosis. They consult an average of two information resources per episode, most commonly UpToDate and PubMed. Forty percent of POC learning episodes result in a planned practice change.
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