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Using a Web-based module to identify barriers in point-of-care learning.


Reddy SG, Holmboe ES. — American Board of Internal Medicine

Green ML. — Yale University School of Medicine

Presented: Asia Pacific Medical Education Conference, January 2011

Aims: Physicians fail to answer the majority of clinical questions that arise while providing care to their patients. With the explosion in medical knowledge combined with advances in electronic information resources, the ability to apply evidence-based practice at the point-of-care is now an important competency for all physicians. The American Board of Internal Medicine (ABIM) developed a Web-based Point-of-Care Clinical Question (POC) module to enable physicians to document the characteristics, information pursuit and application of their clinical questions. They may also document one or more barriers encountered in each question pursuit. After completing 20 questions and reflecting on a POC learning report, they have the opportunity to “commit to change (CTC)” their POC learning strategies, and then develop change ideas to improve their information-seeking process. We hypothesized that physicians who identified barriers were more likely to also write CTC statements about their POC learning strategies.

Methods: We invited a random sample of physicians enrolled in ABIM’s MOC program to complete the POC module as part of a beta test that was conducted from March 2008 to June 2010. Eligible physicians had an internal medicine (IM) and/or IM subspecialty certificate expiring within three years. A total of 225 physicians consented to participate with 79 (35%) completing the module. Using completer data, we compared physicians who identified barriers to answering their questions to those who did not with respect to the primary outcome of writing at least one CTC statement.

Results: The 79 physicians completed a total of 1,587 questions (mean: 20; range: 20-23 questions per physician) over a mean of 108 days (range: 23-264 days). Sixty-one physicians (77%) identified at least one barrier (mean: 9, median: 6, range: 1-43 barriers) in their question set and 560 total barriers were counted among 319 (20% of all) questions. Physicians reported all possible barriers that were listed as options in the module including, not knowing when to stop searching for information (N=98 questions; 18%); lack of access to necessary resources (N=62; 11%); evaluating the validity or usefulness of the information they did find (N=61; 11%); applying their answer to their patient (N=33; 6%); not aware of potentially helpful resources (N=29; 5%); articulating their questions (N=37; 7%); insufficient time to search for an answer (N=24; 4%). “Other” was cited as a barrier in 131 (23% of) questions. Forty-four (56% of) physicians wrote CTC statements. Physicians who identified any barriers were more likely to write a CTC statement (38/61, 62%) than those who did not identify any barriers (6/18, 33%); p=0.035.

Conclusion: Physicians identified barriers to their medical information-seeking process among one in five questions documented as part of the POC module. Those physicians who identified barriers were more likely to develop at least one CTC statement describing how they planned to change their information-seeking process.

For more information about this presentation, please contact Research@abim.org.