Answering Questions at the Point of Care: Do Residents Practice EBM or Manage Information Sources?

McCord, Gary MA; Smucker, William D. MD; Selius, Brian A. DO; Hannan, Scott MD; Davidson, Elliot MD; Schrop, Susan Labuda MS; Rao, Vinod; Albrecht, Paula

Academic Medicine:
doi: 10.1097/ACM.0b013e3180307fed
Evidence-Based Medicine
Abstract

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.

Author Information

Mr. McCord is research coordinator, Department of Family Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.

Dr. Smucker is professor of family medicine, Summa Health System, Akron City Hospital, Akron, Ohio.

Dr. Selius is associate professor of family medicine, St. Elizabeth Hospital Medical Center, Youngstown, Ohio.

Dr. Hannan is assistant professor of family medicine, Aultman Hospital, Canton, Ohio.

Dr. Davidson is assistant professor of family medicine, Akron General Center for Family Medicine, Akron, Ohio.

Ms. Labuda Schrop is associate director for administration, Department of Family Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.

Mr. Rao is a second-year medical student, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.

Ms. Albrecht is a first-year medical student, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Mr. McCord, Northeastern Ohio Universities College of Medicine, Department of Family Medicine, 4209 State Rt. 44, PO Box 95, Rootstown, OH 44272; telephone: (330) 325-6766; fax: (330) 325-5903; e-mail: (gmccord@neoucom.edu).

© 2007 Association of American Medical Colleges