Abstract
ObjectiveThe investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM).MethodsClinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds.ResultsRounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; p<0.01) and answered (3 CLR vs. 2 NCLR; p<0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; p<0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; p=0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (p<0.01). Select participants described how the CL’s presence improved their EBM skills and care decisions.ConclusionsInpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians’ EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills.
Highlights
The increasing volume of complex medical literature and concurrent time constraints have hindered clinicians’ abilities to search for information and apply evidence-based medicine (EBM) skills to clinical practice [1,2,3,4]
Studies have shown that clinicians do not pursue or find answers for about half of their clinical questions that arise during everyday practice [5,6,7,8]
Independentsample t-tests were used for continuous data to compare the time spent asking or answering questions and the time spent rounding per patient between CL was present on rounds (CLR) and NCLR
Summary
The increasing volume of complex medical literature and concurrent time constraints have hindered clinicians’ abilities to search for information and apply evidence-based medicine (EBM) skills to clinical practice [1,2,3,4]. The greatest barrier to answering clinical questions, insufficient time, has contributed to physician burnout and poor patient outcomes [9, 10]. A growing focus on lifelong learning by the American Association of Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) has kindled discussion about the potential role of CLs in medical education [12,13,14]. When they are involved in clinical practice and jmla.mlanet.org
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