Resident Utilization of Information Technology: A Randomized Trial of Clinical Question Formation

Abstract

In the current health care environment, it is expected that individual patient decisions will be made using clinical judgment, expertise, and information from well-designed clinical trials. There is evidence that caring for patients using information from valid clinical trials can improve patient outcomes.1–3 However, the process of moving from an individual patient encounter to practicing evidence-based medicine (EBM) requires explicit skills that are rarely taught. Specifically, clinicians must identify the need for information, formulate questions, search for information, appraise literature, and then apply scientific evidence to the clinical decision at hand. Most physicians, either while in training or in practice, have been exposed to the skills and knowledge needed to critically appraise a scientific report. For example, the User's Guide to the Medical Literature series has clearly outlined how to efficiently appraise most types of scientific reports and trials.4–7 These skills have been used to effectively teach evaluation of the medical literature.8 Established teaching traditions, such as medical journal clubs, have been used to motivate critical reading in house officers.9 However, the critical appraisal process is dependent on asking the right questions and finding the relevant evidence. These important first steps in the EBM process are rarely discussed or practiced. Physicians often form questions from patient encounters,10–12 but the generation of a question does not necessarily lead to a search of the literature.11 One impediment to searching is the lack of a focused and searchable question. The difficulties in formulating questions and moving to the search are troubling, because evidence does exist to treat patients12 and patient outcomes are enhanced when the best available evidence is applied to their care.1–3 Therefore, physicians in training need to be taught the skills of EBM, and studies are needed to show how these educational interventions affect behavior. We designed a randomized controlled trial to objectively measure the effect of an educational intervention on the first steps of the EBM process, moving from a clinical question to a search of the medical literature. We sought to teach residents how to build clinically relevant questions that would facilitate searching. Without an appropriate question, searching is not likely to be fruitful. Our primary hypothesis was that residents taught to frame effective clinical questions would increase their use of medline.