Abstract
BackgroundStaying up to date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases, and tools can help, but clinicians first need to translate their clinical questions into searchable queries. MacPLUS FS (McMaster Premium LiteratUre Service Federated Search) is an online search engine that allows clinicians to explore multiple resources simultaneously and retrieves one single output that includes the following: (1) evidence from summaries (eg, UpToDate and DynaMed), (2) preappraised research (eg, EvidenceAlerts), and (3) non-preappraised research (eg, PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval.ObjectiveOur primary objective was to examine how clinicians formulate their queries on a federated search engine, according to the population, intervention, comparison, and outcome (PICO) framework. Our secondary objective was to assess which resources were accessed by clinicians to answer their questions.MethodsWe performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized controlled trial on search retrieval. Recording account log-ins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (eg, “What is porphyria?”) and foreground questions (eg, “Does treatment A work better than B?”). We then analyzed the type of resources that clinicians accessed.ResultsThere were 695 structured queries, after exclusion of meaningless queries and iterations of similar searches. We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%). This distribution did not significantly differ between postgraduate residents and medical faculty physicians (P=.51). Queries included a median of 3 search terms (IQR 2-4), most often related to the population and intervention or test, rarely related to the outcome, and never related to the comparator. About half of the resources accessed (314/610, 51.5%) were summaries, 24.4% (149/610) were preappraised research, and 24.1% were (147/610) non-preappraised research.ConclusionsOur results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians’ retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice.Trial RegistrationClinicalTrials.gov NCT02038439; https://www.clinicaltrials.gov/ct2/show/NCT02038439
Highlights
Web-based searches have become the norm when looking for information and answers to most of our questions in daily life
We classified 56.5% (393/695) of these queries as background questions and 43.5% (302/695) as foreground questions, the majority of which were related to questions about therapy (213/695, 30.6%), followed by diagnosis (48/695, 6.9%), etiology (24/695, 3.5%), and prognosis (17/695, 2.5%)
How many search terms do they use? How often do their queries fit the PICO framework [12,13]? Do experienced and fully trained clinicians differ from residents in training? Do queries differ according to the medical specialty? We aimed to examine these questions in a large sample of practicing clinicians of various levels of training and specialty type
Summary
Web-based searches have become the norm when looking for information and answers to most of our questions in daily life This has become true in the practice of medicine; online medical resources to access evidence are increasingly considered “as essential as the stethoscope” [1]. Physicians are typically familiar with only a few of these resources, likely those to which they have been exposed in training or by peers, and often ignore most of the ecosystem and architecture of published evidence Their daily practice triggers, on average, five to eight questions every 10 patients [8,9,10].
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