Use of traditional versus electronic medical-information resources by residents and interns

The Educational Resource Preferences and Information-Seeking Behaviors of Veterinary Medical Students and Practitioners

The overall purpose of this study was to assess the information-seeking strategies of individuals representing different stages of veterinary training. More specifically, we conducted a survey to evaluate textbook ownership, to determine the preferred types of educational resources and why these preferences exist, and to determine if changes arise as training progresses. We asked students in the veterinary curriculum, interns, residents, and recent graduates from the University of Georgia (UGA) College of Veterinary Medicine (CVM) to participate in a confidential online survey. A total of 184 individuals participated. Respondents were grouped into one of six categories: recent graduates (n = 6), interns/residents (n = 11), fourth-year students (n = 21), third-year students (n = 46), second-year students (n = 73), and first-year students (n = 27). The results showed that veterinary students used class notes and non-veterinary search engines initially, whereas interns and residents consulted textbooks and the primary literature as their first sources to answer a veterinary question. Veterinary students had accrued textbooks over sequential years in the curriculum, but many interns and residents had almost twice as many textbooks as those who had not pursued additional training after graduation. An ANOVA showed that first-year students reported a preference for printed textbooks significantly more frequently than the third-year and fourth-year students (F_(5,163) = 3.265, p = .006, and p = .012, respectively). Decreased cost was most frequently cited as the factor that would increase textbook purchases.

Undisclosed conflicts of interest in German-language textbooks of anesthesiology, critical care, and emergency medicine

BACKGROUND

Medical textbooks are important throughout postgraduate internship, residency and fellowship programs but authors' conflicts of interest (COI) are rarely disclosed. In anesthesiology, two high-profile cases of research fraud/unethical publishing have previously been identified. This study evaluated whether anesthesiology textbooks in German include controversial recommendations on hydroxyethyl starch (HES) and whether authors had undisclosed COI.

METHODS

Forty-five anesthesiology, critical care, and emergency medicine electronic textbooks (January 2015-August 2017) were identified on the websites of German, Austrian, and Swiss publishers. Six textbooks were excluded (irrelevant content; compilation of peer-reviewed articles). Content on HES ('Kolloid', 'Hydroxyäthylstärke', 'Hydroxyethylstärke', 'HES', 'HAES') and COI ('Interessenkonflikt') was electronically searched; subject lists were manually searched. Recommendations on HES were analyzed in the context of indications/warnings/international guidelines. Potential COI for authors of controversial recommendations were searched on PubMed/EMBASE (January 2016-May 2018).

RESULTS

COI statements were absent in 38/39 textbooks (present for 1/553 authors; 0.2 %). Twelve textbooks did not discuss HES for volume resuscitation. HES was recommended in 13 textbooks; many recommendations were controversial (10/39 textbooks, 26 %; 25/553 authors, 5 %). Journal COI statements were available for 18/25 authors; 7 authors had financial/other COI, including 4/18 (22 %) with ties to HES manufacturers.

CONCLUSIONS

Recommendations on volume resuscitation with HES are highly controversial in German-language electronic textbooks; about one-quarter of relevant textbooks are inconsistent with regulatory authority or international guideline criteria. Undisclosed potential COI of textbook authors making controversial recommendations of HES were frequent, linking roughly one in five authors to the HES-producing industry. Against this background, COI statements must become part of standard textbook publication ethics.

Written and Online Residency Guidebook to Improve Resident Efficiency and Knowledge of Best Patient Care Practices

Introduction

Residents at most institutions change rotations every 2 to 4 weeks. It often takes significant time for residents to become acclimated to the different protocols, expectations, and environments of each unique rotation. As a result, residents often spend time searching for answers, time that could be spent in outside learning and direct patient care. The goal of this resource is to provide a novel guidebook that improves residents' efficiency and knowledge of best patient care practices.

Methods

The guidebook begins with an introductory chapter with key contact information that can be filled in for the user's institution, which is followed by 16 rotation-specific chapters. A rotation-based approach was chosen as it focuses the content on the most pertinent information. Thus, trainees can quickly read a chapter to cover the most pertinent content for their current rotation. As a surrogate marker for efficiency, noon-conference attendance logs were queried to assess improvement in on-time attendance after introduction of the guidebook.

Results

After introduction of the learning resources, on-time arrival to noon conference improved for all residents and interns. Guidebook survey results were universally favorable; however, around half of respondents stated that they used the guidebook once or less per rotation.

Discussion

Underutilization of these resources potentially contributed to the lack of a statistically significant improvement overall. Future directions should focus on augmenting the quality and utilization of the guidebook and then reevaluating if, once well adopted, there is a sustained benefit.

How do junior medical officers use online information resources? A survey

BACKGROUND

Online information resources function dually as important learning tools and sources of the latest evidence-based recommendations for junior medical officers (JMOs). However, little is currently known about how JMOs utilise this information when providing care for their patients. This study aimed to examine the usage and experience of online information resources amongst JMOs in South Australia to ascertain (i) the type of resources accessed, (ii) the frequency, (iii) the intended purpose, and (iv) the perceived reliability.

METHODS

A survey instrument using multiple choices, five-point Likert scales and free-text comments was developed and distributed through SurveyMonkey to South Australian JMOs between 1 May 2014 and 30 June 2014.

RESULTS

Of the 142 surveyed, 100 JMOs (70.4%) used online information resources as their first approach over all other resources available. JMOs overwhelmingly (94.4%, n = 134) used online information resources at least once per day, with the most frequent purpose for use being information regarding prescription medication (82.4%, n = 117, reported 'very frequent' use). JMOs stated online resources were necessary to perform their work and, of the different types of information accessed, they rated peer-reviewed resources as the most reliable.

CONCLUSIONS

JMOs strongly rely upon online clinical information in their everyday practice. Importantly, provision of these resources assists JMOs in their education and clinical performance.

Physicians reading and writing practices: a cross-sectional study from Civil Hospital, Karachi, Pakistan

BACKGROUND

To determine the behavior of physicians regarding medical literature reading and participation in research activities at one of the largest teaching hospitals in Pakistan.

METHOD

This descriptive, cross-sectional study was conducted by interviewing the house officers, residents and fellows of six major specialties (Medicine, Surgery, Pediatrics, Psychology, Obstetrics & Gynecology and Anesthesia) in Civil Hospital, Karachi between August and December, 2011. The questionnaire elicited responses regarding the reading habits of physicians, preferred sources of information, their participation in research activities (publication & supervision) and views regarding journal club. SPSS 17.0 was used for data entry and analysis.

RESULT

A total of 259 completely filled questionnaires were returned with a response rate of 85.19%. Mean age of the participants was 29.67 ± 7.65 years. Books were selected by 71.4% doctors as their preferred source of information, regardless of their clinical specialties. (p < 0.05). E-journals were preferred by 75.7% of the doctors over printed journals. This holds true for doctors from all specialties (p < 0.05). The ease of searching for relevant articles was the major contributor (50.5%) in preference of e-journals. 137 (52.9%) doctors read 5 or less articles per week. 30 (11.6%) doctors have subscription of journals (printed or electronic). At least one research paper has been published by 151 (58.3%) of the physicians interviewed. Most common reason for not participating in research activities was busy schedule (56.4%). Almost half (49.4%) doctors reported lack of journal club in their units. Of these, majority (88.35%) wanted a journal club in their respective units.

CONCLUSION

Urgent intervention is required to promote healthcare literature reading and writing practice in our physicians. Easy access to workplace computers with internet and subscription of paid journals will facilitate physicians. Lack of supervisors and busy schedule were reported to be important contributors for not participating in research. Addressing these issues will encourage doctors to participate more in research activities.

How residents and interns utilise and perceive the personal digital assistant and UpToDate

BACKGROUND

In this era of evidence-based medicine, doctors are increasingly using information technology to acquire medical knowledge. This study evaluates how residents and interns utilise and perceive the personal digital assistant (PDA) and the online resource UpToDate.

METHODS

This is a questionnaire survey of all residents and interns in a tertiary teaching hospital.

RESULTS

Out of 168 doctors, 134 (79.8%) responded to the questionnaire. Only 54 doctors (40.3%) owned a PDA. Although these owners perceived that the PDA was most useful for providing drug information, followed by medical references, scheduling and medical calculators, the majority of them did not actually have medical software applications downloaded on their PDAs. The greatest concerns highlighted for the PDA were the fear of loss and breakage, and the preference for working with desktop computers and paper. Meanwhile, only 76 doctors (56.7%) used UpToDate, even though the hospital had an institutional subscription for it. Although 93.4% of these users would recommend UpToDate to a colleague, only 57.9% stated that the use of UpToDate had led to a change in their management of patients.

CONCLUSION

Although UpToDate and various PDA software applications were deemed useful by some of the residents and interns in our study, both digital tools were under-utilised. More should be done to facilitate the use of medical software applications on PDAs, to promote awareness of tools for evidence-based medicine such as UpToDate, and to facilitate the application of evidence-based medicine in daily clinical practice.