Why general practitioners and consultants change their clinical practice: a critical incident study.
OBJECTIVE
To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change.


METHODS
Interviews using the critical incident technique.


METHODS
Primary and secondary care.


METHODS
Random sample of 50 general practitioners and 50 consultants.


METHODS
Categories of reasons for change in clinical practice.


RESULTS
Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings.


CONCLUSIONS
Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered.
Allery
L A
LA
School of Postgraduate Medical and Dental Education, University of Wales, College of Medicine, Cardiff.
Owen
P A
PA
Robling
M R
MR
D003253:Consultants; D004502:Education, Medical, Continuing; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D013647:Task Performance and Analysis