A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making.
BACKGROUND
Residents' perceptions about evidence-based clinical decision making remain largely unexplored.


OBJECTIVE
To understand how residents perceive and use evidence-based medicine in clinical decision making.


METHODS
Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group.


RESULTS
The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside.


CONCLUSIONS
The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.
Montori
Victor M
VM
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Tabini
Claudia C
CC
Ebbert
Jon O
JO
D020000:Decision Support Systems, Clinical; D004503:Education, Medical, Graduate; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D015397:Program Evaluation; D012938:Social Perception; D013337:Students, Medical / Q000523:psychology*; D014481:United States