Answering questions at the point of care: do residents practice EBM or manage information sources?
OBJECTIVE
To determine the types of information sources that evidence-based medicine (EBM)-trained, family medicine residents use to answer clinical questions at the point of care, to assess whether the sources are evidence-based, and to provide suggestions for more effective information-management strategies in residency training.


METHODS
In 2005, trained medical students directly observed (for two half-days per physician) how 25 third-year family medicine residents retrieved information to answer clinical questions arising at the point of care and documented the type and name of each source, the retrieval location, and the estimated time spent consulting the source. An end-of-study questionnaire asked 37 full-time faculty and the participating residents about the best information sources available, subscriptions owned, why they use a personal digital assistant (PDA) to practice medicine, and their experience in preventing medical errors using a PDA.


RESULTS
Forty-four percent of questions were answered by attending physicians, 23% by consulting PDAs, and 20% from books. Seventy-two percent of questions were answered within two minutes. Residents rated UptoDate as the best source for evidence-based information, but they used this source only five times. PDAs were used because of ease of use, time factors, and accessibility. All examples of medical errors discovered or prevented with PDA programs were medication related. None of the participants' residencies required the use of a specific medical information resource.


CONCLUSIONS
The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.
McCord
Gary
G
Department of Family Medicine, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio, USA. gmccord@neoucom.edu
Smucker
William D
WD
Selius
Brian A
BA
Hannan
Scott
S
Davidson
Elliot
E
Schrop
Susan Labuda
SL
Rao
Vinod
V
Albrecht
Paula
P
D034201:Computers, Handheld / Q000706:statistics & numerical data; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education; D006801:Humans; D016247:Information Storage and Retrieval / Q000706:statistics & numerical data*; D007396:Internship and Residency; D009820:Ohio; D019095:Point-of-Care Systems; D011795:Surveys and Questionnaires; D013782:Textbooks as Topic