title: Increasing the quantity and quality of searching for current best evidence to answer clinical questions: protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials.
abstract: OBJECTIVE
  Finding current best evidence for clinical decisions remains challenging. With 3,000 new studies published every day, no single evidence-based resource provides all answers or is sufficiently updated. McMaster Premium LiteratUre Service--Federated Search (MacPLUS FS) addresses this issue by looking in multiple high quality resources simultaneously and displaying results in a one-page pyramid with the most clinically useful at the top. Yet, additional logistical and educational barriers need to be addressed to enhance point-of-care evidence retrieval. This trial seeks to test three innovative interventions, among clinicians registered to MacPLUS FS, to increase the quantity and quality of searching for current best evidence to answer clinical questions.
  
  
  METHODS
  In a user-centered approach, we designed three interventions embedded in MacPLUS FS: (A) a web-based Clinical Question Recorder; (B) an Evidence Retrieval Coach composed of eight short educational videos; (C) an Audit, Feedback and Gamification approach to evidence retrieval, based on the allocation of 'badges' and 'reputation scores.' We will conduct a randomized factorial controlled trial among all the 904 eligible medical doctors currently registered to MacPLUS FS at the hospitals affiliated with McMaster University, Canada. Postgraduate trainees (n=429) and clinical faculty/staff (n=475) will be randomized to each of the three following interventions in a factorial design (AxBxC). Utilization will be continuously recorded through clinicians’ accounts that track logins and usage, down to the level of individual keystrokes. The primary outcome is the rate of searches per month per user during the six months of follow-up. Secondary outcomes, measured through the validated Impact Assessment Method questionnaire, include: utility of answers found (meeting clinicians’ information needs), use (application in practice), and perceived usefulness on patient outcomes.
  
  
  CONCLUSIONS
  Built on effective models for the point-of-care teaching, these interventions approach evidence retrieval as a clinical skill. If effective, they may offer the opportunity to enhance it for a large audience, at low cost, providing better access to relevant evidence across many top EBM resources in parallel.
  
  
  BACKGROUND
  ClinicalTrials.Gov NCT02038439.
authors.forename: Thomas
authors.initials: T
authors.lastname: Agoritsas
authors.forename: Emma
authors.initials: E
authors.lastname: Iserman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hobson
authors.forename: Natasha
authors.initials: N
authors.lastname: Cohen
authors.forename: Adam
authors.initials: A
authors.lastname: Cohen
authors.forename: Pavel S
authors.initials: PS
authors.lastname: Roshanov
authors.forename: Miguel
authors.initials: M
authors.lastname: Perez
authors.forename: Chris
authors.initials: C
authors.lastname: Cotoi
authors.forename: Rick
authors.initials: R
authors.lastname: Parrish
authors.forename: Eleanor
authors.initials: E
authors.lastname: Pullenayegum
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilczynski
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004059:Diffusion of Innovation; D004503:Education, Medical, Graduate / Q000379:methods*; D019317:Evidence-Based Medicine / Q000193:education*; D005246:Feedback; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards* / Q000706:statistics & numerical data; D020407:Internet; D009864:Ontario; D010549:Personal Satisfaction; D019095:Point-of-Care Systems; D013663:Teaching / Q000379:methods