Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

'Dopesick'; why a critical view of the literature may save your patient's life

INTRODUCTION

Teaching critical literature appraisal is challenging. Providing a compelling clinical context using 'cinemeduation' stimulates interest in the topic.

METHODS

After watching the first episode of the mini-series 'Dopesick', where the scope, timeline and extent of the problem of opioid abuse are clearly seen, abstracts of the period literature strongly supporting the use of Oxycontin for use in chronic pain are shown. All were published in highly ranked medical journals. A simple paper evaluation structure is suggested. It is PPICOREAD which stands for the following questions: Who Paid for the study? What was the Population studied? What was the Intervention given in the study? What was the Control group used? What was the Outcome and was it of clinical significance to you? Was the trial Registered? Was there an Educational element for you? Was there anything Applicable to your practice? What was the Duration of the trial? Is this duration sufficient to reassure you that the trial is relevant to your practice?

RESULTS

The very poor quality and dishonest nature of the conclusions of these papers are quickly and easily uncovered in a supervised workshop. The causes for these clear discrepancies are discussed. The devastating consequences are described.

Canadian Naturopathic Doctor Engagement, Preparedness, and Perceptions of Evidence-Based Practice: A National Cross-Sectional Study

Background: Despite the reported benefits of evidence-based practice (EBP), there are concerns that some practitioners, including naturopathic doctors (NDs), may be cautious about its use. The objective of this study was to explore Canadian ND perceptions, preparedness, and engagement in EBP, and the barriers and enablers to EBP uptake. Methods: The study was a national cross-sectional survey. NDs practicing in Canada were invited to complete the validated 84-item Evidence-Based Practice Attitudes and Utilization Survey between February and May 2020. Results: A total of 252 Canadian NDs were recruited. Participant attitudes toward EBP were predominantly positive, with three-quarters of participants indicating that >50% of their practice was informed by clinical research evidence. One-half of participants self-reported a medium-high to high level of skill across most EBP-related activities. Notable barriers to EBP uptake were lack of clinical evidence in naturopathy, and lack of time. Access to the internet and online databases were identified as useful enablers to improving EBP engagement. Conclusions: By shedding light on Canadian ND engagement with, preparedness for, and perceptions of EBP, the findings will help guide the development of strategies to support EBP uptake in NDs with the expectation of improving quality of care.

Educational strategies to enhance EBM teaching and learning in the workplace: a focus group study

OBJECTIVES

This study aimed to gather and synthesise educational strategies that can improve teaching and learning of evidence-based medicine (EBM) in the workplace, and make them concrete by listing ideas for implementing these strategies. Insight into current workplace-based EBM teaching and learning in general practice was the starting point to generate these strategies and ideas.

DESIGN

Exploratory, qualitative focus group study, applying the consensus method of the nominal group technique.

SETTING

Postgraduate medical education; general practitioner (GP) specialty training at University Medical Centre Utrecht, the Netherlands PARTICIPANTS: 33 GPs and 17 GP trainees, divided in four focus groups. Using opportunistic sampling, participants were selected from the GP workplace because of their role as supervisor or trainee.

MAIN OUTCOMES

An overview of educational strategies and ideas on how to implement these strategies in the workplace, followed by the participants' global ranking of the most useful ideas.

RESULTS

The supervisors and trainees generated a list of educational improvement strategies that can be applied in learning conversations, while observing each other's consultations, and in (multidisciplinary) learning opportunities in the workplace. Table 1 presents the educational strategies and suggestions for implementing them. Ideas regarded as most useful include taking turns to conduct consultations and observing the other, holding a structured, in-depth discussion after observation, preparing and discussing articles found in relevant journals and on-the-spot searching for relevant evidence during learning conversations.

CONCLUSIONS

Participants provided an extensive list of educational strategies and ideas on how to implement EBM learning in daily practice. As a great deal of GP training takes place in clinical practice, supervisors and trainees could apply the suggested ideas to enhance EBM teaching and learning in the workplace.

Learning Conversations with Trainees: An Undervalued but Useful EBM Learning Opportunity for Clinical Supervisors

Phenomenon: Supervisors and trainees can learn skills related to evidence-based medicine from each other in the workplace by collaborating and interacting, in this way benefiting from each other's strengths. This study explores supervisors' perceptions of how they currently learn evidence-based medicine by engaging in learning conversations with their trainee. Approach: Semi-structured, video-stimulated elicitation interviews were held with twenty-two Dutch and Belgian supervisors in general practice. Supervisors were shown fragments of their video-recorded learning conversations, allowing them to reflect. Recorded interviews were analyzed using a grounded theory-based approach.Findings: Supervisors did not immediately perceive workplace learning conversations as an opportunity to learn evidence-based medicine from their trainee. They mostly saw these conversations as a learning opportunity for trainees and a chance to maintain the quality of care within their practice. Nevertheless, during the interviews, supervisors did acknowledge that learning conversations help them to gain up-to-date knowledge and search skills or more awareness of their own knowledge or gaps in their knowledge. Not identified as a learning outcome was how to apply evidence-based medicine within a clinical practice by combining evidence with clinical expertise and the patient's preferences. Insights: Supervisors acknowledge that they learn elements of the three aspects of evidence-based medicine by having learning conversations with their trainee, but they currently see this as secondary to the trainee's learning process. Emphasizing opportunities for bidirectional learning could improve learning of evidence-based medicine during workplace learning conversations.

GP trainees' perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study

BACKGROUND

To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient's preferences and the physician's clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations.

METHODS

We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software.

RESULTS

GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor's experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning.

CONCLUSIONS

Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning.