Online Searching as a Practice for Evidence-Based Medicine in the Neonatal Intensive Care Unit, University of Malaya Medical Center, Malaysia: Cross-sectional Study

Background

The use of the internet for research is essential in the practice of evidence-based medicine. The online search habits of medical practitioners in clinical settings, particularly from direct observation, have received little attention.

Objective

The goal of the research is to explore online searching for information as an evidence-based practice among medical practitioners.

Methods

A cross-sectional study was conducted to evaluate the clinical teams’ use of evidence-based practice when making clinical decisions for their patients' care. Data were collected through online searches from 2015 to 2018. Participants were medical practitioners and medical students in a Malaysian public teaching hospital’s neonatal intensive care unit who performed online searches to find answers to clinical questions that arose during ward rounds.

Results

In search sessions conducted by the participants, 311 queries were observed from 2015 to 2018. Most participants (34/47, 72%) were house officers and medical students. Most of the searches were conducted by house officers (51/99, 52%) and medical students (32/99, 32%). Most searches (70/99, 71%) were directed rather than self-initiated, and 90% (89/99) were completed individually rather than collaboratively. Participants entered an average of 4 terms in each query; three-quarters of the queries yielded relevant evidence, with two-thirds yielding more than one relevant source of evidence.

Conclusions

Our findings suggest that junior doctors and medical students need more training in evidence-based medicine skills such as clinical question formulation and online search techniques for performing independent online searches effectively. However, because the findings were based on intermittent opportunistic observations in a specific clinical setting, they may not be generalizable.

Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews?

BACKGROUND

A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors.

OBJECTIVES

To assess to what extent physicians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance.

METHODS

A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emergency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three.

RESULTS

Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians' assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected specificity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting.

CONCLUSIONS

There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physician's preferences and contextual factors, including differences in the micro environment of each clinical setting.