Physicians Evidence Retrieval Skills Clinical Trial
Official title:
Multifaceted Online Interventions to Increase the Quantity and Quality of Searching for Current Best Evidence to Answer Clinical Questions
Translation of new knowledge from research into evidence-informed health care is a shared
obligation of the clinical and the scientific communities. Unfortunately, studies of quality
of care continue to show that this goal is substantially unrealized. One main barrier is
lack of quick and easy identification, appraisal and synthesis of current best evidence.
Clinicians' information have 5 to 8 questions about individual patients per daily shift, but
face a large volume of 3000 articles published every day, accessible in many scattered
resources.
To address theses problems, McMaster's Health Information Research Unit (Hamilton, Ontario,
Canada) has developed and implemented "McMaster Premium LiteratUre Service Federated Search"
(MPFS), an online search engine that provides a unique 1-stop search and organized access to
current best evidence in daily practice. However additional barriers need to be overcome for
clinicians to actually search and use this evidence in their practice. Theses include
logistical barriers (time constraints, forgotten questions), as well as educational barriers
(eg, lack of awareness of the "architecture" of evidence, limited searching skills, and lack
of reference standards among peers for finding best evidence).
This randomized trial seeks to test 3 innovative online interventions among clinicians
registered to MPFS to overcome these barriers and increase the quantity and quality of
searching for current best evidence to answer clinical questions. These interventions build
on effective models for the teaching of clinical skills at the point of care, so that
clinicians are facilitated in using the search engine as a clinical tool, and perceive
evidence retrieval skills as true clinical skills.
1. Rationale & Objectives
One main barrier to achieving evidence-informed care by clinicians is lack of quick and
easy identification, appraisal and synthesis of current best evidence. Clinicians'
information needs are considerable - but about 3000 articles are published in Medline
every day. Numerous evidence-based resources have been developed to filter and process
the evidence, but although increasingly used by clinicians, each offer a fragmented and
scattered view of information, and none provides comprehensive topic coverage or
satisfactory updating.
To address theses problems, McMaster's Health Information Research Unit (Hamilton,
Ontario, Canada) has developed and implemented "McMaster Premium LiteratUre Service
Federated Search (MPFS)", an online search engine that provides a unique 1-stop search
and organized access to current best evidence in daily practice. MPFS provides both
alerts to users about new research in their chosen disciplines, and a novel federated
search function, with the particular feature of organizing information according to the
"pyramid of evidence-based resources", with the most clinically applicable evidence at
the top. Thus MPFS simultaneously retrieves evidence from Studies ("Medline", both
filtered and unfiltered, at the bottom), then Systematic reviews; Synopses of studies
and systematic reviews (selected for methodological rigor and clinical relevance), and,
at the top level, online widely used Summaries (e.g."Best Practice").
Combining features of the current best evidence-based resources is not enough to
increase access and use of current best evidence, as shown by the relatively low
utilization of searching features among the hundreds of clinicians currently registered
at McMaster University and using the alerting system. Additional well-known barriers
that need to be overcome include logistical barriers (time constraints, forgotten
questions, and simplicity of using one single albeit limited resource), as well as
educational barriers (eg, lack of awareness of the "architecture" of evidence and
limits of other single resources, lack of knowledge and experience of what federated
searches can offer, limited searching skills, and lack of reference standards among
peers for finding best evidence).
2. Hypothesis
This trial seeks to test 3 innovative online interventions among clinicians registered
to MPFS to overcome these barriers and increase the quantity and quality of searching
for current best evidence to answer clinical questions. These interventions build on
effective models for the teaching of clinical skills at the point of care, so that
clinicians are facilitated in using the search engine as a clinical tool, and perceive
evidence retrieval skills as true clinical skills.
3. Methods
1. Study design: Randomized Factorial Controlled Trial.
2. Setting and Participants: The trial will be conducted among postgraduate and
faculty MD registered in MPFS and working in the teaching hospitals and clinics of
McMaster University (see eligibility criteria below)
3. Participating clinicians will be randomized to 3 online interventions (see
description below) in a factorial design (A x B x C), whose permutation results in
8 allocation arms (A+B+C, A+B, A+C, B+C, A, B, C, no intervention, see details
below)
4. Randomization: will be computer-generated, stratified training level
(post-graduate MD, faculty MD), and baseline frequency of searching for evidence
on MPFS. Registrants will be randomly allocated to each study arms. Allocation
will be concealed from research staff.
5. Blinding and control group: Although participants cannot be blinded to the
interventions, they will not be told of the different features offered, and all
will receive usual searching features of MPFS.
6. Primary and secondary outcomes (see below).
;
Allocation: Randomized, Intervention Model: Factorial Assignment, Masking: Single Blind (Investigator)