RESUMO
OBJECTIVE: This article presents the results of complementary research studies on the behaviors of hospital clinicians in asking clinical questions and the relationship between asking of questions, outcome of information searches, and success in problem solving. METHODS: Triangulation in research methods--a combination of mailed questionnaires, interviews, and a randomized controlled study--was employed to provide complementary views of the research problems under study. RESULTS: The survey and interviews found that clinical problems (concerned mainly with therapy and equipment or technology) were expressed as statements rather than questions (average number of concepts = 1.7), that only slightly more than half (higher for doctors) of problems could be solved, and that the majority of clinical questions were not well formed. An educational workshop however improved clinicians' formulation of questions, but the use of structured prompting was found to improve building of hypotheses in the doctors' group without training. The workshop also improved satisfaction with the obtained information and success in problem solving. Nonetheless, for both the experimental and control groups, more structured and complete questions or statements did not mean higher success rates in problem solving or higher satisfaction with obtained information. CONCLUSION: The triangulation methods have gathered complementary evidence to reject the hypothesis that building well-structured clinical questions would mean higher satisfaction with obtained information and higher success in problem solving.
Assuntos
Atitude do Pessoal de Saúde , Competência Clínica/normas , Educação Médica Continuada/métodos , Armazenamento e Recuperação da Informação/normas , Corpo Clínico Hospitalar/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa/normas , Inquéritos e Questionários , Estados UnidosRESUMO
A double-blind randomised controlled trial was conducted on a group of Hong Kong hospital clinicians. The objective was to test if a three-hour educational workshop (with supervised hands-on practice) is more effective (than no training) to improve clinical question formulation, information-seeking skills, knowledge, attitudes, and search outcomes. The design was a post-test-only control group; recruitment by stratified randomization (by profession), blocked at 800. End-user training was more effective than no training in improving clinical question formulation, in raising awareness, knowledge, confidence and use of databases, but had made no impact on preference for secondary databases. It changed the attitude of clinicians to become more positive towards the use of electronic information services (EIS). Participants had higher search performance and outcomes (satisfaction with information obtained (NNT = 3), EIS satisfaction (NNT = 3) and success in problem solving (NNT = 4)). The workshop improved knowledge and skills in evidence-based searching, but this effect gradually eroded with time. Search logs confirmed that follow-up is required if effects are to be sustained. Longer effects on search behaviours appear to be positive. A randomised controlled trial is valuable in identifying cause-and-effect relations and to quantify the magnitude of the effects for management decision-making.