Keeping up with the literature: A current practice survey and qualitative needs assessment among emergency physicians.

Purpose: Physicians face the challenge of staying current with a rapidly growing body of evidence and applying it to their practice. How emergency physicians (EPs) do so is unknown. The authors sought to describe and assess needs around EP patterns of evidence-based medicine (EBM) and continuing medical education (CME) resource use. Methods: The authors conducted a multicenter, cross-sectional study in 2019 across 12 tertiary care, community, and suburban emergency department (ED) sites in the greater area of Edmonton. Information on EBM/CME resource use along with barriers and facilitators to staying current was gathered using a rigorously developed survey tool, distributed electronically and by mail. Responses were tabulated and subgroups analyzed using MANOVA and ANOVA tests. Thematic analysis of comments used a phenomenological lens. Results: A total of 118 EPs (40.1%) completed the survey. Listening to podcasts, attending EM conferences, and subscription-based resources were preferred for staying current. Resource use differed by years in practice but not by age, sex, training background, or site type. EBM had an important impact on respondents' practice (average rating 3.8 out of 5, with 5 indicating "practice changing"). Time was an important barrier. Most (62.7%) felt that they did not spend enough time, despite spending a median of 4 to 5 h monthly on EBM. Facilitators (including journal club summaries or lists of practice-relevant papers) had only moderate impacts. Thematic analysis found three themes (importance of EBM, implementation challenges, and dissemination of EBM) and 13 subthemes. Conclusion: EPs preferentially chose podcasts, conferences, and subscription-based resources to stay current with EBM; time was the biggest barrier. These findings help ED leads and educators tailor CME to physician learning preferences to maximize application of EBM to clinical practice. The next steps include developing/curating resources and disseminating the survey on a larger scale to identify opportunities for shared virtual resources.

Evidence-based Medicine Simulation: A Novel and Practice-relevant Approach to Teaching Real-time Literature Searching to Emergency Medicine Residents.

INTRODUCTION: Evidence-based medicine (EBM) and literature searching skills are competencies within the emergency medicine (EM) residency curriculum. Previously in our residency program, a librarian taught literature searching instruction, including a classroom-based overview of search engines. Learners reported low engagement and poor retention. To improve engagement, interest, and skill retention, we used a novel approach: simulation to teach real-time literature searching. METHODS: Based on a needs assessment of our EM residents, we created a literature searching workshop using a flipped classroom approach and high-fidelity simulation. Goals of the session were to be interactive, engaging, and practice-relevant. With a librarian, we developed a brief list of EM-relevant databases, including tips for searching and links to sites/apps. Prereadings also covered the hierarchy of evidence and formulating a good clinical (PICO) question. Residents (12 junior residents) participated in a high-fidelity simulation involving a stable patient whose management required a literature search to inform decisions. Feedback was collected on the simulation experience. RESULTS: Residents received the list of EM-relevant databases 7 days prior and were instructed to set up and test the resources on their smartphones. The day of the session, one resident volunteered to lead the simulation; all residents participated in the search on their smart phones. Collectively, it took 4.5 minutes to find a study that adequately addressed the clinical question and to manage the patient accordingly. Feedback on the simulation was positive. Students found it "very real and practical" and "immediately institutable into practice." It helped residents learn to efficiently and effectively search the literature while managing a stable patient. CONCLUSION: A flipped-classroom simulation-based teaching strategy made learning literature searching more interesting, engaging, and applicable to EM practice. Based on popular demand, we will continue to use this teaching method.