A Qualitative Assessment of 1st-Year Internal Medicine Residents' Perceptions of Evidence-Based Clinical Decision Making

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Abstract

Background: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. Purpose: To understand how residents perceive and use evidence-based medicine in clinical decision making. Methods: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. Results: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. Conclusion: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.

Original languageEnglish (US)
Pages (from-to)114-118
Number of pages5
JournalTeaching and Learning in Medicine
Volume14
Issue number2
StatePublished - Mar 2002

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Evidence-Based Medicine
Internal Medicine
medicine
resident
decision making
Decision Making
evidence
expertise
Focus Groups
expert
Physicians
Education
Clinical Decision-Making
Research
qualitative method
training program
Group
physician
questionnaire

ASJC Scopus subject areas

  • Nursing(all)
  • Education

Cite this

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title = "A Qualitative Assessment of 1st-Year Internal Medicine Residents' Perceptions of Evidence-Based Clinical Decision Making",
abstract = "Background: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. Purpose: To understand how residents perceive and use evidence-based medicine in clinical decision making. Methods: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. Results: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This {"}self-acquired{"} expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This {"}borrowed{"} expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. Conclusion: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.",
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AB - Background: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. Purpose: To understand how residents perceive and use evidence-based medicine in clinical decision making. Methods: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. Results: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. Conclusion: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.

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