Do we practice what we preach? A qualitative assessment of resident-preceptor interactions for adherence to evidence-based practice

Background: Evidence-based medicine (EBM) is important in training doctors for high-quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM. Methods: The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence-based process; and (3) resident ability to articulate a clinical question. Results: Sixty-seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence-based process. Resident ability to articulate a clinical question when prompted was rated as at least 'fair' in 59 of 67 interactions (88%). Conclusions: EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real-time ambulatory training context.