Aspects of medical knowledge sources among junior doctors and general practitioners : needs, use, values and effects

Sammanfattning: INTRODUCTION Physicians are facing increasing demands to keep up with the accelerated expansion of medical knowledge. There is a rapid development and adoption of information technology in today’s health care, often driven by technology rather than fulfilling the needs of users. As the demand for health care grows, physicians are confronted with an increasing amount of uncertainty, increased complexity and risk of cognitive bias and overload. Seeking medical knowledge in order to gain optimal support for decisions will become an even more critical skill for managing patients with multiple comorbidities in a complex healthcare setting. Two groups of physicians are particularly vulnerable to information overload and obstacles to discerning what is medically relevant. One of these groups is junior doctors in the transitional phase between medical school and clinical healthcare practice who often lack the necessary clinical experience and support from senior colleagues. The other group is general practitioners (GPs) who care for patients with multiple comorbidities. Both groups of physicians need tailored access to medical knowledge sources that fulfill their unique knowledge needs. However, few studies have examined these needs, and several existing studies have used self-reported, biased methodologies that do not focus on quality of health care and patient outcomes. AIM To explore the needs, use, values and effects of medical knowledge sources during the clinical practice of junior doctors and general practitioners. METHODS To gather, analyze and draw conclusions about the needs, use, values and effects of medical knowledge sources in clinical practice, we used qualitative research methods such as individual and focus group interviews, data collected via questionnaires, quantitative research methods analyzing data retrospectively, and a systematic literature review. RESULTS The findings in Study I showed that junior doctors valued access to mobile knowledge sources on handheld computers, but they also expressed concerns, such as depending on a device. The knowledge sources gave them confidence and reduced their anxiety. The study also found that junior doctors had a need to personalize content and tailor a handheld computer into an adaptable tool for information. In Study II, we found that junior doctors used personal interaction with colleagues as the most frequent source of knowledge, closely followed by internet-based guidelines. Overall, access to knowledge sources was the most valued feature. The study also showed that junior doctors’ learning styles were consistent with the findings of previous research. Study III demonstrated that higher frequency of use of a medical knowledge source at PHC centers was associated with higher ratings of patients’ experience of health care. Taken together, the findings indicated that patients’ experiences of health care were associated with the use of a medical knowledge source. In the final study IV, we concluded that most studies focused on information needs or information-seeking. Few studies examined the use of information search results by general practitioners and how these results were used in daily clinical practice. CONCLUSIONS When making patient care decisions, junior doctors and general practitioners require just-intime access to tailored medical knowledge sources. The use of knowledge sources would appear to relate to patient satisfaction of care. There is a need to better understand the use and clinical impact of knowledge sources in PHC.