Dataset Information

Emergency physicians' perceptions of critical appraisal skills: a qualitative study.

ABSTRACT:

Background

Critical appraisal of medical research is a valuable skill set that emergency physicians must learn in order to become competent clinicians. Despite the need for effective critical appraisal skills training, these skills have remained difficult to teach and assess. This study aimed to explore emergency physicians' perceptions of the barriers and motivations for learning critical appraisal skills in order to develop more successful critical appraisal training methods for Emergency Medicine (EM) residents.

Methods

This qualitative study involved in-depth, semi-structured interviews with emergency physicians interested in education and administration at an urban academic hospital. Transcribed interviews were descriptively coded by three main reviewers. A coding template was developed after coding an initial set of interviews and used to code the remaining transcripts. A thematic analysis of the codes was conducted to create a summary report which was given to the interviewees as part of a member checking process to further solidify themes.

Results

Fourteen emergency physicians participated in the study. They described time limitations, perceived difficulty, and disinterest as major barriers to learning critical appraisal. Physicians noted patient care as well as professional identity goals of being a good educator or researcher as motivations for developing critical appraisal skills.

Conclusion

There remain significant challenges to learning critical appraisal skills as well as an increasing need to build these skills during residency. Educational theories and a greater emphasis on professional identity formation during residency can be incorporated to create a more effective approach to teaching critical appraisal skills despite these barriers.

SUBMITTER: Wood S

PROVIDER: S-EPMC9013089 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Emergency physicians' perceptions of critical appraisal skills: a qualitative study.

Wood Sumintra S Paulis Jacqueline J Chen Angela A

BMC medical education 20220415 1

<h4>Background</h4>Critical appraisal of medical research is a valuable skill set that emergency physicians must learn in order to become competent clinicians. Despite the need for effective critical appraisal skills training, these skills have remained difficult to teach and assess. This study aimed to explore emergency physicians' perceptions of the barriers and motivations for learning critical appraisal skills in order to develop more successful critical appraisal training methods for Emerge ...[more]

PMID: 35428300

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Project description:BackgroundMedical research is a central part of any residency training. In view of the new Saudi orthopedic committee promotion regulation that mandates each resident to participate in a research project, the challenges that stand in the way of completion of substantial research within surgical residency must be investigated. The aim of this study was to assess the practice, attitudes, perception, and limitations associated with research among residents in the Saudi orthopedic program in the central region.MethodsA cross-sectional study was conducted between June and July 2020 using an online-based survey. The total number of study participants was 128 orthopedic residents out of the 191 residents enrolled in the central region program. Data were analyzed, and descriptive statistics in the form of frequency and percentage were determined, analytical tests were performed with P < 0.05 being statistically significant.ResultsMost residents (95 %) participated in a research project during residency. Most projects (53.10 %) were case reports followed by retrospective studies (48.40 %). The majority (79.70 %) did not attend a research methods course during residency. Experience in research differed significantly (P < 0.05) by age, residency year, and center. The mean involvement score was significantly higher among males at 3 (± 1) than among females at 2 (± 0) (P < 0.001). Only 40.60 % have access to orthopedic journals, and the same percentage (40.60 %) knew how to Critique original articles. There was a statistically significant difference in the accessibility score according to the training center. Lack of faculty support and mentorship were the main barriers to medical research at 62.50 and 39.10 %, respectively. A total of 68.80 % reported that funding was not available through their institutes.ConclusionsIn Saudi Arabia, the level of meaningful clinical research and publications by orthopedic residents is still low. The results of this study should be taken into consideration before the implementation of the new promotion criteria in the centers under the umbrella of Saudi orthopedic committee.

Project description:BackgroundThe efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it.MethodsWe used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it.ResultsOverall response rate to the questionnaire was 33% (289/869). Response rate of non-users of academic detailing was 15% (60/393), of users was 48% (229/476). The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists.ConclusionUsers of academic detailing highly value its educational value and tend to view information from other sources more critically because of its evidence-based approach. Non-users are unlikely to adopt academic detailing despite its high educational value because they find using office time for CME too much of a barrier. To reach these physicians with academic detailing messages, we will have to find other CME formats.

Project description:BackgroundAcute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients' outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients.MethodsThis investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants' answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test.ResultsWe included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: "Complexity of the topic" (52.4% agreed to find the topic complex), "Cognitive aids" (92.9% agreed to find them helpful), "Time management" (64.3% agreed to feeling time pressure), "Human factors" (95.2% agreed that human factors are essential), "Resources" (95.2% agreed that resources are essential), "Experience" and "Low frequency of cases" (57.1% agreed to lack practice), "Diagnostic methods" (31.0% agreed that the interpretation of test results is difficult), "Anticoagulation" (85.7% agreed to it being difficult), "Treatment" (81.0% agreed to knowing the first therapeutic steps), and "Nothing".ConclusionsAnesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

Project description:ObjectiveTo understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules.MethodsWe invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes.ResultsEight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources.ConclusionWe confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study.

Project description:In Sierra Leone, physicians face a high risk of burnout due to systemic challenges, with studies suggesting a gap in recognizing and addressing this condition. We explored public-sector physicians' experiences and perceptions of the organizational structures and characteristics needed to help them thrive in a resource-limited practice setting. We conducted in-depth, semi-structured interviews with 24 public sector physicians across Western Area Urban (Freetown), Bo, Kono, and Kambia districts in Sierra Leone. Thematic content analysis was carried out using both deductive and inductive techniques to generate codes and identify key themes. Physicians in Sierra Leone face multifaceted challenges that significantly impact both healthcare delivery and personal well-being. Our findings reveal that overwhelming workload and stringent schedules contribute to burnout, directly compromising patient care quality. The emotional burden of caring for patients with economic constraints in accessing treatment further exacerbates physician stress. Limited resources, such as insufficient medical supplies and personnel, foster a sense of helplessness among clinicians, leading to detachment and cynicism towards their ability to effect change. In the absence of formal institutional support, physicians often rely on peer support to manage burnout. These challenges collectively undermine physicians' ability to provide optimal care, as the emotional and physical toll affects their decision-making and engagement with patients. Within Sierra Leone's resource-constrained healthcare context, systemic reforms are necessary to address the root causes of physician burnout, and to improve patient care. Our findings suggest that implementing formal support structures, including counselling services and mentorship programs, is crucial. Improving working conditions through better resource allocation and infrastructure development is essential. Developing strategies to address the emotional burden of care, including robust training programs, could enhance physician well-being, reduce burnout, and consequently improve the overall quality of patient care in Sierra Leone's public health sector.

Dataset Information

Emergency physicians' perceptions of critical appraisal skills: a qualitative study.

Background

Methods

Results

Conclusion

Publications

Emergency physicians' perceptions of critical appraisal skills: a qualitative study.

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