McKibbon K A, Haynes R B, Johnston M E, Walker C J
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Proc Annu Symp Comput Appl Med Care. 1991:73-7.
To determine if a preceptor and timely, individualized feedback improves the performance of physicians in searching MEDLINE using GRATEFUL MED in clinical settings.
Randomized controlled trial.
A 300 bed primary to tertiary care teaching hospital. Computers were installed in wards and clinics of 6 major clinical services, and the emergency room, intensive care and neonatal intensive care units.
All physicians and physicians-in-training from the departments of Medicine, Family Medicine, Surgery, Psychiatry, Pediatrics, and Obstetrics and Gynecology were included if they made patient care decisions for at least 8 weeks during the study period.
All participants were given a 1-hour training class and 1 hour of individualized searching with 1 of the 2 study librarians. After training, participants were randomized to a control group who received no further intervention or to an intervention group in which each person chose a clinical preceptor experienced in MEDLINE searching and received individualized feedback by a study librarian on their first 10 searches, indicating search quality and providing suggestions for improvement. Feedback was mailed the first week day after the search was done.
Baseline characteristics by study group, department and level of training, study participation rates, and searching rates.
308 of 392 eligible physicians joined the study. Participation was almost 80% with some variation by department and level of training. Excellent balance in the baseline characteristics was achieved for the 2 groups, as well as for the number who did first searches. Intervention group participants searched MEDLINE more often than did controls (3.5 searches per month vs 2.5 per month for controls, P = 0.046). The recall and precision for first searches for both groups was significantly less than that of librarians. The analysis of study data will be completed by September 1991.
Clinicians are willing to do self-service searching of MEDLINE in clinical settings but their precision and recall are less than a trained librarian at baseline. Search skills enhancements are needed and the effect of feedback and preceptors is being tested.
U.S. National Library of Medicine and Ontario Ministry of Health.
确定带教老师以及及时、个性化的反馈能否提高临床医生使用GRATEFUL MED检索MEDLINE的表现。
随机对照试验。
一家拥有300张床位的从初级到三级护理的教学医院。在6个主要临床科室的病房和门诊、急诊室、重症监护室和新生儿重症监护室都安装了计算机。
来自内科、家庭医学科、外科、精神科、儿科以及妇产科的所有医生和实习医生，只要他们在研究期间至少8周内参与了患者护理决策即可纳入研究。
所有参与者都参加了一个1小时的培训课程，并与两名研究馆员中的一名进行了1小时的个性化检索指导。培训后，参与者被随机分为对照组（不再接受进一步干预）和干预组，干预组中的每个人选择一名有MEDLINE检索经验的临床带教老师，并由研究馆员对其前10次检索提供个性化反馈，指出检索质量并提供改进建议。反馈在检索完成后的第一个工作日寄出。
按研究组、科室和培训水平划分的基线特征、研究参与率和检索率。
392名符合条件的医生中有308名参与了研究。参与率近80%，不同科室和培训水平略有差异。两组在基线特征以及首次检索人数方面实现了良好的平衡。干预组参与者检索MEDLINE的频率高于对照组（每月3.5次检索，对照组为每月2.5次检索，P = 0.046）。两组首次检索的召回率和精确率均显著低于馆员。研究数据的分析将于1991年9月完成。
临床医生愿意在临床环境中自行检索MEDLINE，但他们的精确率和召回率在基线时低于训练有素的馆员。需要提高检索技能，目前正在测试反馈和带教老师的效果。
美国国立医学图书馆和安大略省卫生部。
