Osheroff J A, Forsythe D E, Buchanan B G, Bankowitz R A, Blumenfeld B H, Miller R A
University of Pittsburgh, Pennsylvania.
Ann Intern Med. 1991 Apr 1;114(7):576-81. doi: 10.7326/0003-4819-114-7-576.
To describe information requests expressed during clinical teaching.
Residents' work rounds, attending rounds, morning report, and interns' clinic in a university-based general medicine service.
Attending physicians, medical house staff, and medical students in a general medicine training program.
An anthropologist observed communication among study subjects and recorded in field notes expressions of a need for information. We developed a coding scheme for describing information requests and applied the coding scheme to the data recorded. Based on assigned codes, we created a subset of strictly clinical requests.
Five hundred nineteen information requests recorded during 17 hours of observed clinical activity were selected for detailed analysis. These requests related to the care of approximately 90 patients by 24 physicians and medical students. Sixty-five requests were excluded because they were not strictly clinical, leaving a subset of 454 clinical questions for analysis.
On average, five clinical questions were raised for each patient discussed. Three hundred thirty-seven requests (74%) concerned patient care. Of these 337 questions, 175 (52%) requested a fact that could have been found in a medical record. Seventy-seven (23%) of these questions, motivated by the needs of patient care, were potentially answerable by a library, a textbook, a journal, or MEDLINE. Eighty-eight (26%) of the questions asked for patient care required synthesis of patient information and medical knowledge.
Clinicians in the study settings requested information frequently. Many of these information needs required the synthesis of patient information and medical knowledge and thus were potentially difficult to satisfy. A typology is proposed that characterizes information needs as consciously recognized, unrecognized, and currently satisfied.
描述临床教学期间所表达的信息需求。
在一所大学附属医院的普通内科服务中进行的住院医师查房、主治医师查房、早交班以及实习生门诊。
普通内科培训项目中的主治医师、住院医师和医学生。
一名人类学家观察研究对象之间的交流，并在现场笔记中记录信息需求的表达。我们制定了一种用于描述信息需求的编码方案，并将该编码方案应用于所记录的数据。基于所分配的编码，我们创建了一个严格意义上的临床需求子集。
在17小时的观察临床活动中记录的519条信息需求被选作详细分析。这些需求涉及24位医师和医学生对约90名患者的护理。65条需求因并非严格意义上的临床需求而被排除，剩下454条临床问题的子集用于分析。
平均而言，每位被讨论的患者会提出5个临床问题。337条需求（74%）与患者护理有关。在这337个问题中，175个（52%）询问的是本可在病历中找到的事实。其中77个（23%）问题，出于患者护理的需求，有可能通过图书馆、教科书、期刊或医学文献数据库（MEDLINE）得到解答。88个（26%）关于患者护理的问题需要综合患者信息和医学知识。
研究环境中的临床医生频繁地请求提供信息。这些信息需求中有许多需要综合患者信息和医学知识，因此可能难以满足。本文提出了一种类型学，将信息需求分为有意识认识到的、未被认识到的和当前已得到满足的。
