Office of Education Research, Mayo Medical School, Rochester, Minnesota2Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota3Knowledge Delivery Center, Mayo Clinic, Rochester, Minnesota.
JAMA Intern Med. 2013 Nov 25;173(21):1962-9. doi: 10.1001/jamainternmed.2013.10103.
Answering clinical questions affects patient-care decisions and is important to continuous professional development. The process of point-of-care learning is incompletely understood.
To understand what barriers and enabling factors influence physician point-of-care learning and what decisions physicians face during this process.
Focus groups with grounded theory analysis. Focus group discussions were transcribed and then analyzed using a constant comparative approach to identify barriers, enabling factors, and key decisions related to physician information-seeking activities.
Academic medical center and outlying community sites.
Purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians, interviewed in 11 focus groups.
Insufficient time was the main barrier to point-of-care learning. Other barriers included the patient comorbidities and contexts, the volume of available information, not knowing which resource to search, doubt that the search would yield an answer, difficulty remembering questions for later study, and inconvenient access to computers. Key decisions were whether to search (reasons to search included infrequently seen conditions, practice updates, complex questions, and patient education), when to search (before, during, or after the clinical encounter), where to search (with the patient present or in a separate room), what type of resource to use (colleague or computer), what specific resource to use (influenced first by efficiency and second by credibility), and when to stop. Participants noted that key features of efficiency (completeness, brevity, and searchability) are often in conflict.
Physicians perceive that insufficient time is the greatest barrier to point-of-care learning, and efficiency is the most important determinant in selecting an information source. Designing knowledge resources and systems to target key decisions may improve learning and patient care.
回答临床问题会影响患者的护理决策，对持续的专业发展也很重要。然而，人们对即时学习的过程还不完全了解。
了解影响医生即时学习的障碍和促进因素，以及医生在这一过程中面临的决策。
使用扎根理论分析的焦点小组。对焦点小组讨论进行转录，然后使用恒定性比较方法进行分析，以确定与医生信息搜索活动相关的障碍、促进因素和关键决策。
学术医疗中心和偏远社区场所。
50 名初级保健和专科内科及家庭医学医生，通过目的性抽样，在 11 个焦点小组中进行了访谈。
时间不足是即时学习的主要障碍。其他障碍包括患者的合并症和背景、可用信息量、不知道该搜索哪个资源、怀疑搜索是否会得出答案、难以记住问题以便日后研究、以及访问计算机不方便。关键决策包括是否搜索（搜索的原因包括罕见情况、实践更新、复杂问题和患者教育）、何时搜索（在临床就诊前、期间或之后）、在哪里搜索（在患者在场或在单独的房间）、使用哪种类型的资源（同事或计算机）、使用哪种特定资源（首先受效率影响，其次受可信度影响）以及何时停止搜索。参与者指出，效率的关键特征（完整性、简洁性和可搜索性）往往存在冲突。
医生认为时间不足是即时学习的最大障碍，而效率是选择信息来源的最重要决定因素。针对关键决策设计知识资源和系统可能会提高学习效果和患者护理质量。
