Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584, CX, Utrecht, The Netherlands.
Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, B-9000, Ghent, Belgium.
BMC Med Educ. 2020 May 6;20(1):139. doi: 10.1186/s12909-020-02051-2.
To be able to practice evidence-based medicine (EBM) when making decisions for individual patients, it is important to learn how to combine the best available evidence with the patient's preferences and the physician's clinical expertise. In general practice training, these skills can be learned at the workplace using learning conversations: meetings between the supervising general practitioner (GP) and GP trainee to discuss medical practice, selected topics or professional performance. This study aimed to give insight into the perceptions of GP trainees on their EBM learning processes during learning conversations.
We held semi-structured video-stimulated elicitation interviews (n = 22) with GP trainees affiliated to GP training institutes in the Netherlands and Belgium. GP trainees were shown fragments of their learning conversations, enabling reflection during the interview. Taking an inductive approach, interview recordings were transcribed verbatim and analysed with NVivo software.
GP trainees perceived learning conversations as useful for learning and discussing EBM. Multiple EBM learning activities were identified, such as discussing evidence together, relating evidence to cases in daily practice and discussing the supervisor's experience and the specific local context in the light of what the evidence recommends. However, for learning to occur, trainees need and expect specific behaviour, both from their supervisors and themselves. Supervisors should supply well-substantiated answers that are applicable in practice and give the trainee confirmation. In turn, the trainee needs to prepare well in order to ask focused, in-depth questions. A safe space allowing equal and open discussion between trainee and supervisor is perceived as an essential context for optimal EBM learning.
Our findings show that trainees find learning conversations useful for EBM learning in general practice. To bring EBM learning to its full potential, attention should be paid to optimising the behavioural and contextual factors found relevant to enhancing EBM learning.
为了能够在为个体患者做出决策时实践循证医学（EBM），重要的是要学会如何将最佳可用证据与患者的偏好和医生的临床专业知识相结合。在一般实践培训中，可以通过学习对话在工作场所中学习这些技能：监督全科医生（GP）和 GP 受训者之间的会议，以讨论医疗实践、选定的主题或专业表现。本研究旨在深入了解 GP 受训者对其在学习对话期间 EBM 学习过程的看法。
我们与荷兰和比利时的 GP 培训学院的 GP 受训者进行了半结构化的视频刺激启发式访谈（n=22）。向 GP 受训者展示了他们学习对话的片段，以便在访谈期间进行反思。我们采用归纳法，逐字转录访谈录音，并使用 NVivo 软件进行分析。
GP 受训者认为学习对话对于学习和讨论 EBM 很有用。确定了多种 EBM 学习活动，例如共同讨论证据、将证据与日常实践中的病例联系起来以及根据证据建议讨论主管的经验和特定的当地情况。然而，为了学习，受训者需要并期望他们的主管和自己表现出特定的行为。主管应提供有充分依据的、适用于实践的答案，并给予受训者确认。反过来，受训者需要做好充分准备，以便提出重点、深入的问题。一个允许受训者和主管之间平等和开放讨论的安全空间被认为是优化 EBM 学习的必要环境。
我们的研究结果表明，受训者认为学习对话对一般实践中的 EBM 学习很有用。为了充分发挥 EBM 学习的潜力，应注意优化与增强 EBM 学习相关的行为和环境因素。
