Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

Abstract

Background: Evidence-based medicine (EBM) in general practice involves applying a complex combination of bestavailable evidence, the patient's preferences and the general practitioner's (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other's consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other's EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods:We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner's consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner's actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other's considerations well with those who did not, we developed a model describing the aspects that influence the observer's recognition of an actor's EBM behaviour.Results: Overall, there was moderate similarity between an actor's EBM behaviour and the observer's recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role.Conclusions: GP trainees and supervisors do not fully recognise EBM behaviour through observing each other's consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decisionmaking is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

Learning Conversations with Trainees: An Undervalued but Useful EBM Learning Opportunity for Clinical Supervisors

“…Within the broader research project to which this study belongs, 19,24 we selected 22 supervisors and their trainees for maximum variation between September 2016 and April 2017 by giving promotional talks and distributing information leaflets during formal educational sessions at the GP training institutes in Antwerp and Ghent (Belgium) and Utrecht (the Netherlands). 25 Since recruitment was more difficult in the Netherlands, convenience sampling was used there.…”

GP trainees’ perceptions on learning EBM using conversations in the workplace: a video-stimulated interview study

“…Not much is known about how learning conversations teach EBM learning. Applying EBM in daily clinical practice is often implicit and rarely a visible process, which might hamper any useful evaluation of EBM considerations [25,26]. While EBM intends to help physicians make decisions by deliberatively reviewing all the information needed, the literature on the concept of mindlines shows that explicitly weighing all available knowledge and information can not always be achieved.…”