Off The Shelf: Still waiting for a breakthrough with physicians

Davies K. The information-seeking behaviour of doctors: a review of the evidence. Health Info Libr J 2007 Jun;24(2):78-94

The Author's Abstract: This paper provides a narrative review of the available literature from the past 10 years (1996-2006) that focus [sic] on the information seeking behaviour of doctors. The review considers the literature in three sub-themes:

• Theme 1: the Information Needs of Doctors includes information need, frequency of doctors' questions and types of information needs;
• Theme 2: Information Seeking by Doctors embraces pattern of information resource use, time spent searching, barriers to information searching and information searching skills;
• Theme 3: Information Sources Utilized by Doctors comprises the number of sources utilized, comparison of information sources consulted, computer usage, ranking of information resources, printed resource use, personal digital assistant (PDA) use, electronic database use and the Internet.

The review is wide ranging. It would seem that the traditional methods of face-to-face communication and use of hard-copy evidence still prevail amongst qualified medical staff in the clinical setting. The use of new technologies embracing the new digital age in information provision may influence this in the future. However, for now, it would seem that there is still research to be undertaken to uncover the most effective methods of encouraging clinicians to use the best evidence in everyday practice.

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No real surprises in this welcome review of recent literature. I have seen this problem in my own practice: doctors have information needs and they have a wealth of resources to find the answers to their questions. But they do not have the time or the skills to get the best results from the tools at hand. Librarians have the time and training but have trouble communicating to clinicians the benefits of information literacy.

As I remarked in my post of July 14, even increasing computer use by physicians and their improved knowledge of health resources does not necessarily lead to a good search when it comes to the crunch. I would argue that we are still a long way from the AI killer app that will answer more complex clinical questions quickly and accurately. And we all know how hard it is to come up with innovative, truly effective instructional techniques, while every study of this kind enjoins us to do so, and to do more research to find out how to do it better.

Although roughly 60% of physicians' questions are simple, according to Davies' evaluation of the literature, that leaves a considerable number of complex queries being brought to Google or PubMed with a few key words typed into the search box. Not an encouraging prospect. Specialized EBM resources, such as the Cochrane Library and UpToDate, helpful as they are, have not done all that well in filling the gap. In a study in which librarians searched these resources for answers to complex questions, no answers were found 40% of the time. How would less skilled searchers have fared?

Among physicians, who are the only objects of this study, time has long been recognized as the key barrier to information searching, and Davies finds it worrying that clinicians are only able to complete "quick and dirty" searches because of time constraints, some spending as little as two minutes on average pursuing an answer. This obviously affects the efficiency of their searching. One study found that 82% of doctors' searches were merely fair (52%) or poor (30%).

Davies' bleak conclusion is that "doctors are not yet embracing the use of computerized resources." They still rely on text sources and the advice of colleagues. When they do search online, they encounter difficulties. Ineffective search strategies do not produce results. If information is not located, it is often assumed not to exist. This can lead to mistaken opinions concerning the contents and coverage of a database. Combine that with the traditional barriers we medical librarians face in making our skills known, and you end up with health professionals who harbour a false perception of their information literacy skill levels.

Time to renew my efforts to get the message out there.

PubMed searching. How do we improve it?

An article in Medical Education (May 2007) reports another study demonstrating yet again that medical students (like many of us) have problems using PubMed effectively.

After being given "pre-assigned readings introducing the logic and technique of searching the MEDLINE database," teams of year 1 and 2 medical students at the University of Louisville completed searches and emailed their search strategies for analysis by librarians. At the conclusion of these sessions, the teams completed a short-answer quiz. It wasn't clear whether PubMed or another incarnation of MEDLINE was used.

Interestingly, the students did well in the quiz, but that abstract knowledge didn't translate into a good search strategy. For example, 22 of the 24 teams received full credit on a question asking them to describe a MeSH term and how it helps to refine a search. However, at the same time the librarians found that "students used poor search techniques, did not understand Boolean logic, and overwhelmingly chose online article availability over article content, even if it resulted in not finding an article and failing the assignment."

To the authors of the study this indicates that although students may grasp the concept of MeSH terms, they do not understand searching logic and technique, that online convenience outweighs article quality, and that more thorough, formalized information literacy training is required.

Since the authors do not describe the "pre-assigned readings" given to the students, it is difficult properly to assess the study results. Perhaps the readings on Boolean logic were dry and did not keep the students' attention. The principal author of the study is not a librarian. I'm speculating here, but the selection of materials may have been made without the kind of assiduousness and professional discretion a librarian would have brought to the task.

It is obvious that good literacy training is required to help PubMed users develop effective search techniques. This study at least adds to the evidence that people need effective instruction which goes beyond passing them a handout.

Wood JA, Smigielski EM, Haynes G. Case-based approach for improving student MEDLINE searches. Med.Educ. 2007 May;41(5):510-511