REVIEW
Knowledge management in clinical practice: a systematic review of information seeking behavior in physicians

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Abstract

Objectives: To determine information seeking behavior of physicians. Data sources: Systematic review of 19 studies that described information seeking behavior in a number of different settings using differing methodologies. Analysis was limited to quantitative studies describing sources of information sought by physicians. Results: Investigators have used questionnaires, interviews and observation to identify the information seeking behavior of clinicians. The results were mainly obtained from trials in the United States and showed a wide variation in primary information sources used by physicians. The most frequent source for information used are text sources, second is asking colleagues and only one study found electronic databases to be the primary resource. Physician's desk reference is the commonest cited printed resource. Convenience of access, habit, reliability, high quality, speed of use, and applicability makes information seeking likely to be successful and to occur. The lack of time to search, the huge amount of material, forgetfulness, the belief that there is likely to be no answer, and the lack of urgency all hinder the process of answering questions. Conclusions: The wide variation in information seeking behavior implies a need for further categorization of information need and information sources. Careful planning of information delivery to physicians is required to enable them to keep up to date and to improve knowledge transfer.

Introduction

The advent of clinical governance demands the incorporation of research-based evidence into clinical practice [1]. Implicit in this demand is the need for access to both medical information and knowledge. Knowledge-need and information-retrieval are distinct entities of the spectrum of information flow through which knowledge transfer occurs [2].

A dilemma has arisen from the explosion in volume of published medical research. Physicians have to effectively deal with the resultant snowstorm of information in order to make informed evidence-based decisions [3]. The encouragement of physicians to adopt the principles and practice of evidence-based medicine should not take place in isolation from the problems associated with knowledge transfer and information retrieval.

Advances in information technology have brought into existence electronic information resources such as MEDLINE, EMBASE, and the Cochrane Library of databases. It was expected that these electronic resources would help tackle the problems of information overflow in clinical practice [4]. However, concerns still exist regarding the gaps in knowledge base of the physician, with lack of timely access to information [5].

Regardless of the etiology, such gaps in knowledge impede the proper practice of evidence-based medicine. The doctrine of evidence-based medicine raises fundamental questions regarding how often physicians generate questions in clinical practice, what the categories of frequently asked questions are [6], what resources are available to them and what resources they frequently patronize in seeking answers to clinical questions.

In the past two decades, a number of studies have addressed directly or indirectly, the information needs of physicians. One review in particular in 1996 described the state of clinical information need [7]. This systematic review updates that review and evaluates the information-seeking habits of physicians determining the nature of their information resource preferences.

Section snippets

Selection criteria

We selected trials or reviews that identified information seeking behavior, frequently asked questions, information needs, clinical questions, information sources, or knowledge resources. Trials had physicians as their primary or sole subjects. Studies had to explicitly or implicitly define information need as medical information need rather than the need for non-medical information or patient data. We excluded studies that did not report quantitative observational or survey data in the form of

Results

The initial search returned over 7000 papers. The second search returned 1947 papers. Nineteen studies met the eligibility criteria (Table 1). The methods used to collect information seeking behavior were questionnaire in nine (47%) studies and interview in eight (42%). Some studies employed a combination of both methods of data collection. The remainder were record reviews or observational in nature. The majority of studies involved primary care physicians; one study involved surgeons and one

Discussion

The weakness of this systematic review lies partly in the drawbacks of the individual studies and partly in the inherent differences of the studies.

Data collection methodology can be fraught with weaknesses that distort study results; for example, there is the concern of potential bias when mail survey method is adopted. Covell et al. [14] compared questionnaire responses with observations made during office-based interviews. The results of this study demonstrated that the study participants

Acknowledgements

Professor Paul Glasziou, Professor in Clinical Epidemiology, Department of Social and Preventive Medicine, Mayne Medical School, The University of Queensland, Qld., Australia. Dr Scott Richardson, Associate Professor of Medicine, Chief, Division of General Internal Medicine, Wright State University School of Medicine, Dayton, OH, USA.

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