This is an interesting article JAMA Intern Med.<http://www.ncbi.nlm.nih.gov/pubmed?term=Barriers+and+Decisions+When+Answering+Clinical+Questions&TransSchema=title&cmd=detailssearch> 2013 Nov 25;173(21):1962-9. doi: 10.1001/jamainternmed.2013.10103. Barriers and decisions when answering clinical questions at the point of care: a grounded theory study. Cook DA<http://www.ncbi.nlm.nih.gov/pubmed?term=Cook%20DA%5BAuthor%5D&cauthor=true&cauthor_uid=23979118>, Sorensen KJ<http://www.ncbi.nlm.nih.gov/pubmed?term=Sorensen%20KJ%5BAuthor%5D&cauthor=true&cauthor_uid=23979118>, Wilkinson JM<http://www.ncbi.nlm.nih.gov/pubmed?term=Wilkinson%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=23979118>, Berger RA<http://www.ncbi.nlm.nih.gov/pubmed?term=Berger%20RA%5BAuthor%5D&cauthor=true&cauthor_uid=23979118>. Source 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. Abstract IMPORTANCE Answering clinical questions affects patient-care decisions and is important to continuous professional development. The process of point-of-care learning is incompletely understood. OBJECTIVE To understand what barriers and enabling factors influence physician point-of-care learning and what decisions physicians face during this process. DESIGN 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. SETTING Academic medical center and outlying community sites. PARTICIPANTS Purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians, interviewed in 11 focus groups. RESULTS 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. CONCLUSIONS AND RELEVANCE 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. PMID: 23979118 [PubMed - in process] Patricia Reynolds Director, Bishopric Medical Library Sarasota Memorial Hospital 1700 S. Tamiami Trail Sarasota FL 34239 941-917-1730 941-917-1646 - fax [log in to unmask]<mailto:[log in to unmask]> http://www.smhcs.org/p.aspx?p=431 ************************************************************************* Confidentiality Notice: the information contained in this email and any attachments may be legally privileged and confidential. If you are not an intended recipient, you are hereby notified that any dissemination, distribution, or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please notify the sender and permanently delete the e-mail and any attachments immediately. You should not retain, copy or use this e-mail or any attachments for any purpose, nor disclose all or any part of the contents to any other person.