This edition of HILJ Club has been prepared by Luca Filippi, Assistant Librarian, Surrey and Sussex Healthcare NHS Trust. @LibrarianLuca
The paper for discussion is Bin Naeem, Salman and Bhatti, Rubina (2020) Measures of self-efficacy among doctors in conducting an online search for clinical decision making, Health Information and Libraries Journal, 37(2), pp. 128-142. https://doi.org/10.1111/hir.12289
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Background
In order to practice Evidence Based Medicine (EBM), clinicians are required to be able to access medical information, evaluate the information, and successfully incorporate the information into patient care decisions (Greenhalgh, 2014). However, in an attempt to find the latest medical information, clinicians are increasingly finding themselves faced with an overwhelming quantity of information that often results in them abandoning their search.
This study quotes research from Bandura (1997) that states that self-efficacy is the single most important factor to influence behavioural change, and in order for clinicians to remain persistent with searching it is necessary to increase the self-efficacy of clinicians when it comes to searching for medical information online.
Objectives
The objective of this paper was to measure the perceived ability and perceived level of confidence of doctors in performing the different tasks involved in conducting an online search for the purpose of clinical decision making.
Methods
This study was comprised of a large-scale cross-sectional survey that was distributed to: 36 District Headquarter Hospitals (DHQs), 89 Tehsil Headquarter Hospitals (THQs), 293 Rural Health Centres (RHCs), and 2,455 Basic Health Units (BHUs) in Punjab, Pakistan. Overall, the researchers collected data from 517 participants. This collected data was then analysed statistically using SPSS.
Results
Of the 517 doctors that participated, 14% had never previously accessed healthcare information online for clinical decision making. Moreover, the majority of doctors surveyed had never used any medical databases for clinical decision making.
While the results indicated that most of the doctors were not confident in their ability to perform the tasks associated with an online search, the majority of doctors perceived they were able to perform the different tasks involved in conducting an online search to some extent.
Conclusion
A majority of the doctors perceived they were able to perform the different tasks associated in conducting a search online; however a majority of those surveyed felt they were not confident in completing these tasks. Age and clinical experience were crucial factors associated with the confidence levels of those surveyed. Moreover, doctors from larger hospitals (DHQs and THQs) rated themselves as having higher levels of confidence in completing each task involved in the search process.
The authors argue that there is a need for promotional and educational activities to motivate interest, increase awareness, and develop knowledge and skills so that doctors can access reliable information online in order to aid their clinical decision making.
Questions for Discussion
As Evidence-Based Medicine (EBM) continues to solidify itself and medical professionals are further encouraged to use online information resources to shape their clinical practice, it is important that medical librarians understand how clinicians feel about using online resources.
Understanding the perceived ability of doctors to perform the steps involved in conducting a literature search is critical information to the healthcare librarian. This allows us to identify knowledge gaps and therefore shape our practice accordingly.
What?
The survey was distributed through several different channels in order to capture as many responses as possible. Sending a link through WhatsApp allowed doctors in rural parts of Punjab to access the survey, and distributing the survey via mail would have allowed those with low information literacy skills to participate too.
It would have been helpful to know more about how the authors analysed the collected data as this is only discussed very briefly in the methodology section. Moreover, it is difficult to assess to what extent the results of this study can be applied internationally. Nevertheless, the authors do well to explain to readers outside of Pakistan how healthcare is structured, and it is easy to understand the differences between the different types of health settings that this study was conducted in.
So what?
This was a particularly interesting article as it helped us to understand the perceived ability of doctors to perform the steps involved in conducting a literature search. For instance, studies quoted in this research have shown that 88% of searches conducted by clinicians lack advanced searching features such as Boolean operators. This knowledge allows healthcare librarians to target our searching training to such matters. In order to provide an effective service for library users, medical librarians must be aware of the knowledge gaps that exist amongst their users.
Now what?
This study raised two implications for practice. Firstly, as has been mentioned, that is to promote the use of medical databases. The authors also ask how health science librarians can improve the ability and level of confidence of doctors in searching for medical information online. Asides from ensuring that staff at more hospitals have access to a healthcare librarian, the study recommends that librarians facilitate doctors becoming “database champions” as this will aid in influencing the attitudes of doctors towards online databases. The authors argue that the involvement of leaders and peers is critical towards growing the use of the medical databases. However, the study does not make suggestions on how to encourage clinicians to become a database champion.
The study recommended a series of promotional and educational activities to ‘motivate interest, increase awareness, and develop knowledge and skills towards effective knowledge access.’ The question that the healthcare librarian must ask is what these sessions should look like. Many healthcare librarians would agree with the authors when they argue that there is a requirement for the healthcare librarian to communicate the benefits of attending such promotional and educational activities. The authors argue that information literacy events should carry credits towards allowing medical professionals to renew their practice license. However, these are decisions that are not within the healthcare librarian’s domain.
Consider the following questions for discussion:
- To what extent do we think the context of this study can be applied to doctors in the UK?
- What is the likely cause for the lack of confidence amongst doctors, and how can health librarians help doctors increase their confidence?
- The authors argue promotional and educational activity should be used to ‘motivate interest, increase awareness, and develop knowledge and skills towards effective knowledge access.’ How should this look like?
- The authors also argue for an ‘information literacy program to influence the behavioural outcomes of doctors performing different tasks involved in conducting an online search.’ What does this look like?
- How can medical librarians get people interested in information literacy programmes and encourage doctors to attend?
Please join in the discussion and let us know what you think of the article. If the article has affected the way you practice, do let us know below!
References
Bandura, A. (1997). Self-efficacy: The exercise of control (pp.158–166). New York, NY: W.H. Freeman and Co.
Greenhalgh, T. (2014) How to Read a Paper: The Basics of Evidence-Based Medicine (5th edn, pp. 5-26). Oxford: John Wiley & Sons.
HILJ Club 
Thank you for this – I love the idea of Database Champions! Librarians supporting doctors to become DCs could have benefits for both parties, and adopting this approach could really help promote native interface searching in the NHS context.
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Thank you for this blog. It was a very interesting article. It highlights some similar issues to those we see with doctors here in the UK. I think one of the biggest barriers for attending training is the issue of a lack of time and therefore attending this sort of training gets pushed to the back of the list. We are fortunate in the UK that most doctors realise that there are libraries within hospitals who will undertake literature searches for them and they receive training at university in how to conduct a search. However, a lot of them must still reach for Google (or other similar search engines) to answer questions quickly.
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Could anyone find a copy of the questionnaire? The link given in the article is to a live version, which requires the reader to answer the questions and, as the questionnaire is broken down into sections, one cannot proceed to the next section without completing the admirably detailed demographic section. This seems to me a flaw, particularly because the authors category of ‘medical databases’ could comprise a variety of different resources, each of which could require different skills to use, and without knowing the questions asked, it is hard to assess the quality of the results.
There is a bigger question: the death of the mediated search has been predicted for decades, yet it’s a long time dying. Is it a good use of a physician, surgeon, or nurse’s time to learn to interrogate bibliographic databases? Or would they do better to co-operate with librarians and information scientists?
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