JMIR Publications

ABSTRACT

Background:

Staying up-to-date and answering clinical questions with current best evidence from health research is challenging. Evidence-based clinical texts, databases and tools can help, but clinicians first need to translate their clinical questions into searchable queries. McMaster Premium LiteratUre Service Federated Search (MacPLUS FS) is an online search engine that allows clinicians to explore multiple resources simultaneously, and retrieves on the same output: (1) evidence from summaries (e.g., UpToDate, DynaMed), (2) preappraised research (e.g., EvidenceAlerts), and (3) non-preappraised research (PubMed), with and without validated bibliographic search filters. MacPLUS FS can also be used as a laboratory to explore clinical questions and evidence retrieval.

Objective:

Our primary objective was to examine how clinicians formulate their queries, on a federated search, according to the PICO framework (Population – Intervention – Comparison – Outcome). Our secondary objective was to assess which resources were accessed by clinicians to answer their questions.

Methods:

We performed an analytical survey among 908 clinicians who used MacPLUS FS in the context of a randomized trial on search retrieval (ClinicalTrials.Gov NCT02038439). Recording account logins and usage, we extracted all 1085 queries performed during a 6-month period and classified each search term according to the PICO framework. We further categorized queries into background (e.g., “What is porphyria?”) and foreground questions (e.g., “Does treatment A work better than B?”). We then analyzed the type of resource clinicians accessed.

Results:

There were 695 structured queries (after exclusion of meaningless queries and iterations of similar searches). We classified 56.5% of them as background and 43.5% as foreground questions, the majority of which were related to questions about therapy (30.6%) followed by diagnostic (6.9%), etiology (3.5%) and prognostic questions (2.5%). This distribution did not significantly differ between residents and faculty physicians (P=.51). Queries included a median of 3 terms (IQR 2–4), most often related to the population and intervention (or test), rarely to outcome and never to comparator. About half of the resources accessed were summaries, 24.4% were preappraised and 24.1% non-preappraised research.

Conclusions:

Our results, from a large sample of real-life queries, could guide the development of educational interventions to improve clinicians’ retrieval skills, as well as inform the design of more useful evidence-based resources for clinical practice. Clinical Trial: The analytic survey was performed using data from MacPLUS FS in the context of a randomized trial on search retrieval ClinicalTrials.Gov NCT02038439.