JMIR Publications

ABSTRACT

Background:

The proliferation of electronic clinical information resources has transformed how evidence is accessed during primary care consultations, particularly in community settings where clinicians must rapidly access reliable information at the point of care. For general practice trainees, who are still developing clinical expertise and information-seeking skills, how these digital resources are used during real-time decision-making remains poorly understood.

Objective:

This study aims to investigate the selection, use, and real-time interaction with electronic clinical information resources used by Australian general practice (GP) trainees (specialist vocational trainees in family medicine) during clinical decision-making.

Methods:

Using a novel qualitative interview and screen-capture approach, this study combines semi-structured interviews with a screen-recorded, think-aloud protocol capturing real-time interaction with digital information systems. Twenty GP trainees participated in the study, first discussing their general approaches to information-seeking, followed by a live, video-recorded task session where participants engaged with hypothetical clinical vignettes using their usual information resources. Data were analysed using reflexive thematic analysis. GP trainees from various community-based training practices across Australia were purposively sampled to capture diverse perspectives within primary care settings.

Results:

GP trainees relied on a combination of personal knowledge, clinical guidelines, and electronic information resources during decision-making. Major themes included a desire to ‘do the right thing’ while under constraints of other themes such as time limits and perceived patient perception. Think aloud sessions revealed common patterns in information resource selection, and that trainees often struggled with the efficiency and accessibility of finding specific information. Trainees sometimes made errors in information synthesis and judgement. Trainees frequently used a stepped approach to choosing internet resources and preferred resources that provided quick, reliable answers, indicating a preference for accessible information resources over comprehensive but time-consuming evidence repositories.

Conclusions:

Trainees used rapid, pragmatic strategies centred on trusted resources to support decision-making within significant time and contextual constraints. While trainees endorsed the principles of evidence-based medicine, the realities of point-of-care practice limited direct engagement with the underlying evidence base. These findings suggest that current electronic clinical resources may require redesign to better integrate with clinical workflows and present clinically relevant evidence in ways that support timely, evidence-informed decision-making in primary care.