Clinical practice guideline repository: Development of a learning tool for residents

Abstract

To meet specified training objectives, trainees need to navigate extensive medical literature to provide current and evidence-informed patient care. Clinical practice guidelines (CPGs) are an important resource to facilitate these learning objectives. However, CPGs are numerous and can be challenging to access, with no centralized tool that collects guidelines pertinent to internal medicine (IM) training. To address this gap, we developed and evaluated a database of CPGs for IM residents. Our goal was to provide local IM residents with a readily available resource to assist with providing evidence-informed patient care while also meeting learning objectives.

The 2018 IM competencies were extracted from the national certifying body website and served as the outline to establish repository content. CPGs associated with specific learning objectives were subsequently gathered through a search of major medical association websites using key terms. We identified the most up-to-date national and relevant international CPGs. The repository content was outlined in a document containing hyperlinks to guideline PDF files, with everything stored in a private-access virtual drive. Once completed, repository access was granted to IM residents during their inpatient rotations.

From January to June 2024, a survey constructed to inquire about the first three levels of the Kirkpatrick model to evaluate a learning tool¹ was administered to assess residents' reactions and evaluate the impact of the CPG repository on their learning and behaviours. The survey consisted of selected and constructed responses. Twenty-eight resident responses were analysed using descriptive statistics, cross-tabulation and content analysis.

The CPG repository was designed to offer IM residents a streamlined way to access guidelines relevant to their learning during inpatient rotations. However, our survey indicated that the resource was not used as frequently as anticipated. When it was used, it was primarily for individual learning and national certification exam preparation rather than for direct patient care. The primary challenge identified was the extensive scope of CPGs in IM, making it difficult to extract the relevant information ‘on demand’ during busy rotations.

Our initial results suggest that a repository of CPGs may not be a practical learning tool for real-time use to support residents in delivering evidence-based patient care. Today's learner may prefer synthesized information delivered rapidly by handheld devices at the point-of-care. Our repository shows potential for other educational applications such as exam preparation and self-directed study. Additionally, it could serve as a useful tool for practicing physicians to maintain specialty-specific knowledge of the latest relevant CPGs. Further evaluation would help to identify whether our guideline repository is an effective tool in these settings.

In addition, maintaining the repository at the frequency at which new IM-relevant guidelines are released was challenging, quickly rendering the tool ‘out of date’. Our team is currently exploring a variety of avenues to establish a sustainable option for ongoing review and update of the repository.

Dominique Yelle: Conceptualization; methodology; writing – review and editing; supervision. Kathryn Sullivan: Conceptualization; investigation; writing – original draft; writing – review and editing; data curation. Nicole Hryciw: Conceptualization; investigation; writing – review and editing. Claire Touchie: Conceptualization; methodology; writing – review and editing; supervision.

None declared.

Ethics approval was obtained through the Ottawa Health Science Network Research Ethics Board.