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Managing febrile infants: impact of literature recommendations published during a physician's residency

Elizabeth D Cox1, Maureen A Smith, Jessica M Bartell

  • 1Center for Women's Health Research, University of Wisconsin Medical School, USA.

Evaluation & the Health Professions
|August 27, 2005
PubMed

Insights

Physicians' sepsis workup recommendations reflect early practice guidelines. Pediatricians and family physicians who completed residency when sepsis workup guidelines were published were more likely to recommend them.

Area of Science:

  • Medical Practice and Education
  • Pediatrics
  • Family Medicine

Background:

  • Physician practice patterns are influenced by medical literature encountered during training.
  • Early recommendations for sepsis workups in febrile infants emerged in pediatric journals (1975-1980) and family practice journals (1981-1987).

Purpose of the Study:

  • To investigate the association between the timing of sepsis workup recommendations in medical literature during residency and current physician practice.
  • To determine if early exposure to sepsis workup guidelines influences physician behavior.

Main Methods:

  • Utilized data from the Community Tracking Study, surveying 3,272 pediatricians and 2,432 family physicians.
  • Defined "percentage of sepsis workups recommended" based on physician responses to a clinical vignette.
  • Employed multivariable regression with piecewise linear functions to analyze the relationship between residency completion date and workup recommendations.

Main Results:

  • Pediatricians recommended sepsis workups 81.6% of the time; family physicians recommended them 67.7% of the time (p < .001).
  • Pediatricians completing residency from 1975-1980 showed increased recommendations (p < .05).
  • Family physicians completing residency from 1981-1987 showed increased recommendations (p < .005), coinciding with publication of specialty-specific guidelines.

Conclusions:

  • The timing of sepsis workup guideline publication during a physician's residency is significantly associated with their current recommendation rates.
  • This suggests an enduring, potentially unrecognized, impact of early medical literature on clinical practice patterns for sepsis workups in infants.

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