Practice inquiry: clinical uncertainty as a focus for small-group learning and practice improvement

Area of Science:

• Medical Education
• Primary Care Medicine
• Qualitative Research

Background:

• Primary care physicians in nonacademic settings often lack collaborative forums to discuss clinical uncertainties.
• Managing case-based clinical uncertainty is a significant challenge in everyday practice.

Purpose of the Study:

• To introduce and evaluate "Practice Inquiry," a set of small-group, practice-based learning and improvement (PBLI) methods.
• To assess the feasibility, acceptability, and utility of Practice Inquiry for managing clinical uncertainty.

Main Methods:

• Practice Inquiry involves regular small-group meetings in clinical settings for case discussion and evidence review.
• Data collection included meeting rosters, case logs, feedback surveys, and field notes for a qualitative evaluation.
• The demonstration effort was implemented in the San Francisco Bay Area from 2001 to 2005.

Main Results:

• 11 sites and 98 clinicians continued regular meetings as of summer 2006.
• The most frequently presented cases involved clinician-patient relationship and treatment dilemmas.
• Clinician feedback highlighted the development of trust and acquisition of new skills for patient management.

Conclusions:

• Practice Inquiry appears to be a feasible, acceptable, and potentially useful PBLI approach for primary care.
• Further work is needed to address limitations, enhance evidence integration, and explore clinician participation factors.
• Dedicated time or incentives may be crucial for the broader adoption and refinement of these PBLI methods.