'Change talk' among physicians in small group learning communities: An ethnographic study

Area of Science:

• Medical Education
• Continuing Professional Development
• Evidence-Based Practice

Background:

• Physicians operate in complex clinical settings requiring continuous learning and adaptation.
• Small group learning offers a collaborative environment for physicians to process new information and address practice challenges.
• Effective translation of evidence-based information into clinical practice is crucial for quality healthcare.

Purpose of the Study:

• To investigate how physicians in small learning groups discuss, interpret, and assess new evidence-based information.
• To understand the decision-making processes physicians employ when integrating new knowledge into their practice.
• To develop a framework illustrating physician engagement with evidence in a group setting.

Main Methods:

• Ethnographic approach involving observation of 15 family physicians in 2 small learning groups over one year.
• Analysis of field notes from 9 learning sessions using ethnographic dimensions and thematic content analysis.
• Supplementation of observational data with 9 interviews and 7 practice reflection documents.

Main Results:

• Facilitators guided discussions by focusing on practice gaps, revealing baseline knowledge and experiences.
• Physicians made sense of new information through questioning, knowledge sharing, and assessing applicability to their practice.
• Key processes included reviewing evidence, testing algorithms, benchmarking, and consolidating knowledge before practice changes, with shared experiences validating guidelines and informing implementation strategies.

Conclusions:

• Empirical data illustrate the process of evidence-based information discussion and decision-making in small physician groups.
• A 'change talk' framework was developed to depict how physicians interpret and assess new information to align current practices with best practices.