Do we practice what we preach? A qualitative assessment of resident-preceptor interactions for adherence to evidence-based practice.

BACKGROUND Evidence-based medicine (EBM) is important in training doctors for high-quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM. METHODS The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence-based process; and (3) resident ability to articulate a clinical question. RESULTS Sixty-seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence-based process. Resident ability to articulate a clinical question when prompted was rated as at least 'fair' in 59 of 67 interactions (88%). CONCLUSIONS EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real-time ambulatory training context.