Why general practitioners and consultants change their clinical practice: a critical incident study

Abstract Objective: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. Design: Interviews using the critical incident technique. Setting: Primary and secondary care. Subjects: Random sample of 50 general practitioners and 50 consultants. Main outcome measures: Categories of reasons for change in clinical practice. Results: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. Conclusions: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered. Key messages Limited information is available from quantitative studies to understand the relation between education and change in clinical practice Doctors recognise organisational factors, education, and contact with professionals as influential in changing their clinical practice In this study education provided one sixth of the reasons for change, and was involved in one third of the changes The average number of reasons per change was three The wide range of factors involved in changing practice need to be considered in the provision and evaluation of education as does the role of education in the majority of changes in clinical practice which currently have no educational component

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