PURPOSE: The 2009 ACCP CME guidelines summarized the science of learning and knowledge transfer among physicians. Key tenets for success included repeated, sustained educational efforts and active learning strategies. An initiative to educate physicians about post discharge VTE prophylaxis, provided an opportunity to assess reaction to a novel treatment suggestion. Although VTE prophylaxis is widely accepted in-hospital, extending after discharge is uncommon despite the high incidence of VTE in these patients. We investigated physicians’ responses to a suggestion of continued pharmacologic or mechanical prophylaxis post discharge from a tertiary teaching hospital.
METHODS: In a multicenter study, May 2009-January 2010, physicians of medical patients meeting inclusion criteria [age≥18, high risk for VTE using a validated assessment tool] received a telephone alert. We categorized responses as: positive (appreciation for suggestions/commitment to write order), neutral, negative, ’did not respond’. A request for/positive response to an offer of evidence-based recommendations was considered a proxy measure of engagement and interest in learning. The unit of analysis was each physician encounter about a patient; some were contacted multiple times for different patients.
RESULTS: There were 121 physician encounters: 59% with oncologists, 30% with internists. 58% elicited positive responses, 24% were neutral, 2% were dismissive, 16% did not respond. Internists and oncologists were similar in percentage of positive responses (42 vs 46%). 100% of no responses occurred with oncologists. Of the 55 MDs contacted, 27% sought further information - 47% were oncologists, 33% internists. The most common objections cited to post discharge pharmacologic prophylaxis were concern about thrombocytopenia and active bleeding.
CONCLUSION: Disparate reactions noted in this study suggest varied learning styles and response patterns among internists versus specialist physicians. Audience characteristics, culture and external factors must be considered when tailoring educational efforts to physicians.
CLINICAL IMPLICATIONS: Understanding physician response to new information is essential to integrating new findings into practice. Future studies should examine learning differences among specialties, the relationship between the qualitative response and whether recommendations were acted upon, and how responses varied over time.
DISCLOSURE: Sara Merwin, No Financial Disclosure Information; No Product/Research Disclosure Information