Abstract
D.Litt. et Phil.
The practice of medicine changes constantly and rapidly. Consequently, it is difficult for
clinicians to learn about innovations, given the vast quantity of information available.
Evidence-based medicine (EBM) is the process by which practitioners turn clinical problems
into questions, and then systematically integrate personal clinical expertise with the best
available external evidence as the basis for clinical decisions. To practice EBM, the
practitioner is required to search the literature for relevant material, and then to synthesise
knowledge and apply findings to each patient. Clinicians require fast and specific access to
multiple data sources, but the availability of electronic full text documents has substantially
exacerbated the lack of time to read the clinical literature owing to the demands of clinical
practice, and is further compounded by the fact that the Web contains much health-related
misinformation. Clinicians therefore require a means of searching the literature that will
enhance the retrieval of accurate and evaluated clinical data from ranked resources,
whereby the most relevant information is retrieved first from the most likely source. Strong
correlations exist between four primary steps in EBM, and the formula commonly used in
search strategy design in the field of information seeking. The similarities inherent in these
steps suggest that an evidence-based approach to information seeking might enable endusers
in the health professions to enhance their searching skills and to translate the clinical
question into an appropriate information-seeking strategy.
A main problem and two sub-problems were investigated, namely whether:
· a Web-based EBM information-seeking model could be designed to enhance the
information-seeking skills of healthcare practitioners
· it was possible to design an information-seeking model more closely aligned with the
clinical decision-making model familiar to healthcare practitioners
· it was possible to design such a model in a manner that could further enhance the
translation of the clinical question into an appropriate information-seeking strategy.
Various models in medicine and the domain of information seeking were investigated. It was
found that the model of the clinical decision-making process accorded with all six phases of
the information-seeking process (ISP), whereas other information-seeking models only
addressed the ISP from the formulation of the problem onwards, thus ignoring prior stages of
initiation, selection and exploration in the ISP. A Web-based EBM information-seeking
model (Model C) was devised and tested for compatibility against a general Web-based
information-seeking model, and was found to be valid. Model C was further empirically
assessed against a Web site design methodology, and was again found to be compatible.
A unique approach to EBM information seeking is thus offered by Model C, which
incorporates all aspects of the clinical-decision-making metaphor, as well as the “PICO” EBM
filters (Patient/Problem, Intervention, Comparative Intervention and Outcome), into a facet
analysis template for the design of a clinical search strategy. Prior to selection of the EBM
information resource, Model C further allows for the ranking of each resource and for the
design of individual browsing and/or analytical search strategies, as appropriate, so as to
enhance EBM information seeking amongst healthcare practitioners.