BACKGROUND Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient's preferences and the general practitioner's (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other's consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other's EBM behaviour through observation, and by identifying aspects that influence their recognition. METHODS We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner's consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner's actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other's considerations well with those who did not, we developed a model describing the aspects that influence the observer's recognition of an actor's EBM behaviour. RESULTS Overall, there was moderate similarity between an actor's EBM behaviour and the observer's recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. CONCLUSIONS GP trainees and supervisors do not fully recognise EBM behaviour through observing each other's consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

中文翻译：

---

在一般实践中应用循证医学：基于工作场所观察的视频刺激访谈研究。

背景技术在一般实践中，循证医学（EBM）涉及在决策中应用最佳可用证据，患者偏好和全科医生（GP）临床专业知识的复杂组合。全科医生和全科医生受训者通过观察彼此的协商以及通过更多以工作场所为基础的学习形式来非正式学习EBM。这项研究旨在通过观察GP主管和受训者通过观察来识别彼此的EBM行为的程度，并确定影响他们认可的方面，从而获得对基于工作场所的EBM学习的见识。方法我们基于成对的GP主管和比利时和荷兰GP培训机构的GP学员配对的视频刺激的回忆访谈（VSI），进行了定性多中心研究。向GP对（n = 22）展示了他们自己和伙伴的咨询片段，并被要求阐明他们自己的EBM考虑因素以及他们在伙伴行为中所认识的因素。采访记录被逐字记录并通过NVivo进行分析。通过比较能够很好地理解彼此的考虑因素的对，我们开发了一个模型，该模型描述了影响观察者对演员的EBM行为认识的方面。结果总体而言，演员的EBM行为与观察者对其的认可之间存在中等程度的相似性。负面影响识别的方面通常与观察者相关。观察员往往具有判断力，不请自来地评论他们将如何行事，更关注学员与主管的关系，而不是客观观察。当演员使用隐式推理时，例如心态（内在化，集体强化的默认指南），人们的认可度就会降低。与结对相关的方面也发挥了作用：以前对特定主题的讨论或EBM决策通常会增强识别度。专门针对磋商的方面仅发挥了很小的作用。结论GP的受训者和主管无法通过观察彼此的协商来充分认识EBM行为。为了提高对EBM行为的认识，并从非正式的观察性学习中受益，观察者需要意识到他们做出的自动判断。创建明确的学习时机，在其中讨论EBM决策，可以改善共享知识，也有助于揭示从思维定势中获得的隐性知识。