The Principles of Information Mastery™
Health care clinicians rely on many sources of medical information to make decisions--journal articles and reviews, textbooks, colleagues, continuing medical education conferences, practice guidelines, videotapes and audiotapes, and pharmaceutical representatives--yet most have had little formal training in assessing the clinical usefulness of the information obtained from each source. The current plethora of Evidence-Based Medicine texts, courses, and journal articles focus just on developing skills for critical reading of the research literature, focusing solely on how to read the clinical research literature and de-emphasizing other sources of information available to clinicians.
Although most clinicians list journals as their preferred source of new information, research has shown that their practice habits do not reflect results of studies published in journals. In other words, the research results that should affect the care of patients are not being seen by the clinicians who need to evolve their medical practice. This discrepancy is most likely the result of the "information overload" that clinicians face. They simply have too much information available to them. In addition to learning how to evaluate new information, they also must learn when to seek new information and where to find it. In 1994, Slawson and Shaughnessy first published their paper introducing the concepts of Information Mastery™. The ultimate in useful information must have three attributes: it must be relevant to everyday practice, it must be correct, and it should require little work to obtain. These three factors can be conceptually related in the following manner:
|USEFULNESS OF MEDICAL INFORMATION =||(RELEVANCE) (VALIDITY)|
Relevance, the initial aspect of this equation, focuses on what should be the ultimate destination--finding information on how to help patients live long, functional, satisfying, pain- and symptom-free lives. The medical literature contains incredible amounts of information about disease: its etiology, prevalence, pathophysiology, pharmacology. These "intermediate level" studies are absolutely crucial to medicine. One must understand how a disease works before it can be diagnosed, treated, or prevented with any certainty. Little of this information, however, determines with certainty how to accomplish the ultimate goal. What is needed instead is patient-oriented evidence. This type of evidence evaluates the effectiveness of interventions that patients care about and that clinicians care about for their patients.
Validity defines to what extent the knowledge gained as a result represents the truth. Well-designed clinical trials that minimize bias are more likely to provide valid conclusions. We use the validity criteria developed by the working group on evidence-based medicine.
Work is the negative attribute one must consider when evaluating the usefulness of information. Working too hard to establish the validity or relevance of information lowers its usefulness. On the other hand, a low work-factor source may also have low validity or relevance. The best source of information would provide highly relevant and valid information with minimal effort required to obtain it. Unfortunately, sources such as this are rarely available. Thus it is necessary to look for balance among the three factors.
Using relevance as the primary screen before determining validity results in the least amount of unnecessary work. Answering "yes" to the following three questions will help identify information of relevance requiring validation: 1) Will this information have a direct bearing on the health of patients, i.e. is it something they care about? 2) Is the problem common in one's practice? 3) If valid, will this information require a change in current practice? When all 3 questions are answered with a yes, we call this type of study a POEM because it provides us Patient-Oriented Evidence that Matters™. Once we identify POEMs, we must then determine whether or not they are valid.
In 1996, Richard Smith, senior editor of the British Medical Journal, wrote in an article entitled "What clinical information do doctors need?" that the answer to the problem of not having good sources available is optimally available by applying the concepts offered by Information Mastery™ (Smith R. BMJ 1996;313:1062-8). In a follow-up to this article, the BMJ Publishing Group used the concepts of Information Mastery™ to guide an international advisory board to create their highly successful publication, Clinical Evidence.
For more information on Information Mastery™:
Journal Articles (compiled by Eric Jackson, PharmD)
The first three provide core readings for the Information Mastery™ curriculum.
- Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract 1994;38:505-13.
- Shaughnessy AF, Slawson DC, Bennet JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract 1994;39:489-99.
- Shaughnessy AF, Slawson DC, Bennett JH. Separating the wheat from the chaff: identifying fallacies in pharmaceutical promotion. J Gen Intern Med 1994;9:563-8.
- Shaughnessy AF, Slawson DC, Becker L. Clinical jazz: Harmonizing clinical experience and evidence-based medicine. J Fam Pract 1998;47:425-8.
- Ebell MH, Barry HC, Slawson DC, Shaughnessy AF. Finding POEMS in the medical literature. J Fam Pract 1999;48:350-5.
- Nutting PA. Tools for survival in the information jungle. J Fam Pract 1999;48:339-41.