www.turner-white.com Vol. 10, No. 10 October 2003 JCOM 531 ORIGINAL RESEARCH Residents’ Attitudes Toward, Knowledge of, and Use of Clinical Guidelines: A Survey J.R. Maclean, MD, Michelle Johnson, Rebecca Rogers, PhD, Jennifer Waller, PhD, Janis Krauss, RN, and Donna Fick, RN, PhD Abstract • Objective: To examine resident physicians’ attitudes and knowledge of the role of clinical guidelines in promoting quality improvement in health care. • Methods: A self-report, 42-item survey was mailed to 378 residents and fellows at a U.S. academic medical center. • Results: 174 (46%) returned questionnaires. Resi- dents generally held positive attitudes toward clinical guidelines and felt that they improved patient care and assisted in clinical decision making. Residents’ experiences with guidelines were minimal, with only a minority (14%) receiving any training in their use and 27% being “unsure” if they have ever encoun- tered a guideline. • Conclusion: Residents have generally positive atti- tudes toward guidelines. Academic medical centers should ensure that resident physician training emphasizes the use of clinical guidelines. C linical practice guidelines have been promoted as a means to improve health care quality, reduce practice variation, and reduce medical errors [1].However, many physicians fail to adhere to guidelines [2]. It is impor- tant for physicians in training to be aware of guidelines and to make clinical decisions based on the best available evi- dence. As a first step to successfully teaching and imple- menting guidelines, academic medical centers (AMCs) need to be aware of the existing attitudes, knowledge, and com- mitment of their residents toward clinical guidelines. Given the dearth of information regarding clinical guide- line use among residents [3,4], a survey was developed to examine resident physicians’ attitudes and knowledge of the role of clinical guidelines in promoting quality improvement in health care. Methods Participants and Setting First-, second-, third-, and fourth-year residents and fellows at an AMC located in the southeast United States were stud- ied. The private, nonprofit AMC includes a 483-bed adult hospital, an ambulatory care center with more than 80 out- patient clinics, a specialized care center housing a regional trauma center, and a 149-bed children’s medical center. At the time the study was conducted (May 2000), the center had approximately 350 physicians and 378 residents in over 80 specialties. Residents and fellows surveyed represented physicians in departments with direct patient contact (ie, medicine, surgery, emergency medicine, neurology, pedi- atrics, family medicine, and obstetrics and gynecology). Survey To assess resident physicians’ attitudes and knowledge re- garding clinical guidelines, a self-report survey was devel- oped. The survey consisted of 15 questions involving resident attitudes on the importance and value of clinical guidelines; 8 questions concerning resident educational and training expe- riences with guidelines as well their actual use of guidelines within the AMC; and 2 questions concerning resident knowl- edge of the guideline development process. In addition, the survey included 2 questions in which residents were asked to read a clinical vignette and then select the best treatment regi- men (out of 5 options) for the patient described. The scenarios were developed by senior faculty members and represented classical, “text-book” presentations that residents would likely have encountered during their residency and for which there were existing clinical guidelines in use at the medical center. One scenario involved a 75-year-old woman with acute deep vein thrombosis and the other involved a 58-year-old man with acute myocardial infarction. Residents were asked to select the initial therapy based on their professional experience and knowledge of existing guidelines at the AMC. Finally, there were 15 questions that asked about demographics/ physician characteristics. The instrument was pilot tested in a group of 16 third- and fourth-year general internal medicine residents at a large VAmedical center adjacent to the AMC. Investigators From the Medical College of Georgia, Augusta, GA.