How do doctors keep up to date with guidelines?

Background

Clinical guidelines continually evolve, and doctors are expected to stay up to date with their recommendations in order to provide the best care to their patients. However, it isn’t always clear exactly how doctors stay informed about new and updated clinical guidelines, or whether this is happening effectively.

New guidelines are published frequently by a variety of organisations, and there is no widespread systematic way of keeping clinicians informed in real time. This topic is not well-explored in existing literature, and the studies that do exist do not provide enough robust evidence to recommend any particular strategy for keeping doctors up to date.

Placing the burden solely on individual doctors to stay up to date can add to moral injury (emotional or psychological distress from feeling that they are unable to do what they believe is ethically right) and burnout. Employers, and the organisations that produce guidelines, also share some responsibility for keeping doctors up to date, but it is not entirely clear how this shared responsibility should work in practice.

Without a reliable, systematic process, there is a risk that important guidance may not reach front-line clinicians in a timely or usable way, potentially compromising patient care, consistency of practice, and equity in healthcare delivery.

We aim to investigate the current landscape of guideline dissemination and develop a robust, ethically grounded national strategy to improve how general medical doctors are kept up to date with new and revised clinical guidelines.

Approach

Our work is structured around four key goals:

• Determining how general medical doctors are currently made aware of new and updated clinical guidelines which are relevant to their practice.
• Exploring stakeholders’ thoughts and preferences on how this process could (or should) work effectively by engaging with doctors, guideline developers, and health system leaders to understand their views and preferences.
• Analysing the ethical considerations around who is responsible for keeping general medical doctors up to date with guidelines (individual clinicians, professional bodies, or health systems).
• Co-producing potential strategies to address this issue on a national level – drawing on the data we collect to co-create strategies that strengthen and standardise guideline awareness, making sure that they are practical and ethically sound.

The project involves five steps:

1. First we will carry out anational survey of general medical doctors to explore how they currently stay up to date with guidelines. We will also interview a smaller group of doctors in order to gain a deeper understanding of the issue.
2. Following this, we will design clinical vignettes (concise, focused patient case studies) using recently published guideline recommendations, and test doctors’ awareness and understanding of them. This will help us identify whether doctors are managing to stay up to date.
3. We will then interview experts in guideline dissemination, to understand how guidelines are currently communicated to doctors, and their views on who is responsible for keeping doctors up to date.
4. We will carry out ethical analysis by putting together insights from the literature, our survey of doctors, the vignette study, and interviews with doctors and people who circulate guidelines, and using these to examine issues such as who is responsible for making doctors aware of new and changed guidelines, the potential burdens on clinicians, and the issues around equal access to guideline information.
5. With this information we will run a consensus-building exercise (a workshop or Delphi study) to co-create recommendations for a national-level strategy to improve guideline awareness, dissemination, and uptake.

Project team

Dr Clare Leong

THIS Institute

Dr Zoë Fritz

THIS Institute

Professor Graham Martin

THIS Institute